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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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QLAB Software 5
QLAB Software 6
QLAB Software 7
QLAB Software 8
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
Studies 11
Studies 12
Image Viewer 13
Image Viewer 14
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.
TMAD Workflow
6 5
1 Load a BiPlane image into the Q-App.
2 Select aTMAD.
Select the end-diastole frame from the
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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.
1 Select Global.
2
Adding Cardiac Cycle Data
NOTE
With images that contain embedded
cardiac phase data, the data fields will
be populated automatically.
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.
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Adding an Apical ROI
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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.
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Measuring Distance
1 Click Distance. 1
2 Click the initial anchor position.
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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.
1
Tagging the Annulus Reference
Points
After you have aligned the image data, you
can place the initial reference points.
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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.
3 4
Using Motion Compensation
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.
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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.
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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.
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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.
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.
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.
1 Click Annotation.
Adding an Angle
1 Click Angle.
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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.