Strato X User Manual - Image Works

STRATO X 0434 

(120V version) 

User's Manual 

Release 7 October 2002 (Rev. 1)

USER'S MANUAL 

Revision history 


Rev. Date Page/s Modification description 

0 21.02.01 - Document approval. 

1 07.10.02 All New intensifying screens. 

Integration of Implant description. 

Integration of diagnostics for radiological images. 

Better description of test. 

General improvement of text and pictures. 

(Ref. RDM 5419, 5502) 

2 

3 

(Rev. 1) 

STRATO X (120V)

USER'S MANUAL 


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STRATO X (120V) (Rev. 1)

USER'S MANUAL 

Contents 

Contents 

1. INTRODUCTION 1 

1.1 Icons appearing in the manual................................................................ 1 

2. SAFETY INFORMATION 2 

2.1 Warnings ................................................................................................ 3 

2.2 Environmental risks and displacement ................................................... 5 

2.3 Symbols used.......................................................................................... 6 

3. CLEANING AND DISINFECTION 7 

4. DESCRIPTION 8 

4.1 Identification labels and laser labels ....................................................... 8 

4.2 Function, Models and Versions ............................................................... 9 

4.2.1 Film / Screen combinations...............................................................10 

4.2.2 Base version......................................................................................11 

4.2.3 Version with cephalometric device......................................................11 

4.2.4 Version with Implant examination......................................................12 

4.2.5 Version with Implant examination and cephalometric device ..............12 

4.3 Parts location........................................................................................ 13 

5. TECHNICAL SPECIFICATIONS 15 

5.1 Dimensions........................................................................................... 20 

5.2 Loading curve of the tube and cooling curve of the anode ..................... 22 

5.3 Applied safety relugations ..................................................................... 24 

5.4 Note on the “Constant magnification” for Panoramic and TMJ 

(close/open mouth) exposures .............................................................. 25 

5.5 Measurement method of technical factors (Paragraph for 

the authorized personnel) ..................................................................... 26 

5.6 Verification method of exposure parameters (Paragraph for 

the authorized personnel) ..................................................................... 27 

6. GENERAL INSTRUCTIONS FOR USE 31 

6.1 Control panel - Descriptions and functions........................................... 31 

6.1.1 Key function description ....................................................................34 

6.2 “Switching ON” the device ..................................................................... 35 

6.3 Positioning of chin support ................................................................... 37 

6.4 Panoramic examination ........................................................................ 38 

6.4.1 Getting started ..................................................................................38 

6.4.2 Anatomic / Manual exposure.............................................................40 

6.4.2.1 Anatomic exposure ...............................................................41 

6.4.2.2 Manual exposure..................................................................42 

6.4.3 How to prepare the patient.................................................................44 

6.4.4 Making an exposure ..........................................................................46 

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Contents 

6.5 TMJ examination .................................................................................. 51 

6.5.1 Getting started .................................................................................. 52 

6.5.2 Anatomic / Manual exposure............................................................. 53 

6.5.2.1 Anatomic exposure............................................................... 54 

6.5.2.2 Manual exposure.................................................................. 55 

6.5.3 TMJ closed mouth............................................................................. 56 

6.5.3.1 Preparing the patient............................................................ 56 

6.5.3.2 First exposure (Closed mouth) .............................................. 58 

6.5.4 TMJ open mouth ............................................................................... 60 

6.5.4.1 Preparing the patient............................................................ 60 

6.5.4.2 The second exposure (Open mouth) ...................................... 62 

6.6 Biaxial temporomandibular joint examination....................................... 65 

6.6.1 Getting started .................................................................................. 66 

6.6.2 Anatomic / Manual exposure............................................................. 67 



6.6.3 How to prepare the patient ................................................................ 70 

6.6.4 Making an exposure .......................................................................... 72 

6.7 IMPLANT examination........................................................................... 76 

6.7.1 Linear tomography programs ............................................................. 78 

6.7.1.1 Examination preparation...................................................... 80 

6.7.1.2 Anatomical parameters......................................................... 81 

6.7.1.3 Tomographic parameters ...................................................... 84 

6.7.1.4 Radiographic results ............................................................ 85 

6.7.1.5 Right side tomography (quadrants 1 and 4)........................... 86 

6.7.1.6 Left side tomography (quadrants 2 and 3) ............................. 87 

6.7.2 Positioning of the implant Bite Lock................................................... 88 

6.7.2.1 Bite block preparing: Maxilla Implant ................................... 89 

6.7.2.2 Bite block preparing: Mandible Implant ................................ 90 

6.7.3 Equipment preparation ..................................................................... 91 

6.7.4 Manual / Anatomic exposure............................................................. 92 



6.7.5 Selection of anatomic and tomographic parameters............................ 94 

6.7.6 How to prepare the patient ................................................................ 96 

6.7.7 Making an exposure .......................................................................... 99 

6.8 Cephalometric examination................................................................. 104 

6.8.1 Getting started ................................................................................ 105 

6.8.2 Anatomic / Manual exposure........................................................... 108 

6.8.2.1 Anatomic exposure............................................................. 109 

6.8.2.2 Manual exposure................................................................ 110 

6.8.3 How to prepare the patient .............................................................. 111 

6.8.4 Making an exposure ........................................................................ 113 

STRATO X (120V) ii 

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Contents 

6.9 Messages on display ........................................................................... 116 

6.10 Research and correction of possible defects in dental radiographies.... 120 

6.10.1 Faults due to a wrong positioning of the patient ...............................120 

6.10.2 Defects due to wrong data setting and to the dark room ...................121 

6.10.3 Defects on film due to the device......................................................121 

6.11 Analysis of the problems on the panoramic examinations ................... 122 

6.11.1 Proper positioning of the patient ......................................................123 

6.11.1.1 Error due to a bad patient's positioning ..............................125 

6.11.1.2 Images with artefacts..........................................................132 

6.11.1.3 Incorrect film contrast and density .....................................136 

6.12 Storing of automatical exposure parameters ....................................... 138 

6.12.1 Exposure parameter ........................................................................138 

6.12.2 Soft tissue filter ...............................................................................139 

6.12.3 Storing parameters ..........................................................................139 

6.12.4 Table of pre-set anatomic parameters...............................................140 

7. MAINTENANCE 141 

This publication can only be reproduced, transmitted, transcribed or translated into 

any human or computer language with the written consent of VILLA SISTEMI 

MEDICALI S.p.a. 

This manual in English is the original version. 

(Rev. 1) 

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Contents 

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STRATO X (120V) iv 

(Rev. 1)

USER'S MANUAL 

Introduction 

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 X, produced by VILLA SISTEMI MEDICALI Spa, is a X-ray device 

for the radiographic analyses of the maxillo-facial complex. 

The base version of this device, enables to perform panoramic analyses 

and analyses on the temporal-mandibular area, both with open/closed 

mouth and with two-axis projection. Fit options are available for 

cephalometric and tomographic analyses of the dental arch, particularly 

useful in implantation procedures. 

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 X 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. 

1.1 Icons appearing in the manual 

 

This icon indicates a NOTE: please read thoroughly the items marked 

by this picture. 

This icon indicates a WARNING: the items marked by this icon refer to 

the safety aspects of the patient and/or of the operator. 

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STRATO X (120V)

USER'S MANUAL 

Safety information 

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. 

Villa Sistemi Medicali, has not to be held responsible for: 

• use of STRATO X different than the intended use, 

• damages to the unit, to the operator, to the patient, caused both by 

installation and maintenance procedures different than those 

described in this manual and in the service manual supplied with the 

unit, and by wrong operations, 

• mechanical and/or electrical modifications performed during and 

after the installation, different than those described in the service 

manual. 

Installation and any technical intervention must only be performed 

by qualified technicians authorised by Villa Sistemi Medicali. 

Only the authorised personnel can remove the covers and/or have 

access to the components under tension. 

STRATO X (120V) 2 

(Rev. 1)

USER'S MANUAL 


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. 

STRATO X has been built to support a continuous operation at 

intermittent load; therefore please follow the described use cycles to 

enable the device cooling down. 

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 and from receivingtransmitting 

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 X and supplied by a different 

electrical line. 

STRATO X 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. 

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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 m far both from the X-ray source and from the 

patient, as shown in the Figure 1 and Figure 2. 

Figure 1 - Panoramic version 

Figure 2 - Cephalometric version 


(Rev. 1)

USER'S MANUAL 


 

WARNING: PRECAUTIONS WHILE USING LASER CENTRING 

DEVICE: 

• Keep always an adequate illumination in the room. 

• Do not look into the output windows of laser centering units. 

• Do not stare at the reflections of laser pointers. 

• Instruct the patient to keep his/her eyes closed as long as the laser 

pointers are active. 

• Before starting an examination, the patient must remove earrings, 

glasses, necklaces and whatever else could reflect the laser beam or 

be impressed on the radiographic image. 

• Do not clean the openings of laser centring devices with tools that 

could modify the optics. Necessary cleaning must be performed only 

by authorised technicians. 

Operations different than those indicated could cause the ejection of 

dangerous non-ionising radiations. 

 

NOTE: 

When the unit is on, do not move manually the rotating arm or the 

tubehead (part 2a of Figure 4). 

2.2 Environmental risks and displacement 

The device contains in some of its parts, materials and liquids that at the 

end of the units life, must be disposed of at the fit disposal centers. 

Particularly the device contains the following materials and/or 

components: 

• Tubehead: dielectric oil, lead, copper, iron, aluminium, glass, 

tungsten, beryllium. 

• Control panel and Remote control: iron, copper, aluminium, glassresin, 

non-biodegradable plastic material packaging. 

• Column, Rotating arm and Extensions: iron, lead, aluminium, 

copper, glass-resin, and non-biodegradable plastic material. 

 

NOTE: 

VILLA SISTEMI MEDICALI is not responsible for the disposal of the 

device performed by the user and for the related costs. 

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2.3 Symbols used 

In this manual and on the STRATO X itself, apart from the symbols 

indicated on the control panel, also the following icons are used: 

Symbol 

Description 

Device with type B applied parts 

∼ 

N 

L 

A.C. 

Connection point to the neutral conductor 

Connection point to the line conductor 

Protection grounding 

Operation grounding 

OFF ; device not connected to the mains 

ON ; device connected to the mains 

Laser 

Laser source output 

Dangerous voltage 

Activation of cephalometry ear-set rods 

0434 

Conformity to the CE 93/42 Directive 


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USER'S MANUAL 


3. CLEANING AND DISINFECTION 

In order to get an accurate hygene and cleaning it is necessary to follow 

thoroughly all indicated procedures. 

 

WARNING: 

Disconnect the unit from the mains 

before performing any cleaning. 

Do not let water or liquids enter the unit, these could cause corrosion or 

short-circuits. 

Use only a wet cloth and a mild 

detergent to clean the painted 

surfaces, the accessories and the 

connection cables, and wipe then 

with a dry cloth; do not use 

solvents (alcohol, benzine, trichloroethylene) 

nor corrosive and abrasive 

solutions. 

To clean the rare earths scintillating screens in the cassette, please follow 

the indication given by its 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. 

It is advisable to disinfect, whenever necessary, the chin-rest, the 

handles, the nose-rest and the temple support with a 2% Glutaraldehyde 

solution or similar (find out what is available; e.g. Milton). 

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Cleaning and disinfection 

4. DESCRIPTION 

4.1 Identification labels and laser labels 

7 

4-5 

6 

3 

2 

1 

1a 

STRATO X 

Identification label 

Figure 3 

1b 

ETL certification label 

2 

Tubehead 

Identification label 

3 

Laser 

warning 

label 

4 

(N° 2) Laser 

symbol label 

5 

(N° 2) Spot laser 

identification 

label 

6 

Cephalometric device 

identification label (Optional) 

7 

Warning label 


(Rev. 1)

USER'S MANUAL 


4.2 Function, Models and Versions 

STRATO X, produced by VILLA SISTEMI MEDICALI Spa is a complete 

ortopantomographic device, which enables to perform all radiographies 

commonly necessary in dental field. 

In some versions, certain examination modes are not available but the 

device (thanks to its computerised control system) can be expanded and 

updated with new releases, directly at the Dentist premises. 

The cassettes used for all examinations are flat. 

For cephalometry the following cassette sizes are available: 8"x10" 

(supplied with the machine as standard accessory) and 10"x12" (to be 

requested when ordering the machine). 

For all other exams the size is unique and corresponds to 15x30 cm. 

The versions available are: 

• Standard version (for panoramic examinations and examinations on 

the Temporal-Mandibular Joint - TMJ). 

• Version with device for Cephalometry. 

• Version with Implant examination. 

• Version with Implant examination and device for Cephalometry. 

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4.2.1 Film / Screen combinations 

To get a good image quality, it is advisable to match the intensifying 

screens and the films, as indicated hereafter: 

Supplier Films Sensibility Screen 

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 6.12.4, 

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 KONICA MG and KONICA 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 6.12. 

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 X 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). 


(Rev. 1)

USER'S MANUAL 


4.2.2 Base version 

The base version (cod. 9309001311) enables to perform the following 

examinations: 

• Panoramic - Children and Adults - 3 Sizes and 3 arches: for 18 

combination in Automatic selection. In manual mode, it is 

possible to vary the voltage from 50 kV to 80 kV, in 2kV steps 

and the anode current from 4 mA to 10mA in 1mA steps. This 

function also allows the examination of half mouth (emipanoramic 

right and left). All examination are performed with a 

"constant magnification" factor of 1.23. 

• Examination of the Temporal-Mandibular joint (TMJ) with 

closed and open mouths for Children and Adults in 3 sizes and 

3 arcs for a total of 18 combination in automatic selection; in 

Manual mode it is possible to vary the voltage from 50 kV to 80 

kV, in 2kV steps and the anode current from 4 mA to 10mA in 

1mA steps. 

• Examination of the Temporal-Mandibular joint – biaxial (biaxial 

TMJ) for adult and children in 3 sizes: for 6 combination in 

automatic mode. In manual mode, it is possible to change the 

voltage from 50 kV to 80 kV, in 2kV steps and the anode 

current from 4 mA to 10mA in 1mA steps. 

The machine is ready to be equipped with the following functions: 

• Cephalometric device with related examination mode. 

• Implant examination. 

4.2.3 Version with cephalometric device 

The version with cephalometric device (cod. 9309002311) enables to 

perform the following examinations: 

• Panoramic, TMJ and TMJ biaxial with the same characteristics 

described for the standard version. 

• Cephalometry for Adult and Children with 3 Sizes for up to 6 

combinations in automatic selection. The manual mode enables to 

change the voltage from 60kV to 80kV in 2kV steps, and the anode 

current from 4mA to 12mA in 1mA steps. The examinations are 

performed on flat cassettes which size is 8"x10" or 10"x12". The 

selection of collimators occurs automatically according to the used 

cassette and to the chosen projection; the Soft Tissues Filter (STF) is 

motorised and can be adjusted to get the best projection of the face 

profile. 

The machine can be also equipped with the following function: 

• Implant examination. 

(Rev. 1) 

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4.2.4 Version with Implant examination 

The version with Implant examination (cod. 9309003311) enables to 

perform the following examinations: 


described for the standard version. 

• Implant for Adult with 3 Sizes in automatic selection. The manual 

mode enables to change the voltage from 50kV to 80kV in 2kV steps, 

and the anode current from 4mA to 10mA in 1mA steps. The 

examinations are performed on flat cassettes which size 15x30 cm. 

The selection of the proper collimator is automatic. 

The machine is ready to be equipped with the following function: 

• Cephalometric device with related examination mode. 

4.2.5 Version with Implant examination and cephalometric device 

The version with Implant examination and Cephalometric device (cod. 

9309004311) enables to perform the following examinations: 


described for the base version. 

• Cephalometry as described in paragraph 4.2.3. 

• Implant as described in paragraph 4.2.4. 

 

NOTE: 

Implant and/or Cephalometric options can be added to existing units at 

any time. 


(Rev. 1)

USER'S MANUAL 


4.3 Parts location 

2 

5 

3 

30 

2a 

4 

1 

1a 

Figure 4 

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.). 

2 - X, Y axes movement unit and rotation support, (CPU board) with 

rotating arm equipped with: HF tubehead with power supply board 

(2a), automatic primary collimator, soft tissues filter (STF) and laser 

centering devices. 

(Rev. 1) 

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USER'S MANUAL 


3 - Cassettes holder for all functions (apart from cephalometry) with flat 

standard cassette 15x30 cm. 

4 - Chin support arm equipped with: control keyboard, temple support, 

chin-rest, centring bite and handles. The control panel is equipped 

with a soft-key keyboard, indication LED for the selected functions 

and an alphanumeric two-row display for all technical, operative 

and warning messages. 

5 - Cephalometric arm (optional) including cephalometric device, 

cassette support (with laser alignment pointer directly from the 

rotating arm) positioned on the left of the column. 

30 - X-ray push button equipped with extensible cable, which allows the 

user to operate the unit from proper distance as required by the 

safety rules. 


(Rev. 1)

USER'S MANUAL 

Technical specifications 

5. TECHNICAL SPECIFICATIONS 

General features 

Type 

Manufacturer 

Class 

Protection degree 

STRATO X 

VILLA SISTEMI MEDICALI 

Buccinasco (MI) Italia 

Class II according to 21CFRsubchapter 

J. 

Class II B for European Directive 

for Medical Devices 93/42. 

Class I with type B applied parts 

according to IEC 601-1 

IP20 

Rated line voltage 120V∼ ±10% 

Line frequency 

60Hz 

Maximum line current 15A (at 108V, 80kV, 12mA - see Note 1) 

Power consumption 

2 kVA 

Protection fuse (F2) 

15A F 

Transformer protection fuse T1 (F1) 0.8A T 

Controls supply protection fuse (F5) 0.5A T 

Column motor protection fuse (F3, F4) 7A T 

Line voltage regulation

USER'S MANUAL 


Exposure time 

Panoramic (PAN) 

Emi Panoramic 

TMJ open/closed mouth 

TMJ biaxial 

Implant 

Cephalometry (Ceph) 

15 s PAN Adult / 13.5 s PAN Child 

8 s Adult / 8 s Child 

5.3 s per image for left and right joint in 

open and closed condition (11 s total 

time) 

10.8 s (total time) 

3.4s (minimum) - 11.4 s (maximum) for 

4 images 

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" for Latero-Lateral 

and Antero-Posterior or Posterior- 

Antero. 

• Cassette 12" x 10" for Latero-Lateral. 

• Soft Tissues filter adjustable by 

motorized movement. 


(Rev. 1)

USER'S MANUAL 


Image magnification 

PAN and TMJ open/closed mouth 

Implant 

CEPH 

No. of images in TMJ (open/closed 

mouth and biaxial) 

Tubehead characteristics 

Model MS 05 

Manufacturer 

Maximum tube voltage 

1 : 1.23 (constant) 

1 : 1.37 (constant) 

1 : 1.1 (average) 

4 

Villa Sistemi Medicali S.p.A. 

20090 Buccinasco (MI) Italia 

80 kVp 

kVp accuracy ± 8 % 

Max. anodic current 

12 mA 

Anodic current accuracy ± 10 % 

Duty cycle 1 : 16 

Nominal power 

Total filtration 

HVL (Half value layer) 

Transformer insulation 

Cooling 

Leakage radiation at 1 m 

Reference time current product 

X-ray tube characteristics 

Manufacturer 

0.96 kW (80 kVp - 12 mA) 

2.5 mm Al eq. @ 70 kVp 

>2.5mm Al eq. @ 80kVp 

Oil bath 

By convection 

Type OPX 105 

< 0.5 mGy/h @ 80 kVp - 12 mA - 3 s duty 

cycle 1/16 

1.2 mAs (6mA for 200msec) 

CEI Bologna (Italia) 

Nominal focal spot 0.5 IEC 336 

Inherent filtration 

Anode tilt 5° 

Anode material 

Nominal maximum voltage 

Filament max current 

Filament max voltage 

Anode thermal capacity 

0.5 mm Al eq. 

Tungsten 

105 kVp 

4 A 

8 V 

30 kJ 

(Rev. 1) 

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Laser centering devices 

3 laser beams are used for the patient positioning; beams align mid Sagittal, 

Frankfurt and Canine Planes (please refer to relevant paragraphs for detailed 

explanation). 

Wave length 

Optical power of laser diode 

Optical power of the collimed beam 

Divergence 

Optical power on the working surface 

Laser class 

DNRO in 30 s application period 

Mechanical characteristics 

Focus-film distance (PAN, TMJ and 

Implant) 

Film size (PAN, TMJ and Implant) 

Focus film distance (CEPH) 

Film size (CEPH) 

Telescopic motorized column run 

Total height max. 

635 nm 

5 mW 

4.5 nW 

6.67 mRad 

< 3 mW 

3 A 

0.05 m 

20" (51 cm) 

15x30 cm flat cassette 

65" (165 cm) 

8"x10" (18x24 cm) and 

10"x12" (24x30 cm) 

26.4" (67 cm) 

91.3" (232 cm) 

Width x Length • 39.4" x 49.2" (100 x 125 cm) base 

machine 

• 69.7" x 49.2" (177 x 125 cm) with 

Ceph 

Weight • 135 kg base machine 

• 150 kg with Ceph 

Column weight 

Weight of arm support, rotating arm and 

tubehead 

Cassette holder weight 

Weight of the chin rest arm 

72 kg 

48 kg 

7 kg 

8 kg 


(Rev. 1)

USER'S MANUAL 


Environmental features 

Working area (please refer to paragraph 

5.3 of the Service Manual) 

Minimum height ceiling (please refer to 

paragraph 5.3 of the Service Manual) 

• 51.2"x51.2" (130x130 cm) base 

machine 

• 74.8"x51.2" (190x130 cm) with Ceph 

98.5" (250 cm) 

Temperature in working condition + 10° ÷ + 40° 

RH (related humidity) in working 

condition 

30% ÷ 75% 

Temperature for transport and storing - 20° ÷ + 70° 

Humidity for transport and storing 

Min. atmospheric pressure for transport 

and storing 

< 95% without condense 

630 hPa 

(Rev. 1) 

19 

STRATO X (120V)

USER'S MANUAL 


5.1 Dimensions 

Figure 5 - Base version 


(Rev. 1)

USER'S MANUAL 


Figure 6 - Version equipped with cephalometric unit 

(Rev. 1) 

21 

STRATO X (120V)

USER'S MANUAL 


5.2 Loading curve of the tube and cooling curve of the 

anode 

Tube "CEI - OPX/105" (0.5 IEC 336) 

Load 

Anode cooling curve 


(Rev. 1)

USER'S MANUAL 


Cooling curve of Tubehead 

E(KJ) 

350 

300 

250 

200 

150 

100 

50 

0 

0 100 200 300 400 500 

min 

(Rev. 1) 

23 

STRATO X (120V)

USER'S MANUAL 


5.3 Applied safety relugations 

STRATO X complies with the following standard: 

FDA 21 CFR chapter J 

CE 93/42 

• General safety: 

IEC 601-1 and UL 2601-1 

IEC 601-1-1 

IEC 601-2-7 

IEC 601-2-28 

• Electromagnetic compliance: 

IEC 601-1-2 

• Protection against radiations: 

IEC 601-1-3 

IEC 825-1 

0434 The symbol CE grants that STRATO X complies with 

directives 93/42 for medical devices issued by the European 

Community. 

Classifications 

STRATO X 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 21 CFR, the equipment belongs to class II. 


(Rev. 1)

USER'S MANUAL 


5.4 Note on the “Constant magnification” for 

Panoramic and TMJ (close/open mouth) exposures 

 

NOTE: 

STRATO X 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 of 1.23 throughout the 

exposure of this shape has been applied to the STRATO X. 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. 

IN ANY CASE, THE PANORAMIC RADIOGRAPHY CANNOT BE USED 

TO PERFORM CALCULATIONS OF DISTANCES, ANGLES ETC. ON 

THE FILM. 

(Rev. 1) 

25 

STRATO X (120V)

USER'S MANUAL 


5.5 Measurement method of technical factors 

(Paragraph for the authorized personnel) 

 

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. 

For the measurement of the exposure parameters with the invasive 

method, please follow the procedure described in paragraphs 7.2 and 7.3 

of the Service manual. 

 

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 51). 

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%. 


(Rev. 1)

USER'S MANUAL 


5.6 Verification method of exposure parameters 

(Paragraph for the authorized personnel) 

The exposure parameters can also be checked using the so called "noninvasive 

method". This method requires the use of a specific instrument, 

identified as a "probe" in Figure 7. 

 

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 X. 

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. 

The exposure parameters can be checked with a non-invasive instrument 

by performing the following procedure: 

1. With the unit on, select the Panoramic examination mode by pressing 

key "17" . 

(Rev. 1) 

27 

STRATO X (120V)

USER'S MANUAL 


2. Press keys "10" , "28" and "24" at the same 

time. LED’s of "patient type", "patient size" and "Arch" switch 

off and the display shows the following two messages alternatively: 

and 

R E M O V E 

C H I N R E S T 

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. 

3. Carry out the actions mentioned above; press key "23" ; 

the unit will carry out a movement to reach the "zero" position. 

During this phase, the display shows: 

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 

4. After opening the cassette holder to Ceph position (this action is 

sensed by the unit which monitors the status of microswitches S25), 

the display shows: 

P L E A S E W A I T . . . 

In the mean time, the unit sets the primary collimator to position 

8"x10" 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 


(Rev. 1)

USER'S MANUAL 


5. Place the measuring instrument over the chin support as shown in 

Figure 7. 

6. Acting on key "4" and "7" and on keys "3" or 

"6" set the exposure parameters to carry out the desidered 

checks. 

The variation range of the parameters is shown in the following table 

(see also NOTE at page 27): 

Parameter Minimum value Maximum value 

kV 50 80 

s 0,2 15 

Table 2 

 

NOTE: 

Acting on key "5" and then on keys "3" or "6" the 

mA value can be changed. 

The mA value ranges from 4 to 12 (1 mA step). 

PROBE 

Figure 7 

(Rev. 1) 

29 

STRATO X (120V)

USER'S MANUAL 


 

WARNING: 

X-ray will be emitted during the execution 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. 

7. Perform an exposure; the emitted parameters (kV and Time) can be 

read on the measuring instrument. 

 

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 

After closing the cassette holder to Panoramic position (the position is 

sensed by the unit through microswitch S24), the display will show the 


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 

and the unit returned at a standard mode. 


(Rev. 1)

USER'S MANUAL 

General instructions for use 

6. GENERAL INSTRUCTIONS FOR USE 

6.1 Control panel - Descriptions and functions 

STRATO X keyboard is divided into 8 functional areas, and a display to 

view the messages and the error codes. 

Next figure shows a general view of the keyboard, while details an each 

functional area are provided in the following pages. 

Signal LEDs 

Anatomical selection 

Luminous 

centering 

devices 

Command 

confirm. 

LED 

Carriage 

movement 

(canine 

plane) 

Exam. 

setting 

key 

Control keys 

Examination mode selection 

Column movement 

Exposure parameters 

manual selection 

Figure 9 

(Rev. 1) 

31 

STRATO X (120V)

USER'S MANUAL 


Reserved for future 

Implant 

settings 

Cephalometric 

Each key enables the selection of a 

specific examination. The pre-set 

examinations are: 

Panoramic – TMJ open/closed mouth, 

TMJ biaxial, Implant, Cephalometry. 

TMJ open/closed 

mouth 

Biaxial TMJ Panoramic 

It is possible to select the examinations 

automatically (anatomic selection) 

using pre-fixed exposure values. This 

kind of selection enables to choose 

between Adult/Child, each with three 

different sizes (small, medium, large); 

for Panoramic, TMJ open/closed 

mouth, and Implant there is the 

possibility to chose among three 

different dental arches. 

Large 

Medium 

Narrow 

In panoramic and TMJ examination 

mode, the system allows the selection of 

the type of the dental arch. 

The arch key allows the selection 

among 3 different mouth 

conformations: narrow - medium - 

large. 

The selection made is confirmed by the 

activation of the corresponding LED. 

The arch selection does not influence 

the values of kV and mA but acts on 

the position of the focus layer. 

Furthermore there is the possibility to 

select manually the exposure 

parameters; in this case select at first 

the parameter to be changed and 

secondly, using the increasing and 

reducing keys, set the required value. 

The parameters available are: kV, mA 

and time. The latter just for 

cephalometry. 


(Rev. 1)

USER'S MANUAL 


This area contains the keys which control 

the tubehead arm movements (canin 

plane) during the patient positioning, and 

the relevant confermation key. When the 

"Command confirmation LED" is lit, it 

means that 

the key 

, must be pressed to 

Command 

confirm. 

LED 

Setting 

key 

confirm the selected command. 

There are two light indicators; the first 

one on the left indicates the condition 

"Machine Ready", indicating the user that 

by pressing the X-ray button key once 

more, X-rays emission will start; the 

second led indicates the emission of 

X-rays. 

The movement of the column is 

controlled by the related keys; for 

safety’s sake, this control is performed 

pressing two keys at the same time, 

the central one and one of the two 

lateral. 

The left button is dedicated to the center 

of sagittal, canine and Frankfurt planes, 

thus adapting the STRATO X to the 

patient anatomy. 

The right button is reserved for future 

use. 

Apart from the keys dedicated to the 

selection of the examination functions, 

part of the STRATO X keyboard is 

dedicated to the services. From left to 

right, we have: the "Test" key (which 

disables the X-ray emission during 

arm rotation), the "Reset" key (to be 

pressed after the unwanted release of 

the X-ray push button "30" during 

exposure) and the "Arm return" (to 

prepare the system for the next 

examination). 

(Rev. 1) 

33 

STRATO X (120V)

USER'S MANUAL 


6.1.1 Key function description 

Figure 10 - Control panel 

LEGEND: 

Messages 

Display: indicates operative messages, warnings and 

exposure parameters. 

Signal lights 

1 - Led indicating the machine is ready for X-ray 

emission (green LED) 

2 - Yellow LED indicating X-rays emission 

Manual setting of exposure parameters 

3 - kV, s or mA increasing 

4 - Seconds 

5 - milliAmpere 

6 - Reduction of kV, s or mA 

7 - KVolt 

Preparation functions 

8 - Key to set Test function 

9 - Reset, axes alignment and enabling to modify 

exam modes 

10 - Positioning of the rotation unit to start the 

selected examination or return of the unit for a 

new setting 

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) 

Examination mode 

14 - Implant (Optional) 

15 - Cephalometry (Optional) 

16 - Reserved for future settings 

17 - Panoramic 

18 - TMJ closed mouth – open mouth 

19 - TMJ biaxial 

Centring devices 

20 - Saggital, Frankfurt and Canine Plane centring unit 

21 - Button not active 

Patient centring 

23 - Enter key 

22, 24, 25 and 26 - These buttons have different actions 

depending on the examination 

selected; refer to relevant 

paragraphs 

Height adjustment 

27 + 28 - Column up 

29 + 28 - Column down 


(Rev. 1)

USER'S MANUAL 


6.2 “Switching ON” the device 

Press the green button on the base of the column to switch the system 

on. The LED on the control panel and the following display message, 

indicate an auto-diagnosis is on the run: 

S T R A T O X 

R E L E A S E * . * * 

After 3 seconds, the display shows the following message: 

> T E S T < 

 

NOTE: 

During this phase, STRATO X 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 

Once the auto-diagnosis is complete, the LED of the confirmation request 

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 


 

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 

(Rev. 1) 

35 

STRATO X (120V)

USER'S MANUAL 


Once the alignment is done, the software indicates the position of the 

cassette holder and the presence of the cassette into its holder. 

If a 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. 

After 3 seconds, the following configuration will be automatically set by 

the system: 

• ADULT : the upper led of key "11" switches ON 

• MEDIUM SIZE: the central led of key "12" switches ON 

• MEDIUM ARCH: the central led of key "13" switches ON 

• PAN the central led of key "17" switches ON 

LED "23" remains ON and the display shows, for example: 

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. 


(Rev. 1)

USER'S MANUAL 


6.3 Positioning of chin support 

STRATO X is equipped with two different chin supports: a standard one 

and one dedicated to edentulous patients. 

The standard chin support must be used, in panoramic and biaxial TMJ 

mode, with all the people who can assure a tight bite on the centering 

bite. 

The edentulous chin support instead must be used in two different 

conditions: 

• In panoramic and biaxial TMJ examination it must be used with 

edentulous patients only. 

• In TMJ (open and closed mouth) and Biaxial TMJ it must be used 

with all patients. 

Two parts compose the chin support: the base and the real chin support. 

The base part can be installed on the arm in two different positions: 

• Standard position (see Figure 11 part. 1 and 3): the side of the base 

marked with "L" towards the front part of the chin support. 

• Raised position (see Figure 11 part. 2 and 4): the side of the base 

marked with "H" towards the front part of the chin support. This 

positioning can be chosen when the vertex of the chin has to be more 

visible on the film. 

 

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. 

1: Chin support in low 

position 

2: Chin support in up 

position 

3: Edentulous chin support in 

low position 

4: Edentulous chin support in up 

position 

Figure 11 

 

NOTE: 

Always remove the chin support when performing Ceph examinations. 

(Rev. 1) 

37 

STRATO X (120V)

USER'S MANUAL 


6.4 Panoramic examination 

When making a panoramic examination, the tubehead support arm 

(X-rays generator) and the film cassette holder make a continuously 

rotating movement. 

After an initial acceleration, rotation is made at a constant speed. The 

movement of the film cassette holder is not made at constant speed since 

the relative movement of the cassette with respect to the rotation speed 

determines the position and thickness of the focused layer. The X-rays 

are emitted only when the rotating arm is at constant rotation speed. 

6.4.1 Getting started 

When the unit is switched on, the Panoramic Examination is selected as 

default. If the operator has previously made another kind of examination 

and wishes to make a Panoramic Examination, this is selected using key 

"17" . 

The system sets to the following configuration: 

• ADULT - the upper LED of button "11" lights up 

• MEDIUM SIZE - the central LED of button "12" lights up 

• MEDIUM ARCH - the central LED of button "13" lights up 

• PANORAMIC - the LED of button "17" lights up 

LED "23" is lit and the default parameters (if this is the first exposure) or 

the radiological parameters (kV and mA) used in the last examination are 

displayed. For example: 

S T D . P A N O R A M I C 

7 4 k V 1 0 m A 1 5 . 0 s 

This indication means that the standard panoramic, that is the complete 

mouth’s examination, is performed. 

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 

modality of the panoramic examination from standard to "EMI 

PANORAMIC RIGHT" to "EMI PANORAMIC LEFT". This selection is a 

toggle one, so pressing the button repeatedly will change the selected 

modality. The "EMI PANORAMIC" mode, right or left, means that only the 

corresponding half mouth is irradiated; the emission will take place only 

from the beginning to slight more the mid sagittal plane for right emi 

panoramic. For left emi panoramic modality, the emission will start slight 

before the mid sagittal and last until the end of rotation. 


(Rev. 1)

USER'S MANUAL 


These two kinds of examinations are useful when it is already known 

that the patient has a problem on only one half of the mouth, so it is 

possible to reduce the irradiation of the patient. 

 

NOTE: 

STRATO X 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 








IN ANY CASE, THE PANORAMIC RADIOGRAPHY CANNOT BE USED 

TO PERFORM CALCULATIONS OF DISTANCES, ANGLES ETC. ON 

THE FILM. 

(Rev. 1) 

39 

STRATO X (120V)

USER'S MANUAL 


6.4.2 Anatomic / Manual exposure 

 

NOTE: 

If the previous examination had been made manually, press key 

"17" to switch back to anatomic exposure. 

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 

change the selection; press key "11" 

to change from Adult to 

Child. 


(Rev. 1)

USER'S MANUAL 


6.4.2.1 Anatomic exposure 

Select the type of patient using the Adult / Child key. 

Select the patient size using the Size small - medium - large key. 

The kV and mA settings selected are displayed as per Table 3. 

Exposure values in PAN mode 

Adult 

(15 sec.) 

Child 

(13,5 sec.) 

kV mA kV mA 

Small 70 10 66 8 

Medium 74 10 68 8 

Large 76 10 70 9 

Table 3 

These values are set according to the recommended film-screen 

combination. 

Select the mouth structure using the Arch wide - medium - narrow 

key . 

 

NOTE: 

The type of Arch does not influence the kV and mA values but does 

influence the position of the focused layer. 

(Rev. 1) 

41 

STRATO X (120V)

USER'S MANUAL 


6.4.2.2 Manual exposure 

If the kV and mA 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 

Panoramic keys will flash. One of the two following messages will be 

displayed: 

or 

> 7 4 k V 1 0 m A 1 5 . 0 s 

7 4 k V > 1 0 m A 1 5 . 0 s 

The symbol ">" indicates which parameter is being changed. 

The selected parameter can be changed using the increase key "3" 

and decrease key "6" . 

The kV value can vary between 50 and 80 kV, with 2 kV steps. 

The mA value can vary between 4 and 10 mA, with 1 mA steps. 

 

NOTE: 

To change the values rapidly, keep the increase key "3" 

decrease key "6" 

pressed. 

or 

Select the mouth structure using the Arch wide - medium - narrow 

key . 


(Rev. 1)

USER'S MANUAL 


Panoramic positioning 

Legend - Patient Positioning and 

Centering Devices 

1 Panoramic chin rest 

2 Bite rod 

3 Centering bite 

4 Temple support rod 

5 Adjustment knob for Frankfurt 

plane laser 

6 Adjustment knobs for temple 

support 

Figure 12 

Legend - Reference Lines 

45 46 

45 Mid-sagittal line 

46 Frankfurt plane line 

47 Canine centering line 

47 

Figure 13 

(Rev. 1) 

43 

STRATO X (120V)

USER'S MANUAL 


6.4.3 How to prepare the patient 

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 

"27+28" keys (up) or "29+28" (down) 

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 12), 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 12) 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. 

6. Press button "20" to switch ON the laser centering device. 

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 13) and the canine 

plane line "47" (Figure 13). 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 

using the key "22" or key "25" , until a perfect 

alignment of the canine centering device "47" (Figure 13) 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 12) located on the side of the tubehead. 


(Rev. 1)

USER'S MANUAL 


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 

12). 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 button "20" 

pressed again or, upon completion of the alignment procedure, key 

is 

"23" is pressed to start the exam procedure. 

10. Make the following recommendations to the patient: the lips 

must remain closed, the tongue must be placed towards the 

palate, he/she must remain perfectly still and do not look at the 

rotating arm during the movements. 

(Rev. 1) 

45 

STRATO X (120V)

USER'S MANUAL 


6.4.4 Making an exposure 

 

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 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 

and then (after 2 seconds), the following message will be displayed: 

> 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. 


(Rev. 1)

USER'S MANUAL 


 

WARNING: 




 

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. 

2. Once the exposure is completed, the system will rotate back to a 

position where it is possible to make the patient to exit. 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 

movement can be stopped by pressing button "9" . 

Now the system is ready to perform a new exam. 

3. Press button "10" . The unit will return to its initial position 

and the following message will be displayed: 

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. 

(Rev. 1) 

47 

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Then, the following message will be displayed: 

R E P L A C E 


Once the cassette has been removed, LED "23" 


will light up 

x x k V x x m A 1 5 . 0 s 


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 

This time enables the X-ray tube's anode to cool down. 

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 replace the rod and disposable 

bite. 


(Rev. 1)

USER'S MANUAL 


 

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. 


. The following message will be displayed: 




W A I T F O R 


and then: 

R E P L A C 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. 

(Rev. 1) 

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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: 

Set value 

Actual value mA 

Actual value kV 

The value displayed during the panoramic examination corresponds to 

the chosen one, while the real value can be different; in any case, the 

system guarantees that accuracy of exposure factors is always according 

to 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 according to the above curve and instrument’s 

accuracy) is within ±10% for kV, while for tube current is within ± 15%. 


(Rev. 1)

USER'S MANUAL 


6.5 TMJ examination 

The TMJ examination with open or closed mouth is similar to panoramic, 

the only difference is that the exposure is performed only on the involved 

area (Temporal mandibular Joint). then it stops and starts on the second 

articulation. The operation sequence of the examination is therefore 

similar to the one described for the panoramic. 

This TMJ function enables to obtain 4 different images on the same film, 

by performing two rotational movements. The 4 images represent the 

right and left condyle of the temporal-mandibular arch (TMJ) with closed 

mouth and open mouth. 

Selecting closed mouth exam only the external sectors of the film are 

exposed, while selecting open mouth exam, the exposure occurs on the 

inner sectors. 

The position of the images couples the images corresponding to the same 

condyle to help a diagnosis. The Figure 14 shows the information related 

to the single sectors. 

RIGHT condyle 

with closed mouth 

RIGHT condyle 

with open mouth 

LEFT condyle 

with open mouth 

LEFT condyle 

with closed mouth 

1 st exposure 

3 rd exposure 

4 th exposure 

2 nd exposure 

R 

L 

Figure 14 

 

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. 

(Rev. 1) 

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to select TMJ. 

The system will set to the following configuration: 

• ADULT : the upper led of key "11" switches ON 

• MEDIUM: the central led of key "12" switches ON 

• MEDIUM ARCH: the central led of key "13" switches ON 

• TMJ mouth open/closed: the LED of key "18" switches ON 

LED "23" lights up and the display shows the default exposure 

parameters, if this is the first TMJ exposure, or the exposure parameters 

(kV and mA) of the last exposure performed. For example: 

7 4 k V 1 0 m A 1 0 . 5 s 

Once the machine is set, position the chin-support if it had previously 

been removed (see notes in paragraph 6.3). 

 

NOTE: 











IN ANY CASE, THE TMJ RADIOGRAPHY CANNOT BE USED TO 

PERFORM CALCULATIONS OF DISTANCES, ANGLES ETC. ON THE 

FILM. 


(Rev. 1)

USER'S MANUAL 



 

NOTE: 

If the previous examination had been performed in manual mode, press 

key "18" 

to restore the anatomic exposure mode. 

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 

operator to select the type of patient. 

The selection is changed by pressing key "11" . 

(Rev. 1) 

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Select the type of patient pressing the key Adult/Child. 

Select the size of patient pressing the Size key small-medium-large. 

The display will then show the kV and mA settings according to the 

selections as per Table 4. 

Exposure values in TMJ examination (10.5 sec) 

Examination Adult Child 

TMJ closed mouth 

& TMJ open mouth 

Table 4 

kV mA kV mA 

Small 70 10 60 10 

Medium 74 10 66 10 

Large 78 10 70 10 

These values have been pre-set on the basis of the recommended filmscreen 

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. 


(Rev. 1)

USER'S MANUAL 



If the kV and mA combinations in the above table are considered 

unsuitable for a particular examination, new parameters can be set in 

manual mode. 

To change the kV or mA values press key "7" , or key "5" . 

The Patient Size LED will switch off, the Adult/Child and TMJ keys will 

flash. One of the following two messages will be displayed: 

or 

> 7 4 k V 1 0 m A 1 0 . 5 s 

7 4 k V > 1 0 m A 1 0 . 5 s 


Using keys "3" and "6" it is possible to increase or reduce 

the value of the selected parameter. 

The kV value ranges from 50 to 80 kV in 2 kV steps. 

The mA value ranges from 4 to 10 mA, in 1mA steps. 

 

NOTE: 

Keep key "3" or "6" pressed to change the values rapidly as 

required. 

Select the mouth structure with the Arch key narrow-medium-large . 

(Rev. 1) 

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6.5.3 TMJ closed mouth 

6.5.3.1 Preparing the patient 


X-rayed (necklaces, earrings, glasses, hair-pins, movable dental 



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 

support. Using the "27+28" keys (up) 

or "29+28" keys 

(down) 

raise/lower the column until the chin support 

rest is aligned with the patient's chin. 

4. If there are no functional problems in the joint, it is recommended to 

use the panoramic byte to help the patient in holding a correct 

positioning. 

Reference lines 

45 Sagittal median line 


45 

46 

6 

1 

4 

5 

Patient positioning and 

centering devices 

1 Edentulous support 


5 Frankfurt plane laser 

adjustment knob 


support 

Figure 15 – TMJ closed mouth positioning 


(Rev. 1)

USER'S MANUAL 


5. Position the patient at temple support "4" (Figure 15). Rest the hands 

on the front handles. 


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 15) 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. 


to the height of the patient. This adjustment is made using knob "5" 

(Figure 15) located on the side of the tubehead. 




position. 






x x k V x x m A 1 5 . 0 s 


 

NOTE: 

The laser centering device remains lit until the laser centering device ON 

button "20" 

is pressed or, upon completion of the alignment 

procedure, key "23" 

. is pressed to start the exam procedure. 

10. Make the following recommendations to the patient: the lips 

must remain closed, he/she must remain perfectly still and do 

not look at the rotating arm during the movements. 

(Rev. 1) 

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6.5.3.2 First exposure (Closed mouth) 

 

WARNING: 



regulations. 




from the emission of the X-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 

function, pressing key "8" . 

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 


(if the unit is in view) and that the X-ray signal sounds. The following 

message will be displayed first: 

E X A M 



> X - R A Y < 

x x k V x x m A x . x x s 


 

NOTE: 





inserted. 


(Rev. 1)

USER'S MANUAL 


 

WARNING: 




 

NOTE: 





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 R E S S → 0 ← 

It will then be possible to setup the system for the open mouth 

examination, keeping the patient in position or letting him free. 

3. Press button "10" . The machine will return to its initial 

position and the following message will be displayed 

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 ! 

(Rev. 1) 

59 

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6.5.4 TMJ open mouth 

 

NOTE: 

It is possible to carry out this examination with a new exposure on the 

same film used for closed mouth TMJ. 

6.5.4.1 Preparing the patient 

1. The patient must be prepared following the operations described in 

paragraph 6.5.3.1. 

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 ! 

2. Press key "23" to confirm. The following message will be 

displayed: 

x x k V x x m A 1 0 . 5 s 


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. 


(Rev. 1)

USER'S MANUAL 


Reference lines 

45 Sagittal median line 


Patient positioning and 

centering device 

1 Edentulous support 


5 Frankfurt plane laser 

adjustment knob 


support 

Figure 16 – Open mouth exam positioning 


6. 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" (Figure 16) 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 16. 

7. After having positioned the head, 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. 

 

NOTE: 


button "20" 




8. Advise the patient to remain perfectly still and do not look at 

the rotating arm during the movements. 

(Rev. 1) 

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6.5.4.2 The second exposure (Open mouth) 

 

CAUTION: 



regulations. 





 

WARNING: 

Using the laser centering devices check that the system is still aligned 

with the patient's sagittal median plane. 

1. Press key "23" .The following message will be displayed: 


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 


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 



(Rev. 1)

USER'S MANUAL 


 

NOTE: 








2. Once the exposure is completed the system will rotate back. When it 

stops, the following message will be displayed: 


P R E S S → 0 ← 

Now remove the patient from the positioning device. 

3. Press button "10" . The machine will return to the patient 

entry position and the following message will be displayed 

P L E A S E W A I T . . . 

 

WARNING: 







is lit. 

Then the following message will be displayed: 

R E P L A C E 


When the cassette has been removed, LED "23" 


will light up 

x x k V x x m A 1 0 . 5 s 


That shows the values set for the exposure just made. A new 

exposure can now be made. 

(Rev. 1) 

63 

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WARNING: 

Clean the edentulous chin support, the handles and the temple support 

thoroughly after each examination. 

 

NOTE: 


patient or with another structure, or the operator realises that the 



of the arm. 


E 5 6 1 



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. 






W A I T F O R 


and then: 

R E P L A C E 



(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. 


(Rev. 1)

USER'S MANUAL 


6.6 Biaxial temporomandibular joint examination 

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. 

The scope of this examination is to determine whether the condyle is 

correctly positioned in the mandibular fossa of the temporal bone. Each 

joint is X-rayed twice at angles that show the condyle projected along its 

longitudinal axis (frontal plane) and along a transversal axis inclined at 

40° with respect to the longitudinal plane. The two images are placed side 

by side to optimize diagnosis. 

TMJ 

Biaxial 

TMJ 

Biaxial 

TMJ 

Biaxial 

TMJ 

Biaxial 

RIGHT 

condyle 

Longitudinal 

axis of RIGHT 

condyle 

Longitudinal 

axis of LEFT 

condyle 

LEFT 

condyle 

1 st 

exposure 

2 nd 

exposure 

3 rd 

exposure 

4 th 

exposure 

R 

L 

Figure 17 

 

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. 

(Rev. 1) 

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Press key "19 

to select the Biaxial TMJ examination. 

The following configuration is automatically set: 

• ADULT : the upper led of key "11" lights up 

• MEDIUM SIZE: the central led of key "12" lights up 

• MEDIUM ARCH: the central led of key "13" lights up 

• Biaxial TMJ: the LED of key "19" lights up 

LED "23" lights up and the display shows the default exposure 

parameters if this is the first Biaxial TMJ exposure made, or the exposure 

parameters (kV and mA) used in the last exposure. For example: 

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: 











IN ANY CASE, THE TMJ RADIOGRAPHY CANNOT BE USED TO 

PERFORM CALCULATIONS OF DISTANCES, ANGLES ETC. ON THE 

FILM. 


(Rev. 1)

USER'S MANUAL 



 

NOTE: 

If the previous examination had been made in manual mode, press key 

"19" to reset anatomic exposure. 

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 

patient may be selected. Press key "11" 

to change the selection. 

(Rev. 1) 

67 

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Select the type of patient using the Adult / Child key. 

Select the type of build using the Size small - medium - large key. 

The kV and mA settings selected are displayed as per Table 5. 

Exposure values in BIAXIAL TMJ examination (10.7 sec) 

Examination Adult Child 

TMJ Biaxial kV mA kV mA 

Small 70 10 60 10 

Medium 74 10 66 10 

Large 78 10 72 10 

Table 5 

These values are set according to the recommended film-screen 

combination. 

The time (10.7 seconds) refers to the total 4 exposures. 


(Rev. 1)

USER'S MANUAL 



If the kV and mA combinations of the above table are not considered 



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 Biaxial TMJ keys will flash. One of the two following 

messages will be displayed: 

or 

> 7 4 k V 1 0 m A 1 0 . 5 s 

7 4 k V > 1 0 m A 1 0 . 5 s 




The kV value can vary between 50 and 80 kV, with 2 kV steps. 

The mA value can vary between 4 and 10 mA, with 1 mA steps. 

 

NOTE: 



pressed. 

or 

(Rev. 1) 

69 

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beam. 

3. Place the patient in a standing position at the edentulous chin 

support. Using "27+28" keys (up) or "29+28" 

(down) 

the column until the chin support rest is 

aligned with the patient's chin. 

Legend - Reference lines 

45 Mid-sagittal line 


47 Canine centering line 

Legend - Patient positioning and 

centering devices 

1 Panoramic support 

2 Bite rod 

3 Centering bite 


5 Adjustment knob for 

Frankfurt plane laser 


support 

Figure 18 - Biaxial TMJ panoramic positioning 


(Rev. 1)

USER'S MANUAL 


4. Position the patient at temple support "4" (Figure 18), 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 18) with his incisors. In case of edentulous patients, 

he/her must rest the chin against the reference shoulder of the 

edentulous chin support. 


6. Press the ON button "20" of the laser centering device. Three 

laser beams will light up the mid-sagittal plane line "45", the 

horizontal line for the Frankfurt plane reference "46" (the plane that 


with the lower part of the orbital fossa Figure 18) and the canine 

plane line "47" (Figure 18). 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. 


to the height of the patient. This adjustment is made using knob "5" 

(Figure 18) located on the side of the tubehead. 




position. 






x x k V x x m A 1 0 . 5 s 


 

NOTE: 


button "20" 




9. Make the following recommendations to the patient: the mouth 

must remain closed, the tongue must be placed towards the 

palate, he/she must remain perfectly still and do not look at the 

rotating arm during the movements. 

(Rev. 1) 

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WARNING: 



regulations. 





 

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 

function, pressing key "8" . 

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 


(if the unit is in view) and that the X-ray signal sounds. The following 


E X A M 



> X - R A Y < 



 

NOTE: 





inserted. 


(Rev. 1)

USER'S MANUAL 


 

WARNING: 




 

NOTE: 








2. Once the exposure is completed, the system will rotate back to a 

position where it is possible to make the patient to exit. Once the 

movement is completed, the following message will be displayed: 


P R E S S → 0 ← 




P L E A S E W A I T . . . 

 

WARNING: 







is lit. 


R E P L A C E 


(Rev. 1) 

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will light up 

x x k V x x m A x x . x s 


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 







 

WARNING: 


the temple support thoroughly and replace the rod and disposable 

bite. 


(Rev. 1)

USER'S MANUAL 


 

NOTE: 





of the arm. 


E 5 6 1 



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. 






W A I T F O R 


And then: 

R E P L A C E 



(cassette and parameters) and the patient can be repositioned. 

 

NOTE: 



 

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. 

(Rev. 1) 

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6.7 IMPLANT examination 

The linear tomography examination (Implant) has been implemented to 

fulfil the emerging need of implant examination; in this way we make 

easiest the pre surgical planning mode and also to follow up the post 

surgical phase. 

Essential requirements for a tomographic examination in the surgical 

planning phase are to correctly determine the available space for implant; 

these requirements comprise the lingual and vestibular contour, bone 

thickness on the point of interest, position of the floor of the maxillary 

sinus or the distance between the alveolar crest and the upper board of 

the mandibular canal. All these structure are not adequately visualised 

using a standard panoramic or periapicals radiographs. 

Linear tomography technique make possible to answer to the above 

requirements with a constant magnification factor (+37%) both in vertical 

and horizontal direction, so making possible to perform measurements 

directly on the film. Additional advantage of linear tomography comes out 

from the dose reduction compared to the standard TC examination. 

 

NOTE: 

The presence of radio-opaque material close to the area under 

examination may generate artifacts which make difficult a good 

diagnosis. 

Implant examinations can be conducted with two different modalities, 

called reduced and complete implant respectively. First mode allows to 

obtain two images of the point of interest, while the second mode obtains 

four images; in both cases, examination is conducted in the same way. 

The images, having a dimensions of 5x7cm, are placed side by side on 

the same film. First image, the longitudinal allow a complete vision of the 

interested zone while the other are transversal images (1 or 3) of the 

selected point and allows to evaluate all the relevant dimensions (height 

and bone thickness). 


(Rev. 1)

USER'S MANUAL 


1 st Image: Longitudinal 2 nd 3 rd 4 th Images: transversal 

Figure 19 

On these images, as already explained, considering the constant 

magnification factor (+37%), it is possible to obtain the real values of 

anatomical parts dividing the measure performed on the film by the 

factor of 0.73. 

For instance, if on the one radiography was measured a dimension of 

3.57cm, thus real measure is equal to 3.57x0.73=2.6cm. 

(Rev. 1) 

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6.7.1 Linear tomography programs 

STRATO X 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 20, 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 20 

The second modality, called “reduced implant” gives two images, one 

longitudinal and one cross, both centred on the point of interest. 

Referring to Figure 21, numbered slices are, respectively: 

1: longitudinal image, centered on point of interest 

2: transversal image, centered on point of interest. 


(Rev. 1)

USER'S MANUAL 


1 

2 

Figure 21 

Please refer to paragraph 6.7.3 for detailed mode of selecting between two 

modalities and also to paragraph 6.7.1.4 to have suggestions on how to 

view images and their correct interpretation (please refer to Figure 27 and 

following). 

Advantage of the reduced mode can be summarised on the additional 

dose reduction, so that mode can be used when a non perfect centring of 

the point of interest is not important for the diagnosis; for instance in the 

post surgical phase to judge the status of the implant’s bony integration. 

(Rev. 1) 

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6.7.1.1 Examination preparation 

For the correct execution of examination, which is detailed description is 

given on paragraph 6.7.3, it is required to insert some anatomical 

parameters, as well as some tomographic ones. Procedures on how to 

position the patient and centering devices are clearly defined starting 

from paragraph 6.7.2. 


(Rev. 1)

USER'S MANUAL 


6.7.1.2 Anatomical parameters 

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 

European 

Standard (*) 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 

Patient Right side 

Patient Left side 

European 

Standard (*) 

American 

Standard 

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 

(*) number to input into the unit 

Figure 21 

The linear tomography implemented on STRATO X is based on a 

statistical model of dental arch, as defined in international literature. 

However, it must be considered that the natural deviation from the model 

due to the individual variability can lead to the possibility that the point 

of interest may be not perfectly centred on the middle of the tomographic 

images. 

To overpass that, STRATO X uses the possibility to introduce correcting 

factors that allows a better centring of the patient; these factors are 

called longitudinal offset and transversal offset. 

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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. 

1. Place the radiograph on the lighted viewing plane, taking into 

account that the longitudinal image is on the left whichever is the 

interested teeth. 

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 X. 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) 

Third 

transversal 

image 

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 X when display showa the following 

message: 

LONGIT OFFS:>+00 

On the same way, it is possible to measure the transversal 

displacement (offset). 


(Rev. 1)

USER'S MANUAL 


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 X. 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 X when display shows the 


TRANSV OFFS:>+00 

Reference line for Point of 

interest 

Reference lines for Image 

borders 

Figure 24 

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6.7.1.3 Tomographic parameters 

Resulting images are tomographic ones, so it is necessary to instruct the 

system about the thickness and spacing transversal slices. On the 

following Figure 25 all these parameters are defined. 

Thickness (→←) of 

longitudinal slice: 4, 6 or 8 mm 

Thickness (→←) of 

tranversal slice: 2, 3 or 4 mm 

Spacing between transversal 

slices: 2, 3 or 4 mm 

Point of interest 

Figure 25 

The parameters defining the point of interest are called by in the 

following sequence: 

• Teeth selection 

• Longitudinal slice thickness (→←) 

• Transversal slice thickness (→←) 

• Offsets 

• Spacing between cross slices (only for complete mode). 


(Rev. 1)

USER'S MANUAL 


6.7.1.4 Radiographic results 

For a correct viewing of the images, we suggest to look at the images in 

such a way to have the longitudinal view on the left side. The image 

result is shown on Figure 27 for a complete examination; for a reduced 

one, please refer to Figure 27, where the transversal image immediately 

follows the longitudinal one. 

Longitudinal 

image 

First transversal 

image 

Second 

transversal image 

(point of interest) 

Third transversal 

image 

Figure 27 

Longitudinal 

image 

Transversal 

image 

(point of interest) 

Figure 27 

With the film placed as above indicated, anatomical point are as per the 

following paragraphs. 

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6.7.1.5 Right side tomography (quadrants 1 and 4) 

In case of complete examination, longitudinal image placed in the left 

position has the distal part of the mouth on the external side of the film 

(left side of film), and the mesial part of the mouth on the inner part (at 

right). 

Exam starts from the distal to mesial, with cross images having 

vestibular part on the left side and the lingual or palatal on the right side 

(refer to Figure 28). 

Distal 

Mesial 

Vestibolar 

Palatal / 

Lingual 

Vestibolar 

Palatal / 

Lingual 

Vestibolar 

Palatal / 

Lingual 

Longitudinal 

image 


image 

Distal 

Second 


Point of 

interest 

Third tranversal 

image 

Mesial 

Figure 28 

Same reference for reduced examination is referred to on the following 

Figure 29. 

Distal 

Mesial 

Vestibolar 

Palatal / 

Lingual 

Longitudinal 

image 

Coronal image 

Point of 

interest 

Figure 29 


(Rev. 1)

USER'S MANUAL 


6.7.1.6 Left side tomography (quadrants 2 and 3) 

In case of complete examination, longitudinal image is placed in right 

position has the mesial part of the mouth on the external side of the film 

while the distal one of the mouth is on the inner part. 

Exam starts from mesial to distal, with cross images having vestibular 

part on the left side and the lingual or palatal on the right side (refer to 

Figure 30). 

Mesial 

Distal 

Palatal / 

Lingual 

Vestibolar 

Palatal / 

Lingual 

Vestibolar 

Palatal / 

Lingual 

Vestibolar 

Longitudinal 

image 


image 

Mesial 

Second 


Point of 

interest 

Third tranversal 

image 

Distal 

Figure 30 

For a reduced examination, references are contained on the Figure 31. 

Mesial 

Distal 

Palatal / 

Lingual 

Vestibolar 

Longitudinal 

image 

Transversal 

image 

Point of 

interest 

Figure 31 

WARNING: 

All images obtained with the Implant program have a magnification 

 

factor of 1.37. 

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6.7.2 Positioning of the implant Bite Lock 

To conduct the implant mode, STRATO X 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. 


(Rev. 1)

USER'S MANUAL 


6.7.2.1 Bite block preparing: Maxilla Implant 

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 

(Rev. 1) 

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6.7.2.2 Bite block preparing: Mandible Implant 

As already stated, this kind of examination has to be performed having 

the patient’s head inclined in order to maintain the mandible border in 

the point of interest most horizontal as possible; in this way radiographs 

will be of better quality and with all clinical interesting points. 

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 


(Rev. 1)

USER'S MANUAL 


6.7.3 Equipment preparation 

To select the IMPLANT mode, press button "14" . 

The equipment will configure itself on the following configuration: 

• ADULT, with the LED of the upper part of button "11" lighted on 

• MEDIUM SIZE, with the LED of the upper part of button "12" lighted 

on 

• MEDIUM ARCH with the LED of the upper part of button "13" lighted 

on 

• IMPLANT with the LED of the upper part of button "14" lighted on 

and with the LED "23" lighted on and the following message on the 

display. For reduced examination: 

T O O T H : 1 4 

■ ■ ( 2 ) 

Another pressure of button "14" 

will select "Complete mode". 

T O O T H : 1 4 

■ ■ ■ ■ ( 4 ) 

After this selection, the procedure has to be completed with the 

positioning of the implant bite block, in case of its removal from the 

support; the implant bite block has to be chosen according to the maxilla 

or mandible examination. 

 

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. 

(Rev. 1) 

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6.7.4 Manual / Anatomic exposure 

 

NOTE: 

If previous exam was conducted on manual mode, to select the 

"Anatomic" mode press button "14" 

during the visualisation’s 

phase of exposure parameters (point 2 of paragraph 6.7.5). 

During the implant selection, it is possible to chose to operate on one of 

the two modes: 

• ANATOMIC: with kV and mA pre-programmed on the system, based 

on patient’s size and the choose tooth 

• MANUAL: with the possibility to set kV and mA. 

 

NOTE: 

Manual mode is easily recognised by the blinking of the LEDS IMPLANT 

"14" and Adult/CHILD "11" . 


Select the patient size, small, standard or large. 

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. 

Select the ARCH size, large, standard or narrow, using button . 


(Rev. 1)

USER'S MANUAL 



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. 

To modify kV or mA, the button "7" , or button "5" has to 

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: 

or 

→ ← L O N G I T : 6 m m 

> 5 8 k V 0 7 m A 0 3 . 5 s 

→ ← T R A N S V : 4 m m 

5 8 k V > 0 7 m A 0 3 . 5 s 

while the symbol ">" will signal which parameter is to be modified. 

Using buttons Increase "3" and Decrease "6" , it will be 

possible to change the value of the selected parameter. 

kV value can be changed in the range 50÷80 kV, step 2 kV. 

mA value can be changed in the range 4÷10 mA, step 1 mA. 

 

NOTE: 

For a quick change, it is possible to speed up the process holding down 

the Increase button "3" or Decrease "6" . 

Select the Dental arch using the button Arch select large – medium (or 

standard) – narrow . 

(Rev. 1) 

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6.7.5 Selection of anatomic and tomographic parameters 

1. Select the teeth using button "26" or "24" ; in this way 

it is possible to select teeth changing the second digit between 1 

(scissors) and 8 (third molar). Acting on buttons "22" 

or 

"25" , it is possible to change the first digit ranging from 1 

(right maxilla) to 4 (left mandible). Please note that in anatomic mode 

kV and mA changes accordingly to the selected teeth. 

The setting is confirmed by pressing button "23" . 

2. Display will visualise: 

→ ← L O N G I T : 6 m m 

5 8 k V 0 7 m A 0 3 . 5 s 

Set the longitudinal slice thickness in the range of values of 4, 6 or 

8 mm using buttons "26" or "24" . 

 

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 


The selection has to be confirmed using button "23" . 

3. Display will visualise the message: 

→ ← T R A N S V : 4 m m 

5 8 k V 0 7 m A 0 3 . 5 s 

Set the longitudinal slice thickness between values of 2, 3 or 4mm 

using buttons "26" or "24" . 

 

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 


Set the chosen value using button "23" . 


(Rev. 1)

USER'S MANUAL 


4. Display will show: 

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 

buttons "26" or "24" ; in this way it is possible to set 

the correct value with its sign; using buttons "22" or "25" 

it will be possible to change the offset in the range ±10units of the 

ruler. Set values must be confirmed using button "23" . 

If reduced implant has been chosen, jump to point 6. 

5. If complete examination has been selected, display will show: 

D I S T A N C E : 2 m m 

5 8 k V 0 7 m A 0 3 . 5 s 

Where the displayed values are those of the cross slices. 

Select the spacing between cross slices in one of the values 2, 3 or 

4 mm using buttons "26" or "24" .Confirm the set value 

using button "23" . 

6. Display will visualise: 

P A T I E N T E N T R Y 

5 8 k V 0 7 m A 0 3 . 5 s 

Where the displayed values are those of the cross slices. 

 

NOTE: 

Indicated exposure time is strictly dependent on the selection of 

tomographic images parameters. 

(Rev. 1) 

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Patient’s preparation is the key factor in order to have diagnostic images, 

because of the geometrical relations between STRATO X and the natural 

individual variability of patients. Following suggestions must be adapted 

with the experience and the user radiological skill. 





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. 

Using the "27+28" keys (up) 

or "29+28" (down) 

raise/lower the column until the implant support bite at a convenient 

height. 

4. Position the patient in the temple support 4 (Figure 34); ask the 

patient to bite with his incisors against the reference notch of plastic 

implant’s bite block, already prepared following the instructions of 

paragraphs 6.7.2.1 and 6.7.2.2. The hands should rest on the front 

handles. 


6. Press button "20" to switch ON the laser centring device. Two 

laser beams will light up the mid-longitudinal plane line 45, the 

horizontal line for the Frankfurt plane reference 46 (the plane that 


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). 


(Rev. 1)

USER'S MANUAL 


Legend for reference planes: 

45 Mid longitudinal plane 

46 Frankfurth plane 

45 46 

1 

5 

4 

6 

Legend of patient’s centring 

devices: 

1 Maxilla implant bite block 

2 Bite 

4 Temple fixing device 

5 Knob for Frankfurth laser beam 


support 

Figure 34: Maxilla position 

Legend for reference planes: 

45 Mid longitudinal plane 

45 

1 

5 

4 

6 

Legend of patient’s centring devices: 

1 Mandible implant bite block 

2 Bite 

4 Temple fixing device 

5 Knob for Frankfurt laser beam 


support 

Figure 35: Mandible position 

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. 

(Rev. 1) 

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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 

pressed again or, upon completion of the alignment procedure, button 

"23" is pressed to start exposure. 

9. Once alignment has been completed, the following message will be 

displayed: 


x x k V x x m A 1 5 . 0 s 


10. Make the following recommendations to the patient: the mouth 

must remain closed, he/she must remain perfectly still and do 

not look at the rotating arm during movements. 


(Rev. 1)

USER'S MANUAL 



 

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: 


and personnel in the area must be in compliance with the regulations in 

force in the country where the machine is used. 




from the focal spot of the tubehead. 

1. Press button "23" ; display will show: 


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 6.7.4. 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 


> S T A R T E X A M 



> X - R A Y < 

x x k V x x m A Y . Y Y s 


during emission, while during intermediate movements the message 

will be displayed. 

> X - R A Y < 

x x k V x x m A Y . Y Y s 


(Rev. 1) 

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NOTE: 

Exposure values displayed are changing according to the selected mode 

(longitudinal or cross). 

 

NOTE: 





inserted. 

 

NOTE: 

The rotation of the arm and the emission of the rays will start with a 


button is a "dead man control, it must be kept pressed until the end 


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 R E S S → 0 ← 


 

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. 


to return the unit to its initial position. This 

movement can be stopped by pressing button "9" . 


(Rev. 1)

USER'S MANUAL 




P L E A S E W A I T . . . 

 

WARNING: 







is lit. 


R E P L A C E 



will light up 


or 

T O O T H : 1 4 

■ ■ ( 2 ) 

T O O T H : 1 4 

■ ■ ■ ■ ( 4 ) 

According to the chosen mode. A new exposure can now be made. 

 

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: 



This time enables the tube's anode to cool down. 

(Rev. 1) 

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WARNING: 


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: 





of the arm. 


E 5 6 1 



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. 






W A I T F O R 



(Rev. 1)

USER'S MANUAL 


and then 

R E P L A C E 



(cassette and parameters) and the patient repositioned. 

 

NOTE: 



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6.8 Cephalometric examination 

There is no rotation of the tubehead (X-ray generator) support arm and 

cassette holder for the cephalometric examination. 

Various projections are possible for the cephalometric examination. The 

diaphragm positions automatically according the cassette format and the 

projection selected. 

The cephalometric examination uses an adjustable filter called soft tissue 

filter (STF). This filter reduces the dose in areas with low bone content 

and highlights the patient's profile which, under normal conditions, 

would be over-exposed and so not visible. 

The STRATO X makes different kinds of exposures, according to the type 

of cassette used: 

8"x10" 

Asymmetrical 

for Latero-Lateral 

8"x 10" 

Symmetrical for 

Antero-Posterior 

and Postero- 

Anterior 

10"x 8" 

Asymmetrical 


12"x 10" 

Symmetrical 


 

NOTE: 

The size of the cassette is not automatically recognized by the unit but 

must be selected 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 

overexposure film. It is recommended 

to use a cassette having a medium 

type intensifying screen or a cassette 

with only one screen. 

An alternative can be to set technique 

factors at 60kV, 8mA, 0.5sec. 

Figure 36 


(Rev. 1)

USER'S MANUAL 



 

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. 


to select the cephalometric examination. 

The following two messages will be displayed alternatively: 

and 

C E P H - R E M O V E 

C H I N R E S T 

C E P H - C L O S E 

T E M P L E S U P P O R T 

 

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. 

(Rev. 1) 

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1. Having completed the above, press key "23" . The two previous 

messages will disappear and the machine will align automatically 

with respect to the cassette and the following message will be 

displayed: 

C E P H 

P L E A S E W A I T . . . 

Once alignment is completed, the following message will be 

displayed: 

C E P H - O P E N 

C A S S E T T E U N I T 

requesting the operator to open the cassette holder for panoramic 

examination. 

 

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. 

None of the leds of button "13" 

, Arch wide - medium - narrow 

lights up during the cephalometric examination. 

2. Insert the cassette ensuring that it is correctly aligned with the 

reference marks on the support and lock it in with the round block. 

 

NOTE: 

The size and the orientation of the cassette is not automatically 

recognized by the unit but must be selected by the operator. 


(Rev. 1)

USER'S MANUAL 


3. With key "22" or key "25" it is possible to select the 

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 

earlier, by pressing key "9" . 

 

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. 

(Rev. 1) 

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NOTE: 

If the previous examination had been made manually, press key 

"15" to change to anatomic exposure. 

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 

patient may be selected. Press key "11" 

to change the selection. 


(Rev. 1)

USER'S MANUAL 



Select the type of patient with the Adult/Child key. 

Select the type of build using the Size small - medium - large key. 

The kV, mA and s values will be displayed according to the selections 

made as per the following table: 

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. 

(Rev. 1) 

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If the kV, mA and s combinations of the above table are not considered 



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 "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: 

Exposure times selectable in manual mode 

0,20 - 0,23 - 0,26 - 0,30 - 0,33 - 0,36 - 0,40 - 0,45 - 0,50 - 0,60 

- 0,70 - 0,80- 0,90- 1,00 - 1,30- 1,60 - 2,00 - 3,00 

Table 7 

 

NOTE: 



pressed. 

or 


(Rev. 1)

USER'S MANUAL 




X-rayed (necklaces, earrings, glasses, hair-pins, movable dental 





beam. 

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). 

4. Place the patient in a standing position at the ear centering device. 

Using the "27+28" keys (up) 

or "29+28" keys 

(down) move the column until the centering pins "5" 

(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). 


6. Press the ON button "20" of the laser centering device. A laser 

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 

13) located on the side of the tubehead. 

Once centering has been completed, press key "20" 

off the laser centering device. 

to switch 

 

NOTE: 

The laser centering device remains lit until the button "20" 

pressed again or, upon completion of the alignment procedure, key 

is 

"23" is pressed to start the exam procedure. 

(Rev. 1) 

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7. If an "asymmetric" projection as been selected, the Soft Tissue Filter 

(STF) will be automatically inserted; by pressing key "26" 

or 

key "24" 

, the STF position can be changed to match the value 

read on the graded scale "3", so to fit the patient’s profile. 

 

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 6.8.3). 

 

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 


2 Nose rest 

3 Graded scale for soft tissues 

filter 

4 Ear centering device 

5 Pins for ear centering device 

6 Height adjustment knob for 

cephalostat group (in low 

position for L.L. 

examinations) 

Figure 37 


(Rev. 1)

USER'S MANUAL 



 

WARNING: 


and personnel in the area must be in compliance with the regulations in 

force in the country where the machine is used. 




from the emission of the X-rays (see Figure 1 and Figure 2). 

1. Verify once again that the exposure data are correct (see paragraph 

6.8.2). Advise the patient to remain still and to keep his mouth closed 

with the teeth touching throughout the duration of the exposure. 

Press key "23" . 

The collimator corresponding to the selected cassette will be placed in 

position. Furthermore, if the type of exposure requires it, the soft 

tissues filter will be positioned according to the value set by the 

operator. 

Check that the light unit ready for X-ray is ON. 

 

NOTE: 

To return to the previous step, 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: 




> X - R A Y < 



(Rev. 1) 

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NOTE: 


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. 

3. Once the exposure is completed, the following message will be 

displayed: 

C E P H 


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 






(Rev. 1)

USER'S MANUAL 


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 


immediately, thus suspending emission of the X-rays. 


E 5 6 1 




C E P H 


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. 

(Rev. 1) 

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6.9 Messages on display 

STRATO X is fully controlled by a microprocessor which controls the 

programming of the emission parameters and signals the various 

conditions of the machine, the possible abnormalities and errors via 

displayed messages. 

The messages can be divided into two groups: 

• operation messages: these messages tell the operator how to set up 

the unit for the examination 

• error messages: these messages are displayed when an error occurs. 

There are three kinds of error messages as follows: 

1 - Messages prompted when the X-ray emission button is released by 

the operator or by pressing key "9" 

. The message displayed 

will be as follows 

E x x x 


xxx = error message code number 

Operations are reset by pressing key "9" . 

2 - Messages generated by a system error. In this case, the Technical 

Service must be called. 

Messages that require the intervention of the Technical Service are 

displayed as follows: 

E x x x 

C A L L T E C H A S S . 


3 - Messages related to H.F. board problems. If this occurs, switch off 

the unit. Wait a few minutes for the capacitors of the relative circuit 

to discharge and then switch the machine on again. If the problem 

persists, call the Technical Service. 

E x x x 

S W I T C H P O W E R O F F 


Those messages requiring the intervention of the Technical Service 

together with the relative verifications and actions are listed here 

below. 


(Rev. 1)

USER'S MANUAL 


Motors movement 

Code 

Error description 

500 Unexpected limit switch activation, X-axis 

501 Unexpected limit switch activation, Y-axis 

502 Unexpected limit switch activation, rotation axis 

503 Unexpected limit switch activation, cassette axis 

504 Time-out motor zeroing 

Collimator 1 

Code 


510 Primary collimator position 0 not found 

511 

512 

513 

Decoding error of primary collimator position (opticalswitches) 

Maximum number of "seek retries" on primary 

collimator exceeded 

Motor in "time-out" during movement of primary 

collimator 

514 

Limit switch not found during reset of primary 

collimator 

515 The "0" microswitch is always closed 

Soft Tissues Filter 

Code 


520 Soft Tissues Filter time-out 

521 

522 

Collimator 2 

Code 

The movement of the Soft Tissues Filter stops at the 

limit switch 

Limit switch not found during reset of Soft Tissues 

Filter 


530 Secondary collimator time-out 

Cassette Holder 

Code 


540 Cassette holder limit switch time-out not found 

541 

Cassette holder not in "PAN" position (cassette holder 

open) or collision alarm (i.e. chin rest collision) 

542 Collision of rotation arm with patient 

(Rev. 1) 

117 

STRATO X (120V)

USER'S MANUAL 


HF Board and Tubehead 

Code 


550 "No power supply" alarm H.F. generator board 

551 H.F. generator board "Overvoltage" alarm 

552 H.F. generator board "Overload" alarm 

553 H.F. generator board "Broken filament" alarm 

554 H.F. generator board "No X-ray issue" alarm 

555 "X-ray emission too long" alarm 

Buttons 

Code 

560 

561 


One or more keys are reported as pressed during the 

switching on phase (see following table) 

X-ray key released during X-rays examination in 

Password mode 

562 

X-ray Key short-circuited during start-up and/or 

during examination programming 

563 Remote X-ray button pressed during start-up 

Memory Checksum 

Code 


570 Checksum error on Flash EPROM 

571 Writing error on Flash EPROM 

572 Error during erase of Flash EPROM 

573 Error during the verification phase of Flash EPROM 

574 Unspecified error on Flash EPROM 

575 Configuration data corrupted on Flash EPROM 

Code 


600 Reset key pressed during movement 


(Rev. 1)

USER'S MANUAL 


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 

Code 

Description 

Key no. 

(Figure 10) 

00000001 Not used 21 

00000002 PANORAMIC centering device switch 20 

00000004 Arrow up 22 

00000008 Arrow right 24 

00000010 ENTER 23 

00000020 Arrow left 26 

00000040 Arrow down 25 

00000100 Selection of Arch type (large, 

normal, narrow) 

00000200 Column key 28 

00000800 Translateral TMJ selection 16 

00001000 Size selection (small, medium, large) 12 

00002000 Adult/Child selection 11 

00004000 Selection CEPHALOMETRY 15 

00008000 Selection IMPLANT 14 

00010000 Column down 29 

00080000 Selection PANORAMIC 17 

00100000 Selection TMJ open/closed mouth 18 

00200000 Selection TMJ BIAXIAL 19 

00400000 Patient input 10 

00800000 Reset 9 

01000000 Spare - 

02000000 Increase by steps 3 

04000000 Column up 27 

08000000 kV selection 7 

10000000 Exposure time selection 4 

20000000 mA selection 5 

40000000 Reduction by steps 6 

80000000 Test 8 

13 

(Rev. 1) 

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6.10 Research and correction of possible defects in 

dental radiographies 

6.10.1 Faults due to a wrong positioning of the patient 

Problem Description Solution 

Too large and blurred 

incisors. 

Too small and blurred 

incisors. 

Radiography with 

blank central area. 

Asymmetric dental 

arch. 

Upper apical area too 

dark. 

Upper central apical 

area out of focus. 

The image is slanted in 

comparison with the 

longitudinal axis of the 

film and some 

anatomical structures 

are not symmetric. 

The teeth on one side 

are bigger than those 

on the other side. 

CEPH exam: white 

area in the lower part 

of the film. 

The patient is not positioned 

correctly, too far from the 

optimal focal plane. 

The patient is not positioned 

correctly, he is too much 

beyond the optimal focal 

plane. 

The spine of the patient 

inhibits the passage of the 

X-ray since it’s too 

compressed. 

The mid-sagittal line does 

not correspond to the laser 

centring beam. 

The patient does not keep 

his lips shut and the tongue 

is not against the palate. 

The patient keeps his head 

rotated backwards 

(Frankfurt plane not 

aligned). 

The patient head is slanted 

(not vertical). 

The head of the patient is 

rotated with respect to the 

axis of the bite. 

Panoramic chin-rest still 

mounted. 

Position the patient correctly, check 

that he holds the bite with the 

incisors on the fit notch and that the 

bite holder rod is vertical. 

Position the patient correctly, check 

that he holds the bite with the 

incisors on the fit notch and that the 

bite holder rod is vertical. 

Check the alignment of the 

Frankfurt plane, try to stretch the 

cervical part of the spine moving the 

feet of the patient forward (see 6.4.3 

points 3/4/6/7) and eventually 

correct the height of the chin 

support. 

Re-align the patient (see 6.4.3 

point 6). 

See paragraph 6.4.3 point 8. 

Position the patient again and realign 

the Frankfurt plane. 

Position the patient again, correcting 

the position of the sagittal plane. 

Position the patient again correcting 

the position of the sagittal plane and 

controlling that the head does not 

rotate. 

Perform the exam again removing 

the PAN chin-rest. 


(Rev. 1)

USER'S MANUAL 


6.10.2 Defects due to wrong data setting and to the dark room 

Problem Description Solution 

Under or overexposed 

film. 

Completely black film. 

Veiled film. 

Film with stripes. 

Film with blurred 

details but with good 

contrast. 

Film completely white. 

Soft Tissues not or 

poorly visible in L-L 

projection. 

The set kV value is not fit for 

the size of the patient. 

Possible error during 

development. 

The film caught too much 

light or underwent an 

involuntary radiation. 

This defect is checked 

looking at the film edges not 

impressed by the radiation: 

if they are not perfectly 

transparent, thus causing a 

poor definition on all film. 

Being rapidly scratched 

against its box the film 

accumulated electrostatic 

charges or the scintillating 

screens have not been 

treated with antistatic 

liquid. 

The film is not correctly 

pressed between the 

screens. 

Missing X-ray emission or 

wrong development. 

The STF value is not correct. 

A symmetric cassette size 

was selected. 

Check the development system, or 

repeat the exam varying the kV 

value: see paragraph 6.4.4. 

Should this solution fail, call the 

Technical Service. 

Verify the locking of the dark room 

and do not keep new films near 

radiogene sources or light sources. 

Verify that the film is not expired 

and that the storing indications 

given by the manufacturer have 

been followed. 

Verify the working of the non-actinic 

lamp in dark room. 

Clean the screens with the antistatic 

liquid. 

Replace the cassette. 

Verify the emission of the X-rays by 

acoustical and luminous signal 

(led 2), if the error persists, check 

the development procedure. If no 

solution can be found, call the 

Technical Service. 

Refer to paragraph 6.8.3 to adjust 

the position of the "STF". 

Select an asymmetrical cassette size 

(which will enable the STF filter). 

6.10.3 Defects on film due to the device 

1. Should the film show non irradiated areas or be completely white, 

this can mean that there is a defect in the alignment between X-ray 

beams and film or a partial or total missing of irradiation; in any 

case, call the Technical Service. 

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. 

(Rev. 1) 

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6.11 Analysis of the problems on the panoramic 

examinations 

The panoramic radiography is the examination of the maxillo-facial 

region normally used to view the dental region inside the complete head 

and sinuses-orbital complex. A good panoramic examination allows 

distinguishing the main anatomical structures that are shown in the next 

drawing: 

Ref. Anatomic structure 

1 Hard palat plane 

2 Maxillary sinus 

3 Mandible 

4 Temporo mandibular condyle 

5 Ascending ramus of the TMJ 

6 Coronoid process 

7 Mandibular canal 

8 Foramen 

9 Nasal anterior spine 

10 Nose 

11 Ioid bone (normally duplicated) 

Figure 38 


(Rev. 1)

USER'S MANUAL 


6.11.1 Proper positioning of the patient 

The proper positioning of the patient during the panoramic examination 

is very important in order to get good quality radiography. This is due to 

the fact that the shape of the focussed area, e.g. of the layer clearly 

shown on the film, tends to follow the dental arch and has a nonconstant 

deepness. 

The objects outside this focussed area will therefore appear blurred on 

the resulting radiography. 

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 

(Rev. 1) 

123 

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6. The patient must extend the spine; this is normally obtained by 

asking the patient to step forward, making sure that all other 

conditions are unchanged. If not properly extended, the spine will 

cause the appearing of a lower exposed area (clearer) in the front part 

of the film. 

7. The patient’s tongue must be positioned against the palate, otherwise 

the air between the tongue and the palate will create a lower 

absorbance area which will result on the film as a darker area which 

in turn will hide the apex of the superior incisor teeth. 

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 

It must be noted that radiography is quite symmetrical, with the 

ascending rami of temporo mandibular joints almost parallel. The 

occlusal plane is shown slightly tilted upward, the palatal plane does not 

overlap the apex of the upper arch and therefore allows a good sight of 

the same. 


(Rev. 1)

USER'S MANUAL 


6.11.1.1 Error due to a bad patient's positioning 

• The film shows the anterior teeth with reduced magnification 

and not well defined. The cervical spine is shown an evident 

white shadow. 

In addition, on the molar zone there are too much shadows, 

disturbing the view. 

The resulting film is similar to the schema shown on Figure 41. 

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. 

(Rev. 1) 

125 

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• Anterior teeth are enlarged and blurred 

The Figure 42 depicts the resulting film. 

Figure 42 


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. 


(Rev. 1)

USER'S MANUAL 


• Part of the image is enlarged while the other one is reduced 

The schema described on Figure 43 the film obtained; it is possible to 

observe that one part of the radiography is blurred and enlarged, 

while the other one is reduced and seems to be on focus; the two 

condiles are at the same height on the film. 

Figure 43 


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 mediansagittal 

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 rightmost 

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. 

(Rev. 1) 

127 

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• The image shows TMJ at different height 

This fact is described in Figure 44. 

Figure 44 


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. 


(Rev. 1)

USER'S MANUAL 


• The image shows undulated teeth rows 

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 


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. 

(Rev. 1) 

129 

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• The radiographic image shows the teeth row too curved 

upward with the lower incisor non-focussed 

Additional defects shown on Figure 46, the temporo-mandibular 

joints will be positioned too high with lines converging upward. In 

some cases the upper condile might not be visible in the image. 

Figure 46 


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. 


(Rev. 1)

USER'S MANUAL 


 

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 

(Rev. 1) 

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6.11.1.2 Images with artefacts 

• Radiographs that show images with soft tissues or artefacts 

The radiographs may show anatomical parts of the soft tissues or 

show radiographic artefacts. 

Normally the soft tissues might be more or less present depending on 

the patient positioning, while the presence of artefacts is strictly 

dependent on the presence of foreign objects on the trajectory of the 

X-ray beam. 

Next figure shows these cases; please consider that all structures 

have a bilateral duplicate. 

Figure 49 

Where different references are described among with the 

cause/remedy, if any. 

Soft tissue Description Artifacts Description 

2 Hear soft tissue 1 Dark shadows due to 

the air gap between 

tongue and palat 

3 Nose soft tissue 4 Spine column 

7 Epiglottis 5 Leaded apron too high 

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. 


(Rev. 1)

USER'S MANUAL 


This is not true, because it is derived from the projection 

geometry used to obtain the panoramic image. The effect can be 

more evident if the film in underexposed due to wrong 

radiological parameters. 

With reference to the previous Figure 49, let’s analyse the cause and 

remedy. 

• Wrong positioning of the spine 

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. 

• Shadows or bright artefacts 

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. 

(Rev. 1) 

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• Non-exposed area in the lower-central part of the image 

If the problem appears as shown in point "5" of the previous Figure 

49, it indicates that there has been interference between the leaded 

apron worn by the patient and the X-ray beam. 

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. 

• The teeth rows are overexposed 

As already described, if the tongue is not positioned against the 

palate during the exposure, it will create an air chamber between the 

tongue and the palate; this air gap creates a less absorbing area that 

overlaps the teeth, often in the apex area. This area is identified with 

reference "1" in Figure 49. 

Remedy: 

Ask the patient to position the tongue against the palate during the 

exposure. 

• Presence of bright spots or rows 

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. 

• Film with images of the cassette locking device 

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. 


(Rev. 1)

USER'S MANUAL 


• Damaged films 

– Presence of scratches or residuals. 


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. 

– The film shows an unexposed area 10x50mm wide. 


In this case a cassette with patient identification window has 

been used. 

Remedy: 

Use a cassette without the identification label. 

• The film shows spots similar to lightning 


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. 

(Rev. 1) 

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6.11.1.3 Incorrect film contrast and density 

• Images too clear 

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 alignment 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) 

• Images too dark 


Exposure parameters too high with respect to the patient size. 

Remedy: 

– Decrease the exposure parameters 

– Check that the development process (liquids, temperatures, 

duration, etc.). 

• Image without contrast (flat image) 

In the case the film has a poor contrast (flat image), there can be 

different causes. 

Possible cause 

kV value too high 

Improper film-screen combination 

Edge of the film (non-exposed area) 

blurred 

Remedy 

Decrease the kV value 

Check film-screen compatibility 

Check the film (expiration date, 

storage) 


(Rev. 1)

USER'S MANUAL 


• Blurred film 


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. 

• One side of the film is overexposed 

Possible cause 

The film was already exposed 

Light filters through the dark room 

or in the cassette 

The cassette has not been properly 

closed 

Remedy 

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 

Check for the presence of light in the 

dark room and eliminate it. Use 

special lamps in the dark room 

Close correctly the cassette before 

exiting from the dark room with a 

new film 

(Rev. 1) 

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6.12 Storing of automatical exposure parameters 

At the end of mechanical installation and functional check the stored 

exposure parameters can be modified depending on the operator needs 

such as the combinations between screens and films or the need to get 

less or more contrasted (exposed) images. 

6.12.1 Exposure parameter 

To modify the automatic exposure parameters, please follow the indicated 

procedure: 

1. Select the exam, the type of patient and the size to be modified. 

2. According to the parameter to be modified press "7" and/or 

"5" and/or "6" (the latter only for Cephalometric 

function). On the display, on the left of the selected parameter value, 

a reference character ">" will be displayed. 

 

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 6.12.3). 

3. Press "3" or "6" to set the value to store. 


(Rev. 1)

USER'S MANUAL 


6.12.2 Soft tissue filter 

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). 

6.12.3 Storing parameters 

To store the set value, press the key "28" e "23" , at the 

same time, the display will show the following message: 

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 

display still shows the same value. 

(Rev. 1) 

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6.12.4 Table of pre-set anatomic parameters 

PANORAMIC 

TMJ open/close mouth 

Adult Child Adult Child 

Thin 

70 

10 

kV 

mA 

66 

8 

kV 

mA 

Thin 

70 

10 

kV 

mA 

60 

10 

kV 

mA 

Normal 

74 

10 

kV 

mA 

68 

8 

kV 

mA 

Normal 

74 

10 

kV 

mA 

66 

10 

kV 

mA 

Robust 

76 

10 

kV 

mA 

70 

9 

kV 

mA 

Robust 

78 

10 

kV 

mA 

70 

10 

kV 

mA 

TMJ BIAXIAL 

CEPHALOMETRY (L.L) 

Adult Child Adult Child 

Thin 

70 

10 

kV 

mA 

60 

10 

kV 

mA 

Thin 

74 

12 

0.8 

83 

kV 

mA 

s 

STF 

72 

11 

0.9 

83 

kV 

mA 

s 

STF 

Normal 

74 

10 

kV 

mA 

66 

10 

kV 

mA 

Normal 

76 

12 

0.8 

83 

KV 

mA 

s 

STF 

74 

11 

0.9 

83 

kV 

mA 

s 

STF 

Robust 

78 

10 

kV 

mA 

72 

10 

kV 

mA 

Robust 

78 

12 

0.8 

83 

KV 

mA 

s 

STF 

76 

12 

0.7 

83 

kV 

mA 

s 

STF 


(Rev. 1)

USER'S MANUAL 

Maintenance 

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. 

The periodical maintenance consists in periodical checks performed 

either by the operator himself and/or by a qualified technician. 

The operator can control the following items: 

• check that the plates are in order and well fixed 

• check possible oil leaks from the tubehead 

• check that the button cable does not show breaking or wearing signs 

• check that the unit is not damaged externally as to compromise the 

safety of protection from radiations. 

 

WARNING: 

It is advisable to perform the above mentioned check before each 

operating period. 

In case the operator would detect faults or abnormalities, he must 

immediately call the Technical Service. 

(Rev. 1) 

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Maintenance 

MAINTENANCE LOG-BOOK 

Installation: Date ........... Technician .................... 

Maintenance: Date ............. Technician .................... 

Cause ............................................. 


Cause ............................................. 


Cause ............................................. 


Cause ............................................. 


Cause ............................................. 


Cause ............................................. 


Cause ............................................. 


(Rev. 1)

Cod. 6909902003_Rev.1 0434 

VILLA SISTEMI MEDICALI S.p.a. 

Via Delle Azalee, 3 

20090 Buccinasco (MI) - ITALY 

Tel. (+39) 02 48859.1 

Fax (+39) 02 4881844 

A DEL Global Technologies Company

Strato X User Manual - Image Works

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