Medical imaging study summary engine mechanisms are provided. The mechanisms receive a medical imaging study having data representing a plurality of medical images of a patient. The mechanisms generate a temporal trajectory data structure of at least a subset of the medical images in the plurality of medical images, wherein the temporal trajectory data structure specifies topological changes in temporally subsequent medical images in the plurality of medical images. The mechanisms select medical image data corresponding to selected medical images from the medical imaging study data structure based on the temporal trajectory data structure. The mechanisms output the selected medical image data via a medical imaging study user interface.