Cardiac MRI user guide

1.1 Open your first study

1. Open the KCMR Studio application in a current desktop browser. For the hosted pilot, use the protected /app/ address provided by the administrator.
2. Read and acknowledge the first-use research notice. The notice appears inside the application and must be completed before using the workspace.
3. Select + Open study ZIP to choose a ZIP archive containing the DICOM study, or choose Open folder (local) to select an unpacked DICOM folder.
4. Wait until the study navigator has indexed the series. Select a series on the left to display it in the active viewer.
5. Use 1×1 for routine review, 2×1 to compare images, Tiled to survey several sequences, or MPR for suitable volumetric acquisitions.

First-study checklist: verify patient details and scan date; confirm cine playback and slice order; assess the study's completeness; review auto-generated contours before accepting any result; save your work before closing the study.

1.2 Recognise the workspace

The study navigator (left) lists available sequences and patient information. The image workspace (centre) displays the selected images. Tools & results (right) contains measurement, volumetry, flow and reporting controls. You can change the active image by selecting a viewer before choosing a sequence.

1.3 Browser and mouse recommendations

Use an up-to-date desktop browser, ideally Chrome or Edge, with a mouse or trackpad. The controls are designed for comfortable use at a desktop-sized screen. Performance depends on study size, image compression, hardware and background activity.

If the application appears unresponsive on first use, check whether a browser privacy extension or popup blocker has hidden the first-use notice. Do not disable browser security globally; allow the application to display its notice, then reload.

2.1 Import a study ZIP or DICOM folder

• ZIP: Select + Open study ZIP or drag a study ZIP onto the application window. You do not need to extract the ZIP first.
• Folder: Select Open folder (local) and choose a folder containing DICOM files. Some browsers display a standard message using the word “upload”; KCMR Studio is designed to read the selected files for local viewing rather than upload the image data to the KCMR server.
• Large studies: Allow indexing to complete before judging series availability or image ordering. The study navigator will populate as the study is prepared.

The browser pilot opens one study at a time. Close study clears the current workspace. Save analysis first if you need to retain measurements or report edits.

2.2 Use the study navigator

Select a sequence by clicking its name. The default ordering is Acquired time, so the navigator follows the scan's acquisition order rather than grouping everything by type.

• Search sequences finds names or descriptions.
• Order changes between acquired time and sequence type.
• Filter shows categories such as Cines, QFlow, LGE, T1 maps and T2 maps.
• Unviewed only reduces the list to sequences you have not yet opened.
• Ctrl-click selects multiple sequences for a tiled comparison or for manual stack pairing/merging where available.

Some closely related short-axis series are presented as a combined LV Volumes stack. If a study has genuinely separate but compatible ventricular acquisitions, use Merge stacks after selecting the relevant entries. Verify slice coverage and orientation before measuring volumes.

2.3 Check image and study details

Review the patient demographics in the left pane and the DICOM tab in Tools & results. Image-derived study data may be incomplete or incorrect; confirm the acquisition date, sequence identity and patient measurements before generating indexed results or reports.

3.1 The four viewing modes

The tools are contextual. For example, selecting LV Volumes opens the LV/RV tools, while selecting a recognised QFlow series opens paired anatomical and velocity-phase images.

3.2 Navigate slices, phases and series

Move the pointer over the viewer you want to control. Left/Right changes cardiac phase; Up/Down changes slice; PgUp/PgDn changes series. The mouse wheel scrolls slices, including when Shift is held to hide overlays. For a cine, press Space or select Play in the viewer controls.

A cine should continue when you move to another compatible cine or slice. A single-frame/static series does not automatically play. You can choose the cine target rate (24, 25 or 30 frames/s) from the workspace toolbar.

3.3 Zoom, pan and window/level

• Middle mouse button + drag vertically: zoom in and out.
• Ctrl + mouse wheel or Alt + mouse wheel in the normal viewer: zoom.
• Hand / Pan: drag to reposition the image.
• Right-drag: adjust image brightness and contrast where supported, or use the windowing controls associated with the viewer.
• F: fit/reset the image in the active viewer.
• W: restore its original window/level.
• Shift (hold): temporarily hide measurements and contours to inspect the underlying image.

The active tool and any unfinished measurement return to Hand / Pan after changing to a different series or viewer layout.

3.4 Compare two views and use intersection lines

Choose 2×1 and place a series in each viewer. Where the two images have usable geometry, a dotted reference line can show where one image plane intersects the other. Hold Shift to hide the overlay temporarily.

Use the comparison to identify corresponding anatomical levels, especially when reviewing a short-axis series alongside a long-axis cine. Intersection guides should be checked against visible anatomy if the source imaging has imperfect geometry.

4.1 Open a set of tiles

1. Choose Tiled. The workspace starts empty.
2. Under Tile sequences, choose a type such as Cines, LGE, Perfusion or QFlow. The application automatically opens a set of matching viewers.
3. Alternatively, Ctrl-click individual navigator items and select Tile selected.
4. Select Fit tiles to organise the open tiles. The default image zoom is 140%.

4.2 Work with individual tiles

Drag a tile by its header; resize it using the lower-right grip. Click a tile to bring it to the front. Minimise or close an individual tile as needed; closing a tile does not automatically reorganise the others. Use Fit tiles whenever you want to re-arrange the remaining tiles.

Play all plays all eligible multiphase series, not just those labelled Cine. Pause all stops the active playback. Tiles remain individually selectable and navigable.

5.1 Distance and area tools

Open Measure under Tools & results.

Area is shown in cm², perimeter in cm, and mean signal intensity in the image's displayed intensity units. These general ROIs can be used on suitably calibrated MPR images as well.

5.2 Edit a measurement

Select a completed measurement to show its editable outline and handles. Drag a handle to reshape the boundary. Right-click a selected handle or contour to access the context menu, including deleting a point or removing the contour. Alt-click a handle to remove that point where supported.

Use Delete to remove the selected ROI. Ctrl+Z undoes eligible contour changes; Ctrl+Y or Ctrl+Shift+Z redoes them. Do not rely on Undo to reverse an entire study import or every workspace change.

6.1 Open a ventricular stack

Select the combined LV Volumes or equivalent short-axis cine stack in the navigator. KCMR Studio shows the LV/RV tab and a compact slice-by-phase grid. Each row is a slice and each column a cardiac phase.

For suitable complete LV cine stacks, AI contours can be prepared in the background. Check the subtle processing/completion status in the series navigator. Partial, RV-only or ambiguously combined stacks may require manual intervention. AI output is an initial draft and requires visual review.

6.2 Review the slice-by-phase grid

Click a grid dot to jump to that frame without resetting your chosen phase when moving through slices. Contour status is indicated at marked ED/ES phases. The phase axis also identifies LV and RV ED/ES positions. Right-click grid cells or use Mark ED and Mark ES to correct phase selections when necessary.

Remember to review basal and apical coverage and ensure the same anatomy is included appropriately at end-diastole and end-systole. The software may warn when the extent of LV endocardial contouring differs by more than one slice.

6.3 Draw or correct ventricular contours

Use the coloured contour tools in LV/RV:

• Red: LV endocardium.
• Teal/green: LV epicardium.
• Yellow: RV endocardium.

To draw manually, click several points around the structure and double-click to finish. With a ventricular contour tool selected, Ctrl + left-drag creates a threshold-based contour. The selection appears as a translucent preview while you drag. Release to apply it, then refine the result by selecting and dragging control points.

Contouring overlays are shown as translucent fills during normal viewing. The boundary and points become visible for editing. Hold Shift to inspect the unobscured myocardium.

6.4 Review and calculate results

After verifying ED/ES and contour coverage, select Recalculate volumes if necessary. Available results include:

• LV: EDV, EDVi, ESV, SV, EF and myocardial mass when suitable contours are available.
• RV: EDV, EDVi, ESV, SV and EF.
• BSA: derived from the patient measurements, with a manual override if required.

A compact ventricular-results overlay appears at the lower right of the 1×1 viewer when an eligible LV volumes stack is selected. Sex-specific reference intervals can be displayed in the report when suitable demographic information is present. Verify that the reference convention matches your contouring approach.

Important: a missing contour on every slice is not automatically an error. Review missing basal and apical coverage deliberately; the volumetry calculation is still being evaluated and must not be used for clinical decisions.

6.5 Advanced AI contours

Normally no model selection is required. Open Advanced → AI contours to pause automatic processing, retry an unsuccessful model load, or request a fresh analysis of the current phase, ED/ES or the full cycle.

Manually corrected contours are intended to be preserved when automatic analysis runs again. After any reanalysis, check previously edited frames and the resulting ventricular values.

7.1 Open a flow acquisition

Select a recognised QFlow acquisition from the navigator. KCMR Studio switches to 2×1 with the anatomical image on the left and the corresponding velocity-phase image on the right. Phases should navigate together.

For Philips acquisitions the preferred anatomical reconstruction is the FFE magnitude image; for Siemens it is the original anatomical magnitude image. You do not need to select the reconstruction type during ordinary review if the pairing is unambiguous.

If the wrong images appear or no pair is found, Ctrl-click the appropriate anatomical and velocity-phase series in the navigator, then select Pair selected in the QFlow panel. Check that both views correspond to the same acquisition and cardiac phases.

7.2 Detect and track a vessel

1. In the QFlow tab, select Detect vessel · 1 click.
2. Click centrally within the vessel on the left anatomical view.
3. Review the proposed vessel contour and select Track phases if it has not been propagated across the cardiac cycle.
4. Scroll or play through all phases, watching for drift, sudden shape changes and nearby structures being included.
5. Select and manually correct any poor contour. Re-run Track phases to propagate corrections to other eligible phases.

Alternatively, use Vessel contour to trace an open smooth curve, then double-click to finish. One vessel ROI per phase is shown in both linked views; editing the anatomical contour affects the corresponding phase measurement.

7.3 Read QFlow results

Once a usable contour is present across the required phases and acquisition calibration is available, the QFlow panel can display a flow curve and measurements including forward, reverse and net flow, peak velocity and regurgitant fraction.

The panel includes Read DICOM phase calibration, Recalculate flow and Open flow graph. Select a different acquisition and check that its VENC and other calibration details correspond to that scan. If a required value is missing or uncertain, the calculation may be withheld or identified as estimated.

Always inspect the shape of the velocity/flow curve and the phase-by-phase contour before interpreting the output. Flow quantification in the pilot is not validated for clinical use.

8.1 Choose the long-axis views

In 2×1, load a 4-chamber cine and a second LA long-axis cine, either 2-chamber or vertical long-axis (VLA). Open Measure → LA biplane. If the two view names are ambiguous, identify which pane is 4CH using the view selector.

8.2 Trace and check the LA measurements

1. Select the appropriate cine phase and click Trace LA on active cine.
2. Start at one mitral annular insertion, follow the LA wall around its roof and finish at the opposite annular insertion with a double-click.
3. Repeat in the second view. The annular line closes the base of the LA trace.
4. Check the proposed atrial long-axis length, from the annular midpoint toward the atrial roof, and adjust its endpoints if needed.
5. Review the biplane LA volume and indexed LA volume (LAVi, mL/m²). Verify height, weight and BSA first.

The LA measurement belongs to the active study and can be reopened with saved analysis. Review atrial boundary definition, phase selection and annular landmarks before relying on a result.

9.1 Open the four-plane workspace

Select a suitable 3D series and choose MPR. Four linked panes open, with colour-matched pane borders and corresponding crosshair guides. They start in familiar orthogonal orientations; after rotating, the images are reformatted relative to the new shared plane orientation.

9.2 Move and rotate the cutting planes

Crosshair guides remain visible during the rotation gesture, so you can see how cutting planes move while the other views update. The guide colours correspond to the other planes. Hold Shift outside an active rotation to temporarily hide image overlays when needed.

9.3 Measure within MPR

Use Distance, Smooth area or Freehand area as in the standard viewer. MPR area results can also display area-derived and perimeter-derived equivalent diameters. Always verify the source-image geometry and orientation when interpreting measurements in an oblique reformat.

10.1 Open the report editor

Select Report under Tools & results, then Open full report editor. The report opens in its own editable window with the report's header, clinical findings and footer visible, instead of a plain-text scratchpad.

The default KCMR Studio template contains editable clinical headings and suggested wording. Select Reset template text to restore it when needed. Confirm before overwriting existing report text.

Appearance: the KCMR report draft is displayed in dark navy with readable pale text and cyan section headings. This is an on-screen editing view only; the standalone HTML export and printed/PDF report always use white paper and dark text.

10.2 Complete the template efficiently

• Patient name, date of birth, identifier, scan date and available height/weight can be taken from the loaded study; verify them before reporting.
• Click directly in the document to edit the visible text.
• Unfinished phrases such as xxx and NORMAL/ABNORMAL are highlighted.
• Select Next incomplete or press Ctrl+Enter to advance to the next field requiring attention.
• Use the built-in bold, italic, underline and list controls for formatting.
• Use Update volumes to refresh the LV/RV measurement tables after recalculation, then check the inserted numbers and reference intervals.

Never assume a pre-filled normal statement is correct. Change it to describe the actual observations before producing a report.

10.3 Save or print the report

The editor has Save editable HTML for a locally saved editable document and Print / PDF for browser printing or PDF output. The template pages retain their letterhead and margins on subsequent pages if the content runs beyond one A4 sheet.

Dark mode does not carry through to exported reports. Always check the print preview before saving a PDF: it should remain black text on white pages, with the KCMR logo and report header.

Before exporting, inspect the on-screen layout, demographics, quantitative tables, page breaks, conclusions and signature. Use Save analysis in the main application separately to preserve the study's measurement and report session.

11.1 Save an analysis file

Choose Save analysis in the top toolbar. The browser downloads a password-protected local KCMR analysis file containing annotations and report information. The source DICOM images are not embedded in this file.

Keep the password and file in an appropriately protected location. KCMR Studio cannot recover a forgotten file password.

11.2 Reopen a previous analysis

1. Open the original DICOM study or study ZIP.
2. Choose Open analysis and select the corresponding local analysis file.
3. Enter its password when prompted.
4. Verify the study, contours, measurements, results and report before continuing.

Closing the browser or refreshing the page may clear unsaved image analysis from memory. Close study ends the current session; save anything needed first.

11.3 Where information is stored

The pilot is designed to process study images within your browser rather than upload them to the KCMR application server. Locally saved analyses and PDFs remain on the computer where you save them. Browser settings and cached resources may persist across sessions.

The hosted pilot requires an internet connection to sign in and load the application. When enabled, AI resources are loaded from the same protected KCMR site. For now, use synthetic or appropriately de-identified data and comply with your organisation's information governance requirements.

12.1 The page loads, but I cannot click anything

Check whether the first-use disclaimer is open or has been hidden by a browser blocker. Reload the application, complete the acknowledgement and try again. If necessary, temporarily allow KCMR Studio's own dialogs; do not disable general browser security.

12.2 A DICOM series is missing or does not display

Confirm it appears in All series rather than a filtered view. Wait for study indexing to finish. Check the DICOM tab and try a different series. Some compressed or unusually encoded DICOM images may not be supported in the current pilot. Record the series description and displayed error for the development team; do not repeatedly upload identifiable datasets to troubleshoot.

12.3 Cine playback is slow or stutters

Allow initial frame preparation to finish before pressing Play again. Try a single 1×1 viewer rather than many simultaneous tiles, close unrelated browser tabs and test the 24 or 25 fps setting. Complex studies may require more memory and processing capacity.

12.4 LV volumes are missing or the wrong stack was selected

Check that the stack contains the intended range of ventricular slices and phases, including its basal and apical coverage. If acquisitions are split, use Merge stacks only for compatible parts. Check Advanced → AI contours for processing status and Retry AI loading if the model did not initialise. Recalculate only after verifying the accepted contours and ED/ES phases.

12.5 A contour is difficult to edit

Select the intended contour first, then drag a visible handle rather than the translucent area. Zoom in to increase precision. Right-click for point/contour deletion options, or use Ctrl+Z to undo an unsuccessful edit. Hold Shift when you want to inspect the image without the contour overlay.

12.6 QFlow opens the wrong paired images

Check that the left pane is the anatomical cine and the right pane is velocity phase, with the same cardiac phase count and corresponding anatomy. Ctrl-select the appropriate anatomical and phase series and choose Pair selected. Recheck VENC and other flow settings after changing acquisitions.

12.7 QFlow tracking drifts or produces an implausible shape

Start with a clear vessel cross-section, use Detect vessel · 1 click near its centre, then inspect all phases. Correct inaccurate frames manually and select Track phases again. If a contour remains anatomically implausible, do not use its quantitative output.

12.8 MPR crosshairs do not match the anatomy

Use Reset planes, reselect a suitable 3D volume and reposition the linked crosshair. Confirm that your click occurs within the reformatted image. MPR depends on consistent source-image geometry; some acquisitions may be unsuitable for accurate reformatting.

12.9 The report contains placeholders or unexpected measurements

Use Next incomplete (Ctrl+Enter) to inspect unfinished text and NORMAL/ABNORMAL alternatives. Verify the demographics and BSA. After correcting volume contours, use Update volumes and review the tables. Check the printed PDF before saving it.

12.10 My work disappeared after a refresh

Unsaved analysis may be cleared when the browser reloads. Reopen the original study and load your saved .kcmr analysis file. Save regularly, especially before reloading, changing computers or closing a browser tab.