Quick Guide, Volume 2

QLAB Advanced Quantification Software English

Release 13
Contents
For easy reference, each section is color-coded. The color of each
section title correlates with the color band on each page in that
section.
Cardiac Motion Quantification Stress
Image Acquisition for CMQ-Stress . . . . . . . . . . . . . . . . . . . . . .5
Selecting a Stage, a View, and a Subloop for Quantification . .6
Adding an Apical ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Viewing Global Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Strain Quantification
Image Acquisition for SQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
General SQ Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Drawing a Virtual M-Line . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Intima Media Thickness
Image Acquisition for IMT . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
General IMT Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Resizing the ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
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Cardiac Parametric Quantification
Image Acquisition for Cardiac PQ . . . . . . . . . . . . . . . . . . . . .13
General Cardiac PQ Procedure . . . . . . . . . . . . . . . . . . . . . . .13
Adding an ECG Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Adding a Myocardial Template ROI . . . . . . . . . . . . . . . . . . . . .15
Modifying the ROI Borders . . . . . . . . . . . . . . . . . . . . . . . . . . .16
General Imaging Parametric Quantification
Image Acquisition for GIPQ . . . . . . . . . . . . . . . . . . . . . . . . . .17
General GIPQ Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Optimizing the Histogram . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
MicroVascular Imaging
Image Acquisition for MVI . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
MVI Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Vascular Plaque Quantification
Image Acquisition for VPQ . . . . . . . . . . . . . . . . . . . . . . . . . . .21
General VPQ Workflow Procedure . . . . . . . . . . . . . . . . . . . .21
VPQ Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
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Fetal Heart Navigator

Image Acquisition for FHN . . . . . . . . . . . . . . . . . . . . . . . . . . .23
General FHN Workflow Procedure . . . . . . . . . . . . . . . . . . . .23
Adjusting the Ductal Arch View . . . . . . . . . . . . . . . . . . . . . . .24
Adjusting the LVOT View . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Annotating the FHN Views . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Elastography Analysis
Image Acquisition for EA . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Adding an Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Elastography Quantification
Image Acquisition for EQ . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Size Comparison Workflow . . . . . . . . . . . . . . . . . . . . . . . . . .30
About This Guide Term Description or Action
Use this Quick Guide to help you use the QLAB Q-Apps step-by-step. Image or The image or image area is the ultrasound-scan
For information about the Q-Apps not detailed in this quick guide, image area area on the imaging display.
the core QLAB software, studies, or the image viewer, see the QLAB Pointer The pointer is the cursor used to select elements
Quick Guide, Volume 1. For more information about the QLAB on the display.
software, see the QLAB Help or the QLAB User Manual. Right-click Position the tip of the pointer or cursor on an
This Quick Guide describes the most extensive configuration of the item and then press either the ultrasound
product, with the maximum number of options and accessories. system selection control (see your ultrasound
Some functions described may be unavailable on your product's system documentation) or the mouse button,
configuration. without moving the cursor.

Most screen captures show the English language interface. Use the These numbering styles are used in this Quick Guide:
images for visual reference. Your display may differ.
Style Description
Conventions
2 This style is used for steps with callouts on graphics.
These terms are used in this Quick Guide:
2 This style is used for steps with no callouts on graphics.
Term Description or Action
Click or select Move the pointer to an object and press either 2 This style is used for callouts not associated with steps.
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.
Hover Pause the pointer over an item on the display.

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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. Images must be single-plane 2D.
NOTE
To achieve the best results for off-cart analysis, select the 2D
Native Data export option on EPIQ, Affiniti 70, Affiniti 50,
iU22, and iE33 systems. Non-native data may also be used.
When non-native data is used, you need to set the event phase
time manually.
Cardiac Motion Quantification Stress (CMQ-Stress)
Image Acquisition for CMQ-Stress
• Use a good ECG signal and acquire one or more heartbeats.
• 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.
• 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.
5
Cardiac Motion Quantification Stress (CMQ-Stress) 6

Selecting a Stage, a View, and a

Subloop for Quantification
1
1 Click the Stages/Cardiac Cycles/ 2
Views section of the control panel.
2 Select a stage.
3
3 Select a view.
4 Select a Sub Loop, if necessary. 4
Adding an Apical ROI
2
1 Select the end-diastolic or end-systolic
frame from the loop.
2 Select the view. 5

3 Click on the left of the mitral valve.

4 Click on the right of the mitral valve.
5 Click the apex.

6 Adjust the placement of the border if

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

Cardiac Motion Quantification Stress (CMQ-Stress) 7

Cardiac Motion Quantification Stress (CMQ-Stress) 8

Viewing Global Results

1
1 Click Global Results. 2 3

2 To display the corresponding one-stage 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
Strain Quantification General SQ Procedure
The Strain Quantification (SQ) Q-App allows you to examine 1. Set the preferences.
Tissue Doppler Imaging (TDI) ultrasound images and provides a tool 2. Draw one or more M-lines on the image data.
for drawing regions of interest that measure the myocardial velocity, 3. To optimize the tracking, edit and adjust the M-lines.
strain, strain rate, and displacement along those regions in the
myocardium. 4. Review the waveform data.

Image Acquisition for SQ 5. Add the mechanical reference timing overlay.

6. Review the trace data.
• Use the highest frequency transducer possible.
7. Rename the M-lines.
• Set the Tissue Doppler Imaging scale to an optimal point for
maximum sensitivity without aliasing. 8. Save and export results and modified images.
• 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.
• 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.
• Use a preliminary pulsed-wave Doppler sample on the mitral
annulus to check for peak velocities.

Strain Quantification (SQ) 9

Strain Quantification (SQ) 10

Drawing a Virtual M-Line

1 Click Add to enable the virtual M-line

drawing tool.
2 Position the cursor on the image where 3
you want to start the virtual M-line. 1
2
3 Click to set the first control point of
the virtual M-line.
A minimum of two control points (start
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
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) 11

Intima Media Thickness (IMT) 12

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 General Cardiac PQ Procedure
The Cardiac Parametric Quantification (Cardiac PQ) Q-App 1. Select the appropriate parametric scale and border ROI type.
provides tools for viewing and displaying the dynamic intensity 2. Review the automatic groups and determine if groups need to be
information contained in contrast-enhanced ultrasound images as eliminated or added.
color-coded parametric images. 3. Add a border ROI.
Image Acquisition for Cardiac PQ 4. Verify and, if necessary, adjust the ROI for accuracy.
• Use R-wave tagged image sequences captured during an exam 5. Generate one or more parametric overlays.
using a contrast agent.
6. Review the parametric data as a cineloop sequence.
• Include echo or power mode data.
7. Apply curve fitting to the waveform data.
• The image file must contain at least four ECG R-waves.
8. Save and export results and modified images.
• 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 Multi-Frame Triggering (MFT).
• Use Echo or Power (Color Power Angio imaging or PMI) to
acquire 2D data.

Cardiac Parametric Quantification (Cardiac PQ) 13

Cardiac Parametric Quantification (Cardiac PQ) 14

Adding an ECG Group

2
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
frames. You can add up to 10 ECG groups. 1

1 Click Edit ECG Groups. 3

2 Select a frame from the thumbnail

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

1 Click Set Initial Points.

2 Click once in the left image pane to set 1 3

the first control point of the border 3
template.
3 Click on three additional locations to
set the rest of the control points for
the border template.
2 3

Cardiac Parametric Quantification (Cardiac PQ) 15

Cardiac Parametric Quantification (Cardiac PQ) 16

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) 17

General Imaging Parametric Quantification (GIPQ) 18

Optimizing the Histogram

6 3 8 7
1 Reduce the data source to those
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 4
Histogram tab.
6 Drag the Low bar to the appropriate
starting level for the parameter of
interest.
7 Drag the High bar to the appropriate
ending level.
8 Drag the Mid bar to the position that
emphasizes the data range of best value
for assessment.

5
2 1
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.
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.
• Include the contrast timer counter. This information is displayed,
as an overlay, on the image.

MicroVascular Imaging (MVI) 19

MicroVascular Imaging (MVI) 20

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 General VPQ Workflow Procedure
The Vascular Plaque Quantification (VPQ) Q-App provides protocol- 1. Set the preferences if necessary.
driven tools for performing a semi-automated analysis of plaque in 2. Define the begin frame of a plaque region.
the carotid artery. 3. Define the end frame of a plaque region.
Image Acquisition for VPQ 4. Define one or more key frames within the plaque region.
• Acquire 3D monochrome single-volume images from an EPIQ, 5. Define a normalization ROI for the loop if necessary.
an Affiniti 70, an Affiniti 50, or an iU22 system with a VL13-5
6. If you have a known intima media thickness (IMT) value, you can
transducer.
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.
the media adventitia complexes. Minimize noise in the image.
• Try to keep the area of interest 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.

Vascular Plaque Quantification (VPQ) 21

Vascular Plaque Quantification (VPQ) 22

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 tool or the Spline
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. Complete the 4-chamber workflow task and adjust as needed.
The FHN Q-App is for visualization only. The FHN tools do not 4. Complete the LVOT workflow task and adjust as needed.
produce quantitative data or measurements.
5. Complete the RVOT workflow task and adjust as needed.
Image Acquisition for FHN
6. Complete the Review workflow task.
• Use the Fetal Echo preset, which defaults to iSTIC in 3D
7. Add any text label annotations you want to the four final views.
standby mode.
8. Save and export the final images.
• 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.

Fetal Heart Navigator (FHN) 23

Fetal Heart Navigator (FHN) 24

Adjusting the Ductal Arch View

2 2
To make any necessary manual adjustments
to the initial ductal arch view:

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 1
controls at the ends of the horizontal 3
blue line to rotate the image around
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 2
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
outflow tract is clearly visible in
image 2.
3 When you are satisfied with this view,
click Next.
A check mark is automatically placed 3
beside the LVOT task and the RVOT
task is activated.

Fetal Heart Navigator (FHN) 25

Fetal Heart Navigator (FHN) 26

Annotating the FHN Views

3
1 Click Annotation.

2 Position the cursor where you want

the annotation, and then click.
3 Click OK to accept the default
annotation, or type any text you want
and then click OK.
1
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.
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) 27

Elastography Analysis (EA) 28

Adding an Angle

1 Click Angle.

2 Click the initial anchor position for the

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

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
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 EQ

• 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) 29

Elastography Quantification (EQ) 30

Size Comparison Workflow

2 3 4 5
1 Identify the best frame to perform the
size comparison.
2 Click Size Compare.
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.
© 2019 Koninklijke Philips N.V.
All rights are reserved.
Reproduction or transmission in whole or in part, in any form or by any means,
electronic, mechanical or otherwise, is prohibited without the prior written
consent of the copyright owner.

Printed in the USA

4535 620 06201_B/795 * MAY 2019 - en_US