GENERAL STATEMENT OF POLICY

The ABO's position on digital records, including but not limited to photographs, radiographic images and study casts is that it is the examinee's responsibility to substantiate the integrity of the records. The overall goal of records is to accurately represent the patient's clinical presentation at the beginning and end of treatment. It is therefore the examinee's responsibility to ensure that records production practices, techniques and technologies are accurate, unaltered, and satisfy the ABO standards. Any steps in processing the data for purposes of clarification, presentation, analysis or otherwise should not bias, interfere with, and/or misrepresent the authentic anatomy of the patient.

Examinees are reminded that all records are legal documents and must be unaltered in anatomical/diagnostic content.

Examinees will prepare digital patient records using the same case report preparation for hard copy records published on this website.

VENDOR SOLUTIONS

Any commercial enterprise offering a product or service intended to aid the examinee in completing the Clinical Examination must accompany the offering with the following statements:

This product is compatible with current standards for submission of case reports to The American Board of Orthodontics as published at www.americanboardortho.com. **

**The American Board of Orthodontics has not reviewed or tested this product and does not endorse, guarantee, or warrant its performance or compatibility with ABO standards.

PRESENTATION OF DIGITAL RECORDS IN PRINTED FORM FOR IN-PERSON EXAMINATION

• For an in-person examination, the examinee may bring digital patient records in printed form. Insert printed pages into the case report notebook according to assembly instructions.
• Photographs and radiographs will be printed on photo glossy paper, with an ABO record identification label affixed to each page.
• Tracings and composite tracings will be printed on transparent media with an ABO record identification label affixed to each page.
• Note: Be sure that you have printed the tracings at the same scale as the untraced lateral cephalometric radiographs. You should be able to overlay the tracing on top of the printed untraced lateral cephalometric radiograph to produce a perfect match.

DIGITAL CASTS

• Digital pretreatment casts are acceptable provided that the digital format is supported by software to view and measure the digital casts for Discrepancy Index (DI) in compliance with ABO case submission criteria.
• Digital interim casts are acceptable only between Phase 1 and Phase 2 treatment provided all appliances are removed prior to impression taking.
• For the upcoming clinical exam, the ABO is prepared to accept allowable digital casts in the following format: OrthoCAD.
• Save allowable digital casts to one CD-ROM. Identify each digital cast with a distinguishing filename (e.g. case number, patient name and stage of treatment).
• NOTE: An accurate and stable occlusal registration (maximum intercuspation) for all digital casts is best achieved by using polyvinylsiloxane (PVS) bite registration material.
• Digital interim casts are not acceptable for pre-surgical study casts.
• Post-treatment digital casts are not acceptable at the current time.

• ABO Directors are actively pursuing the implementation of an automatic scoring system for all digital casts.

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	PRESENTATION OF DIGITAL RECORDS FOR FUTURE ELECTRONIC CASE SUBMISSION
	The ABO is actively involved in the development of case submission by electronic means. Its availability will be announced at a future date. The following standards in digital format will be expected:
	Digital Photographs
	• Photographic images will be: 1. In color. 2. Provided in industry standard JPEG format. 3. All photographs should be of the same dpi and scale. • The ABO recommends 24-bit color-depth, 300-dpi JPEG photographic images with medium compression that are appropriately cropped and rotated.
	Digital Radiographs
	• Radiographic images will be: 1. In grayscale. 2. Provided in industry standard JPEG format. 3. All radiographs should be of the same dpi and scale. 4. All cephalograms must have a calibration ruler (or wire of specified length) visible on the digital image. This is essential to allow for proper preparation of the cephalometric tracing. A calibration ruler of 100mm is typical for scanned images, and most direct digital x-ray systems include a scale somewhere in the system. Alternatively, a 100mm length of wire can be affixed to the cephalometric head stabilizer so that it appears in the image and yet does not interfere with the anatomy. • The ABO recommends that scanned radiographic images be 8-bit grayscale, 200-dpi JPEG with medium compression that are appropriately cropped and rotated. • Examinees with direct capture digital x-ray machines should submit their records using the native resolution of their system. For example, if your digital panoramic machine captures an 8-bit grayscale, 500 x 1200 pixel image, please submit it that way, just save it in JPEG format.
	Digital Cephalometric Tracings and Composite (Superimposed) Tracings
	• Computer generated tracings from anatomical points on the radiograph are acceptable, but the examinee is responsible for the accurate representation of all anatomical landmarks, planes and angles. • All cephalometric tracings will: 1. Be provided in industry standard JPEG format. 2a.  Include the cephalometric tracing as a digital image. b.  Include the tracing and the lateral ceph radiograph with calibration ruler overlayed as one digital image. 3. All tracings and cephalograms should be of the same dpi and scale. • All composite (superimposed) tracings will: 1. Be provided in industry standard JPEG format. 2. Be registered on the true radiographic anatomical outlines in accordance with composite tracing instructions and requirements on this website. 3. Include the composite tracing as a digital image. 4. All composite tracings should be of the same dpi and scale.

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