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QLAB Advanced Quantification Software

User Manual
Release 10.0

4535 617 25481 Rev A 


August 2013

© 2013 Koninklijke Philips N.V. All rights reserved. Published in USA.


Manufactured by Philips Ultrasound
22100 Bothell-Everett Highway
Bothell, WA 98021-8431
USA
Telephone: +1 425-487-7000 or 800-426-2670
Fax: +1 425-485-6080
www.healthcare.philips.com/ultrasound

This Medical Device meets the provisions of the transposition of the Medical Device Directive
93/42/EEC within the country of origin of the Notified Body concerned with the device.
European Union Representative
Philips Medical Systems Nederland B.V.
Quality & Regulatory Affairs
Veenpluis 4-6
5684PC Best
The Netherlands
WARNING
United States federal law restricts this device to sale by or on the order of a physician.
This document and the information contained in it is proprietary and confidential information of Philips Healthcare ("Philips") and
may not be reproduced, copied in whole or in part, adapted, modified, disclosed to others, or disseminated without the prior
written permission of the Philips Legal Department. This document is intended to be used either by customers, and is licensed to
them as part of their Philips equipment purchase, or to meet regulatory commitments as required by the FDA under 21 CFR
1020.30 (and any amendments to it) and other local regulatory requirements. Use of this document by unauthorized persons is
strictly prohibited.
Philips provides this document without warranty of any kind, implied or expressed, including, but not limited to, the implied
warranties of merchantability and fitness for a particular purpose.
Philips has taken care to ensure the accuracy of this document. However, Philips assumes no liability for errors or omissions and
reserves the right to make changes without further notice to any products herein to improve reliability, function, or design. Philips
may make improvements or changes in the products or programs described in this document at any time.
Unauthorized copying of this document, in addition to infringing copyright, might reduce the ability of Philips to provide accurate
and current information to users.
This product may contain remanufactured parts equivalent to new in performance, or parts that have had incidental use.
Philips Ultrasound products may be manufactured under or operate in accordance with one or more of the following United States
patents and corresponding patents in other countries: U.S. Patent Numbers 5,533,510; 5,800,356; 6,447,453; 6,447,454; 6,582,367;
6,676,606; 6,692,438. Other patent applications are pending in various countries.
"Chroma," "Color Kinesis," "Color Power Angio," "High Definition," "QLAB," and "XRES" are trademarks of Koninklijke Philips N.V.
Non-Philips product names may be trademarks of their respective owners.

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Acknowledgments
The Insight Toolkit (ITK)
Copyright © 1999-2008 Insight Software Consortium All rights reserved. Redistribution and use in source and binary forms, with or
without modification, are permitted provided that the following conditions are met:
Redistributions of source code must retain the above copyright notice, this list of conditions and the following disclaimer.
Redistributions in binary form must reproduce the above copyright notice, this list of conditions and the following disclaimer in the
documentation and/or other materials provided with the distribution.
Neither the name of the Insight Software Consortium nor the names of its contributors may be used to endorse or promote
products derived from this software without specific prior written permission.
THIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS "AS IS" AND ANY EXPRESS OR IMPLIED
WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A
PARTICULAR PURPOSE ARE DISCLAIMED. IN NO EVENT SHALL THE COPYRIGHT OWNER OR CONTRIBUTORS BE LIABLE FOR ANY
DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO,
PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER
CAUSED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR
OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE.
The Visualization Toolkit (VTK)
Copyright © 1993-2008 Ken Martin, Will Schroeder, Bill Lorensen All rights reserved.
Redistribution and use in source and binary forms, with or without modification, are permitted provided that the following
conditions are met:
Redistributions of source code must retain the above copyright notice, this list of conditions and the following disclaimer.
Redistributions in binary form must reproduce the above copyright notice, this list of conditions and the following disclaimer in the
documentation and/or other materials provided with the distribution.
Neither name of Ken Martin, Will Schroeder, or Bill Lorensen nor the names of any contributors may be used to endorse or
promote products derived from this software without specific prior written permission.
THIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS ``AS IS'' AND ANY EXPRESS OR IMPLIED
WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A
PARTICULAR PURPOSE ARE DISCLAIMED. IN NO EVENT SHALL THE AUTHORS OR CONTRIBUTORS BE LIABLE FOR ANY DIRECT,
INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT
OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON
ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING
IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE.

QLAB User Manual 4535 617 25481 3


4 QLAB User Manual 4535 617 25481
Contents

Contents
1 Read This First .............................................................................................................. 11
Intended Audience .............................................................................................................. 11
Intended Use ....................................................................................................................... 11
User Information Components ............................................................................................ 12
QLAB Software Conventions ................................................................................................ 12
User Information Conventions ............................................................................................ 13
Upgrades and Updates ........................................................................................................ 14
Customer Comments ........................................................................................................... 14
Customer Service ................................................................................................................. 14
2 QLAB Software .............................................................................................................. 15
QLAB System Requirements ................................................................................................ 16
Installing the QLAB Software ............................................................................................... 16
Before You Begin .........................................................................................................17
Verifying Your Administrator Status ............................................................................18
Installing the Current Version of the QLAB Software ..................................................18
Using Online Registration ............................................................................................19
Using Manual Registration ...........................................................................................20
Using a License File ......................................................................................................21
Saving Your Registration Information ..........................................................................22
HIPAA Compliance ............................................................................................................... 22
QLAB Q-Apps ....................................................................................................................... 23
Starting the QLAB Software ................................................................................................. 25
QLAB Images ........................................................................................................................ 25
Image Thumbnails in the QLAB Software ....................................................................26
Sharing Persistent Data ...............................................................................................26
QLAB Image Display Format Options ...........................................................................27
Displaying Images ........................................................................................................30
Image Data Scaling .......................................................................................................30
Image Scale Markers ....................................................................................................31
QLAB Toolbar Controls ......................................................................................................... 31
QLAB Cinebar ....................................................................................................................... 33
Cinebar Controls ..........................................................................................................34

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Contents

QLAB Quantification Results ................................................................................................ 36


3D Data Set Quantification ..........................................................................................37
Quantification Data .....................................................................................................37
Exporting Data .............................................................................................................37
Single-Frame Image Export .................................................................................................. 39
Exporting Single-Frame Images ...................................................................................39
Multi-Frame Image Export ................................................................................................... 40
Exporting Multi-Frame Images ....................................................................................40
Video Compression Options ........................................................................................41
Q-Assistant ........................................................................................................................... 41
System Management ...................................................................................................42
Data Locations .............................................................................................................42
Specifying Data Storage Locations ...............................................................................42
Using Q-Assistant to Configure the DICOM Settings on a PC ......................................43
Connecting to the QLAB DICOM Server .......................................................................44
Viewing DICOM Images ...............................................................................................44
Backing Up the QLAB License File ................................................................................45
Restoring the QLAB License File ..................................................................................45
3 Working with the QLAB Software .................................................................................. 47
Studies ................................................................................................................................. 47
Data Panel ....................................................................................................................47
Transferring Studies Data to Your Workstation ...........................................................48
Archiving Data to a DICOM Archive .............................................................................48
Setting CD/DVD Write Preferences .............................................................................49
Viewing ................................................................................................................................ 49
Displaying the Image Toolbar ......................................................................................50
Image Toolbar Controls ...............................................................................................50
Annotating an Image ...................................................................................................52
Capturing an Image ......................................................................................................52
Analyzing Images ................................................................................................................. 53
4 Auto 2D Quantification ................................................................................................. 55
a2DQ Fundamentals ............................................................................................................ 56
Cardiac Cycles Overlay .................................................................................................56
Color Kinesis Analysis ...................................................................................................57
Image Acquisition for a2DQ ................................................................................................. 57

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a2DQ References ................................................................................................................. 58


5 Auto Cardiac Motion Quantification ............................................................................. 61
aCMQ Fundamentals ........................................................................................................... 62
Image Acquisition for aCMQ ................................................................................................ 65
aCMQ References ................................................................................................................ 65
6 Cardiac Motion Quantification Stress ............................................................................ 69
CMQ-Stress Fundamentals .................................................................................................. 69
Image Acquisition for CMQ-Stress ....................................................................................... 70
CMQ-Stress References ....................................................................................................... 71
7 Cardiac 3D Quantification ............................................................................................. 75
Cardiac 3DQ Fundamentals ................................................................................................. 76
Image Acquisition for Cardiac 3DQ ...................................................................................... 77
Cardiac 3DQ References ...................................................................................................... 78
8 Cardiac 3D Quantification Advanced ............................................................................. 79
Cardiac 3DQ Advanced Fundamentals ................................................................................. 80
Image Acquisition for Cardiac 3DQ Advanced .....................................................................81
Cardiac 3DQ Advanced References ..................................................................................... 82
9 Mitral Valve Navigator .................................................................................................. 85
MVN Fundamentals ............................................................................................................. 86
Image Acquisition for MVN .................................................................................................. 88
MVN References .................................................................................................................. 88
10 General Imaging 3D Quantification ............................................................................... 91
GI3DQ Fundamentals ........................................................................................................... 91
Image Acquisition for GI3DQ ............................................................................................... 92
GI3DQ References ................................................................................................................ 93
11 Strain Quantification ..................................................................................................... 95
SQ Fundamentals ................................................................................................................. 96
Image Acquisition for SQ ..................................................................................................... 96
SQ References ...................................................................................................................... 97
12 Region of Interest Quantification ................................................................................ 101
ROI Fundamentals ............................................................................................................. 102
Image Acquisition for ROI .................................................................................................. 102
ROI References .................................................................................................................. 103
13 Intima Media Thickness .............................................................................................. 107
IMT Fundamentals ............................................................................................................. 107

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Contents

Image Acquisition for IMT .................................................................................................. 107


IMT References .................................................................................................................. 108
14 Cardiac Parametric Quantification .............................................................................. 111
Cardiac PQ Fundamentals .................................................................................................. 112
Image Acquisition for Cardiac PQ ...................................................................................... 113
Cardiac PQ References ....................................................................................................... 113
15 General Imaging Parametric Quantification ................................................................ 115
GIPQ Fundamentals ........................................................................................................... 115
Image Acquisition for GIPQ ................................................................................................ 116
GIPQ References ................................................................................................................ 117
16 MicroVascular Imaging ............................................................................................... 119
MVI Fundamentals ............................................................................................................. 119
Procedure for Preparing an Image for Viewing .................................................................119
Image Acquisition for MVI ................................................................................................. 120
17 Vascular Plaque Quantification ................................................................................... 121
VPQ Fundamentals ............................................................................................................ 122
Image Acquisition for VPQ ................................................................................................. 123
VPQ References ................................................................................................................. 124
18 Fetal Heart Navigator .................................................................................................. 125
FHN Fundamentals ............................................................................................................ 126
Image Acquisition for FHN ................................................................................................. 127
FHN References ................................................................................................................. 127
19 Elastography Analysis ................................................................................................. 129
EA Fundamentals ............................................................................................................... 129
Image Acquisition for EA .................................................................................................... 129
EA References .................................................................................................................... 130
20 Elastography Quantification ........................................................................................ 131
EQ Fundamentals ............................................................................................................... 132
Image Acquisition for EQ ................................................................................................... 132
EQ References .................................................................................................................... 132
21 QLAB Compatibility Tables .......................................................................................... 135
Exported 2D Images and Loops ......................................................................................... 135
Exported 2D Images and Loops: EPIQ Series Systems ...............................................136
Exported 2D Images and Loops: ClearVue 650 Systems ............................................137
Exported 2D Images and Loops: Sparq Systems ........................................................138

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Contents

Exported 2D Images and Loops: iU22 Systems ..........................................................140


Exported 2D Images and Loops: iE33 Systems ...........................................................141
Exported 2D Images and Loops: HD15 Systems ........................................................142
Exported 2D Images and Loops: CX50 Systems .........................................................144
Exported 2D Images and Loops: CX30 Systems .........................................................146
Exported 2D Images and Loops: HD11 and HD11 XE Systems ...................................147
Exported 2D Images and Loops: HD9 Systems ..........................................................149
Exported 2D Images and Loops: HD7 Systems ..........................................................149
Exported 2D Images and Loops: HD7 XE Systems ......................................................149
Exported 3D Images and Loops ......................................................................................... 149
Exported 3D Images and Loops: EPIQ Series Systems ...............................................150
Exported 3D Images and Loops: ClearVue 650 Systems ............................................151
Exported 3D Images and Loops: iU22 Systems ..........................................................151
Exported 3D Images and Loops: iE33 Systems ...........................................................152
Exported 3D Images and Loops: HD15 Systems ........................................................152
Exported 3D Images and Loops: CX50 Systems .........................................................152
Exported 3D Images and Loops: HD11 and HD11 XE Systems ...................................153
Exported 3D Images and Loops: HD9 Systems ..........................................................153
22 Index .......................................................................................................................... 155

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Contents

10 QLAB User Manual 4535 617 25481


Intended Audience Read This First

1 Read This First


The QLAB Help and the QLAB User Manual are intended to assist you with the safe and effective
operation of your product. Before attempting to use the product, read the user information and
strictly observe all warnings and cautions.
The user information for your Philips product describes the most extensive configuration of the
product, with the maximum number of options and accessories. Some functions described may
be unavailable on your product's configuration.

Intended Audience
Before you use your QLAB user information, you need to be familiar with diagnostic techniques.
Sonography training and clinical procedures are not included here.
This document is intended for sonographers, physicians, and biomedical engineers who operate
and maintain your Philips product.

Intended Use
This product is intended to be installed, used, and operated only in accordance with the safety
procedures and operating instructions given in the product user information, and only for the
purposes for which it was designed. However, nothing stated in the user information reduces
your responsibility for sound clinical judgment and best clinical procedure.
Installation, use, and operation of this product are subject to the law in the jurisdictions in
which the product is used. Install, use, and operate the product only in such ways that do not
conflict with applicable laws or regulations, which have the force of law.
Use of the product for purposes other than those intended and expressly stated by Philips, as
well as incorrect use or operation, may relieve Philips or its agents from all or some
responsibility for resultant noncompliance, damage, or injury.

WARNING
System users are responsible for image quality and diagnosis.

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Read This First User Information Components

User Information Components


The user information provided with your product includes the following components:
• QLAB User Manual: Introduces you to features and concepts, helps you set up your system,
and includes image compatibility information.
• QLAB Help: Available on the product in some languages, the QLAB Help contains
comprehensive instructions for use. It also provides descriptions of all controls and display
elements. To display the QLAB Help, do one of the following:
– Press F1.
– Click .
– Select QLAB Help from the Help menu.
• QLAB Operating Notes: Contains information that clarifies certain product responses that
might be misunderstood or cause user difficulty.
• Shared Roles for System and Data Security: Contains guidelines to help you understand how
the security of your Philips product could be compromised and information on Philips'
efforts to help you prevent security breaches.

QLAB Software Conventions


Your Philips product uses certain conventions throughout the interface to make it easy for you
to learn and use:
• QLAB quantification software icons have four states: idle, highlighted, active, and inactive.
The idle state is the default state. The highlighted state occurs when you move the cursor
over the icon. The icon becomes active when you click it. Inactive icons appear dimmed and
cannot be selected.
• QLAB quantification software menu items initiate specific operations. White, underlined
menu text is idle. Highlighted menu text is yellow. Clicking the menu text activates it and
briefly changes its color to blue.
• All icons and menu items have an associated "tooltip" that explains the function of the icon
or menu item. The tooltip appears when you hover the cursor over an active icon or menu
item. Tooltips do not appear for inactive icons.
• To enter text into a text field, click in the field and use the keyboard.

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User Information Conventions Read This First

• The left mouse button is the primary mouse button you use. (If you change the
configuration of your mouse, then the right mouse button is your primary mouse button.)
• The right mouse button is context-specific, providing a variety of functions, depending on
the location of the cursor. (If you change the configuration of your mouse, then the left
mouse button is context-specific.)

User Information Conventions


The user information for your product uses the following typographical conventions to assist
you in finding and understanding information:
• All procedures are numbered, and all subprocedures are lettered. You must complete steps
in the sequence they are presented to ensure success.
• Bulleted lists indicate general information about a particular function or procedure. They do
not imply a sequential procedure.
• Control names and menu items or titles are spelled as they are on the system, and they
appear in bold text.
• The pointer is the cursor used to select elements on the display.
• Point means to position the tip of the pointer or cursor on an item on the display.
• Click or select means to move the pointer to an object and press either the ultrasound
system selection control (see your ultrasound system documentation), or the primary
mouse button.
• Double-click means to quickly click twice to select an object or text.
• Drag means to place the cursor over an object and then click and hold while moving the
object.
• Hover means to pause the pointer over an item on the display.
• Right-click means to point at an item and then press the right mouse button, without
moving the mouse.
• Shift+click means to press and hold the Shift key while clicking an item on the display.
• Ctrl+click means to press and hold the Ctrl key while clicking an item on the display.
Information that is essential for the safe and effective use of your product appears throughout
your user information as follows:

WARNING
Warnings highlight information vital to the safety of you, the operator, and the patient.

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Read This First Upgrades and Updates

CAUTION
Cautions highlight ways that you could damage the product and consequently void your
warranty or service contract or ways that you could lose patient or system data.

NOTE
Notes bring your attention to important information that will help you operate the product
more effectively.

Upgrades and Updates


We are committed to innovation and continued improvement. Upgrades may be announced
that consist of software improvements. Updated user information will accompany those
upgrades.

Customer Comments
If you have questions about the user information, or you discover an error in the user
information, in the USA, please call Philips at 800-722-9377; outside the USA, please call your
local customer service representative.

Customer Service
Customer service representatives are available worldwide to answer questions and to provide
maintenance and service. Please contact your local Philips representative for assistance. You
can also contact the following office for referral to a customer service representative, or visit
the Philips Healthcare "Contact Us" website:
www.healthcare.philips.com/main/about/officelocator/index.wpd
Philips Ultrasound Headquarters
22100 Bothell-Everett Highway, Bothell, WA 98021-8431, USA
800-722-9377

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QLAB Software

2 QLAB Software
The QLAB software provides an environment in which you select a quantification tool;
manipulate images within the image file; tag image frames; display results as waveforms, image
loops, and reports; and export quantification results.
All QLAB quantification tools belong to individual Q‑Apps. To perform image analysis and
quantification, you load an image that has been acquired on a supported Philips ultrasound
system into a specific QLAB Q‑App. You can then use the Q‑App to obtain results based on the
type of image and the Q‑App you selected.

WARNING
United States federal law restricts this device to sale by or on the order of a physician.

NOTE
In general, the measurement accuracy of measurements performed by the QLAB software will
be ±20% of the actual value.

NOTE
Your ability to analyze images depends on the quality of the image data you intend to analyze.
Image quality is dependent on a number of factors, including the quality and grayscale standard
display function (GSDF) calibration of the reviewing monitors, the ambient lighting in the
viewing environment, and the compression applied to the image when it is exported in DICOM
format. For more information on compression options available on the ultrasound system and
other export options that affect image quality, see the documentation that accompanies your
ultrasound system.

NOTE
For accurate annotation of secondary captures, ensure that the system date and time settings
are correct. For information about viewing and changing the system date and time settings, see
your operating system documentation.

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QLAB Software QLAB System Requirements

NOTE
If the computer running QLAB software is shut down or put into sleep mode without first
closing the QLAB application, you may need to restart the QLAB application and refresh the
display to see the loaded images displayed correctly.

QLAB System Requirements


The recommended PC platform consists of the following minimum configuration:
• Processor:
– Intel Core 2 Duo
– AMD Athlon 64 X2 or greater
• Operating system:
– Windows XP Pro Service Pack 3, 32-bit
– Windows 7, 32-bit
– Windows 7, 64-bit
• Memory: 4-GB RAM
• Graphics processing unit: 64 MB or greater supporting hardware-accelerated OpenGL and
Pixel Shader 3.0
• Hard drive: 20 GB with 7200 RPM (with at least 10 GB of free space)
• Monitor: Minimum 1600 x 1024 resolution and capable of 24-bit or 32-bit color display
• Media:
– CD/DVD drive for transferring files from ultrasound systems that support CD/DVD file
transfer
– USB port for transferring files from ultrasound systems that support USB file transfer
• Mouse with a scroll wheel
• Standard Microsoft keyboard

Installing the QLAB Software


It is important that you follow the instructions for installation exactly as they are written. The
entire process must be followed in order.
If you are upgrading from a previous version of the QLAB software, the installation program
removes the previous version.

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Installing the QLAB Software QLAB Software

The installation process includes the following questions, which determine your path through
the installation process:
• Do you have the administrator privileges required for installing QLAB software on your
computer? QLAB software installation requires administrator privileges.
• Do you have network access for automatically registering your QLAB software? If you plan
to register your QLAB software automatically, the installer checks the proxy settings of the
Microsoft Internet Explorer on your computer. If those proxy settings are correct, the
registration process happens automatically. If the proxy settings are incorrect, the installer
prompts you for the proxy server address and port information.

Before You Begin


This software is furnished under license and may be copied only in accordance with the terms
of such license.
• The serial number for your copy of the QLAB software is printed on the back of the software
CD case.
• If you are installing the QLAB software on a computer connected to a network, contact your
IT department to arrange installation or to acquire the necessary administrative privileges.
• The installation process verifies that you have the appropriate support products installed. If
you do not have Microsoft.NET Framework 2.0 and Microsoft DirectX 9.0, those products
will be installed. You will receive notifications for each product requiring installation. You
must agree to the license agreement and accept the installation to be able to install and use
the QLAB software.
– Microsoft.NET is a set of software technologies for connecting information, people,
systems, and devices; it is based on building-block applications that can connect to
each other as well as to other larger applications over the Internet.
– DirectX is a Windows technology that enables higher performance in graphics and
sound when you are playing games or watching video on your PC.
• Use Western fonts when registering the QLAB software.
• If you are installing the QLAB software on a computer connected to a network and you plan
to register online, contact your IT department for your proxy server and port information.
• When you register the QLAB software, you receive a license file, which enables the core
QLAB software and the specific Q-Apps you have purchased. Philips recommends you keep
a backup copy of the license file. For more information, see “Backing Up the QLAB License
File” on page 45.

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QLAB Software Installing the QLAB Software

• If you are planning to call for your registration information, rather than registering on the
Philips website, you need to record your QLAB node ID from the registration wizard.
• The Registration Wizard dialog box includes an option for saving your registration
information to a file. Store this information on removable media such as a CD or a USB flash
memory drive in case of a hard drive or computer failure.

Verifying Your Administrator Status


Installing the QLAB software requires Windows Local Administrator privileges. If you are unsure
about whether your user account is a member of the Local Administrators group, perform the
following procedure.
1. Click Start and then Run.
2. Type cmd and click OK.
3. At the DOS prompt, type net localgroup administrators and press Enter.
A list of the users in the administrators group appears.
4. Verify that your user name is in the administrators list.
5. If your user name is not in the list, contact your IT department.
6. When you are done, click to close the window.

Installing the Current Version of the QLAB Software

CAUTION
Philips strongly recommends that you back up all data files before installing the QLAB
software.

NOTE
Close all open applications before installing the QLAB software.

NOTE
The QLAB installation program adds a QLAB icon and a Q-Assistant icon to your desktop.

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Installing the QLAB Software QLAB Software

1. Put the QLAB software CD into the CD/DVD drive of your computer. The installation starts
automatically.
If the installation does not start automatically, double-click the Setup.exe file on the QLAB
software CD.
2. Select an installation language from the list of available languages, and then click Next.
3. Read the license agreement and click Yes if you accept the terms.
4. Review the System Configuration Check results to verify that your computer meets system
requirements.
• If your computer passed the System Configuration Check, click Next.
• If your computer did not pass the System Configuration Check, exit the installation
wizard and take the indicated corrective action to bring your computer into
compliance with the system requirements.
5. Click Install.
When the installation is complete, a dialog box asks if you want to register the QLAB
software. If you do not want to register the software immediately, you can opt to restart
the computer and register the software later; however, the software must be registered
before you can use it.

Using Online Registration


After the QLAB software is installed on your computer, you must register the software with
Philips to get your license file. The registration process is required only once, upon initial use of
the QLAB software application.
You can register your QLAB software automatically or manually. The automatic method
requires Internet access; the manual method can be done either by registering online at the
Philips QLAB Software Authorization website or by contacting your Philips customer care
representative.
1. Double-click the QLAB icon to start the program and the registration wizard.
2. Select I Am Connected to the Internet and Would Like to Register Now and click Next.
3. Enter your registered user name (Title, First Name, and Last Name), and Email Address,
and click Next.
4. Enter your QLAB Serial Number, and click Next.
5. If the QLAB registration server cannot be reached, you have two options:
• Select I would like to enter proxy server information, click Next, and then enter the
proxy server address and port number, and, if needed, a user name and password.

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QLAB Software Installing the QLAB Software

• Select I would prefer to manually enter the registration codes, click Next, and then
follow the instructions in the registration wizard to obtain and enter the authorization
code and Q-App activation code.
6. To create a text file with your QLAB installation and registration information, select I would
like to back up my license file and click Finish.
7. Select a location for your back up file and click Save.
8. Click Finish.
9. To protect your license file against loss in the case of computer problems, print a copy of
the e-mail confirmation sent to you from the Philips registration server.
10. To verify the installed features after installation, click . The QLAB software displays your
software version and its activated Q-Apps.

Using Manual Registration


After the QLAB software is installed on your computer, you must register the software with
Philips to get your license file. The registration process is required only once, upon initial use of
the QLAB software application.
1. Double-click the QLAB icon to start the program.
A registration wizard starts.
2. Select I am not connected to the Internet. Tell me how to register. and click Next.
3. Select and copy the information provided as Your Node ID is: and click Next.
4. Obtain a license file using one of these methods:
• If you do not have access to the Internet, contact your Philips representative for your
license file.
• Use the QLAB Software Authorization website (https://www7.medical.philips.com/
product/qstation/qstation_registration2.aspx) to register your QLAB quantification
software and receive your license file.

5. Click , navigate to the location of the saved license file, select the file, click Open, and
then click Next.
6. To create a text file with your QLAB installation and registration information, select I would
like to back up my license file and click Finish.
7. Select a location for your back up file and click Save.
8. Click Finish.

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Installing the QLAB Software QLAB Software

9. To protect your license file against loss in the case of computer problems, print a copy of
the e-mail confirmation sent to you from the Philips registration server.
10. To verify the installed features after installation, click . The QLAB software displays your
software version and its activated Q-Apps.

Using a License File


If your registration process is interrupted, or if you are recovering from a catastrophic computer
failure, you can use the license file to activate your license. If you uninstall and reinstall the
QLAB software, you do not need to run the registration wizard; the software detects and
reloads your license information.
1. Double-click the QLAB icon to start the program.
If you are completing an interrupted registration process, go to step 4.
2. Click .
The QLAB software displays a dialog box that lists your QLAB software version and its
activated Q-Apps.
3. In the dialog box click Update Registration.
4. Select I Already Have a License File and click Next.

5. Click , navigate to the location of the saved license file, and select the file.
• The Windows 7 default location is C:\Program Files (x86)\PMS\QLAB\License.
• The Windows XP default location is C:\Program Files\PMS\QLAB\License.
6. Click Open, and then click Next.
7. To create a text file with your QLAB installation and registration information, select I Would
Like to Back Up My Registration File and click Finish.
8. Select a location for your backup file and click Save.
9. Click Finish.
10. To protect your license file against loss in the case of computer problems, print a copy of
the e-mail confirmation sent to you from the Philips registration server.
11. To verify the installed features after installation, click . The QLAB software displays your
software version and its activated Q-Apps.

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QLAB Software Installing the QLAB Software

Saving Your Registration Information


During the registration process, you can save your registration information to a file. Because
this information is needed in case of a hard drive or computer failure, save the information to
removable media such as a CD, a DVD, or a USB flash memory drive.

NOTE
Review the data safety information included in the Shared Roles for System and Data Security
document found on the product User Information CD.

The text file generated by the QLAB software registration process includes the following
information:
• Title
• First Name
• Last Name
• E-mail address
• Serial Number
• Node ID
• Authorization Code
• Q-App Activation Code
To save your registration information:
1. Prepare a CD, a DVD, or a USB flash memory drive.
2. Before you complete the registration process, select I would like to back up my license file
and click Finish.
3. Select a file location.
4. Enter a name for the file.
Ensure the file name is unique for the location.

HIPAA Compliance
In support of compliance with the United States Health Insurance Portability and Accountability
Act (HIPAA), QLAB software provides a means of stripping protected health information, such
as patient names and other direct means of patient identification, from images.

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QLAB Q-Apps QLAB Software

QLAB software hides the patient information before exporting to PC formats.

QLAB Q-Apps
QLAB quantification software provides an environment in which a variety of analysis-specific
quantification Q‑Apps can be added and used. Each Q‑App can be used independent of the
others. The conventions within each Q-App are consistent. This makes working with each
Q‑App as easy and straightforward as possible.

NOTE
Some Q-Apps may be unavailable in some countries.

Icon Q-App Name Description


Auto 2D Quantification Tools for automated border detection and Color Kinesis (CK) analysis
of 2D echo images. See “a2DQ Fundamentals” on page 56.

Auto Cardiac Motion A suite of tools organized by workflow to assess global and regional
Quantification left ventricular function. See “aCMQ Fundamentals” on page 62.

Cardiac Motion A tool that complements the aCMQ Q-App for use with 2D Stress
Quantification Stress Exams. See “CMQ-Stress Fundamentals” on page 69.

Cardiac 3D Quantification Tools for measuring distance, area, left ventricular volume, mass,
and ejection fraction from a 3D data set. See “Cardiac 3DQ
Fundamentals” on page 76.
Cardiac 3D Quantification Tools for measuring the global and regional function of the LV from
Advanced a 3D full volume data set. See “Cardiac 3DQ Advanced
Fundamentals” on page 80.
General Imaging 3D Tools for manual and semi-automated detection of 2D and 3D
Quantification features. See “GI3DQ Fundamentals” on page 91.

Mitral Valve Navigator Tools to assess lengths, distances, areas, volumes, and angles of
mitral valve and annulus structures from the Philips Live 3D TEE 3D
data sets. See “MVN Fundamentals” on page 86.

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QLAB Software QLAB Q-Apps

Icon Q-App Name Description


Strain Quantification Tools for measuring the myocardial velocity, strain, strain rate, and
displacement for selected LV wall segments in Tissue Doppler
Imaging data sets. See “SQ Fundamentals” on page 96.
Region of Interest Tools for drawing various shapes on the image and generating time
intensity curves or time velocity curves, color indices, and associated
measurements for the selected regions. See “ROI Fundamentals” on
page 102.
Intima Media Thickness Tools for measuring the intima media thickness of the posterior wall
of vessels. See “IMT Fundamentals” on page 107.

Cardiac Parametric Tools for viewing the dynamic intensity information contained in
Quantification contrast-enhanced ultrasound images as color-coded parametric
images. See “Cardiac PQ Fundamentals” on page 112.
General Imaging Tools for viewing the dynamic intensity information contained in
Parametric Quantification ultrasound images from general imaging studies. See “GIPQ
Fundamentals” on page 115.
This Q-App is not available in the United States.
MicroVascular Imaging Tools for viewing the variation in tissue signal in a dual-image
display with an unprocessed image and a processed image. See “MVI
Fundamentals” on page 119.
Vascular Plaque Tools for computing semi-automated quantification of plaques in
Quantification the carotid artery. See “VPQ Fundamentals” on page 122.

Fetal Heart Navigator Tools for manipulating a 3D data set to produce a semi-automated
evaluation of the fetal heart. See “FHN Fundamentals” on page 126.

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Starting the QLAB Software QLAB Software

Icon Q-App Name Description


Elastography Analysis Tools for comparing lesion size and for comparing the stiffness of
the whole image against one ROI. See “EA Fundamentals” on page
129.
This Q-App is only available in the United States.
Elastography Tools for comparing lesion size, comparing the stiffness of whole
Quantification elastograms, calculating strain values, and comparing the strain
values between two regions of interest in the elastogram. See “EQ
Fundamentals” on page 132.
This Q-App is not available in the United States.

Starting the QLAB Software


To start the QLAB software, double-click the QLAB icon that was placed on your desktop during
installation.
If the QLAB icon is not available on your desktop, do the following.
1. Click Start, select All Programs, and then select the QLAB folder.
2. Double-click the QLAB icon.

QLAB Images
When you open an image in a QLAB Q-App, you may want to make changes to the visual
appearance of images in the image area. The image area tools allow you to change the image
presentation to highlight information and make analysis and review easier.
You can use the cinebar to select and display full-scale images.

NOTE
If you open an image in which you expect to see annotations that were placed on the image
during acquisition, those annotations may not transfer to the Q-App image view. Review the
image carefully to note the anatomy and orientation before performing quantification.

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QLAB Software QLAB Images

NOTE
The QLAB software will not load an image into a Q-App if the color depth is insufficient.

Image Thumbnails in the QLAB Software


Thumbnails provide the following information:
• Thumbnails with the Q icon represent images that can be opened with the QLAB software.
• Thumbnails without the Q icon represent images the QLAB software cannot open.
• Thumbnails with the cineloop icon represent multi-frame cineloops. For example, image 34
represents a cineloop with 147 frames.
• Thumbnails without the cineloop icon represent single-frame images.

Image Thumbnails

Sharing Persistent Data


Persistent data is associated with the measurements and quantification results applied to an
image. When individuals create persistent data, it is associated with the specific QLAB software
installation. The persistent data location can be set to make it available for individual
management or group collaboration.
When you set a new location for the persistent data stored for QLAB software results, be aware
of the following issues:
• The users must all have read/write access to the location.

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QLAB Images QLAB Software

• Generally, the images will also be stored on the same shared location.
• If users can delete images from the shared location, ensure that either the Recycle Bin
option is turned off or that the Recycle Bin is emptied regularly.
To share persistent data:
1. Click .
2. In the Preferences dialog box, click the System tab.
Click Persistent Data Path.
3. Click Browse.
4. Navigate to the drive and folder you want to use for storing persistent data.
You can create a new folder if the location does not exist.
5. Click OK and then click OK again.
6. To close the Preferences dialog box, click OK.

QLAB Image Display Format Options

Full Screen View


When the image is a single view, most 2D Q‑Apps open the file as a full-screen image. Some
Q‑Apps then support using a different presentation mode for the image data. Images acquired
in other presentation modes may retain that presentation in the Q‑Apps viewer. Not all
presentation modes are compatible with quantification in QLAB software Q‑Apps.

Dual View
Some Q‑Apps use a dual presentation and some Q‑Apps support a dual image acquisition. The
MVI and Cardiac PQ Q‑Apps present data in a dual view but the information in the two images
is not based on an orthogonal view of the acquisition data. ROI supports dual images for
comparing data points on a waveform. The EA and EQ Q‑Apps display elastography images side
by side for comparison and analysis.

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QLAB Software QLAB Images

The MVI Q‑App provides two views of the image data. The left image pane shows the
unprocessed image. The right image pane shows the processed image.

The Cardiac PQ Q‑App presents a full-frame image and the ECG groups in the data. The image
pane shows the full-frame image. In both the Cardiac PQ and GIPQ Q‑Apps, the generated
parametric images are superimposed on the image pane.

Quad View
The Cardiovascular 3D viewer and the General Imaging 3D viewer support a quad view of the
image data. Generally, the top row and the left side of the bottom row represent orthogonal
planar views of the data; the fourth image presents a volume view in one of several
presentation types. The volume view can be a 3D volume, a plane view, slices, or
representational. A plane view presents the volume using flat, intersecting planes reflecting the
data shown in the MPR views. Thick slice appears slice by slice; iSlice displays an array of slices
(depending on the grid settings).

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QLAB Images QLAB Software

Expanded View
The Expanded view presents the four views with one view in a substantially larger view next to
a column of the other three views. The large image can be any one of the four views from the
Quad image view. When the large image is the volume view, it can be any of the available
rendition formats for the volume view.

iSlice View
The iSlice view presents the data as a series of slices, similar to a CT slice view of the data. You
can manage the number of slices shown, the thickness of the slices, and the range of image
data included in the slices.

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QLAB Software QLAB Images

Displaying Images
You can use the cineloop frames to select and display full-scale images in the image area. The
active frame is outlined in yellow.
1. Click a frame in the cineloop sequence to display the image in the image area.
2. To adjust the image view, use the “QLAB Toolbar Controls” on page 31.
3. To edit or play the cineloop, use the “Cinebar Controls” on page 34.

Image Data Scaling

Decibel Scale
The decibel (dB) scale is derived from the acoustic intensity units provided by the ultrasound
system. Since the decibel data is derived from pre-scan-converted, native data, many
ultrasound system parameters applied as post-processing steps do not affect the quantification
results. For example, color maps or gray maps are applied as post-processing steps, and they do
not affect the intensity scaling.

Velocity or Frequency Scale


The velocity or frequency scale is used when color Doppler velocities or frequencies are
contained in the native data files. This typically is the case in color flow or Tissue Doppler
images. When velocity or frequency scale data is not available, as in DICOM files, the intensity
scale is used.

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QLAB Images QLAB Software

Intensity Scale
The intensity scale is a generic scale that maps the entire range of intensities (provided as R, G,
B triplets) found in the image between 0 and 255 intensity units. The formula for calculating
intensity is (R+G+B)/3. The maximum range of 0 to 255 is used for both grayscale and all color
image types. Because the intensity scale is based on color triplets, it is dependent on many
factors such as the gray map or color map, the compression or dynamic range, and the gain
setting. Use the intensity scale carefully, because many changes in the appearance of the
ultrasound image affect the quantification results.
The intensity scale is also the default scale used if more accurate data cannot be found in the
image file. For example, if color velocity data is found, the color flow results may be displayed in
cm/s and have a range that covers both negative (away from the transducer) and positive
(toward the transducer) flow or motion. If the intensity scale is used, no negative values are
calculated, and no flow information can be derived.

Image Scale Markers


In general, image scaling information is available in the image file header. The QLAB
quantification software requires the scaling data to perform quantification on the selected
image file. If the image scaling information is not available in the file header, quantification is
not possible. Therefore, the quantification Q-App icons are not shown in the QLAB window. It is
still possible to review the images and to create an AVI file or a BMP file.
DICOM images have image scaling markers incorporated into the image data.
The QLAB software displays the image scaling information as an image overlay and provides
you with an image scaling legend. Image scaling markers appear along the right side of the
image display. The image scaling legend appears in the lower right of the image display. The
image scaling legend is limited to 0.5 mm, 1 mm, 5 mm, 1 cm, and 5 cm.

QLAB Toolbar Controls


QLAB toolbar controls appear as icons on the right side of the control panel.
Not all toolbar controls are available for all image types.

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QLAB Software QLAB Toolbar Controls

Control Description
Selects an image

Adjusts image contrast and brightness

Zooms an image

Inverts the image left or right

Inverts the image up or down

Pans the image

Allows you to navigate through a volume

Allows for in-plane rotation

Allows for out-of-plane rotation

Sculpts an image

Erases image sculpting

Displays the selected image in full-screen layout

Switches to quad-screen layout

Switches to expanded-screen layout

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QLAB Cinebar QLAB Software

Control Description
Displays frame 1 in full-screen layout

Displays frame 2 in full-screen layout

Displays frame 3 in full-screen layout

Displays frame 4 in full-screen layout

Resets the orientation of the selected image

Resets the orientation of all images

Shows or hides image color

Shows or hides image echo

Adjusts image blending

QLAB Cinebar
The QLAB quantification software provides a set of cinebar controls for navigation through
image sequences. Images are displayed as thumbnail frames in a loop. The cinebar allows you
to play an image sequence, tag frames, and jump forward and back to tagged frames. This helps
you find and review relevant image frames easily and quickly.
In several Q-Apps, you can show and hide the cinebar. The presentation of the toolbar may vary
between the QLAB viewers.

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QLAB Software QLAB Cinebar

QLAB Cinebar

The frame number is displayed in the upper right corner of the cinebar, with the total number
of frames in the loop. For example, 4/14 indicates that the frame is the fourth out of a total of
14 frames in the loop. The current frame is outlined in the frame boxes above the cinebar, and
the contents of the frame are displayed in the image area. Timing information appears next to
the image number and total images. For example, 0.22s/0.96s indicates that the current frame
occurs at the 0.22-second point in the 0.96 second of the entire cineloop.
When using the keyboard arrow keys to scroll through the frames in an acquisition, the loop
does not automatically jump to the first frame after the last frame is viewed. Use the on-screen
controls to jump back to the first frame.

Image Thumbnails
For some Q-Apps, image thumbnails are displayed in the frame sequence above the cinebar
controls. For example, in the ROI Q-App, a thumbnail image of each frame is displayed to allow
easy navigation to frames of interest.

Image Thumbnails

Cinebar Controls
The cinebar controls appear as icons. Some controls appear when the loop is playing. Some
Q‑Apps enable additional controls. The cinebar controls are used for the following functions:
• Playing and pausing loops
• Jumping to frames
• Tagging frames
• Cutting and restoring frames
• Trimming the loop

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QLAB Cinebar QLAB Software

Icon Name Description


Cut all frames except Removes the frames in the image sequence that do not match the ECG timing of
those at the selected the currently selected frame.
ECG timing
Cut Frame Removes the currently selected frame, and restores individually cut frames.

Decrease Play Speed Decreases the replay speed.

Go To First Frame Selects the first frame in the loop.

Go To Last Frame Selects the last frame in the loop.

Go To Next Heart Selects the next heart beat in the loop. This control is available only in multi-
Beat beat loops.
Go To Next Frame Selects the next frame in the loop.

Go To Next Tagged Selects the next frame in the loop tagged as a frame of interest, such as an ECG
Frame R-wave or a flash frame.
Go To Previous Heart Selects the previous heart beat in the loop. This control is available only in
Beat multi-beat loops.
Go To Previous Selects the previous frame in the loop tagged as a frame of interest, such as an
Tagged Frame ECG R-wave or a flash frame.
Go To Previous Selects the previous frame in the loop.
Frame
Increase Play Speed Increases the replay speed.

Mark First Frame Cuts the loop and starts at the selected frame.

Mark Last Frame Cuts the loop and ends at the selected frame.

Play Replays the loop repeatedly.

Play Once Replays the loop once.

Pause Stops the loop replay.

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QLAB Software QLAB Quantification Results

Icon Name Description


Reset to Default Selects the default heart beat in the loop. This control is available only in multi-
Heart Beat beat loops.
Restore All Cut Recovers all cut frames.
Frames
Tag ED Tags the selected frame as the end-diastolic phase.

Tag ES Tags the selected frame as the end-systolic phase.

Tag R-Wave Tags the selected frame as a frame with an ECG R-wave.

QLAB Quantification Results


After you have optimized your views, worked with the images, performed your measurements,
and obtained your calculations, you can save and export the data set.
There are two ways to store measurement and calculation data:
• You can export measurement and calculation values that appear in the Results panel. Those
results can be used in presentations and notes.
• You can store measurements and calculations as persistent data when you exit the
quantification Q‑App. These results are linked to and used with the image on which they
were made.

Export Data
When you export the QLAB quantification results from a quantification Q‑App, the following
information is included in the Microsoft Excel format output file:
• Image file name
• Image file type
• Image date and time
• Quantification Q‑App name
After the heading information, the results are displayed as columns of data. The results
exported depend on the measurements and calculations in the Results panel of the
quantification Q‑App.

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QLAB Quantification Results QLAB Software

Persistent Data
When exiting a Q‑App, you have the option to save your measurements and calculations as
persistent data. When the image is opened again, QLAB software loads this persistent data to
retrieve the measurements and calculations.

WARNING
Be aware that, when exporting multi-image AVI object files from the QLAB quantification
software, the compression chosen may result in data loss, making it inappropriate to use
these images for clinical diagnoses.

NOTE
In general, the accuracy of all measured quantification results for the QLAB software will be
±20% of the actual value.

3D Data Set Quantification


The interpretation and analysis of 3D ultrasound image data is subject to similar issues as 2D
data, but it is compounded by the extra dimension involved. Pay careful attention to the
anatomic relationships of salient features in the data. The orientation of the transducer during
a 3D acquisition is critical to ensure accurate measurement and interpretation. It is possible,
when adjusting 2D and 3D views of the volume data, that the views no longer correspond to
the orientation providing familiar landmarks. As the views change, pay careful attention to the
changes in the relative positions of features in the volume.

Quantification Data
You can save and export quantification results at any time without exiting the quantification
Q‑App. Exporting the results and updating persistent data allows you to save the quantification
conditions for future reference.

Exporting Data
Alphanumeric and waveform quantification results are stored in a tab-delimited text format
with the .xls file extension.

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QLAB Software QLAB Quantification Results

NOTE
Measurement values from some Q-Apps can also be stored in DICOM SR format.

Exported .xls files include information about the source of the data, including patient data, if
Hide Patient Data is not selected. That information includes the following:
• File name
• File type
• Patient name
• Patient ID
• Image date and time
• Q-App name

NOTE
While exporting loops, do not pause the cineloop playback. The playback cannot be stopped
until the export is complete.

1. Optimize your image, perform the measurements, and generate the quantification results
you want.
2. Click .
3. Select the folder to which you want to save the file.
4. Enter a new file name, or use the default file name.
Ensure the file name is unique.
5. Click Save.
The results are saved to the folder you selected, under the file name you specified, and the
persistent data file is updated.

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Single-Frame Image Export QLAB Software

Single-Frame Image Export


You can select an image frame and save it as a single-frame image file. Single-frame image file
formats provide varying degrees of compression. Find the balance between the degree of
compression required to preserve disc space, and the degree of data loss that can be
accommodated without losing precision. The QLAB quantification software supports the
following PC formats for exporting single-frame image files:
• The bitmap (BMP) files exported from the QLAB software consist of a bit depth of 32 and a
resolution of 96 dpi. The bit depth gives you detail at the expense of file size.
• The TIFF files exported from the QLAB software consist of a bit depth of 24 and a resolution
of 1 dpi. TIFF files provide a great deal of detail with a high level of compression as they
handle the image resolution differently than either BMP or JPEG files.
• The JPEG files exported from the QLAB software consist of a bit depth of 24 and a resolution
of 96 dpi. The bit depth gives you a balance between file size and compression.
• The DICOM Secondary Capture (DCM) files exported from the QLAB software consist of a bit
depth of 24 and a resolution of 96 dpi.
The default directory for saved images is the Results folder in the QLAB installation directory.

NOTE
QLAB software removes the patient data from exported images and data sets.

Exporting Single-Frame Images


To save an image frame as a single-frame image file:
1. Display the frame that you want to export.
2. Click .
3. Select the folder to which you want to save the file.
4. Select the image file type.
5. Enter a new file name, or use the default file name. Ensure the file name is unique.
6. Click Save.
If an image file export error occurs, an error message suggests a solution.

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QLAB Software Multi-Frame Image Export

The image is saved as an image file of the type you selected, to the folder you selected,
under the file name you specified.

Multi-Frame Image Export


You can export multi-frame data files as an audio visual interleave (AVI) file or as a multi-frame
DICOM Secondary Capture image.
You can export an image loop as a multi-frame image file. AVI files can be uncompressed or
compressed. If you have trimmed frames from the loop, it is best to select a different play
speed. The play speed controls the number of frames per second of the AVI file playback speed.
There is a specific interaction between the frame intervals of triggered images and the play
speed of an AVI file. In most cases of triggered acquisition, or in cases where multiple frames
have been cut, it is probably best to select one of the alternate play speeds (5, 10, 20, or
30 fps), rather than using the real-time play speed. Real-time play speed can be used for
continuous image sequences.

WARNING
Be aware that, when exporting AVI files from the QLAB quantification software, the
compression chosen may result in data loss, making it inappropriate to use these images for
clinical diagnosis.

Exporting Multi-Frame Images


1. Select the image frames that you want to save as a cineloop sequence.
The cineloop sequence will be created from every valid frame.
2. Click .
3. Select the folder to which you want to save the file.
4. Select AVI or DICOM Secondary Capture as the file type.
5. Enter a new file name, or use the default file name.
Ensure the file name is unique.
6. Click Save.
• If you selected DICOM Secondary Capture as the file type, the images are saved.

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Multi-Frame Image Export QLAB Software

• If you selected AVI as the file type, the Video Compression dialog box appears (see
“Video Compression Options” on page 41). After you have set the compression
options, click OK. The images are saved.
If an image file export error occurs, an error message suggests a solution.

Video Compression Options


You can create an AVI file from a multiple-frame image file. The Video Compression dialog box
lists the compression codecs that are currently installed on the PC. Some of the codecs are
incompatible with the standard PC presentation programs and should not be used. Philips
recommends using the Cinepak Codec by Radius to provide compressed AVI files. The full-
frame, uncompressed option provides excellent AVI image quality, but results in extremely
large image file sizes.
Select a higher video compression quality setting to ensure quality reproduction of the
graphical information in your cineloop sequence.
Check the codec requirements of your presentation software to confirm which codec will
provide the best playback quality.

WARNING
Be aware that, when exporting AVI files from the QLAB quantification software, the
compression chosen may result in data loss, making it inappropriate to use these images for
clinical diagnoses.

Q-Assistant
Q-Assistant is the configuration application for the QLAB software. This separate application is
installed when you install the QLAB software.

NOTE
To run Q-Assistant, you must be a member of the local administrators group and the
PMWHospitalITUserGrp.

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QLAB Software Q-Assistant

Use Q-Assistant to do the following:


• Configure basic system management settings. See “System Management” on page 42.
• Configure directories and local devices for QLAB data storage. See “Data Locations” on page
42.
• Configure DICOM settings for connections to ultrasound systems. See “Using Q-Assistant to
Configure the DICOM Settings on a PC” on page 43.
• Back up and restore your license file. See “Backing Up the QLAB License File” on page 45
and “Restoring the QLAB License File” on page 45.
• Collect logs.

System Management
The System Management tab in Q-Assistant lets you specify system information such as audit
server and language settings, specify locations in which to store QLAB data, and back up and
restore the QLAB license file.

Data Locations
In the Media/Store section of the Q-Assistant System Management tab, you can specify local
folders, network shared storage areas, and local storage devices as QLAB data locations.

Specifying Data Storage Locations


The storage directories that you specify in QLAB Data Locations appear in the Local Data area
of the QLAB Studies tab.
1. To start Q-Assistant, double-click the Q-Assistant icon on your desktop.
2. In Q-Assistant, click the System Management tab.
3. Click Media/Store.
4. To add a directory for QLAB data storage, in the QLAB Data Locations panel, click Add and
then browse to a local directory or network share and click OK.
5. Do one of the following:
• To activate the new data location immediately, click Activate Now.
• To specify additional data locations or local storage devices, click Activate Later.
6. To activate additional data locations, repeat step 4.
7. To add a USB drive as a local storage device, connect the USB drive to a USB port on the
QLAB computer.

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Q-Assistant QLAB Software

NOTE
FAT-formatted and NTFS-formatted USB drives are supported for QLAB data locations.

8. To configure a CD/DVD drive or a USB drive as a local storage device, in the QLAB Local
Devices panel, select the drive letters that correspond to the CD/DVD and USB drives on
the QLAB computer.
9. Click Save.
When you activate new directories, Q-Assistant restarts.
10. When prompted, click Activate Now.
When you activate new storage locations or local storage devices, Q-Assistant stops and
then restarts.

NOTE
If the QLAB software is open when the Q-Assistant software restarts, the QLAB software closes,
and you must manually restart it.

Using Q-Assistant to Configure the DICOM Settings on a PC


You can use the QLAB DICOM storage server to store images sent from an ultrasound system.

NOTE
In some network environments, you can use host names instead of IP addresses to configure
DICOM access.

1. Follow the instructions in your ultrasound system user information to gather the following
information from the ultrasound system:
• AE Title
• Port Number
• IP Address
2. To start Q-Assistant, double-click the Q-Assistant icon on your desktop.
3. In the Q-Assistant dialog box, click the Network/DICOM tab.

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QLAB Software Q-Assistant

4. Click the DICOM Settings tab.


5. Write down the settings for the following fields in the QLAB DICOM Settings panel at the
top of the dialog box:
• AE Title
• Port Number
• IP Address
You will need to enter this information when you configure a DICOM server on the
ultrasound system.
6. In the DICOM Services Configuration panel, click Add.
7. In the Device Name field, enter a descriptive name for the ultrasound system.
8. In the AE Title field, enter the ultrasound system's AE Title.
9. In the Port Number field, enter the ultrasound system's DICOM Port Number.
10. In the Network Address panel, select one of the following:
• Host Name (IPv4 or IPv6): You can use this setting if your network supports use of host
names.
• IPv4 Address: Use this setting if your network does not support use of host names, or
your ultrasound system does not support IPv6 format.
11. Enter the host name or IP address in the field you selected in the previous step.
12. Follow the instructions in your ultrasound system user information to enter the following
information from the QLAB DICOM storage server:
• AE Title
• Port Number
• IP Address

Connecting to the QLAB DICOM Server


1. Follow the instructions in your ultrasound system user information to configure the system
for DICOM storage server operation.
2. Before you start the exam, ensure that your QLAB DICOM storage server is added to your
ultrasound system setups. In your QLAB DICOM storage server setups, note your PC IP
address, the port numbers, and AE titles for the active and enabled DICOM storage servers
you intend to configure.

Viewing DICOM Images


After images are sent to the DICOM storage server, you can use the QLAB software to view the
images on your PC. The images will be in the folder defined in the DICOMServerUI dialog box.

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Q-Assistant QLAB Software

Backing Up the QLAB License File


You can create a backup copy of your license file during QLAB software registration (see “Saving
Your Registration Information” on page 22). After you have completed the software
registration, you can use Q-Assistant to back up the QLAB license file at any time.
1. To start Q-Assistant, double-click the Q-Assistant icon on your desktop.
2. In Q-Assistant, click the System Management tab.
3. Click Backup/Restore.
4. Select Backup To.
5. Click Browse and select a location to which you want to back up the license file.
6. To start the backup, click Backup. When the backup is complete, a notification message
appears.

Restoring the QLAB License File


In the Q-Assistant software, you can restore the QLAB license file from a backup location.
1. To start Q-Assistant, double-click the Q-Assistant icon on your desktop.
2. In the Q-Assistant software, click the System Management tab.
3. Click Backup/Restore.
4. Select Restore From.
5. Click Browse and select the location from which you want to restore the license file.
6. Click Restore.
When the restoration is complete, a notification message appears, and Q-Assistant restarts.

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Studies Working with the QLAB Software

3 Working with the QLAB Software


This section guides you through procedures commonly used when working with the QLAB
software to analyze patient study data. These procedures include importing and exporting
patient study data, reviewing images, and performing advanced quantification.

For instructions on using the QLAB software, click while you are using a Q-App.

Studies
The Studies tab provides an overview of patient study data stored locally, and allows you to
access patient study data stored on remote data sources.
To open patient study data for processing, the data must reside in the local Studies database.
To add data to the Studies database, you must import patient study data from another source,
such as a CD/DVD drive, a USB storage device, a user-selectable repository, or a remote data
storage location.
After importing patient study data into the Studies database, you can open the data for
processing. After processing, you should export the data to a DICOM archive.

NOTE
You can sort the studies list by clicking the heading of any column. You can reorganize columns
by dragging them to the preferred position.

Data Panel
The Data panel displays data locations that are available to you. The panel is divided into two
sections: Local Data and Remote Data.
• Local Data provides access to the Studies data storage location, which is the database
where patient study information is stored on your workstation. The Local Data section also
provides access to studies stored on CD/DVD drives, USB storage devices, and one or more
User Selectable Repository locations on local or network disk drives.

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Working with the QLAB Software Studies

• Remote Data provides access to data storage locations on workstations or a PACS


connected to your network. You can copy data from remote locations to work with it on
your local workstation. You can copy data to remote data storage locations for archiving.
If you are working with more than one local data location, you can right-click the location
you want to view and add it to the display as a new tab. To close a tab, right-click the tab
and select Close.
If you want additional display space, you can close the Data panel by clicking the X in the upper
right corner, or by clicking Data on the View menu. To reopen the Data panel, click Data on the
View menu again.

NOTE
The Free Space indicator at the bottom of the Data panel compares the amount of unallocated
database space with the amount of free space on the hard drive and displays the lesser of those
values as an indicator of the amount of space available for storing data in the Studies database.

Transferring Studies Data to Your Workstation


1. In the Data panel, select the data location from which you want to transfer patient data.
2. Select the data you want to transfer. You can select:
• One or more images or reports from a single study
• One or more studies from the Studies list
3. Drag the selected data to the Studies data location.

NOTE
You can also use the Copy and Paste commands to transfer data.

Archiving Data to a DICOM Archive


1. Select the data you want to archive. You can select:
• One or more images or reports from a single study
• One or more studies from a single patient
• One or more patients from a Patients list (all data for each patient is archived)

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Studies Working with the QLAB Software

2. Drag the selected data to the destination DICOM archive in the Remote Data section of the
Data panel.

NOTE
You can also use the Copy and Paste commands to transfer data.

Setting CD/DVD Write Preferences


Before writing to a disc for the first time, set the CD/DVD write preferences. You can then use
the same settings each time you write patient data.
1. On the Tools menu, click Customize CD/DVD Write Preferences.
2. Configure the settings and then click Save.

Viewing
Use the View tab to view and measure images, to play loops from stress echo and non-stress
echo studies, to select subloops, and to perform wall-motion scoring on stress echo studies.
You can view both single-frame images and loops (a sequence of images).
The View tab incorporates the pictorial index, which you use to select images for viewing.
Images that are currently open for viewing are highlighted in blue in the pictorial index. To
delete one or more images from a study, right-click the selected pictorial or group of pictorials,
and then click Delete.

NOTE
The image Delete operation does not have an "undo" feature.

You can make adjustments to the displayed images by using tools provided on the View tab.
Menu commands and tools on the main toolbar affect all images. Tools on the image toolbar
affect only the image with which you are working.

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Working with the QLAB Software Viewing

Displaying the Image Toolbar


The image toolbar contains tools that let you adjust the view of an image, select subloops,
make basic unlabeled measurements, and annotate the image.
To display the image toolbar, click on the upper right corner of the image.

Image Toolbar Controls


Control Description
Selects the image.

Scrolls the image.

Adjusts contrast and brightness.

Zooms the image.

Pans the image.

Displays subloops (stress echo images only).

Displays the next subloop (stress echo images only).

Displays the previous subloop (stress echo images only).

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Viewing Working with the QLAB Software

Control Description
Sets a subloop as the preferred loop (stress echo images only).

Displays the measurement tools.

Enables you to draw a line.

Enables you to draw an angle.

Enables you to draw an open contour.

Enables you to draw a smoothed polygon.

Enables you to draw a closed contour.

Enables you to draw an arrow with an annotation.

Resets the image viewing settings.

Captures the image and appends it to the study. (This control is


available when a loop is playing; however, it only captures and
appends the frame that was active at the time of the mouse click.)

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Working with the QLAB Software Viewing

Control Description
Displays image information.

Plays a loop. Available only when Sync Mode is set to Free Run.

Pauses a loop. Available only when Sync Mode is set to Free Run.

Enables you to draw a mask over the patient information.

Annotating an Image
You can add an arrow with a text box to an image. Annotations can be added only to single-
frame images or to frames with within a loop.
1. To display the image toolbar, click .
2. Click .
3. Click on the image to place the arrow, and click again to display the text box.
4. Type the annotation in the text box and click to complete the annotation.
5. To edit the annotation, put the cursor in the text box and type changes.

Capturing an Image
When you capture an image, it is appended to the study as a JPEG-compressed DICOM image.
The icon appears on captured images in the pictorial index.
1. To display the image toolbar, click .
2. Click .

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Analyzing Images Working with the QLAB Software

Analyzing Images
From the Studies tab, you can load an image into a QLAB Q-App for analysis. For information
about working with the Studies tab, see “Studies” on page 47.
1. Select a study in the main Studies list at the top of the Studies tab.
2. Select a study in the Patient Folder study list. By default, the most recent ultrasound study
is selected when you select a single study in the Studies list.
3. Right-click an image on the Series tab of the Patient Folder.
4. Click Analyze With, and then click the name of the Q-App you want to use.
5. For instructions on using the QLAB software, click while you are using a Q-App.

NOTE
Some Q-Apps, such as a2DQ, aCMQ, and CMQ-Stress, allow you to open multiple images at the
same time. To open multiple images, press and hold the Ctrl key, click all the images you want
to open, and then right-click one of the selected images and click the Q-App name in the
Analyze With menu.

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Working with the QLAB Software Analyzing Images

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Auto 2D Quantification

4 Auto 2D Quantification
The Auto 2D Quantification (a2DQ) Q-App provides an Auto ROI feature, which can produce
automated border detection and Color Kinesis (CK) analysis of 2D echo images.

NOTE
Automated border tracking depends upon having sufficient tissue/blood contrast around the
myocardial segments being scanned in the current view. Typically, there should only be mild
dropout of one segment in the current view for the application to perform acceptable tracking.

If you prefer to draw or edit the ROI manually, this Q-App provides Draw and Edit controls.
Images can be single-plane 2D or BiPlane images.
The Auto Tissue Motion Annular Displacement (aTMAD) workflow uses an automated method
based on angle-independent tracking to track the motion of the annulus in relation to the apex
of the ventricle throughout the cardiac cycle.
Anchors placed on a two-chamber or four-chamber view of the heart mark the annular ring and
the apex of the ventricle. Automated tracking applied to all frames in the image loop tracks the
location of the midpoint of the annulus through the entire loop. Using ECG information, the
analysis results in frame-by-frame evaluations of the positions of the two annular points and
the midpoint displayed on a graph. The maximum displacement for each annular point and the
annular midpoint are included in the results.
The aTMAD workflow uses advanced Tissue Motion tracking to improve 2D image
quantification after acquisition. This approach is different from other 2D border-detection
technologies. The tissue motion tracking algorithm improves the border-detection process by
increasing the probability of correctly identifying image data as information rather than noise.
The results include the maximum and normalized displacement of the midpoint of the valve.
The analysis results for apical views include waveform displays for volume, average volume, and
the average derivation. The analysis results for short-axis views include waveform displays for
area, average area, and the average derivation. You can add time measurements to the
waveform displays and add a mechanical data overlay for the cardiac cycle.

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Auto 2D Quantification a2DQ Fundamentals

a2DQ Fundamentals
Workflow-Driven Analysis
The workflow selection affects the procedure used to calculate the wall analysis using up to
three views: short-axis (SAX), apical two-chamber (AP2), and apical four-chamber (AP4).
For SAX views, a circular ROI that you can redraw, resize, and reposition is placed on the image.
For apical views, you can select Area or Volume in the Calculations settings in the preferences.
The apical views use a border template anchored at three points to generate a segmented view
of the ventricle.

WARNING
If you use multiple image files, take care to select images from the same patient and study
and ensure that the selected images have the same cardiac beat cycle.

With a biplane image, you can perform volume calculations based on the position of the ROI in
both an AP4 and an AP2 view.

Auto Tissue Motion Annular Displacement (aTMAD)


The Auto Tissue Motion Annular Displacement (aTMAD) workflow provides global cardiac
quantification based on angle-independent tracking of the cardiac valve's annular motion
throughout the cardiac cycle. Quantification results provide details that add depth to the color-
coded parametric data of the CK overlay. The aTMAD algorithm calculates the valvular annular
displacement curves over time and, combined with the CK overlay, enables you to visualize
valvular annular plane motion parametrically.

Cardiac Cycles Overlay


The Cardiac Cycles tool allows you to create an overlay on the waveform that associates
mechanical activities, such as valves opening and closing (measured from spectral Doppler),
with the data presented on the waveform.

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Color Kinesis Analysis


The CK analysis option uses frame-to-frame, border-position data to overlay colors on the
moving image. Each color of the CK color map represents one frame. As the colors change from
frame to frame, they show easily identifiable displacement of the endocardial border. If
Dyskinesis is enabled, an unexpected transition results in the color overlay showing a bright
red. The advantage of Color Kinesis analysis in left ventricular segmental analysis is that it
allows you to visualize the timing and the extent of endocardial motion on a regional basis
during both contraction and relaxation phases of the heart cycle.

NOTE
Dyskinesis is subject to translation artifacts.

Image Acquisition for a2DQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a good ECG signal and acquire one or more heart beats.
• Whenever possible, you can ask the patient to suspend breathing for a few seconds during
image acquisition to minimize translation of the heart.
• Ensure the apical views are not foreshortened.
• Use the gain and threshold settings on your ultrasound system to ensure you acquire good
endocardial borders.
• The adjustment of the gain controls, TGC, LGC, and transmit gain available on the
ultrasound system has a significant impact on the quality of the ultrasound image. The
success of an a2DQ study depends upon the correct adjustment of the gain controls to
correctly classify all regions as either tissue or blood. The gain controls must be adjusted so
that all regions of similar material exhibit similar intensities. Essentially, those gain
adjustments are the same ones used to obtain a high-quality ultrasound image. You may
also use the Focus and XRES controls on your ultrasound system to obtain good uniform
image quality over the field of view.

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Auto 2D Quantification a2DQ References

NOTE
For EPIQ series systems, iU22 systems, and iE33 systems, set the 2D Native Data Export option.

a2DQ References
Becker, M., Bilke, E., Kuhl, H., Katoh, M., Kramann, R., Franke, A., Bucker, A., Hanrath, P.,
Hoffmann, R. "Analysis of myocardial deformation based on pixel tracking in two dimensional
echocardiographic images enables quantitative assessment of regional left ventricular
function." Heart, 92:1102-1108, 2006.
Bednarz, J. E., et. al. “Technical Guidelines for Performing Automated Border Detection
Studies.” Journal of the American Society of Echocardiography, Vol. 8:293-305, 1995.
DeCara, J.M., Toledo, E., Salgo, I., Lammertin, G., Weinert, L., Lang, R.M. "Evaluation of Left
Ventricular Systolic Function Using Automated Angle-Independent Motion Tracking of Mitral
Annular Displacement." Journal of the American Society of Echocardiography, 18: 1266-1269,
2005.
Eto, Y., Yamada, H., Shin, J., Agler, D.A., Tsujino, H., Qin, J., Saracino, G., Greenberg, N.L.,
Thomas, J. D., Shota, T. "Automated Mitral Annular Tracking: A Novel Method for Evaluating
Mitral Annular Motion Using Two-dimensional Echocardiography." Journal of the American
Society of Echocardiography, 18: 306-312.
Korinek, J., Wang, J., Sengupta, P.P., Miyazaki, C., Kjaergaard, J., McMahon, E., Abraham, T.P.,
Belohlavek, M. "Two-dimensional strain -- a Doppler-independent ultrasound method for
quantification of regional deformation: validation in vitro and in vivo." Journal of the American
Society of Echocardiography, 18:1247-1253, 2005.
Lang, R., et. al. “Echocardiographic Quantification of Regional Left Ventricular Wall Motion with
Color Kinesis.” Circulation, 93:1877-1885, 1996.
Mor-Avi, V., et. al. “Normal Values of Regional Left Ventricular Endocardial Motion: Multicenter
Color Kinesis Study.” American Journal of Physiology-Heart and Circulatory Physiology, 279:
H2464-H2476, 2000; 0363-6135/00.
Mor-Avi, V., et. al. “Segmental Analysis of Color Kinesis Images.” Circulation, 95: 2082-2097,
1997.

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a2DQ References Auto 2D Quantification

Perez, J. E., Lang, Roberto, eds. Echocardiography and Cardiovascular Function: Tools for the
Next Decade. Kluwer Academic Publishers, Dordrecht/Boston/London, 1997.
Perez, J. E., et. al. “Automated On-line Quantification of Left-Ventricular Dimensions and
Function by Echocardiography With Backscatter Imaging and Lateral Gain Compensation.”
American Journal of Cardiology, 70: 1200-1205, 1992.
Reisner, S.A., Lysyansky, P., Agmon, Y., Mutlak, D., Lessick, J., Friedman, Z. "Global longitudinal
strain: a novel index of left ventricular systolic function." Journal of the American Society of
Echocardiography, 17:630-633, 2004.
Vignon, P., et. al. “Quantitative Evaluation of Global and Regional Left Ventricular Diastolic
Function with Color Kinesis.” Circulation, 97: 1053-1061, 1998.

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Auto 2D Quantification a2DQ References

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Auto Cardiac Motion Quantification

5 Auto Cardiac Motion Quantification


The Auto Cardiac Motion Quantification (aCMQ) Q-App provides workflow-driven tools based
on the following:
• Automated border detection and Color Kinesis (CK) analysis of 2D echo images, with the
ability to edit or manually draw the ROI if necessary. The border detection algorithm
distinguishes the blood-tissue interface in an ultrasound image.
• The aCMQ Global workflow provides an angle-independent analysis of regional myocardial-
tissue velocity, displacement, strain, and strain rate, using the next generation of 2D speckle
tracking. From the confidence rating that you select, the Q‑App generates measurements of
the global and regional functions and reports them in a table and a bull's eye display. You
can add time measurements to the waveform displays and add a mechanical data overlay
for the cardiac cycle.
• The Auto Tissue Motion Annular Displacement (aTMAD) workflow provides global cardiac
quantification based on angle-independent tracking of the cardiac valve's annular motion
throughout the cardiac cycle.
• The User Defined workflow allows traces of one or more chords within the cardiac images
and computes corresponding direct tissue speed, displacement, and strain values, which are
identified by a color code of up to 17 colors.

NOTE
Automated border tracking depends upon having sufficient tissue/blood contrast around the
myocardial segments being scanned in the current view. Typically, there should only be mild
dropout of one segment in the current view for the application to perform acceptable tracking.

Images can be single-plane 2D or BiPlane images. For BiPlane images, only the aTMAD
workflow is supported.

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Auto Cardiac Motion Quantification aCMQ Fundamentals

aCMQ Fundamentals
Workflow-Driven Analysis
When you first launch the aCMQ Q-App, the Global workflow is selected by default. Automated
border detection and Color Kinesis (CK) analysis of the 2D echo image is performed, which
automatically distinguishes the blood-tissue interface and displays the results in the image area.
The Region of Interest section of the control panel expands, providing controls that enable you
to edit or manually redraw the ROI if necessary.
If you want to use a different workflow, you can select User Defined or aTMAD at the top of
the control panel. The workflow selection affects the procedure used to calculate the wall
analysis, using up to six views: basal, mid, and apical short-axis (SAX B, SAX M, and SAX A)
views, and apical (AP2, AP3, and AP4) views.
To generate a 17-segment bull's-eye plot of the data, the aCMQ Q-App can use multiple image
files. You can select multiple image files before starting the aCMQ Q-App. Using multiple views,
such as AP4, AP2, and AP3, in the aCMQ Q-App, you can compute a comprehensive result set
represented by the bull's-eye plot on the Global Results tab.

WARNING
If you use multiple image files, take care to select images from the same patient and study
and ensure that the selected images have the same cardiac beat cycle.

The various short-axis (SAX) optimization controls present a circular ROI that you can resize and
reposition. The SAX optimization controls are arranged by image position: SAX B (basal), SAX M
(mid), and SAX A (apical). The SAX M analysis is best for calculating ventricle area and includes
global measurements in the report.
The apical optimization controls use a border template anchored at three points. The apical
view generates a segmented view of the ventricle. The AP3 analysis does not include the
ejection fraction (EF) in the Global Results section of the control panel.

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aCMQ Fundamentals Auto Cardiac Motion Quantification

Wall Motion Scoring


Wall motion scoring is a segment-by-segment visual and qualitative evaluation of the left
ventricular function. Generally, wall motion scoring is performed by viewing the images and
ranking the tissue motion.

NOTE
You cannot perform wall motion scoring in the QLAB software.

Color Kinesis Analysis


The CK controls, available in the Overlays and Measurements section of the control panel,
provide frame-to-frame border position data to overlay colors on the moving image. Each color
of the CK color map represents one frame. As the colors change from frame to frame, they
show easily identifiable displacement of the endocardial border. If Dyskinesis is enabled, an
unexpected transition results in the color overlay showing a bright red. The advantage of
Color Kinesis analysis in LV segmental analysis is that it allows you to visualize the timing and
the extent of endocardial motion on a regional basis during both contraction and relaxation
phases of the heart cycle.

NOTE
Color Dyskinesis analysis is not available for the Global and User Defined workflows.

NOTE
Dyskinesis is subject to translation artifacts.

Auto Tissue Motion Annular Displacement (aTMAD)


The Auto Tissue Motion Annular Displacement (aTMAD) workflow provides global cardiac
quantification based on angle-independent tracking of the cardiac valve's annular motion
throughout the cardiac cycle. Quantification results provide details that add depth to the color-
coded parametric data of the CK overlay. The aTMAD workflow calculates the valvular annular
displacement curves over time and, combined with the CK overlay, enables you to visualize
valvular annular plane motion parametrically.

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Auto Cardiac Motion Quantification aCMQ Fundamentals

User-Defined Workflow
By convention, Lagrangian strain identifies muscle extension as positive strain and muscle
contraction as negative strain. Using strain measurements means you can examine the motion
of the cardiac muscles longitudinally, radially, and circumferentially. The longitudinal strain
identifies the stretch and shortening of the ventricle between the apex and the base. The radial
strain identifies the thickening and thinning of the muscles in the wall of the ventricle. The
circumferential strain measures the rotational motion of the muscles in the ventricle wall.
While fractional shortening shows the changes in the distance between the axis of the ventricle
and the wall, strain shows the motion in multiple directions and along various axes. This
provides a great deal more information for assessing the regional function and, potentially, the
mechanics of the ventricle.

Cardiac Cycles
The Cardiac Cycles feature allows you to create a waveform overlay that associates mechanical
activities (measured from spectral Doppler) with the data presented on the waveform.

aCMQ Support for Smart Exams and Stress Exams


If an exam protocol (also called a "Smart Exam") has been defined on your ultrasound system,
or if you acquire an image during a Stress Exam, each loop you acquire has a defined view
name. For example, your protocol may include the AP4, AP3, and AP2 views for longitudinal
strain, and the SAX B, SAX M, and SAX A views for circumferential strain.

NOTE
For information about working with exam protocols, see the Help for your ultrasound system.

When you load one or more of these views into the aCMQ Q-App, the appropriate ROI
template is selected automatically as you move from view to view. All you need to do manually
to quantify each view is:
• For the AP4, AP3, and AP2 views, set the annular and apical points.
• For the SAX B, SAX M, and SAX A views, fit the mesh to the myocardium.

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Image Acquisition for aCMQ Auto Cardiac Motion Quantification

Image Acquisition for aCMQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a good ECG signal and acquire one or more heart beats.
• Whenever possible, you can ask the patient to suspend breathing for a few seconds during
image acquisition to minimize translation of the heart.
• Ensure the apical views are not foreshortened.
• Set the gain levels high during acquisition to ensure a good dynamic range.
• Ensure all cardiac structures are clearly and completely within the data volume.
• Take care to eliminate artifacts from the surroundings of the heart. Items such as rib
artifacts and shadowing inhibit the tracking accuracy.
• Use a high frame rate during acquisition.
• Avoid out-of-plane motion on the short-axis image.
• XRES processing can be on or off.

NOTE
For EPIQ series systems, iU22 systems, and iE33 systems, set the 2D Native Data Export option.

NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

aCMQ References
Becker, M., Bilke, E., Kuhl, H., Katoh, M., Kramann, R., Franke, A., Bucker, A., Hanrath, P.,
Hoffmann, R. "Analysis of myocardial deformation based on pixel tracking in two dimensional
echocardiographic images enables quantitative assessment of regional left ventricular
function." Heart, 92:1102-1108, 2006.
Bednarz, J. E., et. al. “Technical Guidelines for Performing Automated Border Detection
Studies.” Journal of the American Society of Echocardiography, Vol. 8:293-305, 1995.

QLAB User Manual 4535 617 25481 65


Auto Cardiac Motion Quantification aCMQ References

DeCara, J.M., Toledo, E., Salgo, I., Lammertin, G., Weiner, L., Lang, R.M. "Evaluation of Left
Ventricular Systolic Function Using Automated Angle-Independent Motion Tracking of Mitral
Annular Displacement." Journal of the American Society of Echocardiography, 18: 1266-1269,
2005.
Eto, Y., Yamada, H., Shin, J., Agler, D.A., Tsujino, H., Qin, J., Saracino, G., Greenberg, N.L.,
Thomas, J. D., Shota, T. "Automated Mitral Annular Tracking: A Novel Method for Evaluating
Mitral Annular Motion Using Two-dimensional Echocardiography." Journal of the American
Society of Echocardiography, 18: 306-312.
Goffinet, C., Chenot, F., Robert, A., Pouleur, A., le Polain de Waroux, J., Vancrayenest, D.,
Gerard, O., Pasquet, A., Gerber, B. L., and Vanoverschelde, J. "Assessment of subendocardial vs.
subepicardial left ventricular rotation and twist using two-dimensional speckle tracking
echocardiography: comparison with tagged cardiac magnetic resonance." European Heart
Journal, 30(5):608-617, 2009.
Goffinet, C., and Vanoverschelde, J. "Speckle Tracking Echocardiography." Touch Briefings 2007.
Philips. 1-3, 2009.
Haruki, N., Takeuchi, M., Gerard, O., Nakai, H., Dufour, C., Denis, E., Salgo, I. S., Lodato, J. A.,
Lang, R. M., and Otsuji, Y. "Accuracy of measuring mitral annular velocity by 2D speckle tracking
imaging." Journal of Cardiology, 53 (2):188-195, April 2009.
Jacobs, A., Collins, K.A., Lang, R.M., Settlemier, S., Salgo, I. "Assessment of Temporal Uniformity
of Regional Wall Thickening by Speckle Tracking to Evaluate Left Ventricular Dyssynchrony."
University of Chicago, ACC.07 Abstract.
Ji, R. "Evaluation of Strain Rate in Different Layers of Left Ventricular Myocardium in Early
Diastole Using Strain Rate Imaging: P3-72." Journal of the American Society of
Echocardiography, 20(5):621, 2007.
Korinek, J., Wang, J., Sengupta, P.P., Miyazaki, C., Kjaergaard, J., McMahon, E., Abraham, T.P.,
Belohlavek, M. "Two-dimensional strain -- a Doppler-independent ultrasound method for
quantification of regional deformation: validation in vitro and in vivo." Journal of the American
Society of Echocardiography, 18:1247-1253, 2005.
Lang, R., et. al. “Echocardiographic Quantification of Regional Left Ventricular Wall Motion with
Color Kinesis.” Circulation, 93:1877-1885, 1996.

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aCMQ References Auto Cardiac Motion Quantification

Mor-Avi, V., et. al. “Normal Values of Regional Left Ventricular Endocardial Motion: Multicenter
Color Kinesis Study.” American Journal of Physiology-Heart and Circulatory Physiology, 279:
H2464-H2476, 2000; 0363-6135/00.
Mor-Avi, V., et. al. “Segmental Analysis of Color Kinesis Images.” Circulation, 95: 2082-2097,
1997.
Nishikage, T., Nakai, H., Mor-Avi, V., Lang, R. M., Salgo, I. S., Settlemier, S., Husson, S., and
Takeuchi, M. "Quantitative assessment of left ventricular volume and ejection fraction using
two-dimensional speckle tracking echocardiography." European Journal of Echocardiography,
10(1):82-88, 2008.
Okamatsu, K., Takeuchi, M., Nakai, H., Salgo, I. S., and Husson, S. "Can Speckle Tracking Mitral
Annular Displacement Curve Evaluate Left Atrial Pump Function?" Journal of the American
Society of Echocardiography 21(5):549, 2008.
Okamatsu, K., Takeuchi, M., Nakai, H., Nishikage, T., Salgo, I. S., Husson, S., Otsuji, Y., and Lang,
R, M. "Effects of Aging on Left Atrial Function Assessed by Two-Dimensional Speckle Tracking
Echocardiography." Journal of the American Society of Echocardiography, 22 (1):70-75, 2009.
Penhall, A., Perry, R., Mangoni, A., de Pasquale, C., Chew, D., and Joseph, M. "Can Speckle
Tracking Assist in the Detection of Subclinical Myocardial Changes in Hypertensive Patients?"
Heart, Lung and Circulation, 17(3):S29, 2008.
Perez, J. E., Lang, R., eds. Echocardiography and Cardiovascular Function: Tools for the Next
Decade. Kluwer Academic Publishers, Dordrecht/Boston/London, 1997.
Perez, J. E., et. al. “Automated On-line Quantification of Left-Ventricular Dimensions and
Function by Echocardiography With Backscatter Imaging and Lateral Gain Compensation.”
American Journal of Cardiology, 70: 1200-1205, 1992.
Qui, Q., Yang, L., and Wang, J. F. "Investigation of regional left ventricular diastolic dysfunction
in patients with coronary artery disease by strain rate imaging." Journal of Clinical Rehabilitative
Tissue Engineering Research, 12(17):3389-3392, 2008.
Reisner, S.A., Lysyansky, P., Agmon, Y., Mutlak, D., Lessick, J., Friedman, Z. "Global longitudinal
strain: a novel index of left ventricular systolic function." Journal of the American Society of
Echocardiography, 17:630-633, 2004.
Roberson, D. A. and Cui, W. "Tissue Doppler Imaging Measurement of Left Ventricular Systolic
Function in Children: Mitral Annular Displacement Index Is Superior to Peak Velocity." Journal
of the American Society Echocardiography, 22(4):376-382, 2009.

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Auto Cardiac Motion Quantification aCMQ References

Toldeo, E., DeCara, J. M., Salgo, I. S., Lammertin, G., Weinert, L., Mor-Avi, V., and Lang, R. M.
"Automated Quantitative Assessment of Left Ventricular Asynchrony Using Tissue-Texture
Tracking of Mitral Annular Motion." Journal of the American Society of Echocardiography, 18(5):
518 P2-12, 2005.
Tournoux, F., Chan, R. C., Handschumacher, M. D., Salgo, I. S., Manzke, R., Settlemier, S.,
Guerrero, L. J., Cury, R. C., Weyman, A. E., and Pichard, M. H. "Estimation of Radial Strain and
Rotation Using a New Algorithm Based on Speckle Tracking." Journal of the American Society of
Echocardiography, 21(10):1168-1179, 2008.
van Dalen, B. M., Caliskan, K., Soliman, O. I. I., Vletter, W. B., ten Cate, F. J., and Geleijnse, M.
"Left Ventricular Solid Body Rotation in Noncompaction Cardiomyopathy: A New Objective and
Quantitative Functional Diagnostic Criterion." Journal of the American Society of
Echocardiography, 21(5):523, 2008.
van Dalen, B. M., Kauer, F., Soliman, O. I. I., Vletter, W. B., Michels, M., ten Cate, F. J., and
Geleijnse, M. L. "Influence of the pattern of hypertrophy on left ventricular twist in
hypertrophic cardiomyopathy." Heart, 95 (8):657-661, 2009.
van Dalen, B. M., Soliman, O. I. I., Vletter, W. B., ten Cate, F. J., and Geleijnse, M. L. "Insights
into Left Ventricular Function from the Time Course of Regional and Global Rotation by Speckle
Tracking Echocardiography." Echocardiography, 26 (4):371-377, 2009.
van Dalen, B. M., Vletter, W. B., Soliman, O. I. I., ten Cate, F. J., and Geleijnse, M. L. "Importance
of Transducer Position in the Assessment of Apical Rotation by Speckle Tracking
Echocardiography." Journal of the American Society of Echocardiography, 21(8):895, 2008.
Vignon, P., et. al. “Quantitative Evaluation of Global and Regional Left Ventricular Diastolic
Function with Color Kinesis.” Circulation, 97: 1053-1061, 1998.
Weinert, L., Lang, R. M., Nesser, H. J., Salgo, I. S., Mor-Avi, V., and Sugeng, L. "Assessment of
Right Ventricular Function Using Angle-Independent Echocardiographic Texture Tracking of the
Tricuspid Annular Motion: Comparison with Cardiac Magnetic Resonance." Journal of the
American Society of Echocardiography, 21(5):543, 2008.
Yang, H., Toledo, E., Sugeng, L., Jacobs, L. D., Weinert, L., Mor-Avi, V., Oh, J., and Lang, R. M.
"Quantification of Intra-Ventricular Dyssynchrony and Its Relationship with Left Ventricular
Dysfunction." Journal of the American Society of Echocardiography, 18(5):531-P3-07, 2005.

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CMQ-Stress Fundamentals Cardiac Motion Quantification Stress

6 Cardiac Motion Quantification Stress


The Cardiac Motion Quantification Stress (CMQ-Stress) Q-App provides tools for automated
analysis of stress echo studies by angle-independent analysis of regional myocardial-tissue
velocity, displacement, strain, and strain rate, using the next generation of 2D speckle tracking.
The CMQ-Stress Q-App can analyze multiple stress echo views and stages.
With the confidence rating you select, the Q-App generates measurements of the global and
regional functions. You can add a mechanical data overlay for the cardiac cycle.
The analysis results can include a wide variety of waveform displays, including the speed, strain,
and velocity of the tissue. The CMQ-Stress Q-App generates multi-stage, side-by-side reports
with 17-segment bull's-eye plots. Up to eight bull's-eye plots can be generated and displayed.
Images must be single-plane 2D.
The preferences include options to set the segmentation waveforms generated.

CMQ-Stress Fundamentals
Workflow-Driven Analysis
The CMQ-Stress Q-App is stage-driven as well as workflow-driven. The Stages/Cardiac Cycles/
Views controls allow you to select views across multiple stress stages
Border detection and Color Kinesis (CK) analysis of the 2D echo image is performed, which
automatically distinguishes the blood-tissue interface and displays the results in the image area.
The Region of Interest section of the control panel expands, providing controls that enable you
to edit or manually redraw the ROI if necessary.
The various short-axis (SAX) optimization controls present a circular ROI that you can resize and
reposition. The SAX optimization controls are arranged by image position: SAX B (basal), SAX M
(mid), and SAX A (apical). The SAX M analysis is best for calculating ventricle area and includes
global measurements in the report.
The apical optimization controls use a border template anchored at three points. The apical
view generates a segmented view of the ventricle. The AP3 analysis does not include the
ejection fraction (EF) in the Global Results section of the control panel.

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Cardiac Motion Quantification Stress Image Acquisition for CMQ-Stress

Wall Motion Scoring


Wall motion scoring is a segment-by-segment visual and qualitative evaluation of the left
ventricular function. Generally, wall motion scoring is performed by viewing the images and
ranking the tissue motion.

NOTE
You cannot perform wall motion scoring in the QLAB software.

Cardiac Cycles
The Cardiac Cycles feature allows you to create a waveform overlay that associates mechanical
activities (measured from spectral Doppler) with the data presented on the waveform.

Image Acquisition for CMQ-Stress


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a good ECG signal and acquire one or more heart beats.
• Whenever possible, you can ask the patient to suspend breathing for a few seconds during
image acquisition to minimize translation of the heart.
• Ensure the apical views are not foreshortened.
• Set the gain levels high during acquisition to ensure a good dynamic range.
• Ensure all cardiac structures are clearly and completely within the data volume.
• Take care to eliminate artifacts from the surroundings of the heart. Items such as rib
artifacts and shadowing inhibit the tracking accuracy.
• Use a high frame rate during acquisition.
• Avoid out-of-plane motion on the short-axis image.
• XRES processing can be on or off.

NOTE
For EPIQ series systems and iE33 systems, set the 2D Native Data Export option.

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CMQ-Stress References Cardiac Motion Quantification Stress

NOTE
When acquiring images on the iE33 ultrasound system, ensure that you do not have both black-
and-white and color suppression enabled.

CMQ-Stress References
Anderson, N.H. and Poulsen, S.H. "Evaluation of the Longitudinal Contraction of the Left
Ventricle in Normal Subjects by Doppler Tissue Tracking and Strain Rate." J Am Soc
Echocardiogr, 16:716-723, 2003.
Badran, H., Elnoamany, M., and Seteha, M. "Tissue Velocity Imaging with Dobutamine Stress
Echocardiography—A Quantitative Technique for Identification of Coronary Artery Disease in
Patients with Left Bundle Branch Block." J Am Soc Echocardiogr, 20(7):820-831, 2007.
Bjallmark, A., Larsson, M., Winter, C., Westholm, P., Jacobsen, B., Lind, and Lars-Ake, B.
"Velocity Tracking—A Novel Method for Quantitative Analysis of Longitudinal Myocardial
Function." J Am Soc Echocardiogr, 20:847-856, 2007.
Crosby, J., Amundsen, B-H., Helle-Valle, T., Steen, P.A., and Torp, H. "A New Tissue Doppler
Method for Examination of Left Ventricular Rotation." Ultrasound in Med. & Biol., 34(11):
1741-1751, 2008.
Derumeaux, G., Ichinose, F., Raher, M. J., Morgan, J. G., Coman, T., Lee, C., Cuesta, J. M.,
Thibault, H., Bloch, K. D., Picard, M. H., and Scherrer-Crosbie, M. "Myocardial Alterations in
Senescent Mice and Effect of Exercise Training: A Strain Rate Imaging Study." Circ Cardiovasc
Imaging, 1:227-234, 2008.
Dokainishy, H., Sengupta, R., Pillai, M., Bobek, J., and Lakkis, N. "Correlation of Tissue Doppler
and Two-Dimensional Speckle Myocardial Velocities and Comparison of Derived Ratios with
Invasively Measured Left Ventricular Filling Pressures." J Am Soc Echocardiogr, 22:284-289,
2009.
Edvardsen, T., Gerber, B.L., Garot, J., Bluemke, D.A., Lima, J., and Smiseth, O.A. "Quantitative
Assessment of Intrinsic Regional Myocardial Deformation by Doppler Strain Rate
Echocardiography in Humans Validation Against Three-Dimensional Tagged Magnetic
Resonance Imaging." Circulation, 106:50-56, 2002.

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Cardiac Motion Quantification Stress CMQ-Stress References

Fathi, R., Cain, P., Nakatani, S., Yu, H.C.M., and Marwick, T.H. "Effect of Tissue Doppler on the
Accuracy of Novice and Expert Interpreters of Dobutamine Echocardiography." Am J Cardiol,
88:400-405, 2001.
Goebel, B., Arnold, R., Koletzki, E., Ulmer, H.E., Eichhorn, J., Borggrefe, M., Figulla, H.R., and
Poerner, T.C. "Exercise Tissue Doppler Echocardiography with Strain Rate Imaging in Healthy
Young Individuals: Feasibility, Normal Values and Reproducibility." Int J Cardiovasc Imaging,
23:149-155, 2007.
Gopal, A.S., Chukwu, E.O., Iwuchukwu, C.J., Katz, A.S., Toole, R.S., Schapiro, W., Reichek, N., and
New York Roslyn and Stony Brook. "Normal Values of Right Ventricular Size and Function by
Real-time 3-Dimensional Echocardiography: Comparison with Cardiac Magnetic Resonance
Imaging." J Am Soc Echocardiogr, 20(5):445-455, 2007.
Hanekom, L., Cho, G-Y., Leano, R., Jeffriess, L., and Marwick, T-H. "Comparison of Two-
Dimensional Speckle and Tissue Doppler Strain Measurement During Dobutamine Stress
Echocardiography: an Angiographic Correlation." European Heart Journal, 28:1765-1772, 2007.
Hyodo, E., Hirata, K., Hirose, M., Kamimori, K., Kawarabayashi, T., Shimada, K., Yoshikawa, J.,
and Yoshiyama, M. "Clinical Use of Doppler Echocardiography and Doppler Tissue Imaging in
the Estimation of Myocardial Ischemia During Dobutamine Stress Echocardiography." Journal of
the American Society of Echocardiography, 21(4):331, 2008.
Ingul, C.B., Rozis, E., Slordahl, S.A., and Marwick, T.H. "Incremental Value of Strain Rate Imaging
to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress
Echocardiography." Circulation, 115:1252-1259, 2007.
Langeland, S., Dhooge, J., Wouters, P.F., Leather, A.H., Claus, P., Bijnens, B., and Sutherland,
G.R. "Experimental Validation of a New Ultrasound Method for the Simultaneous Assessment of
Radial and Longitudinal Myocardial Deformation Independent of Insonation Angle." Circulation,
112:2157-2162, 2005.
Marwick, T.H. "Strain Without Pain: Application of Parametric Imaging of Strain Rate Response
for the Quantitation of Stress Echocardiography." Journal of the American Society of
Echocardiography, Vol. 21, No. 4: 307-308, April 2008.
Marwick, TH, Case, C., Leano, R., Short, W., Baglin, T., Cain, P., and Garrahy, P. "Use of Tissue
Doppler Imaging to Facilitate the Prediction of Events in Patients With Abnormal Left
Ventricular Function by Dobutamine Echocardiography." Am J Cardiol, 93:142-146, 2004.

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CMQ-Stress References Cardiac Motion Quantification Stress

Rambaldi, R., Bax, J., Boersma, E., Valkema, R., Duncker, D., Sutherland, G., Roelandt, J., and
Poldermans, D. "Value of Pulse-Wave Tissue Doppler Imaging to Identify Dyssynergic But Viable
Myocardium." The American Journal of Cardiology, 92:64-66, 2003.
Reant, P., Labrousse, L., Lafitte, S., Bordachar, P., Pillois, X., Tariosse, L., Bornoron-Adele, S.,
Padois, P., Deveille, C., Roudaut, R., and Dos Santos, P. "Experimental Validation of
Circumferential, Longitudinal, and Radial 2-Dimensional Strain During Dobutamine Stress
Echocardiography in Ischemic Conditions." J Am Coll Cardiol, 51(2):149-157, 2008.
Sjoli, B., Orn, S., Grenne, B., Halfdan I., Edvardsen, T., and Brunvand, H. "Diagnostic Capability
and Reproducibility of Strain by Doppler and by Speckle Tracking in Patients With Acute
Myocardial Infarction." J Am Coll Cardiol Img, 2(1):24-33, 2009.
Voigt, J., Exner B., Schmiedehausen, K., Huchzermeyer C., Reulbach, U., Nixdorff, U., Platsch, G.,
Kuwert, T., Daniel, W.G., and Flachskampf, F.A. "Strain-Rate Imaging During Dobutamine Stress
Echocardiography Provides Objective Evidence of Inducible Ischemia." Circulation,
107:2120-2126, 2002.
Weidemann, F., Jamal, F., Kowalski, M., Kukulski, T., D'Hooge, J., Bijnens, B., Hatle, L., De-
Scheerder, I., and Sutherland, G. "Can Strain Rate and Strain Quantify Changes in Regional
Systolic Function During Dobutamine Infusion, B-Blockade, and Atrial Pacing-Implications for
Quantitative Stress Echocardiography." J Am Soc Echocardiogr, 15(5):416-424, 2002.

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Cardiac Motion Quantification Stress CMQ-Stress References

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Cardiac 3D Quantification

7 Cardiac 3D Quantification
The Cardiac 3D Quantification (Cardiac 3DQ) Q-App provides tools for calculating global
function using end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF).
If your preferences are set to display the mass calculation, you can also calculate left ventricular
mass. You can also make distance measurements and create annotation labels.

WARNING
When viewing 3D volumes, always verify that features in the 3D rendered view also appear in
the MPR views.

In the App General preferences for this Q-App, you can enable either Trace using 2Ch/4Ch
Templates or Trace using Simple Polygons.
There are two workflows associated with the 2Ch/4Ch template trace. The workflow used
depends on the Display LV Mass preference setting. When Display LV Mass is disabled, the
template requires three primary anchor points. When Display LV Mass is enabled, the template
requires four anchor points.
Simple polygons is a manual trace technique, which allows you to draw simple polygons with no
restrictions on the number of anchor points. This technique is used to trace a volume that does
not fit the standard myocardial shape.
Trace using 2Ch/4Ch Templates and Trace using Simple Polygons both use Simpson's method
of discs to calculate volume. Only a trace that uses the 2Ch/4Ch templates can be used to
obtain a calculation of left ventricular mass.
When you enable the LV mass calculation in the preferences, the template trace provides four
primary points. When the LV mass calculation is disabled in the preferences, the fourth point is
unnecessary.

WARNING
A foreshortened left ventricle in the MPR views will result in inaccurate volume and mass
calculations.

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Cardiac 3D Quantification Cardiac 3DQ Fundamentals

NOTE
Ensure that your video card driver is the most current available and that your computer's
hardware acceleration setting is set to Full. (From the Display Properties dialog box, click
Settings, Advanced, and then Troubleshoot.)

Cardiac 3DQ Fundamentals


The Cardiac 3DQ Q-App uses Simpson's method of discs to measure the left ventricle (LV) and
calculate the ejection fraction (EF). With Display LV Mass enabled, you can also calculate the
end-diastole and end-systole mass of the LV. You can add distance and area measurements that
are not associated with the default measurements and calculations. You can also add
annotations to the image.
Cardiac 3DQ 2Ch/4Ch Template (with Mass Calculation) Cardiac 3DQ Simple Polygon

There are two basic procedures followed within the Cardiac 3DQ Q-App. These procedures
calculate the ejection fraction (EF), volume, area, and mass of the LV.

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The Cardiovascular 3D Viewer


This Q-App uses the QLAB Cardiovascular 3D viewer, which provides many navigation and
optimization controls for viewing cardiovascular 3D data sets, as well as specialized features
such as iCrop (a semi-automated cardiovascular 3D cropping tool) and cardiovascular 3D
subpages (for creating and managing saved sets of cardiovascular 3D viewing parameters). For
more information about the Cardiovascular 3D viewer and instructions for using its features,
see the QLAB Help.

Image Acquisition for Cardiac 3DQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a good ECG signal and acquire at least one heart beat.
• Optimize your image during acquisition to ensure good endocardial borders.
• Ensure that the entire left ventricle is located within the boundaries of the two full-volume
preview sectors.
• Position your transducer to capture a full four-chamber view.
• Minimize temporal and stitching artifacts.
• Optimize the acquisition volume rate.

WARNING
A foreshortened left ventricle in the MPR views results in inaccurate volume and mass
calculations.

NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

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Cardiac 3D Quantification Cardiac 3DQ References

NOTE
When acquiring image loops using an iE33 system ECG trace, the system may record the spike
output from an implantable cardiac device as an R-wave and provide data that is not clinically
relevant. Use the Override HeartRate control to enter the correct value for the heart rate.

Cardiac 3DQ References


Bachat, et al. "Ventricular Resynchronization by Multisite Pacing Improves Myocardial
Performance in the Postoperative Single-Ventricular Patient." The Annals of Thoracic Surgery,
Vol. 78 No. 5: 1678-1683, 2004.
Cerqueira, Manuel, D., et. al. "Standardized Myocardial Segmentation and Nomenclature for
Tomographic Imaging of the Heart: A Statement for Healthcare Professionals from the Cardiac
Imaging Committee of the Council on Clinical Cardiology of the American Heart Association."
Circulation, Vol. 105 No. 4: 539-542, 2002.
Jacobs, Lawrence D., Salgo, Ivan S., et. al., "Rapid online quantification of left ventricular
volume from real-time three-dimensional echocardiographic data." European Heart Journal,
November 30, 2005, doi:10.1093/eurheart/ehi666.
Kapetnakis S., Kearney M. T., Siva A., Gall N., Cooklin M., Monaghan M. J. "Real-Time
Three‑Dimensional Echocardiography: A Novel Technique to Quantify Global Left Ventricular
Mechanical Dyssynchrony." Circulation, Vol. 112 No. 7: 992-1000, August 16, 2005.
Zhang, Qing, et. al. "Assessment of the Effect of Cardiac Resynchronization Therapy on
Intraventricular Mechanical Synchronicity by Regional Volumetric Changes." The American
Journal of Cardiology, Vol. 95 No. 1: 126-129, 2005.

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Cardiac 3D Quantification Advanced

8 Cardiac 3D Quantification Advanced


The Cardiac 3D Quantification Advanced (Cardiac 3DQ Advanced) Q-App includes the basic
Cardiac 3DQ viewing features and the ability to perform both 3D semi-automated border
detection of the left ventricle and LV regional timing calculations on apical full volume images.
It uses a physics-based modeling algorithm that makes no assumptions regarding the geometry
of the left ventricle. The border detection uses all of the voxels to find boundaries.
The Cardiac 3DQ Advanced Q-App provides a semi-automated approach for calculating left
ventricular volumes and ejection fraction without the geometrical assumptions associated with
other methods. Semi-automated border detection improves study efficiency by simplifying the
manual trace steps required to outline the left ventricle of the heart in three dimensions over
time. This can also be referred to as “4D” border detection.
You select five reference points on the left ventricle in two orthogonal MPR views in each of the
end-diastolic (ED) and end-systolic (ES) frames within the loop. The Cardiac 3DQ Advanced
Q‑App calculates the volume, the ejection fraction, and the stroke volume, and then displays
the model, or shell view, of the left ventricle. You can manually edit the 3D shell view. Using the
report option, you can review the global cardiac waveforms, regional timing calculations, and
selected regional waveforms.
You can select four or nine cross-sectional short-axis 2D slices, referred to as iSlices, from the
blue axis orientation, and by clicking on one of those iSlices, you can display it in the blue MPR
view. You can display the EDV mesh, and the ESV endocardial shell inside the EDV mesh.
Regional segments of the left ventricle can also be displayed as a color-coded segmental shell.
The global shell of the left ventricle is yellow. You can display global and regional waveforms
with the beating LV in shell view. In the same view, you can also include a bull's-eye display of
regional segments.
Using low values for the MPR Smooth and high values for the MPR Slice Thickness improves
the border visualization in the MPR and 3D Volume views.
The 3D borders can also be used to generate a global function curve. Additionally, the ventricle
can be segmented into 17 regions. Regional or segmental volume waveforms can be computed
and displayed. The LV regional timing calculations can be generated from the selected
segments.

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Cardiac 3D Quantification Advanced Cardiac 3DQ Advanced Fundamentals

WARNING
When viewing 3D volumes, always verify that features in the 3D rendered view also appear in
the MPR views.

NOTE
Because the Cardiac 3DQ Advanced Q-App uses semi-automated border detection, before using
the results or the waveforms, the border tracking must be verified. Each border and frame can
be edited to ensure accurate border tracking. Borders can be modified both before and after
the sequence analysis.

NOTE
To ensure compatibility with border detection algorithms, borders drawn in the Cardiac 3DQ
Advanced Q-App using earlier versions of the QLAB software should be redrawn before being
used for sequence analysis or reporting.

Cardiac 3DQ Advanced Fundamentals


The Cardiac 3DQ Advanced Q-App includes the basic 3D Cardiovascular viewer features and the
ability to perform semi-automated border detection in 3D of the left ventricle without
geometrical assumptions as to the shape of the left ventricle. You can select the end-diastolic
and the end-systolic reference points.
You determine the end-diastolic and end-systolic reference points and the apex from which the
Cardiac 3DQ Advanced Q-App uses sequential analysis to create the model of the left ventricle.
You can annotate the image area, hide and show display elements, select various views, and
generate reports showing the calculated values for the global and regional volumes. You can
select four or nine cross-sectional short-axis 2D slices, called iSlices, from the blue axis
orientation. You can display ESV inside the EDV mesh. Regional segments of the left ventricle
can also be displayed. The global waveform can be displayed with the beating left ventricle in
shell view. The regional waveforms can also be displayed with the beating shell. A bull's-eye
graphic of regional segments can be displayed in the same view and used to select the regions
included in the report waveform, and to indicate the regional image quality confidence index.

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Image Acquisition for Cardiac 3DQ Advanced Cardiac 3D Quantification Advanced

Image Quality Index


You can enable an index selector that displays the relative image quality of the ED and ES
reference points on the image. You can choose the color indications in the preferences, setting
the scale for the various color indicators. Green-to-red coloring shows the corresponding value
of the data points. You can set the boundaries for the display, using percentage ranges.

The Cardiovascular 3D Viewer


This Q-App uses the QLAB Cardiovascular 3D viewer, which provides many navigation and
optimization controls for viewing cardiovascular 3D data sets, as well as specialized features
such as iCrop (a semi-automated cardiovascular 3D cropping tool) and cardiovascular 3D
subpages (for creating and managing saved sets of cardiovascular 3D viewing parameters). For
more information about the Cardiovascular 3D viewer and instructions for using its features,
see the QLAB Help.

Image Acquisition for Cardiac 3DQ Advanced


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Optimize your image during acquisition to ensure good endocardial borders.
• Ensure that the entire left ventricle is located within the boundaries of the two full-volume
preview sectors.
• Place your transducer such that you capture a full four-chamber view.
• Minimize temporal and stitching artifacts.
• Optimize the acquisition volume rate.

WARNING
A foreshortened left ventricle in the MPR views will result in inaccurate volume and mass
calculations.

NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

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Cardiac 3D Quantification Advanced Cardiac 3DQ Advanced References

NOTE
When acquiring image loops using an iE33 system ECG trace, the system may record the spike
output from an implantable cardiac device as an R-wave and provide data that is not clinically
relevant. Use the Override HeartRate control to enter the correct value for the heart rate.

Cardiac 3DQ Advanced References


Ahmad, M. “Real-time Three-Dimensional Echocardiography in Assessment of Heart Disease.”
Echocardiography, Vol. 18, No. 1: 73-77, January 2001.
Bachat, et al. "Ventricular Resynchronization by Multisite Pacing Improves Myocardial
Performance in the Postoperative Single-Ventricular Patient." The Annals of Thoracic Surgery,
Vol. 78 No. 5: 1678-1683, 2004.
Cerqueira, Manuel, D., et al. "Standardized Myocardial Segmentation and Nomenclature for
Tomographic Imaging of the Heart: A Statement for Healthcare Professionals from the Cardiac
Imaging Committee of the Council on Clinical Cardiology of the American Heart Association"
Circulation, Vol. 105, No. 4: 539-542, 2002.
Jacobs, Lawrence D., Salgo, Ivan S., et. al., "Rapid online quantification of left ventricular
volume from real-time three-dimensional echocardiographic data." European Heart Journal,
November 30, 2005, doi:10.1093/eurheart/ehi666.
Kapentnakis S., Kearney M. T., Siva A., Gall N., Cooklin M., Monaghan M. J. "Real-Time
Three‑Dimensional Echocardiography: A Novel Technique to Quantify Global Left Ventricular
Mechanical Dyssynchrony." Circulation, Vol. 112 No. 7: 992-1000, August 16, 2005.
Kuhl, H., Franke, A., Frielingsdorf, J., et al. “Determination of Left Ventricular Mass and
Circumferential Wall Thickness by Three-Dimensional Reconstruction: In Vitro Validation of a
New Method That Uses a Multiplane Transesophageal Transducer.” Journal of the American
Society of Echocardiography, Vol. 10, No. 2: 107-119, March 1997.
Marx, G. R., Sherwood, M. C., Fleishman, C., Van Praagh, R. “Three-Dimensional
Echocardiography of the Atrial Septum.” Echocardiography, Vol. 18, No. 5: 433-443, July 2001.
Mizelle, K. M., Rice, M. J., Sahn, D. J. “Clinical Use of Real-Time Three-Dimensional
Echocardiography in Pediatric Cardiology.” Echocardiography, Vol. 17, No. 8: 787-90, November
2000.

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Cardiac 3DQ Advanced References Cardiac 3D Quantification Advanced

Mor-Avi, Victor PhD; Sugeng, Lissa MD; Weinert, Lynn BS; MacEneaney, Peter MD; Caiani,
Enrico G. PhD; Koch, Rick MS, MD; Salgo, Ivan S. MS, MD; Lang, Roberto M. MD. “Fast
Measurement of Left Ventricular Mass With Real-Time Three-Dimensional Echocardiography,
Comparison with Magnetic Resonance Imaging.” Circulation, Vol. 110 No. 13: 1814-1818, 2004.
Panza, J. A. “Real-time Three-Dimensional Echocardiography: An Overview.” The International
Journal of Cardiovascular Imaging, Vol. 17, No. 3: 227-235, June 2001.
Qin, J. X., Shiota, T., Thomas, J. D. “Determination of Left-Ventricular Volume, Ejection Fraction,
and Myocardial Mass by Real-Time Three-Dimensional Echocardiography.” Echocardiography,
Vol. 17, No. (8): 781-786, November 2000.
Salgo, I. S. “Three-Dimensional Echocardiography.” Journal of Cardiothoracic & Vascular
Anesthesia. Vol.11, No. 4: 506-516, June 1997.
Schiller, N. B., et al. “Recommendations for Quantification of the LV by Two-Dimensional
Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5:
362-364, September-October 1989.
Takuma, S., Cardinale, C., Homma, S. “Real-Time Three-Dimensional Stress Echocardiography: A
Review of Current Applications.” Echocardiography, Vol. 17, No. 8: 791-794, November 2000.
Zhang, Qing, et al. “Assessment of the Effect of Cardiac Resynchronization Therapy on
Intraventricular Mechanical Synchronicity by Regional Volumetric Changes.” The American
Journal of Cardiology, Vol. 95 No. 1: 126-129, 2005.

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Cardiac 3D Quantification Advanced Cardiac 3DQ Advanced References

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Mitral Valve Navigator

9 Mitral Valve Navigator


The Mitral Valve Navigator (MVN) Q-App provides workflow-driven tools for performing semi-
automated shape analysis on the mitral valve.
MVN performs automated identification of the end-systole phase (Auto ES), and allows you to
confirm or override the Auto ES selection.
An illustration displayed in the 3D Volume view guides you through the process of aligning the
MPR views and placing reference points. When you have completed the reference point
selection step, MVN computes the mitral valve model view, which replaces the guidance
illustration in the 3D Volume view.
The mitral valve visualizations include the leaflets and annulus. The identification of the
regional and localized wall motion abnormalities that affect the papillary-muscle placement
provides information about mitral insufficiency and regurgitation.
You can use the MVN Q-App to evaluate 3D cardiac images where the mitral valve is distinct
and fully imaged.

WARNING
When viewing 3D volumes, always verify that features in the 3D rendered view also appear in
the MPR views.

NOTE
Automated border tracking depends upon having sufficient tissue/blood contrast around the
myocardial segments being scanned in the current view. Typically, there should only be mild
dropout of one segment in the current view for the application to perform acceptable tracking.

NOTE
The measurement results assigned to the anterior and posterior leaflet surface correspond to
the exposed leaflet surface area only. The measurements do not include the leaflet area
contribution due to the coaptation surface between the anterior and posterior leaflets.

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NOTE
The minimal surface is a surface minimizing the bending energy (zero biharmonic) while passing
through the annulus reference points. It is close but not equal to the surface minimizing area
(approximately zero Laplacian) with the annulus as boundary.

MVN Fundamentals
Use the MVN Q-App to mark the standard reference points on a 3D cardiac image acquired
using a TEE transducer. Starting with the frame representing the best end-systolic frame, mark
the four key reference points on the mitral valve annulus. Those points indicate the orientation
of the valve by tagging the anterior, posterior, anterolateral, and posteromedial points.
The segmentation of the mitral valve complex consists of the annulus, the coaptation, and the
leaflets.
Marking the aortic opposition point between the aortic orifice and the mitral plane provides the
angle measurement between the two points. Marking the papillary muscle tips provides the
length of the chords measured from the tip to the associated coaptation midpoint.
MVN locks the MPR slice planes orthogonally. When you perform the active operation on one
view, the other views undergo the same operation. Generally, the orientation of the various
views provides perspective on the acquisition. If the acquisition of the mitral valve was
suboptimal, you can orient the image to present the best view of the mitral valve and the
annulus.
The segmentation model shows the reference points. These are the standard reference points
for the following locations on the annulus, commissure, leaflets, and papillaries:
• Posteromedial (annulus and commissure)
• Posterior (annulus and papillary)
• Anterolateral (annulus and commissure)
• Anterior (annulus and papillary)
• Midpoint (intercommissure)
• Nadir (lowest point on the leaflet saddle)
The Leaflet Segmentation model provides the following reference points and landmarks:

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• Anterior terminus (A)


• Medial terminus
• Anteromedial terminus
• Anterolateral terminus (AL)
• Lateral terminus
• Posterolateral terminus
• Posterior terminus (P)
• Posteromedial terminus (PM)
• Anterolateral anti-commissure
• Posteromedial anti-commissure
• Anterior A1 coaptation
• Anterior A2 coaptation
• Anterior A3 coaptation
• Posterior P1 coaptation
• Posterior P2 coaptation
• Posterior P3 coaptation
• A1/A2 intercommissure
• A2/A3 intercommissure
• P1/P2 intercommissure
• P2/P3 intercommissure

The coaptation appears as a spline curve on the MPR views and as an extension capped by a
cylinder on the 3D Volume view.

NOTE
The measurement results assigned to the anterior and posterior leaflet surface correspond to
the exposed leaflet surface area only. The measurements do not include the leaflet area
contribution due to the coaptation surface between the anterior and posterior leaflets.

NOTE
The minimal surface is a surface minimizing the bending energy (zero biharmonic) while passing
through the annulus reference points. It is close but not equal to the surface minimizing area
(approximately zero Laplacian) with the annulus as boundary.

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Mitral Valve Navigator Image Acquisition for MVN

The Cardiovascular 3D Viewer


This Q-App uses the QLAB Cardiovascular 3D viewer, which provides many navigation and
optimization controls for viewing cardiovascular 3D data sets, as well as specialized features
such as iCrop (a semi-automated cardiovascular 3D cropping tool) and cardiovascular 3D
subpages (for creating and managing saved sets of cardiovascular 3D viewing parameters). For
more information about the Cardiovascular 3D viewer and instructions for using its features,
see the QLAB Help.

Image Acquisition for MVN


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a TEE transducer to acquire images.
• Ensure the mitral valve is fully visible within the 3D volume acquisition.
• In full volume acquisition mode, make sure the entire mitral annulus is captured.
• Use low line density or volume size if necessary.
• In live 3D zoom mode, the entire mitral annulus must be within the zoom box.
• Be aware of acoustic artifacts from intervening body parts or poor optimization during
acquisition.
• Ensure the image is of sufficient resolution to clearly view the annulus, leaflets, and
commissure of the mitral valve.
• Ensure the mitral valve axis is in line with the transducer axis.
• The number of beats acquired is not important to the MVN Q-App results.

NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

MVN References
Adams, D.H., Anyanwu, A., "Pitfalls and limitations in measuring and interpreting the outcomes
of mitral valve repair." J Thorac Cardiovasc Surg. 2006 Mar; 131(3):523-9.

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MVN References Mitral Valve Navigator

Adams, D.H., Anyanwu, A.C., Rahmanian, P.B., Filsoufi, F., "Current concepts in mitral valve
repair for degenerative disease." Heart Fail Rev. 2006 Sep; 11(3):241-57.
Adams, D.H., Emery, R.W., "Cardiac valve surgery." J Heart Valve Dis. 2002 Jan; 11 Suppl 1:S1.
Adams, D.H., Filsoufi, F., Aklog, L., "Surgical treatment of the ischemic mitral valve" J Heart
Valve Dis. 2002 Jan; 11 Suppl 1:S21-5.
Adams, D.H., Anyanwu, A., Rahmanian, P.B., Abascal, V., Salzberg. S.P., Filsoufi, F., "Larger
annuloplasty rings facilitate mitral valve repair in Barlow's Syndrome." Ann Thorac Surg. 2006;
82:2096-10.
Anyaanuwu, Anelechi, Rahmanian, Parwis B., Filsoufi, Farzan, Adams, David H., "The
Pathophysiology of Ischemic Mitral Regurgitation: Implications for Surgical and Percutaneous
intervention." J Interven Cardiol 2006; 19:S78-S86.
Filsoufi, F., Salzberg, S.P., Coutu, M., Adams, D.H., "A three-dimensional ring annuloplasty for
the treatment of tricuspid regurgitation" Ann Thorac Surg. 2006 Jun; 81(6):2273-7.
Salgo, I.S., Gorman, J.H. 3rd., Gorman, R.C., Jackson, B.M., Bowen, F.W., Plappert, T., St John,
Sutton, M.G., Edmunds, L.H. Jr., "Effect of annular shape on leaflet curvature in reducing mitral
leaflet stress." Circulation. 106(6):711-7, 2002 Aug 6.
Vassiliades, T.A. Jr., Block, P.C., Cohn, L.H., Adams, D.H., Borer, J.S., Feldman, T., Holmes, D.R.,
Laskey, W.K., Lytle, B.W., Mack, M.J., Williams, D.O., "The clinical development of percutaneous
heart valve technology." J Thorac Cardiovasc Surg. 2005 May; 129(5):970-6.
Watanabe, N., Ogasawara, Y., Yamaura, Y., Wada, N., Kawamoto, T., Toyota, E., Akasaka, T.,
Yoshida, K., "Mitral annulus flattens in ischemic mitral regurgitation: geometric differences
between inferior and anterior myocardial infarction: a real-time 3-dimensional
echocardiographic study." Circulation. 2005 Aug 30; 112(9 Suppl): I458-62.
Watanabe, N., Ogasawara, Y., Yamaura, Y., Kawamoto, T., Akasaka, T., Yoshida, K., "Geometric
deformity of the mitral annulus in patients with ischemic mitral regurgitation: a real-time three-
dimensional echocardiographic study." J Heart Valve Dis. 2005 Jul; 14(4):447-52.
Watanabe, N., Ogasawara, Y., Yamaura, Y., Kawamoto, T., Toyota, E., Akasaka, T., Yoshida, K.,
"Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time
three-dimensional echocardiography." J Am Coll Cardiol. 2005 Mar 1; 45(5):763-9.

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Mitral Valve Navigator MVN References

Watanabe, N., Yashima, M., Takeuchi, T., Sakaguchi, H., Goto, H., Kuwabara, N., Kuwahara, T.,
"Primary biventricular repair for interrupted aortic arch with left ventricular outflow tract
obstruction and tricuspid valve regurgitation; report of a case" Japanese Journal of Thoracic
Surgery. 59(12):1107-9, 2006 Nov.
Watanabe, Nozomi. Ogasawara, Yasuo. Yamaura, Yasuko. Yamamoto, Katsunori. Wada,
Nozomi. Kawamoto, Takahiro. Toyota, Eiji. Akasaka, Takashi. Yoshida, Kiyoshi. "Geometric
differences of the mitral valve tenting between anterior and inferior myocardial infarction with
significant ischemic mitral regurgitation: quantitation by novel software system with
transthoracic real-time three-dimensional echocardiography." Journal of the American Society
of Echocardiography. 19(1):71-5, 2006 Jan.
Yamaura, Y., Watanabe, N., Ogasawara, Y., Wada, N., Kawamoto, T., Toyota, E., Akasaka, T.,
Tanemoto, K., Yoshida, K., "Geometric change of mitral valve leaflets and annulus after
reconstructive surgery for ischemic mitral regurgitation: real-time 3-dimensional
echocardiographic study." Journal of Thoracic & Cardiovascular Surgery. 130(5):1459-61, 2005
Nov.

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GI3DQ Fundamentals General Imaging 3D Quantification

10 General Imaging 3D Quantification


The General Imaging 3D Quantification (GI3DQ) Q-App provides tools for measuring angles, 2D
distance and area, and 3D volumes. The measurement tools include semi-automated border
detection for identifying the area of hypoechoic lesions.
The optimization controls provide tools for rotating, sculpting, and slicing the image.
GI3DQ can also be used to evaluate data sets acquired with a matrix transducer.
The 3D data set is presented, by default, in a layout of four views. The top left view represents
the acquisition plane as a 2D image. The top right and bottom left are 2D views orthogonal to
the acquisition plane. The bottom right view renders the data set as a 3D volume view.
Additional imaging information, such as timer data and orientation labels are available, if they
were activated on the ultrasound system prior to the export of the image file. QLAB software
supports invert on files from systems that have this feature.

NOTE
Ensure that your video card driver is the most-current available, and that your computer's
Hardware acceleration setting is set to Full. (From the Display Properties dialog box, click
Settings, Advanced, and then Troubleshoot.)

GI3DQ Fundamentals
The GI3DQ Q-App presents 3D/4D images as three MPR views and a volume view. The
optimization tools provide the mechanism for altering the presentation and rendering of the
image. With the image presentation set, you can use manual tools or semi-automated tools to
add 2D and volume measurements.
The image can be presented full-screen, quad screen, or in an expanded view. The full-screen
view presents single views. The selected MPR or volume view fills the available viewing area.
The quad screen view is the default view. The images are organized into a 2x2 presentation.
The expanded view organizes the images into a single large image with the remaining three
image views stacked in a column on the right.

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The semi-automated tools use a border detection algorithm to identify the region of interest.
The Auto Area tool works on 2D regions of interest and produces an area measurement. The
Auto Stacked Contours tool works on 3D regions of interest and produces a volume
measurement. The Auto Volume tool works on 3D regions of interest and produces volume and
length measurements. Those tools draw regions of interest and volumes identifying hypoechoic
lesions.
You can set the default number of slices in the stacked contours (manual or semi-automated) in
the preferences.

NOTE
Some imaging settings for some color acquisitions set the grayscale too high, so that in the
QLAB software, the grayscale data may appear to be missing. To adjust the display, use the
B/W Settings Threshold control to reduce the threshold settings.

NOTE
If you open an HD11 or an HD11 XE system 3D image file acquired with Skeletal enabled, and
the 3D rendering appears dimmer in the QLAB software than it appears on the HD11 or the
HD11 XE system, adjust the QLAB Brightness control.

NOTE
If you edit an ellipse measurement, and the MPR image rotates unexpectedly and the
measurement graphics disappear, click the ellipse measurement in the Results panel to restore
the MPR image and the graphics.

Image Acquisition for GI3DQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use the highest frequency transducer possible.
• Acquire 3D data sets using a calibrated method.

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NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

NOTE
Some imaging settings for some color acquisitions set the grayscale too high, so that in the
QLAB software, the grayscale data may appear to missing. To adjust the display, use the B/W
Settings Threshold control to reduce the threshold settings.

GI3DQ References
Alcazar, J., Merce, L., & Manero, M., “Three-Dimensional Power Doppler Vascular Sampling, A
New Method for Predicting Ovarian Cancer in Vascularized Complex Adnexal Masses,” J
Ultrasound Med, Vol. 24: 689-696, 2005.
Fleischer, W., Wojcicki, E., Donnelly, D., Pickens, G., Thirsk, G., Thurman, & Hellerqvist, C.,
“Quantified color Doppler sonography of tumor vascularity in an animal model,” J Ultrasound
Med, Vol. 18, pp. 547-551, 1999.
Lyshchik, R., Moses, S., Barnes, T., Higashi, R., Asato, M., Miga, J., Gore, & Fleischer, A.,
“Quantitative Analysis of Tumor Vascularity in Benign and Malignant Solid Thyroid Nodules,” J
Ultrasound Med, Vol. 26: 837-846, 2007.
Merce, L., Barco, M., Bau, S., Kupesic, S. & Krujak, A., “Assessment of Placental Vascularization
by Three-dimensional Power Doppler ‘Vascular Biopsy’ in Normal Pregnancies,” Croat Med J,
Vol. 46, No. 5: 765-771, 2005.
Pairleitner, H., Steiner, H., Hasenoehrl, G., & Staudach, A., “Three-dimensional power Doppler
sonography imaging and quantifying blood flow and vascularization,” Ultrasound Obstet
Gynecol, Vol. 14: 139-143, 1999.
Sehgal, P., Arger, S., Rowling, E., Conant, C., Reynolds, & Patton, J., “Quantitative Vascularity of
Breast Masses by Doppler Imaging: Regional Variations and Diagnostic Implications,” J
Ultrasound Med, Vol. 19, pp. 427-440, 2000.
Wilson, W., Valet, A., Andreotti, R., Green-Jarvis, B., Lyshchik, A., & Fleischer, A., “Sonographic
Quantification of Ovarian Tumor Vascularity,” J Ultrasound Med, Vol. 25: 1577-1581, 2006.

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Strain Quantification

11 Strain Quantification
The Strain Quantification (SQ) Q-App allows you to examine Tissue Doppler Imaging (TDI)
ultrasound images and provides a tool for drawing regions of interest that measure the
myocardial velocity, strain, strain rate, and displacement along those regions in the
myocardium.

NOTE
The SQ Q-App does not load the persistent data from images with quantification data from
measurements performed in earlier versions of QLAB software.

The evaluation of the strain and strain rate allows you to determine the range of motion,
percentage of contraction, and the rate of contraction for selected segments of the heart. Using
the waveforms generated in the SQ Q-App, you can evaluate the mechanical activity of the
heart at specific periods of the cycle. You can evaluate and compare the rate of contraction for
specific wall segments.
You can draw up to four virtual M-lines on the image. As you draw each virtual M-line, the
Q‑App calculates the velocity, displacement, strain rate, and strain values and produces a color-
coded virtual M-mode trace, where the mean values from the virtual M-line are graphed
against time and waveforms of the information.
If the image contains the appropriate information, the SQ Q-App is able to derive the R-wave
data and tag the frames accordingly. The Q-App automatically trims the image sequence to
start at the first viable R-wave frame.
You can add time measurements between points on the waveforms.
You can add the timing of mechanical cardiac events to supplement the ECG data. This
information is presented as an overlay on the waveform region.
Automatic M-line tracking adjusts the position of the M-lines on the image as the cardiac wall
moves. You can apply auto-tracking to individual M-lines or to all M-lines. When auto-tracking
is enabled, the M-line attempts to track the same region of the LV anatomy from frame to
frame with cardiac wall motion.

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Using preferences, the toolbar for the trace, and the tabs beneath the waveform, you can
choose the scale, correction method, and information type.
You can change the virtual M-mode data to include different degrees of data. You can include
all or the average of the cardiac cycles. You can also include all sub-regions or only the mean.

SQ Fundamentals
There are two types of virtual M-lines: anatomical and curved. The anatomical M-line is a
straight line anywhere in the ultrasound image, used to trace heart-wall thickening. The curved
virtual M-line allows you to trace an arbitrary contour line within the ultrasound image.

NOTE
Users who want to examine tissue Doppler waveforms for amplitude should turn off curve
processing; this minimizes amplitude changes that can be introduced by waveform smoothing.

Image Acquisition for SQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use the highest frequency transducer possible.
• Set the Tissue Doppler Imaging scale to an optimal point for maximum sensitivity without
aliasing.
• Obtain the highest possible frame rate, adjusting the depth and sector width to include only
the areas of specific interest.
• Use High Definition Zoom if necessary.
• Have the patient hold their breath, during image acquisition, to reduce the motion. Any
relative motion of the sample means potentially new data and appearance of noisier traces,
especially strain rate.
• Ensure adequate Color gain.
• Ensure correct PRF (velocity scale). Use cineloop and replay frame by frame to set the color
velocity scale at the pulsed-wave Doppler peak value.

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• Use a preliminary pulsed-wave Doppler sample on the mitral annulus to check for peak
velocities.
NOTE
When acquiring images on the iU22 and iE33 ultrasound systems, ensure that you do not have
both black-and-white and color suppression enabled.

NOTE
When using the L9-3 transducer to acquire data, you may need to use the QLAB toolbar
control to hide image color and to clear a color overlay from the image. This does not affect the
data in the image loop.

NOTE
Files exported from an HD11 or an HD11 XE ultrasound system must have the Frame Time
Vector option enabled.

NOTE
TDI Images acquired with a baseline shift cannot be opened in SQ.

SQ References
Greenberg, N.L., Firstenberg, M.S., Castro, P.L., Main, M., Travaglini, A., Odabashian, J.A.,
Drinko, J.K., Rodriguez, L.L., Thomas, J.D., Garcia, M.J. “Doppler-derived myocardial systolic
strain rate is a strong index of left ventricular contractility.” Circulation, Vol. 105, No. 1: 99-105,
Jan 2002.
Jamal, F., Kukulski, T., Sutherland, G.R., Weidemann, F., D'hooge, J., Bijnens, B., Derumeaux, G.
“Can changes in systolic longitudinal deformation quantify regional myocardial function after an
acute infarction? An ultrasonic strain rate and strain study.” Journal of the American Society of
Echocardiography, Vol. 15, No. 7: 723-30, July 2002.

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Strain Quantification SQ References

Kowalski, M., Kukulski T., Jamal, F., D'hooge, J., Weidemann, F., Rademakers, F., Bijnens, B.,
Hatle, L., Sutherland, G.R. “Can natural strain and strain rate quantify regional myocardial
deformation? A study in healthy subjects.” Ultrasound in Medicine & Biology, Vol. 27, No. 8:
1087-97, Aug. 2001.
Kukulski, T., Jamal, F., D'Hooge, J., Bijnens, B., De Scheerder, I., Sutherland, G.R. “Acute changes
in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional
velocity, strain rate, and strain measurement.” Journal of the American Society of
Echocardiography, Vol. 15, No. 1:1-12, Jan. 2002.
Urheim, S., Edvardsen, T., Torp, H., Angelsen, B., Smiseth, O.A. “Myocardial Strain by Doppler
Echocardiography Validation of a New Method to Quantify Regional Myocardial Function.”
Circulation, Vol. 102, No. 10: 1158-1164.
Voigt, J-U., Lindenmeier, G., Werner, D., Flachskampf, F.A., Nixdorff, U., Hatle, L., Sutherland,
G.R., Daniel, W.G. “Strain Rate Imaging for the Assessment of Preload-Dependent Changes in
Regional Left Ventricular Diastolic Longitudinal Function.” Journal of the American Society of
Echocardiography, Vol. 15, No.1: 15-19, Jan. 2002.
Wang, M., Yip, G. W., Wang, A. Y., Zhang, Y., Ho, P. Y., Tse, M. K., Yu, C. M., Sanderson, J. E.,
“Tissue Doppler Imaging Provides Incremental Prognostic Value in Patients with Systemic
Hypertension and Left Ventricular Hypertrophy.” Journal of Hypertension, Vol. 23, No. 1:
183-91, January 2005.
Weidemann, F., Eyskens, B., Jamal, F., Mertens, L., Kowalski, M., D'Hooge, J., Bijnens, B.,
Gewillig, M., Rademakers, F., Hatle, L., Sutherland, G.R. “Quantification of regional left and right
ventricular radial and longitudinal function in healthy children using ultrasound-based strain
rate and strain imaging.” Journal of the American Society of Echocardiography, Vol. 15, No. 1:
20-8, Jan. 2002.
Weidemann, F., Jamal, F., Kowalski, M., Kukulski, T., D'Hooge, J., Bijnens, B., Hatle, L., De
Scheerder, I., Sutherland, G.R. “Can strain rate and strain quantify changes in regional systolic
function during dobutamine infusion, B-blockade, and atrial pacing—implications for
quantitative stress echocardiography.” Journal of the American Society of Echocardiography,
Vol. 15, No. 5: 416-24, May 2002.
Yu, C. M., Lin, H., Fung, W. H., Zhang, Q., Kong, S. L., Sanderson, J. E., “Comparison of Acute
Changes in Left Ventricular Volume, Systolic and Diastolic Functions, and Intraventicular
Synchronicity After Biventricular and Right Ventricular Pacing for Heart Failure.” American
Heart Journal. Vol. 145, No. 5: 846, May 2003.

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Yu, C. M., Zhang, Q., Chan, C. K., Yip, G. W., Kum, L. C., Wu, E. B., Lee, E. B., Lam, Y. Y., Chan, S.,
Fung, J. W., “Tissue Doppler Velocity is Superior to Displacement and Strain Mapping in
Predicting Left Ventricular Reverse Remodeling Response After Cardiac Resynchronization
Therapy.” Heart http://heart.bmjjournals.com/cgi/content/abstract/hrt.2005.083592v1, April
2006.

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Region of Interest Quantification

12 Region of Interest Quantification


The Region of Interest Quantification (ROI) Q-App is a tool for analyzing the image pixel content
and the time or intensity data in the image.
The analysis can display the mean, median, standard deviation, flow index, vascularity index,
vascularity flow index, and pixel intensity index for echo, color, and power images.

Quantification can be performed on 2D, Color, CPA, and TDI images saved using DICOM and
Native/DICOM image formats. Because these image formats differ, they are converted by the
QLAB quantification software to a common image file format of 8-bit data separated into an
echo plane and a color plane.
Within the ROI drawn on the image, the mean and median pixel intensity values are calculated
for each frame of the sequence in the image file. For each mean intensity value calculated, the
standard deviation is calculated. If the exported data contains a single frame, the mean
intensity is a single data point. If the exported data contains multiple frames, the mean
intensity is graphed as a curve over time with a data point for each frame.

Depending on the image format used for the quantification, the method of calculating the
mean intensity may vary. For DICOM and Native/DICOM data, the pixel intensity values are in
RGB format. Since RGB values cannot be converted to dB, the geometric mean of pixel
intensities is calculated.

NOTE
Images exported from the iU22 and iE33 systems must be exported as native data to ensure
access to the full ROI functionality.

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Region of Interest Quantification ROI Fundamentals

ROI Fundamentals
ROI includes several Curve Fitting techniques. Use your discretion to decide which type of curve
fitting provides the best approximation to the data. For example, the linear curve fit is available
as a generic fit to any data that appears to have a linear relationship between intensity and
time.
ROI includes two techniques for the display of data in the waveforms using the echo mean:
Linear and Log.
Motion compensation uses an algorithm to track the border motion from frame to frame. It is
important to assess the quality of the border before proceeding. The motion compensation
algorithm attempts to overcome artifacts arising from periodic motion, such as cardiac motion
and respiration, to provide the best quality data for quantification. As motion compensation is
an algorithm that makes these adjustments based on the available image data, it is important
that you review the results of the compensation to ensure that important data is not excluded
from the quantification results.

NOTE
The initial ROI result for color velocity or TDI images defaults to Echo; the waveforms displays
the Color result. To synchronize the result types for the current frame, select a different graph
type from the tabs along the bottom of the waveforms display.

Image Acquisition for ROI


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following information can improve image quality and your quantification
results.
The adjustment of the gain controls, TGC, LGC, and transmit gain available on the ultrasound
system has a significant impact on the quality of the ultrasound image. The success of an ROI
study depends upon the correct adjustment of the gain controls so that all regions of similar
material exhibit similar intensities. Essentially, those gain adjustments are the same ones used
to obtain a high-quality ultrasound image.

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NOTE
When using the L9-3 transducer to acquire data, you may need to use the QLAB toolbar
control to hide image color and to clear a color overlay from the image. This does not affect the
data in the image loop.

NOTE
In side-by-side images with Chroma maps applied during acquisition, the Chroma data appears
incorrectly in the QLAB display. The Chroma map applied to the blood flow data either does not
appear or uses the Chroma setting applied to the tissue data.

NOTE
TDI and color flow images acquired with a baseline shift cannot be opened in ROI.

NOTE
Files exported from an HD11 or an HD11 XE ultrasound system must have the Frame Time
Vector option enabled.

ROI References
Armstrong, W. F., West, S. R., Mueller, T. M., Dillon, J. C., Feigenbaum, H. "Assessment of
Myocardial Perfusion Abnormalities with contrast-enhanced Two-dimensional
Echocardiography." Circulation, 66, 166-73, 1982.
Alcazar, J., Merce, L., Manero, M. “Three-Dimensional Power Doppler Vascular Sampling, A New
Method for Predicting Ovarian Cancer in Vascularized Complex Adnexal Masses.” J Ultrasound
Med, Vol. 24: 689-696, 2005.
Becher, Harald, Burns, Peter. Handbook of Contrast Echocardiography, LV Function and
Myocardial Perfusion. Springer-Verlag, Berlin. 2000.

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Region of Interest Quantification ROI References

Crouse, L. J., Cheirif, J., Hanly, D. E., Kisslo, J. A., Labovitz, A. J., Raichlen, J. S., Schutz, R. W.,
Shah, P. M., & Smith, M. D. "Opacification and Border Delineation Improvement in Patients
with Suboptimal Endocardial Border Definition in Routine Echocardiography: Results of the
Phase III Albunex Multicenter Trial." Journal of the American College of Cardiology, Vol.
22:1494-1500, 1993.
Davila-Roman, V.G., Barzilai, B. "Myocardial contrast echocardiography: enhancement of
perfusion images by color-coding." Journal of Clinical Ultrasound, Vol. 22 No. 1:21-7, January
1994.
deJong, N., Hoff, L., Skotland, T., Bom, N. "Absorption and Scatter of Encapsulated Gas Filled
Microspheres: Theoretical Considerations and Some Measurements." Ultrasonics, Vol. 30, No.
2:95-103, 1992.
deJong, N., ten Cate, F. J., Lancee, C. T., Roelandt, J. R. T. C., & Bom, N. "Principles and Recent
Developments in Ultrasound Contrast Agents." Ultrasonics, Vol. 29, No. 4:324-30, 1991.
deJong, N., ten Cate, F. J., Vletter, W. B., Roelandt, J. R. "Quantification of Transpulmonary Echo
Contrast Agents." Ultrasound in Medicine and Biology, Vol. 19, No. 4:279-88 1993.
Feinstein, S. B., ten Cate, F., Zwehl, W., Ong, K., Maurer, G., Tei, C., Shah, P. M., Meerbaum, S.,
Corday, E. "Two-dimensional contrast Echocardiography: In Vitro Development and
Quantitative Analysis of Echo Contrast Agents." Journal of the American College of Cardiology,
Vol. 3:14-20, 1984.
Fleischer, A. C., Wojcicki, W. E., Donnelly, E. F., Pickens, D. R., Thirsk, G., Thurman, G. B.,
Hellerqvist, C. G. “Quantified color Doppler sonography of tumor vascularity in an animal
model.” J Ultrasound Med, Vol. 18: 547-551, 1999.
Jayaweera, A. R., Edwards, N., Glasheen, W. P., Villanueva, F. S., Abbott, R. D., Kaul, S. "In Vivo
Myocardial Kinetics of Air-filled Albumin Microbubbles During Myocardial Contrast
Echocardiography: Comparison With Radiolabeled Red Blood Cells." Circulation Research, Vol.
74, No. 6:1157-65, 1994.
Jayaweera, A. R., Kaul, S. "Quantification of Myocardial Blood Flow with Contrast
Echocardiography." American Journal of Cardiology Imaging, Vol. 7:317-335, 1993.
Jayaweera, A. R., Matthew, T. L., Sklenar, J., Spotnitz, W. D., Watson, D. D., & Kaul, S. "Method
for the Quantitation of Myocardial Perfusion During Myocardial Contrast Echocardiography."
Journal of the American Society of Echocardiography, 3, 91-8, 1990.

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Jayaweera, A. R., Skyba, D. M., Kaul, S. "Technical Factors that Influence the Determination of
Microbubble Transit Rate During Contrast Echocardiography." Journal of the American Society
of Echocardiography, Vol. 8:198-206, 1995.
Kaul, S., Braunwald, E., editor. Myocardial Perfusion and Other Applications of Contrast
Echocardiography in Heart Disease: A Textbook of Cardiovascular Medicine. WB Saunders,
Philadelphia, 1997, 481-503.
Kaul, S., Jayaweera, A. R. "Myocardial Contrast Echocardiography has the Potential for the
Assessment of Coronary Microvascular Reserve." Journal of the American College of Cardiology,
Vol. 21:356-58, 1993.
Keller, M. W., Segal, S. S., Kaul, S., Duling, B. "The Behavior of Sonicated Albumin Microbubbles
Within the Microcirculation: A Basis for Their use During Myocardial Contrast
Echocardiography." Circulation Research, Vol. 65, No. 2:458-67, 1989.
Lindner, J. R., Skyba, D. M., Goodman, N. C., Jayaweera, A. R., Kaul, S. "Changes in Myocardial
Blood Volume with Graded Coronary Stenosis." American Journal of Physiology, 272, H567-575,
1997.
Lyshchik, A., Moses, R., Barnes, S.L., Higashi, T., Asato, R., Miga, M. I., Gore, J. C., Fleischer, A. C.
“Quantitative Analysis of Tumor Vascularity in Benign and Malignant Solid Thyroid Nodules,” J
Ultrasound Med, Vol. 26: 837-846, 2007.
Masugata, Hisashi, et. al. "Quantitative Assessment of Myocardial Perfusion During Graded
Coronary Stenosis by Real-Time Myocardial Contrast Echo Refilling Curves." Journal of the
American College of Cardiology, Vol. 37, No. 1:262-9, January 2001.
Merce, L., Barco, M., Bau, S., Kupesic, S., Krujak, A. “Assessment of Placental Vascularization by
Three-dimensional Power Doppler ‘Vascular Biopsy’ in Normal Pregnancies,” Croat Med J, Vol.
46, No. 5: 765-771, 2005.
Pairleitner, H., Steiner, H., Hasenoehrl, G., Staudach, A., “Three-dimensional power Doppler
sonography imaging and quantifying blood flow and vascularization,” Ultrasound Obstet
Gynecol, Vol. 14: 139-143, 1999.
Porter, T. R., D'Sa, A., Turner, C., et. al. "Myocardial Contrast Echocardiography for the
Assessment of Coronary Blood Flow Reserve: Validation in Humans." Journal of the American
College of Cardiology, 21, 349-55, 1993.

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Region of Interest Quantification ROI References

Porter, T. R., Xie, F. "Transient Myocardial Contrast After Initial Exposure to Diagnostic
Ultrasound Pressures with Minute Doses of Intravenously Injected Microbubbles:
Demonstration and Potential Mechanisms." Circulation, Vol. 92, No. 9:2391-5, 1995.
Sehgal, C. M, Arger, P., Rowling, S., Conant, E., Reynolds, C., Patton, J., “Quantitative Vascularity
of Breast Masses by Doppler Imaging: Regional Variations and Diagnostic Implications,” J
Ultrasound Med, Vol. 19: 427-440, 2000.
Sklenar, J., Jayaweera A.R., Kaul, S. "A Computer-aided Approach for the Quantitation of
Regional Left Ventricular Function Using Two-dimensional Echocardiography." Journal of the
American Society of Echocardiography, 5, 33-40, 1992.
Tei, C., Sakamaki, T., Shah, P.M, Meerbaum, S, Shimoura, K, Kondo, S, Corday, E. "Myocardial
contrast echocardiography: A Reproducible Technique of Myocardial Opacification for
Identifying Regional Perfusion Defects." Circulation, Vol. 67, No. 3:585, 1983.
Tiemann, K., Becher, H., Köster J., Schlosser T., Pohl C. "Quantification of Tissue Perfusion by
Means of Bubble Destruction Using Harmonic Power Doppler Imaging." Circulation, 98:570,
1998.
Wei, K., Jayaweera, A.R., Firoozan, S., Linka, A., Skyba, D.M., Kaul, S. "Quantification of
Myocardial Blood Flow with Ultrasound-induced Destruction of Microbubbles Administered as
a Continuous Venous Infusion." Circulation, 97: 473-483, 1998.
Wei, K., Skyba, D. M., Firschke, C., Jayaweera, A. R., Lindner, J. R., Kaul, S. "Interactions between
Microbubbles and Ultrasound: In Vitro and In Vivo Observations." Journal of American College
of Cardiology, 29, 1081-1088, 1997.
Wilson, W., Valet, A., Andreotti, R., Green-Jarvis, B., Lyshchik, A., Fleischer, A., “Sonographic
Quantification of Ovarian Tumor Vascularity,” J Ultrasound Med, Vol. 25: 1577-1581, 2006.

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IMT Fundamentals Intima Media Thickness

13 Intima Media Thickness


The Intima Media Thickness (IMT) Q-App provides an automated method of performing
multiple distance measurements of the intima media complex of the carotid or other superficial
arteries.
An edge-detection algorithm determines the intima and media anatomical interfaces, based on
the position of the IMT region of interest. The Q-App provides a graphic display superimposed
on the image data that corresponds to the intima and media points calculated by the software
algorithm.
The IMT Q-App allows you to edit the intima and media position and reposition the frame used
for analysis. After each edit, an algorithm in the Q-App calculates the thickness and success
values for the selected position.
You can edit or redefine the IMT interfaces, manipulate the image, store measurements, and
save and export quantification results.

IMT Fundamentals
The IMT Q-App provides tools for measuring the intima media thickness of a vessel. An edge-
detection algorithm determines the intima and media anatomical interfaces, based on the
position of the IMT region of interest.
There is one basic procedure within the IMT Q-App. That procedure calculates the intima media
thickness of the vessel in the selected frame. You can create and store up to 10 measurements.

Image Acquisition for IMT


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use the most shallow depth setting that is appropriate for the anatomy.
• Use High Definition Zoom on your ultrasound system.
• Ensure that the gain is set properly. The Q-App algorithm works best when there is a clear
definition of the lumen, the intima, and the media adventitia complexes. Minimize
extraneous noise in the image.

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Intima Media Thickness IMT References

• Try to keep the area of the artery that you are interested in quantifying in the center of the
image.
• The Q-App quantifies only the far wall of the selected artery. The far wall is defined as that
portion furthest from the skin line when the image is displayed in normal top/bottom
orientation.
• You can use the Q-App to quantify different portions of the vessel wall by careful
orientation of the transducer at different acquisition angles.

NOTE
When using the L9-3 transducer to acquire data, you may need to use the QLAB toolbar
control to hide image color and to clear a color overlay from the image. This does not affect the
data in the image loop.

NOTE
Files exported from an HD11 or an HD11 XE ultrasound system must have the Frame Time
Vector option enabled.

IMT References
Bots, Michiel, L., et. al. “Common Carotid Intima-Media Thickness and Risk of Stroke and
Myocardial Infarction.” Circulation, Vol. 96, No. 5:1432-1437, 1997.
Kanters, Suzan, D.J.M., et. al. “Reproducibility of In-Vivo Carotid Intima-Media Thickness
Measurements.” Stroke, Vol. 28, No. 3:667:71, March 1997.
Montauban van Swijndregt, Alexander, et. al. “An In Vitro Evaluation of the Line Pattern of the
Near and Far Walls of Carotid Arteries Using B-Mode Ultrasound.” Ultrasound in Medicine &
Biology, Vol. 22, No. 8:1007-1015, 1996.
Raninen, Reino, O. “Ultrasound Imaging for Arterial Wall Thickness Measurement: An In-Vitro
Study with Stereomicroscopic Correlation.” Ultrasound in Medicine and Biology, Vol. 24, No.
6:833-839, 1998.

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IMT References Intima Media Thickness

Stary, Herbert, C., et. al. “A Definition of the Intima of Human Arteries and of its
Atherosclerosis-Prone Regions.” AHA Medical Scientific Statement: Arteriosclerosis and
Thrombosis. Vol. 12, No. 1:120-134, January 1992.
Wendelhag, I., et. al. “Ultrasound Measurement of Wall Thickness in the Carotid Artery:
Fundamental Principles and Description of a Computerized Analysing System.” Clinical
Physiology, 11:565-577, 1991.
Wendelberg, Inger, et. al. “A New Automated Computerized Analyzing System Simplifies
Readings and Reduces the Variability in Ultrasound Measurement of Intima-Media Thickness.”
Stroke, Vol. 28, No. 11:2195-2200, 1997.
Willekes, Christine, et. al. “Evaluation of Off-Line Automated Intima-Media Thickness Detection
of the Common Carotid Artery Based on M-Line Signal Processing.” Ultrasound in Medicine &
Biology, Vol. 25, No. 1:57-64, 1999.

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Intima Media Thickness IMT References

110 QLAB User Manual 4535 617 25481


Cardiac Parametric Quantification

14 Cardiac Parametric Quantification


The Cardiac Parametric Quantification (Cardiac PQ) Q-App provides tools for viewing and
displaying the dynamic intensity information contained in contrast-enhanced ultrasound
images as color-coded parametric images.

NOTE
Approval of specific contrast agents and their applications differs by country. Check with your
local or national regulatory agencies for approved agents and applications.

The Cardiac PQ Q-App performs an analysis of the image data and, depending on the
acquisition method used to capture the ultrasound image, sorts the image frames into groups.
If the acquisition is performed as real time, up to eight ECG groups are automatically created.
ECG groups are created using the frame time relative to the R-wave tag in the cardiac cycle.
Each ECG group contains the image frames that occur at approximately the same point in the
cardiac cycle. The image sequence may be capable of including more groups. If so, you can add
groups after the initial quantification is complete.
If the acquisition is triggered, or was performed using the AutoBeat Sequence (ABS) or the
Triggered Replenishment Image (TRI) method, there is only one ECG group. The manual trigger
methods result in image sequences that, generally, do not need additional sorting.

NOTE
If the image does not contain the required ECG data, QLAB quantification software displays an
error message.

You can position a single-border ROI on the image; this is the region for quantification. The
Cardiac PQ Q-App uses a mathematical model to assess the pixels inside the border ROI per ECG
group and computes the rate of intensity change and the final, steady-state intensity values.

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Cardiac Parametric Quantification Cardiac PQ Fundamentals

Parametric cineloops can be generated from image sequences with at least four groups. Four
result displays show the asymptotic plateau intensity values, the rate of the increase in
intensity, the product of the plateau and rate of intensity increase, and the goodness-of-fit for
the data values.

Cardiac PQ Fundamentals
If the image sequence contains flash frames, the Cardiac PQ Q-App automatically attempts to
find the last flash frame in the image sequence and tag the next frame as the first frame in the
image sequence. The Q-App contains algorithms that attempt to sort the image sequence
frames into ECG groups relative to the R-wave in the cardiac cycle. The generated groups are
listed as either ECG times, TRI#, or ABS#, depending on the method used for the ultrasound
image capture. The list of groups appears in the control area under Groups.

NOTE
Approval of specific contrast agents and their applications differs by country. Check with your
local or national regulatory agencies for approved agents and applications.

• For Real-Time Perfusion Imaging (RTPI) acquisitions, several ECG groups are created and
sorted according to their time relative to the R-wave tagged images in the image sequence.
These groups are identified by their timing data in milliseconds.
• Triggered Replenishment Image (TRI) acquisitions usually produce only one ECG group. This
group is identified by the label TRI#. A TRI is a hybrid acquisition method combining the
fixed image timing of Intermittent Triggered Imaging and the use of flash to clear the
contrast agent from the LV.
• AutoBeat Sequence (ABS) image acquisitions usually produce only one ECG group. This
group is identified by the label ABS#. If multi-frame triggering was enabled during the
acquisition, the Cardiac PQ Q-App attempts to crop all frames other than the first multi-
frame-triggered frame in the image sequence. (ABS is an ultrasound acquisition method
based on user-defined settings that automatically sequence the acquisition by using the
ECG.)

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Image Acquisition for Cardiac PQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use R-wave tagged image sequences captured during an exam using a contrast agent.
• Include echo or power mode data.
• The image file must contain at least four ECG R-waves.
• Use a low-mechanical-index with methods such as Real-Time Power Modulation and Real-
Time Perfusion Imaging in both grayscale and power (angio) modes.
• Use a low-mechanical-index, 1:1 triggering with imaging in both grayscale and power
(angio) modes.
• Use a high-mechanical-index, AutoBeat Sequence methods including Ultraharmonics,
Harmonic Angio, Ultraharmonic Angio, and Pulse Inversion using Auto-Beat Sequencing
with or without Monitoring Mode.
• Use Multi-Frame Triggering (MFT).
• Use Echo or Power (Color Power Angio imaging or PMI) to acquire 2D data.

Cardiac PQ References
Agati L, Tonti G, Galiuto L, Di Bello V, Funaro S, Madonna MP, Garramone B, Magri F; A.M.I.C.I.
Investigators. “Quantification methods in contrast echocardiography.” European Journal of
Echocardiography. Vol. 6 Suppl 2:S14-20, Dec 2005.
Yu, EH., Skyba, DM., et. al. "Incremental Value of Parametric Quantitative Assessment of
Myocardial Perfusion by Triggered Low-Power Myocardial Contrast Echocardiography." Journal
of the American College of Cardiology, Vol. 43, No. 10:1807-13, 2004 May 19.

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Cardiac Parametric Quantification Cardiac PQ References

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GIPQ Fundamentals General Imaging Parametric Quantification

15 General Imaging Parametric


Quantification
The General Imaging Parametric Quantification (GIPQ) Q-App provides tools for identifying
regions of interest in ultrasound echo images and rendering those regions as color-coded
parametric images. The parametric representation of kinetic data can be used to view the
response of the tissue when evaluating the progress of disease and treatment. The histogram
view of the data provides a different view of the data to accommodate the variation between
tissues and tissue states.
You can position one or more regions of interest (ROI) on the image to identify the region for
quantification. The Q-App uses a curve fit that attempts to solve for a set of curve parameters
that best describes the pixels inside the ROI. The analysis can display those parameters. The
parameters vary by the curve fit selected.
The preferences include options to set the parameters mapped onto the image and curve
fitting options applied to the data.

NOTE
The GIPQ Q-App is not available in the United States.

GIPQ Fundamentals
Measurements
The analysis can display the mean, median, and standard deviation for echo images. The mean
is the simple arithmetic average of the data collected. The median is the middle number in the
range of values when the values are listed in order (ascending or descending). The standard
deviation is the positive square root of the variance found in the data set.

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General Imaging Parametric Quantification Image Acquisition for GIPQ

Curve Fitting
Curve-fitted data allows you to interrogate the data and parameters generated in a small point
of interest (POI). Use curve fitting to smooth the data, reducing noise and revealing underlying
patterns in the data.

Parametric Quantification
Parametric quantification provides tools for viewing and displaying the dynamic intensity
information contained in contrast-enhanced ultrasound images as color-coded image overlays.

NOTE
Approval of specific contrast agents and their applications differs by country. Check with your
local or national regulatory agencies for approved agents and applications.

Parametric imaging relies on color maps to represent the values of a specific parameter. The
color scale on the image display is a visual representation of the color map.
You can facilitate the smoothing by selecting the kernel size in the preferences. The kernel size
identifies the number of pixels around each data point over which the data is smoothed. Larger
kernel sizes result in a faster but noisier final parametric image. The maximum kernel size, 21
pixels, results in the noisiest acceptable parametric data results and the lowest curve-fit success
rate.

Histograms
The histogram presents data points representing the frequency of parametric values found in
the data in the ultrasound images. The data in the histogram uses the Parameter of Interest, as
set in the preferences, for the x-axis of the graph. The y-axis is always frequency.

Image Acquisition for GIPQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:

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GIPQ References General Imaging Parametric Quantification

The adjustment of the gain controls, TGC, LGC, and transmit gain available on the ultrasound
system has a significant impact on the quality of the ultrasound image. The success of
parametric quantification depends upon the correct adjustment of the gain controls so that all
regions of similar material exhibit similar intensities. Essentially, those gain adjustments are the
same ones used to obtain a high-quality ultrasound image.

NOTE
When using the L9-3 transducer to acquire data, you may need to use the QLAB toolbar
control to hide image color and to clear a color overlay from the image. This does not affect the
data in the image loop.

NOTE
TDI and color flow images acquired with a baseline shift cannot be opened in GIPQ.

NOTE
Files exported from an HD11 or an HD11 XE ultrasound system must have the Frame Time
Vector option enabled.

GIPQ References
Averkiou, M., Lampaskis, M., Kyriakopoulou, K., Skarlos, D., Klouvas, G., Strouthos, C., Leen, E.
"Quantification of Tumor Microvascularity with Respiratory Gated Contrast Enhanced
Ultrasound for Monitoring Therapy." Ultrasound in Medicine and Biology, Vol. 36, No. 1:68-77,
January 2010.
Fleischer, A. C., Niermann, K. J., Donnelly, E. F., Yankeelov, T. E., Canniff, K. M., Hallahan, D. E.,
Rothenberg, M. E. "Sonographic Depiction of Microvessel Perfusion: Principles and Potential." J
Ultrasound Med. Vol. 23, No. 11:1499-1506, November 2004.
Meyer-Wiethe, K., Cangür, H., Seidel, G. U. "Comparison of different mathematical models to
analyze diminution kinetics of ultrasound contrast enhancement in a flow phantom."
Ultrasound in Medicine and Biology, Vol. 31, No. 1:93-8, January 2005.

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General Imaging Parametric Quantification GIPQ References

Otani, K., Ohnishi, S., Obata, H., Ishida, O., Kitamura, S., Nagaya, N. "Contrast Sonography
Enables Noninvasive and Quantitative Assessment of Neovascularization After Stem Cell
Transplantation." Ultrasound in Medicine and Biology, Vol. 34, No. 12:1893-1900.
Paltiel, H. J., Kalish, L. A., Susaeta, R. A., Frauscher, F., O'Kane, P. L., Freitas-Filho, L. G. "Pulse-
Inversion US Imaging of Testicular Ischemia: Quantitative and Qualitative Analyses in a Rabbit
Model." Radiology, Vol. 239, No. 3:718-29, June 2006.
Powers, J., Averkiou, M., Bruce, M. "Principles of Cerebral Ultrasound Contrast Imaging."
Cerebrovascular Diseases, Vol. 27, Supplement 2:14-24, April 2009.
Quaia, E., Nocentini, A., Torelli, L. "Assessment of a New Mathematical Model for the
Computation of Numerical Parameters Related to Renal Cortical Blood Flow and Fractional
Blood Volume by Contrast-Enhanced Ultrasound." Ultrasound in Medicine and Biology, Vol. 35,
No. 4:616-27, April 2009.
Ross, R. M., Downey, K., Newman, J. M. B., Richards, S. M., Clark, M. G., Rattigan, S. "Contrast-
enhanced ultrasound measurement of microvascular perfusion relevant to nutrient and
hormone delivery in skeletal muscle: A model study in vitro." Microvascular Research, Vol. 75,
No. 3:323-9, April 2008.
Seidel, G., Albers, T., Meyer, K., Wiesmann, M. " Perfusion harmonic imaging in acute middle
cerebral artery infarction." Ultrasound in Medicine and Biology, Vol. 29, No. 9:1245-51,
September 2003.
Serra, C., Brandi, G. "The emerging role of 2D and 2D contrast-enhanced ultrasound with
quantitative analysis in evaluating the response to new antitumoral treatments." Medicamundi,
Vol. 51, No. 2:64-73, November 2007.
Thierman, J. S., Clement, G. T., Kalish, L. A., O'Kane, P. L., Frauscher, F., Paltiel, H. J. "Automated
sonographic evaluation of testicular perfusion." Physics in Medicine and Biology, Vol. 51, No.
14:3419-32, July 2006.

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MVI Fundamentals MicroVascular Imaging

16 MicroVascular Imaging
The MicroVascular Imaging (MVI) Q-App provides tools for assessing the local intensity changes
over time in 2D ultrasound images.
The image data is processed to map intensity changes frame by frame. The processing
suppresses background tissue signals and enhances the vessel conspicuity. The result is
presented in two image panes, displaying a processed image next to the unprocessed image.
The unprocessed image displays more tissue signal. Having a dual-image display improves the
objectivity, speed, and ease of interpretation of the information.
MicroVascular Imaging accentuates blood flow at low velocity flow states. The MVI Q-App
applies image-processing techniques to track bubbles and enhance visualization of normal and
abnormal anatomy. This smooths the image intensity to reduce noise. Background subtraction
normalizes the image data.

MVI Fundamentals
The MVI Q-App provides two views of the image data. The left image pane shows the
unprocessed image. The right image pane shows the processed image.
The image area also displays the timer, if a timer was used during data acquisition.
After you have opened an image file and have started the MVI Q-App, play or scroll through the
cineloop sequence to view the changes in the tissue (processed) and unprocessed layers of the
image data.

Procedure for Preparing an Image for Viewing


Prepare an image for viewing in MVI.

NOTE
You can set the default state for motion compensation in the MVI preferences.

1. Show or hide the unprocessed image:

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MicroVascular Imaging Image Acquisition for MVI

• To show the unprocessed image, select Show Unprocessed Image.


• To hide the unprocessed image, deselect Show Unprocessed Image.
2. Enable or disable motion compensation:
• To enable motion compensation, select Enable Motion Compensation.
• To disable motion compensation, deselect Enable Motion Compensation.

Image Acquisition for MVI


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use a low-mechanical-index, 1:1 triggering with flash-replenishment in either grayscale or
power (angio) modes.
• Use Real-Time Power Modulation or Real-Time Perfusion Imaging in either grayscale and
power (angio) modes.
• Include scaling information in the image data.
• Do not use continuous-wave or pulsed-wave Doppler during image acquisition.
• Include the contrast timer counter. This information is displayed, as an overlay, on the
image.
• Use a high-mechanical-index and AutoBeat Sequence methods. Those methods include
Ultraharmonics, Harmonic Angio, Ultraharmonic Angio, and Pulse Inversion using Auto-Beat
Sequencing with or without Monitoring Mode.

NOTE
When using the L9-3 transducer to acquire data, you may need to use the QLAB toolbar
control to hide image color and to clear a color overlay from the image. This does not affect the
data in the image loop.

NOTE
In side-by-side images with Chroma maps applied during acquisition, the Chroma data appears
incorrectly in the QLAB display. The Chroma map applied to the blood flow data either does not
appear or uses the Chroma setting applied to the tissue data.

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Vascular Plaque Quantification

17 Vascular Plaque Quantification


The Vascular Plaque Quantification (VPQ) Q-App provides protocol-driven tools for performing
a semi-automated analysis of plaque in the carotid artery.
In the manual portion of the plaque quantification process, you use the VPQ tools to define a
plaque region, comprising a contiguous series of frames within a 3D volume cineloop. This
involves defining a begin frame and an end frame, just before and just after the presence of
visible plaque. You must also define at least one key frame with a representative amount of
visible plaque. As with the IMT Q-App, this measurement setup process can be done fairly
quickly, and is suitable for a screening routine.
In the automated portion of plaque quantification, the VPQ software uses the plaque region
that you manually defined as a guide to create and display plaque and lumen areas on
intermediate frames within the region. VPQ then calculates the results for display and export to
analyze the extent of plaque versus lumen.
Clinical analysis results include the location of the maximum reduction site, the percent of
maximum reduction (stenosis), and the overall plaque volume detected in the entire image.
Research results can be displayed and exported to show various values for each tracked frame.
VPQ results are also presented in graphical format, showing the lumen and plaque areas and
also the percent reduction for each tracked frame.
VPQ provides two techniques for scaling echo intensity of the image data: Linear and Log.
Additional preference options include a parameter for specifying the frame interval for plaque
computation and a set of clinical and research measurements that can be selected individually.

NOTE
VPQ supports plaque quantification only on 3D volumes acquired from an iU22 ultrasound
system with a VL13-5 transducer. Monochrome (echo-only) volumes are supported; color
volumes are not supported. Single-volume images are supported; 4D and real-time 3D volumes
are not supported.

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Vascular Plaque Quantification VPQ Fundamentals

NOTE
To help identify the correct laterality of the images you quantify with the VPQ Q-App, you
should use the ultrasound system annotation feature to mark the laterality on the images at
the time of acquisition.

VPQ Fundamentals
A range of frames is necessary for plaque analysis because a single transverse slice can
potentially produce misleading results. Plaques are often inhomogeneous, and quantification
results can vary considerably from frame to frame.

Protocol-Driven Analysis
The VPQ protocol steps require that you use either the Ellipse ROI tool or the Spline ROI tool to
draw a plaque ROI on the begin frame, the end frame, and at least one key frame within the
plaque region. To create a plaque ROI on each of these frames, you use your best clinical
judgment to draw an outline of the outer vessel wall, and then allow the real-time image
segmentation algorithm to draw the other contours.
After you have defined a basic plaque region by performing at least these three required steps,
you can perform the Calculate step to run the tracking algorithm and generate the VPQ results.

Image Segmentation
To segment an individual frame on which you have manually drawn an estimation of the media-
adventitia boundary (MAB), the VPQ software automatically draws the lumen-intima boundary
(LIB) inside the MAB by the distance of the default IMT value. Based on the image's grayscale
values, VPQ then draws the lumen-plaque boundary automatically.
During tracking, VPQ uses your manually drawn plaque ROIs as a guide to perform image
segmentation on intermediate frames within the region.

NOTE
To reduce noise and other artifacts, such as dropouts and shadowing, image segmentation is
performed after a Gaussian low pass filter is applied in the longitudinal direction.

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Image Acquisition for VPQ Vascular Plaque Quantification

The IMT Value


VPQ uses a default intima media thickness (IMT) value of 0.50 mm to draw the inner vessel wall
(LIB) just inside the outer vessel wall (MAB). The inner vessel wall cannot be clearly visualized in
ultrasound images, and so it cannot be drawn accurately with manual drawing tools. If you have
a known IMT value, for example from an IMT measurement, you can override the default by
specifying a user-defined IMT value in the preferences.

Optional Normalization ROI


You can perform an optional protocol step to draw a rectangular normalization region of
interest on a frame that has an area you consider a good representation of clear lumen. VPQ
will then use the normalization ROI as a reference for determining a grayscale level to identify
as clear lumen. This allows the measurements labeled as "normalized" to be meaningfully
compared between two volumes that were acquired with different gain settings.

Anatomy Specification
If you plan to export results to a DICOM SR or an iU22 Ultrasound System report, you must
specify the anatomy for the volume to give context to the displayed and exported results. If you
do not plan to export results to a DICOM SR or an iU22 Ultrasound System report, or if you
want to save your work and complete the protocol later, you do not need to perform the
Specify Anatomy protocol step.

Image Acquisition for VPQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use the most shallow depth setting that is appropriate for the anatomy.
• Use High Definition Zoom on your ultrasound system.
• Ensure that the gain is set properly. The Q-App algorithm works best when there is a clear
definition of the lumen, the intima, and the media adventitia complexes. Minimize
extraneous noise in the image.
• Try to keep the area of the artery that you are interested in quantifying in the center of the
image.
• Use the Res setting in 3D to obtain the most accurate readings.
• Acquire images with the carotid artery transverse in the acquisition plane.

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Vascular Plaque Quantification VPQ References

VPQ References
Ainsworth, C. D., Blake, C. C., Tamayo, A., et al. "3D ultrasound measurement of change in
carotid plaque volume: a tool for rapid evaluation of new therapies." Stroke, 36: 1904-1909,
2005.
Goldstein, L. B., Bushnell, C. D., Adams, R. J., et al. "Guidelines for the primary prevention of
stroke: a guideline for healthcare professionals from the American Heart Association/American
Stroke Association." Stroke, 42: 517-584, 2011.
Greenland, P., Alpert, J. S., Beller, G. A., et al. "2010 ACCF/AHA guideline for assessment of
cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines." J Am Coll Cardiol,
56: e50-103, 2010.
Inaba, Y., Chen, J. A., Bergmann, S. R. "Carotid plaque, compared with carotid intima-media
thickness, more accurately predicts coronary artery disease events: A meta-analysis."
Atherosclerosis, 30 June 2011.
Johnsen, S. H., Mathiesen, E. B. "Carotid plaque compared with intima-media thickness as a
predictor of coronary and cerebrovascular disease." Curr Cardiol Rep, 11: 21-7, 2009.
Landry, A. M., Spence, J. D., Fenster, A. "Measurement of carotid plaque volume by
3‑dimensional ultrasound." Stroke, 35: 864-869, 2004.
Muntendam, P., McCall. C., Sanz, J., Falk, E., Fuster, V. "The BioImage Study: novel approaches
to risk assessment in the primary prevention of atherosclerotic cardiovascular disease--study
design and objectives." Am Heart J, 160: 49-57, 2010.
Naqvi, T. Z., Mendoza, F., Rafii, F., et al. "High prevalence of ultrasound detected carotid
atherosclerosis in subjects with low Framingham risk score: Potential implications for screening
for subclinical atherosclerosis." J Am Soc Echocardiogr, 23: 809-815, 2010.
Stein, J. H., Korcarz, C. E., Hurst, R. T., et al. "Use of carotid ultrasound to identify subclinical
vascular disease and evaluate cardiovascular disease risk: a consensus statement from the
American Society of Echocardiography Carotid Intima-Media Thickness Task Force." Endorsed
by the Society for Vascular Medicine. J Am Soc Echocardiogr, 21: 93-111; quiz 189-90, 2008.
Wald, D. S., Bestwick, J. P., Morton, G., et al. "Combining carotid intima-media thickness with
carotid plaque on screening for coronary heart disease." J Med Screen, 16: 155-9, 2009.

124 QLAB User Manual 4535 617 25481


Fetal Heart Navigator

18 Fetal Heart Navigator


The Fetal Heart Navigator (FHN) Q-App provides a semi-automated alignment of the fetal heart
from a 3D volume acquisition and a protocol that steps you through the standard views.
The objective of the protocol is to obtain the standard set of views that best reveal the most
common fetal heart anomalies (dystrophy of the chambers):
• Ductal Arch
• Four-Chamber
• Left Ventricle Outflow Tract (LVOT)
• Right Ventricle Outflow Tract (RVOT)
The purpose of the FHN Q-App is for visualization only. The FHN tools do not produce
quantitative data or measurements.
The FHN Q-App is best utilized with fetal heart data obtained during a second-trimester scan,
optimally between 18 and 22 weeks gestational age. FHN evaluation may be useful in helping to
assess risk level for anomalies in fetuses that are examined as a part of routine prenatal care.
This approach may also provide useful information for patient counseling, obstetrical
management, and multi-disciplinary care.

NOTE
The FHN Q-App can be used only with 3D STIC or iSTIC data sets acquired on EPIQ series
ultrasound systems or an iU22 Ultrasound System with an X6-1, a V6-2, or a 3D9-3v transducer.

NOTE
The RVOT view used in the FHN Q-App is recommended by ISUOG and AIUM.

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Fetal Heart Navigator FHN Fundamentals

FHN Fundamentals
The FHN Q-App uses multi-frame 3D data sets, which have significant benefits over 2D data
sets:
• Only one good data set is required for analysis, reducing the length of time the fetus must
remain stationary.
• More time can be spent inspecting diagnostic views after the exam.
The FHN Q-App has two primary processing components:
• An algorithm that automatically produces the initial alignment of a 3D fetal heart data set
and finds the ductal arch (without user input)
• A set of protocol steps that guide you through the process of obtaining and adjusting all
views after the initial alignment is complete

NOTE
If the algorithm produces the initial view of the ductal arch, you must verify the orientation of
the ductal arch view. If the algorithm fails to produce the initial view of the ductal arch, a
message is displayed and all protocol steps are disabled.

If the algorithm succeeds in producing the initial ductal arch view, you are guided through the
protocol by instructions and accompanying illustrations. After making any necessary
adjustments to the initial ductal arch view, you proceed through the protocol steps to obtain
the four-chamber, LVOT, and RVOT views by using controls that are presented on the ductal
arch view to optimize each of the other views.

NOTE
The user guidance illustrations of the ductal arch, four-chamber, and LVOT views were provided
by Abuhamad, Alfred. "A Practical Guide to Fetal Echocardiography." Philadelphia, PA: Wolters
Kluwer.

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Image Acquisition for FHN Fetal Heart Navigator

NOTE
The user guidance illustration of the RVOT view was provided by AIUM Technical Bulletin (1998)
"Performance of the Basic Fetal Cardiac Ultrasound Examination." AIUM.

Image Acquisition for FHN


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Use the Fetal Echo Tissue Specific preset, which defaults to iSTIC in 3D standby mode.
• In 3D standby mode, optimize the image quality by adjusting gain, depth, and acoustic
focus.
• In 3D standby or HD zoom, narrow the ROI for maximum temporal resolution in iSTIC
acquisition.
• Try to keep the elevation angle near 28 degrees.
• Consider asking the patient to hold her breath.
• Obtain the best angles of acquisition to maintain four-chamber view.
• Discard any volume that is less than optimum image quality.
• Observe the fetal heart rate and acquire while rate is changing the least.

FHN References
Espinoza, J., Kusanovic, J. P., Goncalves, L. F., Nien, J. K., Hassan, S., Lee, W., Romero, R. "A
Novel Algorithm for Comprehensive Fetal Echocardiography Using 4-Dimensional
Ultrasonography and Tomographic Imaging." J Ultrasound Med, 25: 947–956, 2006.
Espinoza, J., Gotsch, F., Kusanovic, J. P., Goncalves, J. K., Hassan, S., Lee, W., Mittal, P., Romero,
R., Schoen, M. L. "Changes in Fetal Cardiac Geometry with Gestation Implications for 3- and 4-
Dimensional Fetal Echocardiography." J Ultrasound Med, 26: 437–443, 2007.
Garne, E., Stoll, C., Clementi, M., et. al. "Evaluation of prenatal diagnosis of congenital heart
diseases by ultrasound: experience from 20 European registries. Ultrasound Obstet Gynecol, 17:
386–391, 2001.

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Fetal Heart Navigator FHN References

Lee, W., Carvalho, J. S., Chaoui, R., Copel, J., Hecher, K., Paladini, D. "Cardiac screening
examination of the fetus: guidelines for performing the ‘basic’ and ‘extended basic’ cardiac
scan." Ultrasound Obstet Gynecol, 27: 107–113, 2006.
Lee, W., Drose, J., Wax, J. "AIUM Practice Guideline for the Performance of Fetal
Echocardiography." American Institute of Ultrasound in Medicine, 2010.
Salomon, L. J., Alfirevic, V., Berghella, C., Bilardo, E., Hernandez-Andrade, S. L., Johnsen, K.,
Kalache, K., Leung, G., Malinger, H., Munoz, F., Prefumo, A., Toi, A., Lee, W. "Practice guidelines
for performance of the routine mid-trimester fetal ultrasound scan." Ultrasound Obstet
Gynecol, 10.1002/uog.8831, 2010.
Yagel, S., Cohen, S. M., Shapiro, I., Valsky, D. V. "3D and 4D ultrasound in fetal cardiac scanning:
a new look at the fetal heart." Ultrasound Obstet Gynecol, 29: 81–95, 2007.

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EA Fundamentals Elastography Analysis

19 Elastography Analysis

NOTE
The EA Q-App is only available in the United States.

The Elastography Analysis (EA) Q-App provides tools for quantifying elastograms that are
acquired using the elastography feature on the ultrasound system. The EA Q-App provides the
ability to perform size comparison.

CAUTION
The ultrasound system normalizes the elastogram. Elastography measurements and
calculations in the QLAB software are relative quantifications of tissue strain, which are not
necessarily repeatable over time. Do not compare elastography data from different data sets;
the normalization applied and the variability of the tissue strain could result in an inaccurate
analysis.

EA Fundamentals
The Elastography Analysis Q-App displays 2D images and elastograms that are acquired with
the elastography feature on the ultrasound system and enables you to quantify the size of
lesions (Size Compare).

Image Acquisition for EA


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Hold the transducer perpendicular to the chest wall. A light touch allows the patient's
breathing cycle to provide the compression necessary for elastography.

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Elastography Analysis EA References

• Support the weight of the transducer with your hand so that the transducer rests gently in
the layer of gel.
• Try to include normal fat along with glandular tissue in the ROI box, so you can compare
lesion stiffness with the stiffness of surrounding tissue.
• When imaging suspicious lesions, note that lesions that are stiffer than normal fat and
glandular tissues may appear larger in an elastogram than in 2D mode.
• Anechoic imaging (AI) may not work for the first 1 cm of depth. To help acquire a better
anechoic image of a superficial region in the first 1 cm, use a standoff pad or extra gel.

EA References
Gao, L., Parker, K. J., Lerner, R. M., Levinson, S. F. “Imaging of the Elastic Properties of Tissue–A
Review.” Ultrasound Med Biol, 22: 959-977, 1996.
Garra, B. S., CÈspedes, I., Ophir, J., et al. “Elastography of Breast Lesions: Initial Clinical Results.”
Radiology, 202: 79-86, 1997.
Krouskop, T. A., Wheeler, T. M., Kallel, F., et al. “Elastic Moduli of Breast and Prostate Tissues
Under Compression.” Ultrason Imaging, 20: 260-274, 1998.
Lyshchik, A., Higashi, T., Asato, R., et al. “Thyroid Gland Tumor Diagnosis at US Elastography.”
Radiology, 237: 202-211, 2005.
O'Donnell, M., Skovoroda, A. R., Shapo, B. M., et al. “Internal Displacement and Strain Imaging
Using Ultrasonic Speckle Tracking.” IEEE Trans Ultrason Ferroelectr Freq Control, 41: 314-325,
1994.
Ophir, J., Alam, S. K., Garra, B. S., et al. “Elastography: Ultrasonic Estimation and Imaging of the
Elastic Properties of Tissues.” Proc Inst Mech Eng [H], 213: 203-233, 1999.
Ophir, J., CÈspedes, E. I., Ponnekanti, H., et al. “Elastography: A Quantitative Method for
Imaging the Elasticity of Biological Tissues.” Ultrason Imaging, 13: 111-134, 1991.
Regner, D. M., Hesley, G. K., Hangiandreou, N. J., et al. “Breast Lesions: Evaluation With US
Strain Imaging–Clinical Experience of Multiple Observers.” Radiology, 238: 425-437, 2006.
Zhi, H., Xiao, X., Yang, H., Wen, Y., Ou, B., Luo, B., Liang, B. “Semi-quantitating Stiffness of Breast
Solid Lesions in Ultrasonic Elastography.” Academic Radiology, Vol. 15, No. 11: 1347-1353,
November 2008.

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Elastography Quantification

20 Elastography Quantification

NOTE
The EQ Q-App is not available in the United States.

The Elastography Quantification (EQ) Q-App provides tools for quantifying elastograms
acquired using the elastography feature on the ultrasound system. The EQ Q-App provides the
ability to calculate strain ratio, in addition to the ability to perform size comparison and
Parametric Imaging.

CAUTION
The ultrasound system normalizes the elastogram. Elastography measurements and
calculations in the QLAB software are relative quantifications of tissue strain, which are not
necessarily repeatable over time. Do not compare elastography data from different data sets;
the normalization applied and the variability of the tissue strain could result in an inaccurate
analysis.

NOTE
Images acquired on Vision 2009 iU22 or Vision 2009 iE33 ultrasound systems do not have the
full range of measurement options available. Images acquired on those systems can be used for
the following quantification results: Size Ratio, Strain Ratio, Maximum Strain Ratio, and
Average Strain Ratio.

NOTE
Generally, the measurement accuracy of measurements performed in the EQ Q-App will be
±30% of the actual value.

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Elastography Quantification EQ Fundamentals

EQ Fundamentals
The EQ Q-App displays 2D images and elastograms acquired with the elastography feature on
the ultrasound system and enables you to quantify the size of lesions (Size Compare), compare
the strain values between two ROIs in the elastogram (Strain Ratio), and compare the stiffness
of the whole image against one ROI (Parametric Image).

Image Acquisition for EQ


The performance and results obtained depend upon the quality of the image data that you
intend to analyze. The following can improve image quality and your quantification results:
• Hold the transducer perpendicular to the chest wall. A light touch allows the patient's
breathing cycle to provide the compression necessary for elastography.
• Support the weight of the transducer with your hand so that the transducer rests gently in
the layer of gel.
• Try to include normal fat along with glandular tissue in the ROI box, so you can compare
lesion stiffness with the stiffness of surrounding tissue.
• When imaging suspicious lesions, note that lesions that are stiffer than normal fat and
glandular tissues may appear larger in an elastogram than in 2D mode.
• Anechoic imaging (AI) may not work for the first 1 cm of depth. To help acquire a better
anechoic image of a superficial region in the first 1 cm, use a standoff pad or extra gel.

EQ References
Gao, L., Parker, K. J., Lerner, R. M., Levinson, S. F. “Imaging of the Elastic Properties of Tissue–A
Review.” Ultrasound Med Biol, 22: 959-977, 1996.
Garra, B. S., CÈspedes, I., Ophir, J., et al. “Elastography of Breast Lesions: Initial Clinical Results.”
Radiology, 202: 79-86, 1997.
Krouskop, T. A., Wheeler, T. M., Kallel, F., et al. “Elastic Moduli of Breast and Prostate Tissues
Under Compression.” Ultrason Imaging, 20: 260-274, 1998.
Lyshchik, A., Higashi, T., Asato, R., et al. “Thyroid Gland Tumor Diagnosis at US Elastography.”
Radiology, 237: 202-211, 2005.

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EQ References Elastography Quantification

O'Donnell, M., Skovoroda, A. R., Shapo, B. M., et al. “Internal Displacement and Strain Imaging
Using Ultrasonic Speckle Tracking.” IEEE Trans Ultrason Ferroelectr Freq Control, 41: 314-325,
1994.
Ophir, J., Alam, S. K., Garra, B. S., et al. “Elastography: Ultrasonic Estimation and Imaging of the
Elastic Properties of Tissues.” Proc Inst Mech Eng [H], 213: 203-233, 1999.
Ophir, J., CÈspedes, E. I., Ponnekanti, H., et al. “Elastography: A Quantitative Method for
Imaging the Elasticity of Biological Tissues.” Ultrason Imaging, 13: 111-134, 1991.
Regner, D. M., Hesley, G. K., Hangiandreou, N. J., et al. “Breast Lesions: Evaluation With US
Strain Imaging–Clinical Experience of Multiple Observers.” Radiology, 238: 425-437, 2006.
Zhi, H., Xiao, X., Yang, H., Wen, Y., Ou, B., Luo, B., Liang, B. “Semi-quantitating Stiffness of Breast
Solid Lesions in Ultrasonic Elastography.” Academic Radiology, Vol. 15, No. 11: 1347-1353,
November 2008.

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Elastography Quantification EQ References

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Exported 2D Images and Loops QLAB Compatibility Tables

21 QLAB Compatibility Tables


Philips Ultrasound systems produce clinical DICOM image data. Some image file formats
created on Philips Ultrasound systems are incompatible with QLAB software.

2D and 3D export tables provide an overview of the compatibility of 2D and 3D images and
loops exported from your Philips Ultrasound systems. They show which Q-Apps are supported
for each ultrasound system and the supported image file formats for the available Q-Apps. For
information on the image types, see your ultrasound system manuals. For information on
exporting images and loops from your ultrasound system, see your ultrasound system
documentation.

Compatibility Tables
The compatibility tables include footnotes at the end of each section of tables for any special
considerations or conditions applied to the image format, image mode, or Q-App compatibility.
The compatibility tables use the following symbols to indicate compatibility.
Symbol Meaning
The image file format or mode is compatible with the Q-App and can be
quantified.

The image file format or mode is incompatible with the Q-App and cannot be
quantified.

Exported 2D Images and Loops

NOTE
Color Flow and TDI image loops with a baseline shift cannot be quantified in the QLAB software.

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QLAB Compatibility Tables Exported 2D Images and Loops

NOTE
If you open an image in which you expect to see annotations that were placed on the image
during acquisition, those annotations may not transfer to the Q-App image view. Review the
image carefully to note the anatomy and orientation before performing quantification.

NOTE
The following tables show the compatibility between exported image format and Q-Apps. Some
images may be opened in Q-Apps without also being available for quantification. This level of
compatibility is not included in the following tables.

Exported 2D Images and Loops: EPIQ Series Systems


EPIQ Series Systems (1 of 2)
Image File Format

a2DQ aCMQ CMQ SQ ROI IMT Cardiac


Stress PQ
DICOM Composite1 2

DICOM Native Data 2,4 2,4 2,4 4,5 2 6,7

Compressed3

EPIQ Series Systems (2 of 2)


Image File Format

GIPQ MVI EA EQ
DICOM Composite 1 8

DICOM Native Data 9 9

Compressed3

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Exported 2D Images and Loops QLAB Compatibility Tables

Footnotes for Exported 2D Images and Loops: EPIQ Series Systems


1. The default export format for the EPIQ series, iU22, and iE33 ultrasound systems is DICOM
Composite.
2. Color Flow data is not supported.
3. In all cases but the following, native data files are opened as DICOM Composite: 2D
grayscale, Color, Tissue Doppler Imaging (TDI), Color Power Angio (CPA), Live xPlane
grayscale, xPlane Color Flow, and side-by-side imaging.
4. Requires ECG data for quantification.
5. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.
6. Multi-frame image loops with time frame data required.
7. Philips recommends that there be at least four ECG R-waves and the requisite 2D or Power
(Angio or PMI) data.
8. Native format images and loops from EPIQ series systems and from iE33 Vision 2005 and
later systems only.
9. Elastography is not available in all locales.

Exported 2D Images and Loops: ClearVue 650 Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps.

NOTE
RLE Compressed is also recommended because it produces smaller files than uncompressed
formats. All image thumbnails in this format display the Q icon.

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QLAB Compatibility Tables Exported 2D Images and Loops

Image File Format

a2DQ ROI IMT


Palette Color, RLE Compressed 1

Palette Color, Uncompressed 1

Explicit VR Little Endian (ELE)

Palette Color, Uncompressed 1

Implicit VR Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed Explicit VR


Little Endian (ELE)

RGB, Uncompressed Implicit VR


Little Endian (ILE)

Footnotes for Exported 2D Images and Loops: ClearVue 650 Systems


1. Requires ECG data for quantification.

Exported 2D Images and Loops: Sparq Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps.

NOTE
RLE Compressed is also recommended because it produces smaller files than uncompressed
formats. All image thumbnails in this format display the Q icon.

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Exported 2D Images and Loops QLAB Compatibility Tables

Image File Format

a2DQ SQ ROI IMT


Palette Color, RLE Compressed 1 1,2

Palette Color, Uncompressed 1 1,2

Explicit VR Little Endian (ELE)

Palette Color, Uncompressed 1 1,2

Implicit VR Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed Explicit VR


Little Endian (ELE)

RGB, Uncompressed Implicit VR


Little Endian (ILE)

YBR, JPEG Compressed

MONOCHROME2, Uncompressed
(Explicit VR Little Endian)

MONOCHROME2, Uncompressed
(Implicit VR Little Endian)

Footnotes for Exported 2D Images and Loops: Sparq Systems


1. Requires ECG data for quantification.
2. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.

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QLAB Compatibility Tables Exported 2D Images and Loops

Exported 2D Images and Loops: iU22 Systems


iU22 Systems (1 of 2)
Image File Format

a2DQ aCMQ CMQ SQ ROI IMT Cardiac


Stress PQ
DICOM Composite1 2

DICOM Native Data 2,5,6 2,5,6 2,5,6 4,5,6 2,6 6

Uncompressed3

DICOM Native Data 2,5 2,5 2,5 4,5 2

Compressed3

iU22 Systems (2 of 2)
Image File Format

GIPQ MVI EA EQ
DICOM Composite 1 2 7

DICOM Native Data 2,6 6 8 8

Uncompressed3

DICOM Native Data 2 8 8

Compressed3

Footnotes for Exported 2D Images and Loops: iU22 Systems


1. The default export format for the EPIQ series, iU22, and iE33 ultrasound systems is DICOM
Composite.
2. Color Flow data is not supported.
3. In all cases but the following, native data files are opened as DICOM Composite: 2D
grayscale, Color, Tissue Doppler Imaging (TDI), Color Power Angio (CPA), Live xPlane
grayscale, xPlane Color Flow, and side-by-side imaging.

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4. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.
5. Requires ECG data for quantification.
6. Native uncompressed data may be exported only from systems with a software release
prior to September 2007. Color flow and Tissue Doppler Imaging loops containing baseline
shift are not quantifiable in the QLAB software.
7. Multi-frame image loops with time frame data required.
8. Elastography is not available in all locales.

Exported 2D Images and Loops: iE33 Systems


iE33 Systems (1 of 2)
Image File Format

SQ ROI IMT
a2DQ aCMQ CMQ
Stress
DICOM Composite1

DICOM Native Data 4,7,8,9 4,7,8,9 4,7,8,9 3,4 7

Uncompressed2,10

DICOM Native Data 4,7,8 4,7,8 4,7,8 3,4 7

Compressed2

iE33 Systems (2 of 2)
Image File Format

Cardiac GIPQ
PQ
DICOM Composite1

DICOM Native Data 5,6 7

Uncompressed2,10

DICOM Native Data 5,6 7

Compressed2

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QLAB Compatibility Tables Exported 2D Images and Loops

Footnotes for Exported 2D Images and Loops: iE33 Systems


1. The default export format for the EPIQ series, iU22, and iE33 ultrasound systems is DICOM
Composite.
2. In all cases but the following, native data files are opened as DICOM Composite: 2D
grayscale, Color, Tissue Doppler Imaging (TDI), Color Power Angio (CPA), Live xPlane
grayscale, xPlane Color Flow, and side-by-side imaging.
3. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.
4. Requires ECG data for quantification.
5. Native format images and loops from EPIQ series systems and from iE33 Vision 2005 and
later systems only.
6. Philips recommends that there be at least four ECG R-waves and the requisite 2D or Power
(Angio or PMI) data.
7. Color Flow data is not supported.
8. Images acquired using S5-1, S5-2, X7-2, or X7-2t transducers.
9. Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the
aCMQ, and the CMQ-Stress Q-Apps. RLE Compressed is also recommended because it
produces smaller files than uncompressed formats. All image thumbnails in this format
display the Q icon.
10. Native uncompressed data may be exported only from systems with a software release
prior to September 2007. Color flow and Tissue Doppler Imaging loops containing baseline
shift are not quantifiable in the QLAB software.

Exported 2D Images and Loops: HD15 Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps.

NOTE
RLE Compressed is also recommended because it produces smaller files than uncompressed
formats. All image thumbnails in this format display the Q icon.

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HD15 Systems (1 of 2)
Image File Format

a2DQ aCMQ CMQ SQ ROI IMT


Stress
Palette Color, RLE Compressed 1 1 1 1,2

Palette Color, Uncompressed 1 1 1 1,2

Explicit VR Little Endian (ELE)

Palette Color, Uncompressed 1 1 1 1,2

Implicit VR Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed Explicit VR


Little Endian (ELE)

RGB, Uncompressed Implicit VR


Little Endian (ILE)

YBR, JPEG Compressed

MONOCHROME2, Uncompressed
(Explicit VR Little Endian)

MONOCHROME2, Uncompressed
(Implicit VR Little Endian)

HD15 Systems (2 of 2)
Image File Format

GIPQ MVI
Palette Color, RLE Compressed

Palette Color, Uncompressed


Explicit VR Little Endian (ELE)

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QLAB Compatibility Tables Exported 2D Images and Loops

Image File Format

GIPQ MVI
Palette Color, Uncompressed
Implicit VR Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed Explicit VR


Little Endian (ELE)

RGB, Uncompressed Implicit VR


Little Endian (ILE)

YBR, JPEG Compressed

MONOCHROME2, Uncompressed
(Explicit VR Little Endian)

MONOCHROME2, Uncompressed
(Implicit VR Little Endian)

Footnotes for Exported 2D Images and Loops: HD15 Systems


1. Requires ECG data for quantification.
2. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.

Exported 2D Images and Loops: CX50 Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps.

NOTE
RLE Compressed is also recommended because it produces smaller files than uncompressed
formats. All image thumbnails in this format display the Q icon.

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Image File Format

a2DQ aCMQ CMQ SQ ROI IMT GIPQ MVI


Stress
Palette Color, RLE 1 1 1 1,2

Compressed

Palette Color, 1 1 1 1,2

Uncompressed Explicit VR
Little Endian (ELE)

Palette Color, 1 1 1 1,2

Uncompressed Implicit VR
Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed
Explicit VR Little Endian
(ELE)

RGB, Uncompressed
Implicit VR Little Endian
(ILE)

YBR, JPEG Compressed

MONOCHROME2,
Uncompressed (Explicit VR
Little Endian)

MONOCHROME2,
Uncompressed (Implicit VR
Little Endian)

MONOCHROME2, RLE

Footnotes for Exported 2D Images and Loops: CX50 Systems


1. Requires ECG data for quantification.

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QLAB Compatibility Tables Exported 2D Images and Loops

2. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.

Exported 2D Images and Loops: CX30 Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps.

NOTE
RLE Compressed is also recommended because it produces smaller files than uncompressed
formats. All image thumbnails in this format display the Q icon.

Image File Format

a2DQ aCMQ CMQ SQ ROI IMT GIPQ


Stress
Palette Color, RLE 1 1 1 1,2

Compressed

Palette Color, 1 1 1 1,2

Uncompressed Explicit VR
Little Endian (ELE)

Palette Color, 1 1 1 1,2

Uncompressed Implicit VR
Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed
Explicit VR Little Endian
(ELE)

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Image File Format

a2DQ aCMQ CMQ SQ ROI IMT GIPQ


Stress
RGB, Uncompressed
Implicit VR Little Endian
(ILE)

YBR, JPEG Compressed

MONOCHROME2,
Uncompressed (Explicit VR
Little Endian)

MONOCHROME2,
Uncompressed (Implicit VR
Little Endian)

MONOCHROME2, RLE

Footnotes for Exported 2D Images and Loops: CX30 Systems


1. Requires ECG data for quantification.
2. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.

Exported 2D Images and Loops: HD11 and HD11 XE Systems

NOTE
Palette Color, RLE Compressed is the required export format for the SQ, the a2DQ, the aCMQ,
and the CMQ-Stress Q-Apps. RLE Compressed is also recommended because it produces smaller
files than uncompressed formats. All image thumbnails in this format display the Q icon.

QLAB User Manual 4535 617 25481 147


QLAB Compatibility Tables Exported 2D Images and Loops

Image File Format

SQ ROI IMT GIPQ


Palette Color, RLE Compressed 1,2

Palette Color, Uncompressed 1,2

Explicit VR Little Endian (ELE)

Palette Color, Uncompressed 1,2

Implicit VR Little Endian (ILE)

RGB, RLE Compressed

RGB, Uncompressed Explicit


VR Little Endian (ELE)

RGB, Uncompressed Implicit


VR Little Endian (ILE)

YBR, JPEG Compressed

MONOCHROME2,
Uncompressed (Explicit VR
Little Endian)

MONOCHROME2,
Uncompressed (Implicit VR
Little Endian)

Footnotes for Exported 2D Images and Loops: HD11 and HD11 XE Systems
1. Requires ECG data for quantification.
2. SQ requires at least 1 second of Tissue Doppler Imaging data and will not operate on loops
containing more than 2,000 frames.

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Exported 2D Images and Loops: HD9 Systems


Image File Format

ROI IMT
MONOCHROME2

RGB

Exported 2D Images and Loops: HD7 Systems


Image File Format

IMT ROI
HD7 Lite

Exported 2D Images and Loops: HD7 XE Systems


Image File Format

IMT ROI
HD7 XE

Exported 3D Images and Loops

NOTE
Freehand 3D scans are uncalibrated and cannot be quantified.

NOTE
3D data sets that contain color flow information cannot be quantified using the Cardiac 3DQ
Advanced Q-App.

QLAB User Manual 4535 617 25481 149


QLAB Compatibility Tables Exported 3D Images and Loops

NOTE
Zoomed images are not correctly calibrated and measurements performed on zoomed images
may not be accurate.

NOTE
iU22 Vision 2008 series ultrasound system volumetric reference images can be opened only if
the source volume is not in the same directory.

NOTE
If you open an image in which you expect to see annotations that were placed on the image
during acquisition, those annotations may not transfer to the Q-App image view. Review the
image carefully to note the anatomy and orientation before performing quantification.

Exported 3D Images and Loops: EPIQ Series Systems


Image File Format

Cardiac Cardiac GI3DQ MVN FHN


3DQ 3DQ
Adv.
Mechanical 3D DICOM

Mechanical 3D/4D DICOM 2 3,4

Matrix Live 3D Native/DICOM 1 2

Footnotes for Exported 3D Images and Loops: EPIQ Series Systems


1. The Cardiac 3DQ Advanced Q‑App can quantify non-contrast 3D echo (no color) full-volume
loops only.
2. Images acquired using the X7-2t Live 3D TEE transducer.
3. FHN only supports images acquired with an X6-1 or a V6-2 transducer with the following
system default presets, or Quick Save presets derived from these defaults: OB Difficult, OB
Early, OB Fetal Echo, OB Fetal Echo CV, OB General, OB Max Pen, and Gyn Pelvic.

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4. FHN only supports loops that contain eight or more frames.

Exported 3D Images and Loops: ClearVue 650 Systems


Image File Format

GI3DQ
Mechanical 3D DICOM

Exported 3D Images and Loops: iU22 Systems


Image File Format

GI3DQ VPQ FHN


Mechanical 3D DICOM 1

Mechanical 3D/4D DICOM 2,3

Matrix Live 3D Native/DICOM

Footnotes for Exported 3D Images and Loops: iU22 Systems


1. VPQ only supports images acquired with the VL13-5 transducer.
2. FHN only supports images acquired with an X6-1 or a V6-2 transducer with the following
system default presets, or Quick Save presets derived from these defaults: OB Difficult, OB
Early, OB Fetal Echo, OB Fetal Echo CV, OB General, OB Max Pen, and Gyn Pelvic.
3. FHN only supports loops that contain eight or more frames.

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QLAB Compatibility Tables Exported 3D Images and Loops

Exported 3D Images and Loops: iE33 Systems


Image File Format

Cardiac Cardiac GI3DQ MVN


3DQ 3DQ
Adv.
Matrix 3D Native/DICOM 1 2

4D DICOM 2

Footnotes for Exported 3D Images and Loops: iE33 Systems


1. The Cardiac 3DQ Advanced Q‑App can quantify non-contrast 3D echo (no color) full-volume
loops only.
2. Images acquired using the X7-2t Live 3D TEE transducer.

Exported 3D Images and Loops: HD15 Systems


Image File Format

GI3DQ
Mechanical 3D DICOM

Exported 3D Images and Loops: CX50 Systems


Image File Format

Cardiac Cardiac MVN


3DQ 3DQ
Adv.
Matrix 3D Native/DICOM 1 2

4D DICOM 2

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Footnotes for Exported 3D Images and Loops: CX50 Systems


1. The Cardiac 3DQ Advanced Q‑App can quantify non-contrast 3D echo (no color) full-volume
loops only.
2. Images acquired using the X7-2t Live 3D TEE transducer.

Exported 3D Images and Loops: HD11 and HD11 XE Systems


Image File Format

GI3DQ
Mechanical 3D/4D DICOM Zlib

Exported 3D Images and Loops: HD9 Systems


Image File Format

GI3DQ
3D Cartesian Grayscale

QLAB User Manual 4535 617 25481 153


QLAB Compatibility Tables Exported 3D Images and Loops

154 QLAB User Manual 4535 617 25481


Index

22 Index
Numerics references, 58
2D aCMQ
auto quantification, 55 about, 61
data sets, 37 aTMAD workflow, 62
2D images, acquiring, 57, 65, 70, 96, 102, 113, cardiac cycles, 62
116, 120, 136, 137, 138, 140, 141, 142, 144, Color Kinesis analysis, 62
146, 147, 149
fundamentals, 62
3D
global workflow, 62
data sets, 37
image acquisition, 65
fetal heart data set, 126
image compatibility, 136, 140, 141, 142,
3D images 144, 146
acquiring, 77, 81, 88, 92, 149, 150, 151, loading images, 53
152, 153
references, 65
A user-defined workflow, 62
a2DQ wall motion, 62
about, 55 Administrator status, verifying, 18
aTMAD workflow, 56 Annotations
border detection, 56 images, 52
cardiac cycles overlay, 56 Archiving data, 48
Color Kinesis analysis, 57 Assistance, 14
fundamentals, 56 aTMAD
image acquisition, 57 about, 55
image compatibility, 136, 138, 140, 141, Audience
144, 146 intended, 11
loading images, 53

QLAB User Manual 4535 617 25481 155


Index

AVI export semi-automated border detection, 80


on a PC, 40 Cardiac cycles
overlay, 56
B
Cardiac PQ
Backing up the QLAB license file, 45
about, 111
BMP export
ABS image acquisitions, 112
on a PC, 39
fundamentals, 112
Borders
image acquisition, 113
detection, 56
image compatibility, 141
semi-automated detection, 80, 91
loading images, 53
C references, 113
Calculations RTPI acquisitions, 112
exporting, 37 timed acquisitions, 112
Cardiac 3DQ TRI acquisitions, 112
about, 75 Cardiovascular 3D viewer
fundamentals, 76 about, 77, 81, 88
image acquisition, 77 Cinebar, 33
image compatibility, 150, 152 ClearVue 650 Ultrasound System
loading images, 53 exported 2D image compatibility, 137
references, 78 exported 3D image compatibility, 151
Cardiac 3DQ Advanced CMQ-Stress
about, 79 about, 69
fundamentals, 80 cardiac cycles, 69
image acquisition, 81 fundamentals, 69
image compatibility, 152 image acquisition, 70
loading images, 53 image compatibility, 136, 146
references, 82 loading images, 53

156 QLAB User Manual 4535 617 25481


Index

references, 71 images for EQ, 136, 140


wall motion analysis, 69 images for FHN, 150, 151
workflow-driven analysis, 69 images for GI3DQ, 150, 151, 152, 153
Comments images for GIPQ, 136, 140, 142, 144, 147
customer, 14 images for IMT, 136, 137, 138, 140, 141,
Compatibility 142, 144, 146, 147, 149

ClearVue 650 Ultrasound System, 137, images for MVI, 136, 140, 144
151 images for MVN, 152
CX30 Ultrasound System, 146 images for ROI, 136, 137, 138, 140, 141,
CX50 Ultrasound System, 144, 152 142, 144, 146, 147, 149

EPIQ series ultrasound systems, 136, 150 images for SQ, 136, 138, 140, 141, 142,
144, 146, 147
HD11 Ultrasound System, 147, 153
images for VPQ, 151
HD11 XE Ultrasound System, 147, 153
iU22 Ultrasound System, 140, 151
HD15 Ultrasound System, 142, 152
Sparq Ultrasound System, 138
HD7 Ultrasound System, 149
Controls
HD7 XE Ultrasound System, 149
cinebar icons, 34
HD9 Ultrasound System, 149
image toolbar icons, 50
iE33 Ultrasound System, 141, 152
toolbar icons, 31
images for a2DQ, 136, 137, 138, 140,
141, 144, 146 viewing, 49

images for aCMQ, 136, 140, 141, 142, Conventions


144, 146 QLAB software, 12
images for Cardiac 3DQ, 150, 152 user information, 13
images for Cardiac 3DQ Advanced, 152 Customer comments, 14
images for Cardiac PQ, 141 Customer service, 14
images for CMQ-Stress, 136, 146 CX30 Ultrasound System
images for EA, 136, 140 exported 2D image compatibility, 146

QLAB User Manual 4535 617 25481 157


Index

CX50 Ultrasound System loading images, 53


exported 2D image compatibility, 144 references, 130
exported 3D image compatibility, 152 EPIQ series ultrasound systems
exported 2D image compatibility, 136
D
exported 3D image compatibility, 150
Data locations, 42
EQ
Data panel, 47
about, 131
Data reuse, 40, 41
fundamentals, 132
Data sets
image acquisition, 132
2D, 37, 91, 135, 136, 137, 138, 140, 141,
image compatibility, 136, 140
142, 144, 146, 147, 149
lesion size comparison, 132
3D, 37, 80, 86, 135, 149, 150, 151, 152,
153 loading images, 53
Data storage locations, 42 references, 132
DICOM, 44 Exporting
archiving study data, 48 calculations, 37
DICOM images, viewing, 44 data, 37
DICOM storage server, 43 measurements, 37
Display format, 27 multi-frame images, 40
Drives, assigning, 42 results, 37
single-frame images, 39
E
EA F
about, 129 FHN
comparing lesion size, 129 3D fetal heart data set, 126
fundamentals, 129 about, 125
image acquisition, 129 ductal arch, 126
image compatibility, 136, 140 fundamentals, 126

158 QLAB User Manual 4535 617 25481


Index

image acquisition, 127 HD11 Ultrasound System


image compatibility, 150, 151 exported 2D image compatibility, 147
loading images, 53 exported 3D image compatibility, 153
references, 127 HD11 XE Ultrasound System
exported 2D image compatibility, 147
G
exported 3D image compatibility, 153
GI3DQ
HD15 Ultrasound System
about, 91
exported 2D image compatibility, 142
fundamentals, 91
exported 3D image compatibility, 152
image acquisition, 92
HD7 Ultrasound System
image compatibility, 150, 151, 152, 153
exported 2D image compatibility, 149
loading images, 53
HD7 XE Ultrasound System
references, 93
exported 2D image compatibility, 149
semi-automated border detection, 91
HD9 Ultrasound System
GIPQ
exported 2D image compatibility, 149
about, 115
exported 3D image compatibility, 153
curve fit, 115
Heart
fundamentals, 115
segmentation, 80, 86
histograms, 115
Help, 12
image acquisition, 116
HIPAA, 22
image compatibility, 136, 140, 142, 144,
147 I
loading images, 53 iE33 Ultrasound System
parametric quantification, 115 exported 2D image compatibility, 141
references, 117 exported 3D image compatibility, 152
Image quality, 15
H
Image toolbar
Hardware requirements, 16

QLAB User Manual 4535 617 25481 159


Index

displaying, 50 BMP export, 39


Images calibrating data, 31
3D, 91 capturing, 52
a2DQ, 53 Cardiac 3DQ, 53
ABS acquisitions, 112 Cardiac 3DQ Advanced, 53
aCMQ, 53 Cardiac PQ, 53
acquiring, 52 CMQ-Stress, 53
acquiring for a2DQ, 57 Color Kinesis analysis, 57
acquiring for aCMQ, 65 comparing data, 119
acquiring for Cardiac 3DQ, 77 compatibility, 135
acquiring for Cardiac 3DQ Advanced, 81 compression options, 40, 41
acquiring for Cardiac PQ, 113 data scaling, 30
acquiring for CMQ-Stress, 70 displaying the toolbar, 50
acquiring for EA, 129 dual view, 27
acquiring for EQ, 132 EA, 53
acquiring for FHN, 127 EQ, 53
acquiring for GI3DQ, 92 expanded view, 27
acquiring for GIPQ, 116 FHN, 53
acquiring for IMT, 107 full screen view, 27
acquiring for MVI, 120 GI3DQ, 53
acquiring for MVN, 88 GIPQ, 53
acquiring for ROI, 102 IMT, 53
acquiring for SQ, 96 iSlice view, 27
acquiring for VPQ, 123 JPEG export, 39
analyzing, 57 loading, 53
annotating, 52 measuring distance, 91
AVI export, 40, 41 MVI, 53

160 QLAB User Manual 4535 617 25481


Index

MVN, 53 edge detection, 107


noise reduction, 119 fundamentals, 107
presentation options, 27 image compatibility, 136, 137, 138, 140,
presenting 3D data, 91 141, 142, 144, 146, 147, 149

quad view, 27 loading images, 53

quantification data, 37 measurements, 107

removing patient data, 22 references, 108

retaining data, 37 Installation, 16, 18

ROI, 53 activation, 19, 20, 21

RTPI acquisitions, 112 preparation, 17

segmentation, 122 requirements, 18

selecting, 30 Intended audience, 11

selecting frames, 25 Intended use, 11

side-by-side view, 27 iSlice

single-frame export, 39 view, 27

SQ, 53 iU22 Ultrasound System

TIFF export, 39 exported 2D image compatibility, 140

timed acquisition, 112 exported 3D image compatibility, 151

toolbar control icons, 50


J
toolbar controls, 31
JPEG export
TRI acquisitions, 112
on a PC, 39
viewing, 49
views, 27 L
VPQ, 53 License file, 19, 20, 21
IMT backing up, 45
about, 107 restoring, 45
acquiring images, 107

QLAB User Manual 4535 617 25481 161


Index

M MVN
Measurement accuracy, 40, 41 about, 85
Measurements fundamentals, 86
accuracy, 15, 36, 37 image acquisition, 88
cardiac area, 80 image compatibility, 152
cardiac volume, 80 loading images, 53
exporting, 37 marking reference points, 86
general imaging volume, 91 references, 88
GIPQ, 115
N
LV area, 76
Navigation
LV EF, 76
cinebar, 33
LV mass, 76
LV volume, 76 O
whole body area, 91 Operating notes, 12
whole body distance, 91 Operating system requirements, 16
whole body volume, 91
P
M-lines
Patient data, 39
virtual, 96
PC image export options, 39
MVI
Persistent data, 26
about, 119
Philips contact information, 14
comparing images, 119
Preferences
fundamentals, 119
App General, 75
image acquisition, 120
CD/DVD write, 49
image compatibility, 136, 140, 144
display settings, 91
image preparation, 119
removable media settings, 49
loading images, 53
Procedures, 47
timed acquisitions, 119

162 QLAB User Manual 4535 617 25481


Index

Q Q-Assistant, 41
Q-Apps QLAB DICOM server, 44
about, 23 Quantification results
Auto 2D Quantification (a2DQ), 55 exporting, 40, 41
Auto Cardiac Motion Quantification
(aCMQ), 61 R

Cardiac 3D Quantification (Cardiac 3DQ), Read This First, 11


75 Reference points
Cardiac 3D Quantification Advanced marking MV, 86
(Cardiac 3DQ Advanced), 79 References
Cardiac Motion Quantification Stress a2DQ, 58
(CMQ-Stress), 69
aCMQ, 65
Cardiac Parametric Quantification
(Cardiac PQ), 111 Cardiac 3DQ, 78

description, 23 Cardiac 3DQ Advanced, 82

Elastography Analysis (EA), 129 Cardiac PQ, 113

Elastography Quantification (EQ), 131 CMQ-Stress, 71

Fetal Heart Navigator (FHN), 125 EA, 130

General Imaging 3D Quantification EQ, 132


(GI3DQ), 91 FHN, 127
General Imaging Parametric GI3DQ, 93
Quantification (GIPQ), 115 GIPQ, 117
Intima Media Thickness (IMT), 107 IMT, 108
MicroVascular Imaging (MVI), 119 MVN, 88
Mitral Valve Navigator (MVN), 85 ROI, 103
Region of Interest (ROI), 101 SQ, 97
Strain Quantification (SQ), 95 VPQ, 124
Vascular Plaque Quantification (VPQ), Registration
121

QLAB User Manual 4535 617 25481 163


Index

license file, 21 intensity, 30


manual, 20 velocity, 30
online, 19 Segmentation
saving information, 22 heart, 80, 86
Reports MV annulus, 86
hiding patient data, 22 MV coaptation, 86
Requirements MV leaflets, 86
system, 16 Service, customer, 14
Restoring the license file, 45 Settings
Results system, 42
exporting, 37 Software conventions, 12
quantification, 36 Sparq Ultrasound System
ROI exported 2D image compatibility, 138
about, 101, 102 SQ
fundamentals, 102 about, 95
image acquisition, 102 fundamentals, 96
image compatibility, 136, 137, 138, 140, image acquisition, 96, 97
141, 142, 144, 146, 147, 149 image compatibility, 136, 138, 140, 141,
loading images, 53 142, 144, 146, 147
references, 103 loading images, 53
Starting the QLAB software, 25
S
Storage locations, 42
Scaling
Studies
decibel, 30
about, 47
frequency, 30
archiving study data, 48
image data, 30
data panel, 47
image markers, 31
DICOM archive, 48

164 QLAB User Manual 4535 617 25481


Index

local patient data, 47 V


remote patient data, 47 Video compression, options on a PC, 41
transferring, 48 Viewing DICOM images, 44
viewing patient data, 47 Views
System management, 42 dual, 27
System requirements, 16 expanded, 27
System upgrades, 14 full screen, 27
iSlice, 27
T
quad, 27
Templates
side-by-side, 27
2Ch/4Ch trace, 75
VPQ
TIFF export
about, 121
on a PC, 39
fundamentals, 122
Toolbars
image acquisition, 123
image control icons, 50
image compatibility, 151
Trace
image segmentation, 122
2Ch/4Ch, 75
loading images, 53
simple polygon, 75
measuring plaque, 121
Transferring studies data, 48
plaque volume measurements, 122
U references, 124
Updating
W
persistent data, 37
Website, Philips, 14
Upgrades, system, 14
User information
components, 12
conventions, 13

QLAB User Manual 4535 617 25481 165


Index

166 QLAB User Manual 4535 617 25481