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Quick Guide
QLAB Advanced Quantification Software English

Release 10
Contents Applying a Color Kinesis Overlay . . . . . . . . . . . . . . . . . . . . . .20
2D Cardiovascular Reports . . . . . . . . . . . . . . . . . . . . . . . . . . .21
For easy reference, each section is color-coded. The color of each
section title correlates with the color band on each page in that Auto Cardiac Motion Quantification
section. Image Acquisition for aCMQ . . . . . . . . . . . . . . . . . . . . . . . . .23
QLAB Software General aCMQ Workflow Procedure . . . . . . . . . . . . . . . . . .23
QLAB System Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 aCMQ Global Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
QLAB Toolbar Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Adding Cardiac Cycle Data . . . . . . . . . . . . . . . . . . . . . . . . . . .25
QLAB Cinebar Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 TMAD Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Keyboard Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Cardiac Motion Quantification Stress
Image Viewer Keyboard Shortcuts . . . . . . . . . . . . . . . . . . . . . .9 Image Acquisition for CMQ-Stress . . . . . . . . . . . . . . . . . . . . .27
Studies Selecting a Stage, a View, and a Subloop for Quantification . .28
Data Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Adding an Apical ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Analyzing Images in a Q-App . . . . . . . . . . . . . . . . . . . . . . . . .12 Viewing Global Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Image Viewer Cardiac 3D Quantification
Image Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Image Acquisition for Cardiac 3DQ . . . . . . . . . . . . . . . . . . . .31
Cardiac 3DQ General Procedure . . . . . . . . . . . . . . . . . . . . . .31
Auto 2D Quantification
Optimizing the Image Position . . . . . . . . . . . . . . . . . . . . . . . .32
Image Acquisition for a2DQ . . . . . . . . . . . . . . . . . . . . . . . . . .17
Adding a 2Ch/4Ch Template Trace . . . . . . . . . . . . . . . . . . . . .33
General a2DQ Workflow Procedure . . . . . . . . . . . . . . . . . . .17
Measuring Distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
TMAD Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
EF/FAC Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

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Cardiac 3D Quantification Advanced Region of Interest Quantification


Image Acquisition for Cardiac 3DQ Advanced . . . . . . . . . . .35 Image Acquisition for ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
General Cardiac 3DQ Advanced Workflow Procedure . . . .35 General ROI Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Performing a Sequence Analysis . . . . . . . . . . . . . . . . . . . . . . .36 Adding an Auto Area Measurement . . . . . . . . . . . . . . . . . . . .48
Mitral Valve Navigator Using Motion Compensation . . . . . . . . . . . . . . . . . . . . . . . . .49
Combining Quantification Results from Multiple ROIs . . . . .50
Image Acquisition for MVN . . . . . . . . . . . . . . . . . . . . . . . . . .37
MVN General Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Intima Media Thickness
Aligning the Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Image Acquisition for IMT . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Tagging the Annulus Reference Points . . . . . . . . . . . . . . . . . .39 General IMT Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Mitral Valve Anatomy Report . . . . . . . . . . . . . . . . . . . . . . . . .40 Resizing the ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
General Imaging 3D Quantification Cardiac Parametric Quantification
Image Acquisition for GI3DQ . . . . . . . . . . . . . . . . . . . . . . . . .41 Image Acquisition for Cardiac PQ . . . . . . . . . . . . . . . . . . . . .53
GI3DQ General Procedure . . . . . . . . . . . . . . . . . . . . . . . . . .41 General Cardiac PQ Procedure . . . . . . . . . . . . . . . . . . . . . . .53
Using the iSlice View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Adding an ECG Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Cropping an MPR View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Adding a Myocardial Template ROI . . . . . . . . . . . . . . . . . . . . .55
Adding a Stacked Contours Measurement . . . . . . . . . . . . . . .44 Modifying the ROI Borders . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Strain Quantification General Imaging Parametric Quantification
Image Acquisition for SQ . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Image Acquisition for GIPQ . . . . . . . . . . . . . . . . . . . . . . . . . .57
General SQ Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 General GIPQ Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Drawing a Virtual M-Line . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Optimizing the Histogram . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
MicroVascular Imaging
Image Acquisition for MVI . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
MVI Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Vascular Plaque Quantification
Image Acquisition for VPQ . . . . . . . . . . . . . . . . . . . . . . . . . . .61
General VPQ Workflow Procedure . . . . . . . . . . . . . . . . . . . .61
VPQ Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Fetal Heart Navigator
Image Acquisition for FHN . . . . . . . . . . . . . . . . . . . . . . . . . . .63
General FHN Workflow Procedure . . . . . . . . . . . . . . . . . . . .63
Adjusting the Ductal Arch View . . . . . . . . . . . . . . . . . . . . . . .64
Adjusting the LVOT View . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Annotating the FHN Views . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Elastography Analysis
Image Acquisition for EA . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Adding an Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Elastography Quantification
Image Acquisition for EQ . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Size Comparison Workflow . . . . . . . . . . . . . . . . . . . . . . . . . .70

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About This Guide Term Description or Action


Use this Quick Guide to help you use the QLAB program step-by- Pointer The pointer is the cursor used to select elements
step. For more information, see the QLAB Help or the QLAB User on the display.
Manual. Right-click Position the tip of the pointer or cursor on an
item on the display and then press the right
This Quick Guide describes the most comprehensive configuration for
mouse button, without moving the mouse.
the QLAB product, with the maximum number of options and
accessories. Some functions described may be unavailable on your These numbering styles are used in this Quick Guide:
product's configuration.
Most screen captures show the English language interface. Use the Style Description
images for visual reference. Your display may differ. 2 This style is used for steps with callouts on graphics.
Conventions 2 This style is used for steps with no callouts on graphics.
These terms are used in this Quick Guide:
2 This style is used for callouts not associated with steps.
Term Description or Action
Click or select Move the pointer to an object and press either
the ultrasound system selection control (see
your ultrasound system documentation) or the
primary mouse button.
Drag Place the cursor over an object and then click
and hold while moving the object.
Image or The image or image area is the ultrasound-scan
image area area on the imaging display.
QLAB Software QLAB System Controls
The QLAB software provides an environment in which you: General QLAB controls appear as icons at the bottom of the control
panel. They are always available while the QLAB software is running.
• Select a supported Q-App.
• Manipulate images within the image file. Icon Name Description
Export Allows you to export images and cineloop
• Tag image frames.
sequences
• Display results as waveforms, image loops, and reports.
Preferences Allows you to set preferences
• Export quantification results.
To perform image analysis and quantification, you load an image that Save Allows you export results and save
has been acquired on a supported Philips ultrasound system into a persistent data
specific Q-App. You can then use the Q-App to obtain results based
Close Closes the active Q-App
on the type of image and the Q-App you selected.

Help Launches the QLAB Help

About QLAB Displays version information about the


QLAB software

QLAB Software 5
QLAB Software 6

QLAB Toolbar Controls Control Description


QLAB toolbar controls appear as icons on the right side of the Allows for out-of-plane rotation
control panel.
Sculpts an image
Control Description
Selects an image
Erases image sculpting
Adjusts image contrast and brightness
Displays the selected image in full-screen layout
Zooms an image
Switches to quad-screen layout
Inverts the image left or right
Switches to expanded-screen layout
Inverts the image up or down
Displays frame 1 in full-screen layout
Pans the image
Displays frame 2 in full-screen layout
Allows you to navigate through a volume
Displays frame 3 in full-screen layout
Allows for in-plane rotation
Displays frame 4 in full-screen layout
Control Description QLAB Cinebar Controls
Resets the orientation of the selected image The QLAB quantification software provides a set of cinebar controls
for navigation through image sequences. Images are displayed as
Resets the orientation of all images thumbnail frames in a loop. The cinebar allows you to play an image
sequence, tag frames, and jump forward and back to tagged frames.
Shows or hides image color Icon Name Description
Cut all frames Removes the frames in the image
Shows or hides image echo except those at sequence that do not match the ECG
the selected timing of the currently selected frame.
Adjusts image blending ECG timing
Cut Frame Removes the currently selected frame,
and restores individually cut frames.
Decrease Play Decreases the replay speed.
Speed
Go To First Selects the first frame in the loop.
Frame
Go To Last Selects the last frame in the loop.
Frame
Go To Next Selects the next heart beat in the loop.
Heart Beat This control is available only in multi-
beat loops.
Go To Next Selects the next frame in the loop.
Frame

QLAB Software 7
QLAB Software 8

Icon Name Description Icon Name Description


Go To Next Selects the next frame in the loop Reset to Selects the default heart beat in the
Tagged Frame tagged as a frame of interest, such as Default Heart loop. This control is available only in
an ECG R-wave or a flash frame. Beat multi-beat loops.
Go To Previous Selects the previous heart beat in the Restore All Cut Recovers all cut frames.
Heart Beat loop. This control is available only in Frames
multi-beat loops. Tag ED Tags the selected frame as the end-
Go To Previous Selects the previous frame in the loop diastolic phase.
Tagged Frame tagged as a frame of interest, such as Tag ES Tags the selected frame as the end-
an ECG R-wave or a flash frame. systolic phase.
Go To Previous Selects the previous frame in the loop. Tag R-Wave Tags the selected frame as a frame with
Frame an ECG R-wave.
Increase Play Increases the replay speed.
Speed
Mark First Cuts the loop and starts at the
Frame selected frame.
Mark Last Cuts the loop and ends at the selected
Frame frame.
Play Replays the loop repeatedly.

Play Once Replays the loop once.

Pause Stops the loop replay.


Keyboard Shortcuts Image Viewer Keyboard Shortcuts
The following general keyboard shortcuts are available: The following image viewer keyboard shortcuts are available:

Shortcut Function Shortcut Function


Break Play/pause Left Arrow Previous frame in a loop
Ctrl+A Select all Right Arrow Next frame in a loop
Ctrl+C Copy Up Arrow Increase frame rate
Ctrl+I Show/hide image information Down Arrow Decrease frame rate
Ctrl+P Print Home First frame in a loop
Ctrl+R Reset image viewing settings End Last frame in a loop
Ctrl+V Paste Page Up Previous image in a study when viewing in one-up
Delete Delete mode, or previous four images when viewing in
Alt+F4 Exit four-up mode
Spacebar Play/pause Page Down Next page in a study when viewing in one-up
mode, or next four images when viewing in four-
F1 Help
up mode
F5 Refresh
F11 Full screen

QLAB Software 9
QLAB Software 10
Studies
The Studies tab provides an overview of
patient study data stored locally.
Data Panel
The Data panel displays data storage
locations that are available to you.

1 CD/DVD drives

2 One or more user-selectable


repository locations on local or
network disk drives
1
3 USB storage devices
2

Studies 11
Studies 12

Analyzing Images in a Q-App

1 Select a study in the main Studies list


at the top of the Studies tab.
2 If there are multiple studies in the
patient folder, select a study in the
study list.
3 Right-click an image on the Series tab
of the patient folder.
4 Click Analyze With, and then click 1
the name of the Q-App you want to
use.
NOTE
Some Q-Apps, such as a2DQ, aCMQ,
and CMQ-Stress, allow you to load 2
multiple images at the same time. Press
and hold the Ctrl key, click multiple
images, and then right-click a selected
image and click the Q-App name in the
Analyze With menu. 3
Image Viewer
1 Use the View tab to view and measure
1
images, to play loops from stress echo
and non-stress echo studies, and to
select subloops. You can view both
single-frame images and loops (a
sequence of images).

Image Viewer 13
Image Viewer 14

Image Toolbar Control Description


The image toolbar contains tools that let you adjust the view of an Displays the next subloop (stress echo images only).
image, select subloops, make basic unlabeled measurements, and
annotate the image.
Displays the previous subloop (stress echo images only).
Control Description
Selects the image.
Sets a subloop as the preferred loop (stress echo images
only).
Scrolls the image.
Displays the measurement tools.
Adjusts the contrast and brightness.
Enables you to draw a line.
Zooms the image.
Enables you to draw an angle.
Pans the image.
Enables you to draw an open contour.
Displays subloops (stress echo images only).
Enables you to draw a smoothed polygon.
Control Description
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 a study.

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.

Image Viewer 15
Image Viewer 16
Auto 2D Quantification General a2DQ Workflow Procedure
The Auto 2D Quantification (a2DQ) Q-App provides automated 1. Select one or more images.
border detection and Color Kinesis (CK) analysis of 2D echo images. 2. Select either the aEF/FAC or aTMAD workflow.
Images can be single-plane 2D or BiPlane images.
Image Acquisition for a2DQ
• Ensure a clear ECG signal and then acquire one or more heart
beats.
• Whenever possible, 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 controls on your ultrasound system
to ensure you acquire visible endocardial borders.

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

Auto 2D Quantification (a2DQ) 17


Auto 2D Quantification (a2DQ) 18

TMAD Workflow
6 5
1 Load a BiPlane image into the Q-App.

2 Select aTMAD.
Select the end-diastole frame from the
3
2
loop.
4 Place the first anchor to the left of the
mitral valve.
5 Place the second anchor to the right of
the mitral valve.
6 Place the third anchor slightly above
the endocardial surface at the true
apex.
The Q-App automatically calculates
results and displays the waveform data.
7 Play the loop and verify that the
endocardial borders are tracking
accurately.

7 4 3
EF/FAC Workflow

1 Select aEF/FAC.

2 Confirm the end-diastole frame.


Select a loop, and then select the view
3 1
(AP4 or AP2). If SmartExam was
used, select the view only.
4 If the points are not automatically set,
4
manually place the annular and apical
3
points.
5 Edit points if needed. 4 4

Auto 2D Quantification (a2DQ) 19


Auto 2D Quantification (a2DQ) 20

Applying a Color Kinesis Overlay

1 Select Color Kinesis in the Overlays


and Measurements menu.
2 Select the CK Mode:
• Systole to measure the LV
contraction pattern during the
systolic interval.
• Contract to measure the wall 1
motion of a chamber or vessel 2
during systole. Set the Start (ms)
and Duration (ms) for the 3
period of contraction.
• Expand to measure the wall
motion of a chamber or vessel
during diastole. Set the Start
(ms) and Duration (ms) for the
period of expansion.
• Cycle to measure the LV wall
motion throughout the cycle.
3 Set the transparency.
2D Cardiovascular Reports
The Function Report is available when the EF or FAC have been
calculated from the image data. The report displays the data
graphically and provides a table of corresponding data. The data
includes the standard results and additional information. You can
capture the graphic report and use it for notes and patient studies.
The Function Report is a composite waveform composed of area
or volume information from one or more of the beats in the loop.
The waveform on the report displays the LV volume over the course
of an average heartbeat.
Initially, the area or volume waveform is displayed with the bottom of
the graph at zero. This allows quick assessment of the overall
magnitude of the waveform and the relative change in size. For more-
detailed shape information, using Zoom to scale the waveform to fill
the graph area may be helpful. The derivative waveform is always set
at full scale.

Auto 2D Quantification (a2DQ) 21


Auto 2D Quantification (a2DQ) 22
Auto Cardiac Motion Quantification NOTE
For EPIQ series systems, iU22 systems, and iE33 systems, select
The Auto Cardiac Motion Quantification (aCMQ) Q-App provides
the 2D Native Data Export option.
workflow-driven tools for automated border detection and
Color Kinesis (CK) analysis of 2D echo images; allows for analysis of General aCMQ Workflow Procedure
regional myocardial-tissue velocity, displacement, strain, and strain
rate; provides global cardiac quantification; and allows traces of one 1. Select one or more images.
or more chords within cardiac images and computes corresponding 2. Select either the aEF/FAC or the aTMAD workflow.
direct tissue speed, displacement, and strain values.
Images can be single-plane 2D or BiPlane images (TMAD only).
Image Acquisition for aCMQ
• Ensure a clear ECG signal and then acquire one or more heart
beats.
• Whenever possible, 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 controls on your ultrasound system
to ensure you acquire visible endocardial borders.
• Use a high frame rate during acquisition.
• Avoid out-of-plane motion on the short-axis image.
• XRES processing can be on or off.

Auto Cardiac Motion Quantification (aCMQ) 23


Auto Cardiac Motion Quantification (aCMQ) 24

aCMQ Global Workflow

1 Select Global.

2 Confirm the end-diastole frame.


1 4
3 Select a loop, and then select the view.
If SmartExam was used, select the view
only.
4 If the points are not automatically set, 3
manually place the points. 4 4

Edit points if needed. 3


5

2
Adding Cardiac Cycle Data
NOTE
With images that contain embedded
cardiac phase data, the data fields will
be populated automatically.

1 On the Stages/Cardiac Cycles/


Views section of the control panel, 2
click Manual.
2 In the Cardiac Cycles dialog box, 1
enter values in milliseconds for the
mechanical events in the heart cycle.
3 To accept the values, click OK.
4 To update the calculations, click
Refresh.
5 To clear all values, click Reset.
5 4 3

Auto Cardiac Motion Quantification (aCMQ) 25


Auto Cardiac Motion Quantification (aCMQ) 26

TMAD Waveforms
The TMAD waveform graphs depict data
based on the measurements on the image.
Cardiac Motion Quantification Stress Image Acquisition for CMQ-Stress
The Cardiac Motion Quantification Stress (CMQ-Stress) Q-App • Ensure a clear ECG signal and then acquire one or more heart
provides tools for automated analysis of stress echo studies by angle- beats.
independent analysis of regional myocardial-tissue velocity, • Whenever possible, ask the patient to suspend breathing for a
displacement, strain, and strain rate, using the next generation of 2D few seconds during image acquisition to minimize translation of
speckle tracking. Images must be single-plane 2D. the heart.
• Ensure the apical views are not foreshortened.
• Use the gain and threshold controls on your ultrasound system
to ensure you acquire visible endocardial borders.
NOTE
For EPIQ series systems and iE33 systems, select the 2D
Native Data Export option.

Cardiac Motion Quantification Stress (CMQ-Stress) 27


Cardiac Motion Quantification Stress (CMQ-Stress) 28

Selecting a Stage, a View, and a


Subloop for Quantification

1 Click the Stages/Cardiac Cycles/


Views section of the control panel.
2 Select a stage.
3 Select a view.
1
4 Select a Sub Loop, if necessary. 2

3
4
Adding an Apical ROI

1 Select the end-diastolic or end-systolic 2


frame from the loop.
2 Select the view (AP4, AP3, or AP2).
3 Click on the left of the mitral valve.
4 Click on the right of the mitral valve. 5

5 Click the apex.

6 Adjust the placement of the border if


necessary.
The tracking algorithm and results 3
computation run automatically, and the 4
borders are displayed on the image.

Cardiac Motion Quantification Stress (CMQ-Stress) 29


Cardiac Motion Quantification Stress (CMQ-Stress) 30

Viewing Global Results


Click Global Results.
1 1
To display the corresponding one-stage 2 3
2
report, click a stage.
3 To display the Summary report, which
displays one bull's-eye graph per stage,
click Summary.
4 To create a secondary capture for each
bull's-eye graph currently displayed and
to export it, click Export BE.

4
Cardiac 3D Quantification NOTE
When acquiring image loops using an iE33 system ECG trace,
The Cardiac 3D Quantification (Cardiac 3DQ) Q-App provides tools
the system may record the spike output from an implantable
for calculating global function using end-diastolic volume (EDV), end-
cardiac device as an R-wave and provide data that is not clinically
systolic volume (ESV), and ejection fraction (EF). If your preferences
relevant. Use the Override HeartRate control to enter the
are set to display the mass calculation, you can also calculate left
correct value for the heart rate.
ventricular mass.
Image Acquisition for Cardiac 3DQ Cardiac 3DQ General Procedure
• Ensure a clear ECG signal and then acquire one or more heart 1. Set the preferences.
beats. 2. Select the end-diastole frame.
• Optimize your image during acquisition to ensure good 3. Optimize the image.
endocardial borders.
4. Place the template points on the image.
• Ensure that the entire left ventricle is located within the
5. Select the end-systole frame.
boundaries of the two full-volume preview sectors.
6. Add annotations.
• Position your transducer to capture a full four-chamber view.
7. Add distance and area measurements.
• Minimize temporal and stitching artifacts.
8. Save and export results and modified images.
• Optimize the acquisition volume rate.
WARNING
A foreshortened left ventricle in the MPR views results in
inaccurate volume and mass calculations.

Cardiac 3D Quantification (Cardiac 3DQ) 31


Cardiac 3D Quantification (Cardiac 3DQ) 32

Optimizing the Image Position

1 Center the intersection of the red and


green plane indicators on the blue 4 5
plane MPR view.
2 Rotate the green plane indicator in the
blue plane MPR view until the full apex
is visible.
3 For correct segment orientation, orient
the yellow arrow in the blue plane so it
points to the middle of the LV septum
(between the RV and LV septum).
4 In the green plane MPR view, center
the red plane indicator through the
true apex.
5 In the red plane MPR view, center the 1
green plane indicator through the true
apex.
2
Adding a 2Ch/4Ch Template Trace

1 Click on the left of the mitral valve.

2 Click on the right of the mitral valve.


3 4
3 Click the apex.

4 If measuring LV mass, click straight up


from the apex on the epicardial wall.

1 2

Cardiac 3D Quantification (Cardiac 3DQ) 33


Cardiac 3D Quantification (Cardiac 3DQ) 34

Measuring Distance

1 Click Distance. 1
2 Click the initial anchor position.

3 Right-click the terminal anchor


position.
The distance measurement value
appears in the results.

2 3
Cardiac 3D Quantification Advanced NOTE
When acquiring image loops using an iE33 system ECG trace,
The Cardiac 3D Quantification Advanced (Cardiac 3DQ Advanced)
the system may record the spike output from an implantable
Q-App includes the basic Cardiac 3DQ viewing features and the
cardiac device as an R-wave and provide data that is not clinically
ability to perform both 3D semi-automated border detection of the
relevant. Use the Override HeartRate control to enter the
left ventricle and LV regional timing calculations on apical full volume
correct value for the heart rate.
images. It uses a physics-based modeling algorithm that makes no
assumptions regarding the geometry of the left ventricle. General Cardiac 3DQ Advanced Workflow Procedure
Image Acquisition for Cardiac 3DQ Advanced 1. Set the preferences.
• Optimize your image during acquisition to ensure good 2. Select a view.
endocardial borders.
3. Select the end-diastole frame.
• Ensure that the entire left ventricle is located within the
4. Place the ED and ES reference points.
boundaries of the two full-volume preview sectors.
5. Edit the border.
• Position your transducer to capture a full four-chamber view.
6. Perform a sequence analysis.
• Minimize temporal and stitching artifacts.
7. Edit the MPR or 3D border.
• Optimize the acquisition volume rate.
8. Select segments.
WARNING
A foreshortened left ventricle in the MPR views results in 9. View reports.
inaccurate volume calculations. 10. Save and export results and modified images.

Cardiac 3D Quantification Advanced (Cardiac 3DQ Advanced) 35


Cardiac 3D Quantification Advanced (Cardiac 3DQ Advanced) 36

Performing a Sequence Analysis

1 Calculate the ejection fraction.


Click Sequence Analysis. 3
2
The quality index for the global
sequence analysis appears, and the
bull's eye is colored to reflect the
quality indexes for each segment.
3 Click the 3D view and drag to rotate it.
4 Select Segments.
5 Select one or more segments from the
bull's eye or the 3D view and note the
correspondence between the two.
If the waveforms display is enabled, the
regional or normalized %EDV curves
corresponding to the selected
segments in the 3D view are
highlighted.
Mitral Valve Navigator MVN General Procedure
The Mitral Valve Navigator (MVN) Q-App provides workflow-driven 1. Set the preferences if necessary.
tools for performing semi-automated shape analysis on the mitral 2. Confirm or override the Auto ES frame selection.
valve. 3. Align the MPRs.
MVN performs automated identification of the end-systole phase 4. Place the annulus reference points.
(Auto ES), and allows you to confirm or override the Auto ES
selection. 5. Edit the annulus reference points if necessary.

Image Acquisition for MVN 6. Edit the commissure points if necessary.


7. Edit the leaflet trace if necessary.
• Use a TEE transducer to acquire images.
8. Edit the border if necessary.
• Ensure the mitral valve is fully visible within the 3D volume
acquisition. 9. Find and mark the papillary tips if necessary.
• In full volume acquisition mode, make sure the entire mitral 10. Save the data.
annulus is captured.
• 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.

Mitral Valve Navigator (MVN) 37


Mitral Valve Navigator (MVN) 38

Aligning the Image

1 Following the guidance illustration in


the lower right quadrant, adjust the
rotation of the image data in the red 2
and green MPR planes, ensuring the
plane axes bisect the valve on the
sagittal and dorsal planes.
2 Arrange the MPR image so that the
blue plane is parallel to the plane of the
mitral valve.

1
Tagging the Annulus Reference
Points
After you have aligned the image data, you
can place the initial reference points.

1 Move the cursor over the green and


red planes, placing the reference points
as indicated in the illustration. 3
2 Click Next.
Click on the aorta and coaptation nadir, 2
3
adjusting their position if necessary.
4 Review the annular measurements on 5
the right panel.
5 Perform steps 5 through 8, if editing is
needed.

Mitral Valve Navigator (MVN) 39


Mitral Valve Navigator (MVN) 40

Mitral Valve Anatomy Report


The Mitral Valve Anatomy Report
presents the measurements and calculations
generated through the placement of
reference points for the annulus, the leaflet,
the aortic orifice, the coaptation, and the
papillary tips.
General Imaging 3D Quantification GI3DQ General Procedure
The General Imaging 3D Quantification (GI3DQ) Q-App provides 1. Select the setup options.
tools for measuring angles, 2D distance and area, and 3D volumes. 2. Select the view settings.
Image Acquisition for GI3DQ 3. Optimize the image by using the Volume, MPR, or iSlice
views.
• Use the highest frequency transducer possible.
4. Orient the image.
• Acquire 3D data sets using a calibrated method.
5. Use Sculpt and Erase to remove any extraneous image data.
NOTES
• When acquiring images on the iU22 and iE33 ultrasound 6. Place measurements on the image.
systems, ensure that you do not have both black-and-white 7. Add annotations.
and color suppression enabled. 8. Rename measurements.
• 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.

General Imaging 3D Quantification (GI3DQ) 41


General Imaging 3D Quantification (GI3DQ) 42

Using the iSlice View

1 Orient the MPR views, and center the


planes over the region of interest.
2 Click iSlice.
3 Select the Source.

4 Select the number of Slices. 2


5 Using Interval (mm) and Depth
3
(mm), arrange the slices over the
4
region of interest.
5
Cropping an MPR View

1 Rotate the image view to present the


best orientation.
2 On the Trim/Crop tab, select
ROI Box as the Trim Mode.
2
3 Click Edit ROI.
4 Move the cursor to the edge of the
boundary box. 3
5 Drag the boundary box to a new
position and release.

General Imaging 3D Quantification (GI3DQ) 43


General Imaging 3D Quantification (GI3DQ) 44

Adding a Stacked Contours


Measurement
3 4
1 Click Stacked Contours.
2 Click the initial anchor position.
3 Click the terminal anchor position to
display a set of slices.
4 For each slice in the volume, perform
1
the steps that follow.
5 Click the initial anchor position of the
contour.
6 Draw along the boundary.
7 Right-click to set the terminal anchor
position.
8 Press the Left Arrow key or the Right
Arrow key to select the previous or
next slice.
The volume calculation updates as you
complete the slice measurements.
9 To end the measurement, press Enter.
2
Strain Quantification • Ensure correct PRF (velocity scale). Use cineloop and replay
frame by frame to set the color velocity scale at the pulsed-wave
The Strain Quantification (SQ) Q-App allows you to examine Doppler peak value.
Tissue Doppler Imaging (TDI) ultrasound images and provides a tool
for drawing regions of interest that measure the myocardial velocity, • Use a preliminary pulsed-wave Doppler sample on the mitral
strain, strain rate, and displacement along those regions in the annulus to check for peak velocities.
myocardium. General SQ Procedure
Image Acquisition for SQ 1. Set the preferences.
• Use the highest frequency transducer possible. 2. Draw one or more M-lines on the image data.
• Set the Tissue Doppler Imaging scale to an optimal point for 3. To optimize the tracking, edit and adjust the M-lines.
maximum sensitivity without aliasing. 4. Review the waveform data.
• Obtain the highest possible frame rate, adjusting the depth and 5. Add the mechanical reference timing overlay.
sector width to include only the areas of specific interest.
6. Review the trace data.
• Use High Definition Zoom if necessary.
7. Rename the M-lines.
• Have the patient hold their breath, during image acquisition, to
reduce the motion. Any relative motion of the sample means 8. Save and export results and modified images.
potentially new data and appearance of noisier traces, especially
strain rate.
• Ensure adequate Color gain.

Strain Quantification (SQ) 45


Strain Quantification (SQ) 46

Drawing a Virtual M-Line

1 Click Add to enable the virtual M-line


drawing tool.
2 Position the cursor on the image where
you want to start the virtual M-line.
3 Click to set the first control point of
the virtual M-line. 3
1
A minimum of two control points (start 2
and end) are required for a virtual
M-line.
4 Continue to click to set control points
for the virtual M-line.
5 Right-click to complete the virtual
M-line drawing.
6 Play the image loop after drawing an
M-line in the image area. This prevents
any incorrect averaging or sub-region
display problems in the SQ display.

6
Region of Interest Quantification General ROI Procedure
The Region of Interest Quantification (ROI) Q-App is a tool for 1. Set the preferences.
analyzing the image pixel content and the time or intensity data in the 2. Optimize the image for improved border placement.
image. 3. Select the ROI drawing tool.
Image Acquisition for ROI 4. Place the ROI on the image.
• The adjustment of the gain controls, TGC, LGC, and transmit 5. Select the time interval.
gain available on the ultrasound system has a significant impact
6. Select the appropriate curve fit.
on the quality of the ultrasound image.
7. Normalize the initial curve values.
• 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.
• The correct gain adjustments are the same ones used to obtain a
high-quality ultrasound image.
NOTE
TDI and color flow images acquired with a baseline shift cannot
be opened in ROI.

Region of Interest Quantification (ROI) 47


Region of Interest Quantification (ROI) 48

Adding an Auto Area


Measurement

1 Click Auto Area.

2 Click the image inside the region of


interest.
3 To increase the threshold (and the ROI
size), press the Up Arrow key.
4 To decrease the threshold (and the ROI
size), press the Down Arrow key. 2
5 Right-click to end the drawing.

3 4
Using Motion Compensation

1 Load an image into the ROI Q-App and


place one or more ROIs.
2 Click the ROI label in the Results
panel. 5 2

3 Under Motion Compensation, click


On or Off.
4 To delete the current key frame, click
Delete Frame. 3
5 To delete all key frames, except the one 4
on the current frame, click Delete All. 6
6 To reposition the ROI, click
Reposition Frame, drag the ROI, and
then click.
7 To end your edit session, click
End Edit. 7

Region of Interest Quantification (ROI) 49


Region of Interest Quantification (ROI) 50

Combining Quantification Results


from Multiple ROIs
You can combine pixel-intensity values from
multiple ROIs to produce a combined result,
which appears in the Results panel and in
the waveforms display.

1 Right-click an ROI and select


Combine With.
2 Select the ROI with which you want to
combine the first ROI.

1 2
Intima Media Thickness General IMT Procedure
The Intima Media Thickness (IMT) Q-App provides an automated 1. Set the IMT location.
method of performing multiple distance measurements of the intima 2. Optimize the image.
media complex of the carotid or other superficial arteries. 3. Trim the loop.
Image Acquisition for IMT 4. Adjust the IMT ROI.
• Use the most shallow depth setting that is appropriate for the 5. Edit IMT traces.
anatomy.
6. Store measurements.
• Use High Definition Zoom on your ultrasound system.
7. Save and export results and modified images.
• 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.
• 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.

Intima Media Thickness (IMT) 51


Intima Media Thickness (IMT) 52

Resizing the ROI

1 Place the cursor on a corner of the


region of interest.
2 Drag the corner to resize the IMT
region of interest.
3 Repeat, as necessary, using the other
corners of the IMT region of interest.

2
Cardiac Parametric Quantification Angio, and Pulse Inversion using Auto-Beat Sequencing with or
without Monitoring Mode.
The Cardiac Parametric Quantification (Cardiac PQ) Q-App
provides tools for viewing and displaying the dynamic intensity • Use Multi-Frame Triggering (MFT).
information contained in contrast-enhanced ultrasound images as • Use Echo or Power (Color Power Angio imaging or PMI) to
color-coded parametric images. acquire 2D data.

NOTE General Cardiac PQ Procedure


Approval of specific contrast agents and their applications differs 1. Select the appropriate parametric scale and border ROI type.
by country. Check with your local or national regulatory
agencies for approved agents and applications. 2. Review the automatic groups and determine if groups need to be
eliminated or added.
Image Acquisition for Cardiac PQ 3. Add a border ROI.
• Use R-wave tagged image sequences captured during an exam 4. Verify and, if necessary, adjust the ROI for accuracy.
using a contrast agent.
5. Generate one or more parametric overlays.
• Include echo or power mode data.
6. Review the parametric data as a cineloop sequence.
• The image file must contain at least four ECG R-waves.
7. Apply curve fitting to the waveform data.
• Use a low-mechanical-index with methods such as Real-Time
8. Save and export results and modified images.
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 high-mechanical-index, AutoBeat Sequence methods
including Ultraharmonics, Harmonic Angio, Ultraharmonic

Cardiac Parametric Quantification (Cardiac PQ) 53


Cardiac Parametric Quantification (Cardiac PQ) 54

Adding an ECG Group


Image sequences acquired using real-time
methods are sorted into ECG groups
according to their relationship to the
R-wave. The first group is the R-wave 2
frames. You can add up to 10 ECG groups.

1 Click Edit ECG Groups.

2 Select a frame from the thumbnail 1


review area.
3 Click Add Group. 3
Adding a Myocardial Template ROI

1 Click Set Initial Points.

2 Click once in the left image pane to set


the first control point of the border
template.
3 Click on three additional locations to
set the rest of the control points for
the border template. 1 3

2 3

Cardiac Parametric Quantification (Cardiac PQ) 55


Cardiac Parametric Quantification (Cardiac PQ) 56

Modifying the ROI Borders

1 Move the cursor to the area you want


to adjust.
2 Click near the control points and drag
the shape.
3 Click again to release the control
points.

1
General Imaging Parametric Quantification General GIPQ Procedure
1. Set the preferences.
NOTE
The GIPQ Q-App is not available in the United States. 2. Choose the frame for drawing the ROI.
3. Optimize the image for improved border placement.
The General Imaging Parametric Quantification (GIPQ) Q-App
provides tools for identifying regions of interest in ultrasound echo 4. Trim the loop to include only the image frames of interest.
images and for rendering those regions as color-coded parametric 5. Select the ROI drawing tool.
images.
6. Place the ROI on the image.
Image Acquisition for GIPQ 7. Generate the parametric image.
• The adjustment of the gain controls, TGC, LGC, and transmit 8. Adjust the parametric overlay.
gain available on the ultrasound system has a significant impact
on the quality of the ultrasound image. 9. Select the curve fit algorithm.
• The success of parametric quantification depends upon the 10. Examine one or more points of interest.
correct adjustment of the gain controls so that all regions of 11. Display and review the histograms associated with the current
similar material exhibit similar intensities. ROI and the curve-fitting parameters.
• The correct gain adjustments are the same ones used to obtain a 12. Save and export results and modified images.
high-quality ultrasound image.

General Imaging Parametric Quantification (GIPQ) 57


General Imaging Parametric Quantification (GIPQ) 58

Optimizing the Histogram

1 Reduce the data source to those 6 3 7 8


frames with relevant data.
2 Select and apply the appropriate
preferences.
3 Draw the ROI on the image.
4 Click Generate.
5 On the waveforms display, click the
Histogram tab.
4
6 Drag the Low bar to the appropriate
starting level for the parameter of
interest.
7 Drag the Mid bar to the appropriate
ending level.
8 Drag the High bar to the position that
emphasizes the data range of best value
for assessment.

5
2 1
MicroVascular Imaging • Include the contrast timer counter. This information is displayed,
as an overlay, on the image.
The MicroVascular Imaging (MVI) Q-App provides tools for assessing
the local intensity changes over time in 2D ultrasound images. • Use high-mechanical-index and AutoBeat Sequence methods.
Those methods include Ultraharmonics, Harmonic Angio,
The image data is processed to map intensity changes frame by Ultraharmonic Angio, and Pulse Inversion using Auto-Beat
frame. The processing suppresses background tissue signals and Sequencing with or without Monitoring Mode.
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.
Image Acquisition for MVI
• 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.

MicroVascular Imaging (MVI) 59


MicroVascular Imaging (MVI) 60

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.
Vascular Plaque Quantification the media adventitia complexes. Minimize extraneous noise in
the image.
The Vascular Plaque Quantification (VPQ) Q-App provides protocol-
driven tools for performing a semi-automated analysis of plaque in • Try to keep the area of the artery that you are interested in
the carotid artery. quantifying in the center of the image.
• Use the Res setting in 3D to obtain the most accurate readings.
NOTES
• VPQ supports plaque quantification only on 3D volumes • Acquire images with the carotid artery transverse in the
acquired from an iU22 ultrasound system with a VL13-5 acquisition plane.
transducer. Monochrome (echo-only) volumes are General VPQ Workflow Procedure
supported; color volumes are not supported. Single-volume
1. Set the preferences if necessary.
images are supported; 4D and real-time 3D volumes are not
supported. 2. Define the begin frame of a plaque region.
• To help identify the correct laterality of the images you 3. Define the end frame of a plaque region.
quantify with the VPQ Q-App, you should use the 4. Define one or more key frames within the plaque region.
ultrasound system annotation feature to mark the laterality
on the images at the time of acquisition. 5. Define a normalization ROI for the loop if necessary.
6. If you have a known intima media thickness (IMT) value, you can
Image Acquisition for VPQ specify it for use in the calculated results if necessary.
• Use the most shallow depth setting that is appropriate for the 7. Calculate the results for all defined plaque regions within the
anatomy. loop.
• Use High Definition Zoom on your ultrasound system. 8. Specify the anatomical location of the center of the volume and
• Ensure that the gain is set properly. The Q-App algorithm works the frame with maximum reduction.
best when there is a clear definition of the lumen, the intima, and 9. Save and export results and modified images.

Vascular Plaque Quantification (VPQ) 61


Vascular Plaque Quantification (VPQ) 62

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.
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.
Fetal Heart Navigator General FHN Workflow Procedure
The Fetal Heart Navigator (FHN) Q-App provides a semi-automated 1. Adjust the visualization controls if necessary to optimize the
alignment of the fetal heart from a 3D volume acquisition and a views.
protocol that helps you obtain the standard set of views that best 2. Adjust the ductal arch view.
reveal the most common fetal heart anomalies. 3. Proceed to the 4-chamber workflow task.
The FHN Q-App is for visualization only. The FHN tools do not 4. Adjust the 4-chamber view.
produce quantitative data or measurements.
5. Proceed to the LVOT workflow task.
Image Acquisition for FHN
6. Adjust the LVOT view.
• Use the Fetal Echo Tissue Specific preset, which defaults to
7. Proceed to the RVOT workflow task.
iSTIC in 3D standby mode.
8. Adjust the RVOT view.
• In 3D standby mode, optimize the image quality by adjusting
gain, depth, and acoustic focus. 9. Proceed to the Review workflow task.
• In 3D standby or HD zoom, narrow the ROI for maximum 10. Add any text label annotations you want to the four final views.
temporal resolution in iSTIC acquisition. 11. Save and export the final images.
• 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.

Fetal Heart Navigator (FHN) 63


Fetal Heart Navigator (FHN) 64

Adjusting the Ductal Arch View


After the FHN software has produced an
initial ductal arch view, you can perform the
following procedure to make any necessary 2 2
manual adjustments.

1 If the orientation of the descending


aorta (DAo) does not extend to the
left as shown on the illustration, you
can invert the image by clicking
Invert Ductal Arch.
2 If the ductal arch and pulmonary valve
(PV) are not clearly visible, use the
controls at the ends of the horizontal 1
blue line to rotate the image around 3
the DAo until visualization of the ductal
arch and PV are optimized.
3 When you are satisfied with this view,
click Next.
A check mark is automatically placed
beside the Ductal Arch task and the
4-Chamber task is activated.
Adjusting the LVOT View

1 Place the white dot on the aortic root.

2 Move the pointer on the green line to


rotate the image until the left ventricle 1 2
outflow tract is clearly visible in
image 2.
3 When you are satisfied with this view,
click Next.
A check mark is automatically placed
beside the LVOT task and the RVOT
task is activated.

Fetal Heart Navigator (FHN) 65


Fetal Heart Navigator (FHN) 66

Annotating the FHN Views

1 Click Annotation.

2 Position the cursor where you want


the annotation, and then click.
3
3 Click OK to accept the default
annotation, or type any text you want
and then click OK.
4 After the label is placed, you can click it
and drag it to a new location.
5 To modify the text label, right-click the
label and enter new text.
1
6 To delete a label, right-click the label,
delete the text, and then click OK.
Elastography Analysis • Try to include normal fat along with glandular tissue in the ROI
box, so you can compare lesion stiffness with the stiffness of
NOTE surrounding tissue.
The EA Q-App is only available in the United States.
• When imaging suspicious lesions, note that lesions that are
The Elastography Analysis (EA) Q-App provides tools for quantifying stiffer than normal fat and glandular tissues may appear larger in
elastograms that are acquired using the elastography feature on the an elastogram than in 2D mode.
ultrasound system. • 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
CAUTION
the first 1 cm, use a standoff pad or extra gel.
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.

Image Acquisition for EA


• 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.

Elastography Analysis (EA) 67


Elastography Analysis (EA) 68

Adding an Angle

1 Click Angle.

2 Click the initial anchor position for the


intersection point of the angle in the
appropriate 2D image view.
3 Drag one side of the angle.
Click again to adjust the other side of 2
4
the angle.
5 Right-click to end the angle
measurement. 3

4
Elastography Quantification • Try to include normal fat along with glandular tissue in the ROI
box, so you can compare lesion stiffness with the stiffness of
NOTE surrounding tissue.
The EQ Q-App is not available in the United States.
• When imaging suspicious lesions, note that lesions that are
The Elastography Quantification (EQ) Q-App provides tools for stiffer than normal fat and glandular tissues may appear larger in
quantifying elastograms acquired using the elastography feature on an elastogram than in 2D mode.
the ultrasound system. The EQ Q-App provides the ability to • Anechoic imaging (AI) may not work for the first 1 cm of depth.
calculate strain ratio, and to perform size comparison and To help acquire a better anechoic image of a superficial region in
Parametric Imaging. the first 1 cm, use a standoff pad or extra gel.
CAUTION NOTES
The ultrasound system normalizes the elastogram. Elastography • Images acquired on Vision 2009 iU22 or Vision 2009 iE33
measurements and calculations in the QLAB software are ultrasound systems do not have the full range of
relative quantifications of tissue strain, which are not necessarily measurement options available. Images acquired on those
repeatable over time. Do not compare elastography data from systems can be used for Size Ratio, Strain Ratio,
different data sets; the normalization applied and the variability Maximum Strain Ratio, and Average Strain Ratio.
of the tissue strain could result in an inaccurate analysis. • Generally, the measurement accuracy of measurements
performed in the EQ Q-App will be ±30% of the actual
Image Acquisition for EQ
value.
• 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.

Elastography Quantification (EQ) 69


Elastography Quantification (EQ) 70

Size Comparison Workflow

1 Identify the best frame to perform the


size comparison.
2 Click Size Compare. 2 3 4 5
3 Select an ROI tool and define the
region of interest on the 2D image or
the elastogram.
4 The region of interest is copied onto
the elastogram or the 2D image.
5 The size ratio appears in the Results
panel.
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