CBCTScope

A local-first CBCT viewer with native AI-agent control.

Above: an agent driving the viewer in demo mode. Window preset, slice navigation, the multi-slice grid, and the mode switches are MCP verbs sent by the agent; the arch proposal and pano enhancement are the viewer's own one-click tools. Each frame is a capture of the full viewer window as the commands land. The volume is the built-in synthetic phantom, so no patient data can appear, by construction.

The interface at a glance

MPR + 3D	Multi-slice grid	Curved panoramic

Click any thumbnail for full resolution; the per-mode reading guides are in docs/reading-modes.

Open any local CBCT export and read it in eight purpose-built modes: MPR, multi-slice grid, curved panoramic, TMJ, freehand reslice, virtual cephalogram, region growing with airway analysis, and two-volume stitching. Your scan never leaves your computer. An AI agent can drive the whole viewer through a built-in MCP server: it opens scans, switches reading modes, sets the window, moves through slices, and takes snapshots. The agent moves the camera. The human reads.

Research use only. Not a medical device. CBCTScope visualizes and navigates volumes. It never produces findings, measurements-as-conclusions, or diagnoses, in the UI or over MCP. Do not use it for clinical decision-making.

Why this exists

To our knowledge, CBCTScope is the first CBCT viewer with native AI-agent control. Neighboring projects exist and deserve credit: dicom-mcp and the Flux Inc. DICOM MCP server query PACS metadata over MCP, dicom-viewer-mcp-app prototypes MCP-driven DICOM slice rendering, and mcp-slicer drives 3D Slicer through raw Python execution. None of them is a purpose-built CBCT reading environment, and none constrains the agent to a small set of clinical navigation verbs. CBCTScope does both: a dental and maxillofacial reading workflow, plus an agent surface that is deliberately navigation-only.

Privacy stance

• Scans are read in place from the folder you pick. Nothing is copied or uploaded anywhere.
• There is no hosted instance and there never will be one. The server binds to 127.0.0.1 and rejects any request whose Host or Origin is not loopback, so neither another device on your network nor a hostile web page in another tab (DNS rebinding, cross-site POSTs) can reach it.
• No absolute file paths reach the browser or the agent transcript. The UI shows a display label derived from the last folder and file names of what you opened (so name your export folders accordingly) plus technical geometry only.
• The only writes are an app-data folder (~/.cbctscope) holding your annotation sidecars (labels, world-mm coordinates, HU statistics) and a pointer to the last source you opened, so the viewer can restore it. Never pixels. Demo mode writes neither.

Quickstart

Requires Node.js 22+.

npm install
npm run demo     # starts the viewer at http://localhost:3810

Open http://localhost:3810. A built-in synthetic phantom loads immediately, so the full viewer works with zero patient data. Demo mode is also a privacy guarantee: it never restores or remembers a previously opened scan, so a recording or screenshot session can never accidentally surface a real case. The phantom: jaws, dental arches, teeth with enamel and pulp, a metal crown, airway, sinuses, and TMJ condyles, all procedurally generated.

To read a real scan, click open in the header and pick a CBCT export: a folder, a DICOMDIR tree, a multiframe DICOM file, or one slice of a series (the whole series opens). Uncompressed exports are supported; the native file chooser is macOS-only, other platforms can POST /api/cbct/source with a path.

Reading modes

Mode	What it does
MPR	Orthogonal slices with crosshairs, oblique rotation, slab/MIP, measurements, 3D render with adjustable styles, clipping, and a render eraser
Grid	Many parallel slices of a rotatable stack on one screen
Pano	Draw the dental arch once, get a curved panoramic plus cross-sections, nerve tracing, and focal-trough control
TMJ	Both condyles side by side in axis-corrected sections
Reslice	A fresh slice stack along any drawn line or curve
Ceph	A virtual cephalogram, the volume projected flat like a film
Region	Region growing with HU presets, volume and density stats, airway analysis
Stitch	Rigid registration and fusion of two volumes of the same subject

Per-mode reading guides live in docs/reading-modes/.

2D radiographs

The viewer also opens single 2D radiographs (DICOM modality PX, DX, CR, or IO: panoramic, digital and computed radiography, intraoral), uncompressed 16-bit files, the same constraint as volumes. A radiograph gets a dedicated single-image view: window, gamma, invert, cursor-centered zoom, pan, fit. Gray values are display-normalized to a 12-bit scale at load (radiographs carry no HU calibration), and MONOCHROME1 files are flipped so bright is always radiopaque. The volumetric reading modes apply to volumes only. This exists so multi-reader studies can read both image classes in one instrument under identical display settings.

AI-agent control (MCP)

Start the viewer, open it in a browser, then register the MCP server with your agent host:

{
  "mcpServers": {
    "cbctscope": {
      "command": "node",
      "args": ["/absolute/path/to/cbctscope/mcp/server.mjs"]
    }
  }
}

The agent gets eight verbs, all navigation or visualization: open_scan, list_volumes, select_volume, set_view_mode, set_window_level, navigate_slice, snapshot, reset_view. There is no code execution and no tool that returns an interpretation. Details and the full contract: docs/mcp.md.

CBCTScope is one of a pair of agent-native instruments built on the same principle (bounded verbs for the agent, commit rights for the human); the other is Quoin, a text editor for macOS where any agent may edit the buffer and only the human holds the save button. Both at rezamotaghi.com.

Development

npm run dev          # dev server on :3810
npm run typecheck    # tsc
npm run lint         # eslint
npm test             # vitest: arch-spline reformat, NCC registration, region growing, HU windowing, phantom
npm run build        # production build

Built on Cornerstone3D and Next.js. All rendering styles, reading workflows, and reconstruction math are original, from-scratch implementations informed by clinical reading practice; the project contains no vendor code, assets, or documentation.

Author

Built by Dr. Reza Motaghi, oral and maxillofacial radiologist. If you use CBCTScope in research, please cite it (see CITATION.cff).

License

AGPL-3.0-or-later. Free to use, study, and modify. If you build a product or service on this code, its source must be open under the same terms.

For uses the AGPL does not fit (closed-source products, commercial integration), a separate commercial license is available: reach me through the contact page at rezamotaghi.com/contact.