Revision Date Changes
12 May 2017 Adjustment and revision for mRay 5.1
13 July 2017 Adjustment for mRay 5.2
14 March 2018 Adjustment for mRay 5.3
15 June 2018 Adjustment for mRay 5.4

Manufacturer and contact

mbits imaging GmbH

Bergheimer Straße 147

D-69115 Heidelberg

E-Mail: support@mbits.info

Telefon: (+49) 6221-6734 883

Internet: www.mbits.info

mRay 5.4

Radiological image viewer for mobile devices with image processing functions

Release-Date: June 2018

© 2018 mbits imaging GmbH

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Intended purpose

mRay allows medical professionals to view and evaluate radiological images. Main users are physicians. The patient group, for which mRay can be used, includes all patients from whom radiological image data has been created for the purpose of diagnosis or treatment.

mRay can be operated in hospitals, medical practices, on the go or at home. The software is dedicated for mobile devices for fast and immediate access to radiologic images for informational purposes. When using mRay for diagnostic purposes, national regulations within the European Union must be considered and an appropriate display must be used.

mRay allows the display of images and data types that are defined by the Digital Imaging and Communications in Medicine (DICOM) standard (e.g. computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), fluoroscopy (XA), digitalx-ray (CR), ultrasound (US)). The software offers common radiological software tools (e.g. windowing, measurements, thick slices and annotations).

Overview

mRay is a mobile viewer application for radiological images. It supports DICOM image files as well as other common image formats and PDF files. The the major functions of use are:

  • Receive DICOM data per pre-defined communication setup by Picture Archiving And Communication System (PACS)
  • Overview about all available patients, including a search function (name, birth date,imaging modality)
  • Selection of to be reviewed DICOM data to download an entire set of data (multiple patients, multiple studies or multiple series) 
  • Visualization of the DICOM data in a well-established way of DICOM viewing (analogous standard tools for medical image viewing)
  • Assessment of DICOM data by means of standard navigation tools (level window, panning,zooming, etc.)
  • Take pictures for wound documentation and send them as a DICOM file to your PACS including all necessary meta information
  • Calibration routine to adjust the display of grey vaules on a device - DICOM Greyscale Standard Display Function
  • Create simple textual reports and store them as a DICOM file
  • Load and create level window presets
  • Manual measurement of structures of interest on 2D slices including angular and length measurements as well as statistical computations in a region of interest
  • Adding text annotations to images
  • Multiplanar reconstruction for CT datasets (MPR)
  • Thickslices by means of maximum intensity projection for up to 11 slices (MIP) 
  • Browse PACS by DICOM Query (C-FIND) 
  • Request data by DICOM Retrieve (C-MOVE)
  • Encryption and compression of data stored/transmitted
  • Sending messages / images / key images to colleagues, which are shown in a contact list

Operating the application

Welcome screen

The welcome screen appears as soon as the application has been started (Figure 1). You can connect to Demo Server with the button. Additional text fields for username and password appear after the user has specified a server address. If the login data is correct you will be directed to the main screen of the application. Please contact your administrator to get the server address and your login credentials. Enter your login credentials to log in.

Please take note of the following hints for use of mRay

  • If it is your first login it could  take a little time („Connecting“ is written in the status field) – dependent on your connection speed.
  • By clicking and holding a button you can call the interactive help . Thus you can find out every functionality behind a button anytime.  
  • If a PIN code is necessary on your device, you'll stay logged in for a specific period, which means you don't need to enter your login credentials every time you start the app. The period can be adjusted by your admin. 
  • Please set the correct date and time on your device when you are using mRay. 

Figure 1

  1. Server URL field: specify the URL of the server here. Port can be omitted if default port 32000 is being used for the server installation.
  2. Server URL drop down list: Opens a list of all servers that the application was connected with. Entries can be deleted by swiping them from left to right.
  3. User ID field: Enter your user name in this input field.
  4. User ID drop down list: Opens a list of all users who were connected to the currently selected server.Entries can be deleted by swiping from left to right.
  5. Password input field: Enter your password in this input field.
  6. Login button: Tap this button to log in.

PIN Check

A PIN check will be neccesarry when logging in with an ActiveDirectory account for the first time. The PIN will be send to the mail address registered in your ActiveDirectory account. The keyboard can be opened by tapping on the input field (2 Figure 1.1). The PIN will be validated immerdiantly after entering the sixth digit.

1

2

3

Figure 1.1

The PIN dialog features the following UI elements:

  • Notification including the mail address the PIN has been sent to.
  • The PIN input field. The keyboard will open by tapping on the input field.
  • You can close the PIN dialog by tapping on the close button. This will cancel the login process.

Inbox

The inbox will be opened after logging in (Figure 2). With this you can browse and select the wanted DICOM files, which are enabled for you through the server.  Thus you can see all files on the mRay server on which you have access rights.

Figure 2

The following functions are available on this screen: 

  1. A green icon shows, if you are connected to the server. In case of a red icon you can work with the local saved files, but of course you can't receive new files. By clicking the mRay logo you can open the main menu. 
  2. Switch to the Messaging/Chat menu (see below - only if this function has been activated in your system). 
  3. Switch to the search dialog. Here you can search the whole mRay database or query a PACS (if configured).
  4. Switch to Favorites: It is possible to mark your favorites with the star symbol (Item 8). Favorites are working as a kind of bookmark and  and they will be deleted last by the automatically storage management of the application (which means your favorites will only be deleted if it is necessary due to your settings to the data retention or due to low space on your device). 
  5. Shows the currently opened dataset. You can return to the viewer with on click.
  6. Here you are able to quickly and easily share, mark as favorit or download a whole study.
  7. Shows information, missing information and meta data from a patient. 
  8. Shows an overview of the contained series in a study. By clicking a study you will get to the series selection (see below). The green marker indicates that the image data is stored locally.
  9. The time will appear as soon as the data arrived in the mRay (by sending from a PACS and searching in the mRay database). mRay can be configurated to automatically delete data after 'X' hours (default: after 8 hours). 
  10. Here you can filter your inbox by text entry. Please note: by filtering you don't start a PACS query! See item 3 for PACS queries. Please also mind the notes to special characters in the 'known issues'.
  11. Take a photo: see section for secondary capture for further explanations

Scrolling through long lists

Swipe up/down to scroll through lists or use the scrollbar on the right of a list to navigate quickly through them.

Hide entries in the inbox

By swiping right within a list container you are able to hide single study or series. Those won't appear in the list anymore. To view hidden datasets you need to click the button 'show hidden datasets' in the settings. Hide all data at once by executing the gesture with three fingers at the same time.

Figure 3

Series selection

By clicking a study in the inbox you will get to the series selection (Figure 4). 

Figure 4

The following functions are available: 

  1. Back to the inbox 
  2. Enumeration of all recorded images of the study of a patient. These additional information are enumerated:
    • Series description
    • Series ID
    • Recording mode (CT, MRT, CR, XA, US, …)
    • Number of the slices/frames (optional)
    • Recording date of the series
    • When was the dataset added to the pool
    • Solution of the dataset
    • Measures of the image

By cicking a series it will be downloaded (if it's not already downloaded) and opened for viewing.

Barcode scanner

Use the barcode scanner to quickly and easily insert patient IDs into text fields. This function is available in various text fields, such as the search for the patient ID. Hold the camera image over the barcode and make sure that the entire barcode is in the marked area. If the barcode has been recognized, the text is automatically transferred to the text field.

Figure 5

The main menu will be opened after clicking the mRay logo (Figure 6).

Figure 6

The following functions are available: 

  1. Shows the currently logged in user.
  2. You can log out with this button. You'll get back to the log in screen and you are disconnected from the server. This function is needed, if another user wants to log in on this device.
  3. URL of the server you are currently connected to. If there is a download in progress you can see the current download speed here.
  4. Opens the settings screen (see the next chapter).
  5. DICOM Switch between default calibration settings, custom calibration or turn it off. The calibration routine will appear if you have not calibrated the display yet. See section Calibration routine for further details about the calibration of the display.
  6. Tests the download speed of datasets from the mRay server (available if your mRay server is configured to provide such data).
  7. Opens the Lux-Meter to determine the current room class (only available on Apple devices).
  8. Here you can perform the daily constancy check in accordance to the german DIN 6868-157.
  9. Opens the 'About mRay' dialog
  10. Opens the 'Whats new?' dialog
  11. Opens the imprint.

Settings

On this screen you can adjust your settings just as you want (Figure 7). 

Figure 7

The following functions are available: 

  1. Notifications: adjust what kind of notifications you want to receive. You can choose between none, notifications for messages only or notifications for messages and new datasets
  2. Autodownload: in mRay there is a  autodownload feature, which downloads new arriving datasets automatically. You'll recieve a note as soon as the datasets are available. Also you will have access to the image data immediately by opening the app. This function needs to be enabled by your admin. With the menu unter item 1 you can also decide, whether you want to download data via wifi exclusively (default setting) or via wifi and your mobile connection. You can also fully disable this function on the device. 
  3. Max. occupancy: the maximum storage mRay can occupy on your device. 
  4. Constancy check reminder: enables the automic reminder to perform the daily constancy check.
  5. Used: shows the currently used disk space which mRay is using.
  6. Delete: deletes all local saved files (a confirmation dialog will appear).
  7. Show hidden datasets: Views all datasets, which you have hidden before in the inbox.
  8. Calibrate DICOM curve: opens the calibration routine
  9. Change password: Through this button you will get to the 'Change password' screen, on which you are able to change your password by typping your old password and a new one, without contacting the admin.

Change password

By using the 'Change password' screen you are able to change your personal account password, without contacting your admin. The following figures will visualize the procedure

Figure 8

The following items will show you the functionality of this screen:

  1. Your old password is needed in this input field. That's necessary to protect your account from foreign access.
  2. Insert your new password in this input field, which will be valid as soon as the change is successful.
  3. To prevent typing errors you need to insert your new password again in the next input field.
  4. This indicator shows how strong your new password is on a scale from 0 to 100 percent. 0 means very weak and 100 means very strong. The traffic light colors are also an indicator about the strength of your new password.
  5. By clicking this button you accept the input and your password is changed. It requires a connection to the server to get the changed password to every device. The button will be enabled as soon as all input fields are valid.

Note

Please take care that you are able to type all the special characters via your touch devices, if you want to use special characters in your password. Otherwise you have no opportunity to log in. If you use special characters by a mistake and are not able to log in anymore, please contact your admin to reset your password.

DICOM Standard Display Function calibration routine

This routine is used to calibrate your display to be in accordance with the DICOM Standard Display Function (GSDF). You need a luminance measuring device to perform the routine. The routine consists of displaying the image of the TG18 group. Measure the luminance of the displayed square (1) and enter the value with either (6), (2) or (3). Click 'Accept' to proceed to next image / step. After all TG18 images have been processed the calibration results will be stored and applied to the visualization of images.

Figure 9

  1. Grey value valid to be measured.
  2. Adjusts the entered luminance value
  3. Adjusts the entered luminance value
  4. Go back to previous image
  5. Accept value of this step and proceed to next step
  6. Slider to enter measured luminance value
  7. Discard the current calibration

The following points need to be checked before the test:

  • The device's display brightness is set to its maximum value.
  • The image viewing device should be used in an evironment which is in compliance to the desired roomclass.
  • The display should be cleaned.

Download Test

Figure 10

  1. Performs a quick test. The measurement is only estimated, but the duration of the test is shorter than for the complete test. 
  2. Performs a detailed test. The measurement takes longer, but the specific values are exact. 
  3. This area displays the progress and results.

Lux-Meter

Figure 11

  1. Show the current lux value
  2. Starts a measurement of the room class. The recorded values are averaged over time. This simulates the recording of ambient light using the device's built-in front camera. Move the device until the value is levelled and then click OK to confirm the measurement. 
  3. Cancel the measurement here

Figure 12

Note

Due to the measurement method, the recorded values are only an approximation of the actual lux value and thus the room class.

Constancy check

Figure 13

  1. Test criteria (The numbers refer to the test pattern elements from DIN 6868-157). 
  2. Hide the form mask. This can be recalled at any time (tap on the test image shows button with check mark). 
  3. Select the criterion with the check mark if the condition is fulfilled. 
  4. Save the execution and its results.
  5. Get more information (opens the manual, see following section). 

Figure 14

The figure shows the individual test pattern elements. The following points must be checked in detail (according to the standard):

  1. Visibility of the line pair grids with high CONTRAST in the middle and in the four corners of the TEST IMAGE (test pattern element 1)?
  2. Visibility of the 5 % and 95 % fields (test pattern element 2)?
  3. 1) In the white and grey field:"QUALITY CONTROL" for all room classes
    2) In the black field:
      i) Mammography:"QUALITY CONTROL".
      ii) RK1 (? 50 lx):"QUALITY CONTRO".
      iii) RK2 (? 100 lx):"QUALITY CONT".
      iv) RK3 (? 500 lx):"QUALITY CON" (test pattern element 3)?
  4. Visibility of the borders and lines of the raster and the centering of the raster in the active area of the Display (test pattern element 5)? 
  5. Continuity of the appearance of the gradient bars (test pattern element 7)?  

Photo documentation

Warning

The photo documentation feature is expressly not permitted for diagnosis or treament decisions. 
This feature isn't enabled by default. It is only avaible for evalution purposes. If you're interested in taking part of the evaluation, please conctact your mbits support staff. 

When the feature is enabled for the current user you'll see an extra tab for the photo documentation and a button in your inbox to open the camera. 
By pressing on the camera button (Point 2) you'll open the camera and be able to capture all the photos you require. A photo documentation workflow will be like the following

  1. Take pictures
  2. Select photos that should be assigned to a patient or order
  3. Select the bodypart which reflects the content of the photos
  4. Select a patient or order
  5. Add more information to the photos (key wording)
  6. Confirmation

Figure 17

  1. Go to the Photo documentation tab
  2. Open the Photo documentation camera

Camera

When you've captured all the photos you need press the the photo stack (Point 2) to continue to the review process.

Figure 18

  1. Shutter button to capture a image
  2. Image stack of taken images. Click to return to gallery.
  3. Enable or disable autofocus

Photo gallery / Review

The review gallery displays all the photos that you have taken so far ordered by their capture date.

Figure 19

  1. Navigation bar shows current progress and allows you to go to a step by tapping on it. By doing that you can only go to a previous step
  2. Select button to enter image selection mode.
  3. Click on a thumbnail in order to view a image.

Figure 20

  1. Click on a thumbnail to add the image to the selection.
  2. Button to select a row of images.
  3. Cancel selection mode.
  4. Deletes the selected images. Deleted images can not be restored.
  5. Confirm selection and go to the next step.

Danger

Be careful and do not delete images by accident. Deleted images can not be restored.

If you want to inspect an image more detailed you can enter the photo view by clicking the target photo. Inside the photoview you get a fullscreen overview of the image. In this mode you can perform all the transform operations that are already known from the regular viewer (panning, zoom). By clicking the next or previous (Point 2)  button you can navigate between the images.

Figure 21

  1. Go back to the image gallery.
  2. Switch between images. You can also use a swipe gesture to move foreward / backward in the image stack.
  3. Deletes the currently opened image. Deleted images can not be restored.
  4. Shows the date and time the image was taken.

Danger

Be careful and do not delete images by accident. Deleted images can not be restored.

Bodypart

In the next step you are asked to to select a bodypart to which the selected photogroup belongs to. The selected bodypart defaults to "Unspecified" and is displayed in a label (Point 4). To select a bodypart just press on the human. To switch between front and back view you can press the corresponding button (Point 2). For navigation purposes you it's displayed which side is left or right (Point 3).

Figure 22

  1. Body part selection. Click on a body part to select it.
  2. Rotates the body part selection so you can select parts on the front and back of the patient.
  3. Shows the correct direction relative to the body part selection.
  4. Shows the name of the currently selected body part.
  5. Confirm the selection and proceed to the next step.

By tapping on the next button you will continue to the orderview.

Order view

In this page all patients and unprocessed orders are displayed. Each order/patient are displayed with the necessary information to identify them (Point 1). To filter all the entries you can use the search field in the top (Point 3). To scan a QR or Barcode you can use the corresponding button below the search field (Point 4).

Figure 23

  1. Shows patients that are registered in the system.
  2. Shows orders that are registered in the system.
  3. Filter input to filter the displayed results.
  4. Search patient or order by scanning a bar code containing the patient or order id.
  5. Shows when the last updateor order id has been made.
  6. Add a patient to the system by manually entering the correct information.

By clicking an order/patient you'll proceed to the confirm. If there is no order and no patient that fits your case you'll want to add the patient manually with the add patient button (Number).

Patient form

If you have decided to manually add the desired patient, the following view will open. The required tags for the patient are displayed at Point 1 and setup by your pacs administrator. Make sure to enter the correct information before proceeding to the next step.

Figure 24

  1. Input fields for the patient information defined by your PACS.
  2. Confirm the input and continue with the next step.

Confirmation step

In this step you have the ability to review your assigned photos one last time and to add additional tags to the order that can help with identifying the order at a later stage. (The keywording must be configured at the server to be available, please contact your administrator or mbits support)

Figure 25

  1. Preview of the added images and patient information.
  2. Selecttion of further tags and information for the order.
  3. Confirm inputs and proceed.

Assigned view

This view is the default view when you press the photo documentation tab in the top. It is an overview that lists all unassigned photos, pending orders and completed orders. By pressing the unassigned photos (Point 1) you'll proceed into the review gallery where you can assign those photos like already described above. The list of pending orders (Point 1) are the orders that have not yet been confirmed by the server. This can be caused by no internet connection or that the server is still processing those orders. The completed list (Point 2) shows all orders that are known to be completly processed. By pressing the "Clear completed" button (Point 3) those orders are not shown anymore to you.

Figure 26

  1. List of pending orders that are uploading or waiting for approval.
  2. List of completed orders.
  3. Button to clear the list of completed orders.

Messaging

With the messaging function (Figure 17) you are able to send and recieve messages and datasets/key images to your contacts and groups. 

Figure 27

The screen provides the following functions: 

  1. Click to open the chats with a contact.
  2. Click to open the chat of the chat room for group Radiology
  3. Preview of the last messages in the chat.

Chat

Just as known from other messaging applications it is possible to send and recieve messages (Figure 18). Additionally it is possible to share series, key images and sending audio messages. 

Figure 28

This screen provides the following functions: 

  1. Back to the overview.
  2. Chat course: Available series and key-images (key icon above the preview image) can be opened by clicking it. Please notice: If you have no access rights for an image a corresponding error message will be displayed.
  3. Input field to type your text messages. By clicking the 'microphone' button you can stard recording your audio message and send it to the reciever (see chapter 'audio messages').

Photo messages

In addition to text, pictures can also be sent to contacts. This is possible by clicking on the photo camera icon, which is to the left of the text field (see Figure 19).

Figure 29

Figure 30

The above figures illustrate the following functions:

  1. With this button, you will be taken to the photo capture preview, where you can take a photo and send it.
  2. You can open or download a photo by clicking on the message. Whether a photo has not yet been downloaded is indicated by a rough photo resolution and a centered download symbol. As soon as a download is triggered, its progress is indicated by a green progress bar in the lower half of the photo. By pressing and holding the photo you can also share it with other contacts. Therefore you need to click on the appearing share button (see figure 5, item 2).
  3. Use this button to return to the chat history from the photo capture preview.
  4. This button triggers a capture and sends it to your selected contact. You'll be back inside the updated chat history.

Info

In the case of photo messages, there is no access to the private photo memory or the gallery of the device. The photos are only managed and stored internally by and within mRay.

Audio messages

Additionally to text messages you can also send audio messages. Simply click the microphone button, which is located at the opposide of the input field on the chat screen (see Figure 21).

Figure 31

The upper figure visualizes the following functions:

  1. The flashing 'REC' symbol will show up when you are recording an audio message.
  2. The time readout shows how long the record is until now.
  3. By clicking the close button you can cancel the message.
  4. The oscilloscope shows the volume in discrete time steps while you record.
  5. You can take a break from recording by clicking the 'pause' button and continue to another time. By clicking the 'pause' button the icon will change to a microphone, which you need to click if you want to continue.
  6. As soon as the recording is completed you can click the 'send' button to the reciever.

Notifications

mRay informs users about new datasets and messages. These notifications will appear in the center of the upper edge on the screen when the application is opened, or as a system notification (just like recieving a SMS, see Figure 24) when the application is running in background (Figure 23, Item 1). The number of new arrived datasets and messages will be displayed as badges on the corresponding tab symbols of the inbox and the messenger (see Figure 22). You may change the types of notifications in the settings menu.

Figure 32

By clicking the notification you will open the application which will switch automatically to the relevant spot (for example to the messages).

Figure 33

Figure 34

Info

The notifications do not contain patient data or contents of messages to provide protection and privacy as good as possible.  

Search

With the search function you can search the database of your mRay server quickly and easily. The results list shows records matching your search criteria. The search results can be moved to the inbox using the Download button. You can also view records directly in the search or simply share them with a colleague. Note that, of course, only those records appear that you have been granted access rights to. If the desired data record does not appear in the list, it is possible to make a corresponding request via one or more connected PACS. The search fields can also be customized to suit your needs.

Figure 35

  1. You can specify your search criteria here
  2. The search fields can be customized by pressing this button
  3. Send the search query to a PACS (available if your mRay server is configured accordingly)

The search fields can be customized and the following fields are available for selection:

  1. Patient ID
  2. Patient name
  3. Birthdate
  4. Study description
  5. Studies from (date and period of study)
  6. Modality
  7. Referring Physician
  8. Station (DICOM Tag Requesting Service)
  9. Accession number

Figure 36

Notes on the PACS Search

  1. If you want to search by first name and surname, please use the notation "surname^first name". 
  2. Make sure that you limit your search as much as possible. In this way you will quickly receive a search response and avoid possible wrong results.
  3. The PACS results list is also divided into studies / series. You can request the corresponding entry from the PACS at any level.
  4. With the download button on the left side of an entry, you can request the study/series from the PACS. Please note that it may take some time to transfer from the PACS to the mRay server and finally to your device.

Please note the following general information on the PACS search 

    mRay forwards your input to your PACS. So if you want to use so-called wildcards (*/?), you can do the same as from your usual PACS environment. Only the wildcard character "*" is appended to the name field by default. If you do not make an entry, the field is ignored during the query. 

    Favorites

    In the favorites tab your bookmarked datasets will be enumerated. They will be viewed just like in the patient list. You can also remove them from your favorites (see chapter Inbox).

    Viewer

    Selecting a series will open the viewer.

    Figure 37

    The following functionality is available:

    1. Switch back to the inbox/patient list with the inbox button .
    2. Adjust level window presets with the 'Level-Window'-Button.
    3. Hide all information and interaction tools button .
    4. The view shows the image data. The tools allow you to interact and adjust the image.  You can always use the two fingers to zoom in/out, except of you turned on 1:n zoom.
    5. Information about the patient, study, modality, level window, compression and image layer.
    6. Split button and close buttons to manage multiple views (up to 2 on smartphones, 4 on tablets).
    7. The "Close"-Button moves the viewer to the background.
    8. 'MPR-modality'-button to change the view modality. Read more
    9. Measuring scale to quickly estimate sizes.
    10. The scrollwheel allows the user to scroll trought a series.
    11. The scrollbar allows the user to scroll trough a series.
    12. Opens the tool and interaction menu

    Series- and key image buttons

    The series- and key image buttons only appear when there is another series or keyimage for the current series. 

    Figure 38

    1. Go to the previous series in the study.
    2. Go to the next series in the study.
    3. Go to the next key image for that study.

    Interactionbar

    The Interactionbar offers tools and functionality to interact with the currently open image (Figure 30). It contains a toolmenu button (1) and a scrollwheel (2) to navigate trought 3D datasets. The toolmenu button shows the currently selected tool. 

    Figure 39

    The scrollwheel allows you to scroll trought a series image layers. You can interact with the scrollwheel by tapping the arrow keys for next / previous slice or scrolling the wheel with your finger. By releasing the wheel it will instantly stop.

    Scrollbar

    The Scrollbar (Figure 31) allows you to change the currently viewed image slice, like the scrollwheel. In difference to the scrollwhel, the scrollbar's layout instantly indicates where you are in the image slice stack. Depending on your view rotation, the scrollbars top/bottom or left/right edge symbolize the beginning/end of the dataset. There are two different scrolling modes:

    • Relative: If you are tapping the scrollbar at a position of your choice and start to move, you will scroll trought the image slices based on your scroll speed. The finger movement is not synchronized to the scrollbar handle position. The scrollspeed is adjustable by increasing/decreasing the distance of your tap to the scrollbar while scrolling.
    • Absolute: In order to activate this mode double tap on the scrollbar. While this mode is active, changing the position of your finger will change the position of the handle directly. By releasing the touch the scroll behavior switches back to relative.

    Figure 40

    MPR views

    The MPR views allow you to open up multiple views at once (Figure 32). Following screenshots show the MPR view: 

    Figure 41

    The Screenshot shows the original view of a dataset, the locally computet reconstructions (MPRs) and information to the viewed dataset. 

    1. Add more views here. The maximum number of views is 2 on smartphones and 4 on tablets .
    2. Inidication of the current view direction in relation to the original image stack. You can change the view direction by pushing this button .
    3. Use this button to synchronize views

    You can change the perspective with the MPR perspective button (Point 1). This allows you to switch between the different modailitys and a 3D reconstruction. The buttons in the top right corner (Point 2), allows you to open or close a view. If there is more than one view, a button to synchronize view adjustments will appear.

    Info

    The 3D reconstruction shows planes of the currenlty open views.  This view will only contain contents if there is at least one open MPR view. Smartphones can only open up to 2 views and can not use the 3D reconstruction.

    In order to interact with a view you have to select the appropriate view first. In order to do so, just tap on the view. The selcted view is marked by an orange border. 

    Warning

    mRay allows you to load different datasets in different views. After opening a new view, you can open another series by tapping on the inbox button. It is also possible to view two different patients at the same time. To prevent a confusion between different patients a permanent warning is shown.

    Toolmenu

    Figure 42

    You can select the following tools from the toolmenu (Figure 33): 

    • Interaction
      • 'Level Window': With the level window tool you can modify the grayscale values and brightness of the view. (Viewcontrol).
      • 'Panning': The panning tool allows you to pan, increase and decrease the size of the image.  This tool is selected by default
      • 'Thickness':Maximum intensity projection (MIP).View multiple slices at once (slices are superimposed). A maximum of 12 slices can be superimposed on each other.
    • Tools
      • 'DICOM Cine': Allows to play DICOM Cine files. Is only available for 3d datasets.
      • 'Zoom': Zoom the image in and out in the preselected 'FREE' mode. By tapping the tool it will zoom the image to one of the prefabricated zoom levels in the following formats: 1:1, 1:2, 1:4 and 'REAL' (which provides a life size enlargement).
      • 'Create report': Open a dialog to create a structured report while viewing the image. This report will then be uplaoded to the PACS if this feature is included in your license.
    • Annotations
      • 'Measurement': Create measurements on a slice of the image data set.
      • 'Note': Place a note on a slice of the image data set.
      • 'Arrow': Place an arrow on a slice of the image data set to highlight important regions.
      • 'Region of interest': This tool allows to mark a region of interest with an elliptical selection which shows information about the selected region imagedata.
      • 'Angle': Place an angle measurement on a slice of the image data set.
      • 'Remote angle': Allows to measure an angle (like the angle tool) between two lines.
      • 'Length ratio': Show the length ratio between two lines.
      • 'Segmentation': Create a manual segmentation. 
      • 'Save keyimage (to PACS)': Saves the current view with all Annotations. The original dataset will not be touched. Optionally the keyimage will be uploaded to the PACS if your license supports the 'PACS upload' and it is properly configured.
      • 'List of annotations': Contains all annotations you added to the image. By selecting an annotation in the list you'll get the opportunity to rename or delete the annotation.

      Info

      The currently selected tool is saved across studies.

      Level-Window presets

      mRay allows you to create presets for the Level-Window tool. These can be selected from the Level-Window menu (Figure 34, right: In editmode). Please note: These presets are saved to the device and are not synced to other devices.

      Figure 43

      1. DICOM: Sets the level window to the settings set in the DICOM tags.
      2. FULL: Set the level window to the full spectrum of grayscale values.
      3. INVERT: Like full, but inverted.
      4. Tap: Sets the level window for the view. Hold: Selection of Preset(s)
      5. Creates a new preset.
      6. Select one or more presets.
      7. Delete the selected preset.
      8. Edit the selcted preset (Figure 35).
      9. Move preset up/down.

      Figure 44

      Annotation menu

      The following button (Figure 36) will appear in the toolmenu if the user has created any annotations.

      Figure 45

      1. Opens the 'List of annotations' window (Figure 37)

      Figure 46

      1. A single tap selects and jumps to the annotation. Tap and hold will open the annotation submenu (Item 2,3).
      2. Deletes the selected annotation.
      3. Edit the name of the currently selected annotation.

      Text annotations

      The note tool creates text notes in the current slice image. Notes can be edited by double tapping on them. Notes can be selected by tapping on them or selecting them in the annotation list, like measurements. You can move the selected Note with one finger. You can delete notes and measurements from the annotations menu.

      Figure 47

      Measurements

      The measurement tool allows you to create measurements on an image slice. The display length is rounded to one digit after the comma. The inserted measurement can be adjusted by 'Pinch-to-Zoom'. Alternatively you can adjust booth ends separately. In order to do so you have to tap on the transparent circles at the end of the line. You can create as much measurements as you want in one image. You can reselect a measurement by tapping on it or selecting it from the 'List of annotation' window.

      Figure 48

      Attention

      The measurement information is read out the data send by the PACS. Missing or corrupted spacing data could lead to wrong measurments. Should you encounter problems with wrong measurements there could be an issue in the modality setup of the image data. Please consult the appropriate IT-Support. 

      In 2D-radiographs the measurements show the size like it would be shown by the X-ray detector. Keep in mind that measurements show the size of the projection and not the physical size of a structure! This also applies to the 'REAL' zoom mode!

      Angle tools

      The angle tools allows you to create an angle in the current image slice. The angles lines are adjustable in their length and direction so that you can modify the angly by your needs. You can move the whole angle by tap and hold the intercept point. The angle can be deleted from the annotation menu. 

      Figure 49

      Beside the normal angle tool there is the remote angle. While the normal angle is a real angle, the remote angle calculates the angle between two lines without a crossing point. Beside that, it can be used like the normal angle tool.

      Figure 50

      Segmentation

      You can use the "Segmentation"tool to insert a manual segmentation into a layered image. After activating, circle the object to be segmented with your finger. The annotation can then be adjusted. The segmentation points can be easily moved or deleted with double tap. New points can be added by' +'. On the side of the segmentation there is an additional information text which contains the following calculated values for the pixels in the segmentation:

      • area: Segmented area (optional if image spacing is correct).
      • count: Number of pixels inside the ROI.
      • min: Smallest selected greyscale value.
      • max: Biggest selected grayscalwe value.
      • avg: Average grayscale value of all selected pixels.
      • stddev: Average spread of all grayscale values from the average grayscale value.

      Figure 51

      Please note the following:

      • If the measured data set is a color image, the mean value of the color channels is used per pixel for calculating the above mentioned values.
      • Pixels that are not included in the segmentation are determined by the following rule: If a pixel is completely within the segmentation or if it is cut through the contour of the segmentation, it is considered as part of the segmentation. Thus, the pixel center does not play a role in determining the inclusion.
      • A decimal place is used to display the measurement accuracy (exception: count).

      Region of interest

      With the 'Region of interest' feature in the toolmenu you are able to add a region of interest (short: ROI) to an image or a slice. After adding a ROI it is activated by default and ready for individualization. The ROI can be moved by tapping the cross in the middle of it and dragging it around. By using the two touch handles (white, transparent circles at the edge of the ROI) you are able to shape and rotate the ROI. On the opposide of the touch handles you'll find the following information:

      • area: area (optional if image spacing is correct).
      • count: Number of pixels inside the ROI.
      • min: Smallest selected greyscale value.
      • max: Biggest selected grayscalwe value.
      • avg: Average grayscale value of all selected pixels.
      • stddev: Average spread of all grayscale values from the average grayscale value.

      Figure 52

      Attention

      • If you are using a coloured dataset, the above mentioned average will be calculated by all color channles of the image.
      • The ROI will select all pixels that are either contained or hit by the ROI selection.
      • Measurements are rounded to one digit after the comma (exception: count).

      Create report

      If your server license includes the structured reporting feature then your are abel to create textual report within mRay. By tapping the 'create report' button in the toolmenu you are able to create a DICOM Structured Report, which will be added to the current study and saved to the PACS (if the PACS upload feature is included in your server license).

      Figure 53

      1. This will save the report. After saving it to the PACS it will be added to the study.
      2. If you want to close the report window without discarding the currently written text you can easily hide it with this button. The 'create report' icon will appear in the lower right corner of the screen. By tapping the icon the report window will be reopened.
      3. To minimze the window tap this button. Please note that the current report stays in progress and the text will still be available.

      You can reopen the minimized input window by pushing button (1) in the interaction bar.

      Figure 54

      Overlay Menu

      mRay supports the display of DICOM files with up to 16 overlay masks. These overlays can be switched on and off separately via a menu in the viewer. It is also possible to assign a freely selectable color and transparency to each overlay.

      Figure 55

      1. Displays the overlay with color and label information. With one click you can switch the respective overlay on or off. To adjust the color and transparency, press and hold the button for a short time. 
      2. Here you can set the color and transparency for the overlay. 

      Notes

      • Please ensure adequate light conditions when operating mRay.
      • Please ensure a clean display while operating mRay.
      • Only use mRay in stress-free situations in order to ensure correct use.
      • Please note that mRay does not visualize left or right in datasets.
      • Please ensure that the system clock and time are correctly configured.
      • Please ensure that your device is secure against electromagentic rays before using mRay in a magnetic resonance imaging room.
      • Please ensure that you are using the latest version of mRay after reinstallation of the application.

      Frequently asked questions – FAQ

      • Why do some datasets have the red tag „resolution reduced by xy%“? The application supports pictures up to 4096*4096*4096 pixels. Larger datasets will be downsize. The percentage value describes the factor by which it was downsampled.
      • Why do some datasets have the green tag „JPEG”? Those datasets are transferred by employing JPEG compression (according to the Konsensius-Conference [Loose et al. 2009]).
      • The patient list does not show all datasets. Why? Please check if there are still letters in the search field. If so, please delete them.
      • Why are no results shown after performing a query search to my PACS, although the patient is listed in my PACS? Some PACS distributers require a case sensitive search. Searching for “smith” will not lead to a result list as searching for “Smith” does.

      Known issues

      The list of known issues leads to problems identified after the release of the latest version of mRay. These problems, however, were classified as non-critical, so that an unrestricted working with the application is possible.

      1. Pseudonymization of images is not applied to the burned- in pixel data information. Please communicate this fact to the users to ensure that the data is sent only to pools for which Pseudonymization is turned off.
      2. Form fields for floating point numbers within the configuration application only accept values in english format, i.e. with a point as a delimiter.
      3. The auto-download setting Wifi/Mobile is not applicable for the Windows version of mRay client app.
      4. The image retrieve status information can sometimes hang at 100% until the image is finally retrieved.
      5. Multi touch gestures might trigger a button press event if they end above a button. This will happen altough the gesture is recognized as intended.
      6. With Android 6.0.1 and higher it is possible, that the application crashes in some infrequent cases if it is running in background mode. The application then shows a black screen and can not be operated anymore. It will be usable again as soon as it is terminated and restarted, which means you need to remove it from the overview of the running apps.
      7. The Windows desktop client application may show a blank icon in the taskbar for a short time.
      8. Creating DICOM Structured Reports does not work with non DICOM files.
      9. In rare cases it takes a little more time as usual to log in, if the device was just approved by the administrator.
      10. The new Android 7 splitscreen mode will lead the application to crash, if it is displayed in a splitscreen.
      11. The camera on a MED-TAB v2 does not focus correctly.
      12. Emojis in text fields can behave unexpectedly.
      13. A global cache path to a network drive can cause problems (concerns mRay server only) 
      14. A MED-TAB v1 shows artifacts in overlay images when hardware-side DICOM mode is enabled.
      15. The initial layout of a photo in the chat can be wrong.
      16. Automatic memory management on the mobile device may be incorrect if several mRay accounts are used on the device. Although the data is no longer accessible, they are not deleted under certain circumstances.