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Osirix App

Osirix is a free DICOM viewer for Macintosh computers. Osirix MD is the US$599 FDA certified version. Both are powerful fully-featured radiology workstation software, capable of handling any DICOM image from X-ray through CT, MRI, PET, Ultrasound etc. 

Osirix will import JPEGs snapped on a digital camera and, as far as possible, manage them as DICOM images. 

The MD version is legal for diagnosis, whereas the free version has a red banner on each image declaring it ‘not for medical use’ – apart from this they are about the same.

This is not a review of the full function of this software, which includes powerful 3D effects and comes with a 300-plus page manual, but of some very-simple, but very-useful everyday orthopaedic uses.

Essentially one can import, measure and annotate X-rays and other images, and export them to be included in medical reports or for presentation or publication, or to one’s iPhone.

Images can be anonymised completely, or just the patient name removed whilst age and ID number remain, or all data apart from annotations can be removed.

Images can be imported via an internet connection from one’s PACS, or imported from CDs, or imported in any manner.

The basic version of this programme is designed by and for radiologists, and does not have many orthopaedic specific tools, except for a Cobb angle calculator, so, for example, finding the centre of the femoral head to measure CE angle of Wiberg is not as easy as it would be if there was a ‘circle-with-a-centre-point’ tool, but one can get by with an ‘oval-with-no-centre-point’, and measuring femoral version by Murphy’s method by propagating points from slice to slice on the CT.

Third party developers are developing plug ins, which will most likely grow in number to make the software more useful. Presently there are only two plug ins specifically for orthopaedic surgeons. ‘Orthopaedic Studio’ which is quick and accurate for measuring a variety of hip specific angles, including CE angle, sourcil angle, Alpha angle of Notzli and others, and will export the measurements to a spreadsheet. It is not FDA approved. There is a free trial version.

The only template for orthopaedic implants is for Medacta hip arthroplasties. It works quite well, and no doubt other manufacturers will add their implants if Osirix becomes popular.

The software is fairly intuitive and integrates seamlessly with other Macintosh programmes including Mail, iPhoto, Pages and Word (for Mac…).


Images can be rotated, annotated, marked up, measured and labelled.


Annotate and measure any image.


Enlarge a MRI.


Enlarge a radiograph.


Measure an image.


Plan simple procedures.


Non-graphic data can be removed.


Angle measurement.


Measuring femoral version by Murphy’s method – find the centre of the femoral head and propagate to the slice through the lesser trochanter…


Here it is. Measure the angle to the gantry. (Text does not always export smoothly.)


And measure the angle between the femoral condyles to the gantry. About 38 degrees – time for an osteotomy. What would the radiology report say?


Radiograph displayed on desktop monitor, snapped with iPhone camera from oblique angle, emailed, imported to Osirix, levels adjusted, rotated horizontal – but obviously not possible to correct the keystone effect from the original photograph, annotated, exported to medical report…


Orthopaedic Studio’s CE and sourcil angle measurements – the figures can be exported to a spreadsheet, but not displayed on the image. The plug in does this a little more quickly than ‘manually’ using Osirix alone.


Orthopaedic Studio’s Alpha angle and offset ratio measurements are produced much more quickly than ‘manually’ using Osirix alone.