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Getting radiographs in from your equipment

There are three ways to get films from your X-ray machine or PACS into Librevet. If your machine asks only for an AE title, an IP address and a port — most veterinary machines do — you want option 3.

1. Let your equipment send to Librevet (easiest)

Librevet gives you an address and a password. You put those into your X-ray machine or PACS once, as a destination. After that, a study you send arrives in Librevet by itself and waits under Incoming in your case gallery.

Studies there are not cases. Open one and it becomes a case; discard the rest. This matters if your equipment sends automatically: it will send every study the practice takes, most of it soft tissue nobody will plan, and holding it in one place is what keeps that out of your gallery.

To set it up: Settings → Imaging → Your X-ray machine sends here → Create a sending address. In a practice, the owner sets this up once for everyone. Copy the address and the token into your equipment’s “send to” or “destination” settings. Any user name will do. Copy the token straight away — it is shown once and never again; later, that screen says the address is set up, but not the token. One address serves every machine in the practice, and making a new one stops the old one working, so keep the token safe rather than making another for a second machine. Lost it? Make a new token (it asks first) and give it to each sender.

What your equipment needs: it must be able to send by DICOMweb (sometimes listed as STOW-RS, “web send”, or “send to cloud”). Newer digital radiography systems and most cloud-connected PACS can. If yours only offers a DICOM “destination” with an AE title, IP address and port, it is speaking classic DICOM instead — see option 3.

Nothing is installed in your practice for this. Studies you have not opened are held for 7 days and then deleted. On Pro and Ultra the practice owner or a manager can turn that off — Settings → Imaging, under Who may send and fetch → Keep every study sent by your equipment — and then nothing is ever cleared and there is no separate limit on the folder; the films simply count towards your practice’s storage like everything else.

Limits worth knowing. A single send is capped at 32 MB, which is where the platform stops it whatever we do. That is not a limit on study size — a large CT arrives in several sends and is reassembled here — but equipment configured to post enormous batches in one go will be refused. While studies are held for 7 days, Incoming also has a ceiling — 400 films on Free and 1,700 on Pro — and once it is full your equipment reports a failed send until some are opened or discarded. A case holds 12 films; a bigger study opens 12 at a time (see below).

2. Search your existing PACS from Librevet

If your practice already runs a PACS, Librevet can search it and pull a study in on demand, rather than waiting for one to be sent.

To set it up: Settings → Imaging → Search your own PACS. Enter your PACS’s DICOMweb address with its user name and password, and press Connect — Librevet tests the connection before it keeps anything. Setting up happens there and nowhere else.

To search it: New Case → Incoming / PACS → Your PACS, or Incoming / PACS inside a case to add films to that case. The password is not kept unless you tick Remember the password on my Librevet account; without it, Librevet asks for it once each time you open Librevet.

Two things your PACS must do, and the second is the one that usually stops it working:

• speak DICOMweb over HTTPS (QIDO-RS and WADO-RS);
• allow a browser at https://app.librevet.com to talk to it — that exact address; librevet.com is our website and is not enough — by adding it to its CORS allowlist. A PACS that has never been asked to do this will refuse the connection even though the address is correct. Your PACS supplier has to turn it on.

If your supplier cannot or will not enable CORS, use option 1 or option 3 instead. Neither needs it — and most PACS can also send studies on to option 3’s relay like any other destination.

3. The Librevet Relay, for machines that only speak classic DICOM

Plenty of veterinary equipment only speaks classic DICOM — you give it an AE title, an IP address and a port, and nothing else. That cannot reach the internet by itself. The Librevet Relay is free software on a computer in your practice: your X-ray machine sends each film to it, and it passes the film straight into Incoming, using your practice’s sending address and token from option 1. Nothing on that computer can be reached from the internet — it only sends out — so there is no certificate, no open port on your router and no IT project. One file to download and run, and about five minutes.

How do I connect an X-ray machine that only has an AE title, IP address and port?

You need a Windows computer that stays on while you take X-rays, on the same network as the X-ray machine, and permission to install software on it. The practice owner does step 3.

1. On that computer, download it: Settings → Imaging → An older X-ray machine → Connect this computer. The practice owner has to click it, because the download carries your sending key in its name.
2. Run it. Windows will probably say Windows protected your PC: choose More info → Run anyway. It says that about every new program until enough people have run it. Then allow it to make changes.
3. Wait. It sets everything up by itself, with nothing to choose and no restart, and finishes by showing you three values.
4. Add those on the X-ray machine as a DICOM destination — it may be called a storage node, a PACS, a server or a “send to” target: AE title LIBREVET, port 4242, and the IP address it showed you. If the X-ray software runs on that same computer, use 127.0.0.1 as the address instead. Press Echo or Verify if there is one.
5. Send one film. It appears under Incoming within a minute, and Settings → Imaging → An older X-ray machine shows the relay.

On some machines only the maker’s engineer can add a destination. Fujifilm consoles are set up this way, for example. Either send your engineer the three values from step 3, or skip the network altogether: export the study to the folder C:\LibreVet-drop on that computer and it is sent on the same way.

Do films from a newly connected machine measure correctly?

Check before you plan an operation on them. X-ray a ruler taped at the height of the bone — not lying on the table — and measure 100 mm of it in Librevet. Within 1–2 mm is right. If it reads 10–25 % too long, that machine needs a calibration ball on every film. A film can arrive looking perfect and still carry the wrong scale; only a measurement finds it.

Why are films waiting on the relay?

The relay keeps every film until Librevet has it. If your internet drops or Incoming is full, it holds the films and sends them the moment it can. Incoming shows a note when films are waiting on the relay and says why, the relay’s row in Settings → Imaging shows the same, and the practice owner is emailed if any wait more than half an hour. The usual causes:

• Incoming is full. Open or discard some studies; the relay carries on.
• The token was replaced. Making a new token in Settings stops the relay too. Paste the new one into librevet-token.txt; it is picked up within seconds.
• The relay computer’s address changed. Settings shows the new one; give it to your X-ray machine. Asking whoever set up your router to “reserve” the address stops this happening.
• The relay computer is off. The X-ray machine then reports a failed send.
• An image Librevet cannot take — not an X-ray, or unreadable — is kept on the relay computer for 30 days, and the note says what it was.

A film the machine sends twice is only sent once: the relay keeps each film for 7 days after sending it, so it can tell, and then deletes it.

Keeping studies inside the practice instead: Librevet Edge

Some practices would rather keep studies on their own server and have Librevet fetch the one it needs. That is Librevet Edge. Your equipment sends to Edge exactly as it would to a PACS; Librevet then searches it and pulls in a study, the same way as option 2 — connect Edge’s address under Settings → Imaging → Search your own PACS. Edge comes set up for the CORS rule in option 2, so that problem does not arise. Studies sent to Edge do not appear under Incoming.

Edge is an IT job, not a twenty-minute one. Installing it means running Docker, issuing a TLS certificate, opening a port on the practice network, and configuring each sending machine. Budget an hour with whoever looks after your practice’s computers. The setup pack is on the same screen — Download the Edge pack — and it is the whole thing; please do not assemble it from scratch.

Edge can also send the day’s patient list to your X-ray machine — see the next section.

Today’s X-ray list

Librevet can send the day’s patient list to your X-ray machine, through Librevet Edge. The nurse then picks the patient at the console instead of typing the name, patient ID, species and owner, and the films come back to the right case by themselves.

How do I put a patient on today’s X-ray list?

Open the case’s Record. Under This visit, the X-ray line says Put on today’s list — press it. It then says On today’s list, with Take off beside it, and X-rays arrived with the time once the films are back. The line appears once your practice’s Edge has read the list for the first time.

A patient not X-rayed that day is off the list the next day; the case says Not X-rayed on that day, with Put on today’s list to add them again. Putting a case on the list again after its films are back — for the post-operative films, say — gives it a new entry, and those films join the same case.

What does the X-ray machine show for each patient?

The patient’s and owner’s names, the patient ID, species, breed, sex, date of birth and weight — whatever the case records — with the case’s name as the description. A few letters most consoles cannot show are written without their accent: Tūī appears as Tui. The case keeps the real spelling.

Where do the X-rays from the list go?

Into the case the patient was listed from, when its owner opens it — or at once, if it is already open. They are matched by the reference number the list gave the machine, never by the patient’s name, so two patients called Bella never swap films. That works whether they come to Incoming or stay on Edge; for films kept on Edge, the case’s owner needs Edge connected under Settings → Imaging → Search your own PACS.

How do I set up today’s X-ray list?

The Edge setup guide has a section for it, Today’s X-ray list. In short: Edge needs your practice’s sending token (Settings → Imaging → Your X-ray machine sends here), and your X-ray machine’s worklist settings get the same AE title, address and port you gave it for Edge. Most digital consoles have worklist settings; look for Worklist or MWL. Your practice software is not needed.

It is not available through the Librevet Relay yet: the one-file relay for older machines (option 3) sends films into Librevet, but cannot give your X-ray machine the list.

Which one am I?

Can referring vets email X-rays to us?

Yes — the films, the referral letter, the bloods and their message, in one email. Your practice has its own private email address for films, something like films+rk7wmq3hpv@librevet.com. Whatever is emailed to it arrives under Incoming in your case gallery within a few minutes, one card per email, showing who sent it, their subject line, the start of their message and any documents that came with it. Open as a case turns it into a case named after the patient in the DICOM header, or after the subject line when the films carry no name; discard the ones you do not need.

It is as much for you as for them: films sitting in your own inbox, or photographs of them, can be emailed to it from any account, and they arrive the same way.

Where to find it: at the top of Incoming, and at the top of Settings → Imaging, each with a Copy button. There is nothing to set up — every practice has one, the same for everyone in the practice. If neither place shows it, emailing films in is not switched on for your practice yet.

It is an email address, for people. Connecting an X-ray machine is a different thing, with a sending address of its own — see the routes above.

What it takes: DICOM, JPEG and PNG files, or a ZIP of them, attached to the email — up to 24 films and about 25 MB in one email, which is what most email programs will send. Send a bigger study as several emails. An email with more than 12 films opens 12 at a time, the same as a study from your equipment. With them, the referral letter, bloods and reports as PDF or Word (.docx) documents — up to 10, each up to 10 MB, the most a case can keep. Links to files (Dropbox, WeTransfer, Google Drive) cannot be followed; attach the files themselves. Logos in an email signature are left out on their own.

Anything else is sent back. An older Word or Excel file (.doc or .xls), a spreadsheet, an iPhone photo in HEIC format or a video is not kept, and the sender usually gets an automatic reply naming each file and why, so they know to send it another way. No reply goes to an address whose email cannot be verified as really theirs, or to an automated sender, and one sender gets no more than three an hour.

The referring vet sent several emails. Can they go into one case?

Yes. A referral often comes as several emails — the films, then the history, then the bloods. Emails from the same sender about the same animal (the same subject line, or the animal’s name in each) sit together under Incoming in one frame with one button, Open as one case: it makes the case from the first email and puts the others into it as the case opens. An email that arrives after you have already made the case says Looks like more for Bella and offers Add to Bella instead; Open as a case is still there beside it if the guess is wrong, and each email keeps its own Discard.

How do I add emailed films to a case I already have in Librevet?

Open the case and press Add View, then Incoming / PACS in the box that appears beside the films. The emails waiting are listed under Incoming, and Open puts that email’s films into this case, beside the ones already there. Open as a case, under Incoming in the gallery, always makes a new case instead.

What happens to the referral letter and the message?

Open as a case puts the email’s PDF and Word documents into the new case’s Attachments, and its message into the History box on the case’s Record, headed with who sent it and when. It is their message as they wrote it — only the earlier emails in the thread, their signature and the confidentiality notice are left off, and a forwarded referral is kept whole. If the History already says something, the message goes underneath; nothing already there is replaced.

A letter emailed on its own, ahead of the films, opens as a case of its own from the gallery; opened from inside a case with Incoming / PACS, it goes into that case. A document that could not be added stays under Incoming, named, to try again. To have the history written up from the letter, press Draft from history, in the top bar of the case’s Record.

Emailed films are kept for the same time as everything else under Incoming, and count towards the same limit.

Who can send to our email address?

Anyone who has it — that is what makes it easy for a referring vet. Nobody can see or take anything through it; it only lets films in. Give it to people you trust with your Incoming. If it ends up somewhere it should not, the practice owner can replace it in Settings → Imaging: Make a new one stops the old address at once, and anyone who emails it after that gets an automatic reply saying it is not in use.

What if a study has more than 12 films?

A case holds 12 films, however they arrived. Open as a case on a bigger study, or on an email carrying more, puts the first 12 into a new case in the order they arrived. The rest stay under Incoming, with a note of how many were already opened: open it again for another case, or discard what you do not need. Nothing is deleted until it has gone into a case or you discard it.

Opened from inside a case with Incoming / PACS, it fills whatever room that case has left in the same way, and the rest wait under Incoming.

Whatever route the film takes

Radiographs are converted to standard images for planning, and it is those images that are planned on. On Pro and Ultra the original DICOM is kept with the case as well, listed in Attachments under Original radiographs. Patient name, ID, study date and the measurements Librevet reads from the DICOM header are kept with them.