Instructions for Use - InCenter

Transcription

AutoQUANT® 7.0
INSTRUCTIONS FOR USE
453560439121, REV A
2-2008
PAI
Warranty and Copyright Statement
Philips Medical Systems has taken care to ensure the accuracy of this document. However,
Philips Medical Systems assumes no liability for errors or omissions and reserves the right to
make changes without further notice to any products herein to improve reliability, function,
or design. Philips Medical Systems provides this guide without warranty of any kind, either
implied or expressed, including, but not limited to, the implied warranties of merchantability
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changes in the product(s) and/or program(s) described in this manual at any time.
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provide notification of such revision or change.
Trademarks
ACCESSTM, ADAC®, ALLEGRO®, ARGUS®, AtlasTM, AutoQUANT®, AutoSPECT®,
AutoSPECT®Plus, BrightView, CardiaQ®, CardioMD®, CardioTM, CardioTM 60,
CardioTracTM, CCTTM, ColliMATETM, CPET®, ENsphere®, EPICTM, ExSPECTTM,
EZXTM, FlexLOGICTM, ForteTM, GEMINITM, GENESYS®, GlobalQ®, InStill®,
InteLOGICTM, JETPackTM, JETSphereTM, JETStream®, MCD/ACTM, MidasTM,
MOSAICTM, P3IMRT®, P3MD®, PegasysTM, PINNACLE3®, PIXELAR®, PrecedenceTM,
SENTRYTM, ShadowTM, SKYLight®, SKYTableTM, SMARTSIM®, SolusTM, TeleLOGICTM,
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or registered trademarks of Philips Medical Systems.
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Prescription Device Statement
Caution: Federal law restricts this device to sale by or on the order of a physician (or properly
licensed practitioner).
Copyright © 2008, Koninklijke Philips Electronics N.V.
540 Alder Drive, Milpitas, CA, 95035, USA
453560439121, REV A
• PROPERTY OF KONINKLIJKE PHILIPS ELECTRONICS N.V. •
Disclaimer
Neither Philips Medical Systems, its parent, nor any of its worldwide affiliates shall be liable
or obligated in any manner in respect of bodily injury and/or property damage from the use
of the system/software if such is not in strict compliance with instructions and safety
precautions contained in the relevant operating manuals and in all supplements thereto, in all
product labels, and according to all terms of warranty and sale of the system, or if any change
not authorized by Philips Medical Systems is made to the software operating the system.
CE Marking
AutoQUANT is CE Marked to the Medical Device Directive
93/42/EEC.
Manufacturer:
Philips Medical Systems (Cleveland), Inc.
540 Alder Drive
Milpitas, CA 95035
European Authorized Representative:
Philips Medical Systems Nederland B.V.
PMS Quality & Regulatory Affairs
Veenpluis 4-6
5684 PC Best
The Netherlands
Contents
1
Getting Started 1
What This Chapter Contains 1
Indications for Use 1
Organization of This Manual 2
Conventions Used in This Manual 3
Abbreviations Used in This Manual 4
Introduction 7
Overview 11
SPECT Data Preparation 11
General Data Requirements 12
Starting AutoQUANT 12
JETStream Workspace 14
Starting AutoQUANT from the Application
Palette 14
Starting AutoQUANT from the Application
Toolbar 15
Warnings and Precautions 16
2
Tutorial 19
Overview 19
AutoQUANT 7.0 Processing and Analyzing Tutorial
(AutoQUANT MD Only) 20
Loading Normal and Abnormal Patient Datasets
20
Processing an Abnormal Dataset 22
Viewing a Normal Patient Dataset 38
Conclusions from the Normal Dataset 38
Raw Window 39
Slice Window 39
Splash Window 39
AutoQUANT
:
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QPS Window 39
QGS Window 40
3
Controls 41
Processing Commands 43
Processing Data 43
SPECT Review Option: Motion Frozen 45
Implementing the Motion-Frozen Feature in QGS
46
Freezing Images 47
Manually Redefining Bounding Boxes 47
Manually Redefining ROIs 48
Resetting Outlines 49
Manually Redefining Ventricular Contours 51
Displaying Multiple Cardiac Datasets 56
Program Controls 56
Displaying the Defaults Window 57
Saving a Dataset 57
Presenting Studies with Microsoft PowerPoint 60
Description of Saved Files 63
Launching Application Studies from PowerPoint
63
Printing and Saving a Window 65
File Tab 67
Printer Tab 70
Saving a Cine Movie 71
More on File Output Formats 75
File Output Formats 75
Displaying and Printing the Help File 76
Viewing Program Information 77
Scoring a Dataset 77
Specifying the Active Dataset 79
Listing Loaded Datasets 80
Selecting a Normals Limits 84
Displaying Scores 85
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:
AutoQUANT
:
Displaying The ARG Report Panel 85
Using Image Control Bars (ICBs) 86
Common Window Controls 91
Toggling Labels 91
Toggling Orient 91
Toggling Contours 92
Displaying a Box 92
Indicating End Diastolic/Systolic Positions 92
Blurring an Image 93
Smearing an Image 93
Skipping Images 93
Playing Gated Datasets 93
Spinning Images/Spin Rate 94
Rock 94
Displaying Pins 94
Displaying Wall Surfaces 94
Adjusting the Size of Images 95
Adjusting Intervals 95
Oblique 96
Summary 96
Exiting AutoQUANT 99
4
Reviewing and Processing Images 101
Overview 102
Using the Raw Window 102
Toggling Orient 104
Displaying Reference Lines 104
Displaying Summed Projections 105
Gating an Image 105
Spinning or Rocking a Cine 105
Displaying Multiple Datasets 105
Absolute 106
Using the Slice Window 106
Verifying Contour Placement 107
Overlaying Segments 109
AutoQUANT
:
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:
Other Functions 110
Using the Surface Window 111
Changing Image Orientation 112
Other Functions 115
Using the Splash Window 115
Using Popout 118
Other Functions 121
Using the Views Window 122
Other Functions 124
Using the Quantitative Perfusion SPECT (QPS) Window 124
Shape 127
Triangulated Navigation 128
Displaying the Defect Analysis Graph and Table
129
Prone-Supine (Prone+) Quantification 130
Overview 130
Feature Requirements 131
Using Prone-Supine (Prone+) 132
Polar Maps 133
Displaying Function 133
Overlaying a Grid 138
Other Functions 141
Using Quantitative Perfusion Change (QPC) Window
142
Feature Requirements 143
Identifying the Viability Study 143
Using QPC 144
Reviewing QPC Results 144
Assessing Slices, Polar Maps and Surfaces 145
Other Functions 146
Using the Quantitative Gated SPECT (QGS) Window
147
Shape Index 151
QGS Polar Maps 153
Perfusion (%) Polar Maps 154
Function Polar Maps 154
v iii
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AutoQUANT
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Phase Polar Maps 156
Phase Analysis 157
Requirements 157
Displacement and Velocity Graphs 159
Reviewing Results 162
Phase calculations 162
Regional values 162
Global value 163
Comments 163
Volume and Filling Curve 164
Using the Score Box 166
Other Functions 167
Using the Change Window 169
Requirements 170
Using the Change Feature 171
Assessing Change Results 172
Controls 173
Roving Window 174
Other Functions 175
Using the Fusion Window 175
Overview 175
Displaying Oblique Images 177
Using the Fusion Window Features 177
Reviewing Images on the Fusion Window 177
Common Window Controls 179
Mouse Controls 179
Keyboard Controls 179
Using the Roving Window 180
Changing the Display of Fused Images 182
Alpha-Blending 182
W/L Image Control Bar (ICB) 183
Setting Defaults 184
Using the Snapshot Window 185
Using the More Window 187
Using the Database Window 188
AutoQUANT
:
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5
Setting Defaults 191
Defaults Overview 191
Default Types 192
General Tab 194
Window-Specific Parameters 198
Automatic File Selection Parameters 202
AutoMatch Tab 202
Application Colors and Font 211
Theme Tab 211
Graphics Tab 215
ARG Tab 217
Saving, Applying, or Canceling Default Settings 217
6
Managing Databases 219
Overview 220
Database Window 223
Database Window Overview 223
Creating a New Database 226
Adding Patients to an Existing Database 230
Removing Patients from a Database 233
Backing Up and Restoring Databases 234
Viewing Database Attributes 235
Importing and Exporting Databases 236
Deleting a Database 237
Working with Normal Limits 238
Creating a New Normal Limits File 238
Editing a Normal Limits File 239
Viewing a Normal Limits File 241
Deleting a Normal Limits File 241
Database Controls 242
Database Menu 243
x
:
AutoQUANT
:
Exams Menu 244
Limits Menu 245
Current Database Attributes 245
A
Normal Limits Databases 249
What This Appendix Contains 249
Dual Isotope Normal Limits 250
Patient Populations 250
Acquisition Protocols 250
Rest Tl-201 Study 250
Treadmill Exercise Tc-99m Sestamibi Study
250
Adenosine Tc-99m Sestamibi Study 251
Projection Reconstruction 251
Database Generation 252
Vantage Pro AC Stress/Rest Sestamibi Normal Limits
252
Rest Tc-99m Study 253
Stress Tc-99m Study 253
Acquisition 254
Stress/Rest Sestamibi Normal Limits 256
258
Adenosine Tc-99m Sestamibi Study 258
Supine/Prone Stress Sestamibi 260
Acquisition and Reconstruction Protocols 261
Astonish Stress/Rest Sestamibi Normal Limits 262
AutoQUANT
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Stress Tc-99m Study 263
Projection Reconstruction - Full-Time Astonish
265
Projection Reconstruction - Half-Time Astonish
266
Stress Thallium Normal Limits Databases 267
Treadmill Exercise Tl-201 Study 268
Adenosine Tl-201 Study 268
Dipyridamole Tl-201 Study 268
Dobutamine Tl-201 Study 269
Stress/Rest Rubidium Normal Limits Databases 270
B
Control Index 273
C
Troubleshooting 281
Common Messages 282
AutoQUANT Messages 283
AutoQUANT FAQs 284
D
Bibliography 289
Change Page 289
Motion Frozen 289
Prone-Supine 290
Prone + 290
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:
AutoQUANT
:
QPC 290
QGS 291
QPS 301
AUTOQUANT 303
TID 303
Lung/Heart 304
LV Mass 305
Diastolic Function 305
Shape Index 306
E
Glossary 307
Index 321
AutoQUANT
:
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AutoQUANT
1
Getting Started
What This Chapter Contains
This chapter contains the following sections:
• Indications for Use (page 1)
• Organization of This Manual (page 2)
• Conventions Used in This Manual (page 3)
• Abbreviations Used in This Manual (page 4)
• Introduction (page 7)
• Overview (page 11)
• Starting AutoQUANT (page 12)
• Warnings and Precautions (page 16)
Indications for Use
AutoQUANT is intended to enable a fully automated
display, review, and quantification of Nuclear Medicine
Cardiology medical images and datasets. AutoQUANT
can be used in multiple settings including the hospital,
clinic, and doctor’s office. The results provided should be
reviewed by qualified healthcare professionals (e.g.,
radiologists, cardiologists, or general nuclear medicine
physicians) trained in the use of medical imaging devices.
AutoQUANT
1: Getting Started
1
Organization of This Manual
Organization of This Manual
This manual contains the following chapters:
Chapter 1, “Getting Started,” provides an introduction to
AutoQUANT, and describes how to begin the application
and what datasets you can use with it.
Chapter 2, “Tutorial,” provides a tutorial that guides you
through the processing and analysis of the two sample
datasets, Abnormal and Normal, included with
AutoQUANT.
Chapter 3, “Controls,” describes the controls that are
common to most of the windows in AutoQUANT.
Chapter 4, “Reviewing and Processing Images,” provides
detailed information on controls specific to the review and
processing windows in AutoQUANT.
Chapter 5, “Setting Defaults,” provides detailed
information on creating and applying defaults files that
you can use to customize the available controls and startup displays in AutoQUANT.
Chapter 6, “Managing Databases,” provides detailed
information on creating and managing databases, and
creating and using Normals files.
Appendix A, “The Fusion Option,” describes the
additional functionality available in AutoQUANT with
the Fusion option.
Appendix B, “SPECT Review Option: Prone-Supine
(Prone+),” describes the additional functionality available
in AutoQUANT with the Prone-Supine option.
2
1: Getting Started
AutoQUANT
Conventions Used in This Manual
Appendix A, “Normal Limits Databases” provides
descriptions of the methods used to acquire and process
the datasets used in the creation of the Normal Limits
databases.
Appendix B, “Control Index” provides a quick reference
of all AutoQUANT controls.
Appendix C, “Troubleshooting” provides information
about the error messages you might see in AutoQUANT.
Appendix D, “Bibliography” provides references to
publications containing information on which some of the
software is based.
Appendix E, “Glossary” provides definitions of important
terms used in this manual.
Important
Philips recommends that you process the sample datasets
included with AutoQUANT as described in Chapter 2,
“Tutorial,” before processing your own datasets. This
tutorial describes some of the basic procedures to follow
when using AutoQUANT and provides an overview of
many of the main windows in AutoQUANT.
Conventions Used in This Manual
The following conventions are used in this manual:
Messages that alert you to conditions that
could result in death or serious injury.
• WARNING
Messages that alert you to conditions that
may result in one or more of the following:
• CAUTION
- Minor or moderate injury to you or the patient
AutoQUANT
1: Getting Started
3
Abbreviations Used in This Manual
- Damage to the equipment or other property
- Data loss
Vital information that describes how to
properly install, configure, or use the system.
• IMPORTANT
Additional information that may help explain an
action or procedure.
• Note
• Elements of the user interface (buttons, field names,
menu items, etc.) appear in Bold.
• Computer messages appear in the Courier font.
• Keyboard entries appear in a boldface Courier
font.
All warnings and cautions are noted in the appropriate
sections of the manual, where procedures that warrant
them are described.
Abbreviation
4
Meaning
AL
Antero-lateral
An
Anterior
AS
Antero-septal
AttC
Attenuation corrected
BMI
Body Mass Index
BPM
Beats Per Minute
1: Getting Started
AutoQUANT
Abbreviation
AutoQUANT
Meaning
CAD
Coronary Artery Disease
Ecc
Eccentricity
ECG
Electrocardiogram
ED
End Diastole
EDV
End Diastolic Volume
EF
Ejection Fraction
ES
End Systole
ESV
End Systolic Volume
FBP
Filtered Back Projection
HLA
Horizontal Long Axis
ICB
Image Control Bar
IL
Infero-lateral
In
Inferior
IS
Infero-septal
LAD
Left Anterior Descending
LCX
Left Circumflex
LHR
Lung/Heart Ratio
LV
Left Ventricle
MFR/3
Mean Filling Rate for the first third
of the cardiac cycle following ED
MLEM
Maximum likelihood algorithm
Mot Ext
Motion Extent
1: Getting Started
5
Abbreviation
6
Meaning
MPI
Myocardial Perfusion Image
MPS
Myocardial Perfusion SPECT
NAC
N-acetylcysteine
PER
Peak Emptying Rate
PFQ
Perfusion Quantification
PFR
Peak Filling Rate
PFR2
Secondary Peak Filling Rate
QARG
Quantitative Automatic Report
Generator
QGS
Quantitative Gated SPECT
QPC
Quantitative Perfusion Change
QPS
Quantitative Perfusion SPECT
RCA
Right Coronary Artery
ROI
Region Of Interest
RV
Right Ventricle
SAX
Short Axis
SDS
Summed Difference Score
SI
Shape Index
SMS
Summed Motion Score
SRS
Summed Rest Score
SSS
Summed Stress Score
STS
Summed Thickening Score
1: Getting Started
AutoQUANT
Introduction
Abbreviation
Meaning
Thk Ext
Thickening Extent
TID
Transient Ischemic Dilation (ratio)
TPD
Total Perfusion Deficit
TTMD
Time To Maximum Displacement
TTMT
Time To Maximum Thickening
TTPF
Time To Peak Filling from ES (ms)
TTPV
Time To Peak Velocity
Via
Viability
VLA
Vertical Long Axis
Introduction
AutoQUANT is an application for the automatic
segmentation, quantification, analysis, and display of
SPECT/PET myocardial perfusion studies. It is designed
to assist the clinician in making an accurate, reproducible,
and consistent assessment of left ventricular (LV) function
and perfusion.
AutoQUANT works with any study consisting of gated
and static (ungated) short axis, transverse, projection (raw),
or screen capture dataset types, and has specialized support
for a variety of acquisition and processing protocols
including:
• SPECT/PET function
• SPECT/PET perfusion
AutoQUANT
1: Getting Started
7
Introduction
• SPECT/PET viability
• Stress/rest/delayed/reversibility
• Serial perfusion
• Sestamibi/thallium
• Rubidium/FDG
• Male/female
• Supine/prone
Core functionality includes:
• Automatic generation of left ventricle (LV) inner and
outer surfaces and valve plane from LV short axis
perfusion SPECT/PET data, with optional manual
intervention.
• You can display up to 4 short axis (SA) datasets or up to
16 projection datasets, or screen captures
simultaneously. Display formats include, planar,
orthogonal slice sets, surfaces, parametric surfaces, and
polar maps.
• Functional metrics including LV volume/time curve,
ED (end-diastolic) volume, ES (end-systolic) volume,
SV (stroke volume), and EF (ejection fraction).
• Diastolic function metrics including PER (peak
emptying rate), PFR (peak filling rate), PFR2
(secondary peak filling rate), MFR/3 (mean filling rate
over the first third of the ES to ED phase), and TTPF
(time to peak filling from ES).
• Global and regional determination of motion and
thickening abnormalities using normal limits.
8
1: Getting Started
AutoQUANT
Introduction
• Segmental motion and thickening scores based on a 17-
or 20-segment, multi-point scale, with corresponding
summed scores: SMS (summed motion score), STS
(summed thickening score), SM% (summed motion
percent), and ST% (summed thickening percent).
• Global and regional determination of perfusion defects
and defect reversibility using isotope- and genderspecific normal limits.
• Segmental perfusion scores (stress, rest, and reversibility)
based on a 17- or 20-segment, multi-point scale, with
corresponding summed scores: SSS (summed stress
score), SRS (summed rest score), SDS (summed
difference score), SS% (summed stress percent), SR%
(summed rest percent), and SD% (summed difference
percent).
• Optional generation of optimal perfusion normal limits
from studies of only low-likelihood normal patients (3040 cases per gender).
Extended workflow functionality, optimizing clinical
efficiency and utility include:
• Integration of ARG (Automatic Report Generator)
providing the ability within AutoQUANT to create,
edit, sign, review, archive, and share customizable,
consistency-checked reports.
• Storage of all generated results in a separate review file.
• Application defaults, for rapidly switching between
custom configurations for different protocols, cameras,
clinicians, etc.
• PowerPoint generation, for saving the application data,
results, and settings in a format suitable for launching
from within Microsoft PowerPoint.
AutoQUANT
1: Getting Started
9
Introduction
Extended analysis functionality that provides further
perspectives on the data, including:
• Global metrics including TID (transient ischemic
dilation), LHR (lung heart ratio), LV chamber volume,
mid-myocardial surface area, shape index, and
eccentricity.
• Motion-frozen processing to generate ungated
SPECT/PET datasets from gated ones by warping
multiple frames into the end-diastolic frame.
• Global and regional phase analysis of mid-myocardial
motion.
• Change processing for direct quantification of perfusion
changes between two datasets through 3D elastic
registration and count normalization.
• Prone-supine processing for quantification of perfusion
on prone datasets as well as combined quantification of
prone/supine datasets.
Extended modality functionality, enabling the analysis and
display of alternative modalities include:
• SPECT/PET viability quantification to assess
myocardial hibernation.
• Fused display of SPECT/PET/CT/CTA slices in three
orthogonal planes.
• Review of coronary vessels, previously segmented and
labeled from CT Angiography (CTA), fused with LV
surfaces.
• Transverse processing for the quantification and display
of transverse datasets.
10
1: Getting Started
AutoQUANT
Overview
Overview
Important
AutoQUANT provides a convenient method of processing
data for subsequent physician review. Saved AutoQUANT
files contain references to the associated datasets and you
can archive or transfer these datasets to Pegasys systems
outside of the network.
SPECT Data Preparation
Before you use AutoQUANT, reconstruct the SPECT
datasets by doing the following:
• Reconstruct short axis cardiac SPECT datasets using
applications such as AutoSPECT Plus or the Pegasys
SPECT Reconstruction and Reorientation applications.
• Reconstruct short axis gated SPECT datasets using
AutoSPECT Plus or the Pegasys Gated SPECT
processing application.
• Reconstruct Vantage short axis datasets using
AutoSPECT Plus or the Vantage reconstruction
options.
AutoQUANT
Caution
Evaluate reconstructed datasets for proper reconstruction
and reorientation before you use AutoQUANT, and make
sure that you correct for motion and other artifacts. Failure
to perform any necessary corrections may result in
misleading data, which may lead to misdiagnosis.
Important
When processing cardiac SPECT or gated SPECT datasets
from CSImport, AutoQUANT uses the currently selected
defaults file to process all selected datasets. Make sure that
the current defaults file is appropriate for all of the datasets
1: Getting Started
11
Starting AutoQUANT
you select. Also, the number of datasets you can select and
process at one time depends on the amount of available
application memory.
General Data Requirements
You can use AutoQUANT with the following dataset
types:
• Raw projection (64 x 64 and 128 x 128 matrices):
- Summed stress and rest
- Gated stress and rest
• Short axis (64 x 64 and 128 x 128 matrices):
- Summed stress and rest
- Gated stress and rest
• Snapshot files
• AutoQUANT Results files
Starting AutoQUANT
◆
1
To run AutoQUANT:
Double click the CSI/AutoQUANT MD desktop icon.
Figure 1 Desktop icon
2
12
1: Getting Started
If a password window appears, enter your password, then
click OK.
AutoQUANT
Starting AutoQUANT
The CSImport window appears:
Figure 2
Refer to the CSImport Instructions for Use for information
on using CSImport.
Note
3
Select one or more datasets and associated objects.
When one folder with 2 studies (different dates) are loaded
into AutoQUANT, some of the rules to which datasets get
displayed by default (for each page) get modified. This
automatic optimization aids in comparing these types of
studies.
Important
4
AutoQUANT
CSImport main window
Click the AutoQUANT icon on the toolbar (See Figure 2
on page 13):
1: Getting Started
13
Starting AutoQUANT
The application opens in the first window, depending on
the current default window sequence, that is appropriate
for displaying the selected dataset.
Note
If you have the optional QARG application, by factory
default, the ARG reporting panel appears in AutoQUANT
when you first open it. Click the Report button to turn off
the display of the ARG reporting panel.
Note
You can change the default setting for Report in the
Defaults window; see Chapter 5, “Setting Defaults,” for
details on using the Defaults window.
• If the AutoCreate function in QARG is turned off and
you load a new patient into AutoQUANT, a message
appears stating No existing study information
found. Click either Create New Study or Turn
Reporting Off.
JETStream Workspace
In JETStream Workspace, you can start AutoQUANT
either from the Application Palette or from the application
toolbar.
See the JETStream Workspace Instructions for Use for more
information about loading studies in JETStream
Workspace.
Note
Starting AutoQUANT from the Application Palette
◆
1
14
1: Getting Started
To start AutoQUANT from the JETStream Workspace
Application Palette:
Start JETStream Workspace.
AutoQUANT
Starting AutoQUANT
Refer to the JETStream Workspace Instructions for Use for
information on using JETStream Workspace.
Note
2
Select Patient -> Open Patient Browser (or press <F2>).
The JETStream Workspace Patient Browser appears.
3
Select a patient from the list.
4
On the SPECT tab of the Application Palette, click the
AutoQUANT application icon.
Figure 3
Palette
5
AutoQUANT icon on JETStream Workspace Application
After the Patient Bucket window appears, click Proceed
with Selected.
The application opens; all of the objects for the selected
patient are loaded.
If you want to load only some of the objects for the
selected patient, select the objects you want to load before
clicking the AutoQUANT application icon.
Note
Starting AutoQUANT from the Application Toolbar
◆
1
Start JETStream Workspace.
Refer to the JETStream Workspace Instructions for Use for
information on using JETStream Workspace.
Note
2
AutoQUANT
To start AutoQUANT from the JETStream Workspace
application toolbar:
Click on the AutoQUANT application icon.
1: Getting Started
15
Warnings and Precautions
Figure 4 AutoQUANT icon on JETStream Workspace Application
Toolbar
The AutoQUANT Patient Browser appears.
3
Select a patient from the list.
The folder opens, then the application opens.
When you run AutoQUANT as an option in JETStream
Workspace, AutoQUANT opens by default in the window
appropriate for the selected dataset:
• Raw Projection Dataset: Raw window
• Short Axis Dataset: Slice window
• Snapshot file: Snapshot window
• AutoQUANT Results file: Varies, depending on the
type of dataset saved in the Results file.
Note
If you select an inappropriate dataset from JETStream
Workspace and then run AutoQUANT, the AutoQUANT
windows do not contain any patient datasets.
Caution
16
1: Getting Started
Evaluate reconstructed datasets for proper reconstruction
and reorientation before using AutoQUANT, and make
sure that you correct for motion and other artifacts. Failure
to perform any necessary corrections may result in
misleading data, which may lead to misdiagnosis.
AutoQUANT
AutoQUANT
Caution
Make sure that any output that you intend to use for
interpretation is saved or exported in a lossless format (e.g.,
DICOM SC for snapshots saved to the database; TIFF or
PNG for screen captures saved to a folder on a local drive).
Output saved or exported in a lossy format may not
include all information necessary for a diagnosis;
interpretation using non-diagnostic output may therefore
lead to misdiagnosis.
Caution
Make sure that any hardcopy output that you intend to use
for interpretation is of diagnostic quality. Output of nondiagnostic quality may not include all information
necessary for a diagnosis; interpretation using nondiagnostic output may therefore lead to misdiagnosis.
Caution
Make sure that any cine output that you intend to use for
interpretation is saved using a lossless AVI codec (coderdecoder). Output saved using a lossy codec may not
Caution
Make sure that placement of the heart and lung ROIs is
accurate, and verify that these ROIs are over the proper
organs. Inaccurate heart and lung ROIs can result in
incorrect computation of quantitative data, which can lead
to misdiagnosis.
Caution
Make sure that the placement of the LV contours is
correct, and verify that these contours accurately reflect the
myocardial wall limits. Inaccurate ventricular contours can
result in incorrect computation of quantitative data, which
can lead to misdiagnosis.
Caution
Although AutoQUANT allows you great freedom in
manipulating databases, you must take great care when
doing so. Only the proper personnel should attempt this;
1: Getting Started
17
If you are not knowledgeable about working with these
databases, find someone who is. Using databases that
contain conflicting or incompatible patient data may lead
to misdiagnosis.
18
Caution
You must verify correct contour creation. If contours
appear too long, too short, or do not encompass the
myocardium, you must manually adjust and save them.
Incorrect contours generated for the normal limits
population degrade the quantification results when applied
to clinical studies, which may lead to misdiagnosis.
Caution
You must verify that the correct TID is selected when
loading a serial study with multiple stress and rest datasets
from different dates since the TID selection can affect the
QPS scores.
Caution
When using batch processing (processing of multiple
studies within one AutoQUANT session), manually
selecting a normals limit applies that limit to all the studies
that are loaded in the session.
1: Getting Started
AutoQUANT
2
Tutorial
• AutoQUANT 7.0 Processing and Analyzing Tutorial
(AutoQUANT MD Only) (page 20)
Overview
This tutorial guides you through processing and analyzing
two sample datasets, one from a patient study that
indicates significant evidence of coronary artery disease
(Abnormal Patient) and the other from a patient study
that indicates a low likelihood of significant coronary
artery disease (Normal Patient).
Important
This chapter is designed as a tutorial only. Philips
recommends that you process the sample datasets as
described in this section before processing your own
datasets. However, for detailed information on using all of
the features in AutoQUANT, refer to the appropriate
sections in this manual.
AutoQUANT automatically displays the appropriate
dataset for the selected window.
AutoQUANT
2: Tutorial
19
AutoQUANT 7.0 Processing and Analyzing Tutorial (AutoQUANT MD Only)
Dataset
Analysis Windows
Raw summed stress and rest
Raw
Short axis stress and rest
Splash, QPS
Short axis gated stress and rest
Slice, QGS
If the AutoQUANT defaults have been changed from their
factory settings, the available controls and many
parameters may differ from those displayed in this tutorial.
If a control or option is unavailable as described here,
check the settings in the Defaults dialog. You can open this
dialog by clicking on the Defaults button near the upper
right corner of the window. Refer to Chapter 5 for details
on using the Defaults dialog.
Important
AutoQUANT 7.0 Processing and
Analyzing Tutorial (AutoQUANT MD
Only)
Loading Normal and Abnormal Patient Datasets
You must first load the two sample patient datasets before
starting the AutoQUANT application.
◆
1
20
2: Tutorial
To load the sample Abnormal and Normal patient
datasets into AutoQUANT:
Double click the CSI/AutoQUANT MD desktop icon.
AutoQUANT
AutoQUANT 7.0 Processing and Analyzing Tutorial (AutoQUANT MD Only)
Figure 5
2
Desktop icon
If a password window appears, enter your password, then
click OK.
The CSImport window appears:
3
Click on the sample dataset study Abnormal Study, then
hold down the Ctrl key and click on the Normal Study
sample dataset.
4
In the Dataset pane (right pane), click Select All to select
all of the objects associated with these two patient studies.
5
Click the AutoQUANT icon on the toolbar.
AutoQUANT’s main screen appears.
If you have the optional QARG application, by factory
default, the ARG reporting panel appears in AutoQUANT
when you first open it. Click the Report button to turn off
the display of the ARG reporting panel.
Note
6
In AutoQUANT, if the Abnormal patient dataset is not
already visible, use the pull-down menu to select
Abnormal.
Figure 6
7
Note
AutoQUANT
Patient study drop-down menu
Verify that the acquisition protocol used for the dataset is
appropriate for the Normals file that is being applied:
Click More to display expanded patient information.
2: Tutorial
21
Processing an Abnormal Dataset
8
Click 2 to display the information for both Stress and Rest
datasets.
9
Select the SA Summed Stress and SA Summed Rest
datasets.
Figure 7 2 and More selected
10
Click Edit and Reference (located on the Isotope column)
to verify that two different isotopes were indeed used in the
acquisitions.
After selecting and loading the abnormal dataset, use the
Raw, Slice, QPS, and QGS windows to process and
analyze the datasets.
◆
1
To process an Abnormal dataset:
Click the Raw button,
The Raw window is displayed.
2
In the Raw window, click Limits.
The Limits window appears.
3
Select SepdualAuto, then click OK.
The Splash, QPS, and QGS windows use the Normals file
to compare the patient datasets with normal values. The
abnormal dataset was acquired from a male, and used
thallium for rest measurements and mibi for stress
22
2: Tutorial
AutoQUANT
measurements, which is why you apply the SepdualAuto
Normals file. (Sepdual implies separately acquired
thallium/mibi, not simultaneous acquisitions.)
4
Click Process.
This processes the Abnormal Study datasets. After
processing, the viewport displays the representative frame
with two bounding boxes, each enclosing a blue square
region of interest (ROI) (Figure 8). These bounding boxes
confine the search for the ROIs. The two bounding boxes
displayed are:
• Heart bounding box (red)
• Lung bounding box (green)
Heart
Bounding Box
Lung
Bounding Box
Figure 8
5
Image after processing
Click Multiple.
This displays all of the raw datasets for the currently
selected patient:
AutoQUANT
2: Tutorial
23
Figure 9 Raw window in Multiple mode.
6
Click Lines.
Two parallel lines appear. Use your mouse to click and drag
the lines to surround the frame of the heart.
7
Click Spin to check for motion.
This rotates the datasets. Use the Rate control to adjust
the rate of rotation.
8
Click Rock.
Selecting this option with Spin spins all of the displayed
datasets back and forth through 180º.
24
2: Tutorial
AutoQUANT
Motion is indicated by a vertical or horizontal shift in the
dataset. In this example, there is some vertical motion.
9
Click Slice.
The Slice window opens and displays the following:
• Three short axis slices proceeding from apex-to-base.
• One horizontal long axis slice.
• One vertical long axis slice.
10
If not already selected, click Label and Contours.
This displays contours around the inner and outer
ventricular walls, as well as reference lines and slice
numbers.
11
Do the following to adjust the HLA or VLA segments:
• Click and drag on the vertical short axis slice reference
line to update the VLA viewport to show the
corresponding slice (Figure 10 on page 26).
• Click and drag on the horizontal short axis slice
reference line to update the HLA viewport to show the
corresponding slice (Figure 10 on page 26).
AutoQUANT
2: Tutorial
25
Reference line for VLA
Reference line for HLA
HLA Slice
VLA Slice
Figure 10 HLA and VLA segments.
Note
You can also select each of the short axis slices by dragging
the corresponding reference lines in the HLA and VLA
viewports. This updates the slice number of the dataset in
each viewport.
Note
To move both reference lines at the same time, click the
cross-section of the two reference lines (shown inside the
SAX viewport).
12
26
2: Tutorial
Check the accuracy of the contours.
AutoQUANT
In this case the contours correspond to the left ventricular
myocardium and do not contain non-cardiac structures,
irregularities, or high count areas outside of the
myocardium.
13
Click Splash to display the Splash window.
The Splash window displays 16 SAX slices, 8 HLA slices,
and 8 VLA slices for each dataset.
14
Deselect Contours and Label.
Notice that some of the abnormal patient’s stress slices
have significant low count areas, indicating abnormal
perfusion. In a normal patient, the stress and rest slices
show even count distribution in rings (SAX) or
“horseshoe” shapes (HLA and VLA).
15
Reselect Contours and Label.
16
From the Grid menu, select Segments.
This applies the Segments overlay to all the slices.
If Label is deselected, the overlay is not displayed.
Note
17
Region 1
Click Score to display the Visual Score at the bottom of
the window:
Stress
Visual Scores
Rest
Visual Scores
Reversibility
Visual Scores
Region 2
Region 3
Region 4
Figure 11 Visual Scores
AutoQUANT
2: Tutorial
27
To view all 3 polar maps (as shown in Figure 11 on page
27) you must set the number of views to 2.
Note
18
In the Visual Score, click Auto.
This automatically compares your Normals file selection,
and applies Visual scores (Figure 11).
Important
When you use the Dual Isotope or Mibi-Mibi Normal files
as a comparison, AutoQUANT does not allow the rest
scores to be higher than the stress scores for a pair of
datasets associated by the TID tags.
The segments in the stress dataset diagram scored as one,
two, three, or four correspond to slices that have abnormal
perfusion, relative to the selected Normals file. The
segments correspond to the color-coded segments on the
SAX slices displayed in the viewports. The color coding is
most obvious when using a grayscale colormap. (Refer to
your computer screen or the online version of this manual
to view the color display.) In this case, the following
regions show abnormal perfusion:
• Region 1 represents slices in the apical region, and is
colored red in the Segments overlay. There is no
evidence of perfusion defects in this region.
• Region 2 represents slices in the apical mid-ventricular
region. This region is color-coded orange in the
Segments overlay.
• Region 3 represents slices in the basal mid-ventricular
region, colored yellow in the Segments overlay.
• Region 4 represents slices in the basal region, colored
green in the Segments overlay.
The summed scores also indicate abnormality:
• Summed Stress Score (SSS): 24
28
2: Tutorial
AutoQUANT
• Summed Rest Score (SRS): 1
• Summed Differential Score (SDS): 23
19
Click QPS to display the Quantitative Perfusion SPECT
(QPS) window.
The QPS window displays the following information from
SAX datasets and processed results:
• Representative non-gated stress and rest SAX slices
• 2D and 3D polar maps with the results of perfusion and
reversibility analysis
• Patient statistics
20
Deselect Score to remove the Score window.
A graph or a table appear in place of the Score window. If
Graph was selected, a graph appears. If Graph was not
selected, a table appears.
21
This applies the Segments overlay to the polar maps.
If Label is deselected, the overlay does not appear.
Note
22
From the Function menu, select Raw.
This displays the Raw defect analysis values within each of
the segments (Figure 12). These values reflect the actual
counts.
Look for low count regions on the stress, rest, and
reversibility polar maps. In this case, notice the following:
• The Stress polar map has low counts in the lateral and
inferior regions.
• The Rest polar map has a relatively uniform count
distribution.
AutoQUANT
2: Tutorial
29
• The Reversibility map shows significant reversibility in
the lateral and inferior regions corresponding to the low
count areas in the same two regions as the Stress map.
The absence of defects at rest, along with the presence of
defects at stress, are strong indicators of coronary artery
disease.
23
From the Grid menu, select Vessels.
This applies the Vessels overlay to the polar maps.
24
From the Function menu, select Extent.
This displays the Extent defect analysis values within each
of the segments (Figure 12). These values reflect the defect
size for that region, expressed as a percentage of the
myocardium. Confirm your analysis from step 22.
Note
30
2: Tutorial
You can use any of the Grid overlays with any of the
Function options. There are different values within each
segment, depending on your choices. Use multiple
Grid/Function combinations to verify your dataset
analysis. Refer to “Overlaying a Grid” on page 138 for
detailed information.
AutoQUANT
Defect Raw Polar maps
(Segments Overlay) Example only
Defect Extent Polar maps
(Vessels Overlay)
Example only
Figure 12 The Defect Raw and Defect Extent polar maps
25
Make sure Score and Graph are off to display the defect
analysis table.
The defect analysis table summarizes the data from each
vessel (Figure 13).
AutoQUANT
2: Tutorial
31
Figure 13 QPS Defect Analysis Table
In this case, the defect analysis table shows the following:
• Defect extent at rest is zero in the LAD and RCA
regions.
• Rest severity is less than or equal to one standard
deviation in every region.
• Defect severity is near zero in the LAD and RCA regions
at rest.
• Defect severity is between 3 and 7 standard deviations
below normal in the RCA and LCX regions at stress.
26
From the Grid menu, select Walls.
This applies the Walls overlay to the polar maps.
27
Click Graph to toggle the Defect Analysis Graph.
The defect analysis graph shows the following:
• At stress, the extent is approximately 70% in the lateral
and inferior regions, resulting in a reversibility of nearly
60% in these two regions (Figure 14).
32
2: Tutorial
AutoQUANT
Figure 14 QPS Defect Analysis Graph
A defect severity near normal at rest and abnormal at stress
is a strong indication of coronary artery disease.
28
AutoQUANT
Evaluate the Patient Statistics data. (See Figure 15 on page
34.)
2: Tutorial
33
Figure 15 Patient statistics window pane
29
Click QGS to display the Quantitative Gated SPECT
window.
The QGS window displays four polar plots, a volume and
filling curve, and a statistics panel with the reference
images.
30
From the Grid menu, select Vessels.
This applies the Vessels overlay to the polar maps.
34
2: Tutorial
AutoQUANT
Note
If Labels is not selected, the overlay does not appear.
Look for low count regions on the ED and ES Perfusion,
Motion, and Thickening polar maps (Figure 16). Low
count regions on the perfusion maps indicate areas of poor
perfusion at ED or ES. Low count regions on the Motion
and Thickening maps indicate poor wall motion or wall
thickening.
In this case, note the following:
• The value shown in the LAD region is normal,
indicating normal perfusion in this region. The values in
the LCX, and RCA regions on the perfusion maps are at
the lower range of normal, indicating possible perfusion
defects in these regions.
• The value shown in the LCX region on the thickening
map is low, indicating abnormal wall thickening.
• The values shown in the LCX and RCA regions of the
Motion polar map are low, indicating reduced wall
motion.
AutoQUANT
2: Tutorial
35
Figure 16 QGS polar maps (Vessels overlay) Example only
31
This applies the Segments overlay to the polar maps.
Defect analysis values are visible within each of the
segments. Confirm your analysis from step 30.
Use multiple Grid overlays to verify your dataset analysis.
Refer to “Overlaying a Grid” on page 138 for detailed
information on all Grid options.
Important
32
Interpret the Volume (ml) and Filling (ml/s) Curve.
The Volume (ml) and Filling (ml/s) Curve displays the
volume curve determined from the ventricular contours.
The left ventricular volume is calculated and plotted for
each interval, resulting in a plot showing the change in
volume relative to time (Figure 17). Because stroke volume
equals ED volume minus ES volume:
36
2: Tutorial
AutoQUANT
• If the volume curve is too shallow, the ES volume is
higher, resulting in a stroke volume that is lower, and an
ejection fraction that is abnormally low.
• If the volume curve is too deep, the ES volume is lower,
resulting in a stroke volume that is higher, and an
ejection fraction that is abnormally high.
The EF equals the stroke volume divided by the enddiastolic volume.
Normal EF
(Mean -2 sd)
> 42% Male
> 50% Female
This reading indicates that the left ventricle can expel more
that half of its own volume with each contraction. The EF
falls with the onset of heart failure.
Figure 17 Volume (ml) and Filling (ml/s) Curve
33
AutoQUANT
Evaluate the Patient Statistics data, noticing the EDV, ESV,
and EF.
2: Tutorial
37
Viewing a Normal Patient Dataset
◆
To view the Normal patient dataset:
1
Click Raw to display the Raw window.
2
Click Patient Selector and select Normal from the pulldown menu.
Figure 18 Patient study drop-down menu
3
Repeat steps 1 through 33 in “Processing an Abnormal
Dataset.”
Refer to “Conclusions from the Normal Dataset” on page 38 below for details on results from the analysis of the
normal dataset.
4
Note
Exit AutoQUANT.
If you have the optional QARG application installed, when
you exit the tutorial an error message appears regarding
unsaved ARG results. Click OK to dismiss the message and
return to CSImport.
Conclusions from the Normal Dataset
The following summarizes the analysis of the Normal
dataset in each of the five windows used during this
tutorial.
38
2: Tutorial
AutoQUANT
Raw Window
The Heart and Lung ROIs produced when you initially
process the normal dataset are accurately drawn. You do
not need to enter manual mode to reposition or resize the
bounding boxes. The motion analysis procedure indicates
no evidence of motion in this dataset.
Slice Window
The generated SAX contours are acceptable; you do not
need to modify them.
Splash Window
There are no significant low count areas in the SAX slices.
The SAX slices appear as evenly shaded rings, and the HLA
and VLA slices are similar to vertically and horizontally
oriented horseshoes. The Visual Score Window displays all
zeros, except for a 1 in the outer ring, indicating that there
is very little deviation from the Normals file.
QPS Window
The Patient statistics are all within the normal range. The
Defect Analysis Graph is empty since there are no defects
in this dataset. The Defect Analysis Table indicates a
normal dataset as follows:
• There is no reversibility in any region.
• The defect extent at both stress and rest is minimal
except for a small defect in the anterior region at rest.
• The defect severity in all regions, at stress and rest,
averages less than one standard deviation below the
mean of the Normals file.
AutoQUANT
2: Tutorial
39
QGS Window
The Patient Statistics are all within normal range. The
volume curve indicates a normal dataset. The polar maps
show the following:
• ED and ES: No significant low count areas.
• Motion: Slight low count region in LAD and RCA, but
with normal values.
• Thickening: Some peripheral low count regions, but
with normal values.
40
2: Tutorial
AutoQUANT
3
Controls
This chapter contains descriptions of general
AutoQUANT window controls. The controls and
information areas shown in Figure 19 appear on most of
the AutoQUANT windows. Any control that is not
enabled, due to the type or state of the displayed file, or the
type of page selected, is grayed out and not selectable.
Using the controls at the top of the AutoQUANT main
window, you can select a window and perform application
functions such as selecting defaults files, saving files,
printing, or processing images. You can access these
controls regardless of which AutoQUANT window is
currently displayed.
• Processing Commands (page 43)
• Program Controls (page 56)
• Specifying the Active Dataset (page 79)
• Using Image Control Bars (ICBs) (page 86)
• Common Window Controls (page 91)
Note
AutoQUANT
Refer to Chapter 4, “Reviewing and Processing Images”,
for explanations of the various AutoQUANT windows.
3: Controls
41
Processing Commands
Windows
Program Controls
Image Control Bar
Includes: Limits, Scores,
Report, Defaults, Save,
Print, and Movie.
Patient
and
Object
Window
Controls
Patient Statistics and Data
Figure 19 AutoQUANT general window controls (Splash window
shown)
42
3: Controls
AutoQUANT
Processing Commands
Processing Commands
Processing Data
Clicking Process automatically generates the projections or
calculations for the following:
• Lung/Heart Ratio (LHR)
• Heart Volume (of the heart wall)
• Transient ischemic dilation (TID) Ratio
• LV contours on all short axis and HLA/VLA images
• Left ventricular ejection fraction
• Ventricular volumes
• Shape Index (SI) defining 3D LV geometry derived
from LV contours in ES and ED phases
• Eccentricity (Ecc), a measure of the elongation of the LV
Note
AutoQUANT
You must click Process whenever you have redefined
contours or ROIs. The displayed information varies
depending on which window is active.
3: Controls
43
Processing Commands
The following table outlines the calculations that appear in
the QPS, QGS and QPC windows.
QPS Window
QGS Window
2D & 3D Perfusion polar maps
2D/3D Perfusion polar map (ED/ES)
Note: QGS requires you to toggle 3D on
to view 3D polar maps.
2D & 3D Reversibility Perfusion (%) 2D/3D Motion & Thickening polar maps
polar maps (stress/rest)
(Function = Raw)
2D & 3D Difference Perfusion polar 2D/3D Motion & Thickening Severity
maps (stress/stress or rest/rest)
polar maps (Function = Severity)
2D & 3D Severity polar maps
2D/3D Motion & Thickening Extent polar
maps (Function = Extent)
2D & 3D Reversibility Severity polar 2D/3D Motion & Thickening Quant polar
maps (stress/rest)
maps (Function = Quant)
2D & 3D Difference Severity polar
3D ED and ES View
2D & 3D Extent polar maps
3D Gated View displays, TID, LHR, SMS
(SM%), STS (ST%)
2D & 3D Reversibility Extent polar Ventricular Volume [at selected frame]
maps (stress/rest)
2D & 3D Difference Extent polar
2D & 3D Quant polar maps
EDV and ESV Volumes
2D & 3D Reversibility Quant polar
maps (stress/rest). Displays, TID,
LHR, SSS (SS%), SRS (SR%), and
SDS (SD%)
2D & 3D Difference Quant polar
Volume: LV Chamber Volume
Motion Extent (Mot Ext), Thickening
Extent (Thk Ext) [at selected frame]
Wall: LV Wall (myocardial) Volume
44
3: Controls
Ejection Fraction (EF)
QPC Window
2D & 3D Perfusion polar maps
(Function = Raw)
2D and 3D Severity polar maps
(Function = Severity)
2D & 3D Extent polar maps
(Function = Extent)
2D & 3D Quant polar maps
(Function = Quant)
2D & 3D Reversibility (%) polar
maps (must have Rev toggled
on)
2D & 3D Viability (%) polar
maps (must have Via toggled
on)
2D & 3D Mismatch (%) polar
map (must have Mis toggled
on)
2D & 3D Scar (%) polar map.
Must have Scar toggled on to
display, TID, LHR, SSS (SS%),
SRS (SR%), and SDS (SD%)
Volume: LV Chamber Volume
Wall: LV Wall (myocardial)
Volume
Defect: LV Defect Volume
(computed using Normals
limits)
Shape Index [SI ED, SI ES, Ecc [at selected Extent: LV Defect Volume (as
frame]
percent of wall volume)
Toggle Score off to display PER, PFR,
Total Perfusion Defect (TPD)
PFR2, MFR/3, TTPF, and BPM calculations.
Shape: Shape Index [SI],
Eccentricity [Ecc]
AutoQUANT
SPECT Review Option: Motion Frozen
QPS Window
QGS Window
QPC Window
Defect: LV Defect Volume
(computed using Normals limits)
Extent: LV Defect Volume (as
percent of wall volume)
Total Perfusion Defect (TPD)
Shape: Shape Index [SI], Eccentricity
[Ecc]
SPECT Review Option: Motion
Frozen
Figure 20 SPECT Review Option: Motion Frozen
AutoQUANT
3: Controls
45
SPECT Review Option: Motion Frozen
This feature employs a technique to create cardiac motionfrozen perfusion or viability images, by warping all frames
of ECG-gated images to the ED position.
Such motion-frozen perfusion and viability images
improve resolution and contrast since the blurring effect of
cardiac motion is removed. This method of quantification
is based on publications shown in the Appendix D,
“Bibliography.”
The motion-frozen feature requires at a minimum one
processed gated SAX dataset.
Note
Implementing the Motion-Frozen Feature in QGS
The motion-frozen feature requires at a minimum one
processed gated short axis dataset.
Important
◆
To use the Motion Frozen feature within the QGS
window:
1
Click the QGS button.
2
Select the necessary myocardial gated SAX dataset.
3
Verify the automatically-derived contours.
You can select gated datasets on any display window
(Splash, Slice, Views etc.), as Splash and Slice windows are
more useful in viewing the created perfusion images
Note
4
At the QGS window’s main toolbar, click Freeze to initiate
the motion frozen algorithm.
When you click Freeze, AutoQUANT creates cardiac
“motion-frozen” perfusion or viability images by warping
ECG-gated images to the end-diastolic position. Such
46
3: Controls
AutoQUANT
Manually Redefining Bounding Boxes
"motion-frozen" images have improved resolution and
contrast since the blurring effect of cardiac motion is
removed.
The currently displayed gated dataset in the Dataset
Selector pull-down is replaced with the newly created
motion frozen datasets as identified by MF: in front of the
original dataset name.
The display window is updated with the newly created
motion frozen perfusion images.
Contours are automatically generated for the newly
created images. Enable (toggle on) the Contours control
to view contours.
Note
5
Toggle the Contours button on the window control bar to
view contours.
Freezing Images
Typically, motion frozen perfusion images are reviewed in
the Splash window, as are the usual perfusion short axis
datasets.
When you click Manual in the Raw window,
AutoQUANT displays the window in Manual mode. This
allows you to manually redefine the locations of the lung
and heart bounding boxes. These bounding boxes limit the
search area for the lung and heart ROIs, generated by
AutoQUANT
3: Controls
47
AutoQUANT when you click Process. See “Manually
Redefining ROIs” on page 48 for detailed information on
using the Manual control in the Raw window.
When you click Manual in any other window,
AutoQUANT displays the Slice window in Manual mode,
where you can manually redefine a bounding box that
limits the left ventricular search area. See “Manually
Redefining Ventricular Contours” on page 51 for detailed
information on using the Manual control in the Slice
window.
Note
Use Manual when the Process function produces contours
containing non-cardiac structures (such as the gall bladder
or a loop of bowel), or when the contours display jagged
irregularities extending beyond the myocardium.
Caution
Make sure that the placement of the LV contours is
correct, and verify that these contours accurately reflect the
myocardial wall limits. Inaccurate ventricular contours can
result in incorrect computation of quantitative data, which
can lead to misdiagnosis.
Manually Redefining ROIs
After processing datasets, if the heart or lung bounding
boxes contain structures, irregularities, or high count areas
outside of the ROIs, use Manual mode to redefine the
ROIs.
Note
48
3: Controls
Use Manual mode in the Raw window to redefine the
heart and lung ROIs. Use Manual mode in the Slice
window to redefine the ventricular contours (see
“Manually Redefining Ventricular Contours” on page 51).
AutoQUANT
Resetting Outlines
Click Reset to delete the contours, ROIs, and all of the
quantitative calculations AutoQUANT performed when
you selected Process. This button functions like a standard
“Undo” of the Process button.
The following table outlines some of the parameters you
must consider when evaluating the bounding boxes to
determine if you need to be reposition or resize the ROIs.
Contour
Acceptable Parameters
Unacceptable Parameters
Heart Bounding Box
Completely contains LV and does not clip
Contains other structures such as gall bladder
the LV
or a loop of bowel
Heart ROI
Fully within the LV myocardium
Not inside the LV
Lung Bounding Box
Excludes high count areas inside the lung
Fully or partially outside of the lung fields
field
Lung ROI
Fully within the lung field
Contains a high count structure within the lung
field
◆
1
To redefine the heart and lung ROIs in the Raw window:
Click Manual.
The Raw window displays unprocessed heart and lung
bounding boxes. The unprocessed bounding boxes have
four resizing handles and a center handle (Figure 21 on
page 51).
2
Reposition the heart and lung bounding boxes:
• Drag the center handle of the red unprocessed heart
bounding box to the center of the left ventricle.
• Drag the center handle of the green unprocessed lung
bounding box to the center of the lung ROI.
AutoQUANT
3: Controls
49
3
Resize the heart and lung bounding boxes by dragging the
handles to new positions.
Figure 21 on page 51 shows accurately repositioned
bounding boxes.
Make sure that the lung bounding box is large enough to
contain the ROI within the lung, but still excludes high
count areas outside of the lung. If you define the search
box too close to the outer boundary of the lung wall, you
may clip the lung, which produces inaccurate lung/heart
ratios. Make sure that the heart bounding box completely
contains the left ventricle but excludes high count areas
outside of the left ventricle. Areas outside of the boxes are
excluded from the surface detection procedure.
Important
4
Click Process.
AutoQUANT redraws the bounding boxes and ROIs.
Important
50
3: Controls
If you select Process when you are working in Manual
mode, only the raw dataset that was displayed before you
entered Manual mode is reprocessed.
AutoQUANT
Unprocessed Heart
bounding box
Unprocessed Lung
bounding box
Processed Lung
bounding box
Processed Heart
bounding box
Before Repositioning and Resizing
After Repositioning, Resizing, and
Reprocessing
Figure 21 Repositioning and resizing bounding boxes
Caution
to misdiagnosis.
If necessary, you can correct LV contour placement by
repositioning and resizing the bounding boxes using
Manual mode. See the following section, Manually
Redefining Ventricular Contours for details.
Manually Redefining Ventricular Contours
Click Slice to display the Manual window in Manual
mode (Figure 22 on page 52). If the ventricular contours
created during data processing contain non-cardiac
AutoQUANT
3: Controls
51
structures, irregularities, or high count areas that do not
correspond to the myocardium, use Manual mode to
redefine the ventricular bounding boxes.
Use Manual mode in the Slice window to redefine the
ventricular contours. Use Manual mode in the Raw
window to redefine the heart and lung ROIs. (See
“Manually Redefining ROIs” on page 48.)
Note
◆
1
To reposition or resize LV contours:
Click Manual.
The Slice window displays three SAX viewports, one HLA,
and one VLA viewport. Three reference lines in the HLA
and VLA viewports correspond to the three SAX slices.
Figure 22 Manual mode controls
2
52
3: Controls
Define the HLA and VLA slices.
AutoQUANT
For transverse datasets you can also adjust the long axis by
rotating the circular bounding box around the HLA and
VLA views. Left click, then drag a See Figure 23 on
page 53.
D
Drag this box clockwise or counter-clockwise.
Figure 23 Manual mode control for transverse dataset
In one of the SAX viewports, drag the vertical and
horizontal crosshairs to the center of the left ventricle. If
you change the crosshair positions in one SAX view the
crosshair positions in the other two SAX views are
automatically updated.
3
Resize the bounding box on the HLA or VLA slices.
Drag the handles in the HLA and VLA viewports to the
new position. As you resize a long axis bounding box, the
boundary circles on the SAX slices increase or decrease in
size to match the new bounding box definition.
Important
AutoQUANT
Draw the bounding box large enough to completely
contain the left ventricle, but small enough to exclude high
count areas outside of the ventricle. Areas outside the
bounding box are excluded from the surface detection
procedure.
3: Controls
53
Figure 24 shows the bounding boxes before and after
resizing.
Before Resizing the Bounding Box
After Resizing the Bounding Box
Figure 24 Resizing the bounding boxes
4
Click Process.
AutoQUANT determines the ventricular boundaries and
displays the redefined contours on all of the slices.
Clicking Process also turns Manual mode off.
Refer to “Verifying Contour Placement” on page 107 for
information on analyzing the contours.
5
If the processed contours are still not acceptable, redefine
the centerline endpoints (Figure 25):
• Click Manual to return to Manual mode.
• Click Constrain.
54
3: Controls
AutoQUANT
Constrain further limits the search area by forcing the
apical and basal search areas to lie in the vicinity of the
endpoints of the HLA and VLA centerlines.
• Drag the apical centerline endpoint to the middle of the
apex.
• Drag the basal centerline endpoint to the valve plane.
• Repeat steps 2 through 4 of this procedure to redefine
the bounding boxes.
Basal centerline endpoint
Apical centerline endpoint
Apical
centerline
endpoint
Basal
centerline
endpoint
Figure 25 Apical and basal centerline endpoints
• If the processed contours are still not acceptable, click
Manual again and continue to step 6 of this procedure.
See “Verifying Contour Placement” on page 107 for
6
Click Mask to force AutoQUANT to ignore all counts
outside the area surrounding the left ventricle.
Mask limits the ventricular search area used for
determining contours.
AutoQUANT
3: Controls
55
Program Controls
7
If not already toggled on, click Localize. Localize
automates the algorithm to restrict the initial LV search, to
the region.
8
Click Process.
Displaying Multiple Cardiac Datasets
Use the 1, 2, 3, or 4 buttons to simultaneously display one
or more cardiac datasets. This option is useful for
comparison of the following datasets:
•
•
•
•
Stress and rest
Gated and non-gated
Older and newer patient studies
Vantage studies
To display different datasets from the same patient, you
must have loaded the appropriate number of datasets into
AutoQUANT.
Note
In all windows except Snapshot and More, images for each
dataset are displayed in the image display panel and patient
statistics are displayed on the right side of the window.
When two or more cardiac datasets are displayed, the
number of images and the amount of demographic
information for each dataset may be adjusted accordingly
to fit the space available.
Program Controls
AutoQUANT’s Program Controls (see Figure 19 on
page 42 for location) include, Limits, Scores, Report,
Defaults, Save, Print
56
3: Controls
AutoQUANT
Program Controls
Displaying the Defaults Window
Click Defaults to open the Defaults window. Here you can
load, modify, reset, and save the most frequently used
AutoQUANT parameters for each AutoQUANT window.
Other functions include: Define AutoMatch parameters,
Create and apply themes, Change graphic settings, and
Modify ARG settings. Refer to Chapter 5, “Setting
Defaults,” for detailed information on creating and using
your own defaults files.
Saving a Dataset
You can save your processed datasets as AutoQUANT
Results files; these results files are datasets or complete
patient studies that you have opened and processed in
AutoQUANT and then saved to the database. These files
are always saved as an object in the active patient study.
You can also save results and application configuration for
case studies designed for fast and easy launching directly
from a PowerPoint slide.
Use the Defaults window to define the settings for the
Save Results dialog box (refer to Chapter 5).
◆
1
To save a dataset:
Click Save to display the Save Results dialog box.
The Results tab is displayed by default.
AutoQUANT
3: Controls
57
Program Controls
Figure 26 Save Results dialog box, Results tab
2
Do one of the following:
• Click Save All to save all loaded datasets.
• Click Save Current to save datasets from the currently
displayed patient.
• Click Cancel to cancel out of the Save Results window.
◆
1
To save a CT study dataset:
Click Save to display the Save Results dialog box.
The Results tab is displayed by default.
58
3: Controls
AutoQUANT
Program Controls
Figure 27 Save Results with Embed CT window, Results tab
2
• Click the Embed CT checkbox to include CT data into
the Results file.
displayed patient.
AutoQUANT
3: Controls
59
Presenting Studies with Microsoft PowerPoint
Presenting Studies with Microsoft
PowerPoint
It is not within the scope of this manual to describe how to
use the Microsoft PowerPoint application.
Note
The PowerPoint save feature is a useful tool that allows
saving a set of images and results along with a batch file.
The batch file launches the QPS and QGS application and
loads the images and results, which is useful for showing
case studies within a PowerPoint presentation.
◆
60
3: Controls
To save a study in PowerPoint:
1
Select your study (or studies) and start your application.
2
Review the results of the study (or studies) on the display
page you wish to save (e.g. Slice page) and make changes as
necessary (intensity/color scale, zoom, frame rate settings
etc.)
3
Click the Save button to open the Save Results dialog.
4
Click the PowerPoint tab.
AutoQUANT
The following window appears:
Figure 28 PowerPoint tab window
5
Click Browse to select a directory to store the images and
batch file.
6
Type a name in the Filename text area.
7
• Click Save All to save all the selected studies for the
current application session.
• Click Save Current to save the currently display study.
• Click Cancel to cancel out of the PowerPoint Save
Results window.
◆
AutoQUANT
To save a CT study in PowerPoint:
1
Select your study (or studies) and start your application.
2
Review the results of the study (or studies) on the display
page you wish to save (e.g. Slice page) and make changes as
necessary (intensity/color scale, zoom, frame rate settings
etc.)
3: Controls
61
3
Click the Save button to open the Save Results dialog.
4
Click the PowerPoint tab.
The following window appears: (Figure 29 on page 62)
Figure 29 PowerPoint with Embed CT tab window
5
Click Browse to select a directory to store the images and
batch file.
6
Type a name in the Filename text area.
7
• Click the Include CT datasets checkbox to include CT
data into the PowerPoint file.
displayed patient.
Important
62
3: Controls
After saving your PowerPoint file, do not move it to
another location on your hard drive. Your save file must
reside in its original saved location.
AutoQUANT
Description of Saved Files
Three files per study are saved. The 3 files created have
extensions of .vbs, .gsi, and .xml.
The .vbs file is a Visual Basic Script file that will launch the
QPS, or QGS application and load the corresponding .gsi
data file.
The corresponding .xml file loads defaults for the study,
but not all defaults are preserved.
Important
Output files are for PowerPoint use only. Any other usage
of output files (outside of PowerPoint) is not supported.
Note
Launching Application Studies from PowerPoint
The following is a basic overview on how to use
PowerPoint. For more details on its usage, consult your
Microsoft PowerPoint user manual or visit their web site.
Note
Studies must be saved using the procedure in the preceding
section in order to use this PowerPoint feature.
Important
◆
1
Open PowerPoint and insert a new slide.
Depending on your PowerPoint’s security setting, you may
receive a PowerPoint warning message. This warning
message can be disabled within PowerPoint. Consult your
PowerPoint manual for details.
Note
2
AutoQUANT
To create a slide that will launch an application (QPS, or
QGS) study session:
Under the Slide Show menu drop-down, select Action
Buttons and choose an action button graphic from the list.
3: Controls
63
3
Draw the action button on the slide. An Action Settings
dialog window should be displayed when finished drawing.
Optionally, right-click on the action button and select
Properties to bring up the Action Settings dialog.
4
In the Action Settings dialog click the Run program toggle.
5
Using the Browse command, locate the "vbs" file and select
it. The Files of type selection in the browse window may
have to be changed from Programs (*.exe) to All Files (*.*).
6
Click OK.
7
Launch the slide show for the current slide and click the
action button to verify correct launching of the study.
8
Don’t forget to add a text description beside the Action
button, as it may help you better remember the study your
presenting. (See Figure 30 on page 64)
Figure 30 PowerPoint Action button description
64
3: Controls
AutoQUANT
Printing and Saving a Window
◆
For the currently active window, use Print to perform the
following:
1
Click the Database tab to save the screen to the database as
a Snapshot file.
2
Click the File tab to save the screen to a directory on your
hard drive or other storage media.
3
Click the Printer tab to print the screen to a printer.
Caution
Make sure that any output that you intend to use for
interpretation is saved or exported in a lossless format (e.g.,
DICOM SC for snapshots saved to the databse, TIFF or
PNG for screen captures saved to a folder on a local drive).
Output saved or exported in a lossy format may not
Caution
Make sure that any hardcopy output that you intend to use
for interpretation is of diagnostic quality. Output of nondiagnostic quality may not include all information
necessary for a diagnosis; interpretation using nondiagnostic output may therefore lead to misdiagnosis.
Non-diagnostic output is intended only for reference or
inclusion in documents such as reports and presentations.
Note
◆
AutoQUANT
To save the screen as a Snapshot file in the database:
1
Click Print to display the Print dialog.
2
Click the Database tab, if not already displayed (Figure 31
on page 66).
3: Controls
65
Figure 31 Database tab, Print dialog
3
Note
If necessary, edit the Format: DICOM SC field:
DICOM SC is the only format available in the Database
tab.
• Transfer Syntax: Click the drop-down menu to choose
either a compressed or uncompressed file transfer.
• Series Description: Enter a filename in the text box.
This filename appears as a dataset in CSImport and/or
JETStream Workspace.
• Comment: Enter a comment you want to associate with
this file.
• Datasets: Dataset details appear in this area. Click inside
the Operator and Institution text fields to add an
operator and/or institution name.
66
3: Controls
AutoQUANT
Only the Operator and Institution text boxes can be edited
in the Dataset field.
Note
You must remove the focus from the text field (click
outside the text field) in order to save your changes.
Important
• Include a dataset legend: Click this checkbox to display
the above dataset details (as a footer) on your saved
snapshot.
4
Click OK.
File Tab
◆
AutoQUANT
To save the screen on your local hard drive or other
media:
1
2
Click the File tab, if not already displayed (Figure 32).
3: Controls
67
Figure 32 File tab, Print dialog
3
If necessary, edit the fields:
• Filename: Use this to change the filename.
• Browse: Click this if you want to change the directory in
which the file is saved. A file save dialog appears.
Specify the filename and the directory on your local
hard drive where you want to save the file, and click OK
when you are done.
68
3: Controls
Note
The file is not saved until you click OK at the bottom of
the dialog.
Note
Philips recommends that you create your own directory
to store the files.
AutoQUANT
• Format: Select a file format from the list. Available
formats are:
- TIFF
- JPEG
- PNG
- BMP
- DICOM SC
Important
Never change the 3-character filename extensions.
• Format Options: What appears in the Format Options
field depends on the format you choose.
- TIFF: There are no format options available.
- JPEG: Move the quality slider from 40-100.
- PNG: There are no format options available.
- BMP: There are no format options available.
- DICOM SC: Choose either Uncompressed (largest
file size) or RLE Lossless Compression.
this file.
Note
Important
AutoQUANT
You must remove the focus from the text field (click
outside the text field) in order to save your changes.
3: Controls
69
snapshot.
4
Click OK.
Printer Tab
Printing is not intended for diagnostic use.
Important
◆
To print the screen to a printer:
1
2
Click the Printer tab, if not already displayed (Figure 33).
Figure 33 Printer tab, Print dialog
The currently selected printer is listed under Selected
printer.
70
3: Controls
AutoQUANT
Saving a Cine Movie
3
Do the following to complete the Labelling Information
section:
• Series Description: Add a description in this field.
• Comment: Add a comment in this field.
• Datasets: Datasets are displayed.
Note
snapshot.
4
If necessary, click Setup to display a window through
which you can change or configure the selected printer.
To change the selected printer, click Setup to select another
printer, and then click Print.
5
Click OK.
This sends the print job to the device configured for your
machine.
Saving a Cine Movie
For the currently active window that includes a cine file,
use Movie to do the following:
• Save the cine to a directory on your hard drive or other
media.
Caution
AutoQUANT
Make sure that any cine output that you intend to use for
interpretation is saved using a lossless AVI codec (coderdecoder) only. Output saved using a lossy codec may not
3: Controls
71
Saving a Cine Movie
◆
1
To save the current cine to your local hard drive or other
media:
If Labels is on, turn it off.
If you do not turn labels off, the movie may contain
artifacts.
Note
2
Click Movie to display the Movie window.
The following Database window tab appears. See Figure 34
on page 72.
Figure 34 Database tab - Movie window
72
3: Controls
AutoQUANT
Saving a Cine Movie
• Format: AVI and DICOM SC are available for movie
output saved to your local hard drive or other media.
• Codec Options for AVI: Several codec (coder-decoder)
options are available; a quality slider (range: 0–100) is
available for some of these options.
- Select a codec from the list below:
Codec Option
Quality Slider
Cinepak Codec by Radius (Cinepak Codec) [CVID]
X
Microsoft Video 1 (MS-CRAM [MSVC])
X
Uncompressed frames (Uncompressed)
X
• Transfer Syntax: Use the drop-down menu to select
Compressed or Uncompressed DICOM SC.
This filename appears as a dataset in CSImport and/or
JETStream Workspace.
this movie.
movie.
3
AutoQUANT
Click OK to close the Database window tab or click the
File tab for more options.
3: Controls
73
Saving a Cine Movie
Do not touch any keys or click your mouse while your
movie is being created and saved. Touching the keys or
mouse during the creation of your movie file may cause
incomplete animation cycles. Make sure you perform a
quality check of your movie after saving it.
Important
Figure 35 File tab, Movie window
4
If necessary, the File tab allows you to make the following
changes:
• Filename: If you want to use a filename that is different
from the default, enter it here.
Important
Do not change the 3-character filename extension.
• Browse: Click this if you want to change the directory
(or media) in which the file is saved.
74
3: Controls
AutoQUANT
Saving a Cine Movie
5
Specify the filename and the directory for where you want
to save your movie file, then click OK.
More on File Output Formats
Additional guidelines for selecting data output formats are
as follows:
File Output Formats
• TIFF: Lossless; large files.
• JPEG: Always lossy (even at a quality setting of 100);
widely used, however, because file size tends to be
smaller than it would be in other formats.
Note
The JPEG format offers the additional choice of a
variable quality factor between 40 (worst; smallest file
size) and 100 (best; largest file size).
• PNG: 24-bit, lossless, compressed; a good choice for
screen captures.
• BMP: 24-bit, lossless, uncompressed; larger files than
those in PNG format.
• DICOM SC: Retains source file information (patient
name, etc.); useful for data exchange with other medical
imaging programs.
In AutoQUANT, the DICOM SC format option exists
in both the Database tab and the File tab of the Print
dialog.
AutoQUANT
3: Controls
75
Saving a Cine Movie
- In the Database tab, saving in this format saves the
screen as a Snapshot file in the local patient database.
This file appears as an object that you can select to
load into AutoQUANT or your base platform
application.
- In the File tab, saving in this format saves the screen
as a DCM file on any drive location you specify.
Because the file is not saved to the local database, you
cannot access this file through your base platform’s
patient browser.
Note
The DICOM SC format offers an additional field: a
series description (DICOM group,element
0008,103E). This series description is the DICOM
equivalent of the View ID.
• AVI: Different codecs (coder-decoders) available; mostly
lossy; lossless codecs have large file sizes and can be
difficult to display in a cine loop.
Displaying and Printing the Help File
Click Help to open the online Help window, which
displays a version of this manual in PDF format.
Note
You must use Adobe Acrobat Reader to view this file. Refer
to your release document for installation instructions.
You can print the Help file using the Print function in
Acrobat Reader to send the file to the Windows printer
configured for your machine. You can also print the user
manual files from the AutoQUANT CD from any PC that
has Acrobat Reader 8 installed.
76
3: Controls
AutoQUANT
Saving a Cine Movie
Viewing Program Information
Click the pull-down menu button to the right of any
Image Control Bar (ICB) and select About to view version
information for the AutoQUANT application. Click Close
to close the information window.
Scoring a Dataset
Important
Make sure that you apply the correct Normals file.
AutoQUANT does not automatically display score values
until you have applied a Normals file.
Visual scoring diagrams (Figure 36) consist of either a
seventeen or twenty-segment polar map for the stress and
rest datasets, with an additional map for reversibility. Each
segment lies in one of four regions formed by concentric
circles on the diagram.
Stress
Visual Scores
Region 1
Rest
Visual Scores
Reversibility
Visual Scores
Region 2
Region 3
Region 4
Figure 36 Visual Scores panel
Note
AutoQUANT
Right-click on any Stress or Rest polar map segment to
display a pop-up box. The pop-up box identifies the artery
or arteries involved in that area.
3: Controls
77
Saving a Cine Movie
The numerical value for a segment in the visual scoring
diagram indicates the amount of perfusion deviation in
this region relative to the Normals file. Values range from a
normal of 0 (normal perfusion) to a maximum abnormal
of 4 (no perfusion).
If all the values in the scoring diagram are zeros, there is no
deviation from the Normals files for any segment.
Note
If a Normals file is not selected for comparison,
AutoQUANT displays the scores as dashes.
If you flag the images as a pair for TID measurement
(using the TID buttons in the Edit window), they are also
scored as a pair. When the images are paired, and you select
either the Dual Isotope or Mibi Normal Limits file,
AutoQUANT does not allow the rest scores to be greater
than the stress scores. Therefore, if the stress scores are
normal, the rest scores are also normal, even if the rest
study suggests there is a defect.
To evaluate multiple stress and rest datasets, click the
adjacent Edit arrow button to set the TID tags to the pair
of images you want to evaluate.
When AutoQUANT automatically assigns vessels to
segments, it uses an algorithm based exclusively on stress
scores. When AutoQUANT scores a study, this algorithm
intelligently groups related defects to the vessel which is
most prevalent. This is accomplished by changing the
vessel associated with the segment(s).
For example, there is a small defect in the inferior-lateral
wall (segment 11). Typically, this segment is associated
with the LCX. However, if there is already a defect in the
inferior wall (RCA), it is likely that the inferior-lateral
defect is actually part of the larger defect in the RCA. In
this case, segment 11 will automatically change from LCX
to RCA.
78
3: Controls
AutoQUANT
Specifying the Active Dataset
You can override the automatic selection by right-clicking
the segment and selecting the appropriate vessel. You can
also select multiple vessels. In the example above, if the you
manually select LCX/RCA, the automatic dictation may
then state: a medium amount of ischemia of the
RCA, involvement of the inferior-lateral
wall raises the possibility of additional
disease of the LCX.
If you click Auto, AutoQUANT automatically resets both
the scores and the vessel territory assignments.
Note
Use the Patient and Object selectors to specify the active
datasets. You can display up to four datasets. The Object
selector changes depending on how many datasets you
display.
1 dataset displayed
Patient Menu
Object Menu
3 datasets displayed
Figure 37 Patient and Object selectors
◆
1
AutoQUANT
To specify an active dataset:
Click Patient to display the list of patients, and select a
patient name.
3: Controls
79
2
Click the Object Selector (Figure 38) to display the list of
objects for the selected patient, and select an object.
Figure 38 Selecting objects
You can also use the <Up> or <Down> arrow keys on the
keyboard to scroll through the list of patients or objects.
Note
Patients with the same name and ID are grouped under a
single patient, regardless of how they are grouped by
AutoQUANT. If either field is empty, then it is grouped
under multiple patients.
Important
3
If you have clicked the 2, 3, or 4 button to display multiple
cardiac datasets, repeat step 2 accordingly to select
additional objects.
Listing Loaded Datasets
The Exam Object List window displays all of your
currently loaded patients and their datasets.
Important
80
3: Controls
Many AutoQUANT algorithms and displays require the
correct categorization of datasets in order to work correctly.
In cases where automatic categorization did not work, the
dataset editor can be used to correctly re-categorize.
AutoQUANT
AutoQUANT may not automatically find the right normal
dataset to apply if attributes are not recognized from your
AutoMatch filter settings or your DICOM data.
Important
Note
Missing or conflicting AutoMatch criteria in the selected
default can make the automatic categorization fail. For
setting automatch criteria see “AutoMatch Tab” on
page 202
Note
If you have more than one normal database that matches
the criteria you will have multiple matches. For
information on Normal Databases see “Database Window”
on page 223
Philips recommend to have the application launch the
Exam Object List window by default when it fails to
automatically find a matching normal database. You can
do so by enabling the Verify option in the custom
Defaults. See “General Tab” on page 194
Important
◆
1
To use the Exam Object List window:
Click the Edit button (Figure 38) to display the Exam
Object List window:
Figure 39 Exam Object List window
AutoQUANT
3: Controls
81
Active enables the dataset to be processed and displayed.
Each dataset has an Active button, which is highlighted by
default. This indicates that you can select the dataset from
the Object Selector and that AutoQUANT can automatch
the dataset as a stress/rest file.
If the dataset is a stress or rest file, it is identified as such
with a yellow highlighted button.
The Dataset Editor recognizes Stress and Rest datasets
based on a combination of the DICOM data and
AutoMatch filters.
Note
2
Click the other buttons to make the dataset available for
those calculations.
Buttons shown (within the Dataset Editor window) vary
with each dataset. The available buttons include:
• LHR specifies the file to be used for the LHR
(Lung/Heart Ratio) calculation.
Note
Selections made in the Exam Object List window affect
all windows, while selections made from the current
window’s Object selector affect only that window.
• TID specifies the file to use as one of the two files used
to calculate the TID value. Make sure to tag two files for
this.
Note
TID also associates a stress and rest pair that is used
during scoring for the dual isotope and Mibi-Mibi
protocols. For more information, see “Scoring a
Dataset” on page 77.
• AttC specifies that attenuation correction is applied to
the image.
82
3: Controls
AutoQUANT
• Base is short for baseline, a tag that you can define as an
automatch filter (Baseline Filter) to flag a dataset to be
used as the baseline in comparison with others.
• Sex (Patient sex)
• Isotope is the imaging agent.
• Orientation is the patient acquisition orientation.
• Stress (Stress dataset)
• Rest (Rest dataset)
• 4Hour (4 hour delayed dataset)
• Late for a 24 hour or later dataset.
• Primary TID is the default dataset to be used in
reversibility computations.
• AttC (Attenuation corrected)
• Via is viability.
• Database enables the perfusion normal databases to be
applied.
AutoQUANT
3
Click the pull-down menu at the right of the other buttons
to manually select or change which database AutoQUANT
applies to a particular exam.
4
Click OK to save the changes you made and close the List
window. Click Cancel to go back to the last AutoQUANT
window without saving changes.
3: Controls
83
Selecting a Normals Limits
◆
1
To select a Normals Limits:
Click Limits to display the Limits dialog.
Figure 40 Limits window
2
In the Limits dialog, select the Normals Limits that you
want to apply to the current study.
The Normals Limits file you manually apply (to a current
dataset) also get applied to all currently loaded studies.
Important
The QPS and QGS windows use the Normals file to
compare the patient datasets with normal values.
3
• Click OK to save the changes you made and close the
Limits dialog.
84
3: Controls
AutoQUANT
• Click None to cancel out any previous applied Normals
files.
• Click Cancel to go back to the last AutoQUANT
window without saving changes.
See Chapter 6, “Managing Databases,” for detailed
information on creating and using your own Normals files.
Displaying Scores
Click Score to display one of several Visual Score panels.
Refer to “Scoring a Dataset” on page 77, for detailed
information on using the score panels.
Figure 41 Score panel (example)
Displaying The ARG Report Panel
If you have purchased the QARG option, click the Report
button to open the ARG Reporting panel.
See the QARG Instructions for Use for details on the ARG
Reporting panel.
AutoQUANT
3: Controls
85
Using Image Control Bars (ICBs)
AutoQUANT can display up to four ICBs simultaneously.
Each ICB operates on a pre-defined type of image or
dataset:
• The Phase ICB controls the display of 2D phase and
amplitude polar maps.
• The Surfaces ICB controls the display of shaded
surfaces.
• The Polar ICB controls the display of function 2D and
3D polar maps.
• The Slices ICB controls the display of image slices. It is
applied to slice and raw images.
The ICB contains controls for changing background and
brightness color and intensity, and a colormap pull-down
menu for selecting color tables and bar configurations.
colormap pull-down menu
Background Slider
Brightness Slider
Intensity (Gamma) Slider
Figure 42 Examples of an Image Control Bar
86
Note
You can not change background and brightness using the
Surfaces ICB.
Important
To accentuate the count differences in an image, choose a
colormap with discrete color ranges or adjust the
Background or Brightness controls to reduce the number
of colors displayed.
3: Controls
AutoQUANT
◆
1
To change image control settings:
Drag the background, brightness, and gamma slider
controls to the desired settings.
• Background Slider: Controls the lower threshold where
pixel values below the threshold appear as one color,
corresponding to the lowest value in the color table.
Drag the slider to the right to raise the background level,
making low-count image areas less visible. Drag the
slider to the left to decrease the background level,
making the low-count image areas more visible. The
background level appears as a percentage.
• Brightness Slider: Controls the upper threshold where
pixel values above the threshold are displayed as one
color, corresponding to the highest value in the color
table. Drag the slider to the left to raise the threshold,
displaying more detail in high-count areas. Drag the
slider to the right to decrease the threshold, displaying
less detail in high-count areas. The brightness level is
displayed as a percentage.
• Gamma (Intensity) Slider: Controls the intensity of the
displayed image. Drag the Gamma slider control left to
increase the intensity, or drag right to decrease the
intensity. Gamma is initially set at the midrange of 1.0,
but it is adjustable from 0.5 to 2.0.
Note
AutoQUANT
After you adjust the Background or Brightness Sliders,
you can click and drag between the two sliders to change
the position of both the sliders as a group. As you adjust
the pair, the background and brightness percentages
update to reflect the changes. Double-click on the ICB,
or click on colormap and select Reset from the pulldown menu, to reset both sliders to their original
positions.
3: Controls
87
2
Click on the colormap pull-down menu (see Figure 47 on
page 90) and select a color table.
Slices, Phase, and Surfaces each contain different color
choices however, each use Gray as their default table color.
See the following tables for available color choices:
Note
Gray
Thermal
Cool
Warm
Hot
Smart
Prism
Linear
Hotter
Colder
Blue
Ice
Multi
Isocontour
Rainbow
Step4
Step5
Step10
Step20
Figure 43 Color map colors - Slices and Polar
Gray
Thermal
Cool
Warm
Hot
Phase2
Step4
Step5
Step10
Step20
Phase
Figure 44 Color map colors - Phase
Gray
Thermal
Cool
Warm
Hot
Prism
Red
Green
Blue
Ice
Figure 45 Color map colors - Surfaces
All screen captures are saved in 24-bit true color (exactly
like the screen at the time of capture).
Note
3
Select one or more bar configuration options.
In addition to the color tables, the colormap pull-down
menu also contains various bar configuration options:
• The following option is available in the colormap pull-
down menus for all ICBs:
- About: Displays information about the current build
and installed application options.
88
3: Controls
AutoQUANT
• The following options are available only in the
colormap pull-down menus for the Polar and Slices
ICBs:
- Reset: Resets the ICB settings to 0 for Background
and 100 for Brightness
- Invert: Inverts the active color table and intensity
- Step: Divides the current colormap into 10 steps
- Gamma: Activates the Intensity (Gamma) control in
the ICB
- Expand: Expands the ICB contents such that
percentages range from –50 to 150 instead of 0–100
• The following options are available only in the
colormap pull-down menus for the Slices ICB:
- Split: Gives each dataset its own colormap. When
split is not on, all datasets have the same colormap
and Window-Level. If only one dataset is selected,
Split has no effect.
- Normalize: Normalize resets the pixel values that
represent the maximum colors of the colorscale,
making the highest voxel value in the myocardium
white.
• The following options are available only in the colormap
pull-down menu for the primary ICB on the Fusion
page:
- W/L Presets: Lung, Fat, Water, Muscle, Liver, Bone,
CTA, and Edit.
Note
AutoQUANT
Edit allows you to adjust the default levels for each of these
options See Figure 46.
3: Controls
89
Figure 46 Window/Level Editor window
- Window/Level: Use this feature to edit the current
colorscale. When checked, the black and white end
tabs slide inward or outward together. See Figure 46.
When unchecked, the black and white tabs each slide
independently.
Colormap pull-down
Colorscale slider bars
Figure 47 Window/Level colorscale slider and pull-down menu
button.
90
3: Controls
AutoQUANT
Common Window Controls
The following tasks are common to multiple
AutoQUANT windows, and you can initiate them using
buttons on the active window’s toolbar. Refer to the table
under “Summary” on page 96 to see which controls are
available in each window.
Toggling Labels
Click Label to toggle the display of the lines that are
superimposed on the images. This can include text,
reference lines, slice numbers, segment boundaries, and
projection orientation labels.
Toggling Orient
Click Orient to display your dataset’s orientation labels.
These labels (adjacent to each slice) appear as yellow text.
The Orient button resides within the menu bar shown in
Figure 48.
Figure 48 Orient button
The Orient feature can also be set as a Page Option in
Defaults. See Figure 49.
AutoQUANT
3: Controls
91
Figure 49 Orient button as a Page Option in Defaults.
Toggling Contours
When reviewing slices and 2D polar maps, click Contours
to toggle the display of the LV inner and outer contours.
Displaying a Box
For some 3D images, you can display a box that encloses
the image by clicking Box. You can use this as an
orientation reference when you manually manipulate the
3D object.
Indicating End Diastolic/Systolic Positions
Use ED to draw green outlines indicating the end diastolic
position. Use ES to draw red outlines indicating the end
systolic position.
92
3: Controls
AutoQUANT
Blurring an Image
Click Blur to toggle temporal smoothing on or off.
Temporal smoothing is a 1-2-1 smoothing kernel that
wraps around the last interval. This is useful for reducing
statistical noise in low-count images.
Note
The Blur function affects only image display. The QGS
algorithms operate on the original, unsmoothed data
regardless of Blur settings.
Note
Blur has no effect on 3D images.
Smearing an Image
Click Smear to toggle the Smear function on or off. Smear
applies a spatial smoothing algorithm to all images in the
window.
Skipping Images
Use Skip to display every other image.
Playing Gated Datasets
Click Gate to display sequential intervals of a gated
SPECT dataset. Use the Rate arrows to change the display
rate.
AutoQUANT
3: Controls
93
Spinning Images/Spin Rate
Using the Spin button, you can spin some 3D images. Use
the Rate arrows to control the rate of spin. Dual images
spin synchronously, but may be independently oriented.
Rock
Toggles bi-directional rotation for sub-360 degree
acquisitions, while Spin is enabled.
Displaying Pins
The Surface, Views, QGS, QPS, QPC, and Change
windows include a Pins toggle. For any ungated dataset
that was generated from a gated dataset by motion freezing
(see page 47), the Pins option displays graphical
information about the displacement caused by the motion
freezing process: the length the pin is a scale representation
of the size of the motion.
Displaying Wall Surfaces
The Surface, Views, QGS, QPS, QPC, and Change
windows display a Surface pull-down list. You can use this
to display the inner or outer cardiac walls as solid surfaces,
or the inner wall as a solid surface and the outer wall as a
transparent wireframe surface. Wireframe surfaces are a
transparent representation of an object created by
outlining the object surface with a grid of lines. To change
the surface display, go to the Surface menu and select one
of the following options:
94
3: Controls
AutoQUANT
• Inner: displays the endocardial surface as a solid volume.
• Outer: displays the epicardial surface as a solid volume.
• Both: displays the endocardial surface as a solid volume
and the epicardial wall as a wireframe surface.
• Middle: displays the myocardial wall as a solid volume.
• Function: displays the myocardial wall as a solid volume
with the current color map reflecting the relative count
distribution.
• Func/Both: shows Function and Both displays
simultaneously.
• Func/Outer: shows Function and Outer displays
simultaneously.
• None
Adjusting the Size of Images
For 2D images, use the Zoom 왗 or 왘 buttons to enlarge
and shrink images. For 3D images, use the Scale 왗 or 왘
buttons to enlarge and shrink images.
Note
When you highly magnify an image, you may see
pixelation in the image.
Adjusting Intervals
Use the Frame arrows to display a specific interval in a
gated SPECT dataset. Click the 왗 or 왘 buttons to increase
or decrease the displayed interval.
AutoQUANT
3: Controls
95
Oblique
Use Oblique to toggle the display of transverse datasets
within short axis orientations.
Note
The Oblique feature is for PET and CT data only.
Summary
The following table shows the common controls available
(indicated by X) in each window.
96
3: Controls
AutoQUANT
QGS
Change
Fusion
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Orient
X
X
X
Contours
Lines
X
Sum
X
Gate
X
Spin
X
Rock
X
Multiple
X
Absolute
X
Frame
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Cine
X
X
X
X
X
ED
X
X
X
X
X
ES
X
Blur
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Smear
X
X
Oblique
X
AutoQUANT
X
X
X
Scale
Rate
X
X
Box
Zoom
Database
QPC
X
Label
Window Control
Snapshot
QPS
X
Splash
X
Surface
X
Slice
X
Raw
Views
Window
X
X
X
X
X
X
X
X
X
X
X
X
X
X
3: Controls
97
3D
Database
Snapshot
Fusion
Change
QGS
QPC
QPS
Views
Splash
Slice
Raw
Window Control
Surface
Window
X
Pins
X
X
X
X
X
X
Surface
X
X
X
X
X
X
Function
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Graph
X
X
Prone+
X
X
Grid
X
View
X
X
X
Popout
X
Clear
X
Skip
X
Rev
X
Via
X
Mis
X
Scar
X
Phase
X
X
X
Compare
X
Alpha Blend
X
Figure 50 Available common controls per window table
Note
98
3: Controls
Available window controls appear and disappear based on
the type of data displayed.
AutoQUANT
Exiting AutoQUANT
Before exiting AutoQUANT, ensure that you have used
the Print function to save any processed images and
contours that you want to keep. You may also choose to
Save your study data prior to or upon exiting
AutoQUANT.
Click Exit to close the AutoQUANT application and
return to your base platform. If you have processed or
modified any files since opening AutoQUANT, and have
not yet saved the files, a warning window prompts you to
save your changes.
AutoQUANT
3: Controls
99
100
3: Controls
AutoQUANT
4
Reviewing and Processing
Images
• Using the Raw Window (page 102)
• Using the Slice Window (page 106)
• Using the Surface Window (page 111)
• Using the Splash Window (page 115)
• Using the Views Window (page 122)
• Using the Quantitative Perfusion SPECT (QPS)
Window (page 124)
• Using Quantitative Perfusion Change (QPC)
Window (page 142)
• Using the Quantitative Gated SPECT (QGS)
Window (page 147)
• Phase Analysis (page 157)
• Using the Change Window (page 169)
• Using the Fusion Window (page 175)
• Using the Snapshot Window (page 185)
• Using the More Window (page 187)
• Using the Database Window (page 188)
AutoQUANT
4: Reviewing and Processing Images
101
Overview
Overview
Important
The controls available for each AutoQUANT window vary
depending on the currently selected defaults file. Refer to
Chapter 5 for detailed information on setting your own
defaults.
Note
In all windows except Snapshot and More, images for each
dataset appear in the image display panel and patient
statistics appear on the right side of the window. When
two or more datasets appear, you can adjust the number of
images and the amount of demographic information for
each dataset to fit the space available.
Note
If the current value for a patient statistic field is too long to
be displayed completely in the window, you can view the
full field value in the tool tip for that field.
Using the Raw Window
The Raw window initially displays any raw unprocessed
datasets. The dataset can be a gated or non-gated study, or
a Vantage study. The projection dataset used in the
Lung/Heart Ratio calculations is in the left viewport, and a
representative frame is in the right viewport. After
processing, the heart and lung ROIs appear in the right
viewport (Figure 52 on page 104).
Note
The default sort criteria for loading projection data are (in
order of decreasing precedence):
1 non-gated > gated
2 LHR > non-LHR
102
AutoQUANT
3 stress > rest > neither
This matches the order of the exam object list you see
when you click Edit. You cannot change these sort criteria.
Use the Raw window to:
• Review the projection datasets in Spin mode (with or
without lines toggled on) to look for patient motion.
• View and verify the accuracy of the bounding boxes and
the regions of interest (ROIs).
AutoQUANT uses the areas within these ROIs to
calculate the Lung/Heart ratio. The ROIs are not
created until you process the datasets by clicking
Process.
Caution
to misdiagnosis.
• QC information of loaded vantage raw transmission
data appears in the information panel (right pane). See
Figure 51
Figure 51 Vantage QC Info location
AutoQUANT
103
Figure 52 Raw window after processing
Toggling Orient
Click Orient to display your dataset’s orientation labels.
These labels (adjacent to each slice) appear as yellow text.
Displaying Reference Lines
Click Lines to display two reference lines that you can use
when looking for patient motion.
104
AutoQUANT
Displaying Summed Projections
Click Sum to toggle the Sum function on or off.
Sum creates a single composite image from the gated
projections.
Note
When projections are summed, the resultant composite
image is not gated.
Gating an Image
Click Gate to enable the gating feature.
Spinning or Rocking a Cine
Click Spin to rotate the displayed datasets 360 degrees.
While Spin is on, click Rock to rotate all of the displayed
datasets back and forth 180º.
Displaying Multiple Datasets
Click Multiple to display all of the raw projection datasets
for the currently selected patient (Figure 53).
Figure 53 Multiple raw projection datasets
AutoQUANT
105
Using the Slice Window
Note
Each Cine has its own brightness control.
Absolute
Click Absolute to toggle on absolute normalization. When
on, all datasets are scaled to the same maximum value,
taken across all projection datasets in the study.
The Slice window (Figure 54) displays five viewports per
dataset, with three SAX proceeding from apex to base, one
horizontal long axis slice HLA, and one VLA. After
processing is complete, the Slice window displays the
statistics and superimposes the contours on the reference
images (if Contours is on).
Use the Slice window to:
• Verify the accuracy of the contours for SAX datasets.
• Select and analyze various SAX slices.
• Verify that you have a gated or summed stress and rest
dataset.
Note
106
You must process the images by clicking Process before
you analyze the datasets.
AutoQUANT
Figure 54 Slice window (with display button 1 selected)
Verifying Contour Placement
When the contours appear, first check that they are not
obviously misplaced (Figure 55, image on the right).
AutoQUANT
107
Figure 55 Correctly (left) and incorrectly (right) calculated contours
◆
108
To verify the accuracy of the slice contours:
1
Update the VLA viewport by dragging the vertical SAX
slice reference line to show the corresponding slice
(Figure 56).
2
Update the HLA viewport by dragging the horizontal SAX
slice reference line to show the corresponding slice
(Figure 56).
AutoQUANT
Reference line for VLA
Reference line for HLA
HLA Viewport
VLA Viewport
Figure 56 Selecting HLA and VLA segments
Note
You can also select each of the SAX slices by dragging the
corresponding reference lines in the HLA and VLA
viewports. The updated slice number of the dataset appears
in each viewport.
Overlaying Segments
Each region on the Visual Score panel corresponds to one
of the four segment colors on the Segments overlay in the
Splash window (Figure 57) as follows:
Note
Make sure Segments is selected from the Grid drop-down
menu.
• Region 1 (Red): Apical
• Region 2 (Orange): Mid-ventricular towards the apex
AutoQUANT
109
• Region 3 (Yellow): Mid-ventricular towards the base
• Region 4 (Green): Basal
Region 1
(Red)
Region 3
(Yellow)
Region 2
(Orange)
Region 4
(Green)
Figure 57 The Segments overlay on Splash window
Note
The segment colors are most obvious when you use a
grayscale colormap.
Other Functions
• “Toggling Labels” (page 91)
• “Toggling Orient” (page 91)
• “Toggling Contours” (page 92)
• “Indicating End Diastolic/Systolic Positions” (page 92)
• “Playing Gated Datasets” (page 93)
• “Blurring an Image” (page 93)
• “Smearing an Image” (page 93)
• “Spinning Images/Spin Rate” (page 94)
• “Adjusting the Size of Images” (page 95)
• “Adjusting Intervals” (page 95)
• “Oblique” (page 96)
110
AutoQUANT
Using the Surface Window
The Surface window displays a 3D rendering of the
ventricular surface that you can view from different angles,
rotate, or zoom (Figure 58). Use the Surface window to
evaluate ventricular wall motion.
Important
Note
AutoQUANT
Use the 3D images to evaluate ventricular wall motion
only. The wall appears evenly although it may not be
perfused. To evaluate perfusion defects, select Surface ->
Function.
AutoQUANT does not generate 3D displays until you
have processed the datasets.
111
Figure 58 Surface window (two datasets displayed)
Note
At the apex of the 3D images, there may be ridges that
change in size and location during cine. These ridges are
normally displayed and do not reflect motion or perfusion
abnormalities.
Changing Image Orientation
You can change the orientation of images in the Surface
window in three ways:
112
AutoQUANT
• To rotate the 3D volume, click and drag on the image in
the direction you want to rotate. The volume rotates
about each axis of rotation. You can also Scale and Gate
the volume.
Note
The image pivots around the center of the volume.
• Click the View menu to select the projection orientation
that you want to view. The available projections are:
- Anterior
- Lateral
- Inferior
- Septal
- Apical
- Basal
- LAO
- RAO
- Echo
• Click Spin to toggle spin mode off and on. You can
adjust the spin rate by clicking the Rate arrows. There
are 20 speeds available. Dual images spin synchronously,
but may be oriented independently.
AutoQUANT
113
Coronary CTA Vessels Display
Figure 59 Coronary CTA Vessels Display
CTA Overview
If a segmented and labeled coronary vessel dataset from
CT Angiography (CTA) is loaded with SPECT/PET
perfusion or PET viability data, the Coronaries and
CoroReg option allows fusion of the coronary vessels
extracted from CTA with the 3D surface. The coronary
artery tree is extracted and saved as a DICOM object by
the vendor's CTA software.
114
AutoQUANT
Using the Splash Window
In Surface/Views page, click on Vessel label to visualize the
loaded segmented coronary vessel with the 3D surface
data. Depending on the CTA and PET/SPECT
acquisition, the extracted coronary vessels may need
further software co-registration.
If the patient name or patient ID is different from the
perfusion/viability scan, it is necessary to Edit the dataset
using the Edit option and use Attach to attach the object
to the perfusion/viability study.
Other Functions
• “Displaying a Box” (page 92)
• “Displaying Pins” (page 94)
• “Displaying Wall Surfaces” (page 94)
The Splash window displays SAX, VLA (VAX), and HLA
(HAX) slices in one window for either a single dataset or a
stress and rest pair of datasets. As in other windows, the
number of images displayed depends on which Cardiac
Dataset Display button you click.
AutoQUANT
115
For example, in Figure 60, the following images are
displayed for each dataset because the Cardiac Dataset
Display button 2 has been clicked:
• 16 SAX slices, shown from apex to base
• 8 VLA slices, shown from septal to lateral
• 8 HLA slices, shown from inferior to superior
Use the Splash window to:
• Perform a general visual analysis of all SAX, VLA, and
HLA slices
• Apply the Normals file
• Verify the automatically generated visual scores
• Manually score each segment
• Evaluate the following statistics for non-gated objects:
- Summed Stress Score (SSS): Summation of the stress
visual scores indicating the severity of the defect. The
higher the score, the more abnormal the defect. (This
is the sum of all stress values except where Stress=1
and Rest=1).
- Summed Rest Score (SRS): Summation of the Rest
visual scores indicating the severity of the defect. The
higher the score, the more abnormal the defect. (This
is the sum of all Rest values except where Stress=1 and
Rest=1).
- Summed Differential Score (SDS): Summation of
the difference between Stress and Rest scores. The
higher the score, the more reversible the defect. For a
given segment, this is the sum of all differences
between Stress and Rest > 0, except when Stress=4
and Rest=3, or when Stress=3 and Rest=2. In other
116
AutoQUANT
words, if the Stress is 3 in one segment and the Rest is
2 in the corresponding segment, then the rule does
not apply.
Exception Values
When the difference between Stress & Rest is 1 or when
Stress & Rest values are the same use the following values:
• The first exception is when a 4 appears in a segment for
a stress graph, and a 3 appears in the same
corresponding segment for the rest graph, the difference
of this case is a zero, rather than a 1.
• The second exception is when a 3 appears in a segment
in the stress graph, and a 2 appears in the same
corresponding segment in the rest graph; the result of
this case is a zero, instead of 1.
• The third exception is when two corresponding
segments both have a 1 contained in them, the
difference of the two segments is zero for this case, and
otherwise does not contribute to the SDS percentage.
Note
If the current study contains both Rest and Late non-gated
objects, AutoQUANT uses Late scores (instead of Rest) to
calculate SDS as described above.
• Evaluate the following statistics for gated objects:
- Summed Motion Score (SMS): Summation of the
Motion visual scores across all segments.
- Summed Thickening Score (STS): Summation of the
Thickening visual scores across all segments.
Note
AutoQUANT
Summed scores for gated and non-gated objects are
presented both in numerical form (SSS, SRS, SDS,
SMS, STS) and as a percentage of the maximal
117
numerical values obtainable (SS%, SR%, SD%, SM%,
ST%). The latter are independent of the number of
segments used.
Figure 60 Splash window
Using Popout
Popout selects and displays individual slices for analysis.
The system can display up to sixteen slices at a time.
118
AutoQUANT
To use Popout, you must select one or more viewports. If
you have not selected at least one viewport, you see only an
empty box.
Note
◆
To use Popout:
1
Right-click up to sixteen SAX, HLA, or VLA slices.
2
Click Popout.
The selected slices appear. You can use all of the standard
image controls to zoom, smear, grid, or toggle the labels
and contours. You can display slices from gated datasets in
cine form, or you can use the Frame control to display each
interval.
You cannot use Skip while using Popout.
Note
3
Click Popout again to return to the standard splash
display.
4
To deselect the slices, right-click on each slice to deselect it,
or click Clear to deselect all slices.
◆
1
Click Label.
2
Click the Grid menu and select the Segments overlay.
Grid is available only for SAX slices.
Note
3
Note
AutoQUANT
To use the Visual Score window:
Click Score to display the Visual Score window In the
Visual Score window, click Auto.
The Auto option is available only if you have applied a
Normals file.
119
The Auto function scores each segment from 0 to 4
depending on the amount of perfusion deviation relative to
the selected Normals file. Zero indicates normal perfusion;
4 indicates no perfusion.
4
If necessary, manually score the segments.
You can manually override the values if you have additional
information about the dataset you are analyzing or if you
do not have the corresponding Normals file.
The SMS and STS scores are the values for the gated
dataset selected in the left dataset selector (see
Figure 61).
Note
SMS and STS values
Figure 61 Motion and thickening scores
• To increment a value, click it.
• To change all values to zero, click 0.
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AutoQUANT
• To change all values to a dash, click on the Dash (-)
button.
• To display the information in grid form instead of polar
maps, click Grid. In the grid, the first set of boxes
contain the apical values. The abbreviations stand for:
- An: Anterior
- AS: Antero-septal
- IS: Infero-septal
- In: Inferior
- IL: Infero-lateral
- AL: Antero-lateral
• Use the cursor to copy all the values from one map to
another. For example, if you think stress looks very
similar to rest, and should have the values in rest, click
on the STR label and drag to the rest (RST) polar map
or grid heading. This shortcut saves you from having to
click on each segment individually. Clicking Auto resets
all the scores to their original values.
5
Note
Click Accept to remove the red corners, or Reject to draw
them as a reminder that the values are suspect.
The red corners indicate that Auto scores are being used.
Clicking Accept turns Auto scoring off and removes the
red corners. Similarly, if you have manually scored the
segments, Auto scoring is turned off and the red corners
are not displayed. Clicking Reject turns Auto scoring back
on.
Other Functions
AutoQUANT
121
Using the Views Window
• “Skipping Images” (page 93)
Use the Views window to compare images viewed from
different orientations.
The Views window displays a splash window with up to six
(up to sixteen in quadruple mode) 3D images (Figure 62).
There are three viewports for ED and three for ES. Three
orientations with preset angular displacements appear. You
can zoom and rotate the three viewports together while
maintaining their relative alignment.
The dataset listed on the top of the Statistics Panel is on
the top row, and the lower dataset is on the bottom.
122
AutoQUANT
Note
3D displays are not generated until you have selected
Process. Also, at the apex of the 3D images, you may see
ridges that change in size and location during cine. These
ridges are normal, and do not reflect motion or perfusion
abnormalities.
Note
Function is inactive in this window.
Figure 62 Views window
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Using the Quantitative Perfusion SPECT (QPS) Window
Other Functions
• “Displaying a Box” (page 92)
Using the Quantitative Perfusion
SPECT (QPS) Window
The QPS window (Figure 63) contains information from
SAX data and processed results. It displays non-gated stress
and rest SAX datasets in a side-by-side format. It also
displays the results of perfusion and reversibility analysis,
compared to a user-selectable Normals file. The QPS
window has four sections, from left to right:
• Slices section
• 2D polar maps section
• 3D polar maps section
• Patient statistics section
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Important
You must apply an appropriate Normals file to the dataset
in order to display all polar maps and valid statistical data.
Contours, as set in the Slice window, must accurately
reflect the myocardial wall limits for you to obtain accurate
quantitative results. Refer to “Using the Slice Window” on
page 106 for information on analyzing the contours.
Figure 63 QPS window
Use the QPS window to:
• Display SPECT data as 2D and 3D perfusion maps,
showing raw perfusion counts and the extent and
severity of myocardial perfusion defects.
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125
• Display appropriate values of TPD (total perfusion
deficit), defect severity, or defect extent, compared to an
applied Normals file or the raw percentage of perfusion.
• Provide comprehensive results, with reports containing
quantitative perfusion and reversibility data.
• Display non-gated stress and rest polar maps, compared
to a Normals file, and display raw polar maps.
• Provide severity and extent quantification with
reversibility, compared to a Normals file.
You can evaluate the following Patient Statistics in the
QPS window:
Parameter
Definition
Normal
Reference
TID
Transient Ischemic
≤1.22 for rest 201-Tl/post-exercise 99mTc
Abidov, J.J.JNM 2004
Dilation
sestamibi (dual isotope)
45(12): 1999-2007
≤1.36 for rest 201-Tl/post-adenosine 99mTc
sestamibi (dual isotope)
45(12): 1999-2007
≤1.22 for post-exercise/rest 99mTc-sestamibi
Emmett, L. JNM 2005
(mibi-mibi)
46(10): 1596-1602
<0.51 for 201-Tl
Homma et al, JNM 1987;
LHR
Lung/Heart Ratio
28:1531
<0.44 for 99mTc-sestamibi
Bacher-Stier et al, JNM
2000; 41:1190
Volume*
Wall
LV chamber volume
<100 ml for females
(at end-diastole)
<142 ml for males
Sharir et al, submitted
LV wall
[no published data]
N/A
[no published data]
N/A
(myocardial)
volume
Defect
Perfusion defect
volume
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Parameter
Definition
Normal
Reference
Extent
Perfusion defect
[no published data]
N/A
[no published data]
N/A
[no published data]
N/A
extent
TPD**
Total perfusion
deficit
Shape [Ecc]
Eccentricity
* This is the Chamber volume, which in the QPS window
is the average of the ED and ES volumes.
**TPD values appear only when you use PFQ databases.
Shape
Eccentricity values are indicated by [Ecc] in the Shape field
(in the patient statistics panel).
Eccentricity is a measure of the elongation of the LV, and
varies from 0 (sphere) to 1 (line); it is calculated from the
major axis RZ and the minor axes RX and RY of the
ellipsoid that best fits the mid-myocardial surface,
according to the following formula:
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Ecc =
1 – RxRy
--------------2
Rz
AutoQUANT calculates eccentricity for all slices in a gated
series.
Triangulated Navigation
If you click any region in the 2D polar maps, the selected
region is highlighted in the corresponding region on the
2D slice images.
If you right-click a 2D polar map, the cursor’s location is
indicated at the corresponding grid on the 3D volume
(instead of the region), and AutoQUANT rotates the
volume to center the point in the window.
For example, click the stress perfusion polar map to
highlight the corresponding grid location on the stress 3D
volume and the stress SAX, HLA, and/or VLA images.
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Displaying the Defect Analysis Graph and Table
When Score is off, click Graph to toggle between the
Defect Analysis Graph and the Defect Analysis Table
(Figure 64). The Defect Analysis Table and Graph
summarize the data from all six polar maps in the QPS
window for each myocardial region.
Note
You cannot see the graph and table if Score is on.
Defect Analysis Graph
This graph presents the defect extent at stress and the
reversibility for each myocardial region of the currently
chosen overlay. Both the defect extent and the reversibility
are given as a percentage of each region and presented as
side-by-side bars.
Defect Analysis Table
The Defect Analysis Table displays the Stress Extent and
Severity, the Rest Extent and Severity, and the Reversability
statistics for each myocardial region.
AutoQUANT
Note
The myocardial regions shown on the table or graph
change according to the regional overlay selected from the
Grid pull-down menu. Deselect Graph to view the Defect
Analysis Table.
Note
The Graph button is also available in the QPC window.
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Prone-Supine (Prone+) Quantification
Figure 64 QPS Defect Analysis Table and Graph
Overview
Important
The Prone-Supine feature is used for SPECT images only.
Prone-supine (Prone+) quantification allows quantification
on combined prone/supine datasets by applying algorithms
which allow automatic elimination of image artifacts based
on the relative defect locations on prone and supine
images. This method of quantification is based on
publications shown in the Appendix D, Bibliography
If you have purchased the Prone-Supine (Prone+) option,
this appendix contains descriptions of its functionality.
Note
130
Refer to Chapters 3 through 6 for explanations of basic
AutoQUANT functionality.
AutoQUANT
Figure 65 SPECT Review Option: Prone-Supine (Prone+)
Quantification
Feature Requirements
The Prone-Supine (Prone+) quantification feature requires
at a minimum one supine perfusion dataset and one prone
perfusion dataset from the same patient/study. This feature
is available in the QPS Results page and is enabled by
toggling on the Prone+ button of the page control bar.
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Make sure you select Extent (via the Function drop-down
menu) for visual differences between the Polar and 3D
maps.
Note
Using Prone-Supine (Prone+)
◆
1
To use Prone-Supine (Prone+) within QPS:
Select the necessary myocardial perfusion short axis
datasets (and any other desired datasets for a standard QPS
session, raw projections etc.), then start a QPS session.
The short axis datasets are processed by QPS to generate
contours.
2
Verify the contours.
Make sure you select Extent (found in the Function dropdown menu).
Note
3
At the QPS Results page, click Prone+ to apply Pronesupine quantification algorithm.
The results are displayed in the statistics section.
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Note
The application of the Prone+ feature is indicated in the
statistics section of the QPS Results page and in the change
of defect size/location (if any) on the Stress and
Reversibility polar maps.
Note
When the Prone+ feature is been enabled in the QPS
Results page it remains in effect for all other pages
displaying perfusion results in the statistics section
(Surface, Splash, etc.).
Note
The Prone+ feature can be automatically enabled by
toggling it on in the Application Defaults window,
Application Options section and then saving the defaults
AutoQUANT
settings. The Prone+ algorithm is applied during
processing of perfusion datasets (for all subsequent QPS
sessions).
Polar Maps
Displaying Function
Use the Function pull-down menu to select the parametric
perfusion function to display in the polar maps and
parametric surfaces. The following options are available:
• Raw
• Severity
• Extent
• Quant
Raw
This map displays the myocardial perfusion as a raw count
(Figure 66). The pixel corresponding to the maximum raw
count is set to the maximum color scale brightness and
corresponds to a value of 100. Both the raw stress and the
raw rest maps are normalized to their hottest pixel for
display purposes.
Note
One may normalize after processing which takes the
brightest pixel in the myocardium and makes it 100%.
Selection of the segment, territory or wall overlay displays
the average “raw” pixel value in the related regions. The
value 100% corresponds to the highest count pixel in the
map, and is therefore higher than any averaged value in the
overlay.
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133
The raw reversibility map is built pixel by pixel from the
stress and rest raw maps normalized such that the 90th
percentile is equal to 100% (so as to minimize the effect of
hot spots). The relationship is
Reversibility = 100 x (normalized_rest – normalized_stress)
where reversibility < 0 is considered 0. The numbers
appearing in the overlay represent the averages of the pixel
reversibility values in the various segments, territories or
walls. These numbers are not necessarily equal to the direct
subtraction of the raw rest % – raw stress % values.
Raw Stress Perfusion
Raw Rest Perfusion
Raw Reversibility
Figure 66 Raw polar maps
Severity
This map (Figure 67 on page 135) displays a comparison
between the selected Normals file perfusion polar map and
the Normalized polar map for the displayed dataset. The
Severity Stress and Rest polar maps display the number of
standard deviations by which each normalized pixel is
below normal. If a pixel is above normal, it appears as black
(in grayscale mode) regardless of its count value. If a pixel
is below normal by more than 10 standard deviations, it
appears as white (in gray scale parlance). In other words,
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for display purposes, the scale is linear in the 0-10 standard
deviation range, and completely saturated outside the
range.
When the Segment (territory, wall) overlay is on, the
overlaid number for a given segment represents the average
severity for that segment. This is calculated as the average
of the number of standard deviations below normal for
each pixel in the segment, weighted by the myocardial
surface area corresponding to each pixel (some pixels
represent a greater myocardial surface area than others).
For averages computation purposes, all pixels above normal
are considered equal to 0.
The Severity Reversibility polar map displays the results of
rest-stress severity. It is calculated, pixel by pixel, as
stress_severity – rest_severity. Neither stress severity nor
rest severity is constrained to the 0-10 range, and can in
fact be negative if pixel counts are above the mean
(however, the display for severity reversibility is constrained
to 0-10). The overlaid number for a segment is the average
of pixel severity reversibility over all pixels in that segment,
weighted by the myocardial surface area corresponding to
each pixel.
Severity Stress
Severity Reversibility
Severity Rest
Figure 67 Severity polar maps
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135
Extent
This map (Figure 68) displays a measure of defect size. In
the Extent Stress and Rest polar maps, pixels are “blacked
out” if they contain counts lower than a certain threshold
below the normal mean for that pixel. Thresholds are
calculated, on a segment by segment basis, by
automatically and iteratively optimizing sensitivity and
specificity for that segment, based on correlation to expert
visual scores. When the Segment (territory, wall) overlay is
on, the overlayed number for a given segment represents
the percent of the myocardial surface area corresponding to
that segment that contains pixels having counts below
normal. (This is not equivalent to the percent of pixels in
the segment, because some pixels represent a greater
myocardial surface area than others.) If a pixel is not
blacked out, it has the same intensity as in the
corresponding Raw map.
The Extent Reversibility map is the same as the Raw
Reversibility map, except in the area(s) of stress blackout.
Pixels in the area(s) of stress blackout are “whitened out” a)
if the difference between the severity at stress and rest is
above a certain threshold (which is segment-dependent
and automatically determined in a manner similar to that
used for the Extent Stress and Rest maps), or b) if the
homologous pixel at rest is not blacked out. Segment
numbers in the overlay represent the percent of the
myocardial surface area corresponding to that segment that
contains reversible pixels.
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Extent Stress
Extent Rest
Extent Reversibility
Figure 68 Extent polar maps
Quant
Quant Stress and Rest maps (Figure 69) are derived from
the Severity Stress and Rest maps by assigning a number
(corresponding to a score from 0 to 4) to each pixel, based
on automatically and iteratively determined, segmentspecific thresholds (see extent stress and rest maps). The
myocardial surface area-weighted average of the scores of
all pixels in a segment appear in the overlay, and ideally
would round off to the automatic segmental scores
obtained pressing the Score button in QPS. The latter are
not computed on a pixel by pixel basis, but based on the
average segment depth.
The Quant Reversibility polar map is derived from the
Severity Reversibility map. Segment-specific thresholds are
automatically determined in a manner similar to the
Extent Stress and Rest maps, and categorize every pixel as
2 (reversible), 0 (non-reversible) or 1 (indeterminate).
Segment numbers in the overlay represent the myocardial
surface area-weighted average of quant reversibility in the
segment. The range of Quant reversibility is 0 to 2. Unlike
the Quant stress and rest numbers, the Quant reversibility
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137
numbers do not round off to the automatic segmental
difference scores obtained when you click the Score
button.
Quant Stress
Quant Rest
Quant Reversibility
Figure 69 Quant polar maps
Overlaying a Grid
You can overlay four grids on the 2D polar maps in the
QPS window. The numerical values in each of the overlay’s
regions depend on your choice of Raw, Severity, Extent, or
Quant in the Function menu.
Click Grid and select the desired grid overlay from the
pull-down menu.
Note
The Grid overlay is visible only when Labels is enabled.
Segments
Selecting Segments divides each of the three polar maps
into 17 or 20 segments corresponding to six basal, six
midventricular, six apical short-axis, and two apical longaxis segments (Figure 70).
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Figure 70 Segments grid overlay
Note
All categorical polar maps and polar map and functional
surface overlays are available in AHA standard 17-segment
or CS standard 20-segment format. Selection of the active
configuration (17 or 20 segments) is possible through the
default presented in the Defaults window, so that any such
change in configuration can be made both within and
across application invocations. Presentation of 17-segment
polar maps and polar map and functional surface overlays
are identical to those for the 20-segment maps, with the
exceptions that the 2-apex segments are replaced with a
single segment, and that the 6 innermost segments
surrounding the apex are replaced with 4 segments, as per
the AHA standard.
Vessels
Selecting Vessels divides each of the polar maps into three
vascular territories (Figure 71). The three territories
describe a defect location corresponding to a coronary
artery as follows:
• LAD: Left Anterior Descending
• LCX: Left Circumflex
• RCA: Right Coronary Artery
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139
The values in each of the three territories represent the
percent deviation of that territory from the highest pixel
value in the polar map.
LAD
LCX
RCA
Figure 71 Vessels grid overlay
Groups
Select Groups to arrange the 20 segments into three
territories by using a set of physician-defined rules
(Figure 72). These rules allow for anatomic variation by
assigning each segment to the territory to which it is most
likely to belong. The rules are based on the overall pattern
of abnormal perfusion, computed using the Selected
Normal Limits and, if available, the TID Stress Polar Map.
Figure 72 Groups grid overlay
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Walls
Selecting Walls divides each of the three polar maps into
five regions: Anterior, Septal, Inferior, Lateral, and Apical
(Figure 73).
Anterior
Apical
Septal
Lateral
Inferior
Figure 73 Walls grid overlay
Other Functions
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Using Quantitative Perfusion Change
(QPC) Window
Figure 74 QPC window
This QPC module performs the quantitative assessment of
hibernating myocardium in PET or PET/SPECT studies
by calculation of relative regional changes between
perfusion and viability scans in areas of hypo-perfusion at
rest. From the comparison between a rest scan (rest SPECT
or rest PET scan) and the viability scan (PET F-18 FDG),
scar and mismatch parameters are reported as a percentage
of the Left Ventricle. Extent and severity of scar and
mismatch can be displayed in polar map coordinates or as a
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3D surface display. The program allows automatic scoring
of scar or mismatch using a 17- or 20- segment model.
Simultaneous display of stress, rest and viability
quantification results is possible. Stress images are not
required for the quantification of scar and mismatch. This
method of quantification is based on publications shown
in the Appendix D, Bibliography.
Feature Requirements
This QPC module requires at a minimum one PET or
SPECT rest myocardial perfusion dataset and one PET
myocardial viability dataset. The datasets can be in SAX or
transaxial orientation. Typically, the datasets consist of a
PET rest Rb-82 perfusion dataset or a SPECT rest
thallium (or sestamibi) dataset and a PET FDG rest
viability dataset. The module is accessed by clicking the
QPC button on the main application toolbar. Window
specific controls allow for polar map displays of Rest
Perfusion, Mismatch, Scar, Reversibility and optionally
Stress Perfusion.
Note
The rest perfusion dataset (Rb-82, Tl-201, or Tc-99m)
must have a corresponding normal limits database.
Identifying the Viability Study
The Viability study is identified by any one of several
identifiers:
• (a) If the process ID field contains FDG, F 18 or F-18
(case-insensitive)
• (b) If the isotope text field contains FDG, F 18 or F-18
(case insensitive)
• (c) If the isotope enumeration field is FDG.
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Using QPC
◆
The processing sequence for QPC is as follows:
1
Select your desired SPECT and PET myocardial perfusion
SAX datasets (and any other desired datasets, raw
projections etc.), then start AutoQUANT.
2
Click Process to generate the contours of the SAX datasets.
3
Click QPC (top tool bar) to display the QPC window.
Confirm your selection of rest perfusion dataset and
viability dataset (in the slices section within the QPC
window).
If needed, you can manually select appropriate datasets by
using the AutoQUANT’s dataset drop-down menus.
Note
Note
4
To display polar maps showing a mismatch or scar, click
the Mis or Scar buttons.
5
If a matching stress perfusion dataset has been included in
your AutoQUANT session, you can display it in the slices
section by clicking 3 display view and selecting the stress
dataset from the dataset drop-down menu (if not already
selected).
6
To display a reversibility polar map, click Rev.
If appropriate stress and rest datasets are not currently
selected, a Difference polar map appears instead.
Reviewing QPC Results
You can view up to three datasets in the slices section of the
QPC window (the 4 display option is inactive).
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AutoQUANT
The datasets most useful for this window are Stress
Perfusion, Rest Perfusion and a Viability Dataset.
Note
Only Rest Perfusion and Viability Datasets are required
for calculation of QPC results.
Assessing Slices, Polar Maps and Surfaces
QPC provides five slice views for each dataset. You can also
view up to 5 polar maps and corresponding 3D parametric
surfaces representing Stress Perfusion, Rest Perfusion,
Reversibility, Mismatch, and Scar.
The QPC window control toolbar provides optimal
display of slices, polar maps and 3D parametric surfaces.
You can overlay a grid of 20 or 17 segments (Segments), 3
vascular territories (Vessels) or 4 regions (Walls) can be
overlaid onto all polar maps and surfaces from the Grid
pull-down menu. In the polar maps case, the numbers
associated with the overlay represent the average value of
the parameter measured by each map within the segment,
territory or region in which they lie. Both stress and rest
perfusion values are normalized to 100.
The following QPC window specific controls are available:
• Rev: Toggles display Reversibility polar map and
corresponding 3D parametric surface (if there are stress
and rest datasets).
• Via: Toggles display of viability slices in the slices
section.
• Mis: Toggles display of Mismatch polar map and
corresponding 3D parametric surface.
• Scar: Toggles display of Scar polar map and
corresponding 3D parametric surface.
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145
Other Functions
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Using the Quantitative Gated SPECT
(QGS) Window
The QGS window (Figure 75) displays four polar plots, a
volume curve, and a statistics panel with the reference
images. If you are displaying a gated SPECT SAX study,
QGS calculates the left ventricular volume, the LVEF, and
a 3D gated SPECT volume. If you are displaying a nongated SPECT SAX study, AutoQUANT calculates the left
ventricular volume only.
The QGS window is for gated SPECT quantification and
review. You can use it to review a myocardial gated SAX
dataset and compare its function at ED and ES.
Important
Contours set in the Slice window must accurately reflect
the myocardial wall limits to obtain accurate quantitative
results. Refer to “Using the Slice Window” on page 106 for
You can display the following in the QGS window:
• LV endocardial and epicardial surfaces
• Polar maps indicating perfusion, wall thickening, and
wall motion
• Phase information for gated datasets, including phase,
amplitude, maximum displacement, and peak velocity
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147
Perfusion
polar maps
Function
polar maps
Figure 75 QGS window (example)
Use the QGS window to:
• Display comprehensive results, providing a report
encompassing a wide range of quantitative perfusion
and function data
• Show LV function from end diastole through the
complete cardiac cycle with the Volume (ml) and Filling
(ml/s) Curve
• Compare, side-by-side, the ED and ES images that are
valuable for visually comparing ED and ES function:
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AutoQUANT
- SAX/VLA/HLA slice images
- 2D polar maps
- 3D surface maps
- Motion
- Thickening
- Phase
- Amplitude
You can evaluate the following Patient Statistics in the
QGS window:
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149
:
Parameter
Definition
Normal
Reference
TID
Transient Ischemic Dilation
≤1.22 for rest 201-Tl/post-exercise
99mTc sestamibi (dual isotope)
45(12): 1999-2007
≤1.36 for rest 201-Tl/post-adenosine
99mTc sestamibi (dual isotope)
45(12): 1999-2007
≤1.22 for post-exercise/rest 99mTc-
Emmett, L. JNM 2005
sestamibi (mibi-mibi)
46(10): 1596-1602
<0.51 for 201-Tl
Homma et al, JNM
LHR
Lung/Heart Ratio
1987; 28:1531
<0.44 for 99mTc-sestamibi
Bacher-Stier et al, JNM
2000; 41:1190
Volume
LV chamber volume (at
<100 ml for females
(This is the
end-diastole)
<142 ml for males
LV chamber volume (at
<42 ml for females
end-systole)
<65 ml for males
Ejection Fraction
>50% for females
Chamber
volume)
EF
>45% for males
MOT EXT
Motion defect extent
[no published data available]
N/A
THK EXT
Thickening defect extent
[no published data available]
N/A
Eccentricity
Shape Index
[no published data]
N/A
Note
150
Indexing to body surface is an x/y calculation, where x is
the LV chamber volume, and y is the body surface area, in
square meters. (This information does not appear in the
program.)
AutoQUANT
Shape Index
Shape index values are indicated by SI in the Shape field
(in the patient statistics panel).
This parameter defines 3D LV geometry derived from LV
contours in end systolic and end diastolic phases. Shape
index is defined as the ratio between the maximum
dimension of the LV in all short-axis planes and the length
of the midventricular long axis.
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For each SAX plane in the ED image series, maximum
dimension (A) of the LV is found from the 3D contours
derived by the QGS algorithm, using the endocardial
surface as the boundary. Global short-axis end-diastolic
dimension (AED) is found as a maximum for all ED SAX
slices. The short-axis slice and direction of AED is then
used to calculate the maximum short-axis end-systolic
dimension (AES) in the end-systolic image series, by
measuring the distance between the endocardial points in
the identical location (slice and direction) where AED was
found.
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The long-axis dimension of the myocardium is derived by
calculating the distance (B) between the most apical point
on the endocardial surface and the center of the valve
plane. The ED long-axis dimension (BED) is calculated
independently from the ES long-axis dimension (BES).
The end-diastolic shape index (SI ED) and the end-systolic
shape index (SI ES) are derived by AED/BED and
AES/BES, respectively.
QGS Polar Maps
You can display several different types of polar maps in the
QGS window:
• Perfusion: one at ED and one at ES
• Function: one for Motion and one for Thickening
• Phase: one for ED (left) and one for ES (right), for any
of the following:
-
Amplitude
Phase
Time to peak velocity (TTPV)
Time to maximum displacement (TTMD)
Thickening Amplitude
Thickening Phase
Time to Maximum Thickening (TTMT)
You can use the options in the Grid pull-down menu to
overlay a grid of 20 segments (or 17 segments), 3 vascular
territories, 4 regions, or 5 walls on any polar map. The
numbers associated with the grid overlays represent the
average value of the parameter measured by each map for
the segment, territory or region in which they exist.
Note
AutoQUANT
You can also switch from polar maps to a 3D view by
clicking on the 3D button.
153
Note
To display values in the window, deselect the 3D button.
Perfusion (%) Polar Maps
The Perfusion polar maps display the myocardial
perfusion at end diastole and end systole as a percentage.
The pixel corresponding to the maximum ventricular
perfusion equals 100% and is set to the maximum color
scale brightness (white). The polar map brightness
decreases as the perfusion decreases (dark areas indicate
poor perfusion).
Function Polar Maps
Use the Function pull-down menu to select a perfusion
function to display in the function polar maps and
surfaces. The Function pull-down menu contains the
following options:
•
•
•
•
Raw
Severity
Extent
Quant
All options apply only to the function polar maps, and
only the Raw option is meaningful in the absence of
motion/thickening normal limits.
Note
When the Phase control is on, the Function drop-down
menu is disabled.
Raw
The Motion polar map displays the change in endocardial
wall motion from end diastole to end systole in
millimeters. The maximum color scale brightness equals a
10 mm change, and the calculated wall motion appears
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relative to this value. The polar map brightness increases as
the wall motion increases (dark areas indicate poor
motion).
The Thickening polar map displays the change in
myocardial wall thickness from end diastole to end systole
as a percentage, calculated in this way:
100 × [ thickening(ES) – thickening(ED) ]
thickening = --------------------------------------------------------------------------------------------------thickening(ED)
At ED, an area that is twice the thickness of the ED wall
thickness equals 100% and is set to the maximum color
scale brightness. Areas displaying no change from the ED
thickness are set to the minimum brightness. The
brightness increases as the wall thickness increases (dark
areas indicate minimum changes in wall thickness).
Severity
The Severity polar map displays a comparison between the
motion and thickening polar maps for the selected
Normals file and the normalized polar maps for the
displayed dataset. You can determine the relative severity of
the defective regions by the color scale brightness. Pixels
above normal are set to the minimum color scale
brightness regardless of count value. Pixels corresponding
to motion and thickening values that are 10 standard
deviations below the normal mean in the Normals file are
set to maximum color scale brightness. The color
brightness decreases with the difference in each region.
This is the average of the number of standard deviations
below normal for each pixel in the segment, weighted by
the myocardial surface area corresponding to each pixel.
The averages computation sets all pixels above normal to
zero.
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Extent
The Extent polar map displays a measure of defect size.
Pixels with counts lower than a certain threshold below the
normal mean for that pixel are blacked out. If a pixel is not
blacked out, it displays the same intensity as in the
corresponding raw map. AutoQUANT calculates the
thresholds on a segment-by-segment basis by automatically
and iteratively optimizing sensitivity and specificity for
that segment, based on correlation to expert visual scores.
Select a grid overlay to displaysthe percent of the
myocardial surface area corresponding to that segment that
contains pixels having counts below normal for each
region.
Note
This value is not equivalent to the percent of pixels in the
segment, since some pixels represent a greater myocardial
surface area corresponding to that segment.
Quant
Quant Motion and Thickening maps are derived from the
Severity Motion and Thickening maps by assigning a
number from 0 to 5 to each pixel for Motion, and 0 to 3 to
each pixel for Thickening. This is based on automatically
and iteratively determined segment-specific thresholds.
Select a Grid overlay to display the average score of all
pixels for each region, weighted by the myocardial surface
area corresponding to each pixel. These scores reflect the
scores displayed when you select the Score button in the
QGS window.
Phase Polar Maps
AutoQUANT performs phase calculations based on the
analysis of mid-myocardial motion. Displacements are
calculated along the mid-myocardial normal for each
interval, and the resulting time-dependent signal is
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interpolated by Fourier transform. The phase and
amplitude of the first harmonic are computed. Time to
maximum displacement (TTMD) and Time to peak
velocity (TTPV) are measured from the start of the cardiac
cycle (beginning of interval 1).
Important
The phase analysis feature requires at a minimum one
processed gated SAX dataset. The gating acquisition
should be sixteen frames per cardiac cycle. See the Phase
Analysis section below for more details.
Phase Analysis
To toggle Phase on, click the >> button to the right of the
View button (top right of QGS window), then click Phase.
See Figure 76.
Figure 76 Phase button location in QGS
This feature enables phase analysis of mid-myocardial LV
motion. It is accessed via the Phase toggle on the QGS
window, underneath the color scale controls.
Requirements
The phase analysis feature requires at a minimum one
processed gated SAX dataset. The gating acquisition
should be sixteen frames per cardiac cycle.
When the Phase toggle is enabled, an additional panel
appears between the dataset information panel and the
volume/time curve. This panel contains controls that affect
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the display of phase information as well a global measure of
synchrony computed for the whole LV. The phase panel
contains the following controls:
• D/V Graphs: Click the D/V Graphs Show button to
show the displacement/velocity (D/V) graph window.
(Figure 77). Click Hide to hide this graph window.
Note
To view a study’s D/V Graphs, you must click Process.
Figure 77 QGS Phase window (with D/V Graph toggled on)
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Displacement and Velocity Graphs
You can view an additional dialog to show displacement
and velocity (first temporal derivative of the displacement)
curves. See Figure 78.
Figure 78 D/V graph
Note
Only the minimum values are tagged (labeled) in the
Displacement (mm) and Velocity (mm/s) graphs.
The following (left pane) controls are available on the D/V
Graphs window:
• Values: Toggle to show or hide minimum displacement
and minimum (negative) velocity.
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159
• Guides: Toggle to show or hide guidelines that indicate
the location of the minimum and maximum
displacement and maximum (positive and negative)
velocities.
• Grids: Toggle to show or hide gridlines for time values.
• Cursor: Toggle turns the interactive value readout cursor
on or off.
• Echo: Toggle to invert the velocity graphs to match
similar velocity displays in Echocardiography studies.
• Spread: Use the slider to separate or collapse the curves
for easier reading and comparison.
• Scale: Use Scale to resize the vertical axis of the
displacement and velocity graphs.
• Regions: Regions are Grid based.
• All ON: Toggles on display of all displacement, velocity,
thickening, and counts/thick graphs.
• All OFF: Toggles off display of all displacement and
velocity graphs.
The dialog is also affected by settings within the QGS
window. The regions and the units selectors determine
which regions are displayed and whether timing
information is shown in degrees or (milli)seconds.
Regions are determined by the Grid settings (None,
Segments, Vessels, and Walls) on the window control bar.
The Region map in the middle of the dialog allows you to
interactively select which curves are displayed. Click in a
region to toggle the corresponding displacement and
velocity graphs on and off. This allows for selective viewing
of the graphs.
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• Hide: The Hide button closes the dialog (and updates
the D/V toggle on the QGS results window, which can
also be used to re-display the graph window).
The following tabs are available on the D/V Graphs
window:
• Wall Motion: This default tab displays wall motion in
displacement and velocity. Place your mouse cursor on
the graph line. A floating measurement graphic appears,
then changes its calculation as you move up and down
the curve.
• Thickening: Click this tab to view thickening and
counts. Place your mouse cursor on the graph line. A
floating measurement graphic appears, then changes its
calculation as you move up and down the curve.
• Histograms: Click this tab to view the phase
histograms/regions: whole LV/values: mean [ms]. As you
place your mouse cursor at the peaks and valleys of the
histogram, the appropriate time and height values are
shown (at the bottom of the D/V Graphs window).
• Polar Map (left) and Polar Map (right) drop-downs:
each control determines what values are displayed in the
bottom polar maps. Options are: Amplitude, Phase,
TTMD (time to maximum displacement) and TTPV
(time to peak velocity).
• Phase Value drop-down: this control determines what
numbers are displayed within each polar map region.
Options are: Mean (average), SDev (standard deviation),
Mode, and Entropy (Figure 77).
• Units drop-down: this control determines how timing
values (phase, TTMD, TTPV) are displayed in the polar
maps. Options are: Percent Cycle, Degrees,
Milliseconds. If the dataset header does not contain
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heartbeat length information, a 60bpm heart rate is
assumed for all timing calculations as is done elsewhere
in QGS (e.g., for diastolic function calculations).
Reviewing Results
Phase calculations
Phase calculations are based on the analysis of midmyocardial motion. Displacements are calculated along the
mid-myocardial normal for each interval, and the resulting
time-dependent signal is interpolated by Fourier
transform. The phase and amplitude of the first harmonic
are computed. TTMD and TTPV are measured from the
start of the cardiac cycle (beginning of interval 1). Phase,
TTMD and TTPV can be expressed in degrees [deg] (0359) or in milliseconds [ms] with heartbeat length
information that is available in the dataset header
(assuming Amplitude is always expressed in millimeters
(mm).
Regional values
Within any region, the following values are calculated and
can be displayed on the polar map: mean (average over the
region), standard deviation, mode (location of the peak of
the distribution of values), and entropy. The entropy H(X)
is calculated for the distribution of values as follows:
H ( X ) = −∑ P( x) log 2 [ P( x)]
x
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Where P(x) is the probability that variable X is in state x
and Plog2P is defined as 0 if P=0. H(X) is expressed in
percent where 0% (minimum) means all values are
identical in the region and 100% (maximum) indicates
uniform distribution of all values across the region.
Mean and mode are indicators of regional value and can be
used to evaluate interregional variations, while standard
deviation, and entropy measure intraregional variability.
Global value
To provide an assessment of global ventricular synchrony,
the phase panel includes the global LV entropy. This value
is calculated as indicated in the previous section, with the
calculation extended to all LV samples.
Comments
Normal limits or expected values for these measurements
have not yet been derived by the AIM Program at CedarsSinai for myocardial perfusion gated SPECT.
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Note
Amplitude is always expressed in millimeters [mm].
Note
While Phase is toggled on, the Function drop-down menu
is unavailable. The Function control normally affects the
bottom two polar maps, which are replaced with phase
information when Phase is enabled. In addition to the
Phase controls, a Phase ICB is also available. (This ICB
only affects the Phase polar maps.)
Note
The Displacement and velocity graphs window is also
affected by the phase settings in the QGS window: the
regions and the units selectors determine respectively
which regions are displayed and whether timing
information is shown in degrees or (milli)seconds.
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Volume and Filling Curve
Note
Make sure that you have deselected Score to display the
volume curve.
The Volume (ml) and Filling (ml/s) Curve displays a
graph showing Filling (ml/s) vs Time (cardiac intervals) as
an overlay of the Gated Volume (ml) vs. Time (cardiac
intervals) graph. The filling curve represents the rate of
change of the volume curve in milliliters per second (ml/s).
Note
The absolute values are meaningful only if the heart rate at
the time of acquisition is known. If this heart rate is not
known (i.e., cannot be extracted from or is not present in
the image header), a heart rate of 60 bpm is assumed, and
the absolute values are meaningful only to the extent that
this assumption is meaningful.
The left ventricular volume is calculated and plotted for
each interval, resulting in a plot showing the change in
volume relative to time (Figure 79). Because stroke volume
equals ED volume minus ES volume:
• If the curve is too shallow, the ES volume is higher,
resulting in a stroke volume that is lower, and an EF that
is abnormally low.
• If the curve is too deep, the ES volume is lower, resulting
in a stroke volume that is higher, and an EF that is
abnormally high.
The EF equals the stroke volume divided by the enddiastolic volume. A normal stress EF is 50% or higher,
indicating that the left ventricle can expel more than half
of its own volume with each contraction. The EF falls with
the onset of heart failure.
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A normal stress EF is at least 50% for a 16-frame
acquisition. For an 8-frame acquisition, the EF decreases
by about 3%.
Note
Figure 79 Volume and Filling curves (diastolic function)
Any gated SAX dataset with associated LV contours has the
following:
1
PER: Peak Emptying Rate (EDV/s)
[time from 0th interval (intervals)]
2
PFR: Peak Filling Rate (EDV/s)
3
PFR2: Secondary Peak Filling Rate (EDV/s)
This value appears only if there is a second peak.
Note
Note
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4
MFR/3: Mean Filling Rate for first third of cardiac cycle
following ED (EDV/s)
5
TTPF: Time To Peak Filling from ES (ms)
6
BPM: Beats Per Minute. The R-R interval is also
displayed.
If the BPM at time of acquisition is unknown, BPM
appears like this: BPM ? [assume 60].
165
Note
The curves in Figure 79 are shown in ml (volumes) and
ml/s (rates), with the x-axis in intervals. Rates below the
graphs are shown in EDV/s, as a result of calculating rates
(ml/s) divided by EDV (ml) to normalize to the size of the
ventricle; times below the graph are shown in intervals
from the 0th interval.
Using the Score Box
Click Score to display the Score box with its 17- or 20segment overlay. QGS automatically calculates the
following values:
• Motion and thickening scores for all segments
• SMS and STS
• Mot Ext and Th Ext
If you think that any of the segmental scores are
inaccurate, you can increase a score by clicking on its
numeric value in the box; AutoQUANT adjusts SMS and
STS automatically.
Important
Note
AutoQUANT automatically displays the score values when
you select a gated file and the Score button. You can set the
Score values, as discussed in “Scoring a Dataset” (page 77).
Summed function scores are presented both in numerical
form (SMS, STS) and as a percentage of the maximal
numerical values obtainable (SM%, ST%). The latter are
independent of the number of segments used.
Visual scoring diagrams (Figure 80) consist of seventeen or
twenty-segment polar map for the datasets. Each segment
lies in one of four regions formed by concentric circles on
the diagram.
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Wall Motion Scores
Wall Thickening Scores
Region 1
Region 2
Region 3
Region 4
Figure 80 Visual Score window (CS-20 format)
The numerical value for a segment in the visual scoring
diagram indicates the amount of motion and thickening
deviation in this region relative to the Normals file. Values
range from a normal of 0 (normal) to a maximum
abnormal of 3 for thickening, and from a normal of 0 to a
maximum of 5 for motion.
If all values in the diagram are zeroes, this indicates that for
each segment, there is zero deviation from the Normals
file.
Overlaying a Grid
QGS window. Refer to “Overlaying a Grid” on page 138
for detailed information on the Grid options.
Other Functions
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Using the Change Window
Figure 81 SPECT Review Option: Change window
This Change window (Figure 81 on page 169) feature
allows direct quantification of perfusion changes between
two datasets by applying 3D elastic registration of two
myocardial perfusion studies and direct study-to-study
count normalization.
Voxel-by-voxel calculation of positive and negative changes
between two normalized studies is computed and expressed
as the percentage of all the counts in the myocardium.
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Change is visualized directly on image slices and in polar
map coordinates. It is possible to review the quality of
image registration by direct overlay of two sets of images
using a roving window on the display. No databases are
required for the calculation of stress-rest changes
(ischemia) or serial (stress/stress) image changes.
You can use the change feature on stress/rest pairs to
determine global ischemia measure or on serial stress/stress
pairs to evaluate changes over time (both improvement and
worsening). This method of quantification is based on
publications shown in the Appendix D, Bibliography.
Requirements
The change feature requires at a minimum two myocardial
perfusion SAX datasets. The pairs can be of any
combination but the most useful clinically are a stress/rest
pair or a stress/stress pair.
You can use the change feature for a stress/rest pair of
datasets to determine global ischemia when normal limits
databases are not available, or if standard quantification
results are borderline. You can also apply this feature to
pairs of data, where the stress or rest studies are performed
on different dates, to evaluate perfusion changes over time
(serial changes), for example, to monitor a therapy.
Caution
170
You must verify that the correct TID is selected when
loading a serial study with multiple stress and rest datasets
from different dates since the TID selection can affect the
QPS scores.
AutoQUANT
Using the Change Feature
◆
Note
To use the change feature within QPS:
1
Click Change.
2
Click Compare on the window control bar to apply the
change algorithm.
Elastic registration is computationally intensive and may
take some time for the change results to be reported. An
hourglass appears to indicate the calculation progress.
Change results, polar map and change slice display sections
are updated once the change quantitation is performed.
Note
Change results are in % myocardium (volume).
The following information appears:
• If stress-rest studies are compared, change slice display is
labeled Ischemia and change results are displayed as
Ischemia: % myocardium.
• If serial stress (or serial rest) studies are compared,
change results can be displayed as % myocardium
Improvement or Worsening. The default display mode
is Improvement, in which the results, change slices, and
change polar maps for areas where there were positive
changes are displayed. If the Worsening label is toggled,
the results, change slices, and change polar maps for
areas where there were negative changes appear.
Note
AutoQUANT
If the order of the serial comparison is determined by the
study date. If the date is the same, the order is determined
by the time of acquisition. Therefore it is essential that the
data and time of acquisition in the header are correct for
the serial change analysis.
171
• To apply the change algorithm automatically during
QPS session startup, enable (toggle on) the Change
button in the Application Options section of the
Defaults Editor.
Note
The startup time increases while change calculations are
performed. Philips recommends that you use the Compare
feature when you select two studies in the change window.
Note
When you enable Change in the defaults, the Compare
button on the Change window is automatically enabled
indicating that the change algorithm has been applied.
3
Click any other window button to exit the Change
window.
Assessing Change Results
The Change window provides three perfusion polar maps
and three 3D parametric surfaces (stress, rest, and change
are labeled as Ischemia, Improvement, and Worsening,
respectively).
The Function pull-down menu contains the options Raw,
Severity, Extent, and Quant. All these options apply to
both 2D and 3D displays.
You can overlay a grid of 20 or 17 segments (Segments), 3
vascular territories (Vessels) or 4 regions (Walls) can be
overlaid onto all polar maps and surfaces from the Grid
pull-down menu.
In the polar maps case, the numbers associated with the
overlay represent the average value of the parameter
measured by each map within the segment, territory or
region in which they lie. Both stress and rest perfusion
values (or stress pairs) are normalized to 100. In addition, a
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slice display of change (Ischemia, Improvement, or
Worsening) is presented where the change can be
visualized in the original slice coordinates.
Note
Click Contours to view image contours. This helps relate
the change images with the original images.
The contours of the first study (or Stress in Stress/Rest
comparison) appear and overlay the co-registered second
study and change images. No separate contours of rest (or
second) study are displayed during the comparison.
Controls
The following window specific controls are available:
• Compare: Toggle on to apply the registration and
change algorithm to the current pair of datasets to
produce the change slices and change polar map. Toggle
off to reset the slices and polar map.
• Worsening: Applicable for serial stress or serial rest
comparisons only. Toggle on to show the results, change
slices, and change polar maps for areas of negative
changes or hypoperfusion.
• Contours: Toggle on to display contours. Contours are
the intersection of a given slice and the endocardial and
epicardial surfaces obtained by QPS.
Note
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The Change window only contours from the first study are
used and are duplicated for the second study, which is
registered to the first.
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Roving Window
The roving window utility allows for quality control of the
registration process.
◆
1
To use Roving Window feature:
Right-click on an image and hold the mouse button down
to view the slice data window.
The user may zoom the images prior to performing this
step using the Zoom window control.
Note
A rectangular window appears containing slice data as
follows:
• Performing step 1 on a slice in the left-most column of
slices (usually a stress dataset): The window contains
slice data from the adjacent slice in the middle column
of slices (can be either a rest or stress dataset).
• Performing step 1 on a slice in the middle column of
slices (stress or rest dataset): The window contains slice
data form the adjacent slice in the left-most column of
slices (usually a stress dataset).
• Performing step 1 on a slice in the right-most column
of slices (the change slices): The window contains slice
data from the corresponding slice in the left-most
column of images (usually a stress dataset).
174
2
Continue to hold the right mouse button down, then drag
the window to your slice area.
3
Verify the correct registration of the slices by positioning
the window over the underlying slice data.
AutoQUANT
Using the Fusion Window
Other Functions
• “Toggling Labels” on page 91
• “Toggling Orient” on page -91
• “Toggling Contours” on page 92
• “Smearing an Image” on page 93
• “Spinning Images/Spin Rate” on page 94
• “Displaying Pins” on page 94
• “Spinning Images/Spin Rate” on page 94
• “Adjusting the Size of Images” on page 95SPECT
Overview
The Fusion Page allows review of fused original PET, CT,
and CTA transverse slices in three orthogonal planes.
Interactive 3D alignment correction of PET, CT and CTA
is possible. All standard image fusion features are provided
such as interactive alpha blending, roving-window, and
synchronized orthogonal reformatting. CT window/level
presets are read from the DICOM header or can be
predefined. Fusion allows users to perform quality control
of PET/CT or PET/CTA alignment (for verification of
attenuation correction). You can also view LV contours in
the Fusion mode.
Important
AutoQUANT
The Fusion option requires at a minimum one CT dataset
and one SPECT or PET perfusion/viability dataset.
175
These controls are common to multiple AutoQUANT
windows. Refer to the tables under “Common Window
Controls,” which starts on page 179 to see which controls
are available in each window.
Note
Refer to Chapters 3 through 6 for explanations of basic
AutoQUANT functionality.
Figure 82 Fusion window
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Displaying Oblique Images
Click Oblique to reorient transaxial data to short axis
orientation.
See Figure 87 on page 182 for an example of a Fusion
window in which oblique images are displayed.
Using the Fusion Window Features
◆
To use the Fusion feature:
1
Select the desired CT/CTA and PET datasets.
2
Start the application session to create contours on the PET
dataset(s).
3
4
Click Fusion on the main toolbar to display the Fusion
page.
5
Verify any misalignment of the CT and PET images.
Reviewing Images on the Fusion Window
Two datasets appear in the Fusion window (the 1, 3, and 4
display datasets options) are inactive.
The Fusion window (see Figure 82 on page 176) displays
three rows of images (starting from the top):
• Top row: images from the CT or CTA dataset
• Middle row: images from the SPECT or PET dataset
• Bottom row: Fusion (Fused) images from both datasets
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The three columns (starting from the left) contain the
orthogonal views, Coronal, Transverse and Sagittal.
Visual inspection of the fused images provides an
indication of the alignment between the CT acquisition
and the PET acquisition. Accurate alignment of the two
acquisitions is necessary when you apply attenuation
correction of PET data using CT data. The degree of
misalignment noted on visual inspection determines if
repeat imaging/processing is necessary.
Note
The text Hardware fusion appears if the data being
displayed has already been fused prior to being used in
AutoQUANT. (See Figure 83)
Figure 83 Hardware fusion message (lower left of Fusion page)
Slice reference lines are provided to allow you to change
the displayed slices interactively using a mouse. See
“Mouse Controls” on page 179 for more details.
For manual alignment of mis-registered PET and CT
images, see “Keyboard Controls” on page 179.
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The Fusion option enables two controls:
Contours
Turns contour display on and off. Contours are the intersection of a given slice and the
endocardial and epicardial surfaces obtained by QPS.
Alpha Blend
Sets the opacity level of PET images on CT images in the fused image section.
Figure 84 Common Window Controls
Mouse Controls
Left-click,
hold+drag
Left-click, hold sets the slice reference lines to the current mouse pointer position. Dragging
the mouse repositions the slice reference lines on the displayed images and updates the
displayed slices.
Middle-click,
hold+drag
Allows movement of any of the nine display images within the individual display area. Release
the middle button to reset all other displayed images within their display areas.
Right-click,
hold+drag
Enables the Roving Window utility. (See section “Using the Roving Window” on page 180)
Figure 85 Mouse Controls
Keyboard Controls
The following table shows specific keyboard controls used
for manual alignment of mis-registered PET and CT data.
AutoQUANT
Note
Keyboard controls are also shown on the Fusion page’s
upper right panel, next to the word: Register.
Note
You must click once in image display area to activate the
keyboard controls.
179
Up and down arrow
Moves image up and down
Ctrl + up and down arrow
Rotates image
A
Moves the PET images up by one pixel
Shift+A
Moves the PET images up by ten pixels
Z
Moves the PET images down by one pixel
Shift+Z
Moves the PET images down by ten pixels
Left Arrow
Shifts 1 pixel to the left
Shift+Left Arrow
Shifts 10 pixels to the left
Right Arrow
Shifts 1 pixel to the right
Shift+Right Arrow
Shifts 10 pixels to the right
Figure 86 Keyboard controls
Using the Roving Window
The roving window feature allows for quality control of the
registration process.
◆
To use the Roving Window feature:
You can enlarge the images before you perform this step
with the Zoom page control.
Note
1
Right-click on an image and hold the button down until a
rectangular window appears that contains slice data.
• Click on an image in the top row (CT) to view data
from the corresponding middle row image (PET).
• Click on a slice in the middle row of slices (PET image)
to view data from the corresponding upper row slice
(CT image).
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AutoQUANT
• Click on a slice in the lower row of slices (Fused
CT/PET image) to view slice data from the
corresponding upper row slice (CT image).
2
While holding the right mouse button, drag the window in
the appropriate slice area and verify correct registration of
the slices by positioning the window over the underlying
slice data.
• “Toggling Labels” on page 91
• “Toggling Orient” on page -91
• “Toggling Contours” on page 92
• “Smearing an Image” on page 93
• “Displaying Pins” on page 94
• “Displaying Oblique Images” on page 177
• “Adjusting the Size of Images” on page 95
When Oblique is enabled, AutoQUANT reorients
transaxial data into short axis orientation, and displays the
images in an oblique orientation (see Figure 87).
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181
Figure 87 Fusion window, Oblique enabled
Changing the Display of Fused Images
Alpha-Blending
Use the Alpha-Blend slider to adjust the relative
contribution of each dataset to the 2D fusion images. If
you position the slider in the middle of the bar, each
dataset is equally represented. If you position the slider at
the left end of the bar, only images from the primary
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dataset are displayed; if you position the slider at the right
end of the bar, only images from the secondary dataset are
displayed.
W/L Image Control Bar (ICB)
The W/L ICB controls the display of CT and CTA
images.
Note
This ICB appears only in the Fusion window.
Note
See “Using Image Control Bars (ICBs)” on page 86 for
information on all basic ICBs. Use the Defaults window
(see Chapter 5) to set default color table settings for this
ICB.
The following basic bar configuration options are available
in the W/L ICB colormap pull-down menu:
•
•
•
•
•
•
Reset
Invert
Step
Gamma
Window/Level
Normalize
The following additional bar configuration options are
available only for this ICB:
• W/L Presets: These are preset combinations of window
and level settings for various types of images. Options
include:
-
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Lung
Fat
Water
Muscle
Liver
183
- Bone
- CTA
- Edit
Clicking Edit opens a Window/Level Editor dialog in
which you can change and delete existing presets, and
create your own new presets.
• Window/Level
All basic color table options are available.
Setting Defaults
The parameters available in the Defaults window reflect
the Fusion functionality (see Figure 88). Additional
parameters for which you can select default settings
include:
• Application Options
- W/L preset
• Page Options
- Fusion Window
- Oblique
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Using the Snapshot Window
Figure 88 Defaults window, General tab (for AutoQUANT with
QPET option)
Use the Snapshot window (Figure 89) to review snapshot
or Lightbox files.
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185
If you select a snapshot or Lightbox file when you are
selecting patients, AutoQUANT automatically presents
the Snapshot window. Conversely, if you select the
Snapshot window, AutoQUANT displays the first, if any,
snapshot or Lightbox image file in the pull-down menu.
Figure 89 Snapshot window
If the selected image is too large to fit in the image
window, you can change the image display in the following
ways:
• Drag the image up and down to view the area of the
image beyond the window’s frame.
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Using the More Window
• Adjust the Scale factor so that the entire image fits
within the image window.
Note
Note
If a Multi-Frame Secondary Capture (MFSC) is loaded,
the Cine button appears.
You can set a default Scale factor (range = 0.5–3.0) for
Snapshot images in the Defaults window. See Chapter 5,
“Setting Defaults,” on page 191 for detailed information.
Using the More Window
Use the More window to see detailed information on the
patient and the acquisition protocol of the dataset:
acquisition times, isotopes, angles, etc. The information
displayed depends on the number of datasets set and
selected for display. For example, in Figure 90 on page
188, information for both stress and rest datasets appears
because the Cardiac Dataset Display button 2 has been
clicked and two objects have been selected.
Note
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There are no window-specific controls in the More
window.
187
Using the Database Window
Figure 90 More window
Use the Database window to review, create and remove
Normals files in the AutoQUANT application.
For complete information on using the Database window
and the two types of databases, see Chapter 6, “Managing
Databases,” on page 219.
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Figure 91 Database window, PFQ
Overlaying a Grid
Database window. Refer to “Overlaying a Grid” on
page 138 for detailed information on the Grid options.
Note
AutoQUANT
The polar map values for a study may change slightly when
you add that study to a Normals database. This occurs
because the polar map, as stored in the database, assumes a
generic LV geometry that—in particular—has no valve
plane.
189
190
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5
Setting Defaults
• Defaults Overview (page 191)
• General Tab (page 194)
• Window-Specific Parameters (page 198)
• Automatic File Selection Parameters (page 202)
• Application Colors and Font (page 211)
• Graphics Tab (page 215)
• Saving, Applying, or Canceling Default
Settings (page 217)
Defaults Overview
The Defaults window (see Figure 92 on page 193) allows
you to load, modify, reset, and save the most frequently
used AutoQUANT parameters. When you have set up the
Defaults window according to your preferences and the
established clinical protocols for your facility,
AutoQUANT provides the following advantages:
• You can customize the appearance and functionality of
each AutoQUANT window.
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5: Setting Defaults
191
Defaults Overview
For example, you can designate the Slices window to
open with two datasets displayed (Cardiac Dataset
Display button 2 selected), with the Contours and
Labels off. Or, you can designate the Surfaces window
to initially display only one dataset, with the septal
surface in front of the 3D volume.
• You can use automated file selection features.
Default Types
There are several types of defaults to set:
• General parameters: These parameters affect all
AutoQUANT windows. These options are on the
General tab.
• Window-specific parameters: You can customize these
parameters for each window. These options are on the
General tab.
• Automatic file selection parameters: These parameters
define the datasets to use for Lung/Heart and TID ratio
calculations, which datasets are not displayed, or which
datasets are designated as stress and rest files. These
options are on the AutoMatch tab.
• Application colors and font: You can change the general
appearance of the AutoQUANT graphical interface.
These options are on the Themes tab.
Important
You can not make changes to default themes.
• 3D image display characteristics: These options are on
the Graphics tab.
• ARG (Automatic Report Generation) Set report
modifiers and perform ARG administration here. See
the QARG Instructions for Use for more details.
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5: Setting Defaults
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Defaults Overview
You can modify or overwrite all default settings while
AutoQUANT is running.
Important
◆
1
To open the Defaults window:
Click the Defaults button.
The Defaults window appears.
AutoMatch tab: Automatic file selection parameters
Themes tab: Application colors and font
Graphic tab: 3D image display characteristics
ARG tab: ARG preference settings
General
parameters
Windowspecific
parameters
Figure 92 AutoQUANT Defaults window,
AutoQUANT
5: Setting Defaults
193
Defaults Overview
General Tab
This section describes general parameter control function
◆
To set general parameter defaults:
1
Click Defaults.
2
Select the controls outlined in the following table
according to the requirements for your site.
Control
Function
Process
This processes all loaded datasets immediately when AutoQUANT opens.
Prone+
This sets AutoQUANT to automatically perform prone-supine quantification.
Change
This sets AutoQUANT to automatically compare loaded and processed datasets when you display
the Change window.
Anonymize
This hides patient-specific identifiers, ensuring confidentiality.
Verify
Automatically launches the Dataset Editor when automatching can not determine which Normals
to apply.
1, 2, 3, 4
These display the number of datasets selected.
Note: In some windows, this default setting is overridden if the full number of datasets selected
cannot all be displayed at the same time.
Segments
This is the segmentation model to use. When you select segments in the application it applies the
segment model selected here. Note: When using ARG, this setting is global and applies to all
defaults.
Convert
This option converts 20-segment scores to 17-segment scores. It relates to ARG. If a site has
switched models (i.e., they used to score in 20 segments, but now want to switch to 17), then
enabling this checkbox converts all old reports to 17 segments.
Colorscales
Use these drop-down menus to select the initial Surface, Function, Primary, W/L Preset, and
Phase color tables used to display the images.
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5: Setting Defaults
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Defaults Overview
Control
Function
Start Page
Use the drop-down menu to select the window in which you want AutoQUANT to open. If data
you load cannot be displayed in this window, AutoQUANT opens instead in the first applicable
window in the sequence.
Normalize
This sets the brightness on all images to a normalized level. Before processing, this control finds the
brightest pixel in the dataset, sets that pixel to 100%, and scales all pixels in the dataset from there.
After processing, this control finds the brightest pixel in the dataset within the myocardium, sets
that pixel to 100%, and scales all pixels in the dataset from there.
Calibrate
When you enable Calibrate, all displayed slices from short axis and transverse datasets (gated
and ungated) in the patient are scaled so that they share the same number of millimeters per
screen pixel, assuming that they share equal screen zooms (as is the case for all side by side
displays). You typically use this feature when you display PET and SPECT images in the same
window. For example, if you display PET and SPECT data side by side in the Splash window, you
see an apparent visual discrepancy in the LV sizes between PET and SPECT on the same patient,
because PET image data typically have smaller pixel sizes than SPECT image data. Calibrate
compensates for this visual discrepancy.
3
Reorder the sequence of windows as desired.
To change the default sequence of windows listed at the
top of the AutoQUANT main window, click a window
name and use the arrows at the end of the Page Sequence
box to move the window to a different location in the
sequence.
4
Note
Select a Normal Limits file.
This field is usually left blank unless you always want the
same normal limits to be applied by default. For
information on how Normal Limits work see page 220
• Click Browse to display a dialog box that lists the
Normals files available.
- Astonish_Full_Time_MibiMibi
- Astonish_Half_Time_MibiMibi
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5: Setting Defaults
195
Defaults Overview
- MibiMibi
- Pet
- SepdualAuto
- ThalliumThallium
- VantageProMB-AC
• Click the Normals file you want to use as a default, or
click None if you do not want to set a default Normals
file.
• Click OK to select the file and close the dialog box.
5
Enter a Results File name.
AutoQUANT Results files are datasets or complete patient
studies that you have opened and processed in
AutoQUANT and then saved to the database. These files
are always saved as an object in the active patient study.
6
Click Prompt (highlight yellow) to have AutoQUANT
prompt for saving unsaved datasets on exiting.
7
Set defaults for the Stress, Rest, AttCor, and Baseline
labels.
If set, the application uses these labels instead of the
generic ones in the patient information box as the
appropriate datasets appear. For example, Rest is the
generic default for the Rest label; if you change the Rest
label default to Delay, Delay then appears in the patient
information box when a rest dataset appears, as shown in
Figure 93 below. The other labels (Stress, AttCor, and
Baseline) work similarly.
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5: Setting Defaults
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Defaults Overview
changed Rest label
Figure 93 Patient information box showing the changed Rest label
default
8
At the Discard phase information if motion amplitude is
less than ___% of maximum amplitude field (see
Figure 94 on page 198), click on the up or down arrow
button to set the percentage of maximum motion
amplitude.
9
If you want to shift phase data, check the Shift phase data
by ___ degrees checkbox (see Figure 94 on page 198), then
click on the up or down arrow button to set your degree
amount.
The top tier of the Defaults window features many
controls that can be set. See Figure 97 on page 203 for
definitions of these controls.
10
AutoQUANT
After your controls and preferences are set, click OK to
close the Defaults window and apply your saved settings. If
you close the Defaults window by simply clicking the X in
the upper right corner of that window, your saved settings
are NOT applied in the current session.
5: Setting Defaults
197
Window-Specific Parameters
Figure 94 Application Options section - General Defaults window
You can customize each AutoQUANT window with
window-specific parameters.
◆
To set window-specific parameter defaults:
1
Click Defaults.
2
In the Page Options section of the Defaults window
(bottom section), click the name of the window for which
you want to set parameters.
The set of available parameters automatically changes to
match the selected window (Figure 95 on page 199).
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5: Setting Defaults
AutoQUANT
Splash window parameters
QPS window parameters
Figure 95 Examples of available parameters for several windows
3
Inside the Page Options section, click on the desired
controls.
Enabled controls are active in the selected window the next
time you bring up that window.
Note
4
Enable Select (if available) to define how AutoQUANT
determines the number of datasets and datatype displayed
by default in the selected window.
When Select is enabled, you can do one of the following:
• Disable Auto to manually select the following display
parameters:
- Click 1, 2, 3, or 4 to select the number of datasets.
- Click QPS to display non-gated data or QGS to
display non-gated data.
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5: Setting Defaults
199
It is possible to select both QPS and QGS; in this
case, QPS will override the QGS selection, and only
non-gated data appears.
Note
For example, in the QPS window, enabling the 2 and
QPS buttons automatically displays the QPS window in
dual display mode with the TID (summed SA
stress/rest) datasets.
• Enable Auto to toggle on automatic display selection.
When Auto is on, AutoQUANT automatically selects
both the number of datasets and data type to display in
the selected window.
5
Enable the Active button (if available) to make the window
available in AutoQUANT.
When the Active button is highlighted, the window name
is enabled in the Page Sequence row (Figure 92 on page
193). If Active is not highlighted, the name is disabled.
The window name will also not appear in the main
application window bar.
Note
6
Select initial settings from any available pull-down menus.
7
Set the available Zoom, Scale, and Rate factors.
8
Enter a Snapshot filename.
9
Repeat steps 1 through 8 for each window.
The top tier of the Defaults window features many
controls that can be set. See Figure 96 on page 201 for
definitions of these controls.
200
5: Setting Defaults
AutoQUANT
Top Controls
Purpose
Defaults
Select the current defaults.
New
Create new defaults.
Reset
Reset the current defaults.
Reload
Reload the current defaults
Save
Save the current defaults
Save As
Save the current defaults under a different name
Set As Startup
Set the current defaults as the startup defaults
Import
Import defaults that have previously been exported
Export
Save the current defaults to a file
Delete
Delete the current defaults
Reinitialize
Reset the Default defaults to its factory settings and make the startup defaults
Bottom controls
Purpose
DICOM recon. SPECT Data
Check this checkbox if you want to treat unknown RECON TOMO datasets as
Short Axis.
OK
Applies defaults chosen to the application (one-time)
Click Save before OK to make the changes permanent.
Cancel
Exits default dialog without making any changes
Figure 96 Default window - top tier controls
10
AutoQUANT
After your controls and preferences are set, click OK to
close the Defaults window and apply your saved settings. If
you close the Defaults window by simply clicking the X in
the upper right corner of that window, your saved settings
are NOT applied in the current session.
5: Setting Defaults
201
Automatic File Selection Parameters
Important
Use the following conventions when entering file selection
parameters:
• Separate alternatives with a comma.
• Do not use spaces.
AutoMatch Tab
Use the AutoMatch tab in the Defaults window to set the
default automatic file and object attribute selection
parameters.
The use of filters in necessary when object attributes are
not correctly being recognized by the application due to
missing DICOM attributes.
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5: Setting Defaults
AutoQUANT
Figure 97 Defaults window, AutoMatch tab
The automatic file selection parameters determine the
Procedure ID, View ID, or Isotope that AutoQUANT
searches for when it selects one or more datasets for each
category. The following filters are available:
Note
AutoQUANT
The order of filters shown here may differ on some
systems.
5: Setting Defaults
203
• Stress
• Rest
• Late Rest filter (only available if the ARG option is
installed)
• Primary Stress
• Primary Rest
• Lung/Heart
• Change Baseline
• Change Variant
• QGS
• AutoMatch Include
• AutoMatch Exclude
• Attenuation Correction
• Baseline
• Viability
• DICOM Reconstructed SPECT Data
- Check this checkbox if you want to treat unknown
RECON TOMO datasets as Short Axis. If left
unchecked, unknown RECON TOMO datasets will
be treated as transverse. See Figure 97 on page 203.
You can also specify the acquisition matrix of a dataset to
include or exclude as a filtering parameter.
Use the following conventions when entering file selection
parameters:
• Separate alternatives with a comma.
• Do not use spaces.
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5: Setting Defaults
AutoQUANT
Note
Use longer filter strings rather than shorter. Shorter strings
can have unwanted matches. For example, if RES is used
for a rest filter and STRESS for stress, a image called saxstress would have a two conflicting matches. A better filter
would be -RES. For example, for patient studies that
include emission files with View IDs of Raw -EM, enter EM in the AutoMatch Exclude View ID field to exclude
only the Raw -EM files but not all other Raw projection
files.
Note
The AutoMatch text entry fields are not case sensitive.
◆
To specify automatic file selection parameters:
1
Click Defaults.
1
Click the AutoMatch tab.
2
Set the Stress Filters.
If you are using a dual isotope protocol, the stress filter
may already work. If not, remove any text that appears in
the Isotope field, take a common string from the View ID
and enter that value as the stress filter in the Dataset field.
For example, you may label your stress datasets as:
• Raw proj -str
• SAX -str
• Proc GSPECT -str
For this example, it is not necessary to enter each View ID
in the Dataset field of the Stress Filter. Simply enter -str
(the common text string), and AutoQUANT tags these
datasets as stress.
You can also enter multiple strings, separated by commas.
Note
3
AutoQUANT
Set the Rest Filters.
5: Setting Defaults
205
For example, you may label your rest datasets as:
• Raw proj -rst
• SAX -rst
• SAX -del
• Proc GSPECT delay
It is not necessary to enter each View ID in the Dataset
field of the Rest Filter. Enter -rst, del (the common
text strings), and AutoQUANT tags these datasets as rest.
4
Set the Late Rest Filter.
Use this filter when you want to redistribute an ungated
SAX delayed rest dataset. This filter also provides a third
dataset type which you can create a report for. If you
associate datasets with Late, you can then select a sequence
that includes Late, automate the scores, and create a
report.
5
Set up the Primary Stress/Rest Filters.
Determine if the program finds more than one non-gated
stress or non-gated rest SAX dataset by checking the
following:
• If AutoQUANT auto matches on two datasets, and they
are properly labeled stress and rest, then the program
automatically calculates the TID ratio from these files
when it performs processing and you need to take no
action.
Important
In this case, do not enter any automatch criteria in the
Primary Stress/Rest filter panels.
• If AutoQUANT auto matches on multiple stress or rest
datasets, as in the case of Vantage corrected and
uncorrected files, then select the common text string of
the stress and the rest SAX datasets and enter it in the
View ID for the TID calculation.
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5: Setting Defaults
AutoQUANT
Important
In this case, you must specify the exact stress and rest
datasets for AutoQUANT to use for TID calculation.
The application must be able to differentiate between
similar View IDs.
Important
The stress-rest pair tagged as the datasets for TID
measurement are also scored as a pair if you are using the
Dual Isotope or Mibi-Mibi Normals files. When stress
and rest scores are scored as a pair, the rest score is
tempered by the stress score. See “Scoring a Dataset” on
page 77 for more information.
For example, if you want to have TID calculated on the
attenuation-corrected (AC) datasets, and you have
dataset names similar to these:
- SAX -STR
- SAX AC -STR
- SAX -RST
- SAX AC -RST,
enter the text AC in the Dataset fields in the Primary
Stress Filter and the Primary Rest Filter.
• If you have multiple stress or rest SAX datasets with
identical names, manually select the two datasets to use
for the TID ratio calculation from the List popup
window. (Refer to “Listing Loaded Datasets” on page 80
for detailed information.)
To avoid this, use unique names for differently processed
datasets.
Note
6
Set up the Lung/Heart Filter.
AutoQUANT calculates the Lung/Heart ratio (LHR)
based on the projection dataset of your choice. It is not
necessary to enter the entire View ID of your preferred
AutoQUANT
5: Setting Defaults
207
dataset. For example, if you use a dual isotope protocol and
you want AutoQUANT to calculate the LHR on the rest
dataset, enter Tl in the Isotope field.
If you do not use a dual isotope protocol and want
AutoQUANT to calculate the LHR on the rest dataset,
enter a text string that is common to the Procedure ID or
View ID.
For example, you may label your rest datasets as:
• Raw proj -rst
• Proj -rst
You only need to enter -rst in the Dataset field.
7
Note
Set up the AutoMatch Include and AutoMatch Exclude
filters.
If you select all datasets before launching AutoQUANT,
the datasets are filtered based on the factory default
AutoMatch Include and AutoMatch Exclude parameters.
To see which datasets are active initially, click on Edit in an
active window and view the list.
Define the active datasets for the AutoMatch Include filter,
and the inactive datasets for the AutoMatch Exclude filter.
On the Edit list, the active datasets (AutoMatch Include
filter) are highlighted (yellow), and the inactive datasets
(AutoMatch Exclude filter) are not highlighted.
By default, AutoQUANT accepts the dataset types listed
under “General Data Requirements” on page 12. To
exclude other dataset types, enter criteria in the
AutoMatch Exclude Dataset field for:
• VLA files
• HLA files
• Vantage emission and transmission files
208
5: Setting Defaults
AutoQUANT
• Any other datasets, such as reference or test files, that
you do not want loaded into AutoQUANT (that is, any
files other than raw projection, SAX, processed gated
SPECT, or snapshot files)
For example, you may label the above-mentioned datasets
as:
• Stress VLA
• Delay HLA
• Raw -EM
• Raw -TR
• Stress -TRA
For these examples, use these common text strings to enter
in the AutoMatch Exclude Dataset field:
VLA,HLA,EM^,-TR, TRA
It is not necessary to use both AutoMatch Include and
AutoMatch Exclude. In most cases, AutoMatch Exclude is
used to filter out unwanted datasets.
Note
8
Set up the QGS filter.
This pertains to the gated short axis dataset to be used by
default when reporting EF, motion, etc. You can specify
datasets to be associated with QGS, which you can then
configure to appear by default in specific windows by
selecting the QGS button in the window-specific
parameters in the General tab of the Defaults window (see
step 5 on page 200).
For example, enter proc-gspect in the Dataset field.
9
Set up the Attenuation Correction filter.
Define criteria for recognizing attenuation-corrected
datasets for easier selection and comparison on display
windows.
AutoQUANT
5: Setting Defaults
209
For example, you can set -AC as the Attenuation
Correction filter. This means that for any dataset
containing the text string -AC in its name:
• The extension -AC is attached to labels in the Type field.
• The images are tagged as AttC images in both the exam
object list and the object selector.
10
Set up the Baseline filter.
Define criteria for recognizing baseline datasets for easier
selection and comparison on display windows.
For example, you can set AXIS as the Baseline filter. This
means that for any dataset containing the text string AXIS
in its name, images are tagged as Base images in both the
exam object list and the object selector.
11
Click Save to save your current settings or Cancel to
discard them.
If you click Save, a dialog box appears prompting you to
confirm that you want to overwrite the current defaults
file. Click Yes to proceed or No to cancel.
12
Note
210
5: Setting Defaults
Click OK to close the Defaults window and apply your
saved settings.
If you close the Defaults window by simply clicking the X
in the upper right corner of that window, your saved
settings are not applied.
AutoQUANT
Application Colors and Font
Theme Tab
Use the Themes tab in the Defaults window (Figure 98 on
page 212) to set the default colors and font. A theme is a
collection of color and font definitions for the application’s
user interface (buttons, labels, etc.). The Theme Editor
allows you to change the colors and font. The Preview area
displays the main element types in the application as an
example, so you can see how your changes affect the
application.
Note
AutoQUANT
You cannot see the changes in the Preview area until you
save them in the Theme Editor.
5: Setting Defaults
211
Figure 98 Application Defaults window, Themes tab
◆
1
Important
To create a new theme:
Click New.
If you want to create your own theme, click New. When
you click Edit, the settings of the selected theme change
permanently. After you click Edit, Reset does not restore
old settings.
The Theme Editor appears. See Figure 99 on page 213.
212
5: Setting Defaults
AutoQUANT
Figure 99 Theme Editor (new)
2
Enter a name in the Theme Name field.
3
Make changes as desired:
• Use the Change Font button to change the font used in
the interface.
• Use the tabs and buttons to change the colors for the
specified elements.
4
When you are finished, click Save to save your changes (or
Cancel to discard them).
If you click Save, the Windows Save as dialog appears.
AutoQUANT
5: Setting Defaults
213
5
In the File name field, enter the same name for your theme
that you entered in the Theme Editor.
6
Click Save to save your changes and return to the Defaults
window, or click Cancel to discard your changes and
return to the Theme Editor.
The Preview area displays the changes.
You cannot see the changes in the Preview area until you
save them in the Theme Editor.
Note
7
Click Apply to apply your new Theme settings.
8
new Theme settings.
Note
If you do not click Apply before closing the Defaults
window, your saved settings are not applied.
Note
You must restart AutoQUANT to completely refresh all
displays with your changed Theme settings.
◆
1
To edit a theme:
Select the theme you want to edit from the Theme Name
pull-down menu.
If you want to create your own theme, click New. When
you click Edit, the settings of the selected theme change
permanently, and clicking Reset does not restore them.
Important
You cannot make changes to the Cedars and Windows
themes.
Note
2
Click Edit to edit the selected theme.
The Theme Editor appears.
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5: Setting Defaults
AutoQUANT
Changes to a theme affect all places where that theme is
used in both AutoQUANT Plus applications
(AutoQUANT and QBS), and in the optional QARG
application (if installed).
Note
3
Make changes as desired:
• Change the Theme Name.
• Click Change Font and select the font for the interface.
• Click the tabs and buttons to change the colors for the
specified elements.
4
When you are finished, click Save.
5
Enter the theme name with a .xml extension.
The Preview area displays the changes.
Changes in the Preview area are not applied until the
Theme Editor save button is clicked.
Note
6
Click Apply to apply your Theme Editor changes.
7
Click Save (upper toolbar).
A dialog box appears prompting you to confirm that you
want to overwrite the current defaults file. Click Yes to
proceed or No to cancel.
8
Note
saved settings.
If you do not click Apply before closing the Defaults
window, your saved settings are not applied.
Graphics Tab
Use the Graphics tab in the Defaults window to select
display options for 3D images.
AutoQUANT
5: Setting Defaults
215
Figure 100 Defaults window, Graphics tab
You can enable any of the following options:
• 3D OpenGL rendering: Use hardware acceleration on
the video board for faster performance of 3D rendering.
Use the drop-down menu to select Auto, Yes, or No.
• Specular highlights: Use the slider to adjust the amount
of apparent shine.
• Parametric image shading: Applies smooth shading to
the 3D rendered image.
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5: Setting Defaults
AutoQUANT
Saving, Applying, or Canceling Default Settings
ARG Tab
Figure 101 Defaults window - ARG tab
For details on how to use the features within the ARG tab,
see the QARG Instructions for Use manual.
Saving, Applying, or Canceling
Default Settings
Note
AutoQUANT
For information on the Defaults window controls, see
Figure 96 on page 201.
5: Setting Defaults
217
Saving, Applying, or Canceling Default Settings
◆
To save, apply, or cancel default settings:
1
Set your preferences.
2
• Go to the bottom of the Defaults window, and click OK
to save your settings for the current processing session
and close the Defaults window.
Important
The OK button does not save settings for future sessions.
• Click Cancel to close the Defaults window without
saving or applying your changes.
• Click Save (Defaults window’s upper toolbar) to apply
your new default settings to future sessions.
Important
You must always click Save before selecting a different
default file. If you do not, any changes will be lost.
• Click Reset (Defaults window’s upper toolbar) to reset
all control settings back to their factory defaults (except
for Themes).
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5: Setting Defaults
AutoQUANT
6
Managing Databases
• “Overview” on page 220
• “Database Window” on page 223
• “Creating a New Database” on page 226
• “Adding Patients to an Existing Database” on page 230
• “Removing Patients from a Database” on page 233
• “Backing Up and Restoring Databases” on page 234
• “Viewing Database Attributes” on page 235
• “Importing and Exporting Databases” on page 236
• “Deleting a Database” on page 237
• “Working with Normal Limits” on page 238
• “Database Controls” on page 242
AutoQUANT
6: Managing Databases
219
Overview
Overview
AutoQUANT uses Normals databases during
quantification of perfusion defects by QPS.
A Normals limit database is a collection of polar maps
derived from a group of normal (typically low-likelihood)
datasets.
Note
Normal limit databases are automatically applied to images
based on the object attributes.
A Limits file is a set or collection of normal databases. For
example, the SepdualAuto Limits file includes the
following databases:
• FemaleRestTl
• FemaleStressMB
• MaleRestTl
• MaleStressMB
The Limits file enables you to define processing
instructions for a study, for example: “Use only the stress
MIBI normal databases and only the rest Tl normal
databases for images.”
220
Important
You should make sure that the correct normal limits
databases get applied to your datasets. For example, if you
were to load a MibiMibi study, applying the SepdualAuto
Limits would remove any matching normals databases for
the rest datasets.
Note
Since normal limit databases are automatically applied to
the images, it is usually not necessary to apply a limits file.
However, the use of limits can be particularly useful if you
have multiple matches.
AutoQUANT
Overview
Caution
When using batch processing (processing of multiple
studies within one AutoQUANT session), manually
selecting a normals limit applies that limit to all the studies
that are loaded in the session.
In the Database window, you can review and modify userdefined Normals databases, Limits, and associated files.
You can also generate your own Normals databases
according to your patient population and the specific
protocols and isotopes used at your facility.
Caution
Although AutoQUANT allows you great freedom in
manipulating databases, you must take great care when
doing so. Only the proper personnel should attempt this; if
you are unsure whether you know enough, find someone
who does. Using databases that contain conflicting or
incompatible patient data may lead to misdiagnosis.
AutoQUANT comes with the following validated Normals
databases.
Normals databases:
Note
FT=Full Time, HT=Half Time.
• AstonishFTFemaleRest
• AstonishFTFemaleStress
• AstonishFTMaleStress
• AstonishFTMaleRest
• AstonishHTFemaleRest
• AstonishHTFemaleStress
• AstonishHTMaleStress
• AstonishHTMaleRest
• FemaleProneStressMB
AutoQUANT
221
Overview
• FemaleRestMB-AC
• FemaleRestMB
• FemaleRestTL
• FemaleStressMB-AC
• FemaleStressMB
• FemaleStressTL
• MaleFemaleRestPETRb (QPET only)
• MaleFemaleStressPETRb (QPET only)
• MaleProneStressMB
• MaleRestMB-AC
• MaleRestMB
• MaleRestTL
• MaleStressMB-AC
• MaleStressMB
• MaleStressTL
If necessary, you can both modify and delete the
supplied AutoQUANT standard Normals files and
databases.
You can view detailed information on the patient studies
used to establish the supplied Normals files. See
Appendix A, “Normal Limits Databases”
222
AutoQUANT
Database Window
Database Window
Database Window Overview
Using the controls in the Database window, you can
create, modify, and manage Normals databases.
• You typically use 30–40 normal exams to create a
database.
• You can create multiple databases and store them on one
system. For example, you can create separate databases
for stress and rest datasets, or for datasets of male or
female patients. You can choose your own naming
convention for databases you create.
• You can configure AutoQUANT to automatically
match a particular database to a specified dataset during
QPS quantification of perfusion by defining a set of
database attributes. In a typical quantification of a
standard Stress/Rest myocardial perfusion study, you use
two separate databases: one for the Stress exam and the
second for the Rest exam. Using the Limits menu, you
can define a set of limits containing various database
files. You can then choose this set of limits as a default in
the Defaults window.
In addition to the general window controls and patient
statistics, the Database window contains two areas: the
database control panel and the database display panel (see
Figure 102).
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223
Database Window
Figure 102 Database window
The database control panel is divided into 3 separate
panels.
• Database menu (left panel)
• Exam menu
• Limits menu
224
AutoQUANT
Database Window
The database display panel displays the following four
polar maps:
A
B
C
D
Figure 103 4 Polar Views
• Polar View A: Displays the exam selected (highlighted)
in the current database exam list.
• Polar View B: Displays the current exam from the QPS
window
• Polar View C: Displays the database average (the
normalized mean of all exams in the current database).
• Polar View D: Displays the database variation (the
normalized variation of all exams in the current
database).
By changing the selection in the current database exam list,
you can quickly preview polar maps for all cases included
in a database; this can be a useful quality control measure.
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225
Creating a New Database
◆
1
To create a new database:
Select all of the exams that you want to include in the new
database, and load them into AutoQUANT.
Use normal short-axis myocardial perfusion datasets of
low-likelihood patients.
2
Make sure that all datasets are processed by QPS, that all
the contours are defined correctly, and that there are no
obvious perfusion defects in the images.
You must verify correct contour creation. If contours
appear too long, too short, or do not encompass the
myocardium, you must manually adjust and save them.
Incorrect contours generated for the normal limits
population degrade the quantification results when applied
to clinical studies, which may lead to misdiagnosis.
Caution
3
Click Database to display the Database window.
4
Select Database -> New.
This clears all the attribute fields in the current database
attributes panel.
5
Specify all required database attributes by making the
appropriate selections in the drop-down menus and fields
in the current database attributes section of the database
control panel.
See “Current Database Attributes,” which starts on
page 245, for descriptions of these attributes.
Note
226
If you select Any for a particular attribute, AutoQUANT
ignores that attribute during auto matching when running
QPS.
AutoQUANT
6
Select Exam -> Add All.
AutoQUANT compares the exams for each patient with
the combination of attributes defined for the selected
database, and does one of following for each exam:
• If all attributes match and the exam does not already
exist in the selected database, the exam appears in the
current database exam list.
• If the dataset does not match the combination of
attributes you have specified, AutoQUANT displays a
dialog. Click OK to add the dataset anyway, or Cancel.
• If the dataset already exists in the database,
AutoQUANT displays a dialog. Click OK to add the
dataset anyway, or Cancel.
• If no datasets for a patient match the combination of
attributes for the selected database, AutoQUANT
displays a dialog. Click OK to skip the patient, or
Cancel to stop the Add All process.
AutoQUANT
Note
If you want the created database to become the default for
perfusion quantification of exams with a matching
combination of attributes (i.e., if you want the database to
be automatch-enabled), check the box next to Allow
automatic selection during processing.
Important
It is possible to have more than one matching database for
a particular exam. In this case, AutoQUANT displays
<Multiple Matches> in red in the corresponding Database
field in the patient demographics panel (see Figure 104).
227
Figure 104 Example of <Multiple Matches> text
When you use Add All, AutoQUANT considers the open
database, and only those patients that contain precisely one
matching dataset are added without further instructions
from you. Because of this, when creating the set of
databases for which automatch is enabled, it is best to
assign their attributes so that they are all mutually
exclusive. To confirm that this is the case, in the Database
window select Database -> List and make sure that there is
no overlap between automatch-enabled databases.
Note
7
If desired, select Database -> Anonymize.
This removes all patient-specific information from the
created Normals database.
Generic patient names now appear in the current database
exam list.
228
AutoQUANT
Important
This action permanently anonymizes the patients in the
current Normals database file; you cannot re-identify
patients (restore the patient-specific information) that you
have anonymized in this way.
Note
This action affects only the patient-specific information in
the Normals database file; it does not affect the
corresponding patient-specific information in the patient
study database.
8
Select Database -> Save As.
The Save Database As dialog appears, displaying a list of
existing databases.
9
10
Enter a new name in the text field below the list of
databases.
Click OK.
AutoQUANT automatically saves each database as a pair
of files in the same folder, one file with the file type
extension .pfq and one file with the file type extension
.pfq-info. The .pfq file contains the binary image data
needed to generate the scores. The .pfq-info file
contains descriptive fields about the database, such as
database name, isotope used, gender, automatch strings,
etc.
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229
Adding Patients to an Existing Database
Adding Patients to an Existing
Database
You can add exams to an existing database either one at a
time using Add Current, or in a group using Add All.
◆
To add a single exam to an existing database:
1
Select the exam that you want to include in the new
database, and load it into AutoQUANT.
2
Make sure that the exam is processed and that contours for
all studies are defined correctly.
3
4
Select Database -> Open.
The Open Database dialog appears, displaying a list of
existing databases.
5
Select the database you want to modify.
6
Select Exam -> Add Current to add the currently selected
patient.
AutoQUANT compares the current exam with the
combination of attributes defined for the selected database,
and does one of the following for each exam:
230
AutoQUANT
7
• Select Database -> Save.
This overwrites the originally selected database with the
modified database, which now includes the additional
patient.
• Select Database -> Save As.
existing databases.
databases, and click OK.
This creates a new database, preserving the originally
selected database.
◆
To add a group of exams to an existing database:
1
Select all of the exams that you want to include in the new
database, and load them into AutoQUANT.
2
Make sure that all exams are processed and that contours
for all studies are defined correctly.
3
4
existing databases.
AutoQUANT
5
Select the database you want to modify.
6
Select Exam -> Add All to add all currently loaded
patients.
231
AutoQUANT compares the exams for each patient with
the combination of attributes defined for the selected
database, and does one of the following for each exam:
• If no datasets for a patient match the combination of
attributes for the selected database, AutoQUANT
displays a dialog. Click OK to skip the patient, or
Cancel to stop the Add All process.
7
modified database, which now includes the additional
patients you selected.
existing databases.
selected database.
232
AutoQUANT
Removing Patients from a Database
Removing Patients from a Database
◆
To remove patients from a database:
1
2
existing databases.
3
Select the database that you want to modify.
4
Click OK.
5
Select one or more patients from the database exam list.
6
Select Exam -> Delete Selected.
The selected patients no longer appear in the database
exam list.
7
modified database, which now excludes the patients you
selected in step 5.
existing databases.
selected database.
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233
Backing Up and Restoring Databases
Backing Up and Restoring Databases
As a precautionary step, back up the databases regularly,
especially before adding new patients.
◆
To back up all existing databases:
1
2
Select Database -> Backup.
The Browse For Folder dialog appears.
3
Browse to the folder in which you want to store copies of
all existing databases, and click to select it.
You can click Make New Folder if you need to create a
new folder.
Note
4
Click OK.
The selected folder now contains copies of all currently
existing databases.
• To back up a single database, you can use the Export
feature (see “Importing and Exporting Databases” on
page 236); you can then restore it as described below.
◆
To restore previously backed-up databases:
1
2
Select Database -> Restore.
The Browse For Folder dialog appears.
3
234
Browse to the folder that contains the databases you want
to restore, and click to select it.
AutoQUANT
Viewing Database Attributes
If you cannot recall the backup location you used, you can
click Search in Windows Explorer and enter *.pfq to find
the files.
Note
4
Click OK.
A window appears that displays the list of previously
backed-up databases. For any database that currently exists
in AutoQUANT’s active set of databases, AutoQUANT
displays the text Already Exists! to the right of the
filename.
5
Select one or more databases that you want to restore.
6
Click OK.
AutoQUANT adds the selected databases to its set of
existing databases.
If you restore a database that already exists in
AutoQUANT, AutoQUANT automatically adds the
restored copy to the set of existing databases under its
original filename, and renames the existing database using
a default filename. The default filename consists of the
original name plus the suffix (Renamed x), where x is a
system-generated sequential number. If you want, you can
simply delete the copy, or you can rename it by saving it
under a new name and then deleting the copy.
Note
Viewing Database Attributes
◆
To view the attributes of all existing databases:
1
2
Select Database -> List.
The Database List window appears, displaying a list of
existing databases and their attributes.
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235
Importing and Exporting Databases
3
Click Refresh to update your database listing.
4
Click Save to save your database listing as a text file.
5
Click Dismiss to close the window.
Importing and Exporting Databases
AutoQUANT allows you to import and export Normals
databases. For example, you can create a database on one
system and install it on another system or site.
◆
To import a database:
1
2
Click Database -> Import.
The Import Database dialog appears.
3
Browse to the folder that contains the database you want to
import, and double-click to open it.
4
Select the database you want to import.
5
Click Open.
An Import Database to Destination dialog appears for the
selected database, displaying a list of existing databases.
6
Enter a name in the text field below the list.
You can use the current name of the file, but you must
enter it in the text field. If you do not enter a name,
AutoQUANT does not import the database.
7
Note
236
Click OK.
AutoQUANT adds the selected database under the name
you entered to its set of existing databases.
AutoQUANT
Deleting a Database
User's Manual advices user to export Normal files and
databases, as well as patient data used to generate the
Normals files.
Important
◆
To export a single database:
1
2
Select Database -> Export.
The Export Database dialog appears, displaying a list of
existing databases.
3
Select the database you want to export.
4
Click OK.
An Export Database to File dialog for the selected database
appears.
5
Browse to the folder to which you want to export the
selected database, and double-click to open it.
6
Click Save.
The selected folder now contains a copy of the selected
database.
Deleting a Database
◆
To delete an existing database:
1
2
Select Database -> Delete.
The Delete Database dialog appears, displaying a list of
existing databases.
3
AutoQUANT
Select the database you want to delete.
237
Working with Normal Limits
4
Click OK.
A dialog appears asking you to confirm deletion of the
selected database.
If the database shown is not the one you want to delete,
click Cancel to return to the database window without
making a deletion.
Important
5
Click OK.
The database you selected is now deleted.
Creating a New Normal Limits File
◆
To create a new normal limits file:
1
2
Select Limits -> Create.
The Create Limits dialog appears.
3
Click Add.
The Limits Database dialog appears, displaying a list of
existing databases.
4
Select the database you want to add.
5
Click OK.
The database now appears in the list field of the Create
Limits dialog.
6
238
Repeat steps 3 through 5 until you have added all of the
databases you require.
AutoQUANT
7
Click Save.
The Save Limits dialog appears, displaying a list of existing
limits files.
8
Enter a new name in the text field below the list of limits
files.
9
Click OK.
Editing a Normal Limits File
Click Edit in the Limits menu to modify an existing limits
file by adding one or more databases to it. You can also
remove one or more databases from an existing limits file.
◆
To add one or more databases to a normal limits file:
1
2
Select Limits -> Edit.
The Edit Limits dialog appears, displaying a list of existing
limits files.
3
Select the limits file that you want to edit.
4
Click OK.
An Edit Limits dialog for the selected limits file appears,
displaying the list of databases currently in the file.
5
Click Add.
The Limits Database dialog appears, displaying a list of
existing databases.
6
Select the database that you want to add to the current
limits file.
7
Click OK.
The database now appears in the list.
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239
8
Repeat steps 5 through steps 7 through to add other
databases.
9
When you have finished adding databases, do one of the
following:
• Click Save to save the modified limits file under the
current limits name.
• Click Save As to save the modified limits file under a
new filename, preserving the original limits file and
entries.
• Click Cancel to abort the editing process, preserving the
original limits file and entries.
◆
To remove one or more databases from an existing
normal limits file:
1
2
Select Limits -> Edit.
The Edit Limits dialog appears, displaying a list of existing
limits files.
3
Select the limits file that you want to edit.
4
Click OK.
An Edit Limits dialog for the selected limits file appears,
displaying the list of databases currently in the file.
5
Select the database you want to remove from the current
limits file.
6
Click Remove.
The selected database no longer appears in the list.
240
7
Repeat steps 5 and 6 to remove other databases.
8
If you want to remove all databases from the current limits
file, click Clear.
AutoQUANT
9
When you have finished removing databases, do one of the
following:
• Click Save to save the modified limits file under the
current limits name.
• Click Save As to save the modified limits file under a
new filename, preserving the original limits file and
entries.
• Click Cancel to abort the editing process, preserving the
original limits file and entries.
Viewing a Normal Limits File
◆
To view a Normal Limits file:
1
2
Select Limits -> View.
The View Limits dialog appears, displaying a list of
existing limits files.
3
Select a limits file.
A View Limits window for the selected limits file appears,
displaying a list of databases currently in the file.
4
Click Dismiss to close the window.
Deleting a Normal Limits File
◆
AutoQUANT
To delete a Normal Limits file:
1
2
Select Limits -> Delete.
241
Database Controls
The Delete Limits dialog appears, displaying a list of
existing limits files.
3
Select the limits file you want to delete.
4
Click OK.
The limits file you selected is now deleted.
Database Controls
This section describes the controls available for
manipulating databases. All of these controls are located in
the current database attributes section of the database
control panel (see Figure 102 on page 224).
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Database Controls
Database Menu
Control
Function
New
Clears the database attribute fields in preparation for creation of a new database.
Open
Opens a dialog through which you can select an existing database.
Save
Saves a database under its current filename.
Save As
Opens a dialog through which you can save a database under a new filename.
Backup
Opens a dialog through which you can browse to a separate directory and save copies of all existing
databases there.
Restore
Opens a dialog through which you can selectively restore databases from a directory containing one
or more database files. AutoQUANT automatically renames existing databases with the same name.
List
Opens a review window, which lists all defined databases and their attributes.
Import
Opens a dialog through which you can import a single database from a selected location.
Export
Opens a dialog through which you can export a single database to a selected file and location.
Anonymize
Removes patient-specific information (e.g., names) from the current database.
Note: This action permanently anonymizes the patients in the current Normals database file; you
cannot de-identify (restore the patient-specific information for) any patients in that database that
you have anonymized in this way.
Note: This action affects only the patient-specific information in the Normals database “file”; it does
not affect the corresponding patient-specific information in the patient study database.
Delete
Opens a dialog through which you can delete an existing database.
Close
Closes the database that is currently open.
Figure 105 Database menu
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243
Database Controls
Exams Menu
Control
Function
Add Current
Adds the current QPS exam, if processed and of a valid type, to the Current database.
Add All
Adds all loaded QPS exams, if processed and of a valid type to the Current database.
Delete Selected
Deletes selected exams from the current database.
Mismatch Check
When selected, AutoQUANT verifies that the exams to be added match the attributes
(e.g., Sex, Protocol) of the current database. AutoQUANT performs this check during
the process of adding new exams to the current database.
Duplicate Check
When selected, AutoQUANT verifies that the exams to be added do not already exist in
the current database. AutoQUANT performs this check during the process of adding new
exams to the current database.
Note: Duplicate Check fails to find the duplicate under the following circumstances:
• If you add a patient to a Normals database, anonymize and save that database, and
then try to add the same patient again to that database.
• If you add a patient to a Normals database, de-identify the same patient in JETStream
Workspace, and try to add the now de-identified patient again to that database.
Figure 106 Exams window
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AutoQUANT
Database Controls
Limits Menu
Control
Function
Create
Opens a dialog through which you can create a new normal limits file.
Edit
Opens a dialog through which you can edit an existing normal limits file.
View
Opens a dialog through which you can select an existing normal limits file and view its contents.
Delete
Opens a dialog through which you can delete an existing normal limits file.
Figure 107 Limits window
Current Database Attributes
Current database attributes define the type of studies
which are included in the database and which are matched
during processing.
Figure 108 Database window, database control panel, current
database attributes section
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245
Database Controls
Control
Function
Database
Displays the name of current database
Modified
Notifies you that an attribute or exam selection has been changed in the current database.
AutoQUANT automatically updates this read-only field.
Description
Displays the optional text description for the current database.
Allow automatic
When selected (checked), enables the automatic matching of a database to the type of
selection during
processed exam: the current database becomes the default for exams that match the
processing
database’s combination of specified attributes (e.g., Sex, Protocol, Orientation). By default,
this control is not selected.
If there is no appropriate database matched during processing, you can select a database
manually by clicking Edit in the QPS window and selecting an item from the database dropdown menu in the Dataset Editor.
Important: It is possible to have more than one matching database for a particular exam. In
this case, AutoQUANT applies the first matching database (alphabetically by name).
Sex
Specifies the sex attribute (Male, Female, Unknown, Any) for exams in the current
database.
Protocol
Specifies the acquisition protocol (None, Rest, Stress, Reinjection, Redistribution,
Delayed Redistribution, Any) for exams in the current database.
Orientation
Specifies the patient orientation (Supine, Prone, Unknown, Any) for exams in the current
database.
Att Cor
Specifies the attenuation correction attribute (Off, On, Unknown, Any) for exams in the
current database.
Modality
Specifies the modality attribute (Unknown, Nuclear, Pet, Any) for exams in the current
database.
Isotope
Specifies the isotope attribute (Tl-201, Tc-99m, FDG, Rb-82, Tetrofosmin, NH3, I-123,
Unknown, Any) for exams in the current database.
Proc ID Filter
Displays the text string to be matched in the Study header field of exams in the current
database.
View ID Filter
Displays the text string to be matched in the Dataset header field of exams in the current
database.
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AutoQUANT
Database Controls
Control
Isotope Filter
Function
Displays the text string to be matched in the Isotope header field of exams in the current
database.
Note: This is an alternative method for matching the databases by isotope during QPS
processing.
Camera Filter
Displays camera filter setting
Figure 109 Database controls and their functions
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247
Database Controls
248
AutoQUANT
A
Normal Limits Databases
What This Appendix Contains
This appendix contains descriptions of the methods used
to acquire and process the datasets used to create the
following types of Normal Limits:
• Dual Isotope Normal Limits (page 250)
For processed data obtained from Rest Thallium and
Stress Sestamibi (Dual Isotope) imaging protocols.
• Vantage Pro AC Stress/Rest Sestamibi Normal
Limits (page 252)
For processed data obtained from Vantage Pro AC
Stress/Rest Sestamibi imaging protocols.
• Stress/Rest Sestamibi Normal Limits (page 256)
For processed data obtained from Rest Sestamibi and
Stress Sestamibi imaging protocols.
• Supine/Prone Stress Sestamibi (page 260)
• Astonish Stress/Rest Sestamibi Normal
Limits (page 262)
• Stress Thallium Normal Limits Databases (page 267)
For processed data obtained from Stress Thallium
imaging protocols.
• Stress/Rest Rubidium Normal Limits
Databases (page 270)
For processed data obtained from Stress/Rest Rubidium
imaging protocols.
AutoQUANT
A: Normal Limits Databases
249
Dual Isotope Normal Limits
Patient Populations
The study population consisted of 80 patients (40 women
and 40 men) with a low likelihood of coronary arterial
disease (CAD) (<5%), based on age, sex, symptoms, and
risk factors. All had normal (segmental summed score <=1)
stress and rest myocardial perfusion SPECT (MPS) images
acquired with a 16-bin gated protocol, as assessed visually
by 2 observers. In the female population, 11 had
Adenosine stress and 29 had treadmill exercise. In the male
population, 8 had Adenosine stress and 32 had treadmill
exercise.
Acquisition Protocols
Rest Tl-201 Study
Tl-201 (3.0–4.5 mCi) was injected intravenously at rest,
with dose adjusted for patient weight. SPECT imaging was
initiated 10 minutes after injection using a 30% window
centered over the 68–80 keV energy peak and a 20%
window over the 167 keV photopeak.
Patients performed a symptom-limited exercise treadmill
test with the standard Bruce protocol. At near-maximal
exercise, Tc-99m-sestamibi (25–40 mCi based on patient
weight) was injected intravenously. Treadmill exercise was
continued at maximal workload for 1 minute and at one
stage lower for 2 additional minutes when possible.
250
AutoQUANT
Tc-99m-sestamibi SPECT acquisition was started 15–30
minutes after radiopharmaceutical injection using a 15%
window centered over the 140 keV photopeak.
Adenosine Tc-99m Sestamibi Study
Adenosine was infused at 140 µg·kg-1·min-1 for 5 minutes.
At the end of the second minute, Tc-99m sestamibi
(25–40 mCi) was injected, and MPS acquisition was
started approximately 60 minutes later using a 15%
window centered over the 140 keV photopeak. Whenever
possible, during adenosine infusion, patients performed a
low-level treadmill exercise, walking at 0% grade at 1 to
1.7 mph.
MPS acquisitions were performed with a non-circular 180°
acquisition with 64 projections at 25 seconds per
projection for Tc-99m or 35 seconds per projection for
Tl-201 by use of either Vertex (Philips Medical Systems
[Cleveland] Inc.), or E-Cam (Siemens, Hoffman Estates,
IL) cameras. A high-resolution collimator was used. No
attenuation or scatter correction was applied.
Projection Reconstruction
For stress projection images, iterative reconstruction was
performed using 12 iterations with a Butterworth filter
(cutoff = 0.66 cycles/pixel; order = 5 [on a scale of 0–10]).
Short-axis images were generated.
For rest projection images, iterative reconstruction was
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251
Database Generation
Databases were generated for the following populations
using the procedure described in Chapter 6, “Managing
Databases.”
Database Name
Description
FemaleStressMB
Female sestamibi database for treadmill or adenosine exercise studies
FemaleRestTL
Female thallium database for rest thallium studies
MaleStressMB
Male sestamibi database for treadmill or adenosine exercise studies
MaleRestTL
Male thallium database for rest thallium studies
Vantage Pro AC Stress/Rest Sestamibi
Normal Limits
Patient Populations
The study population consisted of a group of 100 patients
(50 women and 50 men) who were selected from 241
consecutive patients with a low likelihood of CAD (5%)
based on age, sex, pre-test symptoms, and ECG response
to adequate treadmill stress testing. These patients had no
history of CAD (prior myocardial infarction or coronary
revascularization) or other confounding cardiac conditions
including congestive heart failure, cardiomyopathy,
significant valvular or congenital heart disease, left bundle
branch block, or paced rhythm. All of these patients’
perfusion studies were of good to excellent quality,
exhibited normal ventricular volumes, wall motion and
global systolic function, and showed no evidence of TID.
252
AutoQUANT
Patient preparation included no caffeine-containing
drinks, food, and medications for 24 hours, no
methyxanthine medications for 36–48 hours unless
clinically contraindicated. Patients were requested to be
free of short-acting nitrates for 2 hours, long-acting
nitrates for 6 hours, calcium blockers for 24 hours, and
beta blockers for 48 hours prior to test. Studies were
performed using Tc-99m rest and Tc-99m stress protocols.
A same-day rest/stress protocol was used for females who
weighed less than 200 lbs or whose BMI was less than 35,
and for males who weighed less than 250 lbs or whose
BMI was less than 40. A two-day rest/stress or stress/rest
protocol was used for those individuals whose weight or
BMI levels were above these levels. The weight/BMIrelated Tc-99m-sestamibi dose schedule ranged from 8.5
to 11.6 mCi for rest myocardial perfusion images (MPI),
to 29.5 to 42 mCi for stress MPI. Two-day protocols used
the stress dose for both the rest and stress portions of the
study.
Rest Tc-99m Study
Tc-99m was injected intravenously at rest. SPECT
imaging was initiated 60 minutes after injection using a
20% windows centered over the 140 keV photopeak.
Stress Tc-99m Study
Patients undergoing exercise stress underwent a symptomlimited treadmill test using a standard Bruce protocol. At
near-maximum exercise, Tc-99m-sestamibi was injected
intravenously. Exercise was continued at the maximum
workload for 1.5 to 2.0 minutes, when possible. When
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253
exercise testing was contraindicated or unsuitable, a
pharmacologic stress test was performed by an infusion of
adenosine at 140 g·kg-1·min-1 for 5 minutes. At the end of
the second minute, Tc-99m-sestamibi was injected. If able,
during adenosine infusion, patients performed low-level
treadmill exercise at 0% grade at 0 to 1.7 mph.
Acquisition
Image acquisition was started at 60 minutes after
administration of Tc-99m-sestamibi at rest or during
adenosine infusion with the patient at rest, and at
15–45 minutes after radiopharmaceutical injection during
treadmill testing or adenosine infusion with low-level
exercise. The patients drank 16 ounces of water
immediately prior to imaging. MPS was acquired using
Vertex dual-detector cameras with low energy, highresolution collimators and Vantage Pro attenuation
correction hardware and software (Philips Medical Systems
[Cleveland] Inc.) using two gadolinium-153 scanning line
sources, resulting in the simultaneous acquisition of ECGgated emission and transmission images. These images
were acquired over a 180° non-circular orbit from 45°
right anterior oblique to left posterior oblique, with a 64 x
64 matrix (pixel size = 0.64 cm) for emission images and
128 x 128 matrix (pixel size 0.32 cm) for transmission
images, at energy windows of 140 keV 20% (Tc-99m),
118 keV 12% (scatter), and 100 keV 20% (Gd-153). At
each of the 64 projection angles, the image data was
recorded into 8 equal ECG-gated time bins. Prior to
imaging, 5-second transmission and scatter data were
obtained over the patient’s heart in order to determine an
adequate time per projection allowing for a transmission
count density resulting in a valid attenuation map. The
time per projection used in this study was 45–50 seconds
for rest MPS and 30–40 seconds for stress MPS.
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Tomographic reconstruction was performed using the
AutoSPECT and Vantage Pro programs. All emission
images were automatically corrected for non-uniformity,
radioactive decay, and motion during acquisition, and all
were subjected to 3-point smoothing. Mechanical center of
rotation was determined to align the projection data to the
reconstruction matrix. The NAC myocardial perfusion
images and gated SPECT were reconstructed by filtered
back projection (FBP) and Butterworth filters as follows:
• Rest MPI: cutoff = 0.50 cycles/pixel; order = 10
• Stress MPI: cutoff = 0.66 cycles/pixel; order = 5
• Rest gated: cutoff = 0.45 cycles/pixel; order = 5
• Stress gated: cutoff = 0.50 cycles/pixel; order = 5
Attenuation maps were reconstructed by a Bayesian prior
approach after logarithmic inversion and normalization to
a reference scan, and an application of a Butterworth filter
(cutoff = 0.5 cycles/pixel; order = 5). The attenuation map
reconstruction used 12 iterations with a fbp initial
estimate. Using the attenuation maps and the emission
data, the AC images were reconstructed using a maximum
likelihood algorithm (MLEM) with 30 iterations and a
uniform initial estimate. Incorporated into this
reconstruction was scatter correction into the emission
photopeak and Tc-99m downscatter correction into the
transmission photopeak, along with non-stationary, depthdependent resolution compensation.
SAX datasets were generated using Stress/Rest AC data as
described above.
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Stress/Rest Sestamibi Normal Limits
Database Generation
Databases.”
Database Name
Description
FemaleRestMB-AC
Vantage Pro AC database for resting Tc-99m sestamibi studies processed using attenuation
MaleRestMB-AC
correction (AC).
FemaleRestMB
MaleRestMB
FemaleStressMB-AC
Vantage Pro AC database for stress Tc-99m sestamibi studies processed using attenuation
MaleStressMB-AC
correction (AC). Stress can be treadmill or adenosine infusion.
FemaleStressMB
MaleStressMB
The methods for Stress sestamibi normal limits have been
described above in the section, “Dual Isotope Normal
Limits,” which starts on page 250. The male and female
stress population and methods in that section are also
described here. The male and female stress normal limits
databases are identical and need only be generated once for
use in either the Dual Isotope (Rest Thallium/Stress
Sestamibi) or Stress/Rest Sestamibi imaging protocols.
Patient Populations
Stress population: The stress study population consisted
of 80 patients (40 women and 40 men) with a low
likelihood of CAD (<5%), based on age, sex, pre-test
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symptoms, and risk factors. All had normal (segmental
summed score <=1) stress and rest myocardial perfusion
SPECT (MPS) images acquired with a 16-bin gated
protocol, as assessed visually by 2 observers. In the female
population, 11 had Adenosine stress and 29 had treadmill
exercise. In the male population, 8 had Adenosine stress
and 32 had treadmill exercise.
Note
This is the same as in the “Dual Isotope Normal Limits”
section.
Rest population: Normal limits were obtained from a
group of 80 patients (40 women and 40 men) who were
selected from 241 consecutive patients with a low
likelihood of CAD (5%) based on age, sex, pre-test
symptoms and risk factors. All of these patients’ perfusion
studies were of good to excellent quality, exhibited normal
ventricular volumes, wall motion and global systolic
function, and showed no evidence of TID.
Rest Tc-99m Study
Image acquisition was started at 60 minutes after
administration of Tc-99m-sestamibi at rest. The patients
drank 16 ounces of water immediately prior to imaging.
Imaging was performed using Vertex dual-detector cameras
with low energy, high resolution collimators (Philips
Medical Systems [Cleveland] Inc.). These images were
acquired over a 180° non-circular orbit from 45° right
anterior oblique to left posterior oblique, with a 64 x 64
matrix (pixel size = 0.64 cm), at energy windows of 140
keV 20%. The time per projection used in this study was
45–50 seconds.
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257
exercise, Tc-99m-sestamibi (25–40 mCi based on patient
weight) was injected intravenously. Treadmill exercise was
continued at maximal workload for 1 minute and at one
stage lower for 2 additional minutes when possible.
Tc-99m-sestamibi SPECT acquisition was started 15–30
minutes after radiopharmaceutical injection using a 15%
window centered over the 140 keV photopeak.
section.
Note
Adenosine Tc-99m Sestamibi Study
Adenosine was infused at 140 µg·kg-1·min-1 for 5 minutes.
At the end of the second minute, Tc-99m sestamibi (25–
40 mCi) was injected, and MPS acquisition was started
approximately 60 minutes later using a 15% window
centered over the 140 keV photopeak. Whenever possible,
during adenosine infusion, patients performed a low-level
treadmill exercise, walking at 0% grade at 1–1.7 mph.
Note
section.
MPS acquisitions were performed with a non-circular 180°
acquisition with 64 projections at 25 seconds per
projection for Tc-99m or 35 seconds per projection for
Tl-201 by use of either Vertex (Philips Medical Systems
[Cleveland] Inc.), or E-Cam (Siemens, Hoffman Estates,
IL) cameras. A high-resolution collimator was used. No
attenuation or scatter correction was applied.
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Note
section.
For stress projection images, iterative reconstruction was
Note
section.
For rest projection images, filtered back projection (fbp)
was performed with a Butterworth filter (cutoff = 0.50
cycles/pixel; order = 10). Short-axis images were generated.
Database Generation
Databases.”
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259
Supine/Prone Stress Sestamibi
Database Name
Description
FemaleStressMB
Female sestamibi database for treadmill or adenosine exercise studies.
Note: same as in the “Dual Isotope Normal Limits” section.
MaleStressMB
Male sestamibi database for treadmill or adenosine exercise studies.
Note: same as in the “Dual Isotope Normal Limits” section.
FemaleRestMB
Female sestamibi database for rest sestamibi studies.
MaleRestMB
Male sestamibi database for rest sestamibi studies.
MaleProneStressMB
Male sestamibi database for stress prone studies.
FemaleProneStressMB
Female sestamibi database for stress prone studies.
For patients who underwent exercise or adenosine stress
99mTc-sestamibi MPS performed in both supine and
prone position.
Patient Populations
Sex-specific normal limits for both supine and prone
acquisitions were derived from a group of 80 patients (40
females, 40 males). No patients in this group had diabetes
mellitus, angina or shortness of breath, abnormal resting
electrocardiogram (ECG), or abnormal stress ECG
response. In this group only, an additional criterion for
inclusion was normal rest and poststress MPS images by
visual assessment. For visual interpretation of poststress
MPS, both supine and prone images were assessed
simultaneously and such combined supine–prone
interpretation was required to be normal.
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Acquisition and Reconstruction Protocols
MPS acquisitions were performed with a non-circular 180
orbit with 64 projections at 25 s/projection for supine
99mTc acquisition, followed immediately by 15
s/projection for prone 99mTc acquisition. Rest 201Tl
acquisition was performed at 35 s/projection (14) in
supine position only. MPS used either Philips (Forte or
Vertex) or Siemens (E-Cam) cameras. High resolution
collimators were used. No attenuation or scatter correction
was applied. After iterative reconstruction (12 iterations)
with Butterworth pre-filtering (cutoff, 0.66 cycle/pixel for
supine 99mTc, 0.55 cycle/pixel for prone 99mTc; order
5), shortaxis images were automatically generated (15).
Exercise MPS Protocol. Patients performed a symptomlimited exercise treadmill test with the standard Bruce
protocol. At nearmaximal exercise, 99mTc-sestamibi
(925–1,480 MBq based on patient weight) was injected
intravenously. Treadmill exercise was continued at maximal
workload for 1 min and at one stage lower for 2 additional
minutes when possible. 99mTc-Sestamibi MPS acquisition
was started 15–30 min after radiopharmaceutical injection.
Adenosine MPS Protocol. Adenosine MPS was performed as
previously described (16). Adenosine was infused at 140
mg/kg/min for 5 min. At the end of the second minute,
99mTc-sestamibi (925–1,480 MBq [25–40 mCi]) was
injected and MPS acquisition was started approximately
60 min later. Whenever possible, during adenosine
infusion, patients performed a low-level treadmill exercise,
walking at 0% grade at 1–1.7 mph (17). With the latter
protocol, imaging began 15–60 min after adenosine stress.
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Astonish Stress/Rest Sestamibi Normal Limits
Astonish Stress/Rest Sestamibi
Normal Limits
For full-time and half-time data obtained from Rest
Sestamibi and Stress Sestamibi imaging protocols
processed with Astonish reconstruction in AutoSPECT.
Patient Populations
Normal limits were obtained from 80 patients (40 women
and 40 men) selected from a group of patients referred to
one of two sites for myocardial perfusion imaging studies.
All patients selected for inclusion had a low likelihood of
CAD (<5%) based on age, sex, pre-test symptoms, and
ECG response to stress. These patients had no history of
CAD (prior myocardial infarction or coronary
revascularization) or other confounding cardiac conditions
including congestive heart failure, cardiomyopathy,
significant valvular or congenital heart disease, left bundle
branch block, or paced rhythm. All of these patient studies
were of good to excellent quality, exhibited normal
perfusion, ventricular volumes, and wall motion and
showed no evidence of TID.
Rest Tc-99m Study
At one site, acquisitions were performed using either a oneday (25 patients) or two-day (23 patients) protocol. Image
acquisition was started approximately 60 minutes after
administration of Tc-99m-sestamibi at rest. Patient doses
were based on patient weight; 10-12 mCi was used for the
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one-day protocol and 25-40 mCi was used for the two-day
protocol. Imaging was performed using either a Forte or
SkyLight variable-angle dual-detector camera with either
LEHR or VXGP collimators (Philips Medical Systems
[Cleveland] Inc.). Myocardial perfusion images were
acquired over a 180º non-circular arc from 45º right
anterior oblique to left posterior oblique, with a 64 × 64
matrix (pixel size = 0.64 cm), using a 20% energy window
centered at 140 keV and 64 projections. At each of the 64
projections, the data was concurrently recorded into 8
equal ECG-gated time bins in addition to the non-gated
perfusion study. The time per projection was 25 seconds
for the one-day protocol and 20 seconds for the two-day
protocol.
At the other site (32 patients), acquisitions were performed
using a one-day protocol. Patients were injected with 8
mCi of Tc-99m-sestamibi at rest, immediately asked to
drink 16 ounces of water and were then taken to the
camera. Image acquisition was started approximately 2
minutes after the sestamibi injection. Imaging was
performed using a CardioMD fixed-ninety dual-detector
camera with LEHR collimators (Philips Medical Systems
[Cleveland] Inc.). Myocardial perfusion images were
acquired over a 180º non-circular arc from 45º right
anterior oblique to left posterior oblique, with a 64 × 64
matrix (pixel size = 0.64 cm), using a 20% energy window
centered at 140 keV and 64 projections. The time per
projection was 20 seconds.
Stress Tc-99m Study
At the first site, patients undergoing exercise stress
performed a symptom-limited exercise treadmill test with
the standard Bruce protocol. At near-maximal exercise, Tc99m-sestamibi (25-40 mCi based on patient weight) was
injected intravenously. Exercise was continued at maximal
workload for 1 to 2 minutes when possible. Gated SPECT
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263
acquisition started 30-45 minutes after
radiopharmaceutical injection using a 20% energy window
perfusion study. The time per projection used was 20
seconds.
When exercise testing was contra-indicated or unsuitable, a
pharmacological stress test was performed using either
dipyridamole or adenosine. Dipyridamole was infused at
140 g·kg-1·min-1 for 4 minutes and 6.5 minutes after the
completion of the infusion Tc-99m-Sestamibi (25-40 mCi
based on patient weight) was injected. Adenosine was
infused at 140 g·kg-1·min-1 for 6 minutes. At the end of
2.5 minutes, Tc-99m-sestamibi (25-40 mCi based on
patient weight) was injected. Gated SPECT acquisition
started approximately 60 minutes after
perfusion study. The time per projection used was 20
seconds.
At the second site, patients undergoing exercise stress
performed a symptom-limited exercise treadmill test with
the standard Bruce protocol. At 85% of the maximal
predicted heart rate (MPHR), 40 mCi of Tc-99msestamibi was injected intravenously. Exercise was
continued at maximal workload for 1 to 2 minutes when
possible. Gated SPECT acquisition started 20-45 minutes
after radiopharmaceutical injection using a 20% energy
window centered at 140 keV and 64 projections. At each
of the 64 projections, the data was recorded into 16 equal
ECG-gated time bins. The gated data was summed to
produce perfusion data. The time per projection used was
15 seconds.
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When exercise testing was contra-indicated or unsuitable, a
pharmacological stress test was performed by an infusion
of adenosine at 140 g·kg-1·min-1 for 4 minutes. At the
end of the second minute, 40 mCi of Tc-99m-sestamibi
was injected. Whenever possible, during adenosine
infusion, patients performed a low-level treadmill exercise,
walking at 0% grade at 1 to 1.7 mph. Gated SPECT
acquisition started approximately 40-60 minutes after
projections, the data was recorded into 16 equal ECGgated time bins. The gated data was summed to produce
perfusion data. The time per projection used was 15
seconds.
Database Generation
Databases were generated for the populations using the
procedure described in “Managing Databases” on
page 219.
Projection Reconstruction - Full-Time Astonish
For all rest projection images, Astonish reconstruction was
used with 4 iterations, 8 subsets, and a Hanning filter
(cutoff = 1.0). Short axis images were generated.
For all stress projection images, Astonish reconstruction
was used with 4 iterations, 8 subsets, and a Hanning filter
(cutoff = 1.0). Short axis images were generated.
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265
Database Name
Description
AstonishFTFemaleStress
Full-time female sestamibi database for treadmill or pharmacological stress
studies processed with Astonish.
AstonishFTMaleStress
Full-time male sestamibi database for treadmill or pharmacological stress
AstonishFTFemaleRest
Full-time female database for rest sestamibi studies processed with Astonish.
AstonishFTMaleRest
Full-time male database for rest sestamibi studies processed with Astonish.
Figure 110 Astonish full-time (FT) database names and descriptions
Projection Reconstruction - Half-Time Astonish
The same patient data describe above was used to generate
the Half-Time Astonish database. Before reconstruction,
however, the raw patient data was modified to remove
every other projection from the data producing stress and
rest data with half the number of frames of the original
data. This half-frame data was processed as follows.
For all half-frame stress projection images, Astonish
reconstruction was used with 4 iterations, 8 subsets, and a
Hanning filter (cutoff = 1.0). Short axis images were
generated.
Database Name
Description
AstonishHTFemaleStress
Half-time female sestamibi database for treadmill or pharmacological stress
AstonishHTMaleStress
Half-time male sestamibi database for treadmill or pharmacological stress
AstonishHTFemaleRest
Half-time female database for rest sestamibi studies processed with Astonish.
AstonishHTMaleRest
Half-time male database for rest sestamibi studies processed with Astonish.
Figure 111 Astonish half-time (HT) database names and descriptions
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Stress Thallium Normal Limits Databases
Stress Thallium Normal Limits
Databases
The following is a description of the methods used to
generate normal limits databases to be applied to processed
data obtained from Stress Thallium imaging protocols.
Note
The Rest Thallium databases are the same as those from
the Dual Isotope Normal Limits.
Patient Populations
The study population consisted of 74 patients (40 women
and 34 men). All had normal stress and rest myocardial
perfusion SPECT images as assessed visually by a
cardiologist with confirmation by an independent second
reader, also a cardiologist. The clinical characteristics of
these normal patient were then reviewed. These
characteristics originated from the original nursing
interview, including whether the patient had chest pain,
the character of this pain, other symptoms. If the patient
had known heart disease, he/she was excluded. If the
patient did not have known CAD, the pre-test probability
of disease was assessed using a table from the ACC
guidelines (CIRC, 1997; 96:345-54). If patient's clinical
characteristics would place them in a low (<10%) risk
category of CAD, or a very low risk (<5 %?) then the
patient was accepted.
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267
The 74 patients comprising the study population were
imaged following either, treadmill stress testing, adenosine
stress testing, dipyridamole stress testing or dobutamine
stress testing.
Treadmill Exercise Tl-201 Study
exercise (85% of predicted heart or better), 4 mCI of Tl201 thallous chloride was injected intravenously. Treadmill
exercise was continued at maximal workload for 1 minute.
Myocardial perfusion SPECT acquisition was started
approximately 5-10 minutes post injection.
Adenosine Tl-201 Study
Adenosine was infused at 140µg · kg-1· min-1 for 4
minutes. At 2 minutes and 15 seconds, 4 mCI of Tl-201
thallous chloride was injected intravenously. Myocardial
perfusion SPECT acquisition was started approximately 510 minutes post injection.
Dipyridamole Tl-201 Study
Dipyridamole was manually infused for 4 minutes. At 6
minutes and 15 seconds, 4 mCI of Tl-201 thallous
chloride was injected intravenously. Myocardial perfusion
SPECT acquisition was started approximately 5-10
minutes post Tl-201 injection.
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Dobutamine Tl-201 Study
Dobutamine was infused intravenously by pump at the
rate of 5, 20, 30, 40 uKg/min. The rate is increased every 3
minutes. At 10 minutes 30 seconds into the dobutamine
drip 4mCi of Tl-201 is injected. Myocardial perfusion
SPECT acquisition was started approximately 5-10
minutes post Tl-201 injection.
Acquisitions were performed using camera(s) and settings
in the following table. All acquisitions were performed
with an 8-bin gated protocol without acquisition zooming.
A high-resolution collimator was used. No attenuation or
scatter correction was applied.
.
Camera
Orbit
Projections
Time per projection (sec)
Isotope peak(s)
Picker Axis
non-circular
34
55
74@30%, 169@20%
Picker Prism
Circular
64
60
72@30%, 167@20%
Filtered back projection (FBP) with Butterworth filter was
used for image reconstruction. Butterworth filter settings
were, cutoff 0.66 cycles/pixel [scale 0-1]; order 10.
Summed data from the gated acquisitions were used and
zooming was applied during reconstruction so that pixel
sizes were in the range 6.4mm to 6.7mm in the generated
stress short-axis images.
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269
Stress/Rest Rubidium Normal Limits Databases
Database Generation
Databases were generated for the following populations:
Database Name
Description
FemaleStressTL
Female thallium database for treadmill or adenosine exercise studies.
MaleStressTL
Male thallium database for treadmill or adenosine exercise studies.
FemaleRestTL
Female thallium database for rest thallium studies
MaleRestTL
Male thallium database for rest thallium studies
Stress/Rest Rubidium Normal Limits
Databases
Patients were studied after an overnight fast and 24-hour
cessation of all caffeine-containing or methylxanthinecontaining substances.
The patients were then injected with 40 to 60 mCi of
rubidium-82 at rest, and after a 90- to 120-s delay (to
allow for adequate blood pool clearance), gated emission
images were obtained for 5 minutes.
Immediately after rest imaging, patients underwent
pharmacologic stress testing using standard infusions of
dipyridamole (0.14 mg/kg/min for 4 min, n =40),
adenosine (0.14 mg/kg/min for 6 min, n =20), or
dobutamine (10 g/kg/ min increments to a maximum of
40 g/kg/min or until achieving 85% of maximum
predictive heart rate, n = 4). At peak stress, a second dose
of 40 to 60 mCi of rubidium-82 was administered and
emission images were acquired as previously described.
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Database Generation
Databases were generated for the following populations:
Database Name
Description
MaleFemaleRestPETRb
Database for rest rubidium studies.
MaleFemaleStressPETRb
Database for stress rubidium studies.
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B
Control Index
This appendix contains a list of AutoQUANT controls and
brief descriptions of their functions
Control
Function
3D
Toggles the ED and ES Perfusion, Motion and Thickening polar maps in the
QGS window from 2D images to 3D volumes.
All OFF
Toggles off display of all displacement and velocity graphs.
All ON
Toggles on display of all displacement and velocity graphs.
Alpha Blend
Adjusts the relative contribution of each dataset to the 2D fusion images.
(Fusion option only).
Blur
Toggles the Blur function on or off (available only in the Slice and QGS
windows). Blur applies a temporal smoothing algorithm to all images in the
window when a gated dataset appears.
Both
Displays the endocardial surface as a solid volume and the epicardial wall as a
(Surface menu item)
wireframe surface.
Box
Displays a box around the 3D surface or perfusion map (available only in the
Surface and Views windows).
Change
Displays the Change window.
Clear
Removes the tags designating popout images from the selected viewports in
the Splash window.
Compare
When toggled on, applies the registration and change algorithm to the
currently displayed pair of datasets producing the change slices and change
polar map. Toggling off resets the slices and polar map.
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273
Control
Function
Constrain
Further limits the search area by forcing the apical and basal search areas to
lie in the vicinity of the end points of the horizontal and vertical long axis
center lines (available only in the Slice window during manual processing).
Contours
Turns the LV inner and outer contours on or off when reviewing slices and
2D polar maps (available only in the Slice, Splash, QPS, and QGS
windows).
Contours (SPECT Review
Turns contour display on and off. Contours are the intersection of a given
Option: Change Page)
slice and the endocardial and epicardial surfaces obtained by QPS. Note: The
Change Page only contours from the first study are used and are duplicated
for the second study, which is registered to the first.
Counts
Displays the middle cardiac wall with the relative count distribution.
(Surface page item)
Cursor
Toggle turns the interactive value readout cursor on or off.
(Phase D/V Graphs)
Database
Displays the Database window.
Defaults
Displays the Defaults window.
Dual
Displays stress and rest datasets simultaneously.
Echo
Toggle inverts the velocity graphs to match similar velocity displays in
(Phase D/V Graphs)
Echocardiography studies.
ED
Displays the end diastole endocardial surface as a green contour on gated 2D
(2D images)
slice displays (available only in the Slice, Splash, and QGS windows).
ED
Displays the end diastole endocardial surface as a green wireframe surface on
(3D images)
the 3D volumes (available only in the Surface, Views, and QGS windows).
By selecting gate with ED enabled, you can evaluate ventricular motion
relative to end diastole.
ES
Displays the end systole endocardial surface as a red contour on gated slice
displays in the Slice, Splash, and QGS windows.
Exit
274
Closes the AutoQUANT program and returns to the desktop.
B: Control Index
AutoQUANT
Control
Function
Extent
Displays the extent polar maps (stress, rest, and reversibility) for 2D, and
(Function menu item)
additionally for 3D if perfusion is selected.
Frame
Displays a specific interval (segment) in a gated dataset.
Freeze
Creates and displays cardiac “motion-frozen” perfusion or viability images.
Function
Displays the myocardial wall as a solid volume with the current colormap
(Surface menu item)
reflecting the relative count distribution.
Fuse
Displays fused slices of SPECT or PET and CT or CTA data.
(Fusion option only)
Fusion
Displays the Fusion window.
Gate
Toggles the cinematic display on or off. Gate provides a motion display of a
gated SPECT dataset that allows you to view a sequential display of the
dataset corresponding to each interval.
Graph
Toggles between the Defect Analysis Graph and the Defect Analysis Table, if
Score is deselected.
Grids
Toggle shows or hides gridlines for time values.
(Phase D/V Graphs)
Groups
Displays the Groups overlay on 2D polar maps.
(Grid menu item)
Guides
Toggle shows or hides guidelines that indicate the location of the minimum
(Phase D/V Graphs)
and maximum displacement and maximum (positive and negative) velocities.
Help
Displays the online version of this manual.
Hide
Button closes the dialog (and updates the D/V toggle on the QGS results
page, which can also be used to re-display the graph window).
Inner
Displays the endocardial surface as a solid volume.
(Surface menu item)
Label
Toggles the reference line, slice number, and grid overlays on and off on slice
(2D images)
images.
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275
Control
Function
Label
Toggles the projection orientation labels (ANT, APEX, SEPT, etc.), and the
(3D images)
Box and Grid options on and off.
Limits
Displays the Limits dialog.
Lines
Displays reference lines on the raw datasets that are used to help assess
motion artifact.
List button:
Displays the Exam Object List or Patient List.
Localize
Localizes the automated algorithm to restrict the initial LV search to the
region (available only in the Slice window during manual processing).
Manual
Displays the Raw window in Manual mode, where you can manually redefine
(Raw)
the locations of the lung and heart bounding boxes.
Manual
Displays the Slice window in Manual mode. Here you can manually define a
(short axis)
bounding box that limits the left ventricular search area.
Mask
Restricts the segmentation algorithms to the region within the mask
(available only in the Slice window during manual processing). Previously in
QGS, Mask was always on. The option to turn it off was added so that you
can use Constrain (for example, to lock the valveplane) without concern
for whether the LV was completely contained within the mask.
Middle
Displays the myocardial wall as a solid volume.
(Surface menu item)
Mis
Displays polar maps and 3D images of mismatch data
(available only with the QPET option).
More
Displays the More window.
Multiple
Displays all of the raw projection datasets for the currently-selected patient.
(Raw)
Oblique
Reorients transaxial data to short axis orientation and displays multimodality images accordingly.
Orient
276
B: Control Index
Click to display your dataset’s orientation labels.
AutoQUANT
Control
Function
Outer
Displays the outer cardiac wall as a solid surface.
(Surface menu item)
Pins
Displays graphical information about the displacement caused by the motion
freezing process (for any ungated dataset that was generated from a gated
dataset by motion freezing).
Popout
Displays a magnified view of one or more slices for closer examination; only
available when the Label control is off.
Print
Displays the Print dialog box.
Process
Automatically processes and produces the quantification calculations for all
loaded datasets.
Prone+
When toggled on, performs quantification of perfusion on prone images as
well as combined quantification of prone/supine datasets
QGS
Displays the QGS (Quantitative Gated SPECT) window.
QPC
Displays the QPC (Quantitative Perfusion Change) window
QPS
Displays the QPS (Quantitative Perfusion SPECT) window.
Quant
Displays discrete quantification based on the visual scoring scale.
Rate
Changes the Gate and Spin rates by 1 frame/second.
Raw
Displays the Raw window.
Raw
Displays raw polar maps (stress, rest, and reversibility) for 2D and,
additionally, for 3D, if perfusion is selected.
Reset
Deletes the contours, ROIs, and all of the quantitative calculations resulting
from processing the datasets.
Rev
Displays a reversibility polar map
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277
Control
Rock
Function
With the Spin option enabled, Rock rotates all of the displayed datasets
180º, immediately reverses the spin direction, and again rotates 180º
(available only in the Raw window).
Save
Displays the Save dialog box.
Scale
Controls the magnification level of the 3D volumes (available only in the
Surface, Views, and QPS windows).
Scar
Displays polar maps and 3D images of scar data
Score
Displays the Visual Score window.
Segments
Displays a 20- or 17-zone overlay to 2D and 3D polar maps. Updates the
(Grid menu item)
graph and/or table when applicable.
Severity
Displays severity polar maps (stress, rest, and reversibility) for 2D and,
additionally, for 3D, if perfusion is selected.
Skip
Displays only every other image (available only in the Splash window).
Slice
Displays the Slice window.
Smear
Toggles the Smear function on and off (available only in the Slice, Splash,
QPS, and QGS windows). Smear applies a spatial smoothing algorithm to
all images in the window.
Snapshot
Displays the Snapshot window.
Spin
Toggles the Spin function on or off. Spin provides a rotating display of 3D
volumes (available only in the Surface, Views, QPS, and QGS windows.
Splash
Displays the Splash window.
Spread
Slider allows the user to separate or collapse the curves for easier reading
and comparison.
Sum
Toggles the Sum function on and off (available only in the Raw window). Sum
sums gated projections and displays them as a single composite image.
Surface
278
B: Control Index
Displays the Surface window.
AutoQUANT
Control
Function
Vessels
Displays a Vascular Bed overlay to 2D and 3D polar maps. Updates the graph
(Grid menu item)
and/or table when applicable.
Vessel
Displays display the major coronary arteries on 3D perfusion images.
Values
Toggle shows or hides maximum displacement and maximum (negative)
(Phase D/V Graphs)
velocity.
Via
Displays slice images containing viability data
Walls
Displays a wall (five regions) overlay to 2D and 3D summed polar maps.
(Grid menu item)
Updates the graph and/or table when applicable.
Worsening
Applicable for serial stress or serial rest comparisons only. Toggling on shows
the results, change slices, and change polar maps for areas where there were
negative changes or hypoperfusion.
Zoom
AutoQUANT
Changes the zoom factor of 2D images in steps of 1.
B: Control Index
279
280
B: Control Index
AutoQUANT
C
Troubleshooting
This appendix provides information about error messages
you may see in AutoQUANT and CSImport.
• Common Messages (page 282)
• AutoQUANT Messages (page 283)
• AutoQUANT FAQs (page 284)
AutoQUANT
C: Troubleshooting
281
Common Messages
Common Messages
Code
Message
Meaning
0
Unspecified Error
Generic unspecified error
ecGeneric
Generic Error
Generic error
ecOpen
File Open Error
General file open error
ecWrite
File Write Error
General file write error
ecRead
File Read Error
General file read error
ecAlloc
Memory Allocation Error
Memory allocation failed
ecInput
Input Error
General incorrect input error (e.g., bad dataset
(if applicable)
type, bad value in file, etc.)
ecState
State Error
Incorrect program state (e.g., incorrect feature
for vendor’s configuration, etc.)
ecError
Error
Generic Error
ecWarning
Warning
Generic Warning
ecMessage
Message
Generic Message
ecNoDisplay
Could not connect to X server
X server refused connection or is not present
ecNoBinding
Could not reserve image display
Program could not allocate required color
resources
system resources
Could not retrieve input dataset list
CSMC specific: program could not access dataset
ecNoXfiles
list
ecNoDatasets
The input dataset list is empty
No valid datasets have been loaded
ecDatasetRead
Dataset Read Error
Generic dataset read error
ecDatasetWrite
Dataset Write Error
Generic dataset write error
ecNoSAXDataset
No short axis dataset is available for
No valid short axis datasets have been loaded
this study
Figure 112 Common messages
282
C: Troubleshooting
AutoQUANT
AutoQUANT Messages
Most of these messages usually contain an additional
explanation of the cause of the error. Listing them all is
beyond the scope of this document as there are over 800
such explanations.
AutoQUANT Messages
Code
Message
Meaning
Database Read Error
Normal limits generation database could not be
(if applicable)
aecDBRead
read
aecDBWrite
Database Write Error
written
aecDBCreate
Database Create Error
created
aecDBAddPatients
Database Adding Patients Error
Could not add patients to Normals limits
generation database
aecDBReformat
Database reformatting error
Could not merge or join Normals limits
generation databases
aecNLGenerate
Error Creating Normal Limits
Could not create Normals limits from database
Figure 113 AutoQUANT messages
AutoQUANT
C: Troubleshooting
283
AutoQUANT FAQs
AutoQUANT FAQs
Note
The questions below do not apply to all versions of
AutoQUANT. Please call the Philips customer support line
if you have any questions.
Q: Why would the scoring information not be displayed?
A: The data must be processed first and the limits file
selected. The default can be set to automatically process
the data when the application is launched. The limits file
can also be set in the default.
Q: Why would the Extent, Severity, or Quant maps not be
displayed?
A: No limits file for use when processing. The proper
limits file must be selected to display the polar maps. Also,
if no processing was done, then no polar maps will be
displayed including the Raw, Extent, Severity and Quant.
Q: Why are summed scores coming up as S-S and S-S
instead of SSS and SRS?
A: The loaded short axis images do not have an extension
that is recognized by the AutoQUANT default
automatching (e.g. SAX). Use labels such as short axis-str
and short axis-rst.
Q: Why is the data displayed on raw page extremely hot in
intensity?
284
C: Troubleshooting
AutoQUANT
AutoQUANT FAQs
A: On the image control panel, turn off normalize, then
scale the images individually as needed. Normalize can also
be turned off in the Defaults page either as a permanent
change or just as needed. You may also need to adjust the
placement of the ROIs themselves.
Q: How can I scale the stress and rest images individually
since they are displaying in different intensities?
A: On the image control panel, highlight dual (or split),
then scale the images as needed. Reprocessing in AS or
using an image extract or mask program may help in these
instances.
Q: Why are there are no motion and thickening maps on
the QGS page of AutoQUANT?
A: A processed gated SPECT image must be loaded into
the program and the Score option selected in order to see
motion and thickening maps on the QGS page.
Q: Why are the stress images on the splash page lighter in
intensity when compared to the rest images?
A: This is most likely because the gated short axis slices are
being displayed. When a gated image is displayed, only one
interval of the gated cycle is displayed (1/8 or 1/16 of the
entire dataset). The default can be set to load the summed
short axis data instead of the gated short axis data. In the
defaults window, in the Page Options section, verify that
Select, 2 and QPS are highlighted.
Q: What is the fewest number of files needed to present
results on all the pages in AutoQUANT Plus?
AutoQUANT
C: Troubleshooting
285
AutoQUANT FAQs
A: The fewest number of files needed to have results
presented for all the pages is 5; stress and rest projection
datasets, stress and rest short axis datasets and a gated short
axis dataset. Of course, additional objects may be loaded
including motion corrected projection images, gated
projection images, additional gated short axis files,
attenuation corrected short axis data, and snapshots.
Q: What strings should be in the automatch exclude field
on the defaults page?
A: The automatch exclude field should contain identifying
strings for any datasets not needed for the AutoQUANT
Plus processing. This includes any non-short axis data
(horizontal long axis and vertical long axis data) and polar
maps. You may also wish to exclude some projection data
such as Vantage Q2 images, -EM or -EMSCR data, or
gated projection data. Make sure that when modifying the
exclude automatching, the string entered in does not
inadvertently exclude something other than what is
desired. Example: To exclude the transverse slices, do not
use “tr” because that could also exclude “short axis-str” .
Use “-tr” instead. Note: Do not use quotation marks.
Q: If a different object is selected within the AutoQUANT
Plus application from the object selector for calculating the
Lung-Heart Ratio (LHR), why is the updated LHR value
only displayed on the Raw Page?
A: The object selector drop down is specific for the page
you are on. These changes to the object will not be
propagated to the other pages which are controlled by the
default settings and the exam object list. In order to have
the LHR value updated on all pages within the application,
you must use the exam object list drop-down (e.g. Edit) to
designate the file to use for calculating the ratio.
286
C: Troubleshooting
AutoQUANT
AutoQUANT FAQs
Q: What criteria is used to sort the raw data displayed on
the raw Page?
A: The sort criteria for projection data is (in order of
decreasing precedence), is as follows:
- 1. Non-Gated > Gated
- 2. Lung Heart Ratio > Non-Lung Heart Ratio
- 3. Stress > Rest > Neither
This cannot be changed. The idea is that the user is
probably most interested in the dataset from which the
lung/heart ratio is derived, and least interested in the gated
raw data (since the summed data would be used to check
for motion).
Q: What is the localize button used for when doing
manual processing?
A: The localize option is used to restrict the region where
the automated algorithm will perform the initial LV
search.
Q: How can the resting segmental scores be 0 when the
rest study visually suggests a defect?
A: When short axis images are paired for TID and a
normal limits file is applied to the data, the AutoQUANT
Plus program does not allow the rest scores to be greater
than the stress. Therefore, if the stress is scored as normal,
the rest is automatically scored as normal, even if a defect is
suggested by visual analysis.
Q: Why does my raw data not show up on the raw page?
AutoQUANT
C: Troubleshooting
287
AutoQUANT FAQs
A: This issue is specific to data coming from the Pegasys. If
the information in the header of the raw data file contains
information that would be present on a processed image,
the AutoQUANT application will treat the file as a
processed dataset. The file must be corrected on the
Pegasys. Please contact the Philips support line for
assistance.
288
C: Troubleshooting
AutoQUANT
D
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Change Page
4
J Nucl Med. 2004 Feb;45(2):183-91
5
JACC Volume 45, Issue 3, Supplement 1, February 1,
2005. 1112-70, 285A
Motion Frozen
6
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Slomka, PJ; Nishina, H; Berman, DS; Kang, X;
Akincioglu, C; Friedman, JD; Hayes, SW; Aladl, UE;
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1615.
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Yamagishi H, Akioka K, Hirata K, et al. Dobutamine stress
electrocardiography-gated Tc-99m tetrofosmin SPECT for
detection of viable but dysfunctional myocardium. J Nucl
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Emmett L, Iwanochko RM, Freeman MR, et al. Reversible
regional wall motion abnormalities on exercise
technetium-99m-gated cardiac single photon emission
computed tomography predict high-grade angiographic
stenoses. J Am Coll Cardiol. 2002;39(6):991–998.
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Feng B, Sitek A, Gullberg GT. Calculation of the left
ventricular ejection fraction without edge detection:
Application to small hearts. J Nucl Med. 2002;43(6):786–
794.
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Shirai N, Yamagishi H, Yoshiyama M, et al. Incremental
value of assessment of regional wall motion for detection of
multivessel coronary artery disease in exercise Tl-201 gated
myocardial perfusion imaging. J Nucl Med.
2002;43(4):443–450.
78
Taki J, Higuchi T, Nakajima K, et al. Electrocardiographic
gated Tc-99m-MIBI SPECT for functional assessment of
patients after coronary artery bypass surgery: Comparison
of wall thickening and wall motion analysis. J Nucl Med.
2002;43(5):589–595.
79
Yamagishi H, Shirai N, Yoshiyama M, et al. Incremental
value of left ventricular ejection fraction for detection of
multivessel coronary artery disease in exercise (201)T1
gated myocardial perfusion imaging. J Nucl Med.
2002;43(2):131–139.
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Higuchi T, Nakajima K, et al. The accuracy of leftventricular time volume curve derived from ECG-gated
myocardial perfusion SPECT. J Nucl Cardiol. 2001
(abstract);8(1):S18.
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Higuchi, T., J. Taki, et al. (2000 (abstract)). "Diastolic and
systolic parameters obtained by myocardial ECG-gated
perfusion study." J Nucl Med 41(5): 160P.
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82
Higuchi, T., K. Nakajima, et al. (2001). "Assessment of left
edge detection method with myocardial ECG-gated
SPET." European Journal of Nuclear Medicine 28(10):
1512-1516.
83
Kikkawa, M., T. Nakamura, et al. (2001). "Assessment of
left ventricular diastolic function from quantitative
myocardial SPET (ERRATA in vol 28, pg 1579, 2001)."
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Kumita, S., K. Cho, et al. (2001). "Assessment of left
ventricular diastolic function with electrocardiographygated myocardial perfusion SPECT: Comparison with
multi-gated equilibrium radionuclide angiography."
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Nakajima, K., J. Taki, et al. (2001). "Diastolic dysfunction
in patients with systemic sclerosis detected by gated
myocardial perfusion SPECT: an early sign of cardiac
involvement." Journal of Nuclear Medicine 42(2): 183-8.
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Germano G, Kavanagh PB, Waechter P, et al. A new
algorithm for the quantitation of myocardial perfusion
SPECT. I: technical principles and reproducibility. J Nucl
Med. 2000;41(4):712–719.
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Sharir T, Germano G, Waechter PB, et al. A new algorithm
for the quantitation of myocardial perfusion SPECT. II:
validation and diagnostic yield. J Nucl Med.
2000;41(4):720–727.
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Berman DS, Kang XP, Schisterman EF, et al. Serial changes
on quantitative myocardial perfusion SPECT in patients
undergoing revascularization or conservative therapy. J
Nucl Cardiol. 2001;8(4):428–437.
89
Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti
M, Su HT, Van Train KF, Berman DS. Automatic
quantification of ejection fraction from gated myocardial
perfusion SPECT. J Nucl Med 1995;36(11):2138-47.
90
Germano G, Erel J, Lewin H, Kavanagh PB, Berman DS.
Automatic quantitation of regional myocardial wall
motion and thickening from gated technetium-99m
sestamibi myocardial perfusion single-photon emission
computed tomography. J Am Coll Cardiol
1997;30(5):1360-7.
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Berman D, Germano G. An approach to the interpretation
and reporting of gated myocardial perfusion SPECT. In: G
Germano and D Berman, eds. Clinical gated cardiac
SPECT. Futura Publishing Company, Armonk; 1999:147182.
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Germano G, Berman D. Quantitative gated perfusion
SPECT. In: G Germano and D Berman, eds. Clinical
gated cardiac SPECT. Futura Publishing Company,
Armonk; 1999:115-146.
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Sharir T, Germano G, Kavanagh P, Lai S, Cohen I, Lewin
H, Friedman J, Zellweger M, Berman D. Incremental
prognostic value of post-stress left ventricular ejection
fraction and volume by gated myocardial perfusion single
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1999;100(10):1035-1042.
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Berman D.S., Kang X.P., Abidov A., Cohen I., Hayes
S.W., Friedman J.D., Sciammarella M., German G.,
Aboul-Enein F., Hachamovitch R., Prognostic value of
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myocardial perfusion SPECT comparing 17-segment and
20-segment scoring systems. J Am Coll Cardiology, 2003
(abstract). 41(6(Suppl.A)):p. 445A.
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Hannequin P, Weinmann P, Mas J, et al. Preliminary
clinical results of photon energy recovery in simultaneous
rest Tl-201/stress Tc-99m sestamibi myocardial SPECT. J
Nucl Cardiol. 2001;8(2):144–151.
96
Berman, DS, Kang XP, et al. Prognostic value of
20-segment scoring systems. J Am Coll Cardiol. 2003
(abstract);41(6) Suppl A:445A.
97
Slomka PJ, Nishina H, Akincioglu C, Abidov A, Hayes
SW, Friedman J, Berman DS, Germano G. Automated
quantification of myocardial perfusion SPECT using
simplified normal limits. J Nucl Cardiol. 2005 Jan–
Feb;12(1):66-77.
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Germano G, Kavanagh PB, Berman DS. An automatic
approach to the analysis, quantitation and review of
perfusion and function from myocardial perfusion SPECT
images. Int J Cardiac Imag. 1997;13(4):337–46.
99
Abidov J.J, Bax S.W, Hayes I, Cohen H, Nishina S, Yoda,
X, Kang F, Aboul-Enein, J, Gerlach, J.D, Friedman, et al.
Integration of Automatically Measured Transient Ischemic
Dilation Ratio into Interpretation of Adenosine Stress
Myocardial Perfusion SPECT for Detection of Severe and
Extensive CAD. J. Nucl. Med., December 1, 2004; 45
(12): 1999-2007.
TID
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100
Emmett L, Magee, M, Freedman SB, Wall VD. The Role
of Left Ventricular Hypertrophy and Diabetes in the
Presence of Ischemic Dilation of the Left Ventricle on
Myocardical Perfusion SPECT Images. J. Nucl. Med.,
2005; 46 (10): 1596-1602.
Lung/Heart
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101
Bacher-Stier C, Kavanagh P, Sharir T, et al. Post-exercise
tc-99m sestamibi lung uptake determined by a new
automatic technique. J Nucl Med. 1998
(abstract);39(5):104P.
102
Bacher-Stier C, Sharir T, Kavanagh PB, et al. Postexercise
lung uptake of 99mTc-sestamibi determined by a new
automatic technique: validation and application in
detection of severe and extensive coronary artery disease
and reduced left ventricular function. J Nucl Med.
2000;41(7):1190–1197.
103
Bhalodkar N, Lone B, Singh R, et al. Lung heart ratio in
patients undergoing Technetium 99m Sestamibi
myocardial perfusion imaging as a predictor of EF, and its
correlation with other scintigraphic and clinical variables
in minorities. 10(1),S45 (2003 (abstract)).
104
Kumar S, Rathinam A, Movahed A. Increased lung to
heart ratio correlates with multivessel coronary artery
disease in patients undergoing stress tc99m sestamibi
myocardial perfusion imaging. 10(1),S48 (2003
(abstract)).
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LV Mass
105
Mochizuki T, Murase K, Tanaka H, et al. Assessment of
left ventricular volume using ECG-gated SPECT with
technetium-99m-MIBI and technetium-99m-tetrofosmin.
J Nucl Med. 1997;38(1):53–57.
Diastolic Function
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106
Berman, DS, Kang XP, et al. Prognostic value of
20-segment scoring systems. J Am Coll Cardiol. 2003
(abstract);41(6(Suppl A)):445A.
107
Higuchi, T, Nakajima K, et al. Assessment of left
edge detection method with myocardial ECG-gated SPET.
Eur J Nucl Med. 2001;28(10):1512–1516.
108
Higuchi, T, Taki J, et al. Diastolic and systolic parameters
obtained by myocardial ECG-gated perfusion study. J Nucl
Med. 2000 (abstract);41(5):160P.
109
Kikkawa, M, Nakamura T, et al. Assessment of left
ventricular diastolic function from quantitative
myocardial SPET (ERRATA in vol 28, pg 1579, 2001).
Eur J Nucl Med. 2001;28(5):593–601.
110
Kumita, S, Cho K, et al. Assessment of left ventricular
diastolic function with electrocardiography-gated
myocardial perfusion SPECT: Comparison with
multigated equilibrium radionuclide angiography. J Nucl
Cardiol. 2001;8(5):568–574.
D: Bibliography
305
111
Nakajima, K, Taki J, et al. Diastolic dysfunction in patients
with systemic sclerosis detected by gated myocardial
perfusion SPECT: an early sign of cardiac involvement. J
Nucl Med. 2001;42(2):183–188.
Shape Index
112
306
D: Bibliography
Abidov A, Slomka P, Hayes SW, Aboul-Enein F, Kang X,
Yoda S, Nishina H, Yang L, Cohen I, Thomson L,
Friedman JD, Germano G, Berman DS. "Left Ventricular
Shape Index Assessed By Gated Myocardial Perfusion
SPECT: A New Scintigraphic Marker of Congestive Heart
Failure." SNM 2004
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E
Glossary
This section provides definitions of terms used in
AutoQUANT.
% Myocardium (Extent)
The formula for this is (QPS only): 100*(LV defect
volume)/(LV wall volume).
Bounding Box
A user-defined area surrounding the left ventricle that
limits the ventricular search area used for determining
contours.
Canvas
The portion of the application display that contains the
viewports, patient information, and user instructions.
Chamber Volume (Volume)
The volume of left ventricular chamber at the currently
displayed interval.
Constrain
When using the Manual option, Constrain limits the left
ventricular search area by forcing the apical and basal
search areas to lie in the vicinity of the endpoints of the
horizontal and vertical long axis centerlines.
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E: Glossary
307
Contour
A line marking the boundary of the inner or outer left
ventricular wall. Contours are determined automatically
for all slices and intervals in the dataset.
Counts
Max counts in myocardium.
Defect Volume (Defect)
The volume of the left ventricular defect.
ECC
Any short axis datasets, static or gated, with associated LV
contours has the eccentricity of its mid-myocardial wall for
each interval computed. The eccentricity of the currently
displayed interval is then displayed in the AutoQUANT
Information Box.
Ejection Fraction (EF)
A measure of the ability of the left ventricle to expel blood.
The ejection fraction equals the stroke volume divided by
the end-diastolic volume. A normal left ventricular ejection
(LVEF) fraction is approximately 0.67, a value that
indicates that the left ventricle can expel two thirds of its
own volume into the aorta with each contraction. The
ejection fraction falls with the onset of heart failure.
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End Diastolic Volume (EDV)
A value representing the amount of blood in the left
ventricle just prior to contraction. With the onset of heart
failure, end diastolic volumes increase as the ventricle
dilates.
End Systolic Volume (ESV)
A value representing the amount of blood in the left
ventricle at which contraction of a cardiac cycle chamber
occurs and blood is expelled.
Extent
The extent parametric map is generated by taking the
severity map and applying to it the threshold (number of
standard deviations below mean) and cutoff (number of
pixels below threshold) criteria established through the
generation of normal limits.
Heart Volume (Wall)
The volume of left ventricular wall (myocardium).
Image Control Panel
The portion of the application display that contains the
controls for changing colormaps and intensity.
Interval (Segment)
The cardiac cycle is divided into equal time segments
called intervals. When you acquire gated SPECT studies,
counts acquired in each projection are associated with the
interval corresponding to the patient’s ECG. When you
process gated SPECT studies, the counts from all the
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E: Glossary
309
projections in a specific interval are combined into a
reconstructed dataset. Processed gated SPECT datasets
contain all of the datasets created from each interval.
Intervals correspond to a specific point in the cardiac cycle.
For example, suppose end diastole occurs in interval 1 and
end systole occurs in interval 4. Selecting Interval 1
displays the end diastole datasets, and selecting Interval 4
displays the end systole datasets.
Lung/Heart Ratio
The ratio is derived from dividing the average counts in the
heart ROI into the Lung ROI (Average counts in lung
ROI) / (Average counts in heart ROI).
Manual
When using Manual, you define a bounding box that
limits the search area used for detecting ventricular edges.
Once you define the bounding box, click Process to
automatically calculate the contours.
Mask
A user-defined area surrounding the left vertical that limits
the ventricular search area used for determination
contours.
Motion defect extent (MOT EXT)
The percent by area of the LV myocardium with
subnormal motion.
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Perfusion Quantification (PFQ)
Automated quantification of myocardial perfusion SPECT
using simplified normal limits.
Prompt
A symbol or phrase that appears to inform you that the
computer is ready to accept input.
Process
Inner and outer left ventricular cardiac surfaces are
automatically determined and displayed as contours on
SPECT images. The contours are used to calculate
statistics, graphs, and volumes.
Reversibility
A measure of the amount of redistribution at rest that
occurs in myocardium that is observed to be underperfused at stress. Reversibility extent and severity are
computed using the criteria for under-perfusion and
redistribution that were established as a part of the normal
limits generation process.
Results File
The file that contains information about the patient
processing session, such as the quantification values,
contours, objects reviewed, etc. You can save this file to the
database when you exit AutoQUANT.
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311
Severity
The area-weighted average of SDs for all pixels in each
region, with all pixels that are less than zero set equal to
zero.
Stroke Volume (SV)
Amount of blood pumped during each heartbeat (diastolic
volume of the ventricle minus the volume of blood in the
ventricle at the end of systole).
Thickening Defect Extent (THK EXT)
The percent by area of the LV myocardium with
subnormal thickening.
Total Perfusion Deficit (TPD)
A QPS result that is the combination of defect severity and
extent. The TPD value is derived by comparison to normal
limits in polar-map coordinates using the PFQ method.
Transient Ischemic Dilation (TID)
The TID value is derived by dividing the left ventricular
chamber volume at rest into the left ventricular chamber
volume at stress. (LV chamber volume at stress) / (LV
chamber volume at rest).
Triangulation
On slice data, the user may click on any one of the three
views (short, vertical and horizontal) and graphically
position the other two views.
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Viewport
A box or region on the canvas that contains an image,
report, or curve.
Wireframe
A transparent representation of an object created by
outlining the object surface with a grid of lines.
Algorithms (Reference)
This is a brief overview of the LV processing algorithms
used in QPS. These algorithms include volumetric LV
segmentation, endocardium and epicardium definition,
and segmental normal limits generation and application. A
variety of global and regional metrics can be derived from
the application of these algorithms to datasets. This
overview does not describe in any detail the theory behind,
or the design and validation of the CSMC (Cedars-Sinai
Medical Center) quantification and analysis algorithms
that are at the core of QPS. For a more detailed overview,
see Appendix D, “Bibliography”.
Volumetric LV Segmentation
Volumetric LV segmentation is a two step process. The
first step is an approximate segmentation, used to locate
the region in which the LV lies. This step uses a variety of
clustering techniques and heuristics to eliminate many
extraneous structures (e.g. the bowel) from consideration,
and provides a starting LV location and shape for the
second, more exact, segmentation step. This second
segmentation uses sub-voxel sampling within an iteratively
refined ellipsoidal coordinate system to generate a set of
points with high likelihood of belonging to the midmyocardial surface. This set of points is then used, in
conjunction with a set of spatial continuity constraints, to
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313
generate a mid-myocardial surface. This mid-myocardial
surface, in conjunction with the underlying data and
various physically based constraints, is then used to
generate the inner and outer walls and valve plane.
Normal Limits Generation and Perfusion Quantification
The QPS normal limits use a simplified approach as
presented at the 2004 ASNC (J Nucl Cardiol
2004;11(4):S12). Briefly, ellipsoidal model and contours
derived by QGS algorithm are used to extract polar maps
samples form the patient data. Patient polar maps are
compared to the set of polar maps (obtained from normal
low-likelihood patients) stored in a given normal database.
Selection of normal patients for the database
The standard or normal population consists of patients
with a low probability of coronary artery disease that also
have a normal test. The low probability is determined by
sequential Bayesian analysis of patient history and
diagnostic tests other than myocardial perfusion resulting
in a value of less than 5%. In addition, an expert
interpreter using visual inspection should determine that
the images are normal and that contours are derived
correctly. Typically, 30-50 patient studies will make up the
standard population. Databases are created from the shortaxis images. Creation of normal databases is described in
Section 14.
Perfusion Quantification
The normalization factor by which the counts in the teststudy are multiplied is found by an iterative technique
minimizing the cost function between the study and the
normal polar maps included in the database. Subsequently
the test-study is compared to the normal limits. The
perfusion defect extent (Defect Extent) is calculated as the
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E: Glossary
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percentage of the total surface area of the left ventricle, for
which test-data are below 3.0 mean absolute deviations
(approximately equivalent to 2.5 standard deviations)
threshold. Average deviation is used instead of standard
deviation due to more robust behavior in non-Gaussian
distributions. A method for assignment of a defect to a
particular vascular territory is based on the assignment of
segments to a given territory, based on segmental scores.
Estimated percentages of abnormal polar-map pixels in
each vessel territory are then reported. Defect extent is
marked on the polar map display in the form of "blackout"
maps.
Calculation of Total Perfusion Deficit (TPD)
This measure combines defect severity and extent. A
continuous score is assigned to each abnormal polar-map
pixel by linear mapping based on the degree the perfusion
value fell below the normal limit. A score of 4.0 was
assigned to all pixels more than 70% below the normal
limit (as derived from subjective criteria used for a score of
4 in visual reading). A score of 0.0 is set for pixels below
the minimum abnormal score. Subsequently, TPD is
defined as follows:
a< A
TPD = 100%* ∑
a =0
p< P
∑ score(a, p) /(4 * A * P)
p =0
where a, p are the radial coordinates of the polar map, A, P
is the maximum number of samples in each dimension,
and is the pixel score at the polar map location (a, p). The
theoretical maximum value for TPD is 100% for a case
with no visible uptake (less than 70% below normal) in the
entire LV myocardium.
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315
Segmental Scoring
Average continuous pixel severity scores are computed
within each segment. Segmental scores are rounded to the
nearest integer values for each segment. The segmental
scores are calculated for stress and rest images
independently. Summed scores are derived for stress (SSS)
and rest (SRS) images. The scores are subsequently
adjusted using two rules: segmental scores with value 1 for
both stress and rest scans are adjusted to 0, and segmental
rest scores with values higher then stress scores are assigned
the stress score values. Reversibility scores are defined as
the difference between Stress and Rest scores.
Shape Index (NEW)
This parameter defines 3D left ventricular (LV) geometry
derived from LV contours in end systolic and end diastolic
phases. Shape index is defined as the ratio between the
maximum dimension of the LV in all short-axis planes and
the length of the midventricular long axis.
6
5
4
3
2
1
A
A
A
A
For each short axis plane in the end-diastolic (ED) image
series, maximum dimension (A) of the LV is found from
the 3D contours derived by the QGS algorithm, using the
endocardial surface as the boundary. Global short-axis enddiastolic dimension (AED) is found as a maximum for all
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E: Glossary
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ED short axis slices. The short-axis slice and direction of
AED is then used to calculate the maximum short-axis
end-systolic dimension (AES) in the end-systolic image
series, by measuring the distance between the endocardial
points in the identical location (slice and direction) where
AED was found.
B
The long-axis dimension of the myocardium is derived by
calculating the distance (B) between the most apical point
on the endocardial surface and the center of the valve
plane. The ED long-axis dimension (BED) is calculated
independently from the ES long-axis dimension (BES).
The end-diastolic shape index (SI ED) and the end-systolic
shape index (SI ES) are derived by AED/BED and
AES/BES, respectively.
Eccentricity
Eccentricity is a measure of the elongation of the LV, and
varies from 0 (sphere) to 1 (line); it is calculated from the
major axis RZ and the minor axes RX and RY of the
ellipsoid that best fits the mid-myocardial surface,
according to the formula:
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317
It is calculated for all slices in a gated series.
RY
RX
RZ
Global Functions
The following standard global functions are computed:
Volume
The LV chamber volume in ml.
Area
The mid-myocardial surface area in cm2.
Regional Function
The regional functions are computed by generating
parametric surfaces within the canonical LV coordinate
system.
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E: Glossary
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The perfusion parametric surface is generated by assigning
to each point on the mid-myocardial surface the maximum
end-diastolic counts along the count profile normal to that
point and lying between the inner and outer myocardial
surfaces.
All methods of quantification (shown above) are based on
publications shown in the Appendix D, “Bibliography.”
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E: Glossary
319
320
E: Glossary
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Index
Numerics
3D images
- controls for 1 1 2
- in Surfaces window 1 1 1
- rotating 1 1 3
A
Abnormal patient
- analyzing graphs for 3 2
- analyzing polar maps for 2 9
- analyzing statistics for 3 3
- analyzing Visual scores for 2 7
- analyzing Volume (ml) and Filling
(ml/s) curve for 3 6
- processing 2 2 -3 7
Acquisition protocol
- verifying 2 1
Automatic
- data set selection 1 9 2
AutoQUANT
- exiting from 9 9
B
Background slider, on image control
bar 8 7
Blur, defined 9 3
Both, surface option defined 9 5
Bounding box
- heart, lung 2 3, 4 9
- repositioning 4 9
A u t o Q UA NT
Brightness slider, on image control bar 8 7
C
colors
- setting 2 1 1
Constrain 5 4
Contours
- defined 9 2
- deleting 4 9
- redefining 47 , 5 1
- verifying accuracy 1 0 6
Controls
- 3D orientation 1 1 2
- auto, on visual score window 1 1 9
- blur 9 3
- constrain 5 4
- contours 9 2
- defaults 57
- dual 51
- exit 9 9
- frame 9 5
- freeze 4 7
- gate 9 3
- graph 3 2, 1 2 9
- grid 1 3 8 , 16 7 , 1 8 9
- help 7 6
- image control bar 8 6 , 1 8 3
- Label 91
- limits 8 4
- lines 1 0 4
- list 80
: I n de x
321
- manual 4 7 , 5 1
- manual, in Raw window 4 8
- movie 7 1
- multiple 2 3 , 1 0 5
- popout 1 1 8
- print 6 5
- process 4 3
- reset 4 9
- rock 2 4 , 1 05
- save 5 7
- scale 9 5
- Score 8 5
- score 2 7, 7 7 , 1 66
- smear 9 3
- spin 2 4
- zero, on visual score window 1 2 0
- zoom 95
Controls, program
- Movie 7 1
Counts 1 3 3
Counts options
- extent 1 3 6
- quant 1 3 7
- raw 1 3 3
- severity 1 3 4
creating a database
- PFQ 2 2 6
CSImport 1 3, 2 1
Customizing, appearance and
functionality 1 9 1
- creating 2 2 6
datasets
- scoring 7 7
Defaults
- defined 5 7
Defaults window
- using 1 9 1 -??
Defect 1 26
Defect analysis graph
- analyzing 3 2
- defined 1 29
Defect analysis table
- analyzing 3 2
- defined 1 29
Defect extent 3 2
Defect severity 3 2
Displaying summed projections 1 0 5
Dual mode
- enabling 5 1
E
EF 15 0
- analyzing 1 6 4
Ejection Fraction
- analyzing 1 6 4
Extent 1 2 7
- Counts option, defined 1 36
- function option, defined 1 5 6
F
D
Data Requirements 1 2
Database window
- using 1 88
databases, PFQ
322
: I n dex
file format 69
file selection parameters
- setting 2 0 2
filters
- automatch 2 0 8
AutoQUANT
- setting 2 05
fonts
- setting 2 11
Frame
- defined 9 5
Freeze
- defined 4 7
Freezing images 4 7
Function options
- Extent 1 5 6
- quant 1 5 6
- raw 15 4
- severity 1 5 5
Function polar map, defined 1 5 4
G
Gamma slider
- see Intensity slider
Gate mode
- defined 9 3
general parameters
- listed 1 9 4
- setting 1 94
Graph
- defect analysis graph 1 2 9
- defect analysis table 1 2 9
- defined 1 2 9
Grid overlay 3 0
- defined 1 3 8 , 1 67 , 1 8 9
- groups 1 4 0
- vessels 1 3 9
- walls 1 4 1
Groups
- grid overlay, defined 1 4 0
A u t o Q UA NT
H
Help
- defined 7 6
I
Image control bar
- background slider 8 7
- brightness slider 8 7
- intensity slider 8 7
- pull-down menu 8 8
- using 8 6, 1 8 3
Images
- adjusting size of 9 5
Inner, surface option defined 9 5
Intensity slider, on image control bar 8 7
Interval
- defined 9 5
Intervals
- adjusting, using Frame control 95
L
Label
- defined 9 1
LHR 1 2 6 , 1 50
Limits 8 4
Lines, in Raw window 1 0 4
List
- using 8 0
M
Manual mode
- in Slice window 51
- using 4 7
: I n de x
323
- using in Raw window 4 8
Middle, surface option defined 95
More window 2 1
- using 1 87
MOT EXT 1 5 0
Motion
- checking for 2 3
- rock control 2 4
- spin control 2 4
Motion defect extent 1 5 0
Movie
- using 7 1
Multiple
- defined 1 0 5
N
Normals files
- selecting 8 4
O
Objects
- selecting 7 9
Oblique
- defined 9 6
Outer, surface option defined 9 5
P
parameters
- file selection 2 0 2
- general 1 9 4
- window-specific 1 9 8
Patient statistics
- in QGS window 1 4 9
- QPS window 12 6
324
: I n dex
- reversibility 1 2 9
Patients
- selecting 7 9
Perfusion polar map, defined 15 4
PFQ databases
- creating 2 2 6
Polar maps 3 5
- analyzing 2 9
- extent 1 3 6
- function, defined 1 5 4
- grid overlays 1 3 8
- on QGS window 1 5 3
- perfusion, defined 1 5 4
- quant 1 37 , 1 5 6
- raw 1 3 3
- reversibility 1 3 4-1 3 7
- severity 1 3 4
- triangulated navigation on 1 2 8
Popout
- using 1 1 8
Print
- printing a screen to a printer 7 0
- printing a screen to file 7 1
- snapshot files 6 5
- using 6 5
Process 5 0
Processing Data Sets
- Process 4 3
Processing data sets
- calculations from 43
- generated projections from 4 3
- QGS calculations from 4 4
- QPS calculations from 4 4
- resetting 49
Program information
- viewing 7 7
AutoQUANT
Q
S
QGS window
- calculations 4 4
- using 1 4 7
- volume curve 16 4
QPS window
- calculations 4 4
- patient statistics 1 2 6
- using 1 2 4
Quant
- Counts option, defined 1 3 7
Quantitative Gated SPECT
- see QGS window
Quantitative Perfusion SPECT
- see QPS window
Save
- defined 5 7
- saving the screen to file 7 1
SAX slices
- selecting 1 0 6
- viewing 1 0 6
- viewing with pop-out feature 1 1 8
Scale
- defined 9 5
Score
- defined 8 5
- manually overriding 1 2 0
- using 7 7, 1 6 6
SDS, defined 1 1 6
Severity
Short axis slices
- see SAX slices 2 5
Slice window
- using 1 0 6
Smear
- defined 9 3
Snapshot files
- saving 6 5
Snapshot window
- using 1 8 5
Splash window
- using 1 1 5
SRS, defined 1 1 6
SSS, defined 1 1 6
Statistics
- analyzing 3 3
- SSS, SRS, SDS 2 8
Sum
R
Raw
Raw window
- data sets used in 1 0 2
- using 1 0 2
Reset
- defined 4 9
Rest severity 3 2
Reversibility 1 2 9
Rock 1 0 5
ROIs
- acceptable parameters 4 8
- deleting 4 9
- redefining 4 7 , 4 8
- verifying accuracy in Raw window 1 02
A u t o Q UA NT
: I n de x
325
- defined 1 0 5
Summed Differential Score, defined 1 1 6
Summed projections
- displaying 1 0 5
Summed Rest Score, defined 1 1 6
Summed Stress Score, defined 1 1 6
Surface
- options 9 4
Surfaces window
- changing image orientation 11 2
- using 9 4 , 1 1 1
T
themes
- setting 2 1 1
Thickening defect extent 15 0
THK EXT 1 5 0
TID 1 2 6 , 15 0
Triangulated navigation 1 2 8
V
Vessels
- grid overlay, defined 13 9
Viewing program information 7 7
Views window
- using 1 22
Visual Score panel
- regions 1 0 9
Visual Score window
- using 1 19
Visual score window 27
- auto control 2 8
- displaying 8 5
- using 7 7 , 1 6 6
Volume 1 2 6 , 1 5 0
326
: I n dex
Volume Curve
- analyzing 1 6 4
W
Wall 1 2 6
Wall motion, evaluating 1 1 1
Walls
- grid overlay, defined 1 4 1
Windows
- Database 1 8 8
- Defaults 1 9 1
- More 2 1 , 1 8 7
- QGS 1 47
- calculations 4 4
- QPS 1 2 4
- calculations 4 4
- Raw 1 0 2
- Slice 1 0 6
- Snapshot 1 85
- Splash 11 5
- Surfaces 1 1 1
- Views 1 2 2
window-specific parameters
- setting 1 9 8
Z
Zoom
- defined 9 5
AutoQUANT

Instructions for Use - InCenter

Transcription

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