Image Editing | Image Scanner | Image Editing


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 reflective 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 scanner’s 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.


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 film) and make a 3 ϫ enlargement (1/12 ϫ 3 ϭ 3/12 or 1/4). For optical and perspective considerations, I use a 135-mm focal length lens with a 35-mm singlelens reflex 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 nonreflective characteristics. Behind the patient and in front of the background is a slaved electronic flash that is triggered by
Affiliate 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, 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 flash; 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 fill 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 magnification 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 Ͼ Fill, with white chosen as the fill 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.

I used a flatbed 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

C and D.” Verify that the tracing will be scanned at the same 100% scale as the headfilm. reproduction scan of the headfilm gray scale). To scan a tracing. Most of the tracing information resides in the right-hand portion of the histogram. Scale to 100%. B). C). and a histogram will appear (Fig 2. designating a width of 3 to 6 pixels with black as the chosen color. To edit the tracing further. select Filter ϾNoise ϾDespeckle Ͼ Dust & scratches. Editing the tracing will provide a cleaner image for superimposition. Scan the tracing and save as a TIF or a JPEG file.216 Decker American Journal of Orthodontics and Dentofacial Orthopedics February 2004 Fig 1. Original patient photos before editing. From the main menu. the less editing you’ll need to do. These parameters are comparable in all currently available scanners. and then open a copy in Photoshop. The integrity of . so editing should maintain that information while making the tracing clearer and with greater contrast. The more carefully you have made your tracing. after adjusting levels and correcting background color. Reinforce the tracing line with the Pencil tool. Beneath the histogram is a line with 3 small triangles. A and B. This is essential to superimpose the tracing on its headfilm. choose View Ͼ Actual pixels (to enlarge the tracing) and Image Ͼ Adjustments Ͼ Levels. then scan and save as a TIF or a JPEG file. Compare the unedited tracing and its histogram (Fig 2. B) with the edited version (Fig 2. which I set to “none. from the main menu. Experiment by moving the triangles to improve the intensity and clarity of the tracing. I use the same scanner settings as above except for tone curve.

then open the edited tracing in the PhotoShop program. select Image Ͼ Mode Ͼ RGB color. A. click on Select Ͼ Color range. open the headfilm. Number 2 Decker 217 Fig 2.) Choose the fill color by positioning the RGB sliders. and Edit Ͼ Copy. The tracing. then Edit Ͼ Paste. (If the color sliders do not automatically appear. then choose Edit Ͼ clear. Click on the Eyedropper tool. Select and position the Eyedropper tool anywhere in the background of the tracing and select Edit Ͼ Clear. From the main menu. as noted in the adjacent color window. To change the color of the tracing. SUPERIMPOSING THE TRACING ON THE HEADFILM To superimpose a tracing on a headfilm. first verify that you are in RGB mode (Image Ͼ Mode Ͼ RGB color). select Window Ͼ Color. with its opaque white background. To exactly position the tracing on the headfilm. The color sliders should be visible and accessible for your choice of fill color (Fig 3). followed by Select Ͼ Inverse. and then choose Edit Ͼ Fill. and Select Ͼ Deselect. B. edited tracing and its histogram. Headfilm. Edit Ͼ Free Ͼ Transform (for . will appear as a layer on the head film. the tracing has been preserved and the contrast markedly enhanced.American Journal of Orthodontics and Dentofacial Orthopedics Volume 125. choose from the main menu. unedited tracing and its histogram. From the main menu. position it anywhere in the background of the tracing and click. leaving only the tracing superimposed on the headfilm (Fig 4). The opaque white background will disappear. Select Ͼ All. C.

Edited and colored tracings superimposed on headfilms. filled blue and red. the file will be smaller. and on one another.218 Decker American Journal of Orthodontics and Dentofacial Orthopedics February 2004 Fig 3. You can now give the headfilm–tracing superimposition a new name and save it as a TIF or JPEG file. If you flatten the image as you save it. Fig 4. Edited tracings. . but you will be unable later to change the position or color of the tracing superimposed. linear movement) or Edit Ͼ transform Ͼ rotate (for rotational movement).

Select Ͼ All. . and Edit Ͼ Copy. now appears as a layer on top of the second tracing. open the tracing upon which you want to superimpose and select Edit Ͼ Paste. The opaque background will disappear.American Journal of Orthodontics and Dentofacial Orthopedics Volume 125. Select the Eyedropper tool and position it anywhere on the background and select Edit Ͼ Clear. When you are satisfied with your work. The first tracing. this superimpositioning technique will work only if both tracings were scanned at 100%. choose Edit Ͼ Save Ͼ Apply transform. Open the tracing that is to be superimposed and select Image Ͼ Mode Ͼ RGB color. Fine tune the positioning by selecting Edit Ͼ Free transform or Ͼ Edit Ͼ Transform Ͼ Rotate. CONCLUSIONS The analysis and comparison of pretreatment and posttreatment records can be facilitated by the image editing and superimposition techniques described here. leaving only superimposed tracings (Fig 4). Now. As before. Number 2 Decker 219 TRACING-UPON-TRACING SUPERIMPOSITION Follow the procedure described above to superimpose a tracing on another. with its opaque white background.

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