mRay^® 6.9 - Instructions for Use

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. In a worst-case scenario the medical condition of the patient may be critical.

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 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), digital x-ray (CR), ultrasound (US)). The software offers common radiological software tools (e.g. windowing, measurements, thick slices and annotations).

Furthermore mRay is capable of performing image processing tasks such as finding, visualizing and quantifying anomalies in tissue. In particular the image analysis module mRay VEOcore may be used to perform an automated processing of brain images from imaging modalities such as CT, CT-Perfusion, or MRI including a Diffusion Weighted Imaging (DWI) Module. As a result, changes in contrast over time are visualized as colored perfusion maps, including flow related parameters and tissue blood volume quantification.

mRay may not be used in Germany on a calibrated mobile device if reporting has to be performed for a x-ray image (CR) or mammography (MG). Reporting may be performed on a regularly calibrated monitor ("Bildwiedergabegerät") with the mRay software.

If mRay is used for viewing medical image data it can be used in the decision process for diagnosis and therapy. The following functionalities allow to do so.

To examine findings in CT images mRay Client is able to visualize images in accordance to the DICOM Grayscale Standard Display Function. By doing so a suitable mobile device is acting as a "Bildwiedergabesystem mit Befundqualität" in accordance with the DIN 6868-157. The constant availability of mobile devices results in time savings compared to stationary solutions.

The perfusion analysis of brain imaging data visualizes and quantifies tissue that is less supplied with blood (penumbra), oxygen deprived tissue caused by obstructed blood flow (core tissue) and the mismatch ratio between the two. The calculated values can be used to support decision making based on an assessment of the extent of tissue damage.

The mRay application is installed via the respective AppStore of the operating system: AppStore for macOS & iOS, Google PlayStore for Android and the Microsoft Store on Windows. Alternative installation packages can be requested from the support team.

A list of installation packages can be found here:

Alternatively the mRay webclient can be used, which runs inside your browser:

The mRay application is automatically upgraded to the latest version via the update mechanism of the respective operating system / AppStore.

The mRay application is completely deleted when the app is removed using the standard procedure for the respective operating system.

For the Magic Mouse setup in iPadOS it’s required to enable right-click by secondary click.

The welcome screen appears as soon as the application has been started (Loginscreen). After deciding whether or not the cloud service should be used, additional text fields for username and password will appear. In the next screen you can then enter your credentials to proceed into the application (see Cloud Login or Own server login). If the login data is correct you will be directed to the main screen of the application. Enter your login credentials to log in.

Use the mRay Cloud service to quickly share and upload your personal medical data.

You can use the custom server login to connect to a mRay Server instance that is hosted by the hospital / medical institution you work at.

A PIN check will be necessary when logging in with an ActiveDirectory (AD) account for the first time. The PIN will be sent to the mail address registered in your ActiveDirectory account. The keyboard can be opened by tapping on the input field (PIN Check). The PIN will be validated immediately after entering the sixth digit.

Follow these steps to enable Two Factor Authentication on your device.

The patient portal appears when you scan a QR code or follow a link you received.

The (Inbox) will be opened after logging in. 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.

By clicking a study inside the Inbox you will get to the series selection (Series).

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

Here you are able to share , mark as favorite or export an individual series. Further actions on a single series can be performed with the Context menu .

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.

The main menu will be opened after clicking the mRay logo (Main Menu).

On this screen you can adjust your settings just as you want.

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

The Lux-Meter can be used to identify the room class of the current environment.

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 (Device notifications) when the application is running in background (In-app notifications, Item 1). That new datasets and messages have arrived, will be displayed as badges on the corresponding tab symbols of the inbox and the messenger (Notification badges). You may change the types of notifications in the Settings menu.

With the search function you can search the database of your mRay server quickly and easily. The results list shows studies matching your search criteria. The search results can be moved to the inbox using the 'Offline available' 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.

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).

Upon clicking on a share icon , a popup for choosing between contacts or a weblink appears.

Various options are available when sharing content via links.

The series buttons only appear when there is another series in the current study.

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

The scrollwheel allows you to scroll through 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.

The Scrollbar allows you to change the currently viewed image slice, like the scrollwheel. In difference to the scrollwheel, 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:

The MPR views allow you to open up multiple views at once ([abbr-mpr] View). Following screenshot shows the MPR view:

You can change the perspective with the MPR perspective button (Point 2). This allows you to switch between axial, sagittal and coronal. The button in the top right corner (Point 1), allows you to open or close a view. If there is more than one view, a button to synchronize view adjustments will appear (see Synchronized Views). In order to interact with a view you have to select the appropriate view first. Therefore tap on the view. The selected view will be highlighted.

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

On devices with a mouse pointer mRay allows some actions to be performed with mouse buttons. See the following list:

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.

A report can either be created manually by pressing the Create report button inside the tool menu (see Toolmenu) or by incoming HL7 orders (please contact your mbits support for this setup). The created draft is created inside the associated studied and is displayed inside the inbox. The draft is visible to all users and can be worked on cooperatively.

When a new draft is created, it’s possible to select a draft template. Depending on the template, different fields are displayed that must be filled in.

After a draft is created it opens right next to the associated series. The patient and study information is filled automatically and the report title is prefilled from the current date. While the report is open it is locked for the current user, which means that no other users can edit it. This avoids multiple users working on the same draft performing conflicting changes.

When you reopen a draft from the inbox you can see the current draft state. You can always open this view even for locked drafts. When the report is locked by another user a closed lock is displayed.

After the draft has been approved it’s not editable anymore and the draft flag is removed. See Final structured report

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

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

To communicate with several people at the same time, it is a good idea to create a chat group (see Messaging). The group members can be selected during the creation process as shown in Group member selection.

After the members have been selected, the new group must be named. The name is then displayed to all group members in the overview. See Name group

After confirming the group name the group appears in the messaging overview. You can edit the group settings by clicking the groupname in the top after opening the chat. See Edit group settings. You can assign a profile photo to the group via the "Camera" icon.

In a group, screen sharing can only be started by a previously determined administrator. For the other participants of the group, the screen sharing starts automatically. In a group only the group administrator can use the voice function.

When you’ve captured all the photos you need press the photo stack (Point 3) to continue to the review process.

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

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.

In the next step you are asked to to select a body part to which the selected photogroup belongs to. The selected body part defaults to "Unspecified" and is displayed in a label (Point 4). To select a body part 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).

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).

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.

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)

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 completely processed. By pressing the "Clear completed" button (Point 3) those orders are not shown anymore to you.

VEOcore is a fully automated image processing tool to calculate quantitative measures of affected brain tissue and healthy tissue. Therefore, this manual covers the instructions on how to interpret the results. It’s an extension the mRay Server application and the results can be viewed inside the mRay Client. Furthermore processed results can be automatically forwarded to the PACS.

VEOcore does not have a user-interface. Data is processed fully automated on reception of DICOM series. All series should be sent in one rush, otherwise the data processing might be invoked multiple times, and result images might appear in the target PACS multiple times.

For MR and CT, the following DICOM images can be sent to the application. For details on series naming conventions as well as compatible and recommended measurement parameters such as slice thickness, repetition times etc. please refer to the Annex.

The following table lists the output which is created by the application. A detailed explanation of all results is given below.

We suggest the following workflow when interpreting the results:

If any unclear issues occurred, consider their impact on the results. Motion and a low or late contrast bolus can lead to false positives or negatives. Take in account if there is any relevant discrepancy with clinical presentation.

The client software is installed on the devices via their corresponding software stores (Apple App Store, Google Play Store) or manually via software packages.

The most recent FAQ can be found under the following link: https://mbits.info/en/mray-faq/

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.