TECHNO BYTES

Image editing
Jay D. Decker, DDS, MSD Seattle, Wash

rthodontists who prepare oral or written presentations that include illustrations will probably need to scan photographs, radiographs, and cephalometric tracings, and then edit the images for color, size, and clarity. The purpose of this article is to describe how to scan and edit these images for presentation. Scanners that provide high-resolution images of reective and transparent images are available at very reasonable prices. Although many records can now be taken with a digital camera, the orthodontist who is preparing a presentation, whether for a single patient, an examining board, a regional meeting, or a publication, will most likely need to scan records and edit them. In addition to a working knowledge of the scanners operation, you will need to be familiar with an image management program, such as Adobe Photoshop or Photoshop Elements (Adobe Systems Inc, San Jose, Calif). For this discussion, I will assume that you have taken digital photographs or successfully scanned your analog photographs and opened them in the image management system. Because end-use requirements can differ greatly, always duplicate your original images and edit only the copies.
FACIAL PHOTOGRAPHY AND EDITING

The ABO examination requires facial images to be presented at one-quarter life size. To achieve this reproduction ratio I take an original 35-mm photo at 1/12 actual size (a 12-in ruler would measure 1 in on the lm) and make a 3 enlargement (1/12 3 3/12 or 1/4). For optical and perspective considerations, I use a 135-mm focal length lens with a 35-mm singlelens reex camera focused at 2 m to obtain the 1/12 size. I seat the patient 4 to 5 feet in front of a white velvet background, chosen for its nonreective characteristics. Behind the patient and in front of the background is a slaved electronic ash that is triggered by
Afliate associate professor, Department of Orthodontics, University of Washington, Seattle, Wash. Reprint requests to: Dr Jay Decker, 4575 Sand Point Way NE, Seattle, WA 98105; e-mail, jdecker@u.washington.edu. Submitted, February 2003; revised and accepted, April 2003. Am J Orthod Dentofacial Orthop 2004;125:215-9 0889-5406/$30.00 Copyright 2004 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2003.10.002

the camera-mounted ash; this eliminates most of the shadow cast by the head. This setup can also be used with a digital camera. Although I routinely use this lighting technique, the background of the facial photograph is not always evenly illuminated. As a consequence, some image editing might be necessary. To begin editing, open a copy of the image in the image management system. From the main menu of Photoshop, choose Image, Adjustments, and Levels. A histogram will appear with a line beneath it (Fig 1). Beneath the line are 3 small triangles; experiment with the end triangles by moving them toward the center. Move the left triangle to darken the image, the right one to lighten it up, and the central one to alter the overall contrast and brightness of the image. (These commands are for the Macintosh version of Photoshop; the PC version might be slightly different.) The most useful tool for correcting the background of the facial image is the Magic wand. Any background ll color for the facial image is possible, but, for this discussion, I will use white. Select the Magic wand from the tool box (by clicking on it) and place it anywhere in the background of the photo (by clicking again); the tool will automatically select all pixels of the same color and density. You can add additional areas of the background by changing to the Rectangular marquee tool. With this tool selected, hold the shift key down and add rectangular areas incrementally. At this point, it might help to increase the image magnication so that you can add very small areas of the background. When as much of the background area has been included with these 2 tools as is possible, proceed with Edit Fill, with white chosen as the ll color. If needed, you can edit additional areas of the background using the Paintbrush and Eraser tools, with white as the brush or eraser color. Figure 1 shows facial photos before (A and B) and after (C and D) editing.
SCANNING AND EDITING CEPHALOMETRIC FILMS AND TRACINGS

I used a atbed scanner to scan the lateral skull cephalometric radiograph and the tracing in Figure 2. Before scanning the radiograph, I set the scan parameters to gray scale, transparent, 300 pixels per inch with a tone curve of gamma 1.8 (this will preserve a linear
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Fig 1. A and B, Original patient photos before editing; C and D, after adjusting levels and correcting background color.

reproduction scan of the headlm gray scale). Scale to 100%; then scan and save as a TIF or a JPEG le. These parameters are comparable in all currently available scanners. To scan a tracing, I use the same scanner settings as above except for tone curve, which I set to none. Verify that the tracing will be scanned at the same 100% scale as the headlm. This is essential to superimpose the tracing on its headlm. The more carefully you have made your tracing, the less editing youll need to do. Editing the tracing will provide a cleaner image for superimposition. Scan the tracing and save as a TIF or a JPEG le, and then open a copy in Photoshop. From the main menu, choose View Actual pixels (to enlarge the tracing)

and Image Adjustments Levels, and a histogram will appear (Fig 2, B). Beneath the histogram is a line with 3 small triangles. Most of the tracing information resides in the right-hand portion of the histogram, so editing should maintain that information while making the tracing clearer and with greater contrast. Experiment by moving the triangles to improve the intensity and clarity of the tracing. To edit the tracing further, from the main menu, select Filter Noise Despeckle Dust & scratches. Reinforce the tracing line with the Pencil tool, designating a width of 3 to 6 pixels with black as the chosen color. Compare the unedited tracing and its histogram (Fig 2, B) with the edited version (Fig 2, C). The integrity of

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Fig 2. A, Headlm; B, unedited tracing and its histogram; C, edited tracing and its histogram.

the tracing has been preserved and the contrast markedly enhanced. To change the color of the tracing, rst verify that you are in RGB mode (Image Mode RGB color). From the main menu, click on Select Color range. Click on the Eyedropper tool; position it anywhere in the background of the tracing and click, then choose Edit clear, followed by Select Inverse. The color sliders should be visible and accessible for your choice of ll color (Fig 3). (If the color sliders do not automatically appear, select Window Color.) Choose the ll color by positioning the RGB sliders, as noted in the adjacent color window, and then choose Edit Fill, and Select Deselect.

SUPERIMPOSING THE TRACING ON THE HEADFILM

To superimpose a tracing on a headlm, open the headlm, then open the edited tracing in the PhotoShop program. From the main menu, select Image Mode RGB color, Select All, and Edit Copy, then Edit Paste. The tracing, with its opaque white background, will appear as a layer on the head lm. Select and position the Eyedropper tool anywhere in the background of the tracing and select Edit Clear. The opaque white background will disappear, leaving only the tracing superimposed on the headlm (Fig 4). To exactly position the tracing on the headlm, choose from the main menu, Edit Free Transform (for

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Fig 3. Edited tracings, lled blue and red.

Fig 4. Edited and colored tracings superimposed on headlms, and on one another.

linear movement) or Edit transform rotate (for rotational movement). You can now give the headlmtracing superimposition a new name and save it as

a TIF or JPEG le. If you atten the image as you save it, the le will be smaller, but you will be unable later to change the position or color of the tracing superimposed.

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TRACING-UPON-TRACING SUPERIMPOSITION

Follow the procedure described above to superimpose a tracing on another. Open the tracing that is to be superimposed and select Image Mode RGB color, Select All, and Edit Copy. Now, open the tracing upon which you want to superimpose and select Edit Paste. The rst tracing, with its opaque white background, now appears as a layer on top of the second tracing. Select the Eyedropper tool and position it anywhere on the background and select Edit Clear. The opaque background will disappear, leaving only

superimposed tracings (Fig 4). Fine tune the positioning by selecting Edit Free transform or Edit Transform Rotate. When you are satised with your work, choose Edit Save Apply transform. As before, this superimpositioning technique will work only if both tracings were scanned at 100%.
CONCLUSIONS

The analysis and comparison of pretreatment and posttreatment records can be facilitated by the image editing and superimposition techniques described here.