How to use Ceph tracing

How to trace a lateral ceph with Ceph tracing: the McGann analysis and others, CVM, airway and hand-wrist, and a PDF for the patient’s file.

• What it does
• Before you start
• Step by step
• Saving and reopening a case
• The PDF
• Settings
• What it costs
• Common questions
• More help

What it does

You open the patient’s lateral ceph and place the points one after another, in the order of the list on the left; the values and their grades update as you go. The McGann tracing uses the same order as SmileStream: 20 points, then the four teeth, then five line drawings. When you are done, you download a PDF with the tracing, the values, the growth stage and the airway.

Before you start

• An approved practice account: log in first. During the beta, only invited testers can use it.
• The lateral ceph as JPG, PNG, TIFF or DICOM, exported at full size. A hand-wrist x-ray is optional.
• A recent Chrome, Edge, Firefox or Safari on a computer, with a mouse for the most accurate points. The x-ray uses the whole width of the page and as much of the screen’s height as it can, so a larger screen gives a larger view.
• Privacy: the x-rays, the patient’s name and date of birth, and the PDF stay on your computer. Ceph tracing works in your browser and uploads none of them.

Step by step

1. Fill in 1. Patient: name, surname, date of birth, x-ray date and sex. Some norms depend on age and sex, so these decide the grades. Choose the Norms: Textbook, or Black South African adults.
2. Drop the ceph on The ceph under 2. X-rays (and the hand-wrist x-ray if you have one), then press Start tracing.
3. Check the scale. The tool finds the ruler or the balls on the nose rod and marks them in red. If the red marks sit on the long lines or balls, press Looks right; if not, press Mark by hand and tap two of them. The first time, set your cephalostat under Ceph settings.
4. Place the points. The card on the left names the next point, says where it goes and shows it on a small map. Tap the x-ray to place it. Drag a point to move it; press Skip for a point you cannot see.
5. Place the teeth. The tool puts the upper and lower incisors and molars where the points say they are. Drag each tooth onto the x-ray (drag its crown or root end to turn it) and press Looks right for each one.
6. Draw the lines: Symphysis, Mandible, Lower Profile, Upper Profile and Maxilla, one after another, by tapping along each outline. While a line is being drawn, a tap on a point or a tooth adds to the line; it does not move them.
7. Read the values in the McGann table on the right. Each grade is also written in words. Tick other Analyses (Steiner, Ricketts summary, McNamara and others) to add their tables; any extra points they need come after the McGann list.
8. Stage the growth in the CVM tab: place the vertebra points and check the ticks the tool suggests. Click the growth graph to see it large; click again (or press Esc) to close it. The Airway and Hand-wrist tabs work the same way.
9. Download the PDF from the PDF card (see The PDF), and press Save case to keep the tracing (see below).

Saving and reopening a case

Nothing is kept on the website, so keep the case on your computer:

• Save case (in the Case card) downloads a small case file named after the patient, for example van der Merwe J – 2026-10-27.ceph.json. It holds the points, teeth, lines, CVM, notes, scale, and the patient’s name, age and sex. It never holds the date of birth. Keep it with the patient’s x-ray.
• To carry on later, choose the case file under A saved case (optional) and the same x-ray under The ceph. The name, sex and x-ray date are filled in; type the date of birth again, then press Start tracing. A case file for a different x-ray is refused.
• Your browser also keeps a copy while you work. If you close the page by mistake, open the same x-ray again and the tool offers to restore it.

The PDF

The PDF card makes it in your browser. Press Preview PDF to see it first, page by page, then Download (or Close to change something); Download PDF saves it straight away. First press Looks right on all four teeth; until then the card says Check the four teeth first (Looks right). Anything not yet done is listed, and the PDF says not measured for the values it could not work out.

• Always: the tracing on the x-ray, the values tables with every grade in words and on a small bar, and a growth and airway page (CVM stage and the growth graph).
• Notes: whatever you type in Notes for the report (in the Case card) becomes a Notes page.
• Patient page: tick it for a page in plain words for the patient (jaw relationship, jaw positions, front teeth, lips and growth stage).
• Tracing on white: tick it for the lines and outlines on white, without the x-ray.
• Your logo: open Practice details (for the PDF) once, type the practice name and choose a logo. They are kept in this browser for every PDF you make here.

Every page ends with Decision support: the treating clinician must confirm: the PDF supports your diagnosis; it does not replace it.

Settings

Setting	Choices	Default	What it changes
Norms	Textbook, Black South African adults	Textbook	The normal ranges the grades are measured against, for this patient.
Analyses	McGann, McGann+, Steiner, Ricketts summary, McNamara, Downs, Tweed, Wits, Soft tissue, Airway	McGann	Which tables show and which points are asked for.
Ceph settings → Cephalostat and Reference on the nose rod	A ruler with long lines, Metal balls in a line, None: my images are at true size	(set once)	How the tool finds the scale on your x-rays. Kept in this browser.
Points and Lines (above the x-ray)	any colour	yellow points, blue lines	The colour of the points and their labels, and of the lines and outlines, on screen. The PDF keeps its own colours. Kept in this browser.
Small points	ticked or not	not ticked	Points 60% smaller, to see the x-ray under them. Kept in this browser.
Point names	ticked or not	ticked	Shows each point’s name, placed where it covers no point and no other name. Untick it to see only the points; a point’s name then shows in the blue flag while the mouse is on it. The PDF always shows the names. Kept in this browser.
Practice details (for the PDF)	Practice name, logo	none	The name and logo at the top of the PDF. Kept in this browser.

What it costs

Free during the beta. After the beta, each new x-ray will use one Ceph tracing credit when you unlock its values and PDF; opening the same x-ray again is free. See the Pricing page.

Common questions

The tool says This case file belongs to another x-ray.

The case file was saved for a different x-ray. Choose the x-ray it was saved with: the same file, not a new export or a screenshot of it.

The Download PDF button stays grey

Press Looks right on each of the four teeth (upper and lower incisor, upper and lower molar). The PDF card says what is still needed.

The red scale marks are not on the ruler

Press Mark by hand and tap two long lines (or balls) whose distance you know. Then check Ceph settings so the tool finds them next time.

Some values say not measured

A point or a line they need was skipped or not drawn yet. Tap it in the list on the left to place it; the value appears at once.

Can I reopen a case on another computer?

Yes: copy the case file and the x-ray to the other computer, and open both as under Saving and reopening a case.

More help

• The Help us improve box under the tool: tell us what to change.
• The Video training page.
• The Contact page.