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GE Healthcare
Table of Contents
Introduction.........................................................................................................................................................3
Product Description.........................................................................................................................................3
CardIQ Xpress™ Pro Feature List ................................................................................................................................. 4
Pre-Requisites....................................................................................................................................................................... 4
Caution Statements.........................................................................................................................................5
Geometric Accuracy .......................................................................................................................................................... 5
Vessel Quantification and Tracking ............................................................................................................................ 5
Vessel Quantification and Tracking ............................................................................................................................ 6
Saving and Filming Images ............................................................................................................................................ 7
Volume Viewer Tips .........................................................................................................................................8
Volume Viewer Shortcuts .............................................................................................................................9
CardIQ Tools ................................................................................................................................................................................... 9
CardIQ XpressTM Pro Protocols ................................................................................................................ 10
Launching CardIQ XpressTM Pro.............................................................................................................. 13
CardIQ XpressTM Pro Workflow................................................................................................................ 15
Step 1: Angiographic View Selection........................................................................................................................15
Step 2: Vessels to Analyze .............................................................................................................................................16
Step 3: AVA Tools: Edit/Measure.................................................................................................................................16
Step 4: Add Measurements...........................................................................................................................................17
Step 5: Report (option 1).................................................................................................................................................18
Step 5: Report (option 2).................................................................................................................................................18
Tree VR Protocol Step 1 .............................................................................................................................. 19
Step 1: Automatic Vessel Selection...........................................................................................................................19
Cardiac Transparency................................................................................................................................. 20
Ejection Fraction - Left Ventricle ............................................................................................................ 21
Cardiac Reformat .......................................................................................................................................... 24
Create a “Beating Heart” Movie.............................................................................................................. 25
2D Cardiac Review........................................................................................................................................ 26
Card Review 1.....................................................................................................................................................................26
Card Review 2.....................................................................................................................................................................27
Card Review 3.....................................................................................................................................................................27
Oblique Review...................................................................................................................................................................28
Quick AVA .......................................................................................................................................................... 29
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Introduction
As with any medical imaging process, only qualified personnel should use this equipment.
You must be aware of the limitations of the basic imaging modality and of ensuing image
processing. This includes understanding the limitations of the initial series acquisition, image-
processing technology used, and image display methods.
This Support and Quickstep Guide together with the Operator Manual are Training materials
available on line on the workstation. Users need to review operating procedures on a regular basis,
paying special attention to Caution statements. Keep this training guide as well as the operator
manual available while using the CardIQ Xpress Pro software. This manual is designed as a Quick
Step Guide only. It should be used in conjunction with the CardIQ Xpress Pro Operators Manual, and
Volume Share 2 Operators Manual, as it is not cover all aspects or features of the CardIQ Xpress
software.
This guide is sectioned into individual chapters to describe the workflow and provide instructions for
the use of the features in CardIQ Xpress Pro. There is no correct order in which you should use these
protocols
If you want to benefit from additional training, please contact your GE Healthcare User Services
representative for assistance.
Product Description
Cardiovascular CT imaging using multi-slice CT technology is a new and exciting clinical application
which may make significant impacts to cardiovascular disease management as a non-invasive
imaging technique. Multi-slice detector CT, which has been quickly adopted by the clinical
community, has the advantage of being easy-to-use, reliable and accessible, in comparison to
other invasive or non-invasive cardiac imaging techniques. One of the critical components for an
effective cardiac CT application is a fully integrated post-processing and analysis tool tailored for
cardiac imaging.
The CardIQ Xpress™ Pro option is designed to provide an easy-to-use and time-effective means for
cardiovascular image manipulation. CardIQ Xpress™ Pro option is an integrated post processing
image analysis software dedicated for the application of cardiovascular imaging on Volume Share 2
(AW) platform. This software option can be used to effectively display, reformat and analyze 2D or
3D cardiac CT images for qualitative or quantitative assessment of heart anatomy and coronary
artery vessels from single or multiple cardiac phase image data sets. Potential clinical applications
include: coronary artery calcification assessment, imaging of cardiac morphology, coronary artery
imaging and assessment, bypass graft patency, post intervention follow-up and functional
assessment.
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CardIQ Xpress™ Pro Feature List
• Quick AVA
• Dynamic AVA
• Vessel Database
• Phase Drop for multi-phase datasets
• Vessel Analysis Protocols
• Single & multi-phase Vessel Tracking
• Combined RT and LT Side Vessel Tracking
• Customizable Screen Layouts
• Dual and Single Reference Measurements for Stenosis Assessment
• Length, Diameter, Volume and Angle Calculation
• Plaque Identification Color Identification
• Semi-automated Curved Planar Reformats
• VR Vessel Tree with automatic vessel detection
• VR Heart & Heart Graft Protocols
• Reformat Protocols
• Automated Cardiac Reformat Protocols
• Cardiac Transparency Protocol
• Multi-Phase Registration
• Beating & Rotating VR Heart Output (JPEG/MPEG – Data Export)
• One Touch Cath Angles
• Ejection Fraction Protocol
• Angiographic View
• Improved Movie Tool
• Report Generation Tool
Pre-Requisites
DICOM image data sets
Volume Share 2
Volume Viewer 3
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Caution Statements
This Chapter reviews the most important information for the safe operation of the VesselIQ Xpress
software. Please review this documentation before using the software.
Geometric Accuracy
The Lumen and 3D views that are displayed and created using the CardIQ Xpress™ Pro software
should be used for orientation purposes only, NOT for diagnostic purposes.
When creating the Lumen view within CardIQ Xpress™ Pro, it is necessary to change the three
dimensional centerline into a straight line. This transformation results in a degree of geometric
distortion of the anatomic features displayed in this view. Use the correlated 2D views to verify
findings.
The 3D views, can be clipped to clearly show the vessel being analyzed among the surrounding
tissue, and may not include all vascular anatomy.
The distance, angle and area measurements created in this software are only accurate if all the
segments used to create the measurement are longer than the inter-slice distance of the data set
being used.
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Vessel Quantification and Tracking
The accuracy of vessel quantification and tracking is highly dependant on, image quality, image
resolution, inter-slice distance, artifacts, pathology, and contrast enhancement.
It is the responsibility of the user to verify the results of the tracking and quantification of the lumen
segments before using the data for diagnosis.
In case of incorrect tracking or quantification, the user must use the provided edit centerline and
edit section tools to make any corrections necessary.
Accuracy of cross sectional distance measurements should be +/- 10% for vessels with a diameter
between 10 and 20 voxels. It should be +/- 5% for vessels with a diameter greater than 20 voxels.
Accuracy of cross sectional area measurements should be +/- 40% for vessels with a diameter
between 10 and 20 voxels. It should be +/- 20% for vessels with a diameter greater than 20 voxels.
Accuracy of volume measurements should be +/- 40% for vessels with a diameter and a length
between 10 and 20 voxels. It should be +/- 20% for vessels with a diameter and a length greater
than 20 voxels.
To access the accuracy of the measurements performed with the Volume Viewer 3 application,
please review the section titled, “Measurement Accuracy” in the Volume Viewer 3 user guide.
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Vessel Quantification and Tracking (cont.)
In exams with very tortuous vessels, and/or severe pathology, the automatic centerline algorithm
may not always follow the true path of the vessel lumen. The user should always examine and
verify that the computed centerline tracking is accurate otherwise the user if necessary correct the
result either by modifying the centerline via the edit centerline tool, or add intermediate tracking
points and repeating the centerline detection process.
After archiving/saving images and before leaving the application, always verify that the archived
images are correct by reviewing them in the viewer.
Before archiving images used for diagnosis, verify that the image orientation annotation and the
patient information is displayed correctly.
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Volume Viewer Tips
• Arrows next to buttons indicate a drop down menu. Click the arrow to open and close these
menus.
• Rest the cursor over a button and a tool tip appears describing the button function.
• Typically click [Next] and [Back] to navigate through the wizard panels.
• Watch the progress bar at the bottom of the desktop. It shows the task progress when loading
data or images.
• To change the cursor shape, the trace tool or always hide reference image complete the
following steps:
• When mouse mode is set to Page/Rotate, Zoom or Roam, double click on the viewport to
enlarge it and display it as full screen.
• Right-click to see short-cut pathways for several features, e.g. Save Image, Hide Reference
Image, Create a Trace, Delete Trace, etc.
• Place the mouse cursor over DFOV or image location and left-click, right-click, or middle click
and drag to change DFOV or image location.
• Place the cursor over red RAS coordinates, click, and drag to roam the image.
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Volume Viewer Shortcuts
H – In vessel analysis tap the H key to hide the green contour lines around the tracked vessel.
S – Tap the S key to save the image in the viewport where your mouse cursor is placed.
C – Tap the C key to hide the 3D cursor, tap the C key again to turn 3D cursor back on.
F1 – Tap the F1 key to film the image in the viewport where your mouse cursor is placed.
F2 - Tapping the F2 key will update the filmer to the identical layout of the screen and film all
images on the screen.
CardIQ Tools
• AutoSelect – use add / remove structure, add / remove vessels to edit a 3D volume
• Quick AVA – single click and two click methods for depositing points onto a vessel
and obtaining a centerline tracking from any protocol.
• Report Cursor – click on report cursor and then click on anatomy of interest to
obtain RAS coordinates and HU values
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2
Tree VR:
This protocol generates a VR model of the coronary arterial
tree and continues with vessel analysis for left and right
circulation.
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Heart VR:
VR Image of the heart automatically segmented from the
surrounding thorax structures.
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2D Cardiac Review:
Use this protocol to perform a 2D analysis of the coronary
arteries and mediastinum. Left and Right monitors are set to
large oblique views, 90 degrees from one another. Use the
Review Steps area to step through and review optimal angles
for each artery.
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CardIQ Xpress Pro Protocols Description
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Cardiac Reformat:
This protocol automatically generates axial, short axis, 2
chambers long axis and 4 chambers long axis views. When
loading a multi-phase data use this protocol to view chambers
in a phase cine loop.
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Left Coronary Analysis:
Use this protocol to analyze the Left Coronary Artery
Circulation. A step-by-step guide is used to define the arteries
to analyze, place measurement points, and identify plaque.
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Right Coronary Analysis:
Use this protocol to analyze the Right Coronary Artery
Circulation. A step by step guide is used to define the arteries
to analyze, place measurement points, and identify plaque.
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Coronary Analysis:
Use this protocol to analyze a single coronary artery. Optimal
when imaging By-pass Grafts, anomalous vessels or
significantly diseased or tortuous vessels.
Phase Registration:
Reformat protocol that supports multi-phase datasets and
allows a user to do phase registration.
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CardIQ Xpress Pro Protocols Description
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Ejection Fraction:
Use this protocol to calculate Ejection Fraction along with
End Systole, End Diastole, and Stroke Volume for the left
ventricle.
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Cardiac Transparency:
Use this protocol to display the Coronary Artery Tree along
with the chambers in a transparent mode. This may be
especially helpful for displaying anomalous vessels.
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Cardiac:
VR Image of the heart in surrounding bony thorax.
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Heart Graft:
Creates a VR image of the heart. This protocol is ideal for
patients who have had by-pass surgery. It also is ideal for
full-gated chest acquisitions.
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Launching CardIQ XpressTM Pro
Step What you select How or Why you select it
1
2
(cont.) If CardIQ Xpress is not listed in the
applications area, click on the More
button, and choose from the list of
installed applications.
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Step What you select How or Why you select it
3
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CardIQ XpressTM Pro Workflow
Step What you select How or Why you select it
1 The Cardiac Vessel Analysis protocols are
built with a step-by-step guide. The
workflow for the protocols is basically the
same, however some protocols will vary in
the number of steps.
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2 Step 2: Vessels to Analyze
Place the “Start of section” point first in
order to track a branch. Next, deposit
points in all the vessels of interest. To skip a
vessel, simply left click the next vessel on
the list, then place your point.
Hints:
• Placing the point in the center of the
contrast enhanced lumen on the 2D views,
produces better tracking results, than
placing the point on the 3D views.
• When placing the points, place the point in
the distal portion as far as you want the
vessel to be tracked
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3 On the wizard panel at step 3, there is a
(cont.) number of tools & measurement options:
• AVA Preferences
• Help
• Save State
• Advanced Views
• Edit (Centerline and Section)
• Color Identification
• Stenosis
• Aneurysm
• Register
• Reporting
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4 To remove a measurement, select the
(cont.) measurement to be deleted, then click on
the [Remove] button. This will remove the
measurement from the final Vessel
Analysis report at the end of the protocol.
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Tree VR Protocol Step 1
Step What you select How or Why you select it
1 Step 1: Automatic Vessel Selection
All of the vessel analysis protocols
workflow is the same, except for Step
1 of the Tree VR protocol.
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Cardiac Transparency
Step What you select How or Why you select it
1
Once you have your Vessel Tree
created, you can then create a
Cardiac Transparency model of the
entire circulation and heart
chambers.
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Ejection Fraction - Left Ventricle
Step What you select How or Why you select it
1
From the CardIQ protocol page, select
the Ejection Fraction Functional
analysis protocol. This protocol will
provide calculations for Left Ventricle
Ejection Fraction, Stroke Volume, End
Systolic and End Diastolic Volumes.
3
Click on [Adjust Long Axis] or [Adjust
Short Axis] if adjustments to the
orientations are needed.
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4
Clicking the [Adjust Long Axis] button
will display the oblique line on the
Sagittal image.
5
Clicking the [Adjust Short Axis] button
will display the oblique line on the four-
chamber view.
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7
Position the 3D cursor in the mid
portion of the Mitral Valve and click
[Store Position].
• Ejection Fraction
• Stroke Volume
• End Systolic Volume
• End Diastolic Volume
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Cardiac Reformat
Step What you select How or Why you select it
1 Cardiac Reformat automatically
generates
• Sagittal View
• Four chamber long axis view
• Short axis view
• Vertical long axis view
(Vertical long axis view is behind the wizard
panel).
2 Create Batch:
To create batch reformats of any view:
Output:
On the Modify Batch screen, select
output then choose how you want to
export the series of images generated:
• Film
• Save
• Film & Save
• Filmer Images
• Filmer Movie
• Function (will not show up unless
CardIQ Function is installed.
2 Capture Images:
To create a movie, you must capture the
image that you want to see in motion twice.
This can be a 3D model or a 2D image.
• First make sure view is in the RED
viewport
• Second click on the [Add a new step]
Button TWICE (you should see the same
image in Step 1 & Step 2
• On the Wizard Panel, set the number
of heart cycles to 2
• Click on [Preview] or Select Output
preference and apply.
Output:
Select output then choose how you want to
export the series of images generated:
• Film
• Save
• Film & Save
• Filmer Images
• Filmer Movie
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2D Cardiac Review
Step What you select How or Why you select it
1
On the Cardiac protocol page, you
will find a protocol that leads you
through a 2D review of the coronary
arteries.
3 Card Review 1
Sets the orientation for both the left
and right screens to angles to best
demonstrate the greater structures
of the heart and mediastinum.
The Left Monitor displays the
chambers and great vessels. Scroll
up and down through the dataset to
review.
Hint: Double clicking on the viewport will
make scrolling easier.
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4
The Right Monitor displays the
chambers of the heart and the
descending aorta.
5 Card Review 2
The Left Monitor will demonstrate
the proximal coronary arteries and
the chambers of the heart with a
LAO Caudal View. Again, double
click to isolate the left monitor will
make it easier to scroll through the
dataset.
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The Right Monitor provides an LAO
Cranial View for the LAD and the
diagonals. Double click to isolate
the right monitor and page through
the dataset.
7 Card Review 3
The Left Monitor provides a short
axis view to best demonstrate the
right coronary artery. Double click
to isolate the left monitor and page
through the dataset.
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8
The Right Monitor provides an RAO
Caudal View of the LCX, PDA and
PLB. Double click to isolate the right
monitor and page through the
dataset.
9 Oblique Review
This layout provides an easy way to
create x-sectional images without
generating a centerline.
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Quick AVA
Step What you select How or Why you select it
1 Quick AVA provides you with the capability to
quickly perform quantitative analysis of a
lesion from any 3D, Reformat, or Vessel
Analysis protocol by a single click or two
clicks. This means that you no longer have to
start in a Vessel Analysis protocol in order
have full Vessel Analysis capabilities.
Warning:
If Quick AVA is launched within a Vessel
Analysis protocol after vessel tracking has
been performed, it will erase all tracked
vessels, and start over.
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Step What you select How or Why you select it
1
When the vessel has been tracked and
displayed, the vessel name will be Vessel 1,
annotated “V1”.
• Vessels to Analyze
• AVA Tools: Edit/Measure
• Add Measurements
• Report
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