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Frequently asked questions

General

Is Librevet 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. You can import a DICOM directly — the app reads the file itself — drag one straight in, paste it, pick it from the file dialog, or drop a whole study in — as a ZIP, or the folder straight off the disc. Most compressed studies open as well as uncompressed ones: JPEG, JPEG Lossless, JPEG-LS, JPEG 2000 and RLE. A few rare encodings (12-bit JPEG, Deflated and Big Endian) and multi-frame studies are refused, and the app says so; export those as PNG from your imaging software.

Higher-resolution images give more precise measurements but use slightly more memory.

How do I get films from my X-ray machine into Librevet?

Three routes. If your X-ray machine can send to a web address, let it send studies straight to Librevet. If it asks only for an AE title, an IP address and a port — most veterinary machines do — use the Librevet Relay: free software on a practice computer that passes each film into Incoming, set up in about 20 minutes. Or search a PACS you already run. Set any of them up under Settings → Imaging. With Librevet Edge, your X-ray machine can also be given the day’s patient list, so the nurse picks the patient on the machine instead of typing them in, and the films come back to that case by themselves. See Getting radiographs in from your equipment.

Can I email X-rays to Librevet?

Yes. Every practice has its own email address for films — it is at the top of Incoming in the gallery, and in Settings → Imaging, with a Copy button. Anything emailed to it, by a referring vet or by you from your own inbox — films as DICOM, JPEG, PNG or a ZIP of them, and the referral letter or bloods as PDF or Word documents — waits under Incoming, one card per email, ready to open as a case with the documents in its Attachments and their message in the History on its Record. Several emails from the same vet about the same animal sit together and open as one case, and a later one offers Add to the case you made. To add films to any other case, open that case and press Add View, then Incoming / PACS. See Can referring vets email X-rays to us?.

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. Look for Offline — saved locally in the top bar.

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.

Plans and billing

How do I upgrade to Pro?

Click your picture or initials to open the account menu, then Your plan. Choose Pro, monthly or yearly (a year costs the same as eleven months), name your practice, and pay by card. When you come back you are the practice’s owner: every case you already have is in the practice’s shared library, and you can invite colleagues under Your practice straight away. Prices are in US dollars, with tax added where it applies.

Can I get Ultra?

Not yet — Ultra is in development. It is shown on the Your plan page, marked In development, and it cannot be bought.

Who can change our practice’s plan?

The practice’s owner and its managers. They see Your plan in the account menu; other members of the practice do not.

How do I change the card, or get an invoice?

Your plan → Open billing takes you to Stripe’s billing page for your practice. Change the card or the billing address, add a tax number, and download any invoice there.

How do I pay yearly instead of monthly?

On Your plan, pick Yearly — 12 months for the price of 11, then Pay yearly instead, and confirm on the Stripe page that opens. Nothing changes until you confirm there; once you do, the change takes effect straight away, and the difference is charged or credited at once.

How do I cancel?

On Your plan, choose Move to Free, and confirm on the Stripe page that opens — closing that page without confirming leaves the plan as it was. Your plan carries on until the end of the period you have paid for, then the practice moves to Free. Until then you can change your mind with Keep Pro on the same page. Moving to Free removes nobody from the practice and deletes nothing, but the practice can then only do what Free allows — for example, nobody new can be added.

What happens if a payment fails?

Your plan says so and offers Update card. You keep your plan while the card is retried; if payment still cannot be taken, the practice moves to Free.

Viewing the film

How do I flip an X-ray?

The film’s own toolbar has two flips, side by side. Mirror image, the flip-horizontal icon, reverses the film left to right. Flip image vertically, the flip-vertical icon beside it, turns the film top to bottom. On a narrow pane both sit under ⋯ More image tools instead. A button lights cyan while its flip is on, and clicking it again — it now reads Unmirror image or Unflip image — puts the film back. From the keyboard, H mirrors and V flips; see Keyboard shortcuts.

Mirror a film that has come out back to front, or the wrong way round from the view you are used to reading. Flip one that has come out upside down. A flip, either way, leaves a mirror image of the film, so if a film has simply been turned upside down, turn it back with two quarter-turns of Rotate image instead.

Both flips are display settings on that one view, saved with the case, and both can be undone with Ctrl/Cmd + Z, whether you used the button or the key. The stored image is never altered, and the other views of the same patient are unaffected.

Of the two, only mirroring can change which hip a Norberg angle labels L and which R. Where the app has read a lead side marker on the film, the marker decides, so each label stays with its hip when you mirror. Without a marker, the app assumes the film is hung the usual way for its view, and mirroring tells it the film had been stored back to front — so L and R stay on the same sides of the screen. Flipping top to bottom never changes them, because it leaves the patient’s left on the same side of the picture.

An implant moves with the bone through either flip: it stays on the same stretch of bone, with the same end of the plate at the same end of the bone. Neither flip turns it over, though. A left plate is a physical left part and stays one, so the plate in your surgical report never changes because of how the film is hung. To use the other side’s plate, change the film’s side on the Left/Right chip beside its name. The app reminds you of this the first time you flip a film that has an implant on it.

How do I rotate an X-ray?

Five routes, all to the same rotation:

• The knob in the bottom-right corner of each film, on a computer. Press it and drag round it: the film turns with you, and the wider the circle you make, the finer the control. The middle of the knob shows the angle. Double-click it to put the film level. Click it and the arrow keys turn the film a degree at a time, ten with Shift, and Page Up or Page Down a quarter turn. Rather not have it? Switch off Knob in the corner in Settings → Shortcuts → Mouse and trackpad; the same switch brings it back, on every film.
• Rotate image on the film’s toolbar, wherever there is no knob: on a touchscreen, on a film too small to spare the corner, or with the knob switched off. It has a dial for any angle, a 90° button each way for an exact quarter turn, and Level, which puts the film straight again.
• Scroll-click and drag: hold the mouse wheel down — the middle mouse button — and drag on the film. That is what the middle button does unless you have changed it under Settings → Shortcuts.
• Hold Option/Alt and move the pointer around the film — no click needed. This works whatever the mouse buttons are set to, and it is the way to turn a film on a trackpad or a Magic Mouse, neither of which has a middle button. Let go of the key and the film stays where you left it.
• Twist two fingers on the film on a touchscreen. A twist on a laptop trackpad works in Safari only; other browsers never pass it to the page.

A drag, a twist, the knob or a turn with Option catches on level and on each quarter turn: stop within a degree and a half of one and the film sits exactly on it. Reset view also puts the film back to level, and re-fits it as well. Settings → Shortcuts shows which mouse button will rotate the film for you.

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 — for the film’s brightness and contrast. 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. On a trackpad or a Magic Mouse, hold Shift and move the pointer over the film — no click needed: up for brighter, right for more contrast. Which mouse button does it can be changed under Settings → Shortcuts; the W key is fixed. See Keyboard shortcuts.

Can I brighten a colour photograph?

Yes. On a colour photograph, such as a microscope slide or a clinical photo, Adjust image has Brightness and Contrast sliders instead of the presets, Level and Width, and the photograph keeps its colours. The right-button drag, W and Shift work on it too. Invert black/white is not offered on a photograph.

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 both flips, inversion and your brightness settings alone; those are how you have chosen to read the film, not where you happen to have dragged it.

A number on the film is in the way. Can I move it?

Yes — drag the number itself somewhere clearer, off whatever bone it was covering. The labels on lengths, angles and the TPA all move this way. It stays where you put it through zoom, rotation and flipping, and when the case is opened again, with a dotted line back to what it measures. Double-click it to put it back.

The TPA’s number already sits just past the caudal end of the plateau line, off the joint. To hide every number on the film at once instead, use the ruler button in the top bar (Readings on the film in the menu on a narrow window). The lines stay, and nothing is deleted.

Marking up the film

How do I change the brush size, or draw a thicker line?

In Annotation, choose Draw, then pick one of the five sizes under Brush size. The thinnest is the line drawings have always had, and the thickest is six times as heavy. The next line you draw is that thick.

With a drawing selected, picking a size changes that drawing instead, as a colour does. That includes the line you have just drawn, which stays selected. The size works the same on a video.

How do I make an arrow thicker?

In Annotation, choose Arrow, then pick one of the five sizes under Thickness. The thinnest is the arrow you have always had, and the thickest is six times as heavy, with a head that grows with it. The next arrow you put down is that thick.

With an arrow selected, picking a thickness changes that arrow instead, as a colour does. An arrow keeps its own thickness, separate from the brush size you draw with, and it works the same on a video.

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 there is no marker in the film?

You cannot calibrate a film that has no calibration marker, or other reference of known size, in it, and the app will not give a length in millimetres, place an implant or plan an osteotomy until a scale is set. The Norberg angle and CORA still work without one, because they read only angles. Locking the millimetre tools is deliberate: a measurement without calibration is worse than no measurement, because it looks authoritative while being wrong.

Three things count as a marker, so a film without a calibration ball is not necessarily lost:

• Any round object whose true diameter you know, taped beside the limb at the same height as the bone — the next question covers what makes a good one. Calibrate with Circle and type its diameter.
• A ruler or linear marker. Calibrate with Line over a length you know.
• A DICOM’s own pixel spacing, offered as a fourth button when the film carries it. Read Should I trust a DICOM’s own scale? before taking it — it describes the detector, not the bone, and usually reads 10–25% too large.

If the film has none of the three, re-shoot it with a marker in the picture. Nothing in the app can recover the scale from a picture that never carried one.

Can I use a coin or other improvised reference?

Yes, as long as you know its real-world diameter. In Calibration, place a Circle over it, type its diameter in the Marker box, then Set Scale.

Set Scale also remembers that size as your ball size, and offers it on the next film, Auto included. After using a coin, put your usual size back — in the Marker box on the next film, or under Settings → General → Planning Defaults → Your Calibration Markers. The default is 25 mm (a typical radiopaque sphere), kept for your account on every computer you plan from.

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 change the size of a placed implant?

Click the implant on the film. The swap panel opens in the bottom-left corner of the films with the implant’s sizes, hole counts, side and view. Drag the size slider and the implant on the film changes as you go. See Placing implant templates.

Why is a row in the implant panel greyed out?

The implant on the film has nothing to choose in that row, but other sizes of the same implant do. The row stays so that the size slider and its buttons don’t move while you step through sizes. Step to a size that offers the choice and the row comes back to life. See Placing implant templates.

Can I move the implant panel, or put it in the sidebar?

Yes. Drag it by its header to anywhere over the films, or use the button in its header to put it at the top of the sidebar’s Implants tab instead. Float the implant panel over the films, the first button in its header there, floats it back out. The app remembers your choice for your account, on every computer. On a window narrower than about 1,024 pixels — a phone or a tablet held upright — the panel always sits in the Implants tab.

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

How do I share a case?

Two routes, and they answer different questions. To send a case to a referring vet or an owner, create a read-only referral link: open the case, click Send this case (the share icon) in the top bar, choose A colleague, and under Referral links type their email address and press Send Link — or press Create Link and Copy it to send it yourself. To work on a case with a colleague, name them by email address under People with access on the same page instead — they sign in and the case appears in their own gallery, and they can work on the plan. See Sharing and referrals.

How do I stop someone seeing a case?

For a referral link, click Send this case, then the row saying how many referral links are open, then the bin beside the link, and confirm with Revoke Link. It stops opening straight away, and nobody is notified. For a named colleague, take their email address off the case.

The one thing revoking cannot do is recall a radiograph image the recipient has already loaded — see Sharing and referrals.

Can I put a password on a link?

Yes — it is called a PIN. Tick Require a PIN on the new link when you make the link, and the app gives you a 6-digit code the recipient must type before the case will open. A link you have already sent can be given one afterwards with Add a PIN beside it. Send the PIN by a different route from the link itself; a PIN in the same email protects nothing.

Write the PIN down when the app shows it. The app keeps it beside the link on the computer you made it on, until you sign out there, and nowhere else: the server keeps only a scrambled version it cannot turn back into the PIN, so nobody can look it up for you later. A PIN cannot be changed either — if you lose it, revoke the link and make a new one.

Do recipients of a shared link need an account?

No. The link itself grants read-only access. Recipients don’t need to sign up or log in. You can also put a PIN on a link, which they must type before the case opens.

Does the recipient see my later changes?

Yes, whenever they open the link or reload the page. A link points at the case, so no new link is needed — but a page they already have open does not update by itself. The flip side: a colleague can open the link while you are mid-edit and see a half-finished plan. On a computer or tablet their view says the case is live and when it was last edited; on a phone it does not, so tell them yourself when the plan is finished.

Can I revoke a shared link?

Yes. Click Send this case, then the row saying how many referral links are open, then the bin beside the link and Revoke Link. It stops opening straight away. One honest limit: revoking cannot recall a radiograph the recipient has already downloaded or saved. The picture addresses the viewer uses expire within about fifteen minutes, so a revoked link cannot fetch the films again. See Sharing and referrals.

Can I share a case without the patient’s name on it?

Yes. When you create the link, untick Patient and vet identifying details. Species, breed, weight and the rest of the clinical record are still shown, under Clinical record on the link’s page, because the receiving surgeon needs them. Read your own free-text notes through first — the app can’t strip names out of prose. Attachments are left off an anonymised link, because a letter or report carries names inside it. Check the film itself too: an owner’s name or a clinic burned into the corner of the X-ray is part of the picture and is still shared.

Can recipients edit the case?

It depends how you shared it. A referral link is read-only — the recipient sees what you have placed and measured, as it stands, and cannot modify any of it. A named colleague can edit the plan, at the same time as you; see Can two of us edit the same case at once? below.

Reports and record-keeping

Can I get a PDF of the plan?

Yes. Surgical report in the top bar builds a Surgical Plan Report PDF from the case as it stands: the patient details and the clinical summary; your own report, if you have written one under Specialist report (diagnosis, prognosis, findings, plan, aftercare and follow-up, signed with your name); and then, for each radiograph, its calibration, the measurements you took, the osteotomy planning, and the implants you placed. The button is disabled until the case has at least one radiograph in it.

It opens as a page of the case, with the PDF itself on it, page by page, exactly as it will download. Along the top you choose which radiographs go in and can add a note for theatre; the pages change as you do, and Download PDF saves what you see. The note saves with the case as you type — there is no Save button — so it is still there the next time you make the report. Press Imaging to go back to the films.

The first page is headed with your practice: its logo, name, address, phone, email and website, as set under Your practice → Practice details. Without a practice, the Practice name under Account → Profile heads the report instead. See Settings.

How do I see who changed what?

On the case’s Logging screen. Open the case and press Logging in the top bar — the clock, the last of the five buttons after the case’s name; on a phone, a tablet or a narrow window it is a row of the More (⋯) menu. The screen holds two lists, and they answer different questions:

Audit trail: who placed, changed or removed each measurement, and each arrow, label or drawing on a video, who changed the clinical record and which part of it (the History, the Examination, the owner’s details and so on — never what was written), who added or removed each file and each video, by name, and when. It also records who the case went to: sharing it with a colleague, making, emailing or withdrawing a share link, sending it to a supplier or for a specialist opinion (and the report coming back), a colleague taking their own copy, and the case joining a practice. Renaming the case, changing a film’s brightness or contrast, and restoring an earlier version are there too. When several people work on a case at once, one screen saves everybody’s changes, so each entry names the person who made the change and says whose screen saved it. It is written by our servers as the change happens, kept for a year, and can be downloaded as a CSV to go into a clinical record.

For the plan as it stood rather than the list of changes, see the next question.

Can I go back to an earlier version of the plan?

Version history, at the top of the case’s Logging screen, holds the last 20 versions of the plan. Logging is a screen of the case, like the films: press Logging in the top bar (the clock) and the canvas changes, and press Imaging to go back to the films. A version is kept each time something on the films changes — a film added or removed, a scale set, a measurement placed, changed or removed — and not when only the record, the case’s name, its files or a video change. Each version says what changed, when, and whether you or a colleague made the change — the audit trail names who. Restore puts an earlier version back and saves it as a new version, so nothing is lost.

Appearance

How do I make the screen brighter?

It depends what looks too dark.

• The whole page — the app is light unless you chose Dark under Settings → General → Appearance → Theme; switch it back to Light there and every screen turns pale, close to a white background — the films screen inside a case included. Only each radiograph keeps a black background and a dark bar across its top, in both themes, so the dark around a film is that, not the theme.
• The X-ray itself — open Adjust image on the film’s toolbar, drag on the film with the right mouse button, or hold Shift and move the pointer over the film. More in The X-ray is too dark or too bright.

The monitor’s own brightness is set on your computer, not in the app.

Can I use the app in light mode?

Yes — it is the default. Settings → General → Appearance → Theme switches between Light and Dark, and the choice applies to every screen, the films inside a case included. Whichever you pick, each radiograph sits on a black background with a dark bar across its top, so the film’s greys read the same in both.

The choice is kept for your account on that computer, so a machine in theatre and a machine in the office can differ, and a colleague who signs in on the same computer keeps their own.

The text is too small

Settings → General → Appearance → Text size offers Default, Large and Larger. It moves the whole interface — the type, the buttons and the sidebar widen together — so nothing is cut off at the bigger settings.

It does not resize the readouts painted onto the radiograph itself: the millimetre and degree labels on the film are drawn into the picture and are not interface text. If those are what is too small, say so in a bug report and it will be taken as a request.

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 from Help & Feedback (bottom right) on the BUG tab — your browser, system and screen size go with it automatically.

Collaboration

Can two of us edit the same case at once?

Yes. Everyone on a case can draw on its films and write in its record at the same time, and nobody waits for anybody.

• Marks appear as they are made. A line, an osteotomy, an implant or a label a colleague places shows up on your films a moment later, and yours on theirs.
• Each mark is its own. Two people placing different marks both keep theirs. If two of you drag the same mark at the same moment, it ends where whoever let go last put it.
• Undo takes back only your own work, never a colleague’s.
• Each change is credited to whoever made it. The audit trail and Version history name the person who drew or changed a mark, even when it was saved from a colleague’s screen.
• The top bar shows who else is on the case right now, as a coloured initial each. Point at one, or tap it, for their name and where they are typing. Point at Send this case to see everyone who can open the case.
• Views belong to the case’s owner. Only the owner adds or removes a view; everyone else plans on the views that are there, or uses Make my own copy.

If your connection cannot pass changes on as they happen, that screen goes back to one person editing at a time, and a banner over the films says who is editing.

The record works the same way — see the next question.

Can two of us write in the record at the same time?

Yes.

• Writing merges, as in a shared document: you see each other’s words appear, your cursor stays among the same words, and nothing either of you typed is lost.
• Every other answer is one answer — a weight, a heart rate, a pick-list, a date, the patient’s name. Whoever entered it last is what it says; two entries are never mixed into one. If you are both typing in the same box at once, whoever leaves it last has it.
• A field somebody else changes lights up briefly on your screen, so you notice it happened.

How do I know who placed a measurement?

Look at the Items list. A mark a colleague placed carries their initials, in grey just after its name; point at the initials for their name. Your own marks carry none, and nor does a colleague’s mark from before the case knew their name. The audit trail names who placed, changed or removed each one, and when.