QUAD @ Cedars-Sinai

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QGS+QPS – Quantitative Gated and Perfusion SPECT

QGS+QPS is an interactive standalone application for the automatic segmentation, quantification, analysis and display of gated and ungated short axis myocardial perfusion SPECT images.

This application combines the former QGS and QPS applications into one program. It offers all the function information of QGS and perfusion analysis of QPS.

Specifically, QGS+QPS provides the following functionality:

• Automatic generation of left ventricle (LV) inner and outer surfaces and valve plane from LV gated and ungated short axis myocardial perfusion SPECT data
• Display of stress and rest projection (raw) images in static and cine mode, 2D and 3D display of stress and rest short axis SPECT images in 1 (single), 2 (dual), 3 (triple), or 4 (quadruple) mode. Also display of screen capture images (also known as snapshots).
• Automatic computation of functional metrics including LV chamber volume and mid-myocardial surface area
• Automatic generation of stress, rest and reversibility surfaces and polar maps, which display in parametric fashion the pattern of LV myocardial perfusion. Determination and display of the severity and extent of perfusion defects using isotope- and gender-specific normal limits.
• Automatic computation of global quantitative defect size, both in absolute terms and as a percentage of the mid-myocardial surface area.
• Automatic generation of segmental perfusion scores (stress, rest and reversibility) based on a multi-segment, multiple-point scale, and subsequent derivation of the global scores SSS (summed stress score), SRS (summed rest score), SDS (summed difference score), SS% (summed stress percent), SR% (summed rest percent), and SD% (summed difference percent).
• Generation of quantitative data including LV volume/time curve, ED (end diastolic) volume, ES (end systolic) volume, SV (stroke volume), EF (ejection fraction), mid-myocardial surface area, SMS (summed motion score), STS (summed thickening score), SM% (summed motion percent), and ST% (summed thickening percent).
• Automatic computation of diastolic function parameters from the time-volume curve, including PER Peak Emptying Rate (ml/s), PFR Peak Filling Rate (ml/s), MFR/3 Mean Filling Rate for first third of cardiac cycle following end diastole (ml/s), and TTPF Time To Peak Filling (intervals)
• All categorical polar maps and polar map and functional surface overlays in QGS and QPS is available in the 20 segment format and in the AHA standard 17 segment format. 17 segment format categorical scores will be able to be automatically generated using either 17 or 20 segment using motion and thickening databases.
• Automatic generation of surfaces and polar maps, which display in parametric fashion the pattern of motion and thickening of the LV using normal limits.
• Any gated short axis datasets with associated LV contours will have the eccentricity of its mid-myocardial wall for each interval automatically computed, and expressed as an “eccentricity index”. It will be displayed in the QGS Information Box as ECC, and will have values between 0 (sphere) and 1 (line).
• Improved Perfusion Quantification (PFQ)
  – A more accurate quantitative perfusion analysis is the key advantage of PFQ, the improved quantification module of QPS. This software provides as its primary nuclear variable the Total Perfusion Deficit (TPD), reflecting the extent and severity of the overall perfusion defect, and correlating strongly with the widely used visual variables of SSS or % myocardium abnormal. PFQ has been shown to be superior to the previous quantitative algorithm of QPS and even to be able to outperform expert visual analysis. PFQ also allows a greatly simplified addition of new perfusion databases.

(may not be in all versions)

• Prone/Supine combined imaging has been a hallmark of the Cedars-Sinai approach for a decade, improving observer confidence. Prone-supine quantification allows a single measurement to be reported, representing the combination of prone and supine quantifications. This has been documented to improve the accuracy of SPECT interpretation over supine interpretation alone. The clinicians at Cedars-Sinai use this tool on every patient with questionable findings.
• Stress Rest Registration and Serial Change is a more sensitive method for defining the difference between two studies is direct quantification of perfusion changes between images by a 3D elastic registration of two myocardial perfusion studies. No databases are required for the calculation of stress-rest changes (ischemia) or serial image changes. This can be particularly useful in assessing changes in perfusion patterns on serial studies or in resolving discrepancies between visual analysis and PFQ.
• Phase toggle gives access to information regarding the synchrony of contraction from gated myocardial perfusion SPECT images, and can be of importance in assessing the likelihood of a patient benefiting from the growing procedure of cardiac resynchronization therapy (CRT).
• Shape Index defines 3D left ventricular (LV) geometry derived from LV contours in end systolic and end diastolic phases. It’s the ratio between the maximum dimension of the LV in all short-axis planes and the length of the mid-ventricular long axis and has been shown to improve the identification of left ventricular failure.
• The Presentation (a.k.a. PowerPoint) feature provides the ability to save results and application configuration for case studies, allowing fast and easy launching directly from a PowerPoint or Keynote slide, excellent for presentations and demonstrations.
• Integration of ARG (Automated Report Generator) within QGS+QPS for reporting functionality.