Second Opinion® User Manual

Description of How Second Opinion® Operates

The Second Opinion® system consists of three parts: in-office application or UserInterface ("UI") (the "Second Opinion® Client"), Application Programing Interface ("API"),and Computer Vision.

The Second Opinion® Client is continually monitoring a local (or networked) resource where dental radiographs (refer to Section 2.4 for list of supported image types) are stored. Once new imagery is discovered, the Second Opinion® Client invokes cloud-based APIs which submit the imagery to Computer Vision Models ("CV Model", “CV Models”) for processing. The metadata that these CV Models produce describe the nature and location of detected pathologic or non-pathologic features that may appear in the radiographs.  

This metadata information is then sent back to the Second Opinion® Client, which renders it for visual display and review within the Client’s user interface. Any potential pathologic or non-pathologic features detected will appear inscribed within color-coded boundary boxes overlaid on the original radiograph.

The entire process outlined above takes five to ten seconds to complete.

Second Opinion® CADe detects potential pathologic or non-pathologic features based on their visual appearance. Features are detected because they closely resemble known features present in the radiographs used to train the Second Opinion® CV Models.

The system can assist the radiologist in minimizing observational oversights by identifying regions that may warrant a more meticulous review.

The Second Opinion® software may be used only as an aid for detecting certain potential pathologic or non-pathologic features that can appear in bitewing and periapical radiographs.It is not for use as an aid in radiographic diagnosis or interpretation.

Getting Started

Follow the launch application instructions to begin using the Second Opinion® Client.

Launch Application

To launch the SecondOpinion® Client, open the operating system’s Start menu and click the Allprograms/All apps button to display a list of all installed applications. Clickon the Second Opinion® application toopen it.

Logging On

At the login window, enter Username and Password, then click Login.

Note: For security reasons, the password is issued by the system administrator.

Opening Screen

When the application launches, the Home screen will display in the user interface window.

To search for a patient’s X-rays a search bar is provided.  To return to recent radiographs you may select the clock and arrow icon to the right of the search bar.

Settings Tab

To re-configure the Client, use the mouse to click on the “Settings” option underneath the letter icon in the application toolbar, update the file location and press save. 

The language tab within settings allows for configuration of interface language and date format.

Finding Specific Charts

The search bar above the Chart List can be used to search charts by patient identifier, date, or combination thereof.

Image 4. Using search to find all radiographs for a specific patient identifier.

Typical Image Display

The Detection screen will open when a chart has been selected. The first radiograph in the chart will appear in the large radiograph display pane of the Detection screen. 

Radiographs in the radiograph display pane will be scaled to fit within the pane,

To the left of the radiograph display pane is the image selector pane, displaying a thumbnail filmstrip of all radiographs contained in the chart, grouped (and collapsed) by date of radiographic capture.  

To the right of the radiograph display pane, the Conditions index presents a list of all potential pathologic and nonpathologic features that Second Opinion® has detected. 

Within the radiograph display pane, annotated bounding boxes are overlaid on the original radiograph to indicate regions where detected features appear. To highlight the region where a feature has been detected, the user can hover the cursor over the bounding box. Users can also highlight a region containing a detected feature by hovering the cursor over the corresponding feature in the Conditions index.

Image 5. The Radiograph Detection Display screen

Users can limit which detected features are displayed and listed using the sensitivity/specificity slider, the pathology/non-pathology toggles above the conditions index, and the checkboxes adjacent the labels. These functionalities will be further explained in sections 5.2.10 and 5.2.11 of this User Manual.

To quickly access and load a different chart, users can use the search bar, press the recent charts icon (to the right of the search bar) or press the back arrow adjacent the current chart’s name to go back to prior results. 

A vertical toolbar along the upper right side of the radiograph display pane includes five tools for manipulating the appearance of the radiograph in the radiograph display pane. Listed from top to bottom as they appear in the toolbar, these tools and their corresponding icons are:

Brightness: Adjust brightness
Contrast: : Adjust contrast
Zoom: Zoom in or out
Invert: Invert colors
Rotate: Rotate image orientation

To access one of these tools, simply use the mouse to click on its icon using the mouse. 

Section 5.2.12 of this User Manual explains these image adjustment functionalities in greater detail.

Image Selector Filmstrip

When a chart is loaded, all radiographs in the patient record are presented to the left of the radiograph display pane in a thumbnail filmstrip. Each date of radiographic capture serves as an expandable folder and notes the number of images contained within. 

To select an image for display in the radiograph display pane, use the mouse to click on its thumbnail in the filmstrip. Users can also move between images by pressing the keyboard’s up and down arrow keys.

How to Read Results

Second Opinion® applies bounding boxes around all potential pathologic and nonpathologic features that it detects. These bounding boxes are color coded according to the system’s confidence in a detection’s accuracy. Users should understand how Second Opinion® evaluates the accuracy of a detection in order to make informed use of its detection capabilities.

The system’s confidence is determined by the specificity of discernment required to make a detection. Detections that the system is most confident in are those made when a high specificity of discernment is required to flag a detection. Naturally, the system makes fewer detections when it approaches them with a high specificity requirement. 

When the specificity requirement is relaxed, the system will make more detections, but it will be less confident in their accuracy. In other words, when specificity requirements are lowered, the system will be more sensitive to the presence of potential pathologic and nonpathologic features in a radiograph, at the risk of flagging features that are not present (false positive detections).

In order to offer a comprehensive list of features potentially warranting the user’s attention, Second Opinion® is designed to approach the detection process with varying degrees of specificity.

The detections presented by the Second Opinion® Client are color coded to allow users to understand whether the detection is the product of a) a specificity-first detection approach, b) a sensitivity-first detection approach, or c) a detection approach that balances specificity and sensitivity. 

Users should consider every Second Opinion® detection in light of the color of the bounding box inscribing it (or the color of the three dots next to the detected feature’s name in the Condition index). The detection color codes are as follows:

  • Aqua Blue: The system is highly confident in the detection’s accuracy.
  • Yellow: The system is moderately confident in the detection’s accuracy.
  • Red: The system has low confidence in the detection’s accuracy.

Second Opinion® users should move the Confidence Slider (found at the top of the Conditions index) between the red/low, yellow/medium, and aqua/high positions to gain a fuller understanding of the qualitative character of the Second Opinion® detections prior to taking any Second Opinion® detections into consideration.

Explanation of the Confidence Slider functionality is included in Section 5.2.10 of this User Manual.

Image 6. All three types of bounding boxes displayed

How to Use the Confidence Slider

The Confidence Slider (found at the top of the Conditions index pane of the Detection screen) allows users to limit which detections are displayed based on the system’s confidence in the detections’ accuracy. By moving the slider from left to right (low to high, sensitive to specific), users can hide low and medium-confidence detections from display in both the radiograph display pane and the Conditions index. Low- and medium-confidence detections are less likely to be accurate because less specificity of discernment was required to spot them (see section 5.2.9). The slider allows users to display detections based on the following confidence thresholds:  

  • High (more specific): Only the high confidence detections will be displayed. 
  • Med: Both high and medium confidence detections will be displayed. 
  • Low (more sensitive): High, medium and low confidence detections will be displayed. 

Users should view Second Opinion® detections at all three confidence threshold settings before taking any detections into consideration.

Selective Display of Potentials Detections

Located below the Confidence Slider are two toggle buttons, labeled “Pathology” and “Non-Pathology.” Users can select these toggles to show or hide detected features based on their pathologic or nonpathologic classification. When a toggle’s background is light gray, it is in the “on” state and that all detections of that class will be displayed. To display both classes of detections, ensure that both toggles are on.

Image 7. Detection screen with the Confidence Slider set to Med, Non-Pathology toggle in the “off” state, and Calculus toggled off.

As each class of detection is grouped, when there exist results of that class there is an active checkbox.  Toggling the box off will temporarily hide results of that class.  If the box is inactive then there are no results of that class to hide or show. 

How to Use Image Adjustment Controls

To improve the viewability of a radiograph in the radiograph display pane, Second Opinion® offers five image adjustment tools located in a toolbar on the upper right-hand side of the radiograph display pane. These tools can be used as follows:

Brightness: Use this slider to adjust image brightness. Move the slider to the left to decrease image brightness. Move the slider to the right to increase image brightness. Midpoint is default (and original) brightness.
Contrast: : Use this slider to adjust image brightness. Move the slider to the left to decrease image contrast. Move the slider to the right to increase image contrast. Midpoint is default (and original) contrast.
Zoom: Use this slider to zoom in and out of the image. When the slider is the far left position, the full un-zoomed image fills the radiograph display pane; this is the default position. Moving the slider to the right will zoom in to magnify the image. When zoom is applied the image may be moved around via click and drag. 
Invert: Select this toggle button to invert coloration of the radiograph. Black regions of the original image will become white. White regions of the image will become black. 
Rotate: elect this button to rotate the radiograph clockwise. Each time the button is clicked, the radiograph will rotate 90 degrees.

Image 8. Example of a radiograph with brightness and contrast increased, zoom applied and color inverted.