Frequently asked questions
General
Is Librevet Ortho a substitute for surgical training?
No. The app is a planning aid for surgeons and clinicians who already have orthopaedic training. It helps with accurate measurement and visualisation; surgical decisions and execution remain yours.
What image formats can I use?
DICOM, JPEG and PNG. DICOM files are read by the app itself — drag one straight in, paste it, pick it from the file dialog, or drop a whole study in as a ZIP. Compressed studies are handled as well as uncompressed ones (RLE, JPEG Lossless, JPEG-LS and JPEG 2000).
Higher-resolution images give more precise measurements but use slightly more memory.
Where are my cases stored?
In the cloud, tied to your account. They sync automatically. Radiograph images are stored separately in cloud storage and load on first open of each case in a session.
Does the app work offline?
Partly. A case you already have open keeps working — your edits are written to this device and go up when the connection comes back, and the app tells you which state it is in rather than letting you assume it saved.
What needs the network is everything that has to reach the cloud for the first time: signing in, opening a case this device has not seen before, and streaming radiographs that are not yet cached. A case planned offline exists only on that computer until it syncs, so don’t plan offline on a machine you are about to hand back.
Viewing the film
How do I flip an X-ray?
Click Mirror image on the film’s own toolbar — the flip-horizontal icon. On a narrow pane it sits under ⋯ More image tools instead. It reverses the film left-to-right, the button lights cyan while the view is mirrored, and clicking it again puts the film back.
That is the control for a film that has come out back to front, or the wrong way round from the view you are used to reading.
Flipping changes which side of the patient you are looking at, and the app follows it: where the film carries a side marker or a DICOM view position, the L and R labels on a Norberg angle mirror with the picture rather than staying stuck to the screen.
Mirroring is a display setting on that one view, saved with the case. The stored image is never altered, and the other views of the same patient are unaffected.
There is no vertical flip. Turn a film upside down with two quarter-turns of Rotate image instead.
How do I rotate an X-ray?
Three routes, all to the same rotation:
- Rotate image on the film’s toolbar — a dial for any angle, plus −90° and +90° buttons. This is the only route that lands an exact quarter turn or puts a film back to level.
- Hold Option/Alt and drag with the left mouse button.
- Two-finger twist on a trackpad or touchscreen.
Measurements, implants and overlays are anchored to the bone, not to the screen, so they turn with the film.
The X-ray is too dark or too bright
Open Adjust image on the film’s toolbar — the half-filled circle. It holds the window presets and the Level and Width sliders, named as every PACS names them: a higher level shows a higher band of greys, so the picture darkens, and a wider window spreads the same 256 shades over more values, so it softens.
While you are working, the quicker way is to drag on the film with the right mouse button, or press W and then drag. Both are re-mappable under Settings → Shortcuts — see Keyboard shortcuts.
Can I see the X-ray as a negative?
Yes. Invert black/white, under ⋯ More image tools on a narrow pane, puts bone dark on a light ground. Click it again for the normal film.
How do I put the view back where it started?
Reset view — the counter-clockwise arrow, first on the film’s toolbar. It re-fits the film to the panel and straightens it, and it is undoable. It deliberately leaves mirroring, inversion and your brightness settings alone; those are how you have chosen to read the film, not where you happen to have dragged it.
Calibration
Why does every radiograph need its own calibration?
Radiographic magnification varies between exposures. The same bone projects at slightly different sizes on different shots. Calibrating per-image is what makes the rest of the app’s measurements accurate.
What if I don’t have a calibration marker in my radiograph?
You can’t calibrate without one. The app will refuse to unlock measurements and template placement until a scale is set. This is intentional — a measurement without calibration is worse than no measurement, because it looks authoritative while being wrong.
Can I use a coin or other improvised reference?
Yes, as long as you know its real-world diameter and set that as the reference size before placing. The default is 25 mm (a typical radiopaque sphere). Other sizes are configurable in the calibration sub-panel.
Templates
Are the implants the right size?
Yes, as long as the radiograph is properly calibrated. Template dimensions reflect manufacturer specifications.
What if a template’s dimensions look wrong?
First check the calibration. If that’s correct, report the template via the help icon — it’s almost certainly a library data issue rather than a calibration issue.
Can I add a template that isn’t in the library?
Not directly from the app interface. Template additions are handled administratively. Send a request via the help icon with the manufacturer’s specifications.
How do I delete a placed template?
Select it and press Delete or Backspace, or use the trash icon in the swap panel.
Why does my placed implant rotate when I rotate the X-ray?
By design. Implants are anchored to the bone, not to the screen. Rotating the radiograph for viewing rotates everything attached to it — implants, measurements, overlays — so the implant stays in the correct position relative to the anatomy regardless of viewing angle.
Sharing
Do recipients of a shared link need an account?
Not for a referral link — the link itself grants read-only access, and the recipient never signs up or logs in.
A named colleague is different: you name them by email, and they sign in with that address to reach the case. That is the one that lets them edit.
Can I revoke a shared link?
Yes. From the Referrals modal (top bar), click revoke on any link. Revocation is immediate.
Can recipients edit the case?
No. Shared access is read-only. Recipients see exactly what you’ve placed and measured, but can’t modify it.
Performance
Why are templates slow on first session?
The template library prefetches in the background after the app loads. Within a few seconds of opening, all templates are cached and subsequent placements are instant. If you place a template before prefetch completes, the first one may take an extra moment.
Why does the gallery feel sluggish on first open?
Radiograph thumbnails decode on first open. After the first session they’re cached and load instantly. If the gallery is consistently slow, report it via the help icon with your browser and OS.
Collaboration
Can multiple people work on the same case at the same time?
You can all have it open, but only one person holds the pen. Whoever opens the case first gets the edit lock; everyone else sees it read-only, and can take the pen over when they want it. If the holder shuts their laptop or drops off, the lock lapses on its own after about a minute rather than stranding the case.
That is deliberately not simultaneous editing — two people typing into one plan at once is how a measurement quietly disappears. Live co-editing is on the roadmap.
How do I see who changed what?
Every save is kept, up to the last twenty, under Version history. Restoring one puts those films back on the planner and saves them as a new version, so nothing is lost either way.
Beside it, the Audit trail records each change as it happens: who placed, moved or removed each measurement, on which film, and when. It also records sharing a case, binning it and restoring it.
It is written by our servers rather than by the app, so it cannot be edited or removed — not by a colleague, not by the account that owns the case, and not by us. Entries are kept for a year, and you can export the trail as a spreadsheet for a file or an insurer. It is destroyed along with the case if the case is deleted, so export it first if you need to keep a copy.