Please note, that the Ctrl/Alt + Click combinations work only with Internet Explorer 5.5 or higher.

Please make sure that you have the Enable third-party browser extensions option enabled:

1. In Internet Explorer click the Tools menu and choose Internet Options;
2. Click the Advanced tab;
3. Scroll to the Browsing section, make sure Enable third-party browser extensions is checked;
4. Close all IE windows and open a new IE window.

Also, make sure no program blocks the Picture Ace BHO (Browser Helper Object).

If nothing of the stated above works, you would have to use another integration method - the IE context menu. Open the Web Browser Options dialog, uncheck the Method 1 option and check the Method 2 option, then restart Internet Explorer.