ORTHO BYTES The use of computers, computer programs, and other computerized equipment to assist in the orthodontic practice will be reported under this section of the American Journal of Orthodontics and Dentofacial Orthopedics, Manuscripts, comments, and reprint requests, unless otherwise noted, may be submitted to Dr. Martin Abelson, 14720 N. Shotgun PI. , Tucson, AZ 85737.
OCR and other valuable software Martin N. Abelson AB, DDS, ABO Tucson, Ariz. Most computer systems can benefit from the use of auxiliary software programs. Selected back-up programs and antivirus software are necessities and have become commonly used auxiliaries. This month's Ortho bytes will cover a few lesser known but equally valuable addon software items. Considerable typing time can be saved by scanning patient records and other documents rather than retyping them . Scanners bring in a document as a digitized image (Le., a picture). OCR or Optical Character Reading software becomes a necessity if you scan documents into your computer. To work with and edit a document, it must be in a text format. Converting a digitized document to a text format also has a beneficial side effect. Digital documents are large and bulky and converting them to text format saves considerable storage space. OmniPage Pro by Caere: There are any number of scanning programs and OCR programs available . Although OmniPage Pro is a premium priced product, it stands head and shoulders over any of the other products I have tried. Installation was simple and uncomplicated. Even though my flat-bed scanner was not one of the specifically supported scanners, the program functioned faultlessly with it from the start. The OmniPage interface is simple, and there is almost no learning curve. The dialogue screen presents buttons with simple choices raging from a button that will simply load an image to one marked Auto that will do a scan, load the image, do an OCR conversion, and give you a chance to make corrections of questionably converted items, in one step. OmniPage Pro handles single or multiple page documents with ease; once you select the format you want the converted document to use and where the file is to be saved, even that process is all but automatic. Most of my documents will be sent to my word processor, WordPerfect, so I simply have them stored with my
Reprint requests to : Martin N. Abelson, AB, DDS, ABO, 14720 N. Shotgun Place, Tucson, AZ 85737. Copyright © 1998 by the American Association of Orthodontists. 0889-5406/98/$5.00 + 0
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WordPerfect documents in a folder called Scanned. If I wish, I can have OmniPage Pro send the document directly to my faxing software. Best of ail, the accuracy of recognition is the best I have seen. OmniPage Pro has option settings with which to fine tune it for any conceivable situation including foreign language recognition. It boasts a slew of features available to do just about anything you might wish with a scanned document, but delightfully, you do not constantly trip over them. The options are easy to understand and use. I use both a flat-bed scanner and a film scanner. This is the only scanning software I have used that will remember which scanner I want it to use. All other scanning software I have tried required me to change the default scanner to the one I wished to use first, usually using another program because the scanning software was not set up to select a scanner. I found this to be a major bother. I encountered one peculiarity with OmniPage Pro. Contrary to standard practice, I do not leave my scanners on all of the time, having them on at boot up. I discovered if I make the mistake of trying to access the OrnniPage software without turning on my scanner first, I have to reinstall the fax manager software. This may just be peculiar to my system. Because I usually tum each scanner on before attempting to use it, this does not present a real problem. It is rare for me to react so positively about a software product, but OmniPage Pro is one program I can recommend without reservation. CleanS weep by Quarterdeck: DOS programs were always stored in discrete directories making them simple to remove completely. Windows programs habitually use "shared files and .dlls" that can be scattered all over your hard drive. These files can take up considerable space and are about as easy to clean up as shrapnel from a hand grenade. Simply removing a Windows 3.x program file and its folder really does only part of the job. The residual auxiliary files installed with the program get left behind and soon become almost impossible to identify and eliminate. Windows 95 specific programs come with builtin "Uninstall," but earlier Windows 3.x software presents a major clean-up problem. About the only way to get rid of these excess space killing files is to back up your files, refor-
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mat your hard drive, and then reinstall your current programs. CleanS weep and other uninstall programs are designed to eliminate this problem. When you install a new program, CleanS weep prompts you and asks if you wish to monitor the installation. If you say yes, it monitors where all of the components are installed. Should you wish to uninstall that program at a later date, CleanSweep remembers where the files went and can uninstall all of the pieces wherever they are stored. CleanS weep offers single-click cleanup directly from Windows 95 for fast and easy operation. CleailSweep can also quickly copy files to a laptop or second computer. It supports Windows 3.l, 95, and NT. There are a number of additional useful features. One of the neatest features is one which finds and removes duplicate files and programs. Using it, I located and eliminated 85 megabytes of copies of duplicated programs that for some unknown reason ended up in the folders of programs with which they had absolutely no relationship .. DLL files in particular can take up a lot of space. Frequently these files can be duplicated many times and be located in varied locations during installation. CleanS weep can find and evaluate duplicate files, advise you as to where to best relocate the master version, and to help eliminate the duplicate and older versions. When it comes to deleting possibly critical files, CleanS weep is super cautious and insists that at least for the time being you back up the files you are deleting until you are absolutely sure they are not needed. Later on, a message will pop up to remind you that those backed up files were not needed and to delete them. All in all, an uninstall program like CleanS weep, which is an inexpensive product, deserves a place on your system. NaturallySpeaking by Dragon Systems: Voice recognition software has been around for a while. Until recently, this type of software could only be trained to recognize a word or phrase in your voice and perhaps execute a command. Not exactly star wars stuff. A capability, called general-purpose continuous speech recognition, has long been promised by the computer industry but never delivered before this software was introduced. Now, however, a small company in Newton, Mass., Dragon Systems has done it. Average consumers with average price computers can use it. The software is potentially accurate enough to be used on a daily basis. With the software you get a headset with a noise canceling microphone that you use to dictate whole sentences and phrases at essentially your normal pace of speech into a dedicated word processor. When you have completed dictation, the document can then be transferred to your preferred word processor for formatting and finalizing. At the suggestion of one of our Australian readers, I decided to look into Dragon NaturallySpeaking. You can use Dragon NaturallySpeaking to compose e-mail messages, create reports, draft letters, edit proposals and more, just by speaking. Dragon NaturallySpeaking is intuitive and not terribly difficult to learn. You speak at a normal pace and what you say appears as text in the Dragon document window. You have commands you can use to correct and revise text, move around the document, and control the application; these are simple and relatively easy to remember, but they do take some getting accustomed to. Remembering oral commands precisely takes a bit of concentration and time. Until you master them, you can revert to key-stroke commands. You copy your final document to other programs such
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as Microsoft Word or an e-mail program via the Windows clipboard. You can not transfer text to a program that does not have the ability to access the Windows 95 clip-board. The following tasks can be performed with Dragon NaturallySpeaking: dictate continuously, speaking naturally without forcing between words; dictate and say voice commands concurrently, simply by pausing before and after saying a command; correct recognition errors and revise and format text by voice or keyboard; correct as you go or revise later; correct recognition errors as soon as they occur by saying Correct That or later by saying Correct text (then saying the text) or by saying Select text, and then speaking the corrected word; spell naturally, using the names of the letters; select any text in the document window simply by saying Select, and the word or words you want to select. You can create dictation short-hands for words or phrases you dictate frequently; control most features by voice. Say What Can 1 Say at any time to display a list of commands you can say in the current context. Recognition accuracy is increased by customizing the general purpose vocabulary and word-usage information by using documents based on orthodontics. NaturallySpeaking appears to be a potentially useful tool. Installation and setup were easy enough and straightforward. To use the program you must have a sound board in your computer. Some sound boards may not be compatible. Dragon suggests a list of those that have been tested. Initial voice recognition results after going through the basic voice training practice were quite disappointing. Perhaps this was the result of my fast talking manner lacking proper enunciation of words. Admittedly, I have never been mistaken for a midwestern radio announcer. The instructions suggest that the user train the vocabulary builder by retrieving documents previously written by the user before acquiring NaturallySpeaking to teach it your personal style. Unfortunately, all of my documents were written in WordPerfect and NaturallySpeaking software only recognizes Microsoft Word. This is a shortcoming that will be corrected in future editions of the program. A phone call to technical support in Massachusetts did provide a simple solution to this problem, but it took some time to get to the right person. It seems that NaturallySpeaking will recognize any document if it is saved in ASCII text format. When I retrieved a sample document and then saved it as ASCII text, I was able to retrieve it in NaturallySpeaking's vocabulary trainer. The trainer software then selected all of the words in the document that were not in the current usage dictionary and then prompted me to accept or delete words before adding them. Several selections from books are provided to train the program to recognize your speech patterns. After a number of these sessions the level of recognition improved considerably. I found that if you breathe heavily or bump into the microphone, the program tended to enter words like "the" and "in." This proved to be a nuisance. I have a tendency to snack or drink when I am writing these articles. This too created untoward results. I am essentially a hunt and peck typist. In the beginning, I found I could type far faster than the program would write accurately. Dragon claims that some people are able to dictate at as much as 100 words per minute. Basically, the voice recognition results were quite acceptable as long as I spoke carefully and enunciated my words. This of course
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slowed me down. Interestingly, one of the included hints is to avoid speaking slowly and instead, speak at a regular pace. My problem was that to make sure I was enunciating, I slowed down considerably. According to the documentation, NaturallySpeaking will provide higher and higher levels of recognition by usage. One thing is certain, you must adapt to the program as much as the program will adapt to you. If you are not accustomed to enunciating all your words precisely, you soon learn to do so. NaturallySpeaking provides two recognition hot keys. To force words to be recognized as commands, you press and hold down the Control key. To force words to be recognized as dictation, you press and hold down the Shift key. Once you become accustomed to doing this, you can avoid a number of problems caused by conflicts in word meaning. Perhaps it is my impatient nature, but it seemed the speed of voice recognition was frequently painfully slow and I found myself spending an inordinate amount of time waiting for the program to catch up. Making corrections while the microphone was still connected also seemed to lead to additional problems, until I got into the habit of using the prescribed verbal correction terms. The more I used NaturallySpeaking, the faster and more accurate my dictation became. I encountered what may be an unusual problem. Each time I exited the program and the software asked if I wished to save my voice files, Windows 95 gave me an error warning, "This program has performed an illegal operation and will be shut down." After about a half hour on the telephone with Dragon technical support, I was advised that this was a Windows problem that is probably associated with my Cyrix CPU. It was suggested to eliminate this problem it would be necessary to reinstall Windows 95. This can be accomplished by inserting your Windows 95 CD into the proper drive and then go to Start and Run. You type in the appropriate drive letter and SETUP. Reinstalling Windows 95, however, did not solve my problem. The program saves error messages, and I was instructed to fax them to Dragon for analysis. Voice files should be saved regularly to keep fine tuning the software. I solved my problem by making it a point to save my voice files before I exited the program. Perhaps I expect too much, but it seems to me that a voice dictating program needs to be extremely reliable rather than present major problems of its own. As a test, I'm now writing these words on a personal computer at a rapid pace, without touching the keyboard. Instead, I am dictating into a microphone and words are appearing on the screen as I say them, courtesy of this new software program. I'm able to speak at a normal, conversational speed. Generally, I am dictating considerably faster than the words appear on my screen. If the computer makes an error, I can correct it on the fly using spoken commands. The computer learns from its mistakes. So do I. Dragon NaturallySpeaking requires a PC running Windows 95 with at least a Pentium 133 processor, which is a fairly modest machine. It does require a higher than average 32 MB of memory, but computers so equipped are now readily available in stores at under $2,000. MMX technology is said to be beneficial. The software is not expected to be available for the Macintosh. A single user version of the software is available at
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about $299. A multiuser version is scheduled to be introduced at $695 by the time this is published. The software can be purchased directly and through catalogs. The program requires you to use the high-quality headset microphone that is included and to spend some time training it to recognize your voice by reading canned passages aloud. This training is quite simple and if you are accustomed to enunciating, seeing your words interpreted correctly can be accomplished in 20 to 30 minutes. The required readings are excerpts from best-seIling books. In my case it required reading several passages from several books as well as making quite a number of corrections before the software was reasonably accurate. As you work with it, the interpretations of your words get better and better. The software does not make spelling errors but it can frequently goof by making substitution errors in similar words. For example, it will confuse my, by, buy, read, red, or substitute trips for drips, etc .. Some of these errors can be handled by enunciation or by specifically training the program. I found them to be a nuisance. I was forced to do more proofreading than if I simply typed. Breathing hard or bumping into the microphone can cause the program to enter a, and, the, or the like. It can take several correction efforts and better enunciation to reduce all these errors. I must admit that when I first started working with NaturallySpeaking I became very frustrated. There were just too many recognition errors and too much time wasted in making corrections. After a few days, however, the program became more and more intriguing. There is just something very fascinating about being able to sit and talk to a computer and watch your words appear on the screen. The more I would dictate to NaturallySpeaking, the more accurate the program became. One question that occurred to me was how useful could a system like this be in a clinical environment. The person entering the data must wear a headset to do so. It occurred to me that this could possibly be turned into an advantage, by installing a foot or other switch that could permit communication to someone with a headset at the front desk as well. Will verbalizing treatment notes, etc., compromise privacy? Will the use of a headset and microphone present clinical problems? These are questions that practical trials will answer. In any case, the concept is very interesting. Dragon Systems also has software to issue commands called Dragon Dictate. IBM has a product called "Via Voice," which has just been introduced. Via Voice software supposedly offers command dictation or continuous speech dictation. The competition should improve both products for the benefit of the consumer. I intend to try to get hold of copies of the continuous speech and command dictation software on the market and hopefully will be able to provide more definitive conclusions.
Editor's note: Many thanks to those of you who correspond regularly and exchange ideas. The investigation of computer software and hardware for use in orthodontics is everyone's project. It behooves all our readers to write and report their experiences- both good and bad. Sharing is what it is all MA about. Keep those letters and papers coming.
