01 Getting Started
BCeph is a free, browser-based cephalometric analysis tool for orthodontists, residents, and dental students. There is nothing to install — open bceph.com/app in a modern browser and you are ready to trace. Your X-ray images are stored locally on your device; analysis data is optionally synced to the cloud when you sign in.
System requirements
- ✓Browser: Latest Chrome, Firefox, Safari, or Edge. BCeph uses Canvas 2D, IndexedDB, and the File API — all standard in evergreen browsers.
- ✓Display: Minimum 1366×768. The workspace is desktop-optimised with a fixed 240 px left sidebar and 420 px right analysis panel — tablets work, phones are cramped.
- ✓Internet: Required to load the app once. After that, tracing and analysis run offline — only cloud sync needs a connection.
- ✓Account: Optional. You can run analyses without signing in; a Google account unlocks unlimited usage and cross-device sync.
02 Quick Start
From a fresh tab to a printable report in five steps:
- Load your cephalogram. Click
Load Cephin the top toolbar and select a lateral cephalogram (JPEG, PNG, WebP, or GIF). The image renders on the canvas and is stored locally in your browser. - Calibrate. Click
📏 Calibrate, mark two points on a known reference (typically the ruler etched on the film), and enter the real-world distance in millimetres. Linear analyses (McNamara, Wits, E-Line, Kim) require this step. - Place landmarks. The pip bar shows the active landmark; click on the canvas to place it. Selection auto-advances to the next required landmark. Skip ones you cannot identify with
⊘ Skip. - Review the analyses. The right-hand panel updates in real time. Each analysis tab shows progress (placed / required) and a colour-coded deviation from the norm.
- Export. Click
📄 Reportto generate a print-ready multi-analysis report, or📋 Copyto grab a TSV ready to paste into Excel or Sheets.
— or needs calibration, scroll up and run step 2 — millimetre-based measurements unlock the moment the px/mm ratio is set.03 The Interface
BCeph's workspace has three zones: a fixed top toolbar, a left sidebar with patient and canvas controls, and a right analysis panel.
Top toolbar
Patient opens the patient database. Load Ceph uploads an image. 📏 Calibrate sets the px/mm ratio. 📐 Ruler provides a free-draw measurement tool. 🗑 Clear, 💾 Save, 📂 Restore, ↩ Undo, ↪ Redo, 📋 Copy, 📄 Report, and Tour handle workflow and output.
When signed in, ☁️ Sync pushes patient data to the cloud and 🚪 Sign Out ends the session. A live badge shows your current calibration ("Not calibrated" or "X.XX px/mm" in green).
Left sidebar
The patient bar shows the currently loaded patient (name, file number, age, gender, X-ray date, doctor, chief complaint). Age is auto-computed from DOB and X-ray date.
The canvas toolbar contains the active landmark selector, ⊘ Skip, visibility toggles for tracing lines (✏️ Tracing) and labels (🏷 Labels), and a ⊞ Fit button to reset zoom.
The image enhancement bar exposes sliders for brightness, contrast, and sharpen, plus invert and reset. Below that, the analysis filter pills let you toggle which analyses appear in the right panel.
At the bottom is the landmark pip bar — 30 coloured pips covering skeletal, dental, and soft-tissue landmarks. Placed pips turn green, the active pip is gold with a halo, and skipped pips are greyed with a dashed border.
Right analysis panel
One tab per analysis. Each tab badge shows placed / required with a status colour: green complete, amber ≥ 50 %, red < 50 %.
A norm selector at the top of the panel switches the reference values (Adult, Adolescent, Mixed). Inside each tab, measurements appear in a four-column table: name, computed value, norm ± SD, and a colour-coded deviation. Quick-access boxes summarise classifications such as Skeletal Class, Growth Pattern, MMPA, and Björk divergence.
04 Image Upload
BCeph accepts standard web image formats: JPEG, PNG, WebP, and GIF. Click Load Ceph in the top toolbar and choose a file. There is no file-size cap beyond what your browser can hold in memory; high-resolution images (typically 1500 × 2000 px or larger) produce more precise landmark placement.
Recommended input
- ✓Lateral cephalogram — a true profile radiograph with clear skeletal and soft-tissue outlines.
- ✓Visible reference scale — a 10 mm ruler etched on the film, a known intra-oral structure, or any object of known length. Required for calibration.
- ✓Reasonable contrast — if the image is too dark or too washed out, the enhancement sliders on the left sidebar can help (brightness, contrast, sharpen, invert).
05 Calibration & Ruler
Cephalometric measurements expressed in degrees are independent of image scale — angular analyses (Steiner, Eastman, Tweed, Downs) will work as soon as you place landmarks. Linear measurements (millimetres) require calibration so BCeph knows how many pixels correspond to one millimetre.
Calibrating the image
- Click
📏 Calibratein the top toolbar. A floating HUD appears: "Click FIRST point on ruler." - Click two endpoints of a feature whose real-world length you know — typically a 10 mm or 20 mm ruler etched on the film.
- Enter the real distance in millimetres in the modal that appears. BCeph computes
px / mmand stores it with the image. - Confirm. The calibration badge in the toolbar turns green and shows the ratio. Linear measurements across all analyses become live immediately.
Press Esc at any time to cancel calibration without changing the existing ratio.
The ruler tool
The 📐 Ruler button is separate from calibration. It lets you measure any distance on the image after calibration is set — useful for spot-checking, comparing structures, or measuring distances that are not part of a built-in analysis. Click two points to read the measurement live; press Esc or the ✕ in the HUD to exit.
06 Landmark Tracing
BCeph supports 30 landmarks across three anatomical groups: skeletal (S, N, Or, Po, Ar, Ba, Pt, Go, Me, Gn, Pg, A, B, ANS, PNS, Co, and more), dental (U1T, U1A, L1T, L1A, U6, Op1–Op3), and soft tissue (Prn, Cm, Sn, Ls, Li, sPg, MeP). The pip bar in the left sidebar shows every landmark; the active one is highlighted in gold.
Placing landmarks
- →Click on the canvas to drop the active landmark at the cursor. Selection auto-advances to the next required landmark for the currently visible analyses.
- →Pick a different landmark by clicking its pip in the sidebar or selecting it from the canvas-toolbar dropdown.
- →Fine-tune position with the arrow keys — each press nudges the landmark by 1 px, Shift+Arrow nudges by 5 px. Changes are undo-aware.
- →Skip landmarks you cannot identify with
⊘ Skip. Skipped landmarks are drawn dashed and excluded from analysis dependencies. Click the pip again to un-skip.
Reading the canvas
Placed landmarks appear as filled circles with their abbreviation label (toggle labels with 🏷 Labels). Tracing lines auto-draw between key landmark pairs — S–N, N–A, N–B, Po–Or, Go–Me, the occlusal plane, the Ricketts facial axis, and the H-line — and can be hidden with ✏️ Tracing for a cleaner view.
07 Cephalometric Analyses
BCeph ships with 12 classical analyses covering skeletal, dental, and soft-tissue assessment. All are modular — each analysis declares which landmarks it needs, so unused landmarks never block your workflow. Tabs in the right panel show progress and a colour-coded deviation from the selected norm set.
Norm sets and deviation
Use the dropdown at the top of the analysis panel to switch between norm references (Adult, Adolescent, Mixed). Each measurement is compared to its norm ± SD and tagged:
within 1 SD 1–2 SD > 2 SD
The 12 analyses at a glance
| Analysis | What it measures | Required landmarks | Learn more |
|---|---|---|---|
| Eastman | UK standard: SNA, SNB, ANB, MMPA, incisor angulations, LAFH ratio | S, N, A, B, Go, Me, U1T, U1A, L1T, L1A | Eastman → |
| Steiner | SN-plane angles: SNA, SNB, ANB, GoGn–SN, U1–NA, L1–NB, interincisal | S, N, A, B, Go, Gn, U1T, U1A, L1T, L1A | Steiner → |
| Downs | Facial angle, convexity, A–B plane, Y-axis, mandibular plane | N, Po, Or, A, B, Pg, Go, Me, S, Gn | Downs → |
| Tweed | FMA, FMIA, IMPA (the 180° diagnostic triangle) | Po, Or, Go, Me, L1T, L1A | Tweed → |
| McNamara | Linear cranial-base, maxilla and mandible lengths (Co–A, Co–Gn, A/N-Perp, Pg/N-Perp) | Co, A, Gn, N, Pg needs mm | McNamara → |
| Björk-Jarabak | Saddle, articular, gonial angles, Sum of Angles (396°±6°), PFH/AFH ratio | S, N, Ar, Go, Me | Björk-Jarabak → |
| Ricketts | Facial axis (Ba–N to Pt–Gn), convexity, depth, A-Po distances, denture height | Ba, N, Pt, Gn, A, Pg, Po, Or | Ricketts → |
| Holdaway | Soft-tissue: H-angle (sPg–Ls to NB), nasolabial angle, lip-to-H-line, ST convexity | N, B, sPg, Ls, Sn, Cm, Li, MeP | Holdaway → |
| Wits | AO–BO perpendiculars on the occlusal plane (functional jaw discrepancy) | A, B, Op1, Op2 needs mm | Wits → |
| E-Line | Upper and lower lip position relative to the Prn–sPg aesthetic line | Prn, sPg, Ls, Li needs mm | E-Line → |
| Kim | ODI (overbite depth), APDI (anteroposterior dysplasia), Extraction Index | A, B, Po, Or, Op2, Op3, ANS, PNS, Pg EI needs mm | Kim → |
| ABO | American Board 8-core: SNA, SNB, ANB, SN–MP, U1–SN, IMPA, interincisal, lower lip to E-plane | S, N, A, B, Go, Me, U1T, U1A, L1T, L1A, Prn, sPg, Li | Included in app |
08 Reports & Exports
Generating a clinical report
Click 📄 Report in the top toolbar. A modal lets you choose which analyses to include and whether to embed the traced X-ray image and a summary deviation chart. BCeph opens a print-ready window with patient demographics, the selected analyses, measurement tables with norms and colour-coded deviations, and brief interpretation text — use your browser's print dialog to save as PDF.
Spreadsheet exports
- →
📋 Copy— copies the current patient's visible measurements as TSV to your clipboard. Paste directly into Excel, Google Sheets, or Numbers. - →CSV (this patient) — downloads a
.csvwith every analysis, measurement, value, norm, SD, and deviation for the loaded patient. - →CSV (all patients) — bulk export of every saved patient in one file. Useful for research, audits, and longitudinal review.
JSON backup & restore
The Export Backup action writes your full patient database as a portable .json file. A lightweight option excludes image data for a much smaller backup; the full backup is self-contained. Use Import Backup to restore on another device or recover from browser data loss — you can merge with existing patients or replace the database entirely.
09 Patient Database
Click Patient in the top toolbar to open the database. Each record stores demographics, the X-ray image, and all placed landmarks per image.
What is saved per patient
- ✓Demographics: name, file number, date of birth, gender, X-ray date, referring doctor, chief complaint.
- ✓Computed age at the time of the X-ray (derived from DOB and X-ray date).
- ✓Cephalogram image in browser IndexedDB.
- ✓Landmark coordinates and calibration ratio.
- ✓Image enhancement settings (brightness, contrast, sharpen, invert).
Click a patient to load their record. 💾 Save writes the current state into the loaded patient; 📂 Restore reverts to the last saved version.
10 Account & Cloud Sync
BCeph is fully usable without an account — patient records persist in your browser's IndexedDB and survive page reloads. Signing in unlocks two things: unlimited usage beyond the free trial sessions, and cloud sync so your patient database follows you across devices.
Sign-in flow
- Open the login modal from the toolbar or after exceeding the free trial sessions.
- Sign in with Google. BCeph uses Firebase Authentication — no separate password to manage.
- First-time sync. Existing local patients are merged with anything in your cloud account (smart conflict resolution: skip duplicates by ID, update if cloud is newer).
- Day-to-day. Click
☁️ Syncany time to push and pull. Click🚪 Sign Outto clear the session — local data stays in IndexedDB.
11 Keyboard Shortcuts
| Shortcut | Action | Notes |
|---|---|---|
| Ctrl / ⌘ + Z | Undo last landmark or nudge | Undo stack covers placement, skip, and arrow-key nudges |
| Ctrl / ⌘ + Shift + Z | Redo | Also available as Ctrl / ⌘ + Y |
| Arrow keys | Nudge active landmark by 1 px | Use after selecting a landmark |
| Shift + Arrow | Nudge active landmark by 5 px | Faster fine-tuning for large images |
| Esc | Exit calibration or ruler mode | Calibration ratio is preserved when you cancel mid-way |
12 Privacy & Data Handling
BCeph runs in your browser and processes everything client-side. There are no servers performing landmark detection or geometry calculations on your behalf.
- ✓X-ray images are stored in your browser's IndexedDB. They are never uploaded.
- ✓Cephalometric calculations run entirely in your browser using the Canvas 2D API and BCeph's local geometry library.
- ⚠Analysis metadata — landmark coordinates, measurements, and any identifiers you enter — syncs to Firebase Firestore when you are signed in. Use anonymised case IDs for HIPAA-covered records.
- ✓Exports (CSV, JSON, printed reports) are written directly to your device. There is no cloud intermediary.
13 FAQ & Troubleshooting
Frequently asked questions
Is BCeph free?
Yes. BCeph is free for clinical and educational use. There is no payment step and no paid tier.
Do I need an account?
No — you can trace and analyse without signing in. A Google account unlocks unlimited use beyond the trial sessions and enables cloud sync.
Can I work offline?
Once the app has loaded, yes. Tracing, calibration, analyses, and report generation all run offline. Only cloud sync requires a connection.
Which browsers are supported?
Latest Chrome, Firefox, Safari, and Edge. BCeph relies on Canvas 2D, IndexedDB, and the File API — standard in all evergreen browsers.
Where are my X-ray images stored?
In your browser's IndexedDB on this device. Images are never uploaded to a BCeph or Firebase server.
Can I sync between devices?
Sign in with Google and click ☁️ Sync. Patient demographics, landmarks, and measurements travel; X-ray images remain local on each device.
Can I export to Excel?
Yes — 📋 Copy places a TSV on your clipboard ready to paste, or use CSV export for a downloadable file (per-patient or all patients).
How accurate is BCeph?
Geometry is exact within the precision of your landmark placement. Use arrow-key nudge and the enhancement sliders to refine positions for clinical-grade output.
Troubleshooting
- ⚠Image won't load: Confirm the file is JPEG, PNG, WebP, or GIF. Try a smaller resolution if the browser tab runs out of memory on very large scans.
- ⚠A measurement shows "needs [IDs]": One or more required landmarks are missing or skipped. Click the listed landmark IDs in the pip bar to activate and place them.
- ⚠Linear measurements show "—" or "needs mm": Calibration is not set for this image. Click
📏 Calibrateand mark a known reference distance. - ⚠Sync not working: Make sure you are signed in (the toolbar shows your account). Reload the page if the
☁️ Syncbutton does not appear. - ⚠Lost your patients after clearing browser data: IndexedDB is cleared when you clear site data. Always keep a JSON backup of important cases — Export Backup writes one in seconds.