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Open Annotator

Copy the link that you were given into Google Chrome Browser to open up your specific project and exams. You should have gotten an email invitation.

Your first annotation

Click on a label to activate it. You will see a bar across the top of the image area showing the name and type of the active activation and also a button to inactivate it. All mouse / trackpad functionality works for that active label (instead of the usual scrolling or window / level functionality).

If it’s inactivate, it can’t be drawn or modified. Colored tags show up on the bottom of the image showing the team member who did the annotation. You can also add a note to any individual annotation to indicate special circumstances.

If the annotation uses a Global label, you’re done and ready to go to the next case.

If the annotation is Local, you would use your cursor to draw the appropriate annotation. When you are done, you can edit the annotations by grabbing and moving the entire shape, moving individual points, or moving the sides of a bounding box.

When the annotation is to your liking, you can either click inactivate on the bar above the image or just go to the next Image. Saving is automatic.

If you want to do some more editing on an annotation, just click on its tag at the bottom of the image or click + shift on the annotaion itself and it will become active again and available for editing.

Brief Freeform Annotation Video

Mask Video

Mask annotation mode allows multiple shapes to be drawn on the same image. The drawing tool includes pencil width and shape as well as an eraser for corrections. Undo and Redo will remove/reinstate the last drawing or erasing action.

Image Manipulation

You can zoom, pan, and change the contrast and level using your mouse, trackpad, or with keyboard. Specific instructions are seen by clicking the mouse and keyboard icons in the Navigation column. There are buttons above the image to change the contrast and level values. You can use the preset buttons, keyboard shortcuts for CT scans, or select custom values with the window /level sliders.

Applying Multiple Labels

Applying different labels on the same image

Apply each label, one by one, and the bottom Annotations toolbar will indicate all the labels applied on that image.

Applying the same local label multiple times

Applying the same local label multiple times works the same way. Just click on the same label again to apply the label on the image again.

Remember that keyboard shortcuts (Alt-1 to Alt-9) are available to quickly apply a label.


Freeform shapes, polygons, lines, boxes

Can be used for bounding boxes, shapes, and image level labels to automatically add labels on images between anchor frames.

  • Draw a box or freeform shape or polygon or line
  • Click Add Frame
  • Skip a few images and draw another box/shape/etc
  • Click Add Frame again
  • Repeat until you have as many frames as you like
  • Finally click Interpolate and the boxes/shapes/etc in between will be drawn as a smoothed average between the anchor frames

Image level labels

Similarly for image level labels,

  • Label the first image where an entity is seen
  • Click Add Frame
  • Label the last image showing the entity
  • Click Add Frame again
  • Finally click Interpolate and all the images in between will be labeled automatically

If you make a mistake, you can use Label Controls to bulk remove.

Boxes and Shapes


Image Labels


Bulk Remove

If you have many labels that you would like to remove and possibly redraw. Use the Bulk Remove option.

  • Use Label Controls to select Select labels to BULK REMOVE associated annotations
  • Pick the scope for deletion, either image, series, or entire exam
  • Click the Bulk Remove button and the annotations will be deleted

Copy Annotations To Next Image

To copy an Active annotation quickly to the next image in an exam, use the Copy Annotation button in the toolbar above the image view.

Increase Size of Viewing Area

  • Hide Dicom with Layers Control button
  • Make all columns narrower by clicking on headers
  • Zoom in on image
  • But best of all - use Fullscreen mode with toolbar button or keyboard shortcut

Keyboard Shortcuts

Use the keyboard icon to view the shortcuts for your operating system. Shortcuts will speed up the annotation process.

Clean up Display

Hide or show dicom information, annotations, notes, measurements, and model outputs.

Use the Filter Label Group toggle to only show annotations in a specific label group.

Label Notes

Simple text nodes can be added to each annotation. To add a note, click on the [+] for an applied label at the Annotations toolbar below the image

Notes can be added and viewed by all collaborators. Radlex tags can be added as well.

Label Owner

On the Annotations toolbar below the image, the owner of the label is indicated by the owner's avatar. Hovering over the label will also show the owner's name and avatar.

Radlex Tags

Radlex coding tags can be added to global and local labels in order to use standardized terms for labels. They can also be added to notes.

Label Thumbs Up or Thumbs Down

Clicking on the Thumbs Up icon on the label tag will add a Positive Review to the label. Conversely, clicking on the Thumbs Down icon will add a Negative Review