Key Image Groups are dynamically updated.
When you mark a new Key Image, the Key Image is immediately available in the Key Image group.
When you clear an existing Key Image, the Key Image is removed from the Key Image group.
You can modify an existing Key Image by changing image parameters such as zoom, pan, windowing, or graphics. Click Save 
to retain the changes.
Example
If a study has no Key Images and you mark an image as a Key Image, a Key Image Group is available in the Patient Min-Archive (PMA) and in the Replace With – Series List. You can display the group on screen.
Any operation performed directly on the images included in the Key Image Group affects the group and the relevant original images. When you clear an image from the Key Image Group, the Key annotation is updated on the original group (from which the key image originated).