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Quantitative Gated SPECT

1. from o none to 100 maximum reflection If enabled parametrically mapped surfaces such as perfusion Fourier phase and amplitude mapped surfaces are also shaded In some cases the shading may interfere with the interpretation of the parametric mapping hence the ability to disable this option Graphics tab ll e Hardware rendering and acceleration The Notes in the graphics tab help describe the OpenGL hardware rendering options The viewport with the cube at the bottom left of the tab is active and can be used to determine what functionality is available on multiple monitors by dragging the Defaults dialog to another screen then attempting to rotate the cube by left dragging with the mouse If the rotation succeeds hardware acceleration is supported on that monitor If the viewport appears frozen hardware acceleration is not supported and should be disabled for this system which will allow OpenGL viewport to function correctly on all monitors trading rendering performance for compatibility It is also possible to use a configuration file to let the system decide whether to enable hardware acceleration or not automatically Acceleration will be enabled by default if the setting is set to Auto unless the identifier of the graphics card is found in a blacklist file named opengl xml and located in the system s configuration folder for CSMC software listed at the bottom of the Defaults dialog after Configuration fo
2. Study STRESS MIBI Dataset SA Stress Gated Volume 58m 7 EDV 74ml 8 ESV 19m 4 EF 75 Area 98cm 7 MotEx go 7 ThkExt Gr Ocm 7 Eccentricity 0 82 7 Matrix 64x64 x 23 z x Gm MmNvox 6 51 6 51 6 51 Mo 4s Auto o Grid Accept Reject The splash page in normal mode The splash page displays each dataset as multiple rows of small slices one or two rows of short axis one of vertical long axis one of horizontal long axis automatically or interactively selected The corresponding LV surface contours can also be displayed The location of each row of slices within its dataset can be changed by scrollbar or by dragging slice reference crosshairs in orthogonal views these are only visible while the left mouse button is depressed When more than one dataset is being displayed the rows of slices are interleaved For example with two datasets rows 1 3 5 7 correspond to the first dataset 2 4 6 8 to the second The page specific controls are Popout Toggles popout mode When on only selected slices are visible Clear Deselects all slices selected for popout mode Skip Toggles slice skipping When on slice spacing is doubled Est Process Reset Manual 1 2 3 4 Raw Slice Sais Splash Views Results Snapshot More Score Repot Defaults Save Print Move About oss NORMAL Z STRESS we SA Stress Gated 1223 1999 09 49 x Edit zack Popout Clear Label Contours ED ES Blur Smear Skip Gate Fra
3. 4 Click the Database or File tab as appropriate See settings sections below Fill out or select the appropriate information Select labeling options See Labeling section below If so desired enter a description in the Series Description or Dataset field this field may have a different name depending on the platform 7 Click OK to save the movie or click Cancel to cancel the task w DY 15 1 Database Settings If saving screen captures to the image database is possible a Database tab will be part of the Print dialog Database File Format DICOM SC D Transfer Syntax ETT Warning The DICOM Transfer Syntax determines the encoding and compression of the file and therefore can significantly affect file size Not all systems support all proposed transfer syntaxes Be particularly careful when using lossy compression as this may degrade image quality DK e EE EE IFS TFT FSSISFFVIFFSFFFV Database tab of Print dialog On most systems only one format will be available DICOM SC When DICOM SC is selected as the output format a Transfer Syntax setting drop down will be available allowing the SC to be saved in a compressed mode RLE Lossless Compression On some systems known to not support compression only Uncompressed largest file size will be available Additional transfer syntaxes may be added in future versions Note that selecting a compressed transfer syntax will result in decreased storage requirements
4. Primary Colorscale Gray X Phase Colorscale Phase y Start Page Raw y Normalize Calibrate Page Sequence Raw Slice Surface Splash Views Results More Results File QGS Results Prompt Discard phase information if motion amplitude is less than 8 of maximum amplitude TF Shift phase data by 180 4 degrees Page Options Raw Slice Surface Splash Views Results More Label Contours ED ES Blur Smear Gate Select Auto active Score Grid None bl Zoom 4 4 Rate 164 gt Snapshot File Save Screens AGS Configuration folder u conf Cancel The application defaults editor is used to display edit reset and save the default application launch configuration This editor dialog consists of four tabbed panels General Automatch Themes and Graphics 16 1 Controls for Defaults Sets The top row of the Defaults dialog allows multiple sets of application defaults to be defined and stored The bottom OK and Cancel buttons are also described here The following controls are available Defaults Selects the current set of defaults New Creates a new set of defaults based on factory settings Reset Resets the current set of defaults to factory settings Reload Reloads the current set of defaults from its last saved state Save Saves the current set of defaults Save As Saves the current set of defaults under a new name Set As Sets the current set of defaults to be loaded automati
5. Results QPC Change Fusion Snapshot More Displays projection datasets can be used for quality control and review The slice page displays each dataset as a set of five large slices three short axis one vertical long axis and one horizontal long axis automatically or interactively selected and can be used to examine features in detail It is well suited for assessing motion and thickening Displays each processed dataset as a single large 3D image of the LV surfaces and can be used to interactively visualize features and their spatial relations to each other Displays each dataset as multiple rows of small slices one or two rows of short axis one of vertical long axis one of horizontal long axis automatically or interactively selected The corresponding LV surface contours can also be displayed Displays each processed dataset as one or two rows of small 3D images of the LV surfaces for a single gated dataset one at ED and one initially at ES and can be used to interactively visualize features and their spatial relations to each other Displays an overview of processed results and functional analysis for a single dataset using slices surfaces polar maps graphs and tables Quantitative assessment of hibernating myocardium in SPECT PET studies Direct quantification of perfusion changes between two datasets Fused review of SPECT PET CT CTA slices in three orthogonal planes Displays screen captures Displays demo
6. 132 ml D mim 77 133 ml D mlim2 0 00 Exercise 45 00 Exercise indicates studies that have not been signed Refresh History 0 1 ECG 0 0 Quant 0 0 Dictation 0 1 Header Info 0 1 Blacklist 0 0 Warning Header Info Patient s ID does not match image header Warning History Patient did not sign consent form Warning Dictation Patient s previous study on September 5 1997 was not mentioned in dictation gg lo Consistency Checks ARG contains a collection of checks resulting in various notifications of errors and warnings These checks ensure that the report data is consistent For Example If Normal was entered for overall perfusion scan findings and a large defect exists in the visual scores then an error will occur Most checks can be viewed directly from the ARG interface by looking at the color of the field name field inconsistencies resulting in errors are labeled in red warnings in yellow Descriptions of errors and warning are displayed in the Errors and Warnings window shown below after clicking the Save button Critical Errors and Warnings pes Errors and Warnings The study contains the following inconsistencies All Errors must be fixed or checked as acknowledged prior to saving 1 remaining OK Cancel Critical errors prevent the report from being saved These fields show up red in the ARG panel and are listed next to a check box in the errors and warning dialog Most critical
7. Grid Selects grid mapping mode View Selects surface orientation Zoom Selects planar zoom Scale Selects surface zoom Phase Toggles phase functionality on off D V Toggles display of displacement velocity graph Left Right Selects the left and right phase polar map types Value Selects the value to be displayed in phase information labels Units Selects the units to be used for phase information labels Snapshot File Sets snapshot file dataset ID Select Active 16 3 AutoMatch Settings General AutoMatch Themes Graphics Language m Stress Filter Study STR MIBI MB Dataset STR MIBI MB Isotope Rest Filter Study REST RST TL Dataset REST RST TL Isotope Selects preferred page display mode 1 2 3 or 4 Activates Deactivates page selection on the toolbar QGS Filter Study Dataset Isotope mAutoMatch Include Study Dataset sts Isotope eg Mati AutoMatch Exclude Study Dataset tits Isotope A Mati DICOM Reconstructed SPECT Data I Treat unknown RECON TOMO datasets as Short Axis NOTE Enable this option if short axis datasets are displayed upside down because they are detected as TRANSVERSE see the More page to verify this cm 58 The following settings are available on the AutoMatch tab page of the Application Defaults editor Stress Filter Tags a dataset as stress based on text strings in study dataset or
8. but may cause problems if the file is later to be sent to another system that does not support this transfer syntax correctly Despite the warning displayed in the Database tab lossy compression is currently not available 15 2 File Settings A File tab will always be available on the Movie dialog Multiple formats are usually available These include AVI and DICOM SC AVI offers lossless or lossy compression depending on the codec coder decoder used DICOM SC is compressed only ifthe RLE transfer syntax is selected 54 Database Eile Filename C Documents and Settings user My Documents slice_movie avi Browse Format AVI X Format Options Codec MANR IATA A NAT TES X Quality a 100 This format requires that the file extension be au If the filename you select does not end with this extension it will be appended automatically before the file is written Labeling Information dd amp 4 4 4 4 4 4 4 4 4 4 4 4 4 4 44 4 4 4 4 4 4 e sf e File tab of Print dialog Note that the Format Options panel will only display controls if the format has optional settings These settings are a Codec selector and Quality slider for AVI quality can be set from o to 100 with o providing the lowest image quality and 100 the highest image quality and a Transfer Syntax setting for DICOM SC see previous section for restrictions on transfer syntaxes For certain AVI codecs the Quality slider may be disabled if th
9. middle counts The counts selection displays the mid myocardial surface with maximal counts mapped onto it for both gated and ungated datasets Pins Toggles pin display where parametric data is represented by lines extending from the surface with length proportional to magnitude Vessels Toggles display of the coronary vessels previously segmented and labeled Fuse Registers the coronary vessels to its associated LV surface 3 3 Viewing Polar Maps Polar maps are 2D representations of the LV myocardium The polar map to LV mapping is Center Apical Left Septal Right Lateral Up Anterior Down Inferior 3 4 Study Selector ABNORMAL H STRESS MIBI IRawSum Stress 04107 1998 12 11 el Edil o 2 E ABNORMAL 123456789 NORMAL 1123456789 The study selector selects the study to display where each study is a collection of datasets 3 5 Dataset Selector ABNORMAL Y STRESS MIBI Raw Sum Stress 04 07 1998 12 11 el Edit p lo 04 07 1998 12 11 37 Static Stress ER pine STRESS MIBI Raw Sum Stress REST THALLIUM Raw Sum Rest 0407n 998 10 19 30 Raw Static Rest Supine STRESS MIBI ISA Stress 04 07 1998 12 11 37 IShorAx Static Stress Supine PRI REST THALLIUM SA Rest 04 07 1998 10 19 30 Shorix Static Rest leupine PRI Each dataset selector selects a dataset to display from the current study If more than one dataset is currently being displayed then one dataset selector will be displayed per dataset with the
10. Primary 1 Active Stress Rest Primary 1 Active Stress Rest Primary 1 Active Stress Rest Primary cancer A Dataset Editor using filter settings above OOOO S 16 4 Themes Settings Application Defaults Previas The Themes tab page allows the user to set default colors and fonts for QGS s user interface buttons labels background etc The user can view changes in the Preview area prior to saving them permanently The user creates a new theme by clicking the New button or the edit the currently displayed theme in the Theme Name box by clicking the Edit button To change colors and fonts for the currently selected theme click the Edit button to display the Theme Editor window To change the font click the Change Font button to display the Select Font window The Select Font window is similar to the regular Windows 2000 and Windows XP dialog for font selection Select font font style and font size from this window and then click OK to accept the choices or Cancel to abort There are also other choices for the user interface such as Foreground Background color etc for the Active Disabled and Inactive regions of the display The user is allowed great range in tailoring the user interface to his her liking i i Theme Editor D conf themes csmc xml E xi Theme Name Cedars Family Helvetica Point Size 9 Weight 50 Change Font Active Disabled Inactive Custom Co
11. as one or two rows of small 3D images ofthe LV surfaces for a single gated dataset one at ED and one initially at ES and can be used to interactively visualize features and their spatial relations to each other N N 4 6 Results Page But Process Reset Manual 1 2 3 4 Raw Slice Surface Splash Views Results Snapshot More Limits Score Report Defaults Save Print Movie About Jose NORMAL y STRESS wg Label Contours ED ES Blur Smear Gate Spin 3D Frame 44 Zoom4 4 Stale 104 Rate 204 SA Stress Gated 112234999 09 49 y Edit DE 100 Fe 100 gt E 100 gt Sun Both y Function Raw x GridjSeaments y wend Pan zl Name OGS NORMAL PatID 9876543 Sex FEMALE SMS 0 STS 0 SM 0 ST 0 Study STRESS MIBI Dataset SA Stress Gated Date 12 23 1999 09 49 49 Volume mam Hl EDV 74ml 8 ESV 191 4 EF 75 Area Tiem 4 Mot Ext 0 Ocm 4 ThkExt 0 Oc 4 Eccentricity 0 82 4 Matrix 64x64 x 23 z x Bit Mmivox 6 51 x 6 51 x 6 51 Volume ml and Filling mls 804 104 aot 504 De 30 E 104 0 Rates PER 2 74 EDVIs 1 7 PFR 2 12 EDV s 5 3 PFR2 2 02 Eis 7 4 BPM assume 60 Misc MFRI3 1 32 EDVis TTPF 184ms The results page displays an overview of processed results and functional analysis for a single dataset using slices surfaces polar maps graphs and statistics The slices section contains two columns of
12. be available on the Print dialog The currently selected printer is listed under Selected printer To change to a different printer or to edit the properties of the printer click the Setup button This will open the operating system s Print dialog that will allow the selection of a different printer and a number of other options on Microsoft Windows these options include the number of copies On Windows clicking Print in this dialog will cause printing to happen immediately Alternatively one may click OK in the QGS Print dialog to print or Cancel to abort the operation Selected printer xerox Phaser 6250DX PS Setup m Labeling Information LLL e 4 4 4 4 4 4 4 4 4 4 4 4 4 AAA 4 4 4 4 4 4 4 4 4 A A File tab of Print dialog 14 4 Labeling The bottom portion of the Print dialog remains the same no matter what tab is selected This portion of the dialog is dedicated to image labeling On DICOM based systems a Series Description and Comment can be entered On other systems these fields may have a different name or be absent altogether depending on what fields the proprietary host platform supports These fields are meant to allow for the identification of the screen capture when listed in a typical medical image database browser The Datasets section lists all datasets present on the current page For each dataset acquisition and processing information are listed along with image generation time This allows for the
13. below Abn rest worse Ex l R Gated Sequence Stress EF Stress EDV Stress ESV Rest EF Rest EDV Rest ESV TID LHR Scan Findings Scan Defects Stress WMWT Rest WMWT The quantitative results for stress and rest are displayed in this figure The TID and LHR fields are entered in manually by the clinician they are not calculated by QGS Stress and Rest WMWT Wall Motion and Wall Thickening check boxes should be checked if the study exhibits wall motion wall thickening at stress and rest respectively The GSSS Gated Summed Stress motion Score and GSRS Gated Summed Rest motion Score are automatically calculated and display if the data has been processed Manually adjusting the polar map scores automatically re calculates and updates these values Selects which gated sequences were acquired Stress Ejection Fraction Stress end diastolic volume Stress end systolic volume Rest Ejection Fraction Rest end diastolic volume Rest end systolic volume Allows user entry of TID Transient Ischemic Dilation Allows user entry of LHR Lung Heart Ratio Overall findings of the function test If Scan findings is not normal this describes the type of defect If the study exhibits wall motion wall thickening defects at stress this box should be checked If the study exhibits wall motion wall thickening defects at rest this box should be checked Le Visual Scores ARG extends scoring by a
14. does not include the information box to the right of the main viewport or the application controls at the top of the application s main window Movies can be saved either to the host system s image database if supported by the host system or to a file always available On DICOM based systems movies are saved as true color DICOM multi frame secondary captures MFSC Proprietary formats may be used for other platforms but exporting screen captures as DICOM MFSCs can be an option when saving a file to the file system as opposed to saving to the image database unless the platform is know to not support MFSCs in which case the option is disabled to avoid creating files that the host system cannot handle When generating a movie note that the final frame rate of the movie will vary with the application s Rate setting in the top application controls and attempt to match this rate For example to create a faster movie of a beating heart increase the Rate setting The application will pick automatically how the movie will be generated i e by gating the image or displaying a rotating image based on the current page selection To save a screen capture follow these steps II 53 Ll 1 Select your study ies and start your application 2 Configure the screen as desired e g process the data change the selected dataset adjust the zoom factor select a different color scale etc Click the Movie button to open the Movie dialog
15. five slices one at ED and the other initially at ES each with three short axis one horizontal long axis and one vertical long axis The surfaces section contains two LV surface images one at ED and the other initially at ES The polar maps section contains four polar maps ED Perfusion ES Perfusion Motion Thickening ED perfusion in normalized counts ES perfusion in normalized counts Endocardial wall motion scaled from o to 10 mm Wall thickening from ED to ES scaled from 0 to 100 These polar maps can be viewed as parametric surfaces by turning on the 3D toggle 5 4 7 More Page Em Process Reset Wan 1 2 3 4 Raw Sike fur Splash Views Results Snapshot More Database Lis Score Repot Desauts Baw Print Mowe About ANDRA CIGL CHOCO ouarn on 10192 Kat o I EE Care Dataset ODIA one 121137 ymetws dbUocanelT g DiMomawendtvocanans y SHORT AXIS The more page displays demographic data from each image dataset header and can be used to confirm that all relevant fields are filled appropriately Manual Mode Est Process Mono 123 4 Jj Raw Gace Swie Pe Views eh Gnapshot Moro Database Limits Score Dutt Defans Swe Print Mowe About GC Po tal fw anus wi NMED DN 10 Tas Ven Gen Leg Gordours Bear Zen 5 sl pa ex over LV cantor end porte over LV apes and base process le outage of mask et Constan locke LY apex and bawa Manual mode is used to supply hints constrai
16. identification of the datasets The Operator and Institution fields are filled in automatically from the dataset headers if available otherwise they can be edited before printing If the Include a dataset legend checkbox is checked each dataset on the printed screen will be identified by its designation letter A B or C in the example below and a legend that includes the information in the table will be added at the bottom of the printed or saved output The legend table will also include patient information name patient ID date of birth unless anonymization is enabled and dataset orientation and laterality as provided by the dataset headers Vi N Myocardial Perfusion Cardiac Stre 2007 01 23 09 36 49 Tech 1 Myocardial Perfusion 2007 01 23 09 36 44 Tech 1 2 Imagi nter Myocardial Perfusion Resting Stati 2007 01 23 09 40 28 Tech Labeling section of Print dialog Note that the Format Options panel will only display controls if the format has optional settings These settings are a Quality slider for JPEG quality can be set from 40 to 100 with 40 providing the lowest image quality and 100 the highest image quality and a Transfer Syntax setting for DICOM SC see previous section for restrictions on transfer syntaxes 15 Saving Movies Movies of the application s screens can be saved by clicking the Movie button These movies only include the relevant portion of the viewport as decided by each application for each page and
17. parametric shading enabled parametric shading and specular reflections specular reflections enabled gt No hardware acceleration No hardware acceleration parametric shading or parametric shading specular reflections enabled no specular reflections S SJal Det ults lepot le main onf qca qca defaults usr Default E Defaults x New Reset Reload Save Save As SetAs Startup Import Export Delete Reinitialize General AutoMatch Themes Graphics Arg Please Note Modifying these values for Arg will affect al users connecting to the same Arg database Report Snapshot Order Slice Images Image Data Arg Administration Slice Colorscale Cool y Save Image Data to Arg Database Screen Name issn Iw Include Contours User Manager aw Slice Site Manager Surface Splash Referring Monitoring Physician Manager Views E ops El User Configurable Code Editor Pe Report Template Select Edit More Database oK Cancel Report Snapshot order is the order which captured snapshots should appear in the report If multiple snapshots of the same page are included they will be appended in the order they were created Slice images are automatically captured for all studies at the time of saving These are included in the report by default but can be removed by creating a manual report and removing the slices from the perfusion page Image data may also be saved to the ARG database This will
18. short axis dataset Stress SAX would be used as the Primary stress dataset As mentioned previously the user can use the Dataset Editor to manually select the correct Stress Rest Primary datasets However careful setting of filter parameters on the AutoMatch page requires no manual intervention by the user In this example the user could type Supine or Sup or sup etc in the Study field of the Primary Stress Filter click OK or Save to automatically set the Primary Stress dataset Setting AutoMatch filters for the first time is probably done best by clearing the existing factory shipped settings and then trying the most common combinations of Study name and Dataset name for the user s site naming conventions 38 Dataset Editor pomo Ja Jan Jg Jos adem als 2005 02 11 10 57 REST THALLIUM RAW 2005 02 11 10 57 RESTTLProne RAW 1 Active Stress Rest 2005 02 11 10 57 24HR TL RAW 1 Active Stress Rest 2005 02 11 10 57 STR MIBI Supine RAW 1 Active Stress Rest 2005 02 11 10 57 STR MIBI Prone RAW 1 Active Stress Rest 2005 02 11 10 57 STR MIBI Prone Stress SAX_P 2005 02 11 10 57 REST THALLIUM Rest SAX_S 2005 02 11 10 57 STR MIBI Supine Stress SAX 1 Active Primary 2005 02 11 10 57 24HR TL Rest SAX 1 Active Stress Rest Primary 2005 02 11 10 57 4HR TL Rest SAX 1 Active Stress Rest Primary 2005 02 11 10 57 RESTTLProne Rest SAX 1 Active Stress Rest Primary co Dataset Editor Window For the datasets used in thi
19. Auto 0 Grid gt LVE Rest No SRS 0 0 SDS 0 0 r NM Times E Save Normal Sian Extended Report New Edit Capture Connected MSDE localhost v2 23 argheta Integration of ARG Automatic Report Generator provides the ability within QGS to create edit sign review archive and share customizable consistency checked reports A reporting pane and a few extra dialogs have been added to QGS for this purpose ARG is enabled by the Report button on the right hand side of the top row of buttons When on the info box is replaced by the ARG panel 10 1 Starting QGS with ARG ARG will automatically match the identifying information contained in the image headers with existing previously saved studies If an existing study is found then it is possible to modify the data or view the report associated with that study If no study is matched then ARG will automatically create a new study This new study will not get permanently saved to the database until the Save button is clicked Multiple Studies x Ifa patient has more than one study within two days of one another Testdate Study Study Twe v Stress Sep Dual 2003 04 07 then a dialog is displayed prompting the user to choose the relevant Unknown 2003 04 07 study Multiple studies are a unique occurrence and should only be used when the user wishes to bill for multiple studies To create a multiple study click the New button
20. Cedars Sinai Medical Center CHS Department of Medicine Artificial Intelligence in Medicine Program QGS Quantitative Gated SPECT Reference Manual Version 2012 1 October 2011 Options ARG QPET PlusPack2o Fusion Coronary Tree This document and the technology described herein are the property of Cedars Sinai Medical Center and shall not be reproduced distributed or used without permission from an authorized company official This is an unpublished work subject to Trade Secret and copyright protection Copyright 201 Cedars Sinai Medical Center Warranty and Copyright Statement Cedars Sinai Medical Center has taken care to ensure the accuracy of this document However Cedars Sinai Medical Center 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 Cedars Sinai Medical Center provides this guide without warranty of any kind either implied or expressed including but not limited to the implied warranties of merchantability and fitness for a particular purpose Cedars Sinai Medical Center may make improvements or changes in the product s and or program s described in this manual at any time This document contains proprietary information which is protected by copyright All rights are reserved No part of this manual may be photocopied reproduced or translated to another language without written permissi
21. ESS MIBI GATED ED 1999 12 23 09 49 49 Tc 99m Supine Raw 64x64 x 64 z Active Stress Rest LHR AC REST THALLIUM GATED ED 1999 12 23 08 32 10 TI 201 Supine Raw 64x64 x 64 z Active Stress Rest LHR AC 1999 12 23 09 49 49 Snapshot 1024x832x 1 z Active AC Unknown attributes are highlighted in red Change as appropriate limits last Many QGS algorithms and displays require the correct categorization of datasets in order to work correctly In cases where automatic categorization did not work either because dataset fields were empty or because they did not match the criteria specified in the application defaults the dataset editor can be used to correctly re categorize It is accessed by the Edit button to the right of the dataset selector and allows for changes to the following fields Sex Isotope Orientation Active Stress Rest 4Hour Late Primary AttC Via Limits Patient sex can only be set for the patient not for individual datasets The imaging radiopharmaceutical s isotope Patient acquisition orientation Enables the dataset to be processed and displayed Stress dataset Rest dataset 4 hour delayed dataset 24 hour or later dataset The default datasets to be used in reversibility computations Attenuation corrected Viability not always available The perfusion normal limits to be applied Select OK to accept changes Cancel to discard If the limits field is incorrect before changing
22. Edit DO RE b rs Smear Zoom44 Grid None gt ABNORMAL 123456789 MALE A SepdualMale 558 25 zeen SDS 26 88 33 SR 0 SD 33 STRESS MIBI SA Stress Volume gin d 105cm Defect 33cm en 32 study AE Eccentricity 0 85 REST THALLIUM Dataset Volume The QGS main window consists of e Controls in a horizontal pane spanning the top edge control how the study is processed and displayed e Pages in the rectangular area beneath the controls for providing a series of alternative perspectives on the data and processed results Only one can be displayed at a time e The info box in a vertical pane beneath the controls and to the right of the pages for displaying study information and statistics The intent is to give as much space as possible to displaying data while still providing quick access to commonly used controls 2 1 Main Controls The main controls for the application are Exit Exits the program Process Processes all datasets automatically segmenting and quantifying Reset Deletes processed results from the current dataset s Manual Toggles manual mode In cases where fully automatic processing fails or is suboptimal manual mode can be used to provide guidance to the LV segmentation algorithms 1234 Selects the number of datasets to simultaneously display For side by side evaluation of multiple datasets e g stress rest or frames e g ED ES Raw
23. PET datasets in the transverse format are required Kinetic analysis is designed to function with any number of frames but typically 16 26 frames are most commonly used in clinical settings 9 2 Kinetic page displays The Kinetic pages displays quantitative results utilizing polar map time activity graphs and score chart formats e Polar Maps There are two rows of polar maps displayed on the Kinetic page o The polar maps displayed towards the top of the page show the absolute blood flow in the Myocardium for the loaded datasets in ml g min If both Rest and Stress dynamic flow datasets are loaded an additional CFR polar map showing the coronary flow reserve is also displayed The polar maps can be segmented into Vessels Groups Walls and Segments using the grid pull down menu The values are averaged for the polar map pixels for each user defined segment o The Polar maps displayed in the middle of the page show radiotracer activity within the myocardium in Bq ml Time Sec There are up to 4 polar maps displayed in this region if both the rest and stress flow datasets are loaded Two of the polar maps show summed data that sums the information from all frames Right the remaining two polar maps show data for the specific frame being displayed Left Time Activity graphs The time activity curves display radiotracer activity both within the blood pool of the right and left ventricles left and for the Myocardium right When t
24. Slice Surface Splash Views Results QPC Change Fusion Kinetic More Phase Score Report Defaults Button Defaults Menu Save Print Movie About Selects the current page with each page providing an alternative perspective on the data and processed results Toggles the segmental scores window Toggles the ARG Automatic Report Generator panel Brings up the application defaults editor for creating editing and managing application defaults To the right of the defaults button for quickly selecting and applying a set of application defaults Saves the processed results and manual overrides to the clinical database for archiving and review Prints the current screen either to the image database as an image file TIFF JPEG etc or to a system defined printer Saves a movie of the current dataset to the image database if supported or as a movie file AVI or DICOM MFSC if supported Brings up version and copyright information 3 Viewing Images QGS supports multiple image display formats including slices surfaces polar maps and projections The following controls are common to more than one image type as appropriate Label Toggles image labeling slice numbers surface labels etc ED Toggles ED lock When on ED LV contours are displayed on every frame ES Toggles ES lock When on ES LV contours are displayed on every frame Gate Toggles temporal inter frame cine Frame Selects the gated frame to d
25. TIPF m The slice page displays each dataset as a set of five large slices three short axis one vertical long axis and one horizontal long axis automatically or interactively selected and can be used to examine features in detail It is well suited for assessing motion and thickening 4 3 Surface Page Defaults Save Print Moe About Ext Process Reset Manual y 2 3 4 Rew lee Suire Solas E ve h Mews Results Snapshot More Score Report f MAL A Stress Gated 40 Eat Leg Bor ED oae mb Frame tia e sua EEE Foncion Rew nel one verao El e fetmese wer Name OGS NORMAL PMO 9870543 Sex FEMALE SMS eme zu ST 0 Study STRESS MIBI Dataset SA Stress Gated Date 1223 1999 09 49 49 Volume gtt ew Tamis ESV main EF 75 Area Wew Moea Oem 1 mut T nt Eccontricity Aan Matric rant x s pm mn 6 514651 6 51 The surface page displays each processed dataset as a single large 3D image of the LV surfaces and can be used to interactively visualize features and their spatial relations to each other 4 4 Splash Page Exit Process Reset Manual 1 2 3 4 Raw Slice Surface Splash Views Results Snapshot More Limits Score Report Defaults Save Pin QGS NORMAL STRESS miel SA Stress Gated 12 231999 09 49 x Edit och Popout Clear Label Contours ED ES Blur Smear Skip Gate Frame 7 4 Zoom5 Rate20 gt Orii SM 0 sT 0
26. a uses a process of pattern matching to match user string entries in the Study and Dataset fields with the Study name and Dataset name to identify stress datasets rest datasets a primary stress dataset and a primary rest dataset Optionally isotope criteria may be entered in the Isotope field to further narrow down the identity of the correct datasets The string entries may consist of complete names e g Stress or partial names e g Str numbers e g 24 and can include the wildcard characters question mark and asterisk for single and multiple characters respectively A carat can be used to match the beginning or the end of a line Multiple entries for the same field are permitted but must be separated by commas and not have any spaces Examples using AutoMatch with filters Example 1 In this first example a patient named Test 1 will be used All of the datasets for this patient will be selected as input to the QGS application Selecting all the datasets for patient Test 1 and then clicking the QGS button will run the QGS application with factory default settings for AutoMatch Opening the Dataset Editor reveals the default rest and stress datasets including primary datasets highlighted in yellow based on the current AutoMatch settings Using the factory shipped filter settings the STR MIBI Prone short axis dataset Stress SAX is automatically selected as the Primary stress dataset by QGS Normally the STR MIBI Supine
27. able the text to be displayed in red refer to publications for threshold values LV chamber volume in ml at end diastole LV chamber volume in ml at end systole Ejection fraction in Mid myocardial surface area in cm for the current frame Motion abnormality area in cm and as percent of the mid myocardial surface area Thickening abnormality area in cm and as percent of the mid myocardial surface area LV eccentricity for the current frame a measure of elongation that varies from o sphere to 1 line LV shape index for ED and ES and eccentricity for the current frame Eccentricity is a measure of the elongation and varies from o sphere to 1 line Shape index is the ratio between the maximum dimension of the LV in all short axis planes and the length of the mid ventricular long axis Dataset dimensions in voxels Voxel dimensions in mm The diastolic function panel contains the volume time and filling time curves and the following statistics PER PFR Peak emptying rate Peak filling rate 17 PFR2 BPM MFR 3 TTPF 4 Pages Secondary peak filling rate Heart rate in heart beats per minute if available Mean filling rate over the first third of the end systolic to end diastolic phase Time to peak filling from end systole The pages are the central focus of QGS with each one providing a different perspective on the input data and processed results Raw Slice Surface Splash Views
28. age 6 1 Requirements The phase analysis feature requires at a minimum one processed gated short axis dataset The gating acquisition should be sixteen frames per cardiac cycle e Show buttons These controls are used for showing displacement and velocity first temporal derivative of the displacement curves thickening and regional counts curves as well as phase histograms The following controls are available Guides Toggle shows or hides guidelines that indicate the location of the minimum and maximum displacement and maximum positive and negative velocities Grids Toggle shows or hides gridlines for time values Cursor Toggle turns the interactive value readout cursor on or off All Units Toggles on display of all displacement and velocity values e Units drop down this control determines how timing values are displayed in the polar maps Options are Degrees Milliseconds and Cycle Ifthe dataset header does not contain heartbeat length information a 6obpm heart rate is assumed for all timing calculations as is done elsewhere in QGS e g for diastolic function calculations Phase Analysis Region Selector HI Show Guides Grid Cursor All Units Units Degrees angle Y ams Milliseconds Cycle PER 4 13 EDV s 3 6 PFR 3 66 EDV s 14 1 x 6 2 Reviewing Results Phase calculations Phase calculations are based on the analysis of mid myocardial
29. al value To provide an assessment of global ventricular synchrony the phase panel includes the global LV entropy derived from mid myocardial wall motion This value is calculated as indicated in the previous section with the calculation extended to all LV samples Note the type of value provided in this space may change in future releases as the clinical value of this information is assessed Phase related graphs and histograms An additional dialog can be displayed to show displacement and velocity first temporal derivative of the displacement curves thickening and regional counts curves as well as phase histograms The following controls are available on the dialog The following controls are available on the Displacement Velocity dialog Values Toggle shows or hides maximum displacement and maximum negative velocity Guides Toggle shows or hides guidelines that indicate the location of the minimum and maximum displacement and maximum positive and negative velocities Grids Toggle shows or hides gridlines for time values Cursor Toggle turns the interactive value readout cursor on or off All Units Toggles on display of all displacement and velocity graphs The dialog is also affected by settings of the results page the regions and the units selectors determine respectively which regions are displayed and whether timing information is shown in degrees milli seconds or R R Regions are determined by the Grid setting
30. cally upon application Startup startup Import Import a set of defaults from an previously exported XML file located in the file system Export Exports the current set of defaults to the file system Delete Reinitialize OK Cancel Deletes the current set of defaults Not available for None Default or Factory defaults Resets the Default set of defaults to its factory settings and make this set the startup set of defaults Applies current defaults to the application one time Exits default dialog without making any changes Defaults can be selected on the fly from the main application window by selecting a set from the Defaults drop down list 16 2 General Settings The general panel is divided into two sections one for application wide settings and one for page specific settings The application settings are Process Anonymize 1234 Score Report Segments Convert Surface Color scale Function Color scale Primary Color scale Normalize Sequence Browse Results File Prompt Toggles automatic processing of input datasets Toggles off display of patient identification Sets default display mode one two three or four datasets Sets display of scoring polar maps Sets the initial state ofthe ARG Auto Report Generator panel Sets the default scoring model to Cedars 20 segment or AHA 17 segment Converts old ARG studies from 20 segments to 17 segments if applicable Ifunchecked old ARG stu
31. 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 Extended analysis functionality providing further perspectives on the data includes Global metrics including 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 and myocardial thickening Extended modality functionality enabling the analysis and display of alternative modalities includes 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 SPECT PET Absolute Blood Flow and Coronary Flow Reserve quantification Transverse processing for the quantification and display of transverse datasets 2 Interface Exit Process Reset Manual 1 2 3 4 Raw Sice Surface Splash Views Results Snapshot More Database Limits Score Report Defaults Save Print Movie About ABNORMAL Z STRESS mal SA Stress 04 07 1998 12 11 z REST THALLIUM SARest 04 07 1998 10 19 gt
32. d first be shaped and positioned so that it encompasses the LV while excluding all extra cardiac activity before doing so it may be advisable to toggle the incorrect contours off by clicking the Contours button It may be easier to visualize the LV on the Manual page by using longer frames typically the last 3 6 frames of the acquisition protocols are commonly acquired for longer durations Time information for the displayed frame is shown in the right side of the page next to the volume information Then try processing with a suitable combination of hints enabled when the Process button is pressed all enabled hints are applied The available hints in order of increasing strength i e decreasing preference are Localize Restricts the initial LV search to the volume defined by the masking graphics Use if the algorithm completely missed the LV Mask Restricts the entire LV segmentation algorithm to only use data within the volume defined by the masking graphics Use to exclude extra cardiac activity e g spleen that caused contours to be distorted Constrain Constrains the long axis used by the LV segmentation algorithm to lie on the end points apex and base specified by the masking graphics Use to force valveplane to be at a specific basal position As transverse data sets are often generated for PET studies manual mode can also be used for automatically determining reorientation angles and then displaying the results in either tran
33. d may be registered in certain jurisdictions UNIX is a registered trademark of The Open Group Linux is a trademark of Linus Torvalds and may be registered in certain jurisdictions Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and or other countries Other brand or product names are trademarks or registered trademarks of their respective holders User Assistance Information For assistance please visit our website or contact us via e mail Website www csaim com E mail support csaim com Table of Contents 1 2 trett 7 Interface ie c5 00s3ss30sdacndansiassdasibensisasbonsbsdubesatssshosstvasdnssbasstacsiasstunsdsaubosshssabesabsssbssshsesbossbssszassdatsinesbonstd 9 2 1 NE A ted hide dialed ee Atak caceahe tt ade tedicontdhte dtedacodeantents 9 Viewing Imag eS Eeer 10 31 Viewing lees aaa u 32 Viewing e II e Ge E Maps cscs ceases astesesenn tena oteacteeadeasdennseteseoetenesaece cases ase 12 34 Study Selector aaa 12 3 5 PASAS 12 36 Dataset E 3 37 Colors CINE E 14 O erte DO in ni rima 15 300 nfo BO sesser PPP EEEE 16 Ee 18 4 1 A OS 19 A 20 O E E A E anne coaines 20 E Splash A cad 21 II NEE 22 w6 Results O E E E 23 ET Mr E E EEE NEE ERE 24 Manual Modena ana 24 5 1 BK EE ER TEE 25 Phase PU A so aca sence saa sanae pasesossoeea sean edasaeeacenon evasoden nacoesean esos nae 26 6 1 e ET 26 6 2 Reviewing Results s ssesessoessseseeserse
34. dies will load in the number of segments they were saved with Sets the default surface color scale for all 3D surface images Sets the default polar map parametric surface color scale Sets the default color scale for all 2D images Toggles automatic normalization of display windowing levels based on segmented LV surfaces or regions Defines default page ordering on the toolbar Allows selection of default normal limits Sets results file dataset ID Toggles prompting for a file name when saving results The following settings are available on the General tab page in the Page Options section Availability of any setting is specific to the page selected in this section Label Lines Spin Gate Rock Multiple Toggles image labeling Toggles motion reference lines Toggles continuous spatial cine Toggles temporal cine Toggles bi directional angular projection cine for sub 360 acquisitions Toggles multiple mode Box Toggles LV surface orientation box Contours Toggles LV surface contour display ED Toggles end diastole contour surface reference overlay ES Toggles end systole contour surface reference overlay Blur Toggles 1 2 1 temporal smooth of displayed slices Smear Toggles 1 2 1 spatial smooth of displayed slices Skip Toggles display of every second slice Surface Selects surface render mode Inner Outer Both Middle Function Function Selects parametric function mode when Surface is set to Function
35. e codec does not offer an adjustable quality setting Note that using uncompressed output may lead to extremely large files that may not play well in the format s display program For example a large screen movie of a beating epicardial surface saved as an uncompressed AVI may display poorly when played in Windows Media Player if the system s resources are insufficient Generally it is recommended to use a compressed codec when generating AVI movies Also note that the list of codecs available on a system varies depending on what software has been installed It is possible to install codecs individually and thereby obtain improved display performance but doing so may reduce the portability of the file e g when sending a movie toa colleague the other person will also need that codec in order to view the file 15 3 Labeling The bottom portion of the Movie dialog remains the same no matter what tab is selected This portion of the dialog is dedicated to image labeling For details on labeling please consult the corresponding section for labeling screen captures in the Print dialog section 14 4 55 16 Application Defaults Editor QS Application Defaults Defaults Default y New Reset Reload Save Save As Set As Startup Import Export Delete Reinitialize General Automatch Themes Graphics Application Options Process Anonymize verity 1 2 3 4 Segments AHA 17 y Surface Colorscale Gray y Function Colorscale Cool
36. e display mode single dual triple or quadruple The user can select gated datasets on any display page Splash Slice Views etc with Splash and Slice pages being more useful to view the created perfusion images 5 User clicks Freeze on the QGS application main toolbar to initiate the motion frozen algorithm 6 The currently displayed gated dataset s in the Dataset Selector pull down are replaced with the newly created motion frozen datasets as identified by MF in front of the original dataset name 7 The display window is updated with the newly created motion frozen perfusion images Note Contours are automatically generated for the newly created images Toggle the Contours button on the page control bar to view contours The motion frozen feature is enabled by default in QGS There are no user configurable settings in the Defaults Editor for this feature The figure shows the QGS main application wndow and the location of the Freeze button on the main toolbar 11 3 Reviewing Motion Frozen perfusion images Typically motion frozen perfusion images are reviewed on the Splash page as are the usual perfusion short axis datasets The figure shows the Splash page with a stress summed short axis dataset and a motion frozen perfusion dataset created from the same stress gated short axis dataset as the stress summed short axis dataset 12 Saving Results Processing results can be saved from within the QGS application for later recall T
37. eceseeeceseeseceeeeseenneeseeess 47 Saving Rest a 47 PowerPoint Integration 0 0 0 0 ceesscesseecesscecesseeesscecesseecesacecscecesacecesaeecssaecesacecesaeecesaeeesseeeesaes 48 Bi Decio saved Piles psy eae ry tater acca ascents Saat la tikes 49 Vi 13 2 Launching application studies from PowerPoint cooonconicniccnocnnonconconncnncnnncnnonnnonncnnnonncnnnonos 49 14 Saving screen Captures ad Printing EE 50 ta Database SEUA nia 51 DAS SPU SOUS E socairwdscusistasuau ge oesuruss E 51 143 Pinter EE 52 WA Labeling a a a anentee 52 15 Saving MOVIES A 53 51 Database elisa ass a a is aa uaa aa 54 e o i E ae EE EE 54 O EE 55 16 O 56 loa Controls for Delaults Seis a o 56 162 General Setting Sisane eee e ee 57 16 3 AutoMatch e ASILO 58 Using Filters to Automatically Determine Dataset Category ooooccoocccoccooccnoccnonnconnnonnnonononoss 59 Examples using AutoMatch Wire lla ds 61 E GN 63 1605 Graphics Seira engen 64 Hardwarerendering EE 66 Highliehtsand shading canoa raul celeste lralslas lala ieten entan eui eti 66 Le 68 167 Language E EE 69 17 EE 69 17 1 Volumetric LV Segmentation cssccsccssccssssscssscsscsnscsecensssecensssecsnssercsnssensensseacenssensenss 69 17 2 Normal Limits Generation and Perfusion Quantification coocnnonnnocononnconnconncnonnconncnnnnnn 69 E er 71 ett ZECHES 72 17 5 A atta See sea A AEA da haa A Aaaa beaten naan Kani 72 0 Regional A POE a In Ester ia a a eels EP Ss Ha
38. ect these quantities is removed This issue should not affect interpretation as amplitude histograms are not expected to provide clinically relevant information Comments Normal limits or expected values for these measurements have not yet been derived by the AIM Program at Cedars Sinai for myocardial perfusion gated SPECT PET 7 Fusion Page Exit Process Reset Manual les 3 Raw Slice Surface Splash Views Results QPC Change Fusion Snapshot More Database Limits Score Defaults CSMC Save Print Movie Help About Percr Z Specials PETCT_SlowCT 5 0 eFov2003 11 21 12x 4 gt Specials PETCT _ FDG_PET_2Atten 2003 1121 157 4 Edit oes La DEE uz tours Smear Oblique Zoom 5 Grid None gt Alpha Blend deeg Name PETCT Pat ID Sex MALE Limits Change ee o S 49 SOS 2 KIRT S S 61 SD 3 A i f Specials PETCT_Herz h MAY Y wut LY i DW a V Dataset SIowCT 5 0 eFoV 2003 11 21 12 42 54 lt No Matches gt Specials PETCT_Herz Dataset FDG_PET_2Atten 2003 11 21 12 25 01 Volume 131ml 156cm Mismatch 6 Scar 28 Shape 0 77 SI 0 76 Ecc This feature allows fused review of original SPECT PET CT and CTA transverse slices in three orthogonal planes Interactive 3D alignment correction of SPECT 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 lev
39. el presets are read from the DICOM header or can be predefined The feature allows users to perform quality control of SPECT PET CT or SPECT PET CTA alignment for verification of attenuation correction LV contours can also be displayed in the fusion mode In addition the feature allows display of segmented and labeled coronary vessels from CT Angiography CTA fused with 3D surface perfusion SPECT PET data or viability PET data The coronary artery tree is extracted and saved as DICOM by the vendor s CTA software This feature is accessed by clicking the Fusion button on the application main toolbar 7 1 Feature Requirements The Fusion feature requires at a minimum one CT dataset and one SPECT PET perfusion or PET viability dataset For coronary artery fusion and display the segmented coronary tree dataset must be available in addition to the SPECT PET perfusion viability dataset 7 2 Implementation A typical sequence for using the Fusion feature is as follows z User selects necessary CT CTA and SPECT PET datasets User starts application session Session will create contours for the SPECT PET dataset s Optionally user verifies contours User clicks Fusion on the main toolbar to display the Fusion page E wy Note If the data comes from a Hybrid scanner and is aligned by the vendor the Fusion page shows hardware fusion on the image display in the bottom 6 Misalignment of CT and SPECT PET images can be visually ascer
40. errors deal with the absence of required data however some are due to major inconsistencies with the data If errors exist in the report it is possible to continue however the errors must be acknowledged by clicking the checkbox next to the error Clicking the checkbox will accept the error for the current study only To permanently disable hide and error right click the error and select Add consistency check to blacklist Warnings do not prevent the report from being saved However the physician must review them and explicitly choose to ignore them prior to saving Theoretically warnings should not be allowed However in some circumstances the inconsistency should be allowed i e the patient had a bypass surgery Ignoring warnings should be done scarcely and only after careful consideration Hiding unwanted consistency checks Users may disable errors and warnings that are irrelevant to their site by right clicking the consistency check once the dialog is opened This moves the consistency check to a hidden group The consistency check can be re enabled by right clicking on the error inside the black listed group 45 11 Motion Frozen Exit Process Freeze Reset Manual 1 2 3 3 Splash Raw Sloe GPS Surface Views GS Snapshot More Database Limits Score Defaults CSMC Save Print Movie Help QGS NORMAL z STRESSMEI SA Stress Summed 2003 12 17 0927 4 STRESSMIE MFSA Stress Gater 1999 1223092 y 4 p Edit oo e wo P
41. es problems it may be necessary to disable OpenGL by unchecking this checkbox Turning off this option may adversely affect performance for some advanced visualization tasks such as viewing coronary trees In case of issues with rendering try turning off hardware acceleration first see below Note changing this setting will only affect viewports that have not been created yet i e to pages that have not been visited To apply this setting fully save the defaults and restart the application If hardware acceleration causes problems it is recommended to disable OpenGL hardware acceleration by setting this option to No A typical issue involves dual monitor setups where on the secondary display the 3D viewports appear frozen If this is the case set acceleration to No save the defaults and restart the application Note changing this setting will only affect viewports that have not been created yet i e to pages that have not been visited To apply this setting fully save the defaults and restart the application If OpenGL is enabled surfaces can be rendered with added specular reflections This adds a shiny appearance to the surfaces potentially making it easier to visually assess the shape of the surface This can be useful for isosurfaces but may also be distracting If checked the amount of specular reflection can be controlled using the Surface shininess slider Controls the amount of specular reflection or shine
42. f the NM dataset instead of a translation Rotations are performed in increments of 2 or 20 degrees depending on whether the Shift key is also pressed 7 7 Roving Window The roving window feature allows for quality control of the registration process The following describes how to use this feature on the Fusion page Note The user may wish to enlarge the images prior to performing this step using the Zoom page control 1 Inthe display area with the mouse pointer on a slice image click and hold the right mouse button A rectangular window appears containing slice data as follows a Ifthe user performed step 1 on a slice in the upper row of slices CT image the window contains slice data from the corresponding middle row slice SPECT PET image b Ifthe user performed step 1 on a slice in the middle row of slices SPECT PET image the window contains slice data from the corresponding upper row slice CT image c Ifthe user performed step 1 on a slice in the lower row of slices Fused SPECT PET CT image the window contains slice data from the corresponding upper row slice CT image W N 2 While holding the right mouse button the user can drag the window in that slice area and verify correct registration of the slices by positioning the window over the underlying slice data 8 Coronary CTA Vessels Display Lave Box Spe Pns Dique Vessels Fase Scala 18 3 gt fimo 29 3 Seil Sp zl Feel Gan If a segme
43. graphic data from each image dataset header and can be used to confirm that all relevant fields are filled appropriately 18 4 1 Raw Page The raw page displays projection datasets and can be used for quality control and review The page specific controls are Lines Sum Spin Rock Multiple Absolute Toggles motion reference lines Toggles frame summation for ungated display of gated datasets Toggles projection cine Toggles bi directional projection cine for sub 360 acquisitions with spin also enabled Toggles multiple mode When on as many datasets as can fit on the screen are displayed Toggles absolute normalization When on all datasets are scaled to the same maximum value taken across all projection datasets in the study 4 2 Slice Page Ext Process Reset Manus 1 2 3 4 Raw Ske Surface Splash Views Results Snapshot More Score Report Defaults Save Print Mowe About fans norma al ermessme Serie wao Eat B abet Contours EO Es ge smear Oae Fames Zoom A 1 A ofrone Name OGS NORMAL rap 9076543 SMS 0 STS O zwa SIRO Study STRESS wn Dataset SA Stes Gated Date 12291999 09 49 49 Volume sitt EDV Tawas Ee rant EF 1 Moa Wew in ThkEt 0 Oem 1 Eccentricity am Maru 22 x BAD mun 651K 6 59K6 59 Volume ni and Filling mV Rates PER 2 74 EDVis 1 7 PFR 2 12 EDV 5 3 PERZ 2 02 EDV s 17 4 BPM assume 60 Mise MERI LI2EDVS
44. he Grid setting is set to Vessels the Myocardium graph will also display the curves for each of the 3 main coronary blood vessels LAD LCX and RCA The values in the time activity graphs represent absolute radiotracer activity Bq ml Time sec Results Scores The bottom right side of the screen shows results for absolute flow CFR and the spill over fraction SF for each area of the Myocardium SF is the amount of radiotracer that has spilled over into the Myocardium as defined by the segmentation or contours from the blood pool region for stress and rest The SF value helps the clinician QC the technical quality of the dataset A SF value of gt 60 or 0 60 is considered to be of poor quality Str Flow RstFlow CFR StrSF RstSF LAD 218 094 246 032 0 33 LCX 0 81 095 084 030 0 30 RCA 453 081 19 032 030 TOT 170 093 41 032 0 32 9 3 Manual Processing mode for dynamic PET data sets Exit Process Freeze Reset Manual la 2 3 4 Raw Slice Surface Splash Views QPS QPC QGS Change Fusion Kinetic Snapshot More Database Phase Limits Score Defaults Default z Save Print Movie Help CFR abnormal LC ERES ca gt PET _REST_ DYNt6frames_ 2011 03 18 10 Edit Bes fr Localize Mask Constrain Align Label Orient Contours ED ES Blur Smear Gate ROI Oblique Frame 13 4 13 4 Zoom 5 4 gt Rate 16 4 Gg one o Name CFR abnormal LCX Sex MALE SS S S SDS S S SD Stud
45. he polar map labels are O O 15 Ll SMo Stress motion STh Stress thickening RMo Rest motion RTh Rest thickening The grid display mode labels are An Anterior AS Anteroseptal IS Inferoseptal In Inferior IL Inferolateral AL Anterolateral Scores can be copied from one polar score map to another by clicking in the blue area bounded by the red corner triangles and dragging to another map Similarly in grid mode click in the red box and drag to another red box 3 9 Info Box The info box displays panels of information for the displayed patient study and datasets with the exact format depending on the dataset type projection short axis etc number of datasets being A mp IL displayed and current page raw slice etc When multiple datasets are displayed the topmost dataset panel corresponds to the leftmost dataset selector The patient panel fields include Name Patient name PatID Patient ID Sex Patient sex The study panel fields include SMS Summed motion score STS Summed thickening score SM Summed motion percent ST Summed thickening percent The dataset panel fields include Study Dataset Date Volume Qc EDV ESV EF Area Mot Ext Thk Ext Eccentricity Shape Matrix Mm Vox Acquisition ID Dataset ID Date and time if available of the acquisition LV chamber volume in ml for the current frame Segmental quality score Note Scores exceeding threshold values will en
46. his feature allows manually adjusted contours and visual scores to be saved in order to avoid repeating this operator dependent step When results are saved all datasets pertaining to the study being saved are associated with the results file which becomes a self contained entity Transferring the results file without any other datasets to another system e g using a DICOM transfer mechanism on platforms supported by QGS is sufficient to retain all necessary information At this time only transfers to a system that uses the same vendor platform is fully supported though interoperability between vendors may be possible if CSMC application versions match To save results for one or more studies follow these steps Select your study ies and start your application Review the results of the study ies and adjust contours and or scores if necessary Click the Save button to open the Save Results dialog Click the Results tab to display save options See figure below If so desired enter a description in the Dataset field this field may have a different name on some platforms Click Save Current to save the currently displayed study or click Save All to save all the selected studies currently loaded As multi study or multi patient processing may not be available on all platforms on some systems Save Current and Save All will perform the same task ES A QS Save Results Results PowerPoint Dataset Results Save All Save C
47. hysician should mention any changes or no change since the patient s last visit ARG will provide a warning if no mention is made Clicking the comparison button will initialize the comparison sentence ARG matches the previous study based on patient ID Ifthe patient ID was mistyped in the original study it must be changed before ARG can auto match Of course you may also manually enter the old study date and ARG will be able to auto match any future studies For more information on editing the comparison sentence or viewing raw changes refer to the dictation section in the QARG manual Refresh Refreshes the list of codes in the database Custom Codes Custom codes are simple macros that provide a mechanism to store frequently typed sentences Codes are made up of a code key small word describing the code and code value text which is appended to the dictation Codes are accessed by highlighting the code key and clicking the Append Add button double clicking a code key or typing code key in the dictation editor Please see the Custom Code Manager section in the QARG User Manager for details regarding customization of these codes Previous Study The previous study pane gives a very informative comparison of the patient s previous studies From this pane you can view how the patient was reported in previous visits QS Extended Fields Editor Prob abnormal 10 Exercise Normal 0 0 0 Exercise 71 67 ml D mim 71 74 ml D mim 0 00 83
48. ion button to verify correct launching of the study Adding a text description beside the Action button will aid in reminding what the study was about during a presentation 49 Patient XYZ showing low EF post exercise Patient ABC showing normal EF post exercise with ischemic changes on perfusion study PowerPoint slide with Action button 14 Saving Screen Captures and Printing Snapshots of the application s screens can be saved by clicking the Print button These screen captures include the information box to the right of the main viewport but not the application controls at the top of the application s main window Screen captures can be saved either to the host system s image database if supported by the host system to a file always available or printed to a Windows printer if available On DICOM based systems snapshots are saved as true color DICOM secondary captures SC Proprietary formats may be used for other platforms but exporting screen captures as DICOM SCs is always an option when saving a file to the file system as opposed to saving to the image database To save a screen capture follow these steps 1 Select your study ies and start your application 2 Configure the screen as desired e g process the data change the selected dataset adjust the zoom factor select a different color scale etc 3 Click the Print button to open the Print dialog 4 Click the Database File or Printer tab as appro
49. is process as efficient as possible ARG includes powerful built in macros and a very stunning flexible custom code editor Append New Patient History For details on the History ECG and Recipients pane reference the QARG manual 1 at History 0 1 ECG 010 Quant uf Dictation 0 0 Header Info 0 1 Blacklist 0 0 Type Category _ Description Warning Header Info Patient s ID does not match image header No te that if QARG has not been Warning History Patient did not sign consent form purchased only the dictation screen will be visible Dictation Two powerful macros are included on the dictation editor The buttons for these macros are located directly underneath the Custom Codes title in the Dictation Editor window beside the Refresh button Auto An automatic dictation is used by default This dictation updates real time as fields are modified The automatic dictation is shown in blue Note that text can be added before or after the automatic dictation without affecting the behavior of the auto dictation You may alter or remove the automatic dictation at any time simply by editing it Note that once the automatic sentence s have been modified then the dictation will no longer be updated automatically To re enable the automatic dictation click the Auto button Comparison If the patient is returning for a follow up visit the Comparison button is enabled If this is the case then the signing p
50. isotope fields Rest Filter Tags a dataset as rest based on text strings in study dataset or isotope fields AutoMatch Tags a dataset as active based on text strings in study dataset Include isotope or matrix fields In the Dataset Editor active datasets are highlighted in yellow AutoMatch Tags a dataset as inactive based on text strings in study dataset Exclude isotope or matrix fields In the Dataset Editor inactive datasets are not highlighted DICOM When enabled the application will assume that DICOM datasets Reconstructed that are of RECON TOMO or GATED RECON TOMO image type SPECT Data but contain no view type are short axis datasets The following actions are supported OK Applies AutoMatch settings for the current QGS processing session and closes the Application Defaults screen Settings are not saved for future processing sessions Cancel Closes the Application Defaults screen without applying or saving changes Save Saves all AutoMatch settings to a file and are effective for every QGS session until changed and re saved Reset Restores the AutoMatch defaults to the factory shipped settings Using Filters to Automatically Determine Dataset Category Filters are used to automatically identify datasets as stress rest raw short axis etc A dataset is identified by a Study name and a Dataset name Carefully selecting filters to identify datasets allows the QGS application to run automatically and in a continuous manner wi
51. isplay Rate Selects the cine speed Grid Selects the grid mapping to use in defining how images should be divided into regions ungated only Function Selects which function type to display in polar maps and parametric surfaces Oblique Toggles display of transverse datasets in short axis orientation The grid mappings are Vessels LAD LCX RCA DGA Walls Apical septal lateral superior inferior 10 Segments 17 AHA or 20 segments as defined by the active segmental score model Note that grid mappings while independent of the specific dataset to which they are applied are defined in a way that is intended to be representative of most datasets The function types are Raw Raw data before any normal limits processing has been applied Severity The data in terms of its difference from a normal value Extent The data in terms of whether or not it falls within a normal range 3 1 Viewing Slices Slices are 2D cuts from short axis and transverse datasets Slice locations within datasets can be changed by dragging the corresponding slice reference lines in orthogonal views or if labeling is turned off anywhere in the viewports Slices are displayed in the standard formats short axis vertical long axis and horizontal long axis transverse sagittal coronal Rows and columns of a given slice format are always presented in standard order From left to right or top to bottom Short axis Apical to basal Horizontal long axis Infe
52. it first try to correct any other incorrectly assigned fields as this should lead to the limits field being correctly reassigned 13 3 7 Color Scale Control CIN so Reset Invert Step Gamma Expand Split Normalize le Gray Thermal Cool Warm Hot Smart Phase Phase2 Prism Linear Hotter Colder Blue Ice Multi Isocontour Rainbow Step4 Steps Step10 Step20 About The color scale control selects the current color scale and color scale mapping for displayed images The color scale mapping is defined by its lower and upper level bars both of which can range from o to 100 percent and which together specify the portion of a dataset s dynamic range that is mapped onto the full color scale Depending on the page being displayed there may be more than one color scale control for example one for surfaces one for polar maps and one for slices To change the current color scale click the color scale down arrow and select from the drop down menu To change the lower and upper level bars the color scale viewport supports these actions e Left drag either level bar to move it e Left drag any other point on the viewport to move both level bars simultaneously e Middle click or drag any point on the viewport to move the closer level bar to that point e Double left click anywhere in the viewport to reset the level bars to o and 100 The following options are also available through the drop down menu Reset Rese
53. lder The contents of this XML file look as follows lt DOCTYPE OpenGLRendererBlackList gt lt OpenGLRendererBlackList gt lt Renderer Id Implementation String 1 gt Renderer Id Implementation String 2 gt A lt Renderer Id Implementation String nn gt lt OpenGLRendererBlackList gt Where the line containing Implementation_String_x may be repeated for a variety of graphics adapters A complete line can be obtained by clicking Copy to Clipboard in the Graphics tab For the adapter in the graphics tab example above the line with the implementation string should read lt Renderer Id NVIDIA Corporation GeForce 8800 GTS PCI SSE2 gt If the setting is Yes hardware acceleration will be enabled whether the adapter s identification string is found in the blacklist file or not This can be used for testing without requiring changes to the blacklist file Highlights and shading The following figures show examples of parametrically mapped perfusion surfaces with various settings for the graphics options NOTE specular reflection and shading should be taken into account if parametric surfaces are evaluated If such surfaces are used to assess the patient s condition it is recommended to turn off parametric shading and specular reflections ls Hardware acceleration no Hardware acceleration Hardware acceleration parametric shading or
54. leftmost dataset selector controlling the leftmost or topmost displayed dataset 3 6 Dataset Edi Dataset Editor Patient tor DOB A_QGS NORMAL ANT0892286 00 00 0000 00 00 00 Female y Dataset Date Isotope Orientation Type Dimensions STRESS MIBI GATED SUMMED 1999 12 23 09 49 49 Tc 99m Supine Raw 64x64 x BA STRESS MIBI RAW REST THALLIUM RAW REST THALLIUM GATED SUMMED 1999 12 23 08 32 10 T1 201 Supine Raw 54x64x64 2 STRESS MIBI GATED RAW 1999 12 23 09 49 49 Tc 99m Supine Raw 64x64x64 2 x8 0 STRESS up GATED RAW 1999 12 23 09 49 49 Tc 99m Supine Raw 64x64x64 2 x8 REST THALLIUM GATED RAW 1999 12 23 08 32 10 T1 201 Supine Raw 64x64 x 64 z x 8 t Active Stress Rest LHR REST THALLIUM GATED RAW 1999 12 23 08 32 10 TI 201 Supine Raw 64x64 x 64 z x 8 t Active Stress Rest LHR STRESS MIBI SHORTAXIS 1999 12 23 09 49 49 Tc 99m x Supine Z ShortAx 64x64 x 23 z Stress Rest 4Hour AttC FemaleStressMB lt Auto gt Y 1999 12 23 09 49 49 Tc 99m Supine Raw 64x64 x 64 z 1999 12 23 08 32 10 TI 201 Supine Raw 64x64 x 64 2 REST THALLIUM SHORT AXIS 1999 12 23 08 32 10 TI 201 xj Supine ShortAx 64x64 x 23 z ate AC FemaleRestTl lt Auto gt y STRESS MIBI GATED SHORT AXIS 1999 12 23 09 49 49 Tc 99m Supine Y Shortax 54x64x23 2 x8 0 REST THALLIUM GATED SHORT AXIS 1999 12 23 08 32 10 T1 201 Supine Z Shonas 64x64 x 23 z x 8 t Active Stress Rest QGS AC STRESS MIBI SNAPSHOT STR
55. lgorithm to lie on the end points apex and base specified by the masking graphics Use to force valveplane to be at a specific basal position 5 1 Transverse Manual Mode E Jg slal xj Results Snapshot More Database Lat Score Repot ep See Frint Mowe About proes erg D of mass and or Consiraln Jocks LV apex and basa In addition to processing short axis datasets QGS can also process transverse datasets which often arise in PET studies automatically determining LV surfaces and reorientation angles and then displaying the results in either transverse sagittal coronal format or short axis horizontal long axis vertical long axis form In cases where the automatic LV segmentation or reorientation is unsatisfactory transverse manual mode can be used to apply corrections to both Transverse manual mode is the same as short axis manual mode with the exception that reorientation may be interactively specified by dragging the handles small blue boxes attached to the reorientation circles yellow dashed circles so that both yellow arrows point towards the apex The following page specific controls are available for transverse manual mode Align Forces the reorientation angles to be those specified using the reorientation circles Otherwise they will be automatically generated 6 Phase Analysis This feature enables phase analysis of LV mid myocardial motion and myocardial thickening It is accessed via the Phase p
56. located in the Reporting Panel of QGS or the New button on the multiple study dialog New Study Turn Reporting oi Multiple Sites x Many physician groups read studies for more than one hospital or location site ARG is designed to support multiple sites When more than one site has been configured a dialog will be displayed each time a new study is created The user must choose the site to which the patient belongs If the intended use of ARG is to support only one site then this dialog will not be displayed 10 2 Reporting Panel The ARG fields are displayed on the right hand portion of the screen These fields can be toggled on or off at any time by using the Report button located on the toolbar Patient Information Sample Patient The items listed in the patient 0123456789 information portion contain the values Test Date 1999 12 23 as contained in the database These Age 43 Sex female Site mysite values can be easily edited by clicking on the Edit button in the reporting Referring Physician Smith John DI panel Three fields that must be filled in a Type SE z by the user are the Referring Physician Physician phys1 D hd Test Type field and the Physician field 40 Function Fields AL Function fields are filled in by the reporting physician and allow a natural language sentence construction by ARG depending on the field entries Descriptions of the field entries are listed in the table
57. lors Background Change Color ARG Error Bonge coor Foreground Change Color 4ROWaming E Change Color Base Change Color Polarmap LAD Change Color Polarmap LX Change Color Text a Change Color p Polarmap RCA Change Color Button Change Color Polarmap DGA Change Color Button Text E Change Color OU Toggle Color H Change Color Light Change Color Miscellaneous Mid Light Change Color 3 Polarmap Outlines On d Dark El Change Color ARG Errors change Foreground Mid Change Color Shadow E Change Color Highlight Change Color Highlighted Text Change Color AAA Bright Text Change Color Save Cancel 10 5 raphics Setting The Graphics tab page allows the user to set certain parameters that affect the rendering of 3D surfaces In general using hardware acceleration is beneficial as the program is more responsive when surfaces are interactively rotated In some instance however there may be a degradation in image quality that may justify disabling hardware acceleration QGS uses OpenGL hardware acceleration which is available on most systems The following options are available in the graphics tab O 7 Enable 3D OpenGL hardware rendering Enable OpenGL hardware acceleration Enable specular highlights Surface shininess Enable parametric image shading If hardware rendering caus
58. me 1 Zoom5 Rate204 gt ong Name OGS NORMAL Pap 9876543 Sex FEMALE SMS 0 sg SM 0 STH O Study STRESS MIBI Dataset SA Stress Gated Date 1223 1999 09 49 49 Volume 67m 1 EH RT ESV 19814 E 75 Area 103cm 1 MotEt teen ThkEt 0 0cm 1 Eccentricity 0 81 1 Matis 4x64x 2342 x SN Wun 6 51x6 51x6 51 oo acen ae The splash page in popout mode Popout mode can be used to view only slices of interest First select the desired slices by right clicking selected slices have blue borders right click again to deselect then enable popout 4 5 Views Page Est Process Reset Manual 1 2 3 4 Ruw Sie Guixe Splash views Results Snapshot Mora Limas Score Report Dotauts Save Prit Mowe About oos ne STRESS mor 1222309990949 sl Eat lo it be Label Gor EO Gate gpn Frame 4 fm 18 Role 204 Guraceloom Functon Raw oul on dl vemo Name 045 NORMAL Patio 9676543 Ser FEMALE w n STS 0 seur o suo ew SA Swess Gated Sudy STRESS mI Dataset SA Stress Gated Date 12231090 09 40 40 Vom matt ew RI Eau mat EF 75 Aen Tee HU Mot Et 0 0cm HI TAEA o ew Eccentnieiy O82 147 Wir GANG 23M x et Wun 51 651x651 Volume ani ang Filing mus 2 ae ere O A Rates PER 2 74 EVs 11 7 PER 2 12 EDVs 15 9 PERZ 2 02 EDV s 7 4 BPM assumo 60 Misc MERO 132 EDV TIPE mis The views page displays each processed dataset
59. motion or myocardial thickening derived from the epi and endocardial surfaces Displacements and thickening are calculated along the mid myocardial normal for each interval and the resulting time dependent signals are interpolated by Fourier transform The phase and amplitude of the first harmonic are computed Phase values can be expressed in degrees deg 0 359 in milliseconds ms with heartbeat length information that is available in the dataset header assuming a default heart rate of 6obpm if the actual beat length is not available or as a percentage of the cardiac cycle duration cy 0 99 Amplitude of motion or thickening 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 gt P x log P where P x is the probability that variable X is in state x and Plog P is defined as o 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 Glob
60. n be used to launch the application from a presentation program such as Microsoft PowerPoint Save All Save Current Cancel Save Results with PowerPoint tab selected 13 1 Description of Saved Files Three files per study will be saved and have extensions of vbs gsi and xml The vbs file is a Visual Basic script file that will launch the QGS application and load the corresponding gsi data file along with the xml file containing the saved default settings for the study ies 13 2 Launching application studies from PowerPoint Studies must be saved using the procedure in the preceding section in order to use this PowerPoint feature To create a slide that will launch an application QGS study session follow these steps 1 2 Open PowerPoint and insert a new slide Under the Slide Show menu drop down select Action Buttons and choose an action button graphic from the list 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 In the Action Settings dialog click the Run program toggle 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 Click OK Launch the slide show for the current slide and click the act
61. nsistent with a normal study Edit Toggles on and off the Edit Study Information window Sign Reports must be signed by the physician entering their password prior to the Unsign signature appearing Once the study has been signed it is locked from future modifications If it is necessary to modify the study physicians may un sign the study by entering their password thus releasing the study lock However once the data is un signed and re saved the old data and corresponding report will be overwritten Report Displays the PDF report New Creates a New multiple study for this patient Extended Opens the extended editor which permits editing of the dictation history and ECG sections Capture Captures the current screen to save in report Ctrl Shift P will also capture the current screen The key combination is useful ifthe ARG Panel is not desired in the screen capture Extended Editor Extended Fields Editor The Extended editor contains areas for Dictation History ECG Recipients Previous Study dictation history ECG recipients and Summary Custom Codes pi a LAD Ja large amount of ischemia in the anterior and anteroapical walls Auto Comparison v Refresh Previous studies Each study may have a E main dictation associated with it in chest Rss addition to a history dictation The pancana dictation is free text that is included on S the report cover letter The dictation Eechen editor is designed to make th
62. nted and labeled coronary vessel dataset from CT Angiography CTA is loaded with SPECT PET perfusion or PET viability data the Vessels and Fuse 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 In Surface Views page the user can Click on Vessels label to visualize the loaded segmented coronary vessel with the 3D surface data Depending on the CTA and SPECT PET acquisition the extracted coronary vessels may need further software co registration This can be done by pressing Fuse which co registers the CTA extracted vessels to the surface and updates the fusion display Note If the patient name or patient ID is different from that of 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 33 L 9 Kinetic Page Coronary Flow Reserve The Kinetic analysis feature for dynamic PET studies allows for automated quantification of absolute stress and rest blood flow within the myocardium using algorithms specifically developed for PET Rb and N NH tracers It also allows for non invasive determination of absolute coronary flow reserve CFR The kinetic modeling method for s Rb is the 1 tissue compartment model Lortie et al EJNM 34 1765 1774 2007 Whereas the kinetic modeling method for 2N NH
63. nts to the LV segmentation algorithm in cases where the fully automatic LV segmentation fails or returns unsatisfactory results For best reproducibility the weakest possible hint or combination of hints that returns satisfactory results should be preferred These hints are provided using essentially the same interface as the slice page with masking graphics volumetric ROIs superimposed upon the slices The shape and position of the masking graphics which are initially configured to resemble an idealized LV can be changed by dragging its handles the small blue boxes To apply manual corrections the mask should first be shaped and positioned so that it encompasses the LV while excluding all extra cardiac activity before doing so it may be advisable to toggle the incorrect contours off by clicking the Contours button Then try processing with a suitable combination of hints enabled when the Process button is pressed all enabled hints are applied The available hints in order of increasing strength i e decreasing preference are Localize Restricts the initial LV search to the volume defined by the masking graphics Use if the algorithm completely missed the LV Mask Restricts the entire LV segmentation algorithm to only use data within the volume defined by the masking graphics Use to exclude extra cardiac activity e g spleen that caused contours to be distorted Constrain Constrains the long axis used by the LV segmentation a
64. on from Cedars Sinai Medical Center Cedars Sinai Medical Center reserves the right to revise this publication and to make changes in content from time to time without obligation on the part of Cedars Sinai Medical Center to provide notification of such revision or change Copyright O 2011 Cedars Sinai Medical Center Artificial Intelligence in Medicine AIM Program 8700 Beverly Blvd CA 90048 USA Property of Cedars Sinai Medical Center Disclaimer Neither Cedars Sinai Medical Center 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 Cedars Sinai Medical Center is made to the software operating the system Trademarks ADAC AutoQUANT AutoSPECT AutoSPECT Plus CardioMD CPET ENsphere Forte GEMINI GENESYS InStill JETSphere JETStream MCD AC Midas Pegasys Precedence SKYLight Vantage and Vertex are trademarks or registered trademarks of Philips Medical Systems Adobe the Adobe logo Acrobat the Acrobat logo and PostScript are trademarks of Adobe Systems Incorporated or its subsidiaries an
65. opout Clear Label Conta u Skip Zoom 4 4 Grid None Y OGS NORMAL FEMALE 1 13 Change ssso sss4 SDS 4 Seu eo SD 6 STRESS MIBI Dataset SA Stress Summed 2003 12 17 09 49 49 FemaleStressMB Volume 46ml 103m 0 59 SI 0 82 Ecc STRESS MIBI Dataset MESA Stress Gated 1999 12 23 09 49 49 FemaleStressMB e 67m 119m1 0 65 SI 0 81 Ecc This feature employs a novel technique to create cardiac motion frozen perfusion or viability images by warping all frames of ECG gated images to the end diastolic position Such motion frozen perfusion and viability images improve resolution and contrast since the blurring effect of cardiac motion is removed Reference J Nucl Med 2004 45 1128 1134 11 1 Feature Requirements The motion frozen feature requires at a minimum one processed gated short axis dataset 11 2 Implementation A typical sequence for using the motion frozen feature in the QGS application is as follows 1 User selects necessary myocardial gated short axis datasets and any other desired datasets for a standard QGS session raw projections etc and then starts an QGS session 2 The gated and ungated short axis datasets are processed as usual by QGS to generate contours 3 User verifies automatically derived contours 4 User selects the necessary gated short axis dataset s from the Dataset Selector pull down menu from 1 to 4 gated datasets depending on th
66. priate See settings sections below Fill out or select the appropriate information 5 Select labeling options See Labeling section below 6 Ifso desired enter a description in the Series Description or Dataset field this field may have a different name depending on the platform 7 Click OK to save or print the screen capture or click Cancel to cancel the task 14 1 Database Settings If saving screen captures to the image database is possible a Database tab will be part of the Print dialog Database File Printer Format DICOM SC e Transfer Syntax RLE Lossless Compression DI Warning The DICOM Transfer Syntax determines the encoding and compression of the file and therefore can significantly affect file size Not all systems support all proposed transfer syntaxes Be particularly careful when using lossy compression as this may degrade image quality Labeling Information SR OOO DT OOO OF O II Database tab of Print dialog On most systems only one format will be available DICOM SC When DICOM SC is selected as the output format a Transfer Syntax setting drop down will be available allowing the SC to be saved in a compressed mode RLE Lossless Compression On some systems known to not support compression only Uncompressed largest file size will be available Additional transfer syntaxes may be added in future versions Note that selecting a compressed transfer syntax will result in decreased storage
67. requirements but may cause problems if the file is later to be sent to another system that does not support this transfer syntax correctly Despite the warning displayed in the Database tab lossy compression is currently not available 14 2 File Settings A File tab will always be available on the Print dialog Multiple formats are always available These include TIFF JPEG PNG BMP and DICOM SC TIFF PNG and BMP offer lossless compression JPEG is always lossy compressed even with the quality setting set at the maximum value and DICOM SC is compressed only if the RLE transfer syntax is selected Database Eile Printer Filename C Documents and Settings user My Documents screen png Browse Format PNG e Format Options There are no options for this format Parra I III A A dare dd rs fe dis fe do to db oe die db das ds dae tae dae dos dae Ac ha a File tab of Print dialog Note that the Format Options panel will only display controls if the format has optional settings These settings are a Quality slider for JPEG quality can be set from 40 to 100 with 40 providing the lowest image quality and 100 the highest image quality and a Transfer Syntax setting for DICOM SC see previous section for restrictions on transfer syntaxes All output file formats except for DICOM SC shall be water marked to indicate that they are not for diagnostic purposes 14 3 Printer Settings A Printer tab will always
68. 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 o 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 17 3 Shape Index 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 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 Abstract No 500 page 176P 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 end diastolic dimension AED is found as a maximum for all 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 measu
69. ributions 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 lt A p lt P TPD 100 gt 3 score a p I 4 A Pin a 0 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 Score d p 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 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
70. ricle LV inner and outer surfaces and valve plane from LV short axis perfusion SPECT PET data with optional manual intervention e Display of short axis datasets up to 4 simultaneously projection datasets up to 16 simultaneously and screen captures Display formats include planar orthogonal slice sets surfaces parametric surfaces and polar maps e 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 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 Extended workflow functionality optimizing clinical efficiency and utility includes Integration of ARG Automatic Report Generator providing the ability within QGS 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 QGS between
71. ring the distance between the endocardial points in the identical location slice and direction where AED was found 71 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 17 4 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 17 5 Global Functions The following standard global functions are computed Volume The LV chamber volume in ml Area The mid myocardial surface area in cm 17 6 Regional Function The regional functions are computed by generating parametric surfaces within the canonical LV coordinate system 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 18 References 1 Germano G Kiat H Kavanagh PB Moriel M Mazzanti M Su HT Van Train KF Berman DS Automatic q
72. rior to superior Vertical long axis Septal to lateral Transverse Superior to inferior Sagittal Left to right Coronal Posterior to anterior The slice specific controls are Zoom Selects the slice zoom Contours Toggles contour display if processed results are available Contours are the intersection of a given slice and the computed endocardial and epicardial surfaces Blur Toggles temporal inter frame smoothing When on a 1 2 1 smoothing kernel is applied across frames Smear Toggles spatial inter slice smoothing When on a 1 2 1 smoothing filter is applied across slices 3 2 Viewing Surfaces Surfaces are 3D surface rendered images of the processed LV Surface viewpoints can be changed by dragging the image or by selecting one of the preset orientations Scale Selects the surface image scale normalized so that a scale of 1 0 fills most of the viewport Box Toggles the surface display orientation box each face of which corresponds to one of the orientation tags Spin Toggles angular inter view cine When on the surface rotates about the vertical axis 11 View Sets the display orientation Choices are anterior lateral inferior septal apical basal LAO RAO ECHO the standard echocardiographic view Note that the LAO and RAO viewpoints are intended to be representative as specific short axis reorientation angles cannot in general be recovered Surface Selects which wall surface to display inner outer both
73. rom the first study are used and are duplicated for the second study which is registered to the first Alpha Sets the opacity level of SPECT PET images on CT images in the fused image Blend section 7 5 Mouse Controls The following page specific mouse controls are available for interactive slice display Left click Left click hold sets the slice reference lines to the current mouse pointer hold drag position Dragging the mouse repositions the slice reference lines on the displayed images and updates the displayed slices Middle click Allows movement of any of the nine display images within its individual hold drag display area Releasing the middle button resets all other displayed images within their respective display areas Right click Enables the Roving window utility as described in Section o hold drag 7 6 Keyboard Controls The following page specific keyboard controls are allowed for manual alignment of mis registered NM and CT data Note User must click once in image display area to activate the keyboard controls A Moves the NM data upwards by one pixel Shift A Moves the NM data upwards by ten pixels Z Moves the NM data downwards by one pixel Shift Z Moves the NM data downwards by ten pixels Left Arrow 1 pixel left shift Shift Left Arrow 10 pixels left shift Right Arrow 1 pixel right shift Shift Right Arrow 10 pixels right shift Using the Control Ctrl key in addition to the above keys performs a rotation o
74. rozen Display and Quantification of Myocardial Perfusion J Nucl Med 2004 45 7 128 1134 73
75. s None Segments Vessels and Walls on the page control bar QS QGS D V T SPELIS Hidden 02 0 0 0 00 00 00 SHORT AXIS values WallMotion Thickening Histograms SS Regions Walls lt gt APX gt Wall motion regional displacement and velocity graphs The Region map to the left of the dialog allows the user to interactively select which curves or histograms are displayed Clicking the mouse in a region will toggle on or off the corresponding displacement and velocity graphs allowing selective viewing of graphs S QGS D V T SPELIS Hidden 02 0 0 0 00 00 00 SHORT AXIS Values WaliMotion Thickening Histograms Guides Spread _ 100 Scale _ 100 Units Degrees Regions Walls Wall motion regional phase histograms for the lateral and septal walls The histograms displayed on this dialog correspond to the Polar Map left setting of the Phase Analysis control section on the main resultspage Note a histogram will be displayed even if a distance quantity amplitude or thickening amplitude is selected The horizontal scale of such histograms is scaled to the same units as phase quantities 0 360 o duration or 0 100 depending on the units regardless of the fact that these units are meaningless for such quantities This is a known issue and these histograms should not be used until the scaling is addressed or the option to sel
76. s example filter settings shown could be used as default settings if the naming conventions were consistent among patient studies Looking at the Dataset Editor one can see that all datasets have been correctly defined as Stress or Rest and that the correct Primary datasets have been identified These filter settings will be saved by clicking OK and used in the next example where the dataset naming convention is different 61 SE Application Defaults General AutoMatch Themes Stress Filter Study str Dataset Isotopef Rest Filter Study Rest Dataset Isotopef 21 x Late Rest Filter mo Dataset s Isotope s S Primary Stress Filter Study supine Dataset Isotope Primary Rest Filter Study Dataset Isotope AutoMatch Include wg Dataset st S s Isotope Mati mAutoMatch Exclude aw s Dataset Ss Isotope Matrixf128 256 OK Cancel Save Reset AutoMatch settings Example 1 d Dataset Editor AAA AA O_O 2005 02 11 REST THALLIUM RAW 2005 02 11 STR MIBI Prone RAW 2005 02 11 STR MIBI Supine RAW 2005 02 11 24HR TL RAW 2005 02 11 REST TL Prone RAW 2005 02 11 STR MIBI Supine Stress SAX 2005 02 11 REST THALLIUM Rest SAX_S 2005 02 11 STR MIBI Prone Stress SAX_P 2005 02 11 24HR TL Rest SAX 2005 02 11 4HR TL Rest SAX 2005 02 11 REST TL Prone Rest SAX EE EE Stress Rest Ea Fr de ross set Prien Rest
77. save approximately 10MB of image data for each study essentially duplicating the patient s archive The advantage is that if a patient comes in for a repeat study ARG will be able to automatically load the study into the current session for image and results comparison The ARG Administration section provides a method within QGS to access the QARG administrative features For descriptions on the dialogs here please refer to the administration section of the QARG user manual 68 16 7 Language Settings General AutoMatch Themes Graphics Arg Language This application has been translated into several different languages Select from the list the language you prefer to see This single setting applies to the entire suite of Cedars Sinai applications You must exit and restart the application for a new language to take effect Language English D Select the language Chinese simplified English French German Japanese Spanish System Default to apply to the entire suite of Cedar Sinai application Note Application must be restarted for the new language to take effect 17 Algorithms This is a brief overview of the LV processing algorithms used in QGS 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 de
78. scribe 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 QGS For a more detailed overview see the Bibliography section in this document 17 1 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 mid myocardial surface This set of points is then used in conjunction with a set of spatial continuity constraints to 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 17 2 Normal Limits Generation and Perfusion Quantification The QGS 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 69 extract polar maps samples form the patien
79. seesrsseseesrssesessesestesestesereeseestsseseesrssesessrsesesseseesesseseeee 27 E EE ET 27 Regional values A A 27 Global valle comandada E N E daa danos 27 Phase related graphs and histogram cssssecsssssssssssseccssseecssscscssssscesscsnsssscsnsssncsnsssnsenass 27 ETA ee 20 7 10 11 12 13 Fusion Pareto 30 7 1 A AN 30 7 2 Implementation naar 30 7 3 Reviewing Images on the Fusion page ceccsssssseeseesseeseceeceseceeceseceeeseceeeeaeceaeeaeeeeeeaeenees 31 Fed Control satan es 31 75 enee 31 7 6 E eege 32 JI Rovine Osa a a a A A O O 32 Corondiy A 33 Kinetic Page Coronary Flow Reserve sa AE 34 9 1 Kinetic page reguireMentS ionni EEE EE E EE EE Es 34 Oo e TEE 34 9 3 Manual Processing mode for dynamic PET data setz 37 ARG Automatic Report Generation cccscescessessescescescescescescencesceseeseeseeseesseseeseeseeseeseeneenes 39 101 Starine OGS With ARG ana 39 KE e A A EE A0 Mi dd cea ra 40 eg Reporting Panel ardor 40 Patito dla 40 Function Held cnisia si ni enn entenas n siea eie eriet eninin los 41 VISTAS COTOS Eed 42 IT E EE 42 Reporting EE 42 Extended Editor eeprenee eoremmemncre cere err eer recta e rt eee ee tern re cere ern ee crre emt Torco ren ert etree emer 43 Consistency EE 45 Motion Fro eMA hl 46 ni Feature Regutements non nncnnn nn nnnnnnnannncnnn cnica nncnnnnnno 46 u 2 ve 46 1 3 Reviewing Motion Frozen perfusion images sccsccsscceseesececees
80. ssigning a coronary vessel to each segment By default ARG will attempt to choose the vessel based on the visual scores This can be overwritten by right clicking on a segment and selecting the appropriate vessel In some cases it is unclear to which vessel the defect belongs When this occurs select the abnormal segment in Auto 0 Reload Old Grid Times question and choose a combination of vessels Edit Panel ges Edit Study Information PR First Name Last Name Sample a 1956 12 11 a az Patient ID for 23456789 Admission No AN Study Type Stress SepDual z Testdate 19991223 y ate CTA Studyid 20 o Reporting Panel The Reload button will load the previously saved scores The Edit Panel allows editing of patient demographic data for reporting purposes only This will not change the data in the image header Note that either DOB date of birth or Age can be filled in at any given time DOB will always take precedence over age if age was originally entered Up to two physician signatures can be placed on the report The physician drop down displays all Signing Physicians as defined in the QARG database See QARG User Manual The primary physician is displayed topmost Save Normal Sign Extended The ARG action buttons shown on the Report NEN Edit Capture Le left are described in the table below Save Saves all ARG information to the database Normal Sets all blank fields to values co
81. sverse sagittal coronal format or short axis horizontal long axis vertical long axis format In cases where the automatic LV segmentation or reorientation is unsatisfactory transverse manual mode can be used to apply corrections to both Transverse manual mode is the same as short axis manual mode with the exception that reorientation may be interactively specified by dragging the handles small blue boxes attached to the reorientation circles yellow dashed circles so that both yellow arrows point towards the apex The following page specific controls are available for transverse manual mode Align Forces the reorientation angles to be those specified using the reorientation circles Otherwise they will be automatically generated 10 ARG Automatic Report Generation Exit Process Reset Manual B 2 3 4 Raw Slice Surface Splash Views Results More Database Limits A_068 NORMAL Y STRESS MIBI SHORT AXIS Contours Smear Zoom 4 4 Grid None X 1999 12 23 09 2 y at Edit Defaults Default v Save Print Movie About LEO Sample Patient 0123456789 Test Date 1999 12 23 Age 43 Sex female Site mysite Referring Physician Smith John Test Type Stress Sep Dual y Physician pnys1_y PS Perfusion Orientation Sequence Scan Findings Likelihood Scan Quality Supine Rst Str zl Late Pending Normal v Prognosis low 2 9 good e Visual TID No SSS 0 0 Es 0
82. t at es ste PO Bane Pot PST ea ANT 72 18 Eeer ege 73 1 Introduction alo xi Eit Process Reset Manual 1 2 3 4 Raw Slice Surface Splash Views Results Snapshot More Score Report Defaults Save Print Movie About Name OGS NORMAL rap 9076543 Sex FEMALE suso S18 0 SMA O SIRO Sudy STRESS en Dataset SA Stress Gated Date 1223 1999 09 49 49 Volume emt Ew asdf esv O Er 75 Area 103cm 1 Wat gemet s n o ocni Eccorteci Gm War GANA ZA Menon 6 51 6 51x651 Volume ri and Filling mis Le ae bt cat ee Rates PER 273 Diva IL PFR212EDVS 5 3 PFR2 2 02 EDW s 7 4 BPM assume 60 Mise MFRS 1 32 EDVs TTPF 18408 QGS Quantitative Gated SPECT 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 LV function It 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 e SPECT PET function e SPECT PET viability e Stress rest e Dynamic PET Coronary Flow Reserve and Absolute Blood Flow e Serial perfusion e Sestamibi thallium e Rubidium FDG e Male female e Supine prone Core functionality includes e Automatic generation of left vent
83. t 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 short axis images Creation of normal databases is described in Section 14 Perfusion Quantification The normalization factor by which the counts in the test study 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 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 dist
84. tained 7 3 Reviewing Images on the Fusion page Clicking on the Fusion page indicator on the main toolbar will bring up the Fusion page Two datasets will be displayed in the Fusion page the 1 3 and 4 display datasets options are inactive The Fusion page provides an image display area comprised of three rows and three columns The three rows starting from the top consist of NM CT and fused images respectively The three columns starting from the left comprise the orthogonal views Coronal Transverse and Sagittal respectively Visual inspection of the fused images provides an indication of the alignment between the CT acquisition and the NM acquisition Accurate alignment between the two acquisitions is necessary when applying attenuation correction of PET data using CT data The degree of misalignment noted on visual inspection will determine if repeat imaging processing is necessary Slice reference lines are provided to allow the user to change the displayed slices interactively using a mouse Mouse controls are described in section 7 5 below In addition keyboard controls described in section 7 6 below allow manual alignment of mis registered SPECT PET and CT data 7 4 Controls The following page specific controls are available Contours Turns contour display on and off Contours are the intersection of a given slice and the endocardial and epicardial surfaces obtained by QGS Note that in the change page only contours f
85. thout user intervention For example if the QGS application is capable of determining which of all the datasets selected are the stress and rest short axis datasets then selection of normal limits and generation of results is automatic If QGS is unable to determine the stress and rest short axis datasets then results may not be calculated and the user must manually set the datasets using the Dataset Selector pull down menu Definitions used in this section Study refers to the name of a dataset and typically identifies the dataset in general terms For example a dataset with a study name of Rest Thallium suggests that the data is from either a rest thallium acquisition or the data was generated from a processing procedure raw data or processed data respectively 59 Dataset refers to the name of a dataset and typically identifies the dataset in more specific terms For example a dataset name containing Raw or Short Axis suggests the dataset is raw data or processed data respectively When the two terms are use together a dataset can be uniquely identified A dataset with a Study name of Rest Thallium and Dataset name of Short Axis identifies the dataset as a set of rest thallium short axis tomographic slices The QGS application uses internal criteria to distinguish raw datasets from processed datasets and then uses the AutoMatch filter settings to determine which processed datasets are to be used for automatic processing In partic
86. ts lower and upper levels to o and 100 Invert Toggles the sense of the lower and upper levels flipping the color scale Step Toggles color scale discretization making the color scale stepped Gamma Toggles display of the gamma control which can be used to brighten or darken the color scale Expand Toggles dynamic range expansion of lower and upper levels so that the entire image may be represented using only a portion of the color scale Split Toggles individual dataset color scale controls Available only on pages with multiple datasets displayed Normalize Toggles automatic dataset normalization based on segmentation results 3 8 Score Box Score box in 20 segment mode Score box in 17 segment mode The score box is used to display and edit segmental scores in either 17 AHA or 20 segment format for function assessment The segmental scores each of which can range from o to 5 for motion and o to 3 for thickening are displayed as numbers in standard polar map format and can be changed by left right or middle clicking The score box controls are Auto Automatically generates scores from normal limits and processed results o Sets scores to zero Sets scores to unread Accept Accepts scores protecting them from further updates during processing Reject Rejects scores allowing further updates during processing Grid Toggles grid display mode When on segmental scores are displayed in a rectangular grid T
87. uantification of ejection fraction from gated myocardial perfusion SPECT J Nucl Med 1995 36 11 2138 47 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 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 147 182 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 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 photon emission computed tomography Circulation 1999 100 10 1035 1042 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 myocardial perfusion SPECT comparing 17 segment and 20 segment scoring systems J Am Coll Cardiology 2003 abstract 41 6 Suppl A p 445A Slomka PJ Nishina H Berman DS Kang X Akincioglu C Friedman JD Hayes SW Aladl UE Germano G Motion F
88. ular QGS needs to be able to identify a Primary stress and or rest short axis dataset Typically a study will contain a processed stress dataset and a processed rest dataset but QGS will work if only one processed dataset is selected and used as input Ifa study contains more than two processed datasets for example processed stress processed rest processed 24 hour delayed etc QGS will need a way to identify which two datasets are the Primary stress rest datasets The user has two methods to set the correct Primary stress rest datasets 1 Use the Dataset Editor and click the required Stress or Rest and Primary labels for the datasets to highlight them yellow Stress yellow Primary 2 Adjust the filter settings on the AutoMatch page of the Defaults Editor and let QGS select highlight the correct datasets Using method 1 the user cannot select a Primary dataset unless the Stress and or Rest label for the dataset has also been selected A further constraint is imposed using either method in that QGS will not allow two Primary Stress datasets or two Primary Rest datasets only one of each Note Using the first method the user cannot select a Primary dataset unless the Stress and or Rest label for the dataset has also been selected A further constraint is imposed using either method in that QGS will not allow two Primary Stress datasets or two Primary Rest datasets only one of each QGS along with the AutoMatch filter criteri
89. urrent Cancel Save Results with Results tab selected Note the PowerPoint tab may not be present in all software configurations 13 PowerPoint Integration 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 QGS application and loads the images and results This is useful for showing case studies within a Microsoft PowerPoint presentation PowerPoint integration is supported in Office 2000 SRia and above To save a study for showing in a PowerPoint presentation follow these steps 1 2 Nop Select your study ies and start your application Review the results of the study ies on the display page you wish to save eg Slice page and make changes as necessary intensity color scale zoom frame rate settings etc The changes applied will be automatically saved as the default setting for the study ies Click the Save button to open the Save Results dialog Click the PowerPoint tab to display save options See figure below Click Browse to select a directory to store the images and batch file Type a name in the Filename text area Click Save Current to save the currently displayed study or click Save All to save all the selected studies for the current application session 48 QSS Save Results Results Filename Browse This option allows you to save a set of images and results along with a batch file that ca
90. uses simplified 2 compartment model Choi et al JNM 34 3 488 497 1993 AVATAR E SA ATT TERA TEE POSTA A SE pr TZ Exit Process Freeze Reset Manual 1 2 3 4 Raw Slice Surface Splash Views QPS QPC QGS Change Fusion Kinetic Snapshot More Database Phase Limits Score Defaults None al Save Print Movie Help CFR abnormal PETM_REST_ DYNt6frames_2011 03 18 11 PET_REST_ DYN16frames 2011 03 18 10 4 Edit Ed E Js M Label Orient Contours ED ES Blur Smear Gate ROI Oblique Frame 13 4 134 Zoom 6 4 Rate 16 4 Grid Vessels v Name CFR abnormal LCX Pat ID Sex MALE Limits TID LHR S S SS SDS S S SD9 Study PET 1_REST_STRESS_RB82 Adi Dataset DYN16frames_STRESS_2D_ap AC Date 2011 03 18 11 08 24 Dcy Cor Unknown RPP Volume 56ml 13 120s QC 0 00 IR 0 00 Shape 0 67 SI 0 77 Ecc BPM Edit SysBP Edit Study PET 1_REST_STRESS_RB82 Adi Dataset DYN16frames_REST_2D_ap AC Date 2011 03 18 10 59 05 Dey Cor Unknown RPP Volume 39ml 13 120s QC 0 00 IR 0 00 Shape 0 69 SI 0 81 Ecc BPM Edit SysBP Edit Str Flow Rst Flow CFR StrSF RstSF LAD 2 18 0 94 2 46 0 32 0 33 LCX 0 81 0 95 0 84 0 30 0 30 RCA 1 53 0 81 1 90 0 32 0 30 TOT 1 70 0 93 1 91 0 32 0 32 9 1 Kinetic page requirements The Kinetic feature requires at a minimum one processed transverse dynamic cardiac PET dataset however for CFR results both Rest and Stress dynamic cardiac
91. y PET 4_REST_STRESS_RB82 Adi Dataset DYN16frames_STRESS_2D_ap AC Date 2011 03 18 11 08 24 Dey Cor Unknown J Volume 56ml 13 120s QC 0 00 IR 0 00 Shape 0 67 SI 0 77 Ecc Study PET 1_REST_STRESS_RB82 Adi Dataset DYN16frames_REST_2D_ap AC Date 2011 03 18 10 59 05 Dey Cor Unknown Volume 39ml 13 120s QC 0 00 IR 0 00 Shape 0 69 SI 0 81 Ecc Auto 0 Grid Accept Reject 1 Position short axis crosshairs over LV center 2 Position long axis line end points over LV apex and base 3 Position mask outside of LV 4 Select Localize limits initial LV search to mask and then process 5 If necessary reprocess with Mask disregards all counts outside of mask and or Constrain locks LV apex and base and or Align locks reorientation angles Manual mode may be used to supply hints to the segmentation algorithm in cases where the fully automatic LV segmentation fails or returns unsatisfactory results For best reproducibility the weakest possible hint or combination of hints that returns satisfactory results should be preferred These hints are provided using essentially the same interface as the slice page with masking graphics volumetric ROIs superimposed upon the slices The shape and position of the masking graphics which are initially configured to resemble an idealized LV can be changed by dragging its handles the small blue boxes To apply manual corrections the mask shoul

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