Manual

Spatial OS

1. Spatial OS
1.A Quick start
1.A.1 Running Spatial OS 1.A.2 Connecting your VR headset 1.A.3 Switching between screen and VR view 1.A.4 Connecting a 3D screen
1.1 Activating license keys
1.2 Sidebar
1.2.1 Data 1.2.2 Team 1.2.3 Settings 1.2.4 License 1.2.5 Full screen 1.2.6 Manual 1.2.7 Support 1.2.8 Exit 1.2.9 Reset scene 1.2.10 Light/dark mode 1.2.11 3D screen 1.2.12 Frame rate
1.3 Top bar
1.3.1 VR view 1.3.2 2D screen 1.3.3 Take screenshot 1.3.4 Start recording
1.4 Data
1.4.1 Saved files 1.4.2 Medical Imaging XR 1.4.3 Dissection Master XR 1.4.4 Anatomy Master 2 1.4.5 RecordXR
1.5 Team
1.6 Settings
1.6.1 Application settings 1.6.2 Recordings 1.6.3 TeamXR 1.6.4 Medicalholodeck Link
1.7 Loading models
1.7.1 Active model 1.7.2 Remove model
1.8 Data manipulation
1.8.1 Cut 1.8.2 Scale 1.8.3 Mouse and keyboard shortcuts
2. Medical Imaging
2.1 Importing data
2.2 Editing and viewing DICOM data
2.2.1 Presets 2.2.2 Colors 2.2.3 AI 2.2.4 Quality 2.2.5 Multiplanar reconstruction (MPR)
3. Medicalholodeck AI
3.1 Running a segmentation
3.2 Editing a segmentation
3.2.1 Structure 3.2.2 Options
4. Dissection Master
4.1 Load 4.2 Layers 4.3 Annotations
5. Anatomy Master
5.1 Load 5.2 Hierarchy
6. RecordXR
6.1 Recordings
6.1.1 Download/play 6.1.2 Delete 6.1.3 Description 6.1.4 Export
6.2 RecordXR panel
6.2.1 Play/pause 6.2.2 RXR slider 6.2.3 Export 6.2.4 Mute/unmute 6.2.5 Close
7. TeamXR
7.1 Creating a team 7.2 Joining a team
7.3 Session settings
7.3.1 Users in session 7.3.2 Join audio chat 7.3.3 Session code 7.3.4 Sync model panels and selections 7.3.5 Disconnect

Virtual Reality

1. Medicalholodeck
1.A Quick start
Licenses, navigation, connectivity
1.A.1 Activating license keys on standalone 1.A.2 Activating license keys on PC-VR systems 1.A.3 Hand navigation 1.A.4 Create screenshots and videos (standalone) 1.A.5 Create screenshots and videos (PC-VR) 1.A.6 Connect to Link 1.A.7 Export RXR files on PC-VR and standalone
1.1 Main control pad
1.1.1 Library 1.1.2 Jump 1.1.3 4D Record 1.1.4 TeamXR 1.1.5 Remote Render 1.1.6 Settings 1.1.7 Reset workspace 1.1.8 Undo 1.1.9 Redo 1.1.10 Exit 1.1.11 Capture a movie 1.1.12 Take a photo 1.1.13 Handle
1.2 Object pad
1.2.1 Cutter 1.2.2 Laser 1.2.3 Masking 1.2.4 Measure area 1.2.5 Measure distance 1.2.6 Delete 1.2.7 Scale 1.2.8 Move 1.2.9 Move backward 1.2.10 Frame rate 1.2.11 Remove dataset 1.2.12 Light on/off 1.2.13 Measure angle 1.2.14 Draw 1.2.15 Marker 1.2.16 Rotate horizontally 1.2.17 Rotate vertically 1.2.18 Handle
1.3 Library panel
1.3.1 Saved scenes 1.3.2 Medical Imaging 1.3.3 RecordXR 1.3.4 Dissection Master 1.3.5 Anatomy Master
1.4 Object marker
1.4.1 Lock 1.4.2 Center 1.4.3 UI 1.4.4 Delete 1.4.5 Groups 1.4.6 Cuts visibility
1.5 Lighting
1.5.1 Light 1.5.2 Light marker
1.6 Controllers
1.6.1 Left controller 1.6.2 Right controller
1.7 Settings
1.7.1 Settings 1.7.2 Licenses 1.7.3 PACS 1.7.4 Services
1.8 Link
1.8.1 Device bar 1.8.2 License management 1.8.3 Datasets 1.8.4 RecordXR 1.8.5 Presets 1.8.6 Transfer functions 1.8.7 Upload 1.8.8 Support
2. Medical Imaging
2.A Quick start
Data import, DICOM editing
2.A.1 Importing data on standalone devices 2.A.2 Importing data on PC-VR systems 2.A.3 Edit DICOM 2.A.4 Measure, mark and draw on DICOM
2.1 User interface
2.1.1 Import data 2.1.2 Save 2.1.3 Export 2.1.4 Load data 2.1.5 Delete data
2.2 Medical Imaging panel
2.2.1 Panel selector 2.2.2 Option preset 2.2.3 Transfer function 2.2.4 Transfer function preset 2.2.5 Tissue filter 2.2.6 Quality settings 2.2.7 Handle
2.3 AI segmentation panel
2.4 Multiplanar
2.4.1 Slider 2.4.2 Fit 2.4.3 Zoom out 2.4.4 Zoom in 2.4.5 Controller zoom 2.4.6 Window 2.4.7 Threshold
2.5 Tools
2.5.1 Mesh generator 2.5.2 Edge filter
2.6 Quality settings
2.6.1 Medical imaging settings 2.6.2 Low framerate screen 2.6.3 About 3D DICOM files 2.6.4 Processing and texturing 2.6.5 Challenges with large datasets in VR 2.6.6 Adaptive detail rendering
2.7 PACS connection 2.8 DICOM push
3. Medicalholodeck AI
3.A Quick start
Data loading, AI segmentation
3.A.1 Importing data 3.A.2 Loading data to the workspace 3.A.3 AI Segmentation panel 3.A.4 Choosing an AI model 3.A.5 Running segmentation 3.A.6 Visualization 3.A.7 Smoothing 3.A.8 Segments
3.1 Segmentation control panel
3.1.1 Structure 3.1.2 Options
3.2 Running AI segmentation locally
3.2.1 Installing Python 3.2.2 Installing PyTorch 3.2.3 Installing TotalSegmentator
4. Dissection Master
4.1 Changing layers 4.2 Scaling 4.3 Moving 4.4 Rotating 4.5 Annotations 4.6 Visibility controls
5. Anatomy Master
5.1 Scaling 5.2 Taking apart 5.3 Moving 5.4 Rotating 5.5 Cutting 5.6 Annotations 5.7 Visibility controls
6. RecordXR
6.1 User interface
6.1.1 Main control pad 6.1.2 RecordXR section 6.1.3 RecordXR panel
7. RecordXR Studio
7.A Quick start
Recording import, editing, export
7.A.1 Get records from Medicalholodeck 7.A.2 Open RecordXR Studio 7.A.3 Open a project 7.A.4 Add recordings 7.A.5 Zoom in/ zoom out 7.A.6 Change the order 7.A.7 Trim 7.A.8 Set the metadata 7.A.9 Add an avatar 7.A.10 Saving the project 7.A.11 Export a .RXR file 7.A.12 Exit the platform 7.A.13 Open the recording
7.1 Editing tools
7.1.1 Preview window 7.1.2 Timeline toolbar 7.1.3 Timeline
7.2 Metadata section
7.2.1 Title 7.2.2 Avatar 7.2.3 Preview icons 7.2.4 Duration 7.2.5 Description
7.3 Project controls
7.3.1 Save project 7.3.2 Export RXR 7.3.3 Close
8. TeamXR
8.1 Creating a team 8.2 Joining a team 8.3 Adding data to a session
8.4 Session settings
8.4.1 Session 8.4.2 Users in session 8.4.3 Session code 8.4.4 Disconnect 8.4.5 TeamXR settings 8.4.6 Open library
9. Remote Rendering
9.1 Accessing Remote Rendering 9.2 Using Remote Rendering
10. Mobile Device Management
10.1 Creating your Meta managed account and organization
10.2 Enrolling Meta Quest Devices through Horizon Managed Services
10.2.1 Add Medicalholodeck to Apps & content 10.2.2 Add your Wi-Fi network 10.2.3 Create a device preset with Medicalholodeck 10.2.4 Create a device group for Medicalholodeck headsets 10.2.5 Enroll devices

1. Spatial OS

1.V1.9-01

Spatial OS is the operating system for spatial medical imaging and visualization. It is available on Windows PCs.

It supports glasses-free stereoscopic 3D displays, virtual reality headsets, and standard 2D screens simultaneously from a single computer. Clinical teams can view and work with patient data together in the same spatial environment.

Spatial OS

Spatial OS transforms DICOM into clear, interactive 3D visualizations.

The platform is designed for everyday hospital workflows and supports medical communication in a shared spatial workspace.

  • One platform for glasses-free 3D, Virtual Reality, and 2D displays
  • 3D visualization for case review, discussion, and training
  • Fast, precise, and secure AI segmentation
  • Local processing and segmentation, PACS connectivity, and HIPAA-compliant security

1.A Quick start

1.A.V1.9-01

1.A.1

Running Spatial OS

1.A.1.V1.9-01

Spatial OS runs on Windows computers and lets you work with DICOM datasets, imaging, and 3D data across different hardware setups. You can use it on standard PC screens, autostereoscopic 3D displays, in VR, either individually or simultaneously.

  1. Download Spatial OS on your PC from Steam or our website.

  2. Activate the applications. Learn more here.

1.A.2

Connecting your VR headset

1.A.2.V1.9-01

Spatial OS allows you to connect a VR headset to your PC and work with your data in a VR environment. Your PC handles all rendering for both the PC screen and the VR headset.

Once connected, you can work either in the VR headset or on your PC screen. Use the View switch at the top of the interface to move between PC screen view and VR view.

To use the PC and VR headset at the same time, activate the Second Viewer license.


For Meta Quest headsets

Watch this video tutorial for a visual guide on connecting a Meta Quest headset to a PC with Link:

  1. Install the Meta Horizon Link on your PC.

  2. Allow VR apps, such as Spatial OS, to use your Meta Quest headset via Meta Horizon Link.
    In Meta Horizon Link, open Settings → General → find OpenXR Runtime → click Set Meta Horizon Link as active. If the button is greyed out, Meta Horizon Link is already the active OpenXR runtime.

  3. Connect your headset to your PC using USB or Wi-Fi.

  4. Open Meta Horizon Link on your PC and confirm the connection in the headset.

  5. Start Spatial OS on your PC.

For Pico headsets

  1. Install Pico Connect on your PC (from the official Pico website) and on your headset (from the Pico Store).

  2. Install SteamVR from Steam on your PC.

  3. Start Pico Connect on your PC and confirm the connection in the headset (connect the headset via USB or Wi-Fi).

  4. Launch SteamVR from Pico Connect in the headset.

  5. Add Spatial OS to SteamVR on your PC and run it.

1.A.3

Switching between screen and VR view

1.A.3.V1.9-01

To switch between the PC screen and VR view, use the View switch located in the top bar. It lets you choose which perspective you want to use to interact with the data.

If the Secondary Viewer license is activated, you can use both the PC screen and the VR headset at the same time. In this case, the switch allows you to move between working on the PC and previewing the VR environment.

1.A.4

Connecting a 3D screen

1.A.4.V1.9-01

A typical setup involves installing the required drivers and software from the manufacturer’s website. Then, connect the display using an HDMI or DisplayPort cable for video and, if needed, a USB cable for data transfer. Some devices support a single USB-C connection that carries both video and data.

After connecting the cables, power on the monitor and your computer, and make sure the correct input source is selected. Finally, launch the manufacturer’s software to enable 3D features.

1.A.4.1

Supported 3D screens

Compatible devices include Acer SpatialLabs, Samsung Odyssey 3D, and Barco Eonis. These systems are calibrated for high-resolution medical imagery and precise depth rendering.

Important notice regarding clinical use Specialized features for surgical planning and other pre-operative professional applications are only available in Medical Imaging XR PRO FDA/CE version. This version is not yet available. Medicalholodeck is not a certified medical device and must not be used for clinical decision-making, diagnosis, surgical planning, or navigation. Use in clinical contexts is restricted to non-diagnostic purposes such as training, education, communication, and research. Any use of the software must comply with applicable local and national regulations. For specific use cases, please contact us. Medicalholodeck is currently undergoing FDA and CE certification processes. We are working to meet all regulatory requirements and expect Medical Imaging XR PRO to become available in the United States and the European Union. For updates, regulatory status, or inquiries, contact info@medicalholodeck.com.
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