Onyx-RAD Chiropractic Tools Step by Step Guide - Viztek

Onyx-RAD Chiropractic Tools Step by Step Guide
Table of Contents
Introduction……………………………………………………………………………....3
Short Explanation of Onyx-RAD Chiropractic Toolbars...……………………….......5
General Chiropractic Toolbar……………………………………………………..5
Advance Orthogonal Toolbar……………………………………………………..6
Gonstead Analysis Toolbar………………………………………………………..7
NUCCA Analysis Toolbar……………………………………………………...…8
Step By Step Advanced Orthogonal Analysis….………………………………………9
Side View Tool………………………………………………………………........9
Normal Frontal Shot Angle Tool………………………………………………...10
Save Annotation………………………………………………………………….11
Delete Annotation………………………………………………………………..11
Horizontal Analysis……………………………………………………………...12
Frontal Plane Analysis…………………………………………………………...14
Aberrant Analysis………………………………………………………………..18
Step By Step Ilium Analysis……...…………………………………………………….20
Ilium Analysis……………………………………………………………………20
Gonstead Ruler………………………………………………………………...…22
Cervical Curve Tool……………………………………………………………...23
Lumbar Curve Tool………………………………………………………………24
Change the Radius of Circle (Change Curve)……………………………………24
Step By Step NUCCA Analysis………………………………………………………...25
Frontal Analysis………………………………………………………………….25
Vertex Spinous Process Tool…………………………………………………….30
Axial Alignment Tool……………………………………………………………31
General Chiropractic Tools……………………………………………………………32
Level Tool………………………………………………………………………..32
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Onyx-RAD Chiropractic Tools Step by Step Guide
Vertical Axis Tool………………………………………………………………..33
Vertebrae Line Tool……………………………………………………………...34
Center Point Tool………………………………………………………………...36
Measure Compare Tool…………………………………………………………..37
Mark Spot Tool…………………………………………………………………..38
George’s Line Tool………………………………………………………………39
Additional Annotations – Template Annotation……………………………………...40
Disclaimer……………………………………………………………………………….41
Authors: Aris Basic and Kristen Tabone
Viztek, Inc.
6491 Powers Avenue
Jacksonville, FL 32217
904-730-0446
800-366-5343
Onyx-CHIRO Manual
Revision 5
February 2006
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Onyx-RAD Chiropractic Tools Step by Step Guide
Introduction
Onyx-RAD Chiropractic tools are built as an addition to existing annotation tools of
Onyx-RAD and therefore have all limitations and features of those.
NOTE: The terminology “annotation” and “chiropractic tool” will be used
interchangeably.
The Onyx-RAD Chiropractic tools have several new functional additions when compared
to regular Onyx-RAD annotations:
• Template tools are activated through the keyboard:
o Rotate Left () - Will rotate template left or right in ¼
degree steps. The Rotate Left button is three buttons to the left of the left
Shift key and also contains the comma. The Rotate Right button is one
button to the right of the Rotate Left button and also contains the period.
o Zoom In (+), Zoom Out (-) - Will zoom in/out template if template is not
used for direct measuring (not size dependent.) The Zoom In button is one
button to the left of the Backspace button and also contains the equal sign.
The Zoom Out button is one button to the left of the Zoom In button.
o Reset Zoom (0) – Will reset the zoom level on the template. The Reset
Zoom level is located one button to the left of the Zoom Out button.
o Invoke Action () - Will draw a line from template or request insertion of
the value inferred from template. The Invoke Action button is one button
to the left of the left Shift key and also contains the forward slash (/.)
o Change template (\) – Will change the style of the Center of Skull tool.
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Onyx-RAD Chiropractic Tools Step by Step Guide
• A newly created Chiropractic annotation will replace an existing one (only one of
each type can exist at the same time on an image.) [One does not need to delete
old annotation]
• All calculations will appear in the bottom right corner of the image viewing
screen.
• Some of the annotations can only be deleted by using the select all – delete
process (see page 11.)
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Onyx-RAD Chiropractic Tools Step by Step Guide
Short Explanation of Onyx-RAD Chiropractic Toolbars
General Chiropractic Toolbar
o Side View Tool – Frontal Shot Angle - This tool is used to find a proper
angle for the frontal shot.
o Normal Frontal Shot Angle Tool –Frontal Shot Angle – This tool is another
method to find the proper angle for the frontal shot.
o Cervical Curve Tool – This tool displays a curve, from a circle with a 17
centimeter radius, on a lateral cervical view.
o Level Tool – This tool is used to determine the difference between a line
plotted on an image and a level line.
o Vertical Axis – This tool plots a vertical line at the point picked on the
image.
o Vertebrae Line – This tool plots a vertical line based on five points plotted
on the image.
o Center Point – This tool finds the center point of two plotted points.
o Measure Compare - This tool measures the distance between a right point
and a center point and a left point and a center point, then displays the larger of
the two values.
o Mark Spot – This tool allows the user to mark as many points as necessary
on the image.
o George’s Line – This tool is used to draw vertical lines on each vertebra
along the spine.
o Templates Tool – This tool contains templates that can be applied to various
images.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Advance Orthogonal Toolbar
o Calculate Icon - When this tool is turned on (embossed) the calculations
appear on applied chiropractic tools/annotations.
o Frontal View Tool – Center of the Skull (Frontal Cephalic Line) - With this
template, one can find FCL line, which is used together with AFP line to calculate
Atlas Cephalic Displacement Angle.
o Frontal View Tool – Atlas Frontal Plane Line (AFP) - Use this tool to mark
AFP line on frontal image.
o Frontal View Tool – Condyle Circle – C part of C/A (The Circles Tangent
angle.) - This tool is used to find the C value.
o Frontal View Tool – Axial Circle – A part of C/A (The Circles Tangent
angle.) - This tool is used to find the A value.
o Frontal View Tool – Five points tool – This tool is used to determine the
Cervical Spine Line (CSL) and Axis Spinous Rotation by marking 5 points on the
image. CSL and AFP are used in calculations of the Cervical Spine Correction
Angle.
o Frontal View Tool – PreY this button will allow you to pass “PreY” value
found in Horizontal View to a Frontal View where most of analysis is taking
place (this separation allows multiple shots to be available in study.)
o Aberrant Analysis Instrument – The Aberrant Analysis Instrument is used
to measure aberrancy in the head.
o Horizontal View Tool – Atlas horizontal rotation template is used when
locating Horizontal Cephalic Line. HCL is used together with Atlas Horizontal
Plane Line in calculations of Atlas Horizontal Rotation Angle (PreY).
o Horizontal View Tool – Atlas Horizontal Plane Line - Use this tool to mark
AHPL.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Gonstead Analysis Toolbar
o Ilium Analysis Tool – This tool is displays lines and measurements based on
16 points plotted on a pelvic or full spine image.
o Gonstead Ruler Tool – This tool allows the user to view and mark any
variation in the horizontal plane of each vertebra.
o Cervical Curve Tool – This tool displays a curve, from a circle with a 17
centimeter radius, on a lateral cervical view.
o Lumbar Curve Tool – This tool displays a curve, from a circle with a 22
centimeter radius, on a lateral lumbar view.
© 2005 Viztek Imaging Inc.
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Onyx-RAD Chiropractic Tools Step by Step Guide
NUCCA Analysis Toolbar
o Calculate Icon - When this tool is turned on (embossed) the calculations
appear on applied chiropractic tools/annotations.
o Central Skull Line (CSL) Tool – This tool activates a template used to find
the Central Skull Line.
o Atlas Plane Line (APL) Tool – This tool is used to mark the APL line on a
frontal image.
o Plane Line Tool – This tool allows the user to view the offset of the Plane
Line to the Atlas Plane Line in millimeters.
o Angular Rotation (AR) Tool – This tool is used to find the angular rotation
of the vertical axis line.
o Condyle Circles NUCCA Tool – This tool is used to find the C value.
o Axial Circles NUCCA Tool – This tool is used to find the A value.
o Vertex Spinous Process Tool – This tool finds the spinous center on a
horizontal view and calculates the misalignment (if any) of the spinous center
versus the dens center.
o Axial Alignment Tool – This tool creates points that can be used as a guide
for the Axial Circles tool.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Step by Step Advanced Orthogonal Analysis
(Optional Step) - Side View Tool
Take a lateral/sagittal view of the patient and use Side View Tool to find proper angle for
frontal shot.
1. Left click on the lateral view in the image viewing window.
2. Left click on the Side View Tool.
3. Left click on the image to plot the first point.
4. Left click on the image to plot the second point.
5. Upon plotting the second point, the angle is determined at which the frontal shot is
taken to yield the best frontal shot.
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Onyx-RAD Chiropractic Tools Step by Step Guide
(Optional Step) – Normal Frontal Shot Angle Tool
Take a lateral/sagittal view of the patient and use the Normal Frontal Shot Angle Tool
to find proper angle for frontal shot.
1. Left click on the lateral view in the image viewing window.
2. Left click on the Normal Frontal Shot Angle Tool.
3. Left click on the image.
4. Move the mouse and notice that the angle measurement changes. Left click to set
the measurement.
5. The angle displayed will yield the best frontal shot.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Save Annotation:
Left click on the Save Annotation button ( ) and the measurement will save. When a
measurement is saved, it changes color - from pink to red. The next time this exam is
opened, the user can view the previous measurements.
Delete Annotation:
1. Left click on the Annotation Edit Mode button ( ).
2. Right click on the image, to open the annotation menu.
3. Left click on the Select All option.
4. Right click on the image, to open the annotation menu again.
5. Left click on the Delete option.
If this annotation was previously saved, then the user must left click on the Save
Annotation button to save the changes.
Annotation Menu:
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Onyx-RAD Chiropractic Tools Step by Step Guide
Step 1
Take Frontal and Horizontal views and acquire those into Onyx-RAD system. (Image
Acquisition is out of the scope of this document, for help with that look at Onyx-RAD
Handbook)
Step 2 - Horizontal Analysis
1. Using Atlas Horizontal Rotation Template tool ( ) find HCL (Horizontal
Cephalic Line)
A. Left click on the horizontal view in the
series/stacks window, so that it appears in the
image viewing area.
B. Left click on the Atlas Horizontal Rotation
Template tool ( ) and make sure that the
Annotation Edit Mode button ( ) is turned
on.
C. Left click on the image. The Atlas Horizontal
Rotation Template now appears (shown on
left.)
D. To move the template, hover your cursor over
the small box in the center of the template.
When the cursor changes to a pointing hand, hold the left mouse key down
and move the mouse around to position the template.
E. Resize and rotate: - and + on the keyboard can be used to resize the template
and < and > on the keyboard can be used to rotate the template.
F. Calculate: Press on the keyboard to calculate the Horizontal Cephalic Line.
2. Use to mark/find AHPL (Atlas Horizontal Plane Line.)
A. The horizontal view should appear in the image window, with the Horizontal
Cephalic Line showing.
B. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
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Onyx-RAD Chiropractic Tools Step by Step Guide
Pan tool ( ) to move the image around until there is a good view of the atlas
and axis.
C. Left click on the Atlas Horizontal Plane Line tool ( .)
D. Left click on a left atlas point and then a right atlas point. A line will connect
the two points and the software will calculate a Pre Y value.
(Horizontal Cephalic Line and Horizontal Plane Line)
3. To enable the Chiropractic calculations, left click on the Calculate button ( .)
4. The Pre Y value will appear in the lower right corner of the image. If the user
does not have a Pre Y value, the overlays may be turned off. Left click on the
Overlay button ( ) to turn it on or off. When the button is turned on, it will look
like it has been “pressed in.” Note the Pre Y value for later use.
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Onyx-RAD Chiropractic Tools Step by Step Guide
5. Left click on the frontal view in the series/stacks window so that it will appear in
the image viewing window. Then, left click on the Pre Y button ( .) Enter the
discovered Pre Y value in the window.
Step 3 - Frontal Plane Analysis
1. Using FCL template tool ( ) find FCL (Frontal Cephalic Line.)
A. Make sure that the frontal view is selected.
B. Left click on the Center of Skull tool ( ) and make sure that the Annotation
Edit Mode button ( ) is turned on.
C. Left click on the frontal view to place the template on the image. (There are
two types of FCL template tools. To view the other type, press the \ on the
keyboard, above the enter key.)
(Center of Skull Tool)
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Onyx-RAD Chiropractic Tools Step by Step Guide
D. To move the template, hover your cursor over the small box in the center of
the template. When the cursor changes to a pointing hand, hold the left mouse
key down and move the mouse around to position the template.
E. Resize and rotate: - and + on the keyboard can be used to resize the template
and < and > on the keyboard can be used to rotate the template.
F. Calculate: Press on the keyboard to calculate the Frontal Cephalic Line
(Frontal Cephalic Line)
2. Using the Atlas Frontal Plane Line tool ( ), mark the AFP (Atlas Frontal Plane
Line).
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool ( ) to move the image around until there is a good view of the atlas
and axis.
B. Left click on the Atlas Frontal Plane Line tool ( .)
C. Left click on a left atlas point and then a right atlas point. A line will connect
through the two points. More calculations can be seen in the bottom right
corner of the image as long as the Calculate button ( ) is turned on.
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Onyx-RAD Chiropractic Tools Step by Step Guide
(Frontal Cephalic Line and Atlas Frontal Plane Line)
3. Use the Condyle Circle tool ( ) and the Axial Circle tool ( ) to find values for
C (Condyle Circle) and A (Axial Circle).
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool (
and axis.
) to move the image around until there is a good view of the atlas
B. Left click on the Condyle Circle tool ( ) and
make sure that the Annotation Edit Mode button
( ) is turned on.
C. Left click on the image to set the Condyle Circle
template in place (shown on the left.)
D. To move the template, hover your cursor over
the small box in the center of the template.
When the cursor changes to a pointing hand,
hold the left mouse key down and move the
mouse around to position the template.
E. Rotate: < and > on the keyboard can be used to
rotate the template.
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Onyx-RAD Chiropractic Tools Step by Step Guide
F. Press on the keyboard, which opens a window titled “Enter Discovered
Value.” Press OK after entering in the value.
G. Left click on the Axial Circle tool ( ) and make sure that the Annotation Edit
Mode button ( ) is turned on.
H. Left click on the image to set the Axial Circle template in place (shown
below.)
I. To move the template, hover your
cursor over the small box in the center
of the template. When the cursor
changes to a pointing hand, hold the
left mouse key down and move the
mouse around to position the template.
J. Rotate: < and > on the keyboard can be
used to rotate the template.
K. Press on the keyboard, which opens a
window titled “Enter Discovered
Value.” Press OK after entering in the
value.
4. Use the Five Point tool ( ) to find AxSP (Axis Spinous) and CSL (Cervical
Spine Line)
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool ( ) to move the image around until there is a good view of the entire
cervical column.
B. Left click on the Five Point tool ( ).
C. Plot the five points listed below. (A left click will plot one point.)
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Onyx-RAD Chiropractic Tools Step by Step Guide
Point Description
1 Left base of dens (odontoid) or Left lateral C2 body
2 Right base of dens (odontoid) or Right lateral C2 body
3 Tip of Spinous process
4 Left lateral body of C6 or C7
5 Right lateral body of C6 or C7
Step 4
Disable/Enable Chiropractic Calculations in order to refresh view and you should have
results of analysis displayed in lower right corner of the image.
(Optional Step) – Aberrant Analysis
The Aberrant Analysis tool is used on a frontal shot when the head appears aberrant.
1. Left click on the frontal shot in the series/stacks window, so that it appears in the
image viewing area.
2. Left click on the Aberrant Analysis tool and make sure that the Annotation Edit
Mode button ( ) is turned on.
3. Left click on the image. The Aberrant Analysis tool now appears (shown below.)
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Onyx-RAD Chiropractic Tools Step by Step Guide
4. To move the template, hover your cursor over the small box in the center of the
template. When the cursor changes to a pointing hand, hold the left mouse key
down and move the mouse around to position the template.
5. Resize and rotate: - and + on the keyboard can be used to resize the template and
< and > on the keyboard can be used to rotate the template. Rotate the template
so that the left side of the head lines up with it. Record this value. Rotate the
template so that the right side of the head lines up with it. Record that value.
6. Calculate: Press on the keyboard
and enter the determined value (The
value is the large number minus small
number. It is positive if the head leans
to the right and negative if it leans to
the left.)
The Aberrant Analysis will change the results of the Atlas Orthogonal calculations.
Advanced Orthogonal Analysis Complete!!!
*The Horizontal Analysis and Frontal Analysis can be interchanged.
NOTE: For most accurate results use high-resolution display and 1:1 mode when doing
analysis and/or reading results. Use the measurement displayed in the image viewing
window.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Step by Step Ilium Analysis
Step 1
Take Full Spine AP view and acquire those into Onyx-RAD system. (Image Acquisition
is out of the scope of this document, for help with that look at Onyx-RAD Handbook)
Step 2 – Ilium Analysis
1. Left Click on the Ilium Analysis tool.
2. Plot the 16 points listed below. (A left click will plot one point.)
Point Description
1 Top of the left iliac crest
2 Top of the right iliac crest
3 Left sacral groove
4 Right sacral groove
5 Center of the first sacral tubercle
6 Lateral border of the left ilia
7 Lateral border of the left sacrum
8 Medial border of the left ilia
9 Medial border of the right ilia
10 Lateral border of the right sacrum
11 Lateral border of the right ilia
12 Top of left femur head
13 Top of right femur head
14 Center of symphysis
15 Most inferior border of left ischia
16 Most inferior border of right ischia
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Onyx-RAD Chiropractic Tools Step by Step Guide
3. Upon completion of the 16 points, lines and measurements (in millimeters) are
displayed on the image:
-Iliac Crest Lines
-Lines of Lateral Sacral Border
-Horizontal Plane Line of the
-Width of Left and Right Ilium
Sacrum
-Width of Left and Right Sacrum
-Femur Head Line
-Height of Left and Right Pelvis
-Ischium Lines
-Vertical difference in height of
-Sacral Center Line
femur heads
-Lines of Medial Ilia Border
-Horizontal difference between
-Lines of Lateral Ilia Border
Center of Sacrum and Symphysis
Difference in height of femur heads
Width of Left Ilium Difference between sacrum and symphysis Width of Right Ilium
Width of Left Sacrum Width of Right Sacrum
Length of (Left and Right) Pelvis
© 2005 Viztek Imaging
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Onyx-RAD Chiropractic Tools Step by Step Guide
Step 3 – Gonstead Ruler
1. Use the same Full Spine AP view that the Gonstead Analysis was performed.
2. Left click on the Gonstead Ruler tool and make sure that the Annotation Edit
Mode button ( ) is turned on.
3. Left click on the image. The Gonstead Ruler tool now appears (shown below.)
4. To move the template, hover your cursor over the small box in the center of the
template. When the cursor changes to a pointing hand, hold the left mouse key
down and move the mouse around to position the template.
5. Rotate: < and > on the keyboard can be used to rotate the template. The ruler
will align with the horizontal plane line of the sacrum.
6. Use the ruler to check the level of the vertebrae.
7. When a vertebrae appears to be off, go back to the previous vertebrae and mark it
by pressing on the keyboard. This is a guide line.
8. Now, use the rotate buttons to move the ruler so that it lines up with the off
vertebrae and mark it by pressing on the keyboard.
9. Continue to check the entire vertebral column. Every time one seems off, mark
the vertebrae before, line up the ruler on the off one and mark it as well.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Cervical Curve Tool
1. This tool is used on a lateral view of the cervical spine. Left click on a lateral
view in the Series Stacks window and the lateral image will appear in the image
viewing area.
2. Left click on the Cervical Curve tool.
3. Left click on the first point, which should be the center of the anterior tubercle of
the anterior arch.
4. Left click on the second point, which should be the top of the second thoracic
vertebrae.
5. The third and final left click will cause the line to curve left or right. Left click to
the left side of the spine and the curve will be on the left side. Left click to the
right side of the spine and the curve will be on the right side.
Point 1
Point 3
Point 2
The Cervical Curve tool displays a curve of a circle with the radius of 17 centimeters. This radius can be changed.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Lumbar Curve Tool
1. This tool is used on a lateral view of the lumbar spine. Left click on a lateral view
in the Series Stacks window and the lateral image will appear in the image
viewing area.
2. Left click on the Lumbar Curve tool.
3. Left click on the first point, which should be the bottom of the twelfth thoracic
vertebrae.
4. Left click on the second point, which should be the top of the sacrum.
5. The third and final left click will cause the line to curve left or right. Left click to
the left side of the spine and the curve will be on the left side. Left click to the
right side of the spine and the curve will be on the right side.
The Lumbar Curve tool works similar to the Cervical Curve tool, but the Lumbar Curve tool displays a curve of a circle
with the radius of 22 centimeters. This radius can be changed.
Change Radius of Circle (Change Curve)
1. Left click on the Annotation Edit Mode button.
2. Left click on a point on the curve annotation.
3. Press the on the keyboard.
4. Enter the value for the radius of the circle in millimeters.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Step by Step NUCCA Analysis
These tools are not yet approved by NUCCA. They are a work in progress.
Step 1
Take Frontal and Horizontal views and acquire those into Onyx-RAD system. (Image
Acquisition is out of the scope of this document, for help with that look at Onyx-RAD
Handbook)
Step 2 – Frontal Analysis
1. Using CSL template tool ( ) find CSL (Central Skull Line.)
A. Make sure that the frontal view is selected.
B. Left click on the CSL tool ( ) and make sure that the Annotation Edit Mode
button ( ) is turned on.
C. Left click on the frontal view to place the template on the image.
(Central Skull Line Tool)
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Onyx-RAD Chiropractic Tools Step by Step Guide
D. To move the template, hover your cursor over the small box in the center of
the template. When the cursor changes to a pointing hand, hold the left mouse
key down and move the mouse around to position the template.
E. Rotate: < and > on the keyboard can be used to rotate the template.
F. Calculate: Press on the keyboard to calculate the Central Skull Line
(Central Skull Line)
2. Using the Atlas Plane Line tool ( ), mark the APL (Atlas Plane Line).
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool ( ) to move the image around until there is a good view of the atlas
and axis.
B. Left click on the Atlas Plane Line tool ( .)
C. Left click on a left atlas point and then a right atlas point. A line will connect
through the two points. More calculations can be seen in the bottom right
corner of the image as long as the Calculate button ( ) is turned on.
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Onyx-RAD Chiropractic Tools Step by Step Guide
(Central Skull Line and Atlas Plane Line)
3. Next, use the Plane Line tool ( .)
A. Fit the image to the image viewing window by left clicking on the Fit tool
( ) or, from the keyboard, press Alternate and the F key.
B. Now, left click on the Plane Line tool ( .)
C. The first point should be placed at the left intersection of the skull and the
Atlas Plane Line.
D. The second point should be placed at the right intersection of the skull and the
Atlas Plane Line. A numeric value should now appear indicating the offset
between the Atlas Plane Line and the Plane line in millimeters.
(Central Skull Line, Atlas Plane Line, and Plane Line)
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Onyx-RAD Chiropractic Tools Step by Step Guide
4. Use the Condyle Circle tool ( ) and the Axial Circle tool ( ) to find values for
C (Condyle Circle) and A (Axial Circle).
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool ( ) to move the image around until there is a good view of the atlas
and axis.
B. Left click on the Condyle Circle tool ( ) and
make sure that the Annotation Edit Mode button
( ) is turned on.
C. Left click on the image to set the Condyle Circle
template in place (shown on the left.)
D. To move the template, hover your cursor over the
small box in the center of the template. When the
cursor changes to a pointing hand, hold the left
mouse key down and move the mouse around to
position the template.
E. Rotate: < and > on the keyboard can be used to
rotate the template.
F. Press on the keyboard, which opens a window
titled “Enter Discovered Value.” Press OK after entering in the value.
G. Left click on the Axial Circle tool ( ) and make sure that the Annotation Edit
Mode button ( ) is turned on.
H. Left click on the image to set the Axial Circle
template in place (shown on the left.)
I. To move the template, hover your cursor over the
small box in the center of the template. When the
cursor changes to a pointing hand, hold the left mouse
key down and move the mouse around to position the
template.
J. Rotate: < and > on the keyboard can be used to rotate
the template.
© 2005 Viztek Imaging Inc.
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Onyx-RAD Chiropractic Tools Step by Step Guide
K. Press on the keyboard, which opens a window titled “Enter Discovered
Value.” Press OK after entering in the value.
5. Use the Angular Rotation (AR) tool ( ) to find the angular rotation and the
vertical axis line.
A. Hold the right mouse key down and move the mouse to adjust the brightness
and contrast of the image. Left click on the True Size tool ( ) and use the
Pan tool ( ) to move the image around until there is a good view of the entire
cervical column. If the part of the cervical column is out of view, use the
Zoom tool (
) to resize the image.
B. Left click on the Angular Rotation tool ( ).
C. Plot the five points listed below. (A left click will plot one point.)
Point Description
1 Left base of dens (odontoid)
2 Right base of dens (odontoid)
Point is generated at the center of the
dens
3 Tip of Spinous process of C2 (or
junction of the lamina)
4 Left lateral body of C7 or T1
5 Right lateral body of C7 or T1
(Angular Rotation)
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Onyx-RAD Chiropractic Tools Step by Step Guide
Vertex Spinous Process Tool
1. Make sure that the horizontal view is selected. Hold the right mouse key down
and move the mouse to adjust the brightness and contrast of the image. Left click
on the True Size tool ( ) and use the Pan tool ( ) to move the image around
until there is a good view of the entire cervical column. If the part of the cervical
column is out of view, use the Zoom tool (
2. Left click on the Vertex Spinous Process Tool ( .)
3. Plot the four points listed below with a left click.
*Plot all points from top to bottom and left to right.
) to resize the image.
Point Description
1 Left side of the dens.
2 Right side of the dens.
A point is generated by the software as the center of the
dens.
3 Left side of lamina-pedicle junction of C2.
4 Right side of lamina-pedicle junction of C2.
A point is generated by the software as the spinous process
center.
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Onyx-RAD Chiropractic Tools Step by Step Guide
(Optional Step) – Axial Alignment Tool
1. The Axial Alignment Tool is used to create points that can be used as a guide for
the Axial Circles tool on the frontal view. Left click on the Axial Alignment tool
to activate it. Left click on the frontal view.
2. Left click on the left lateral most point on the superior articulating surface of C2.
3. Left click on the point where the left para-odontoid dip begins. This point is also
described as on the surface of C2, where the lateral masses of C2 end medially.
Upon clicking on the second point, a dot is created 2.4mm below the lateral paraodontoid
dip point and perpendicular to the joint surface.
4. Left click on the Axial Alignment Tool to activate it.
5. Left click on the right lateral most point on the superior articulating surface of C2.
6. Left click on the point where the right para-odontoid dip begins. This point is
also described as on the surface of C2, where the lateral masses of C2 end
medially. Upon clicking on the second point, a dot is created 2.4mm below the
lateral para-odontoid dip point and perpendicular to the joint surface.
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Onyx-RAD Chiropractic Tools Step by Step Guide
General Chiropractic Tools
Level Tool
1. Left click on the first point on the image.
2. Left click on the second point on the image.
3. The Onyx-Chiro software will display a level line and display the discrepancy
between the level line and the line created in millimeters.
Change the measurement from millimeters, to inches, to degrees:
1. Left click on the Annotation Edit Mode button.
2. Left click on a point on the actual line. The line should change to a purple,
dashed line.
3. Use the action key ( on the keyboard) to change the measurement from
millimeters, to inches, to degrees.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Vertical Axis Tool
1. This tool plots a vertical line at the point selected on the image. Simply left click
on the image to produce the vertical line.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Vertebrae Line Tool
1. Left click on the Vertebrae Line Tool.
2. Plot the six points listed below with a left click.
Point Description
1 Left side of vertebral body.
2 Right side of vertebral body.
Software will generate a middle point of the vertebrae from
points 1 and 2.
3 Junction of lamina (or tip of spinous process.)
Software will generate a middle point from the middle
point of the vertebrae and point 3, which represents the
center of the spinal canal.
4 Left side of the following vertebral body.
5 Right side of the following vertebral body.
Software will generate a middle point of the vertebrae from
points 4 and 5.
6 Junction of the lamina (or tip of spinous process.)
Software will generate a middle point from the middle
point of the vertebrae and point 6, which represents the
center of the spinal canal.
*Plot all points from top to bottom and left to right.
*Use the same type of point for point 3 and point 6.
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Onyx-RAD Chiropractic Tools Step by Step Guide
3. Upon plotting the six points, a line is generated that passes through the points
represented as the centers of the spinal canals.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Center Point Tool
1. The Center Point Tool finds the center of two plotted points. Left click to plot the
first point.
2. Left click to plot the second point. A center point is generated by the software.
*Plot all points from left to right.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Measure Compare Tool
1. The Measure Compare Tool measures the distance between a right point and a
center point and a left point and a center point, then displays the larger of the two
values. Left click to plot the first point.
2. Left click to plot the second and middle point.
3. Left click to plot the third and final point. The longest distance will now display
in millimeters.
Point 1 Point 2 Point 3
*Plot all points from left to right.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Mark Spot Tool
1. The Mark Spot Tool allows the user to plot as many points as necessary on an
image.
2. Left click to plot the first point.
3. Left click to plot the second point. Continue to left click to create additional
points.
4. Double click on the last point to turn the Mark Spot Tool off.
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Onyx-RAD Chiropractic Tools Step by Step Guide
George’s Line Tool
1. This tool is used on a lateral view of the cervical spine. Left click on a lateral
view in the Series Stacks window and the lateral image will appear in the image
viewing area.
2. Left click on the Georges Line
Tool and begin drawing lines on
each vertebral body from top to
bottom.
3. Left click on the top of a
vertebral body.
4. Left click on the bottom of a
vertebral body.
5. Repeat steps 3 and 4 until lines
have been drawn on part or all of
the vertebral column.
6. Double-click off to the side of
the lines and the software will
generate measurements, which
account for the offset (in
millimeters) between the lines
plotted on the vertebral bodies.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Additional Templates - Template Annotation
6. Make sure that the Annotation Edit Mode button ( ) is turned on.
7. Left click on the Template Annotation tool.
8. Left click anywhere on the image and a list of templates will appear. The user
can left click on a template and preview it.
9. To select a template, left click to highlight it and then left click on the OK button.
10. To move the template, hover your cursor over the small box in the center of the
template. When the cursor changes to a pointing hand, hold the left mouse key
down and move the mouse around to position the template.
11. Resize and rotate: - and + on the keyboard can be used to resize the template and
< and > on the keyboard can be used to rotate the template. (Some of the
templates cannot be resized.)
12. Press on the keyboard to finish the use of the template.
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Onyx-RAD Chiropractic Tools Step by Step Guide
Disclaimer:
** Viztek Imaging does not guarantee accuracy of the calculations because of
discrete and limited range of values that can be produced by digital imaging. It is up
to medical professional to check validity and accuracy of calculated values. 1:1 view
provides us with full spectrum of data available from digital image there will
provide most accurate calculations. All testing done by Viztek Imaging has shown
that results received from software do correspond to results a medical professional
would get by using widely used Atlas Orthogonal Templates. All the results
produced that deviate from reality should be considered a bug and needs to be
immediately reported to the Viztek Imaging on 1-800-366-5343.
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