CardIQ Xpress Pro

GE Healthcare
CardIQ Xpress Pro

CardIQ Xpress Plus
User Guide
5180542-100
Revision 3
Do not duplicate
Copyright 2007
by General Electric Company inc. All rights reserved.
User Guide
REGULATORY REQUIREMENTS
This product complies with the regulatory requirements of the following:
• Council Directive 93/42/EEC concerning medical devices: the label affixed to the product testifies
compliance to the Directive.
European registered place of business:
GE Medical Systems SCS
Quality Assurance Manager
BP 34
F 78533 BUC CEDEX France
Tel: +33 (0)1 30 70 40 40
• Medical Device Good Manufacturing Practice Manual issued by the FDA (Food and Drug Administration,
Department of Health, USA). CardIQ Xpress approved by FDA under k number K041267.
• Underwriters' Laboratories, Inc. (UL), an independent testing laboratory.
• Canadian Standards Association (CSA).
• International Electrotechnical Commission (IEC), international standards organization, when applicable.
• USA/HHS:
United States Federal law restricts this product to use by or on the order of a physician.
CAUTION
• General Electric Medical Systems is ISO 9001 and EN 13485 certified.

• The original document is written in English.
CardIQ Xpress 5180542-100 Rev. 3 i

CardIQ Xpress 5180542-100 Rev .3 ii
TABLE OF CONTENTS
REGULATORY REQUIREMENTS .............................................................. I
TABLE OF CONTENTS............................................................................ III
CHAPTER 1 - INTRODUCTION .................................................................. 1
1 Introduction ........................................................................................ 2
2 System Requirements ........................................................................ 2
3 CardIQ Xpress options ....................................................................... 3
4 Using CardIQ Xpress .......................................................................... 6
5 Functions ............................................................................................ 7
Overview ........................................................................................................................................... 7
Vessel Analysis protocols ................................................................................................................. 9
Ejection Fraction ............................................................................................................................. 12
Volume Rendering .......................................................................................................................... 13
Batch ............................................................................................................................................... 14
Using CardIQ Xpress with Multi-phase Datasets ............................................................................ 15
CardIQ Xpress 5180542-100 Rev. 3 iii

Other Functions .............................................................................................................................. 16
6 How to use this Document ................................................................ 17

7 Conventions for this Manual ............................................................ 19
CHAPTER 2 - SAFETY ............................................................................. 21
Intended Use .................................................................................................................................. 22
Patient Confidentiality ..................................................................................................................... 22
Volume Viewer 3 ............................................................................................................................. 23
Image Requirements ...................................................................................................................... 23
Vessel Analysis ............................................................................................................................... 23
Views Used with Vessel Analysis ................................................................................................... 25
Tree VR and Angiographic View Images ........................................................................................ 25
Volume Rendering Images ............................................................................................................. 25
Quantification Reload ..................................................................................................................... 26
Phase Registration ......................................................................................................................... 27
Measurements ................................................................................................................................ 28
Annotations on Filmed or Saved Images ........................................................................................ 29
Segmentation .................................................................................................................................. 30
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Segmentation [Pro] ......................................................................................................................... 30
Cardiac Filters ................................................................................................................................. 31
Color Identification [Pro] ................................................................................................................. 31
SOFTWARE SAFETY-RELATED MESSAGES ............................................................................. 32
CHAPTER 3 - SUMMARY OF FUNCTIONS .............................................. 33

1 Multi-Phase Datasets ........................................................................ 34
2 Vessel Analysis ................................................................................. 35
3 Ejection Fraction [Pro] ...................................................................... 45
4 Volume Rendering ............................................................................ 47
5 Reformat ............................................................................................ 49
6 Batch ................................................................................................. 50
7 Phase Registration ........................................................................... 52
CHAPTER 4 - STARTING CARDIQ XPRESS AND LOADING THE EXAM 53
1 Image Requirements ........................................................................ 54
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2 Start CardIQ Xpress .......................................................................... 56
3 Select Protocol .................................................................................. 57
CHAPTER 5 - VESSEL ANALYSIS - PROCEDURES ............................... 61
1 Overview ........................................................................................... 62
2 Using the Protocols .......................................................................... 65
Preliminary Step - Automatic Selection ........................................................................................... 67
Overview [Angiographic View] ................................................................................................... 67
Overview [Tree VR] ................................................................................................................... 68
Overview [Left Coronary, Right Coronary, Coronary] ................................................................ 69
Step 1 - Identification of the Vessels to Analyze ............................................................................. 70
Step 2 - Verification/Edition of the Results ..................................................................................... 71
Verify Vessel Identification ......................................................................................................... 73
Verify Centerlines and Cross Sections ...................................................................................... 75
Edit, Register and Save ............................................................................................................. 78
Explore and Analyze .................................................................................................................. 83
Step 3 - Selection of Section of Interest (does not appear for all protocols) ................................... 84
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Overview .................................................................................................................................... 84
Measurements ........................................................................................................................... 85
Step 4 - Add A New Measurement ................................................................................................. 88
Overview .................................................................................................................................... 88
Measurements ........................................................................................................................... 89
Procedure .................................................................................................................................. 89
Step 5 - Reports .............................................................................................................................. 91
CHAPTER 6 - VESSEL ANALYSIS - FEATURES ..................................... 95

1 DYNAMIC AVA .................................................................................. 95
2 Adding/Removing branches ............................................................ 99
3 QUICK AVA ...................................................................................... 101
4 Stenosis and Aneurysm Tools ....................................................... 104
5 Color Identification ......................................................................... 108
6 Automatic Measurement points ..................................................... 112
7 Minimum/Maximum Length Measurement .................................... 114
CardIQ Xpress 5180542-100 Rev. 3 vii
CHAPTER 7 - VESSEL ANALYSIS - VIEWS, CONTROLS,
MEASUREMENTS ................................................................................. 115
1 Overview ......................................................................................... 116
2 Lumen View .....................................................................................................117
Overview ....................................................................................................................................... 118
Geometry ...................................................................................................................................... 118
Measurements .............................................................................................................................. 119
Graph ............................................................................................................................................ 119
Cursor Line ................................................................................................................................... 120
Active Annotations ........................................................................................................................ 120
On-View Menu .............................................................................................................................. 121
3 Curved View .................................................................................... 122

Overview ....................................................................................................................................... 123
Geometry ...................................................................................................................................... 123
Orientation .................................................................................................................................... 125
Measurements .............................................................................................................................. 127
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On-View Menu .............................................................................................................................. 128
4 Oblique View ................................................................................... 129

Overview ....................................................................................................................................... 130
Geometry ...................................................................................................................................... 131
Measurements .............................................................................................................................. 131
On-View Menu .............................................................................................................................. 133
5 Other Views ..................................................................................... 134

3D View ........................................................................................................................................ 136
6 Density Measurement ..................................................................... 138

7 Measurement Accuracy ................................................................. 139
Summary ...................................................................................................................................... 139
Voxel Dimensions ......................................................................................................................... 140
Geometrical Accuracy ................................................................................................................... 141
Acquisition Accuracy ..................................................................................................................... 142
Multi-Phase Measurement Accuracy ............................................................................................ 143
CardIQ Xpress 5180542-100 Rev. 3 ix

Quantification Algorithm ................................................................................................................ 143
Partial Volume Effects .................................................................................................................. 144
Display Settings and Display Resolution ...................................................................................... 145
CHAPTER 8 - VESSEL ANALYSIS - CONFIGURING PROTOCOLS ..... 147

1 Pre-defined Protocols .................................................................... 148
2 Custom Protocols ........................................................................... 149
Overview ....................................................................................................................................... 149
Configuring Tracking (Vessel Definition) Points ............................................................................ 150
Configuring Reference Points and Measurements ....................................................................... 155
Overview .................................................................................................................................. 155
Configuring Reference Points .................................................................................................. 156
Configuring Measurements ...................................................................................................... 161
Saving the Protocol ....................................................................................................................... 166
Deleting a Protocol ....................................................................................................................... 167
CHAPTER 9 - EJECTION FRACTION [PRO] .......................................... 169

1 Ejection Fraction Protocol ............................................................. 170
CardIQ Xpress 5180542-100 Rev. 3 x
CHAPTER 10 - IMAGE REVIEW ............................................................. 175
1 Volume Rendering Protocols ......................................................... 176
"Heart" Protocols ........................................................................................................................... 177
Cardiac Transparency protocol ..................................................................................................... 178
Other Protocols ............................................................................................................................. 180
Volume Rendering ........................................................................................................................ 180
Presets .......................................................................................................................................... 181
Controls ........................................................................................................................................ 182
- VR Presets Panel ................................................................................................................ 183
- VR Opacity Panel ................................................................................................................ 184
- VR Colors Panel .................................................................................................................. 186
- Other Functions ................................................................................................................... 189
2 Cardiac Reformat Batch Protocol .................................................. 190

Adjusting Long and Short Axis views ............................................................................................ 191
Using Batch buttons ...................................................................................................................... 192
Using the Double Oblique Protocol ............................................................................................... 198
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3 Phase Registration ......................................................................... 200
Overview ....................................................................................................................................... 200
Step 1 - Prepare Registration ....................................................................................................... 201
Step 2 - Phase Registration .......................................................................................................... 202
Step 3 - Saving Results ................................................................................................................ 205
4 Cardiac Specific Review Functions ............................................... 206

Layout Presets .............................................................................................................................. 206
3DPOS Active Annotation ............................................................................................................. 208
Cardiac Annotation ....................................................................................................................... 208
Cardiac Filters ............................................................................................................................... 209
Color Identification [Pro only] ........................................................................................................ 210
Color ROI ...................................................................................................................................... 211
Color Ramp ................................................................................................................................... 211
Other Volume Viewer 3 Functions ................................................................................................ 213
CHAPTER 11 - MOVIE CREATION ......................................................... 215

1 Batch Loop ...................................................................................... 216
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CHAPTER 12 - OUTPUT ......................................................................... 217
1 Saving and Filming Images ............................................................ 218
2 Filling in a report [Pro] .................................................................... 219
3 Annotations .................................................................................... 223
4 Save State ........................................................................................ 225
APPENDIX 1 - LANDMARK EXAMPLES .............................................. 227
1 Left Coronary Arteries .................................................................... 228
2 Right Coronary Arteries ................................................................. 235
GLOSSARY ............................................................................................ 241
REVISION HISTORY .............................................................................. 247
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CHAPTER 1 - INTRODUCTION
CardIQ Xpress is an optional software extension of the Volume Viewer 3 application for
Advantage Workstation (AW) systems.
It provides you with a number of functions for the analysis and review of CT cardiac exams, in
the form of a set of "CardIQ Xpress" protocols available within the AW Volume Viewer 3
application.
The protocols can be used with both single-phase and multi-phase datasets.
CardIQ Xpress comprises four main categories of protocols:
-Vessel Analysis protocols for analysis of the coronary vessels,
-Ejection Fraction protocol for computation of the left ventricle ejection fraction,
-Volume Rendering protocols for global review of the cardiac anatomy,
-Batch protocol to prescribe batch series of short and long axis views of the heart.
This manual describes the CardIQ Xpress options. For information concerning the Volume
Viewer 3 application, refer to the Volume Viewer 3 user documentation.
This chapter contains the system requirements, an overview of the functions available in CardIQ
Xpress, a brief summary of the contents of the manual, and a list of typographical conventions
used.
CardIQ Xpress 5180542-100 Rev. 3 1

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1 INTRODUCTION
CardIQ Xpress is an optional software extension of the AW Volume Viewer 3 application on Advantage
Workstation (AW) systems, in the form of new CardIQ Xpress protocols available within the Volume Viewer 3
application.
This manual is a supplement to the Volume Viewer 3 user guide and describes only the use of the CardIQ Xpress
option.
For all information concerning the use and functions of the Volume Viewer 3 application itself, refer to the Volume
Viewer 3 user documentation.
2 SYSTEM REQUIREMENTS
The CardIQ Xpress option can be installed on any AW workstation that already has the AW Basic Display and
AW Volume Viewer 3 software installed.
Note: The Volume Viewer 3 application requires an AW workstation equipped with at least 256 Megabytes of
memory (RAM), and with AW Basic Display software version AW4.4 or later.
Note: For loading multi-phase datasets a minimum of 1 Gigabyte of memory is highly recommended.

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3 CARDIQ XPRESS OPTIONS

CardIQ Xpress has two options: CardIQ Xpress Plus or CardIQ Xpress Pro. Each option includes specific features/
protocols as shown in the tables below. Always check these tables to verify their applicability.
CardIQ Xpress Plus upgrades CardIQ 2 and allows the review of cardiac images and vessel analysis. CardIQ
Xpress Pro offers extra protocols and improved tools to speed up image review and analysis.
The intended use in Chapter 2 covers the whole range of clinical features available in CardIQ Xpress Pro. Please
note that some of these features are not available in CardIQ Xpress Plus.

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CardIQ CardIQ
CardIQ Xpress protocols Xpress Xpress
Plus Pro
Reformat X X
Heart X X
Heart Graft X X
Phase Registration X X
Cardiac X X
Angiographic View X X
Coronary X X
Left Coronary X X
Right Coronary X X
TreeVR X X
Cardiac Reformat X X
Cardiac Transparency X
Ejection Fraction X
Table 1 - Protocols applicability

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CardIQ CardIQ
CardIQ Xpress features Xpress Xpress
Plus Pro
3DPOS Active Annotation X X
Cardiac filters X X
Oblique Review X X
Phase Drop X X
Review Steps X X
Save State X X
AVA Layouts X X
Layout Customization X X
Color Identification X
Reporting X
Table 2 - Features applicability

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4 USING CARDIQ XPRESS

This manual assumes that you are already know how to use the AW workstation, and the AW Basic Display and
AW Volume Viewer 3 software.
If this is not yet the case, you should first consult the relevant user documentation to familiarize yourself fully with
the operation of the workstation, the use of the various controls, menus and windows, and the procedures used
for image selection and display, before starting to use CardIQ Xpress.
This applies in particular to:
• Selecting image series in the AW PatientList for processing with CardIQ Xpress,
• Starting CardIQ Xpress or the Volume Viewer 3 application from the AW Patient List,
• Using the features other than CardIQ Xpress available in the Volume Viewer 3 application.

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5 FUNCTIONS
Note: For protocol applicability, check the table in the CardIQ Xpress options section of Chapter 1.
Overview
CardIQ Xpress consists of a set of protocols for the analysis and review of CT cardiac exams, for both single-
phase and multi-phase datasets.
The Vessel Analysis protocols (Left Coronary, Right Coronary, Coronary, Tree VR and Angiographic View)
allow you to perform a detailed review and quantitative analysis of the coronary vessels. Each protocol contains
the successive steps required to perform an analysis: vessel selection, vessel identification and quantification,
selection of sections of interest (measurement points), adding quick measurements, report review, and filming or
saving of the report. These protocols extract the aorta and coronary vessel tree structure from the surrounding
tissue, allowing them to be viewed in isolation.
Pre-defined protocols are supplied for the analysis of the left and right coronary artery. Use these as supplied or
modify them to create new custom protocols to meet specific requirements.
The Ejection Fraction protocol has been developed to provide a simplified workflow for a quick computation of
the left ventricle ejection fraction.
The Volume Rendering protocols (presets) (Cardiac) allow you to obtain a global view of the cardiac region and
to examine overall spatial relationships. Heart, Heart Graft and Cardiac Transparency protocols display VR
views of the heart without surrounding anatomy.

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The basic Reformat protocol is the same as that in Volume Viewer 3. The Cardiac Reformat Batch protocol
allows you:
• to display the volume along the Short Axis, the Long Axis and the Vertical Long axis, and to review the volume,
• to prescribe batch series of reformatted images aligned with the short and long axes of the heart, then save
and/or film these as required.

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Vessel Analysis protocols

Left Coronary, Right Coronary and Coronary
Left Coronary, Right Coronary and Coronary protocols have been developed for rapid, consistent and
repeatable quantitative analysis of coronary vessels in cardiac CT data sets.
They consist of comprehensive instructions, combined with the tools needed to perform the analysis, contained in
protocol panels in the same manner as other protocols in Volume Viewer 3.
This minimizes the need to memorize the procedures, or to have to refer continuously to the user documentation.
The pre-defined vessel analysis protocols in CardIQ Xpress can either be used directly, or you can modify and
edit them to adapt them to your own specific requirements, then save such customized protocols under a new
name.
CardIQ Xpress is supplied with a set of pre-defined vessel analysis protocols. Use these protocols directly, or
modify and edit them to adapt them to your own specific requirements, then save such customized protocols under
a new name.
Tree VR and Angiographic View

Tree VR and Angiographic View protocols combine left and right vessel analysis and allow you to review the
aorta and the coronary vessel tree structure separate from the surrounding anatomy.
These protocols extract and display the aorta, the vessel tree and the cardiac muscles (Angiographic View only)
by removing surrounding tissue (bone, lungs, ...) from the 3D volume, allowing them to be viewed in isolation.
Tree VR and Angiographic View can be used for plotting points in vessel analysis protocols.
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Functions
• The user identifies the branches of the vessel to be analyzed by marking points inside the vessel (start of
section, end of each branch, and intermediate points if required).
• The software then automatically detects the vessel centerline for each branch and computes cross section area
and mean diameter at each point.
• Using the "Lumen" view together with curved and oblique reformatted views (see next page) the user can now
interactively explore the anatomical context, and if necessary edit the results from the automatic centerline and
cross section computation.
Computed vessel dimensions (diameter, cross section area) are displayed as a curve in the Lumen view, and
the corresponding numerical values can be read at any given point by moving a cursor line.
All other Volume Viewer 3 view types are also available during vessel analysis.
• To produce a report, the user marks significant points on the views, such as start and end of an aneurysm or
stenosis, position of supplied/supplying vessels, bifurcations, etc.
The report will contain both the measurement values concerning these points and a full set of correlated
images (curved and oblique views). Automatic measurements computed by the software and manual
measurements performed by the user can be included.
Once the user has marked the measurement points, the report is generated automatically by the software.
Reports can be filmed and/or saved on the workstation.

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By performing the "mechanical" tasks of vessel analysis (centerline detection, quantification, report generation)
automatically, CardIQ Vessel Analysis allows you to:
- Analyze cardiac exams rapidly and consistently,
- Improve the repeatability of the analysis, in particular between pre and post-surgical exams, but also
between different users,
- Produce reports faster, and in a standardized format and style that will help the referring physician to
interpret and use the measurements and images in a consistent manner.
Views
CardIQ Vessel Analysis uses three specific view types:
- The "Lumen" view shows the complete length of the selected vessel, "unfolded" along the centerline,
- The oblique cross section view (X-section) shows a true cross section of the vessel (perpendicular to the
centerline) at any given point,
- The oblique longitudinal section view (L-section) shows a longitudinal section of the vessel (parallel to the
centerline) at any given point.
CardIQ Vessel Analysis also generates a curved reformatted view that uses the centerline as the reference trace.
Oblique X-section and L-section views can be positioned interactively at any point along the centerline using the
3D cursor. The Lumen, oblique L-section and curved views can all be rotated interactively. A "best" oblique
L-section can also be displayed that is rotated automatically to show as much of the vessel as possible (plane of
maximum curvature).
These functions allow you to rapidly and completely explore the anatomical context (lesions, calcifications,
branches, nearby anatomy).

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Ejection Fraction
The Ejection Fraction protocol has been developped for rapid, consistent and repeatable computation of left
ventricle ejection fraction.
The Ejection Fraction protocol workflow is structured as follows:
• The user checks the consistency of automatic cardiac orientations and ajusts them if necessary,
• The user scrolls through the phases to select end systolic and end diastolic phases,
• The user places the cursor on the mitral valve using the 4-chamber long axis view for reference, for both
phases,
• The software then automatically extracts the left ventricle and removes papillary muscles for both phases. The
user has the ability to adjust and edit the left ventricle segmentation on the 3D view,
• The software then automatically computes heart functional parameters such as ejection fraction, stroke volume
and volumes for both phases.

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Volume Rendering
CardIQ Xpress is supplied with a set of optimized protocols for cardiac image review (Cardiac, Heart, Heart Graft
and Cardiac Transparency).
Use these to obtain a global view of the cardiac region, to examine the overall spatial relations and those parts of
the vasculature located on the outside of the region.
Volume rendering (VR) is a technique used to display 3D objects by allocating different levels of "opacity" to
different voxel values. Additional information can be shown by using color shading.
The pre-defined presets supplied with CardIQ Xpress have been optimized to show the large blood volumes and
vascular structure as distinct from the surrounding features. You can modify the settings, e.g., to accentuate
different features, then save the settings as a new custom preset.
CardIQ Volume Rendering protocols with names beginning with "Heart" automatically segment the 3D volume to
remove surrounding features (bone, lungs) in order to display only the cardiac region
Cardiac Transparency protocol allows you to display a 3D segmented view of the heart cavities and bones.
Transparency of each structure can be adjusted separately.

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Batch
CardIQ Xpress is supplied with Cardiac Reformat: a Batch protocol allowing you to view, save and film batch series
of reformatted images aligned with the short and long axes of the heart.
These batch images can be used as input for the Function package.
The Cardiac Reformat protocol combines the prescription of batch series of short axis views, four-chamber long
axis views and two-chamber long axis views in the same protocol.
The Cardiac Reformat protocol replaces former short/long axis batch protocol capabilities.

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Using CardIQ Xpress with Multi-phase Datasets

The CardIQ Xpress protocols can be used both with single-phase and multi-phase series (with the exception of
the Phase Registration protocol which is specific to multi-phase series and of the Cardiac Transparency protocol
which is specific to single-phase series).
The user selects the series to be processed in the Patient List, then selects the CardIQ Xpress protocol to be used
in the Cardiac protocol selection panel. If the selected series is a multi-phase series, a separate panel allows you
to select the phases to be loaded.
With a multi-phase series, any action taken by the user within a specific phase can be automatically applied to all
other phases, by selecting sync mode in the {review controller} (default mode). The protocols allow the user
to work within a specific phase and then retrieve the same state for another phase by simply paging through the
phases with the Phase active annotation or with the vertical slider of the {review controller} in Card. mode.
To apply a given action to only a single phase while multiple phases have been loaded, the user can switch off
sync mode, e.g., to individually “clean up” the 3D volumes created with a VR Heart protocol by means of the
Scalpel tool, prior to creating a movie loop (beating heart animation).
For faster computation and diagnosis, the user is enabled to reduce the number of phases anytime during the
study. This “phase drop” procedure is described below:
• Click the active phase annotation and click Select Phases in the drop down menu: the phase selection panel
is displayed showing all the currently loaded phases,
• Check the boxes of the phases to keep,
• Click (Keep selected phases only).

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Note: Unchecked phases cannot be retrieved nor reloaded. Exit out of the application and return to the main
browser in order to reload phases.
Other Functions
Certain separate applications that can be used for cardiac image analysis (such as SmartScore and CardIQ
Function) can be invoked directly from the Cardiac category protocol panel.
For the use of such applications, refer to their user documentation.
If the CardEP option is also installed on the workstation, a control in the Cardiac category protocol panel allows
you to switch directly between the lists of CardIQ Xpress and CardEP protocols. You will note that some of the
protocols are common to both options.
Refer to the CardEP user documentation for information on the CardEP functions.

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6 HOW TO USE THIS DOCUMENT

• For an overview of the features and functions of the CardIQ Xpress software, refer to this chapter.
• To review the safety information that you should be familiar with before using CardIQ Xpress, read Chapter 2
- Safety.
• For a summary and quick reference guide of the successive operations to be performed when using CardIQ
Vessel Analysis protocols, and of the functions of the Volume Rendering and Batch image review protocols,
refer to Chapter 3 - Summary of Functions.
• To start CardIQ Xpress and load an exam, see Chapter 4 - Starting CardIQ Xpress and Loading the Exam.
• To familiarize yourself with the procedures (protocol steps) used to process the exam with a CardIQ Vessel
Analysis protocol, refer to Chapter 5 - Vessel Analysis - Procedures.
• For a description of the views and controls used with CardIQ Vessel Analysis and for the information required
to assess measurement accuracy, consult Chapter 7 - Vessel Analysis - Views, Controls, Measurements.
• To modify existing CardIQ Vessel Analysis protocols and save them as new custom protocols, refer to Chapter
8 - Vessel Analysis - Configuring Protocols.
• To familiarize yourself with the CardIQ Ejection Fraction protocol, see Chapter 6 - Ejection Fraction [Pro].
• To familiarize yourself with the Volume Rendering and Batch protocols and other available image review
functions, see Chapter 10 - Image Review.
• To create Movies and save them, refer to Chapter 11 - Movie Creation.
• For notes concerning the saving and filming of the results of CardIQ vessel analysis and image review, refer
to Chapter 12 - Output.
• For examples of landmark points that can be used for vessel analysis, see Appendix 1 - Landmark Examples.

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• For a list of the terms in this manual that are specific to the application, refer to the Glossary at the back of the
manual.

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7 CONVENTIONS FOR THIS MANUAL

Throughout the text in this manual, certain type styles and symbols are used to differentiate between one tool or
graphic and another:
• Applicability appears in bold face italics, within brackets: [CardIQ Xpress Plus, Pro]
• Menu and control panel titles appear in bold face: Application menu.
• Menu options appear in bold face, within square brackets: [Exit].
• Graphical buttons appear in bold face, within parentheses: (View).
• On-screen tools appear in bold face, within braces: {scroll bar}.
• On-screen prompts and messages appear in italics: Login: .
• User typed-in responses appear in bold face italics: sdc.
• Keys on the workstation keyboard appear within angle brackets: <Enter>.
• A key combination such as <Ctrl-T> indicates holding down the <Ctrl> key, pressing the <T> key, then
releasing the <Ctrl> key.
• Mouse buttons are underlined: left.
Whenever this manual refers to "clicking", "selecting", "pressing a button", etc. with the mouse, this always means
using the left mouse button, unless the middle or right mouse button is specifically mentioned.

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Safety notice legends:

THIS INDICATES A POTENTIALLY HAZARDOUS SITUATION WHICH, IF NOT AVOIDED,
WARNING
COULD RESULT IN DEATH OR SERIOUS INJURY.
This indicates a potentially hazardous situation which, if not avoided, may result in minor
CAUTION
or moderate injury.
This indicates a non-hazardous situation which, if not avoided, could result in equipment
NOTICE damage, lost time, or reduced image quality.

CHAPTER 2 - SAFETY
2
To assure an efficient and safe use of CardIQ Xpress, it is essential to read this chapter before
attempting to use the package.
This chapter is extremely important. It contains safety information that you must thoroughly
understand before you begin to use the software.
The primary users of CardIQ Xpress software application shall be a CT, MR, nuclear medicine, or
radiology technologist, radiologist, cardiologist, or physician qualified with advanced applications
training for software competencies or other personnel that the owner feels is properly trained for
this software use (radiology assistant, physician assistant, etc...).
To avoid usability error, the user MUST have a good knowledge and understanding of both the
Advantage Workstation and primary operating function of this software application. This will be
accomplished through applications training and through the correct knowledge and application of
User Guide content. Please contact your GE representative to order and follow this mandatory
training. A qualified individual is determined by the site. The site is the owner of the program and
can be located within either hospital, clinic, or private office setting (fixed or mobile) or wherever
an AW Workstation, either a fixed or remote, is located.
Make certain that the correct version of your operator manuals are readily available at all times.
Make a point to review the procedures and safety precautions periodically.
Additional safety concerns are addressed in the Advantage Workstation Basic Display and
Volume Viewer 3 documentation.

Intended Use
CardIQ Xpress is a CT image analysis software package, which allows the visualization of 2D and 3D medical
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image data of the heart derived from DICOM 3.0 compliant CT scans for the purpose of cardiovascular disease
assessment. It provides functionally for 2D/3D rendering, assessment of calcified and non-calcified plaque to
determine the densities of the plaque within a coronary artery, ventricular function of the heart, and measurement
tools to detect coronary artery stenosis. This product can be used to help a trained physician to process, render,
review, archive, print and visualize cardiac anatomy and coronary vessels.
This tool provides the physician with additional information, meant to complement
CAUTION diagnosis based on classical techniques.
Patient Confidentiality
The equipment on which the CardIQ Xpress application runs includes one or more hard disk
CAUTION drives which may hold medical data related to patients. Such equipment may in some
countries be subject to regulations concerning the processing of personal data and the free
circulation of such data.
It is strongly recommended that access to patient files be protected from all persons not in
medical attendance.

Volume Viewer 3
CardIQ Xpress is a software extension of the Volume Viewer 3 application and uses several 2
CAUTION of the features of this application. When using CardIQ Xpress, you should be fully familiar
with these features and the relevant safety information from the Volume Viewer 3 user
documentation.
Image Requirements
It remains the responsibility of the physician to determine whether the inter-slice distance
CAUTION of a given exam is acceptable for use with CardIQ Xpress.
Always bear in mind that, within an exam, details with dimensions in the order of or less
than the inter-slice distance cannot be identified with an acceptable degree of reliability.
Vessel Analysis
Before using an image set for vessel analysis, the user should check for the presence of
CAUTION heart beat motion and other artifacts on axial and coronal images.
It is the user's responsibility to insure that sufficiently accurate acquisition parameters are
used with respect to the dimensions of the features to be analyzed.
Insufficient acquisition resolution (temporal, dimensional and contrast) may result in
pathologies or other anatomical features not being visible on the images. It may also result
in degraded measurement results and the appearance of artifacts.
The automatic vessel tracking algorithm (vessel identification) relies on the user correctly
CAUTION marking the start and end points of the vessel branches to be tracked.

Incorrectly marking a "start of section" point inside the aorta rather than inside the coronary
ostium (origin) and/or marking an end point at a location that is not a part of the coronary
vessel structure to be analyzed may result in the software identifying a part of the cardiac 2
vascular structure completely different from the one intended. It is the responsibility of the
user to verify that all vessel branches to be analyzed have been identified correctly by the
software. This verification is more reliable when done on a MIP view.
In difficult situations, such as a vessel with a complex trajectory, or vessels touching each
CAUTION other in the images, the automatic vessel tracking algorithm may not always follow the
correct trajectory.
The user should always examine the computed trajectory before moving on to the next step
in the protocol, and if necessary correct the result either by modifying the centerline trace
or by correcting the tracking points and/or adding intermediate points, then repeating the
centerline detection process.
Correct vessel quantification is critically dependent on factors such as acquisition image

CAUTION quality and voxel size (image resolution and inter-slice distance), and anomalies may occur
because of limitations in the available data.
It is the responsibility of the user to verify the result of the vessel identification and
quantification process before using the data for analysis.
Make sure to deposit the initial point close to the aorta center for dual branch protocols, and
CAUTION close to the ostium for single branch protrocols.
Always check the tracking result on a 3D MIP view.

Views Used with Vessel Analysis
In the "Lumen" view, the geometrical transformations necessary to "unfold" the vessel, or, 2
CAUTION in other words, to transform the three-dimensional centerline into a straight line, result in a
degree of geometrical distortion of the anatomical features in this view, so that the view
does not represent the real orientation or trajectory of the vessel.
For these reasons the Lumen view should be used for orientation purposes only, NOT for
diagnostics.
Tree VR and Angiographic View Images

Because of the limitations in the available data and the different types of image processing
CAUTION used, the Tree VR and Angiographic View images may not clearly show all features of the
vascular anatomy (this applies in particular to small and low-contrast features).
The Tree VR and Angiographic View images should always be used together with the
original acquisition images.
Volume Rendering Images

On views displayed in volume rendering mode, the visibility of anatomical features depends
CAUTION on settings of curve type (threshold mode), opacity thresholds and maximum opacity.
Essential anatomy or pathologies may not be visible for a given setting of these parameters.
Views that use volume rendering should always be correlated with the original acquisition
images.

Volume Rendering protocols with names beginning with "Heart" use an automatic
CAUTION segmentation feature to remove surrounding tissue (bone, lungs) and display only the
cardiac region. 2
The user should cross-check on the original acquisition images that no essential anatomy
or pathologies have been removed from the Volume Rendering images by this process.
Quantification Reload
Reloading a saved tracking result shall restore the tracking centerline in a similar state as
CAUTION when it was saved. The software will then compute the quantification automatically starting
from the centerline.

Phase Registration
When performing a Manual registration, the result of the registration can only be visualized on 2
CAUTION a small part of the volume (the axial, oblique and coronal views for the current location).
Due to several factors, such as variation in heart movements or the fact that some cardiac
regions may be at rest at different phase locations, this operation can result in new
misregistration artifacts in other parts of the volume.
Therefore, when using this mode, carefully study the entire volume in all rotations, before
saving, networking or filming any images created using phase registration, so as to check that
the registration has not degraded image quality.
When performing a registration (in particular, in the Around Cursor mode, or in a Vessel
CAUTION Analysis protocol), the software looks only at the misregistration in a specific region.

Measurements
The software calculates and displays measurements with a resolution of one decimal place
2
CAUTION (such as 0.1 mm, 0.1 degree, etc.).
You should be aware that the real measurement accuracy is generally considerably less for
a number of different reasons.
To assess the accuracy of the measurements performed with CardIQ Xpress, you should be
fully familiar with the section "Measurement Accuracy" in the chapter "Measurements" of
the Volume Viewer 3 User Guide, and with the information in Chapter 7 - Vessel Analysis -
Views, Controls, Measurements, section "Measurement Accuracy", page 139 onwards.
Distance, angle and area measurements are valid only if all segments defining the
CAUTION measurement are longer than the inter-slice distance.
The geometrical accuracies of measurements performed with CardIQ Vessel Analysis, when
CAUTION related to vessel measurements, are valid only if the vessel diameter is larger than 2mm.
It is not recommended to perform any measurements on a 3D volume rendered model. All

CAUTION measurements should be done from a 2D image.

Annotations on Filmed or Saved Images
While working on an exam, you can turn off the system annotations and user annotations
2
CAUTION on the screen (see the Volume Viewer 3 user documentation). If you have done so they will
not be present on the filmed or saved images either.
Images without annotation may be suitable for teaching purposes, but diagnosis should not
be performed with such images.
While working on an exam, you can hide the patient name on the views for increased
CAUTION confidentiality. If you have done so, make sure to show the patient name again on the views
BEFORE filming or saving images for diagnostic purposes.
When filming or saving images for diagnostic purposes, always make sure the patient name
is displayed on all views.

Segmentation
After segmentation, perform a visual check of the grafts and manually add missing grafts 2
CAUTION using Autoselect tool (Add/Remove vessels).
After segmentation, perform a visual check of the coronaries and manually add missing
CAUTION coronaries using Autoselect tool (Add/Remove vessels).
Segmentation [Pro]
After Left and Right Ventricle segmentation, check the accuracy of the contours of the
CAUTION segmented ventricles for ES and ED phases by looking on reformatted views.
Refine the segmentation if needed by using Autoselect tool (Add/Remove structures).

Cardiac Filters
2
CAUTION Check the displayed annotations to know if the volume is the original one or the filtered one.
Color Identification [Pro]

The user shall check and adjust the limits of the color ramp segments to be consistent with
CAUTION the anatomical tissue intensity ranges.

SOFTWARE SAFETY-RELATED MESSAGES
Messages giving information and warnings relating to the current system status are displayed on the Advantage 2
Workstation screens.
Some of these messages may be related to safety issues. For example, a message may warn that a screen or
printed image will be enlarged or reduced, and this must be taken into consideration when making a diagnosis. It
is important that users take note of and act on the information given in these messages.
The table below shows safety–related messages which may be displayed. In manuals intended for use in
countries in which the on–screen language is different from the local language, the table shows the displayed
messages and gives a translation in the local language. In manuals intended for use in countries in which the on–
screen language is available in the local language, the table is not applicable.

CHAPTER 3 - SUMMARY OF FUNCTIONS
CardIQ Xpress comprises four main categories of protocols: Vessel Analysis, Ejection Fraction,
Volume Rendering and Batch.
3
The purpose of this chapter is to serve as an introduction to the CardIQ Xpress features, and as a
quick reference guide.
The Vessel Analysis and Ejection Fraction protocols (for both single-phase and multi-phase
datasets) consist of a number of steps. The panels associated with each step contain both the
instructions on how to perform each step and the necessary controls (buttons, menus, etc.).
Section 2 VESSEL ANALYSIS of this chapter summarizes the sequence of operations used with
CardIQ Vessel Analysis. For a full description of the Vessel Analysis procedures, refer to Chapter 5.
The associated views, controls and measurement accuracy are described in Chapter 6. The
customizing of an existing Vessel Analysis protocol is described in Chapter 7.
The Volume Rendering protocols are started from the "Cardiac" protocol panel and need little or no
further user action.
The Cardiac Reformat Batch protocol (for both single-phase and multi-phase datasets) combine
setup instructions, semi-automatic batch prescription and batch film/save controls for oblique
reformatted short and long axis batch series within the same protocol. Sections 4 VOLUME
RENDERING and 6 BATCH of this chapter summarize their use and functioning.
For a full description of these protocols, refer to Chapter 10 - Image Review.

1 MULTI-PHASE DATASETS
CardIQ Xpress supports multi-phase cardiac acquisitions i.e., image sets that for each location contain several
images, corresponding to different phases in the cardiac cycle. 3
When you load a multi-phase dataset, you will be able to select/drop phases (see phase drop feature description
in Chapter 1) and to perform Vessel Analysis, Volume Rendering or Batch functions on a given phase. Then you
can switch to another phase to validate the measurement, tracking, or else, in the other phases.
The same protocol is used for single-phase and for multi-phase datasets. By switching sync mode on or off in the
{review controller} the user can select to perform the functions either on all phases, or only on a single phase.

2 VESSEL ANALYSIS
Note: For feature and protocol applicability, check the tables in the CardIQ Xpress options section of
Chapter 1.
3
Selecting and Loading the Exam
To start using CardIQ Vessel Analysis:
• Select the exam, and if necessary the series within the exam, in the AW Patient List.
• Start CardIQ Xpress, either directly from the Patient List or from the Volume Viewer 3 "Cardiac" protocol
category.
• Select the appropriate CardIQ Vessel Analysis protocol.
This can be one of the pre-defined protocols (Left Coronary, Right Coronary, Coronary, Tree VR or
Angiographic View) supplied with the application, or a custom protocol defined by the user.
The Left Coronary and Right Coronary protocols allow to study the coronary arteries with their sub-branches.
The Coronary protocol allows to study the coronary arteries individually.
Tree VR and Angiographic View protocols have been developed to extract and view the aorta, the coronary
vessel tree and the cardiac muscle in CT cardiac exams for both single-phase and multi-phase datasets. In brief,
the protocols extract and display the aorta, the vessel tree or the cardiac muscle by removing surrounding tissue
(bone, lungs, ...) from the 3D volume. They also provide the ability to proceed with tracking of vessels.

Notes: For Tree VR and Angiographic View protocols to function correctly, it is necessary that the coronary
vessels have adequate contrast enhancement. The presence of features such as motion artifacts in the
exam can adversely affect the quality of the images.
Because of the limitations in the available data and the different types of image processing
CAUTION
used, the Tree VR and Angiographic View images may not clearly show all features of the
3
vascular anatomy (this applies in particular to small and low-contrast features).
Tree VR and Angiographic View images should always be used together with the original
acquisition images.
The Vessel Analysis protocols function in the same way on multi-phase datasets as on single-phase datasets.
Perform the extraction on one phase and then validate the result on the other phases, paging through phases with
the vertical slider of the {review controller} or the Phase active annotation. This protocol can be used to create
movie loops (beating vessel animations).
For more details on vessel analysis, see Chapter 4 - Starting CardIQ Xpress and Loading the Exam and Chapter
5 - Vessel Analysis - Procedures for details.

Vessel Selection
After starting the protocol, the software performs a 3D filtering operation to extract the cardiac region.
The result is displayed as a 3D MIP view, together with an axial and coronal view and the Step 1 protocol panel.
The protocol now prompts you to place the points that are necessary to define the branches of the vessel to be
analyzed. 3
• To move through the 3D volume, use the same controls as with Volume Viewer 3: 3D cursor, active annotations
and keyboard arrow keys.
• To place each point, click with the left mouse button.
• The protocol will prompt you for each point in sequence, but when necessary you can return to a point, clear it
and place it again.
• You can skip points that are not required for a particular analysis.
When all points are placed to your satisfaction, switch to Step 2 of the protocol.
You will be prompted to mark the points associated with the vessel branches defined for the specific protocol you
have selected. You can, however, re-configure a protocol by adding, modifying or removing branches and
intermediate points, as required for a particular type of analysis. Such a re-configured protocol can either be
applied to the current session only, or saved and re-used as a new custom protocol.

Editing, Registering and Saving
• In Step 2 of the protocol, select (Accept).
This starts the automatic process of computing the vessel centerline (identification) and vessel cross section
at each point along the centerline (quantification).
• When the process is complete, you will have to confirm on the 3D MIP view that the software has identified all 3
vessel branches correctly.
A misplaced start point or end point of a branch can lead to the software identifying a part of the cardiac
vascular structure entirely different from the one intended.
After this, a curved reformatted view, a "Lumen" view and an oblique view are displayed. The curved view
shows the entire currently selected vessel branch, the "Lumen" view shows the vessel branch "straightened
out", and the oblique view can show either a longitudinal section (L-section) or a cross section (X-section) of
the vessel at the cursor position.
• At this stage, you should verify that the software has tracked all vessel branches correctly, and quantified the
vessel cross section at each location correctly.
Limitations in the data and features such as closely adjacent vessels, may occasionally lead to the software
not following a vessel centerline correctly. Use the available views to check that the displayed centerline for
each branch matches the desired vessel.
The limited resolution and other factors may also lead to cross section quantification errors. These can be
identified on the Lumen graph and on the oblique X-section view as irregularities in the contours that do not
match the vessel outline. Check the successive cross sections by moving the 3D cursor along the centerline.

• Both the centerline and the cross section contours can be edited at this stage if necessary (see Chapter 5 -
Vessel Analysis - Procedures for details).
This can be effective for minor errors. If a wrong branch was identified, repeat Step 1, correcting the tracking
points and/or add intermediate points if required. In the case of significant quantification errors, do not use the
associated automatic measurements for the report, but perform the necessary measurements manually.
3
• If you have edited the centerline or the cross section contours, repeat the computation by again selecting
(Accept) and then (Back) to close the panel before going to the next step.
• To review the vessel traces again on a 3D view, move to Step 3 and select (Advanced Views) > [VOI].
• At this level, if you are dealing with a multi-phase dataset and the Curved view appears to contain some
disruptions, it is possible to perform a phase registration of the exam. Once the registration is over, you can
go back to the quantification, which will then be recalculated on the registered volume (for more information
on registration, refer to Chapter 5, Section 2 USING THE PROTOCOLS, Step 2 and Chapter 10, Section 3
PHASE REGISTRATION).
• You can also, at any time, save the result of a tracking operation (including Editing and Registering operations)
in a 3D object in the Patient List, allowing you to more easily and quickly re-enter this function.

Exploring the Exam
Once you have verified the correct identification of all vessel branches and the cross section quantification, a
range of tools and controls is available to explore the anatomical features and possible pathologies in the vessel:
- You can select each of the vessel branches separately.
- You can move to any location in and around the vessel using the 3D cursor,
3
- You can rotate the curved view to examine different features adjacent to the vessel (the curved view is a
"thin", i.e., one-voxel-thick, curved cross section so that features not located on the centerline will rotate
into and out of view as the view is rotated).
- The Lumen view shows the vessel with the centerline "straightened out", and a graph alongside the view
can show diameter or cross section area as required. You can rotate the Lumen view around the
centerline, and adjust the width of the view to display more or less of the adjacent anatomy.
- By default, the oblique view shows a "best" longitudinal cross section (Best L-Section mode). This view is
located at the position of the cursor and oriented automatically by the software to show as much of the
vessel as possible (plane of maximum curvature).
You can also display a longitudinal section view that is tangent to the vessel at the cursor position and that
can be rotated around the centerline (L-Section mode), or a view that shows the vessel cross section
perpendicular to the centerline at the position of the cursor (X-section mode).
- While using CardIQ Xpress, you can switch any of the views to one of the other types available in Volume
Viewer 3, such as baseline or 3D views.
- A tool is provided to allow you to move the cursor on curved and oblique cross-sections and have real time
display of the density of the tissues at the cursor level.
- You can deposit a color identification or an ROI to display volumetric statistics or to adjust the color ramp.
- You can send findings to the report and add images, measurements, and comments to each finding.

- You can generate a Movie Loop on the Curved and Lumen view or along a vessel branch on the Oblique
view (in Best L-Section, L-Section and X-Section modes).
See Chapter 7 - Vessel Analysis - Views, Controls, Measurements.

Measurements
• In Step 3, mark the locations where measurements are required in the final report.
The protocol prompts you to place measurement points. The automatic measurements computed by the
software (quantification) linked to these points such as diameter and cross section area, and between these
points, such as distance, angle and volume, will be included in the report. 3
See Chapter 5 - Vessel Analysis - Procedures.
• The protocol prompts you for those measurement points and measurements that have been pre-defined in the
protocol. You can, however, configure a protocol by adding, modifying or removing measurement points and
measurements as required for a particular type of pathology. Such a re-configured protocol can either be
applied to the current session only, or saved and re-used as a new custom protocol.
See Chapter 8 - Vessel Analysis - Configuring Protocols.
• To quickly add one or more measurements to be used only in the current session, you can use Step 4 of the
protocol. In this step you can define measurement points and measurements (diameter, area, distance, angle
volume) that will be included in the current report, but cannot be saved in a custom protocol.
You also use this step to include manual measurements in the report, if for any reason the automatic
measurements resulting from the automatic quantification are not satisfactory.
Moreover, you can, if needed, add at this level a new Simple Reference Point, or a new Double Reference
point (one distal and one proximal). In this case, all the measurements computed after the creation of the new
Reference Point(s) will be relative to these new point(s).
See Step 4 - Add A New Measurement (page 88) in Chapter 5 - Vessel Analysis - Procedures.

Reports
• In Step 5 of the protocol you can examine in tabular form all measurement information that will be included in
the report. At this stage you can still return to the earlier steps in the protocol and make changes, add
measurements, etc. as required.
• Once you are satisfied with the report contents, either film (print) the report, or save it as a new series on the 3
image disk of the workstation.
The filmed or saved report consists of two main parts: the tables of measurement results and a set of images
(screen captures) that is linked to the measurements. The number and type of images in the report may differ
depending on the protocol, but generally includes curved and oblique reformatted images for the significant
points in the exam.
• During the analysis you can perform additional screen captures and "queue" the resulting images. These will
then be added automatically at the end of the filmed or saved report.
See Chapter 5 - Vessel Analysis - Procedures and Chapter 12 - Output.
Customizing Protocols
CardIQ Xpress is supplied as a set of pre-defined protocols.
As already mentioned above, you can use these protocols as they are, or use them as a starting point to configure
your own custom protocols, to account for individual differences in patient pathology.
See Chapter 8 - Vessel Analysis - Configuring Protocols.

Multi-phase Datasets
• When you are performing vessel identification (tracking) on a multi-phase dataset, each time you deposit a
point on the current phase, an equivalent point is automatically computed for all the other phases. Page
through the phases to see where the point has been placed.
• Tracking is computed for each phase successively (starting with the current phase). It must be validated for
each phase in the MIP view. 3
• When you are performing a measurement on a multi-phase dataset, each time you deposit a point on the
current phase, an equivalent point is automatically computed for all the other phases. Page through the
phases to see where the points have been placed.
• A measurement report is generated for the current phase only. Switch to another phase to regenerate it.

3 EJECTION FRACTION [PRO]
The Ejection Fraction protocol is a multiphase protocol dedicated to the calculation of the ejection fraction from
the left ventricle volume at end systole and end diastole.
3
Launching the Ejection Fraction protocol automatically launches Cardiac Reformat that displays oblique views
of the heart oriented along the short axis and the long axis.
Note: The orientation of Short Axis, Long Axis and Vertical Long Axis views is locked by default.
Follow the panel instructions:

• Adjust the Short Axis and Long Axis views if necessary (see Cardiac Reformat protocol) and click (Next): the
Sagittal view turns into an Axial view and the ES/ED Phase Selection panel is displayed,
• Click the arrow buttons on the panel to display the different phases on all views,
Note: To display the different phases, you can also right-click the phase annotation or press and hold <ALT>
while hitting <Page Up> or <Page Down> .
Note: By default, the first phase to select is the End Systole phase.
• Once you have selected the End Systole phase, click (Store Phase) to validate. The panel switches
automatically to End Diastole selection mode allowing you to select the End Diastole phase,
• Select the End Diastole phase and click (Store Phase) to validate,

• Click (Next): the Prepare Segmentation panel is displayed,
• For the End Systole phase, place the cursor on the mitral valve using the 4-chamber long axis view for
reference and click (Store Position),
• For the End Diastole phase, place the cursor on the mitral valve using the 4-chamber long axis view for
• Click (Next): the left ventricle is automatically extracted for both the ES and the ED phases according to the
3
cut planes defined above and the Left Ventricle Model Edition panel is displayed. The papillary muscles are
excluded from the subtracted volume.
• Use (Add Structure), (Remove Structure) or (Scalpel) buttons to improve the Left Ventricle segmentation in
case LV contours are not accurate for ES and ED phases,
• Click (Next) to display the results:
• ED volume (EDV),
• ES volume (ESV),
• Stroke volume (SV = EDV - ESV),
• Ejection Fraction (EF = SV/ED).

4 VOLUME RENDERING
Chapter 1. 3
To use the CardIQ Xpress Volume Rendering protocols for a global review of the structures in a CT cardiac exam:
• Select the exam, and if necessary the series within the exam, in the AW PatientList.
• Start CardIQ Xpress, either directly from the Patient List or from the Volume Viewer 3 "Cardiac" protocol
category.
• Select the appropriate Volume Rendering protocol.
This protocol can be one of the pre-defined protocols (Cardiac, Heart, Heart Graft or Cardiac Transparency)
supplied with the application, or a custom protocol defined by the user.
Volume Rendering protocols with names that begin with "Heart" include an automatic segmentation feature that
removes the surrounding features (bone, lungs, descending aorta) before displaying the cardiac region.
User-defined custom protocols that use the same naming convention will also include this feature.
A 3D view using the selected Volume Rendering protocol is displayed. You can now review the exam, and use
the Volume Viewer 3 VR Tools panels to modify the VR settings or select another VR preset, as required.
The VR protocols function in the same way on multi-phase datasets as on single-phase datasets. Apply the
function on one phase and then validate the result on the other phases, paging through phases with the vertical

slider of the {review controller} or the Phase active annotation.This protocol can be used to create movie loops
(beating heart animations).
The Cardiac Transparency protocol allows you to display a 3D segmented view of the heart cavities and bones.
Transparency of each structure can be adjusted separately. Refer to Chapter 9 - Image Review, Section 2 -
Volume Rendering protocols, Cardiac Transparency protocol paragraph for more information.
3

5 REFORMAT
The basic Volume Viewer 3 Reformat protocol can also be accessed directly from the CardIQ Xpress protocol
panel. Refer to the Volume Viewer 3 user documentation for the use of this protocol.
3

6 BATCH
Use the CardIQ Xpress Cardiac Reformat Batch protocols to view, save and film batch series of reformatted
images aligned with the short and long axes of the heart.
Launching the Cardiac Reformat protocol computes automatically cardiac orientations. The volume is displayed 3
along Short Axis, Long Axis and Vertical Long axis.
Note: The orientation of Short Axis, Long Axis and Vertical Long Axis views is locked by default.
The user checks the consistency of these orientations and ajusts them if necessary.
• Click on the Long Axis button. The Sagittal view is selected and the Long Axis view is unlocked,
• Position the cursor on the mitral valve on the Sagittal View,
• Rotate the yellow line on the Sagittal view to adjust the orientation of the Long Axis view,
• Click on the Short Axis button. The Long Axis view is selected and the Short Axis view is unlocked,
• Position the cursor on the mitral valve on the Long Axis view,
• Rotate the yellow line on the Long Axis view to adjust the orientation of the Short Axis view.
• Click on Short Axis button again to deactivate the edit mode and to display batch icons.
The Short Axis batch button is used to prescribe batch series of short axis views only.
The Long Axis batch button is used to prescribe batch series of long axis views only.
The Vertical Long Axis batch button is used to prescribe batch series of vertical long axis views only.

Resulting images can then be used with the CardIQ Function package (activated either from the Protocol Panel
or from within the protocol).
See Chapter 10 - Image Review for a full description.
The protocols use an oblique view and a sagittal view. Full instructions on how to set up each batch are shown in
the protocol panels. The "batch lines" that define the views to be included in each batch are displayed
automatically at each step of the protocols. The Batch Film panel in these protocols, used to review, save and/or 3
film the results, is the same as in Volume Viewer 3.
Defining the Long Axis Plane

• On the sagittal view, align the reference line (that defines the plane of the oblique view containing the long axis)
so that it passes through the mitral valve and the apex of the heart.
Defining Four-Chamber Long Axis Views
• On the sagittal view, align the batch lines parallel to the oblique reference line (long axis plane), to define the
four-chamber long axis views.
• Check and if necessary modify the resulting batch, then save and/or film it as required.
Defining Short Axis Views
• On the oblique view, align the batch lines perpendicular to the long axis, to define the short axis views.
• Check, save and/or film the batch as before.
Defining Two-Chamber Long Axis Views
• On the oblique view, align the batch lines parallel to the long axis, to define the two-chamber long axis views.
• Check, save and/or film the batch as before.

7 PHASE REGISTRATION
The Phase Registration protocol allows you to align a ventricle or a coronary vessel, in order to suppress the
artifacts which often occur in the phases far away from the diastole because of the heart movements. 3
To obtain an improved quality on a given dataset, the software will replace the offset slices by others taken in other
phases of the current dataset.
You first position the Oblique view so as to have a good vision of the artefact you want to correct.
The protocol then allows two types of Registration modes:
• Around Cursor: In this case, the registration is performed automatically by the software around the current
cursor position. It will modify slices located no further then 2 cm from the current cursor position.
• Between Lines: In this case, the registration on the slices comprised between the two lines you have defined.
This registration can be Automatic (done by the software), or Manual, in which case you will be able to
choose in which phase the software will fetch the slices you want to change.
Once you are satisfied with the registration, you can save it in a new 3D object, which will be created in the
workstation Patient List.

CHAPTER 4 - STARTING CARDIQ XPRESS AND LOADING THE EXAM
A CT cardiac exam to be processed with CardIQ Xpress has to meet certain basic requirements.
Select the exam in the AW Patient List, then start CardIQ Xpress either directly from the Patient List or from
within Volume Viewer 3. 4
This chapter describes the image requirements and start-up procedure.

1 IMAGE REQUIREMENTS
CardIQ Xpress accepts CT cardiac image sets such as those acquired with a GE LightSpeed CT scanner or a
GE e-Speed Electron Beam scanner.
A CT cardiac image set to be used with CardIQ Xpress should meet at least the following requirements (these are
the same as those for the basic Volume Viewer 3 application):
- Field of view, matrix size and display center must be the same for all images in the set,
4
- Orientation and gantry tilt should be the same for all images in the set,
- Tilted acquisitions are not supported for right/left decubitus patient orientations,
- There MUST NOT be two images corresponding to the same location in the set, or within the same cardiac
phase in the case of multi-phase datasets,
- The set should include only AXIAL, SAGITTAL, CORONAL or OBLIQUE images. Other types such as screen
saves, etc. are not supported,
Note: When loading a CT image set, the CardIQ Xpress software uses the FIRST selected image in the
Patient List as a basis for using/discarding the other images selected for building the 3D model. For
example, any images having a matrix size or gantry tilt different from that of the first selected image in
the Patient List are discarded.

For use with CardIQ Xpress, the following requirements should also be taken into account:
- For the Vessel Analysis image processing to function correctly, the arterial vasculature in the exam must have
adequate contrast enhancement.
- The presence in the exam of artifacts resulting from temporal resolution deficiencies, patient motion or other
effects may adversely affect the results of the image processing with any of the CardIQ Xpress protocols.
- The inter-slice distance should be suitable for vascular review and analysis. It MUST be less than 10 mm.
Inter-slice distances in the order of 0.625 to 1.25 mm are generally acceptable.
Although CardIQ Xpress will accept and load CT exams with larger inter-slice distances, in practice exams 4
with such inter-slice distances are not suitable for vessel analysis, because of the small diameters of most of
the vessels that are essential for the analysis.
It remains the responsibility of the physician to determine whether the inter-slice distance
CAUTION of a given exam is acceptable for use with CardIQ Xpress.
Always bear in mind that, within an exam, details with dimensions in the order of or less
than the inter-slice distance cannot be identified with an acceptable degree of reliability.
- Anatomical features and pathologies in an exam to be reviewed using the Volume Rendering protocols should
NOT be located in the upper or lower end slices of the exam. The end slices are used by the software to
correctly compute the 3D images without spurious "end slice" effects, but the features in these slices are not
displayed on the 3D views.
An exam to be reviewed using these protocols should contain at least four upper and lower end slices that do
not contain any features that require review.
This requirement does not apply to exams to be analyzed using the CardIQ Vessel Analysis or Reformat
protocols.
2 START CARDIQ XPRESS
To start using CardIQ Xpress:
• Select the exam and series to be analyzed in the AW Patient List (see the AW Basic Display user
documentation for details).
The exam should meet the image requirements listed earlier (see page 54).
You can now start CardIQ Xpress either directly from the AW PatientList or from within Volume Viewer 3. 4
To start CardIQ Xpress from the Patient List:

• Select [CardIQ] in the Patient List Application list.
• If [CardIQ] is not shown in the list, click on [More...] at the bottom of the list and select [CardIQ] in the Software
Manager menu.
To start CardIQ Xpress from within Volume Viewer 3:

• Click on the (Volume Viewer 3) button in the Task Bar.
• The Cardiac protocol panel is automatically displayed, and you can select a protocol in this panel.
If more than one cardiac option is installed (e.g., CardIQ and CardEP), first select (CardIQ) at top right in the
Cardiac panel, then select the protocol.

3 SELECT PROTOCOL
Note: For protocol applicability, check the table in the CardIQ Xpress options section of Chapter 1.
When you start the CardIQ Xpress software, the Protocol Selection panel is displayed allowing you to choose the
protocol you want to use.
The same protocol is used for both single-phase and multi-phase datasets. 4
When you move the mouse cursor onto an icon, a help popup will show the function of the protocol. Click on the
icon to select and start the protocol and load the exam.
The Review Steps window displays a list of protocols allowing you to launch another protocol and to display its
associated protocol panel and layouts without having to go to the Protocol Selection panel. The protocols listed
by default in the Review Steps window are:
• Cardiac Reformat
• Ejection Fraction
• Angiographic View
• Tree VR
• Coronary Vessel Analysis
• Heart Graft
• Cardiac Transparency
Configure the list of protocols displayed and the protocol order at your convenience.

- The Vessel Analysis protocols have been developed for the detailed analysis of the coronary arteries. Left
Coronary, Right Coronary and Coronary protocols allow you to analyze the left and of the right coronary
arteries. See Chapters 5 to 7. In addition to reviewing all of the coronary arteries, Tree VR and Angiographic
View protocols allow you to extract and view the aorta, the coronary vessel tree and the cardiac muscles. See
Chapter 10 - Image Review.
- The Ejection Fraction protocol allows you to compute the ejection fraction, ES, ED and Stroke volumes by
segmenting the left ventricle at end systolic and end diastolic phases. See Chapter 8 - Ejection Fraction,
Section 2.
- The Volume Rendering (Cardiac, Heart, Heart Graft and Cardiac Transparency) protocols can be used to
view the cardiac region and part of the vasculature separate from the surrounding tissue. See Chapter 10 -
4
Image Review, page 176 onwards.
- The Cardiac Reformat batch protocol allows you:
• to display the volume along the Short Axis, the Long Axis and the Vertical Long axis, and to review the
volume.
• to prescribe batch series of oblique reformatted images aligned with the short and long axes of the heart,
for both single-phase and multi-phase datasets. See Chapter 10 - Image Review, page 190 onwards.
-- The Phase Registration protocol allows you to align a ventricle or a coronary vessel in a multi-phase dataset.
See Chapter 10 - Image Review, page 200 onwards.

Other protocol icons may be available in the Cardiac protocol panel. These can be:
- User-defined custom protocols, created by reconfiguring an existing protocol and saved as a new protocol in
the Cardiac protocol category.
- Standard Volume Viewer 3 protocols. Their functions are documented in the Volume Viewer 3 user
documentation.
- Protocols that allow you to directly access other applications relevant to the analysis of cardiac images (such
as the SmartScore or CardIQ Function applications). See the separate user documentation for these
applications.
4

4

CHAPTER 5 - VESSEL ANALYSIS - PROCEDURES
CardIQ Xpress is supplied with five pre-defined Vessel Analysis protocols: Left Coronary and Right
Coronary, for the imaging and quantitative analysis of the left and the right coronary artery, respectively,
with sub-branches; Coronary, for the imaging and quantitative analysis of single coronary arteries; Tree
VR [Pro only] and Angiographic View for the extraction of the coronary musculature from the surrounding
tissues . These protocols can be used with both single-phase and multi-phase datasets.
Each protocol contains the successive steps required to perform an analysis: vessel display adjustment,
vessel selection, vessel identification (tracking) and quantification, selection of sections of interest
(measurement points), adding quick measurements, report review, and filming or saving of the report. 5
Use these protocols as supplied, or configure them to your own particular requirements and then save them
as new custom protocols.
The current chapter describes the Vessel Analysis procedures, while the next chapter (Chapter 7 - Vessel
Analysis - Views, Controls, Measurements) describes the associated special view types and tools, and
discusses the measurements that can be performed.
To define custom vessel analysis protocols, refer to Chapter 8 - Vessel Analysis - Configuring Protocols.
The other cardiac image review protocols supplied with CardIQ Xpress are described in Chapter 10 - Image
Review.

1 OVERVIEW
You use the CardIQ Vessel Analysis protocols for rapid and consistent imaging and analysis of cardiac vessel
pathologies.
The main features are:
- Automatic selection: the user adjusts vessel display by adding/removing vessels or structures.
- Automatic vessel identification: the user places points to define the start of the vessel and the end of each
branch, and the software automatically identifies and tracks the vessel centerline of each branch.
- Multiple-branch analysis: after vessel identification you can select each of the branches for further analysis.
5
- Automatic generation of curved reformatted views that show an entire branch in a single view, using the
centerline as a reference.
- Additional oblique view modes: a longitudinal section view (tangent to the centerline), a cross section view
(perpendicular to the centerline) and a "best" longitudinal section view (oriented to show as much of the vessel
as possible). Each of these can be moved to show any point along the centerline.
- Phase registration to align a coronary vessel in multi-phase datasets if required.
- Automatic vessel quantification: during vessel identification the software also determines the cross section
area and mean diameter at each point along the centerline.
- "Lumen" view, showing the currently selected branch "straightened out" together with a curve indicating the
cross section area or mean diameter at each point.
- Automatic report generation.

Each of the CardIQ Vessel Analysis protocols follows the same overall procedure:
• Preliminary Step:
- Display adjustment of the enhanced vessels.
• Step 1:
- Definition of the vessel(s) to be analyzed.
• Step 2
- Automatic computation of the vessel centerline and cross section,
- Validation of the results, and editing of the centerline and cross section if required.
- Phase registration if required
- Intermediate saving of the tracking if required.
• Step 3: 5
- Review of the exam,
- Definition of sections of interest to be included in the report.
• Step 4:
- Adding new Simple or Double Reference points if required.
- Adding measurements if required.
• Step 5:
- Review of the measurements to be included in the report
- Automatic generation of exam report,
- Saving and/or filming of the report.
CardIQ Xpress is provided with five pre-defined Vessel Analysis protocols. Use these as supplied, or use them
as "templates" to configure your own custom protocols.

This chapter describes the common features of the CardIQ Vessel Analysis protocols. The individual features of
each protocol such as the points required to define the vessel(s) are documented in the protocols themselves. In
most cases you will be using the tools and views provided by the protocols. However, all the other standard and
optional tools, view types, etc. that are part of the Volume Viewer 3 application are also fully available.

2 USING THE PROTOCOLS
After selecting the exam in the AW Patient List and starting CardIQ Xpress (see Chapter 4 - Starting CardIQ
Xpress and Loading the Exam), select the appropriate Vessel Analysis protocol in the "Cardiac" protocol panel.
The six steps that constitute each CardIQ Vessel Analysis protocol are described in the following paragraphs.
As a first stage, the software loads the selected exam and constructs the corresponding 3D model in the
workstation memory, then performs a 3D filtering operation. This operation extracts the cardiac region by
removing extraneous tissue and enhances the cardiac vessels. If you are processing a multi-phase dataset, the
3D filtering operation is performed on all the loaded phases. 5
The result is displayed as a 3D MIP view, together with an axial and coronal view and the protocol panel. The 3D
MIP view is initially displayed with the same orientation as the axial view (inferior-to-superior) but you can rotate
it as required.
The Angiographic View protocol displays an angiographic-like 3D MIP view of the heart, showing:
• the aorta,
• coronary vessels,
• cardiac muscles.
Note : If not displayed, the aorta may be added back with a single click.

After computation with the Angiographic View protocol, perform a visual check of the
CAUTION coronaries and manually add missing coronaries using Autoselect tool (Add/Remove
vessels).
On views displayed in MIP mode, the visibility of small anatomical structures such as small
coronaries vessels depends on the intensity values in the surrounding tissues.
Views that use MIP should always be correlated with the original acquisition images.
You can now proceed with Step 1 of the protocol.

Preliminary Step - Automatic Selection
Overview [Angiographic View]
The Angiographic View Selection panel allows you to add/remove structures or vessels and to display the aorta.
Note: If a Tree VR protocol has been performed before, the (Add Vessel from Tree VR) button will allow you
to retrieve the vessels filtered during the Tree VR build.
Click (Next) to display the Identification panel.

Overview [Tree VR]
The Tree VR protocol displays a VR view, three reformatted views and the Automatic Vessel Selection panel
that allows you to display the aorta and to grow coronary vessels.
To display the aorta on the VR view, place the cursor in the aorta on a reformatted view, and click (Display Aorta).
To grow coronary vessels on the VR view, proceed as follows:
• Using the <Shift> key on a reformatted view, place the cursor in the LMA and click (Display Vessel),
• Using the <Shift> key on a reformatted view, place the cursor in the RCA and click (Display Vessel),

• Using the <Shift> key on a reformatted view, place the cursor on the additionnal vessels you want to display,
and click (Display Vessel),
Note: Checking (Display Contours) in the Automatic Vessel Selection panel highlights the selected vessels
to help you adjust vessel display.
• Click (AutoSelect) in the Automatic Vessel Selection panel: the Tree VR Selection panel is displayed and
allows you to refine vessel display via (Add/Remove Structure), (Add/Remove Vessel), (Dilate) buttons.
Click (Next) to display the Identification panel [Pro only].
Overview [Left Coronary, Right Coronary, Coronary]

Launching the Left Coronary, the Right Coronary or the Coronary protocol directly displays the Identification 5
panel (see next step). Click (AutoSelect) to refine vessel display.

Step 1 - Vessels to Analyze
Branch list
Instructions/Actions area
Protocol Configuration area
Hide Panels Go to next step in protocol

5
The Branch list is the area where you can select the vessel you want to identify.
The Instructions/Actions area displays the instructions or actions available for the selected branch.
For more information on how to identify vessels, see Chapter 6, Section 1.

Step 2 - Verification/Edition of the Results
CardIQ Xpress now first extracts a volume of interest (VOI) that contains the vessel and computes the vessel
centerline (identification), then computes the cross section at each point along the centerline (quantification) and
displays the result of the tracking on the viewports.
At this stage, a message is displayed asking you to accept or reject the identification of the vessel branches.
5
While the message is displayed, you will have to check whether the software has correctly identified all the vessel
branches, using the method described in the paragraphs hereafter (see Verify Vessel Identification on page 73
and Verify Centerlines and Cross Sections on page 75).
Once you have checked the tracking, click (Reject) if you are not satisfied with the result. You will then go back
to Step 1 and be able to create new points. If you click (Accept), the Edition/Tools panel is displayed allowing
you to Edit, Register, Save images (see Edit, Register and Save on page 78), to explore and analyze the exam.
Instead, if an error message appears telling you that the tracking has failed, it means that the software was unable
to compute a tracking with the elements you gave it. In this case, you can:
• go back to step 1 to modify the position of the points in the vessel and define multiple points and bridges if
necessary to extract the desired vessel.

With multi-phase datasets, all the phases are created automatically as a background task, starting with the current
phase. Once the computation is finished, a message for each phase allows you to (Accept) or (Reject) the result
for this phase (displayed on the MIP view). If the tracking on one particular phase fails or is rejected, you will be
able to go on with the operation, but no quantitative information will be given for the failed or rejected phases.

Verify Vessel Identification
After the vessel identification and quantification, the centerlines of the vessel branches identified by the software
are displayed on the 3D MIP view. As noted before, the start-of-section point should be placed inside the vessel
near its origin, not in the aorta, to avoid vessel identification errors.
Note : The software will automatically identify a section extending into the aorta (i.e., beyond the start-of-
section point) and include this in the analysis, so that the transition from aorta to coronary will clearly be
shown in the images.
This extension is also shown on the 3D MIP view.

The automatic vessel tracking algorithm (vessel identification) relies on the user correctly
CAUTION marking the start and end points of the vessel branches to be tracked.
Incorrectly marking a "start of section" point inside the aorta rather than inside the coronary
ostium and/or marking an end point at a location that is not a part of the coronary vessel
structure to be analyzed may result in the software identifying a part of the cardiac vascular
structure completely different from the one intended.
It is the responsibility of the user to check, for each phase, that all vessel branches to be
analyzed have been identified correctly by the software. This verification is more reliable when
done on a MIP view.
5
In the case of multi-phase datasets, the choice of the initial phase conditions the result of the
CAUTION tracking for all the other phases.
The user should therefore very carefully choose the most favourable phase before launching
the tracking.

Verify Centerlines and Cross Sections
Curved view Lumen view
Protocol panel Oblique view

5
After confirming that all vessel branches have been identified correctly, the displayed views switch from the initial
3D and baseline views to a curved reformatted view, a "Lumen" view, and a MIP (thick slice) oblique view.
An active annotation on each of these views allows selecting which branch of the vessel being analyzed is
displayed.
- The curved reformatted view shows the entire selected branch in a single view, using the centerline as a
reference.
- In the Lumen view, the full length of the vessel section is displayed "unfolded" along the centerline, together
with a graph that can show either the section area or the mean diameter at each point on the centerline.

- By default, the oblique view is located at the position of the cursor and oriented automatically by the software
so as to show as much of the vessel as possible (Best L-section mode). Alternatively, you can display the
oblique plane perpendicular to the vessel centerline at the current cursor position (X-section mode).
You can also display a view that is oriented tangent to the vessel centerline at the current cursor position and
that can be rotated around the centerline (L-section mode), or "unlock" the orientation and rotate the oblique
view around the 3D cursor in all directions as required.
Because of the way the Lumen view is generated, by "unfolding" the vessel as a projection at each point of the
vessel centerline, the Lumen view by itself is unsuitable for diagnostics. When performing diagnostics, you can
use the Lumen view as a reference, correlating the information with the other views. For further details on this
view, see Chapter 7 - Vessel Analysis - Views, Controls, Measurements.
• Verify that the vessel centerline(s) correspond to the vessel(s) to be analyzed. In the case of complex vascular
structures, it is possible for the automatic centerline computation to follow an incorrect trajectory or to identify a 5
wrong branch in the structure.
In the case of minor corrections, use the (Edit Center) function (see Edit on page 79) to locally edit the centerline
as required. For major corrections it is usually advisable to return to Step 1 and define the vessel again by
correcting the tracking points and/or adding intermediate points as required.
To review the vessel traces again on a 3D view, select (Advanced Views) > [VOI].
In difficult situations, such as a vessel with a complex trajectory, or vessels touching each
CAUTION other in the images, the automatic vessel tracking algorithm may not always follow the
correct trajectory.
The user should always examine the computed trajectory before moving on to the next step
in the protocol, and if necessary correct the result either by modifying the centerline trace or
by correcting the tracking points and/or adding intermediate points, then repeating the
centerline detection process.

• Verify the vessel quantification, as shown by the graph in the Lumen view and by the cross section contours
on the oblique view in X-section mode.
Local anomalies may occur in the vessel quantification because of limitations in the available data, such as low
contrast or motion artifacts. You can remove such local anomalies by using the (Edit Section) function (see
Edit on page 79) to edit the cross section contour as required.
With some exams, the overall quality of the available data may be insufficient for satisfactory automatic vessel
quantification (indicated by a "noisy" graph and irregular cross section contours, see Chapter 7 - Vessel Analysis
- Views, Controls, Measurements). In such cases, use the graph and contours for information only, and perform
any measurements to be included in the report manually (see Step 4, page 88 onwards).
With multi-phase datasets, verification should be done for each phase. If the quantification of one phase has failed
or been rejected, the graph of the Lumen view will not be displayed and no automatic measurement will be
available.
5
Note : It is not possible to change the phase during an Edit or a Registration operation.
When analyzing a vessel with several branches, make sure to verify each branch separately. Switch between
branches by using the active annotations on the views (see Chapter 7 - Vessel Analysis - Views, Controls,
Measurements).
Correct vessel quantification is critically dependent on such factors as acquisition image
CAUTION quality and voxel size (image resolution and inter-slice distance), and anomalies may occur
because of limitations in the available data.
It is the responsibility of the user to verify the result of the vessel identification and
quantification process before using the data for analysis.

Edit, Register and Save
Go to Edit
Go to Registration
Go to previous or next step
in protocol
5
Once you have accepted the tracking, the other buttons of this panel become accessible:
- Click on the (Edit) button to modify the centerline or cross-sections of the tracked vessel.
- Click on the (Register) button to align a coronary vessel branch (in multi-phase datasets).
- Click on the (Save State) button to save the current state of the tracking.

Edit
Edit cross section

Edit centerline
Undo edit
Close panel
5
To edit the vessel centerline:

• Move the 3D cursor to the approximate position of the section of the centerline trace to be modified.
• Select (Edit Center).
The centerline is displayed on an oblique L-section view (lower right of the screen).
• Point the mouse cursor onto the section, click and hold down the left mouse button, and drag the trace to the
desired shape.

To edit a cross section contour:
• Move the 3D cursor to the position of the section to be modified.
• Select (Edit Section).
The outline of the contour at the current position along the centerline is shown on an oblique X-section view.
• Point the mouse cursor onto the part of the contour to be modified, click and hold down the left mouse button,
then drag the contour into shape.
You may have to click and drag on several points of the contour to obtain the desired outline.
When you edit a cross section contour, the changes are applied only to the currently
NOTICE
selected branch. For a vessel with more than one branch you will have to select and edit
each branch separately, including the parts that may be common with another branch.
When you edit a centerline, changes done on parts common to several branches are
5
applied to all branches.
• Select (Undo Edit) to revert to the previous trace or contour if the result of the edit is not satisfactory.
• After editing either the centerline or the cross section contours, select (Accept) again to update the vessel
analysis computation.
• Once you are fully satisfied with the results, select (Close) to close the Edition Tool panel.

Register
This function works in the same way as the Phase Registration protocol, except that you will use the Curved view
to perform the registration, which will be centered on the selected vessel branch.
• Adjust the cursor, either by dragging the mouse cursor directly on one of the views (usually the Curved view)
on the area of the vessel you want to register, or by using the slider of the Registration panel.
• To change the vessel branch, use the Branch active annotation at the top left hand side of the views.
• The red lines on the Coronal view (bottom right viewport) represent the area to be registered.
• You can perform either an Automatic Registration, by clicking on the corresponding button of the Registration
panel, or a Manual one, by clicking on the (Previous Phase) or on the (Next Phase) button.
• The (Undo) button cancels the last performed operation.
• The (Restore Orig. Volume) button returns to the original volume for the current phase. 5
In this mode, the software looks only at the misregistration of the current vessel branch.
CAUTION
Therefore, when using this mode, carefully study the entire volume to check that the automatic
registration has not degraded image quality.
Once the registration is over, you can go back to the quantification by clicking on the (Back) button.(For more
information on Registration, refer to Chapter 10 - Image Review, Section 3 PHASE REGISTRATION).

Save State
Save State saves all objects that have been computed.
The Save State function allows you to save the current state of the tracking in the Patient List for later use. All
editions on centerlines and cross-sections will be saved as well as deposited measurement points.
• Click on the (Save State) button to activate the function.
• A window pops up requesting you to enter the name of the new created object. This name will appear in the
description of the new object in the Patient List, accompanied by the name of the protocol.
• If you later reload this object by selecting it in the list and activating the Volume Viewer 3 software, you will be
directly brought back in the same protocol, at Step 2 as if you had just performed the tracking, the Edit and
Registering operations being memorized and restored just as they were.
• With multi-phase datasets, only the current phase is saved and therefore restored. 5
Note : In order to be able to reload the saved tracking, all the original slices of the saved volume have to be
present on the AW. If they are not, you can reload them before starting the protocol.
Note : For Heart Fusion users, Save State will automatically save a model that is compatible with Heart
Fusion.

Explore and Analyze
Explore and analyze the exam using the same range of tools as available in Volume Viewer 3.
- Click on the (Advanced Views) to rapidly display the most frequently used view types in the top left view.
The primary views used with CardIQ vessel analysis are the curved, Lumen and oblique views (X-section and
L-section views), but all the other Volume Viewer 3 view types are also available. The (Advanced Views) button
allows you to rapidly display the most frequently used view types in the top left view:
• [Curved]: curved reformatted view,
• [VOI]: 3D view in MIP rendering mode showing the volume of interest used for analysis.
You can change this view to show the volume around the centerline corresponding to the width of the
Lumen view by clicking right on the Lumen view and selecting [Clip to Width] in the drop-down menu (see
Chapter 7 - Vessel Analysis - Views, Controls, Measurements).
5
• [X-Section]: oblique view in X-section (oblique cross section) mode,
• [Navigator]: Navigator view,
• [MIP]: 3D view in MIP rendering mode showing the initial volume (i.e., the entire exam),
• [L-Section]: oblique view in L-section (oblique longitudinal section) mode.
You can move through the exam using the 3D cursor and the Lumen view cursor line, and rotate the
curved, Lumen and oblique L-section views as required. For a full description of the specific features and
controls available on the views refer to Chapter 7 - Vessel Analysis - Views, Controls, Measurements.
- Click on the (Stenosis) or (Aneurysm) button to deposit stenosis or aneurysm measurements (see Chapter
6, Section 4).
The (Color Identification) button allows you to deposit color regions based on HU intensities.
The (Report Finding) button creates a new finding in the report for you to add comments and images.

Step 3 - Selection of Section of Interest (does not appear for all protocols)
Current point label and abbreviation

(check mark indicates point has been
placed)
Configure (customize) protocol

in protocol 5
Overview
Once vessel identification and quantification (Step 2) are satisfactory, explore and analyze the exam using the
tools available in Volume Viewer 3. Multiple vessels can be analyzed.
You can reconfigure the measurements in the protocol by clicking the (Configure Protocol) button to define and
save a new custom protocol. You can also use Step 4 to add measurements that are not part of the protocol (see
page 88).

Measurements
Overview
CardIQ Vessel Analysis automatically computes the vessel cross section (area and mean diameter) for each point
on the vessel centerline (quantification). If the results of this quantification process are satisfactory (see page 77
and Chapter 7 - Vessel Analysis - Views, Controls, Measurements) you can use the corresponding automatic
measurements in the exam report.
The measurements defined in Step 4 of a protocol can be of the following types:
- Distal Reference Point and Proximal Reference Point: all the measurements will have to be located
between these two points, which have to belong to the same vessel branch. The created vessel section
is represented on Lumen view by a theoretical yellow dotted line. The double reference points will be used
to compute the nominal section for each point of the coronary between these two points and to derive the 5
relative measurements. The measurements will be shown in the report both as absolute values
(expressed in mm and mm²) and as relative values (expressed in % of the reference).
- If you only mark one of the two reference points, the relative values will be relative to the created point only.
- You can place a measurement outside the reference points. In this case, the absolute value in mm and
mm² will appear in the table, but not the relative values.
- Auto Diameter: mark a point on the centerline. The associated automatically computed diameter and area
measurements for the point will be included in the report.
- Manual Diameter: move the 3D cursor to the appropriate cross section, then place two points on the
oblique X-section view to measure the corresponding diameter (distance).
- Length: mark two points on the centerline to measure the distance along the vessel centerline between
the two points.
- Angle: mark two points on the centerline to measure the angle between a straight line connecting the two
points and the vertical (RAS coordinate system).

- Volume: mark two points on the centerline. The resulting measurement is the volume of the section of
the vessel between the two points, calculated from the automatic quantification results.
For each measurement, the result will be included in the report together with the associated images (see
page 93).
Procedure
The protocol will prompt successively for each point defined in the protocol. You are not obliged to mark all points:
if you do not mark a particular point, the corresponding measurements will not appear in the report.
Mark the points in the same manner as when placing points to define the vessel (Step 1). Mostly, you will be using
the Lumen view to mark the points, but other views can be used as required.
Move the 3D cursor as before by holding down the <Shift> key and moving the mouse on the views. To move the
plane of a view (image location) "back and forth" on baseline and oblique views, use the <left> and <right> arrow
keys on the keyboard or the active annotations.
5
• To mark each point, click with the left mouse button. Note that the point is marked at the current location
of the mouse cursor, not of the 3D cursor.
• To skip one or more points, click the current point label in the list of points.
• To make corrections, click the current point in the list to select the point and mark it again by clicking with
the left mouse button.
In the case of multi-phase protocols, each time you deposit a Reference or Measurement point an equivalent point
is automatically determined for each of the other phases. To check where the point has been placed on a given
phase, switch to this phase.
Note : When placing the points on the views, they are labeled automatically. If any of the labels overlap or hide
features on the views, click and drag on the label to move it to a different position.

Adding and Modifying Measurements
After placing the pre-defined measurement points, at times you may want to add one or more measurements, or
modify an existing one.
• To quickly add one or more basic measurements (such as diameter, area, distance, angle or volume)
select (Next) to go to Step 4 in the protocol. See page 88.
• For changes to the existing points and measurements in Step 3, select (Configure Protocol).
This function allows you to configure the protocol to your requirements by adding, modifying and removing
measurement points and related measurements. The resulting protocol can then either be applied to the current
session only, or saved and re-used as a new custom protocol.
See Chapter 8 - Vessel Analysis - Configuring Protocols for full details. 5

Step 4 - Add A New Measurement
Select measurement type, Modify previous measurements

then follow instructions

Close panel in protocol 5
Overview
Use Step 4 of the protocol to perform "quick" measurements that are not part of the protocol. These
measurements will be included in the report.
If you do not require any such additional measurements, skip this step (click on (Next) to go to Step 5).

Measurements
You can add the following types of quick measurements:
• (Auto Diameter): the computed mean diameter and cross section area for a point along the vessel centerline,
• (Manual Diameter): distance between two points. This will usually be a diameter (e.g., the actual vessel
diameter in the presence of a thrombus where the automatic diameter measurement is that of the lumen) but you
can also use this function to measure, e.g., the distance between the vessel wall and nearby bone,
• (Length): distance between two points located on the vessel centerline and measured along the centerline,
• (Volume): volume of the section of the vessel between two points,
• (2 Point Angle): angle between a section of the vessel, defined by two points, and the vessel centerline,
• (3 Point Angle): angle between two sections of the vessel, defined by three points. The measurement is the
angle between the segment defined by the first and second point and the segment defined by the second and third 5
point.
• (Min/Max Length): see Chapter 6, Section 7.
Procedure
To add a quick measurement, select the type of measurement you require. You are prompted to place the
necessary point(s). If you wish you can create new reference points for the coming measurements, either just a
proximal reference point, defining a simple reference, or a proximal and a distal reference point, defining a double
reference. A default name (label) is automatically added in the list in the protocol panel and a default abbreviation
on the Lumen view.
In the case of multi-phase datasets, each time you deposit a Reference or Measurement point an equivalent point
is automatically determined for each of the other phases.To check where the point has been placed on a given
phase, switch to this phase.
After placing the points, you are asked to validate the measurement (to include it in the report). Click on (Yes) to
validate, or click on (No) to cancel (the points are removed from the views and not included in the report).
To modify the name or the abbreviation of a quick measurement, or remove it:
• First select (Modify Previous Measurements). A list of the existing quick measurements is displayed.
To modify the name or the abbreviation of a quick measurement:

• Select it in the list by clicking on the label.
• Select (Modify) and change the name or the abbreviation in the text fields.
• Switch (Film) on or off to determine whether the images associated with the measurement should be included
in the report.
To remove a quick measurement: 5

• Select it in the list by clicking on the label.
• Select (Remove) to delete the measurement from the list.
Note : To define additional measurements that are to be included in a custom protocol, use (Configure
Protocol) in Step 3 or Step 4 (see Chapter 8 - Vessel Analysis - Configuring Protocols). The quick
measurements added during Step 4 are used only during the current session, and will not appear in a
custom protocol.

Step 5 - Reports
Report contents:
exam data and measurements
(exam data illustrated, measure-
ments on following pages)
Select Output Move through report pages

Set film format Save Report
Close panel Go to previous step in protocol 5
Use Step 5 of the protocol to review the exam data and measurement information that will be included in the report.
Use the arrow buttons at either side of the current page label to move through the pages.
If during the review you notice any measurements that need to be corrected, return to Step 3 or Step 4 using the
(Back) button and make the necessary corrections (such as adding or moving a measurement point, or changing
an annotation).

You can save or film the report as soon as you are satisfied with the measurement information that will be included
in the report.
• Select (Save) or (Film) in the protocol panel as required.
If you are filming the report, you can select the film format (layout of the images on the film in columns and rows).
• Open the (Film Format) menu and select [2x2], [2x3], [2x4], [4x4] or [4x5] as required.
The software automatically composes and formats the report. The display will cycle automatically through the
successive images that will be included in the report. Once the report is composed, you can select (Hide Panels)
in the protocol panel to end the analysis, and select the next exam in the Patient List.
5
If you choose to film the report, it is sent to the same laser camera linked to your workstation that you use to film
images from Volume Viewer 3 or from other applications such as the AW Viewer. Refer to the Volume Viewer 3
and AW Basic Display user documentation for details. Filming is performed as a background task: the workstation
is available for the next exam as soon as the data have been "queued" for transmission to the laser camera.
If you choose to save the report, it is saved on the image disk as a new series, attached to the current exam. It
consists of a set of secondary captures (type SCPT) that can be reviewed using the AW Basic Display Viewer and
filmed as required at a later time.
In the case of multi-phase datasets, the Film and Save functions only create a report for the current phase. To
save another one you must change the phase and re-create the report for the new phase.
The filmed or saved report consists of:

- The exam data and tables of measurement results,
- A set of images (screen captures) that is linked to the measurements,
- Any screen saves that have been "queued" during analysis.
Exam data and measurements

The first part of the report consists of a text page with the exam data (exam name, patient name, hospital name,
acquisition parameters) and text pages with tables of measurement results. The contents and format of these
tables depend on the protocol.
Note : If a reference point is defined in the protocol, measurements are also listed expressed in % relative to
the reference section, in addition to the absolute values.
Note : If you have created new reference point(s) at this level, the measurements made with the first reference
points will appear as PRef and DRef and will be relative to this first reference point(s) and the
5
measurements made after the creation of the second reference point(s) will appear as PRef-x and DRef-
x and will be relative to the new reference point(s).
Images
The second part of the report consists of a set of images.
The number and type of images in the report depend on the protocol, and on the number and type of
measurements in the analysis. They include curved reformatted images for each branch, branch views ("best"
plane oblique views of each branch) and oblique X-Section and L-Section images for the measurement points.

Extra annotations are added automatically on all images that allow you to determine unequivocally the location
and orientation of each image, and to which measurement the image refers.
Screen Saves
During the analysis you can "queue" additional screen captures by means of the [Queue Report Image] menu
item on the on-view menus - activated by a right mouse click on the view - (see Chapter 7 - Vessel Analysis -
Views, Controls, Measurements). These will be added automatically at the end of a report, when it is saved or
filmed.

CHAPTER 6 - VESSEL ANALYSIS - FEATURES
1 DYNAMIC AVA
Vessel Analysis protocols provide an improved means of identifying vascular trees. It is called Dynamic AVA and
it enables to:
- Use the bridging (previously called “Cross Occlusion”) feature as well as intermediary points in multibranches
protocols,
- Have a visual feedback of the identified vessels while you are defining them.
At this stage, Step 1 of the protocol, the Vessels to Analyze panel, is displayed together with three baseline views
(axial, sagittal, coronal).
You are now prompted by the protocol to place the points that are necessary to define the section of the vessel to
be analyzed. To move through the 3D volume, you use the same controls as with Volume Viewer 3: 3D cursor,
active annotations and keyboard arrow keys. 6
As a minimum, it is necessary to specify the Start point and one other point to move onto the next step in the
analysis.
After each point is added, you have the ability to display the centerline of the vessel section by clicking the (Show
Tracking) button (see paragraph 1.2 “Displaying Branches”).
When all centerlines are computed and displayed to your satisfaction or once you have deposited all branch
points, click (Next) to go to Step 2 of the protocol. This starts the automatic process of computing the vessel cross
section at each point along the centerline (quantification) and applies the default layout for the protocol.

You can change the default layout in the [Protocol List]. The selected one is added to the Review Steps panel
and removed from the [Protocol List].
1-1 Tracking the first branch (from any view)

1. Click on view with the left mouse button to place the start point.
2. Select in the branch list on the protocol panel the branch you wish to identify.
3. Click on view with the left mouse button to place the first branch point.
4. If needed, click (Show Tracking) to automatically compute and display the first branch on the 3D view.
1-2 Displaying branches

Click the (Show Tracking) button anytime to display on the right hand screen monitor the following views:
- batch cross–section views,
- a vertical lumen view,
- a 3D VR view of the vessel,
- a curved view. 6
Checking the box next to the (Show Tracking) button activates the automatic display of the vessel after each
deposited point.
1-3 Extending a branch (from any view)

1. Select in the branch list on the protocol panel the branch you want to extend and click on its annotation (on any
view): the branch becomes active.
2. Click on any view to deposit a new distal point: the branch is automatically extended to this point and views are
updated.

1-4 Using Multiple Points per branch
In case of long or tortuous vessels, or of vessels close to bones, you can deposit multiple points on the same
branch to avoid incorrect tracking.
1. Select the branch you want to track.
2. Check the Use Multiple Points box.
3. Deposit as many points as you want.
1-5 Correcting a branch

In case of wrong tracking, clicking the (Correct Branch) button will delete the last deposited point and activate
the Multiple Points function. You can then deposit as many points as you want on the same branch.
1-6 Identifying a new branch

From Start point
1. Select in the branch list on the protocol panel the new branch you wish to identify.
2. Click on view to deposit the distal point of the branch. 6
From a Bifurcation point

1. Select in the branch list on the protocol panel the new branch you wish to identify.
2. Click on the (Define bifurc.) button.
3. Click an arbitrary position on an existing branch: the branch becomes active from Start point to this new position
(i.e. the bifurcation point).
4. Click on view to deposit the distal point of the branch.

1-7 Deleting a branch (from any view)
To remove the branch up to the first bifurcation:
1. Drag and drop the branch or its annotation outside the view, or
2. Right–click the branch or its annotation and select Remove Branch in the drop–down menu, or
3. Uncheck the branch in the protocol panel.
1-8 Renaming a branch (from any view)

1. Right–click the branch annotation to display the contextual branch menu.
2. Choose a label among the predefined list of labels sorted by anatomy: the branch name is updated, or
3. Click Rename and type in new branch name, nickname and comment the new name is stored in the
predefined list of labels and the branch name is updated.
1-9 Defining a new bridge (from any view)

1. Select the branch in the branch list on the protocol panel.
6
2. Click (Start bridge).
3. Deposit points on view: these new points are considered bridge points for the current bridge.
4. Click the (End bridge) button to exit the bridge mode.
1-10 Tracking error cases

If the tracking algorithm cannot find a path (even incorrect) between two consecutives points, the software will
automatically define a bridge between these two points.

2 ADDING/REMOVING BRANCHES
For any Vessel Analysis protocol, you have the ability to add and remove branches to the vessel section being
defined for analysis in the Protocol Configuration area.
To add a new branch to a section:
1. Select the exam, and if necessary the series of the exam, in the AW Patient List.
2. Launch Volume Viewer 3.
3. Select the protocol category then the desired protocol. At this stage, Step 1 of the protocol, the Vessels to
Analyze panel, is displayed.
4. As prompted by Step 1 of the protocol, begin placing the points that are necessary to define the section of the
vessel to be analyzed.
5. Click (Add Branch) to add a branch to the section.
6. To add a predefined branch label, select the name of the branch from the pop–up menu. The new branch will 6
now be displayed in the list of branches.
To create your own label for a branch, select New branch... from the pop–up menu and in the Add A New
Branch dialog box, specify the Point Name, Abbreviation name, and Prompt text for point. Click (Accept) to
save the label and display it in the list of branches.
7. Place the new branch point onto a view by clicking the chosen vessel with the left mouse button.
The 3D view will update to show the centerline of the new branch.

To remove a new branch from a section:
1. In the list of branches displayed in the Vessels to Analyze panel, uncheck the Done checkbox for the branch
you want to remove. The 3D view will update with the centerline of the removed branch no longer visible.
2. If you want to remove the branch completely from the list of branches for the current protocol, then select the
branch and click (Remove Branch).

3 QUICK AVA
One-Click AVA Two-Click AVA
Quick AVA controls

Quick AVA provides you with the capability to quickly perform quantitative analysis of a lesion without having to
leave the current protocol session.
Quick AVA comprises the following tools available in the Segment (or My Tools) palette:
- A one–click AVA tracking tool, which requires just a single click anywhere in the vessel under examination. The
software will automatically track the vessel in both directions proportionally to the diameter of the vessel.
- A two–click AVA tool that prompts you to deposit two points: a Start point and an End point. In between these
two points, this tool will calculate the centerline of the lesion.
To perform a one–click AVA analysis:

1. From any Volume Viewer 3 or Vessel Analysis protocol, click the one–click AVA button on the Segment (or
MyTools) palette.
2. Click the vessel in any view on which you want to perform a Quick AVA analysis. The 3D image will redraw to
display the centerline of the selected vessel based on the proportional vessel diameter along the length of the
vessel. 6
To perform a two–click AVA analysis:

1. From any Volume Viewer 3 or Vessel Analysis protocol, click the two–click AVA button on the Segment (or
MyTools) palette.
2. Click the start point of the vessel section in any view on which you want to perform a Quick AVA analysis.
3. Click the end point of the vessel section in any view. The 3D image will redraw to display the centerline of the
selected vessel section.

Once the centerline is calculated and displayed, you have the ability to open any AVA protocol panel by clicking
on one of the following buttons:
- Identification (see Section 1 “Dynamic AVA”)
- Verification / Edition
- Measurement
- Report
The (Start New) button allows you to deposit further traces without restarting Quick AVA one-click or two-click.
The (Delete Traces) button allows you to delete tracking after a QuickAVA one-click or two-click before restarting
a new one.

4 STENOSIS AND ANEURYSM TOOLS
The stenosis and aneurysm tools are available from Step 2 of any Vessel Analysis protocol. These tools allow you
to calculate the start and end points of a stenosis or aneurysm, as well as the stenosis or aneurysm dimensions.
4-1 Stenosis
To specify a stenosis:
1. In Step 2 of the chosen protocol, click (Stenosis).
2. Place the proximal reference point by clicking on any view.
3. Place the distal reference point by clicking on any view.
The start point, the end point and the minimum diameter of the stenosis are calculated automatically and
displayed on the 3D and lumen views. The stenosis measurements annotation is displayed on Reformatted and 6
Lumen views along with the length, area, percentage and minimum diameter of the stenosis.
You have the ability to move any point by clicking and dragging its associated line on the lumen view.

6
Lumen and 3D views of a stenosis

4. If needed, repeat step 1 to step 3 to calculate additional stenosis measurements. The 3D and Lumen views will
update and the stenosis measurement annotation menu on Reformatted views will allow you to delete the
selected measurement or switch to another measurement.
5. Click (Next) to move to the next step in the protocol.
On completion of all steps of the protocol, the exam report will include stenosis measurements and additional
stenosis images.
To delete a stenosis measurement, right–click on its annotation and select (Delete).
4-2 Aneurysm
To specify an aneurysm, proceed as described in paragraph 4–1 using the (Aneurysm) button. Start point, end
point and maximum diameter of the aneurysm are calculated and displayed automatically (as with the Stenosis
tool).
The aneurysm measurements annotation is displayed on Reformatted and Lumen views along with the length,
area, percentage and maximum diameter of the aneurysm.
6
To delete an aneurysm measurement, right–click on its annotation and select (Delete).
4-3 Measurement computation using single/double reference point

To compute the stenosis/aneurysm measurements, you have the ability to choose a simple reference point (distal
or proximal) or a double reference point by right–clicking its annotation.
With a proximal reference point (first point deposited), the measurements are computed relatively to the proximal
point.

With a distal reference point (second deposited point, by default for Head & Neck), the measurements are
computed relatively to the distal point.
With a double reference point (by default for all protocols except Head & Neck), the measurements are computed
relatively to the interpolated value between proximal and distal points.

5 COLOR IDENTIFICATION
The Color Identification function enables you to create a color–coded volume along the centerline of a defined
vessel section. The vessel will be colorized up to the maximum diameter. The function is available for all Vessel
Analysis protocols.
To use the Color Identification function:
1. Click the (Color Identification) button (available in the Verification of the Results panel in Step 2 of the
protocol),
2. Click on view to deposit the first point,
3. Click on view to deposit a second point: a color ramp is automatically applied around the segment defined by
the two deposited points. It is displayed in all reformatted views as well as curved and oblique views.
4. Click the plaque diameter annotation to modify the diameter of the plaque and grab Start and End points on the
lumen view to modify the length of the plaque, 6
5. Click the plaque name annotation to display a drop–down menu allowing you to send the plaque to the Report,
to delete the plaque, or to select another deposited plaque.
A discrete color ramp with four segments is displayed on the left hand side of each view (except lumen and 3D
views). The color ramp defines a color for a range of voxel values.

Color Identification of a vessel section
6

5-1 Adjusting the Color Ramp
To adjust the color ramp, click the color ramp on the left–hand side of an oblique, axial or curved view. The Color
Map Table panel containing three tabs is displayed.
The Statistics tab displays a table containing the volumetric statistics of each range of voxels corresponding to a
color. The third column shows for each color the percentage of colorized volume inside the region of interest. If
several color structures have been deposited on the same exam, they can be compared in the same table.
The Configuration tab enables you to configure the color ramp. You can:
- Add/Remove color segments. By default, a new segment has no color.
- Change the color of a segment by clicking the color cell. A range of colors will display allowing you to select a
new color or to switch to “Black and White”.
Note: If you select “Black and White”, the voxels belonging to this segment will not be colorized but will 6
display their own gray level values. It allows you to create a gap between two color regions.
- Enter a name for a segment to personalize the color ramp.

- Adjust the limits of a segment.
Note: These limits can also be adjusted by middle mouse clicking and dragging to left or right the red
annotations on the ramp.

Note: Color segments are adjacent: the maximum value for a segment is the minimum value for the next
segment.
- Switch the color ramp from steps to continuous mode by checking the Continuous Ramp box. In continuous
mode, the color ramp is smoothed to better detect repartition of gray values within each segment.
Note: Volumetric statistics are not available in continuous mode.
- Click the Presets tab once the color ramp is adjusted.

The Presets tab allows you to:
- Save the current color ramp as a preset.
- Remove the last applied preset.
- Apply a different preset.

6 AUTOMATIC MEASUREMENT POINTS
The Automatic Measurement Points feature allows you to dynamically add automatic measurement points to the
currently selected Vessel Analysis protocol.
To add an automatic measurement point:
1. Click the (Configure Protocol) button (available in the Selection of Section of Interest panel in Step 3 of the
protocol).
2. On the Ref. Points panel, click (Add) to display the Add a New Point dialog box.
3. From the Diameter type pop–up menu, select [Auto Diameter] and specify a Point name, Abbreviation name
and Prompt text for point.
4. Check the Automatic Measurement box to define the point as an automatic point.
5. From the Select a Point drop–down menu, select a point to use as reference for the new automatic 6
measurement. The measurements available will depend on the current Vessel Analysis protocol.
6. In the mm text box, enter the number of millimeters that the new measurement will be the point selected in the
previous step.
7. Click (Accept) to save the new measurement. This measurement will now be displayed in the Ref. Points list.
8. Repeat steps 2 to 4 to add additional automatic measurements.
9. If you wish to save the current configuration as a new protocol, then click (Save Protocol). Enter name for the
new protocol in the Save Configuration As New Protocol dialog box and click (Save).
10. Click (Close) to return to the Selection of Section of Interest panel (Step 3 of the current protocol).

To modify an automatic measurement point:
1. Click the (Configure Protocol) button (available in the Selection of Section of Interest panel in Step 3 of the
protocol).
2. On the Ref. Points panel, click (Modify) to display the Modify a Point dialog box.
3. From the Diameter type pop–up menu, ensure that [Auto Diameter] is selected and make any required edits
to the Point name, Abbreviation name and Prompt text for point.
4. If necessary, from the Select a point drop–down menu, select new point to use as reference for the automatic
measurement. The measurements available will depend on the current Vessel Analysis protocol.
5. In the mm text box, enter the number of millimeters that the measurement will be the selected point.
6. Click (Accept) to save the new measurement. This measurement will now be displayed in the Ref. Points list.
7. Click (Close) to return to the Selection of Section of Interest panel (Step 3 of the current protocol).

7 MINIMUM/MAXIMUM LENGTH MEASUREMENT
The Min/Max Length Measurement feature allows you to calculate and display the minimum and maximum length
on the wall of the vessel (see Figure below) in addition to the length on the centerline of the vessel.
The length is dedicated to the preparation of stent placement.
Minimum/Maximum measurements are taken on the quantification contours. Before using minimum/maximum
measurements, you shall make sure quantification is correct by using the Edit Section tool.
Minimum/Maximum Length Measurement

Note: The Min/Max Length Measurement feature is optimized for aorta and carotids.

CHAPTER 7 - VESSEL ANALYSIS - VIEWS, CONTROLS,
MEASUREMENTS
The CardIQ Vessel Analysis protocols (Left Coronary, Right Coronary, Coronary, Tree VR
[Pro only] and Angiographic View) use several view types that are either specific to or optimized
for vessel analysis, in addition to the standard view types available in Volume Viewer 3.
The Lumen view shows the currently selected vessel branch "straightened out". The curved view
shows the entire branch in a single view, using the centerline as a reference. For the oblique view
additional longitudinal and cross-section modes specific to vessel analysis are available.
In CardIQ Vessel Analysis reports you can include measurements computed automatically by the
software and measurements you perform manually. To correctly assess the accuracy of such
measurements, you should be familiar with the various factors that affect this accuracy.
This chapter describes the view types and associated controls used with CardIQ Vessel Analysis,
and discusses the factors that affect measurement accuracy.
7

1 OVERVIEW
With CardIQ Vessel Analysis, you will mostly be using the Lumen view and the curved and oblique reformatted
views.
The Lumen view shows a vessel branch "straightened out" together with a curve indicating the cross section area
or mean diameter at each point. See section LUMEN VIEW.
The curved view shows an entire vessel branch in a single view, using curved-plane reformatting with the
centerline as the reference trace. Rotate the view as required, to examine all features of the selected branch on
the one view. See section CURVED VIEW.
The oblique view uses plane oblique reformatting to show part of the vessel. Specific longitudinal section and
cross-section modes allow you to examine anatomical details at a given location. Since the view shows a plane
("flat") cross section of the 3D volume, it cannot show an entire vessel with a complex geometry at once, but all
geometric relations in the view are maintained so that it can be used both for diagnostics and for measurements.
See section OBLIQUE VIEW.
The other Volume Viewer 3 view types are also fully available at all times. When used with CardIQ Xpress, some
additional features are available on the 3D view. See section OTHER VIEWS.
The controls on the views used with CardIQ Vessel Analysis are mostly identical to those that you will be familiar 7
with from Volume Viewer 3. Refer to the Volume Viewer 3 user documentation. Controls that are specific to
CardIQ Vessel Analysis are described in this chapter.
To correctly assess the accuracy of both automatic and manual measurements performed within CardIQ Vessel
Analysis, you should be familiar with the various factors that affect this accuracy. These are discussed in section
MEASUREMENT ACCURACY.

2 LUMEN VIEW
View type Patient name
Branch
Angle of rotation Graph
around centerline
Cursor line and
Linear position of cursor measurement
Field of view
Rendering mode
(Rfmt or MIP)
Curve type
(section area or
Width of Lumen "stripe" mean diameter)
Lumen
Window Width/Level
Centerline (not displayed on view)

7

Overview
The Lumen view shows the vessel "unfolded" along the centerline, with the centerline straightened out. You can
display either a reformatted "thin" strip (section), or the "tube" around the centerline in MIP mode. If you have
defined a vessel with branches, you can switch the display between the branches.
The graph can show either the cross section area or the mean diameter.
A cursor line allows you to correlate the Lumen view with the other views.
You can rotate the Lumen view around the centerline, and change its width if required.
The vessel and graph are displayed either vertically or horizontally, depending on the predominant orientation of
the vessel in the exam.
Geometry
A Lumen view is constructed by transforming the three-dimensional centerline into a straight line and then
displaying for each point of the centerline the intersection with the plane perpendicular to the centerline.
This transformation results in geometrical distortion of the displayed anatomical features

CAUTION because the successive intersections are not parallel. For this reason the Lumen view
should NOT be used for diagnostic purposes by itself, but always in combination with other
views. 7
Note: The curved reformatted view (see section CURVED VIEW, page 122) is generated by constructing a
curved plane that intersects the vessel centerline, then "flattening out" this plane for display on the
screen. In this case the geometrical relations in the plane are maintained. Of course, due care should
still be taken when interpreting a curved view, because it displays the intersection of the anatomical
features with a curved cut plane.

Measurements
The computed value of the section area or mean diameter at the cursor position on the Lumen view is displayed
on the graph.
You can also use the tools available in Volume Viewer 3 to perform measurements on the Lumen view. However,
because of the distorted geometry of the Lumen view, only two types of measurements are possible:
- Distance measurements along a horizontal line (e.g., vessel diameter, or distance between vessel and
nearby feature),
- Distance measurements vertically along the centerline.
Any other measurements are meaningless.
For other measurements, use the Lumen view to 'navigate' along the vessel, and place the measurement points
on the plane oblique and/or baseline views where their position in all three dimensions can be determined
unambiguously.
Graph
The graph on the Lumen view can show either the section area or the mean diameter.
Note: The section area at a given point is the cross section area of the vessel lumen at that point, as computed
by the software and as indicated by the green outline on the cross section oblique view.
The mean diameter at a given point is defined as the diameter of a circle with the same area as the 7
section area at that point.
To display either section area or mean diameter, click right on the curve type active (red) annotation and select
the desired type in the drop-down menu. From this menu you can also rescale the curve to display a range of
values around that corresponding to the current cursor position, or reset the scale to display the full range.

Cursor Line
The graduated cursor line on the Lumen view indicates the intersection with the plane that contains the 3D cursor
and that is displayed in the oblique X-Section view.
To position the 3D cursor using the Lumen view, the view must be selected. Move the 3D cursor as usual by
pointing with the mouse while holding the <Shift> key. Move the cursor along the centerline in steps by means of
the <left> and <right> arrow buttons on the keyboard (the mouse should be positioned on the Lumen view or on
an oblique view), or use the vertical slider of the {review controller} with Card. mode off, or use the LP (linear
position) active annotation (see next paragraph). On the Lumen view, the 3D cursor is shown as a red tick mark
on the cursor line. When you position the 3D cursor using one of the other views, this red tick mark is not
displayed.
Active Annotations
The active annotations of the Lumen view operate in the same way as elsewhere in Volume Viewer 3.
The use of the View Type, DFOV, W/L and Patient Name active annotations is identical.
When analyzing a vessel with branches, use the branch annotation to select which branch is displayed. This
annotation also appears on the curved and oblique views. When you select a branch on one of the views, the
other views automatically display the same branch.
Use the Angle annotation to rotate the Lumen view around the centerline of the vessel.
Use the rendering mode annotation to select either Reformat (Rfmt) or MIP as the rendering mode for the Lumen
7
view. In Reformat mode the Lumen view shows the "strip" or "ribbon" along the centerline that corresponds to the
current angle setting, in MIP mode the view shows the "tube" around the centerline.
Use the LP (linear position) annotation to move the 3D cursor along the centerline (the value shown is the 3D
distance, measured along the centerline, between the cursor line and the starting point).

Use the Width annotation to vary the width of the "strip" along the centerline (or the diameter of the "tube" in MIP
rendering mode), in order to observe features further away from the centerline.
For the curve type annotation, see paragraph "Graph", page 119.
On-View Menu
To use the on-view menu, click and hold right anywhere on the Lumen view (except on the red annotations or the
3D cursor mark), then move down to the required menu item.
[Save Image]: saves the full contents of the view (Lumen view, graph, annotations) as a screen save.
[Queue Report Image]: places the same information in a "queue" of screen saves, that will be added at the end
of a report, when it is saved or filmed.
[Clip to Width]: if you have changed one of the other views to a 3D view, this functions clips the 3D view to a
"tube" around the vessel centerline with the same diameter as the current width of the Lumen display (also see
section 3D View, page 136).
[Enlarge]: enlarges the view, so that it takes up the entire viewing area. The menu item changes to [Reset Size]
to return to the original size (one quarter of the viewing area).
[Reset Pointer]: returns the 3D cursor to the center of the 3D volume.

3 CURVED VIEW
View type
Patient name
Branch
Angle of rotation
Field of view
Orientation
Window Width/Level 7
Curved View

Overview
The curved view shows the entire currently selected branch in a single view, using curved-plane reformatting with
the centerline as the reference trace. You can rotate the view as required, to examine all features of the selected
branch on the one view.
The curved view does not exhibit the same geometrical distortion as the Lumen view so that it can be used for
diagnostics.
Geometry
The curved reformatted view is generated by constructing a curved plane that intersects the vessel centerline, then
"flattening out" this plane for display on the screen.
Expressed more accurately, the curved view is constructed as the intersection of the
vessel centerline and a vector which sweeps out a curved surface that can be
transformed into a plane surface for display while maintaining the geometrical relations
in the plane. See illustration.
With CardIQ Xpress, the vector is oriented initially parallel to one of the main axes of the
RAS coordinate system. Also, rotation is constrained to the planes perpendicular to the
main axes. 7

Because of the way in which the curved view is constructed, the type of geometrical distortion that occurs on the
Lumen view (see section LUMEN VIEW, page 118) does not occur on the curved view; the geometrical relations
in the "flattened out" plane are maintained. Nevertheless, all due care should still be taken when interpreting a
curved view, because it displays the intersection of the anatomical features with a curved cut plane. In particular,
in the case of a complex vessel, "waves" and "folds" in the vessel centerline may result in anatomical features at
some distance from the vessel centerline appearing in more than one place on the image when the view is rotated
to certain angles.
A point to bear in mind is that the curved view is a "thin" reformatted view, not a MIP view. Points that are not
actually located on the centerline (e.g., calcifications or bifurcations), will rotate into or out of view when the curved
view is rotated.

Orientation
To interpret the curved view correctly, the following information may be useful.
S S S
S-I R-L A-P
A L A L L
A
Curved views:
Initial orientation and rotation axis determined by predominant vessel orientation (S-I, R-L or A-P)
- The predominant orientation of the vessel (or rather, of the line connecting the end points of the center line)
determines the initial orientation of the view (0° rotation) and the axis around which the view will rotate. See
figures above.
As an example, for a vessel oriented predominantly S-I, the vector that defines the curved plane in 7
combination with the centerline is oriented A-P, and the resulting view is oriented the same way as a sagittal
view, i.e., S-I and A-P. Rotation is around the Z-axis (S-I axis), i.e., the vector remains in the axial plane.

A S S
R L A P R L
Axial Sagittal Coronal
P I I
Display conventions for baseline views
- When a curved view is rotated, the software always displays the view in such a manner, that the orientation
matches the display conventions used for the baseline views. See figures above.
As a result, when a curved view is rotated it may suddenly flip left-right or rotate 90° in order to match the
orientation of the baseline view nearest to the current angle of the display plane. Note that only the display
changes, not the axis around which the curved display is rotated.
You also have the possibility of creating a movie loop around a Curved view (refer to Chapter 10 “Movie Creation”,
Section 1 “Batch Loop”). In this case the current aspect at the time the movie is started is kept and therefore flip
left-right or rotate 90° are not possible.

Measurements
Some of the Volume Viewer 3 measurement tools can be used on a curved view. However, because of the
particular geometry of the curved view, due care should be taken to interpret such measurements correctly.
- Cursor report measurements function normally. You can also be interactively given the density of the tissues
along a specific structure (for example a vessel) by moving the cursor on the view (refer to Section 6 “Density
Measurement”).
- Distance and angle measurements on curved views can only be "3D".
"3D" measurements return the true 3D distance or angle between points marked on the view, as measured
from the 3D volume, irrespective of the curved plane geometry.
- Area measurements are not possible on curved views. Volume measurements will show either the exam
volume or the volume of the VOI; these have no practical application for the analysis.
Active Annotations
The active annotations on the curved view operate in the same manner as elsewhere in Volume Viewer 3 (see the
Volume Viewer 3 user documentation).
The use of the View Type, DFOV, W/L and Patient Name active annotations is identical.
Use the branch annotation to select which branch is displayed, as on the Lumen view. See page 120.
7
Use the Angle annotation to rotate the curved view. Note that the displayed value of the angle on the curved is
not related to that on the Lumen view, because the way the two views are constructed and rotated are different.

On-View Menu
To use the on-view menu, click and hold right anywhere on the curved view (except for the red annotations or the
3D cursor), then move down to the required menu item.
The [Save Image], [Queue Report Image], [Enlarge] and [Reset Pointer] menu items are the same as those of
the Lumen on-view menu. See page 121.
[Lock Cursor to Trace]: locks the 3D cursor to the vessel centerline on all selected views. Move the 3D cursor
as before by holding down the <Shift> key and moving the mouse cursor: the 3D cursor will now move only along
the centerline. The menu item changes to [Unlock Cursor] to unlock the 3D cursor from the centerline.

4 OBLIQUE VIEW
View type
Patient
Branch
Linear position of cursor name
from start of centerline
Field of view
Orientation
Section type
Rendering mode
Slice thickness
7
Window Width/Level
Oblique View

Overview
An oblique reformatted view is a plane ("flat") view that contains the 3D cursor and can be rotated to any
orientation.
Use the oblique view to examine anatomical details at a given location in the vessel. Since it is a plane ("flat")
cross section of the 3D volume, it cannot show an entire vessel with a complex geometry at once, but since it does
not exhibit any of the geometrical distortion that occurs on the Lumen and curved views (see earlier), it can be
used for diagnostics and measurements in the same manner as the baseline views.
The oblique reformatted views in CardIQ Xpress are the same as in Volume Viewer 3, with the addition of a
number of oblique modes specific to CardIQ Vessel Analysis. An X-Section view shows the cross section at the
3D cursor, an L-Section view shows a plane tangent to the vessel, and a Best L-Section view is oriented so as to
show as much of the vessel as possible.
The vessel cross section contour is shown in green on the views.
Otherwise, the views are the same as in Volume Viewer 3, i.e. they are plane reformatted slices. By default a
"thick" slice in MIP rendering mode is displayed (using MPVR, see Volume Viewer 3 user documentation). You
can modify the slice thickness, or display a "thin" (one voxel thick) slice.

Geometry
As noted before, the oblique views represent plane ("flat") cross sections of the 3D volume, so that all geometric
relations in the plane are maintained.
- The X-Section view shows a reformatted slice that is perpendicular to the vessel centerline and contains
the 3D cursor.
- The basic L-Section view shows a reformatted slice tangent to the vessel centerline at the location of the
cursor line on the Lumen view, and oriented parallel to the Lumen view at that point. When the Lumen
view is rotated around the centerline, the L-section view rotates with it.
- The Best L-Section view is located at the position of the cursor and oriented automatically by the software
so as to show as much of the vessel as possible for a given cursor position (plane of maximum curvature).
Measurements
All measurements tools available in Volume Viewer 3 can be used on an oblique view. Refer to the Volume Viewer
3 user documentation.
Active Annotations 7
The active annotations on the oblique view operate in the same manner as elsewhere in Volume Viewer 3 (see
the Volume Viewer 3 user documentation).
The use of the View Type, DFOV, slice thickness, thick-slice rendering mode (Average, MIP, MinIP or VR), W/
L and Patient Name active annotations is identical.

Use the branch annotation to select which branch of the vessel is displayed, as on the Lumen and curved views.
See page 120.
Use the LP (linear position) annotation to move the 3D cursor along the centerline, as on the Lumen view (the
value shown is the 3D distance between the cursor line and the starting point, measured along the centerline).
Note: You can also move along the centerline in steps by means of the <left> and <right> arrow buttons on
the keyboard (the mouse should be positioned on the Lumen view or on an oblique view), or use the
slider and arrows of the {review controller}.
You can also generate a Movie along the vessel (X-Section, L-Section and Best L-Section modes). For more
information, refer to Chapter 10 “Movie Creation”.
To change the orientation mode of the oblique view, look for the section active annotation in the lower left corner
of the view next to the slice thickness/rendering mode annotation. Click on the annotation and select the mode
from the drop-down menu:
• [No Lock]: standard oblique view. Use the on-view cube or cross reference lines to rotate the oblique plane
around the 3D cursor position. See the Volume Viewer 3 user documentation.
• [XSection]: displays the vessel cross section (perpendicular to vessel centerline) at the current 3D cursor
position.
• [LSection]: displays a longitudinal section (tangent to vessel centerline) at the current 3D cursor position,
oriented parallel to the plane of the Lumen view at the same position. 7
• [Best LSection]: displays a longitudinal section at the current 3D cursor position, oriented in the plane of
maximum curvature of the vessel.
Use the [Align 3D Views] menu item to align a 3D view with the current orientation of the oblique view (if one of
the views has been changed to a 3D view).

On-View Menu
To use the on-view menu, click and hold right anywhere on the oblique view (except for the red annotations or the
3D cursor) then move down to the required menu item.
The [Save Image], [Queue Report Image], [Enlarge] and [Reset Pointer] menu items are the same as those in
the Lumen and Curved on-view menus. See page 121.
The [Lock Cursor to Trace] menu item is the same as that in the Curved on-view menu. See page 128.
[Unlock Orientation]: when selected on an X-section or L-section view, returns the orientation mode to No Lock.
See page 132.
Use the [Create Trace], [Clear Last Point] and [Clear Trace] menu items to create 3D traces on the view if
required. They do not affect the centerline computed by Vessel Analysis.
Use the [Center on FOV], [Center on Object] and [Center on Cursor] menu items to center the oblique view on
the current field of view, the current volume of interest or the current 3D cursor position.
These menu items are the same as those of the standard oblique view. See the Volume Viewer 3 user
documentation.

5 OTHER VIEWS
By default, a curved view, Lumen view and oblique view are displayed during vessel analysis (after vessel
identification and quantification). However, all other Volume Viewer 3 view types are also available.
To display a different view type in one of the views, select it in the view type on-view menu.
Alternatively, use the (Advanced Views) button in the Step 3 protocol panel to rapidly display the most frequently
used view types in the top left view (see page 88):
- Curved,
- 3D VOI,
- X-Section,
- Navigator,
- 3D MIP,
- L-Section.
The view type on-view menu also displays the list of previously segmented objects or protocols:
- Tree VR,
- Angiographic,
7
- Heart Graft,
- Heart.
Note: This list may change depending on the CardIQ Xpress option installed on your AW - check protocol
applicability table in the CardIQ Xpress Options section of Chapter 1).

Selecting one of these object/protocol will recall and display the segmented object if previously segmented or will
launch the corresponding protocol.
The specific features of the 3D views are described below. For the other Volume Viewer 3 view types, refer to the
Volume Viewer 3 user documentation.

3D View
When used with CardIQ Vessel Analysis, a 3D view includes the vessel centerline and the vessel cross section
contour corresponding to the position of the cursor line on the Lumen view.
The 3D view can use several different modes.
To display the entire exam volume in HD MIP rendering mode:

• Select [3D] in the on-view menu, or [MIP] in the Advanced Views panel.
To display the VOI (Volume Of Interest) computed by the software:

• Select [VOI] in the Advanced Views panel.
To display the volume around the centerline corresponding to the width of the Lumen view:
• Display a 3D "MIP" or "CVOI" view, then select [Clip to Width] in the Lumen on-view menu.
To align the orientation of the 3D view with that of an oblique view:

• On the oblique view, select [Align 3D Views] in the drop-down menu of the section mode active annotation. 7

When used with CardIQ Vessel Analysis, the 3D view contains an additional shutter mode active annotation (at
lower left, "No VOI" by default).
To display a curved VOI (Volume Of Interest) i.e., a “curved slice” that uses the centerline as a reference and that
is displayed in 3D:
• Display a 3D "MIP" or "VOI" view, then select [Curved VOI] in the drop-down menu of the shutter mode active
annotation.
Adjust the thickness of the 3D “slice” by means of the VOI slice thickness active annotation that appears next
to the shutter mode active annotation when a curved VOI is displayed.
To display the 3D view with a spherical "shutter" centered on the 3D cursor (only the volume inside the sphere is
displayed):
• Display a 3D "MIP" or "VOI" view, then select [Shutter on Cursor] in the drop-down menu of the shutter mode
active annotation.
Adjust the diameter of the sphere by means of the shutter size active annotation that appears next to the
shutter mode active annotation when a shutter is used.
When you move the 3D cursor, the shutter moves with it.
7

6 DENSITY MEASUREMENT
While processing exams with the CardIQ Vessel Analysis protocols, the user can perform density measurements
on the images, e.g., if an abnormality is detected on an image.
• Click on the (Display Tools) button on the Control Panel and select the X cursor tool in the pull-down menu,
or select directly the X cursor tool from the Review Controller.
• Move the cursor onto a reformatted view.
• Deposit a point with a left click on the feature you are interested in.
The density of the tissue at this point in Hounsfield values is displayed on the view, as well as the RAS
coordinates of the point. This annotation line can be attached to the X cursor by selecting the Linked
Annotation box in the ROI Preferences panel (available by clicking Display Tools > Preferences > ROI Prefs).
To measure the density at different points, drag the X mark on the view with the left mouse button, or place
more points.

7 MEASUREMENT ACCURACY
This section discusses some of the aspects concerning measurement accuracy that are applicable in particular to
the measurements performed with CardIQ Xpress.
The software calculates and displays measurements with a resolution of one decimal place
CAUTION (such as 0.1 mm, 0.1 degree, etc.).
You should be aware that the real measurement accuracy is generally considerably less for
a number of different reasons.
To assess the accuracy of the measurements performed with CardIQ Xpress, you should be
fully familiar with the section "Measurement Accuracy" in the chapter "Measurements" of
the Volume Viewer 3 User Guide, and with the information below.
Summary
A CT exam (data set) consists of voxels (volume elements). The dimensions of a single voxel determine the lower
bound of the measurement accuracy (geometrical accuracy).
7
The final accuracy is further limited by a number of factors.
Automatic measurements computed by the software (vessel quantification) are affected by the limitations in the
available data. Noise, patient motion, acquisition and reconstruction imperfections, partial volume effects, the
small size of some features, etc., all tend to reduce the final accuracy that can be obtained.

If you are performing multi-phase automatic measurements (multi-phase vessel quantification), you should be
conscious that the limitations in the available data concern all the phase datasets you are working with and NOT
only the currently displayed one. The calculation of the quantification for one specific phase will depend on the
image quality of this particular phase.
Manual measurements are further affected by the fact that anatomical features are not of a uniform density, hence
dimensions are not unequivocally defined, and the apparent dimension of a feature (e.g., vessel diameter) on the
views can change with different display settings. When performing manual measurements under these
circumstances, a degree of judgment is usually necessary, and measurements made by different users will not
necessarily be identical.
Only the geometrical accuracy is mathematically quantifiable. The other factors will have to be evaluated by the
user, by examining the image data, to arrive at an assessment of the overall measurement accuracy.
Voxel Dimensions
The image set resolution, i.e., the dimensions of the voxels (volume elements) that constitute the image set, is
determined by the size of the field-of-view, the matrix size and the inter-slice distance.
In a typical CT image set to be used for vessel analysis, the voxel cross section in the acquisition plane will be in
the order of 0.3x0.3 to 0.5x0.5mm for a 512x512 acquisition matrix and a field of view in the order of 15 to 25cm.
Ideally, voxels should be isotropic (with the same dimensions along all three axes), i.e., the inter-slice distance 7
should be the same as the voxel dimension in the acquisition plane. In practice, however, considerations such as
patient irradiation dose levels will usually lead to the choice of a larger inter-slice distance.
To reliably identify and measure the small-diameter vessels that are significant in cardiac analysis, inter-slice
distances in the order of 1 to 2mm, and less if possible, should be used. An upper limit of 2.5mm may be
acceptable for some cases.

You should be aware that details with dimensions in the order of or less than the inter-slice distance cannot be
identified or measured with any degree of reliability.
Geometrical Accuracy
For CT image sets, the largest dimension of a voxel (normally the inter-slice distance) determines the geometrical
accuracy:
- For a distance measurement, the geometrical accuracy of the displayed length is equal to +/- largest voxel
dimension,
- For an angle measurement, the geometrical accuracy depends on the length of the segments, and
improves as the length of the segments increases. As an example, for an angle measured between
segments which are five times larger than the largest voxel dimension, the geometrical accuracy of the
displayed angle value is equal to +/- 10 degrees.
- For an area measurement, the geometrical accuracy of the displayed area value is equal to +/- the
circumference of the region of interest multiplied by (largest voxel dimension)2 / 2.
The geometrical accuracy defines a lower bound on the overall accuracy that can be obtained. Further limiting
factors are the acquisition accuracy, vessel analysis quantification algorithm, partial volume effects, display
settings and display resolution.
Note: The accuracy (+/-) values shown in the Vessel Analysis reports corresponds to the geometrical accuracy
as defined above. 7
Distance, angle and area measurements are valid only if all segments defining the
CAUTION
measurement are longer than the inter-slice distance.

The geometrical accuracies defined above, when related to vessel measurements, are valid
CAUTION only if the vessel diameter is larger than 2mm.
Acquisition Accuracy
The quality of the vessel analysis, quantification and measurement results is critically dependent on the quality of
the original acquisition.
Cardiac acquisitions can contain heart beat motion and breathing motion artifacts that will degrade the vessel
analysis results. These can be caused by inadequate synchronization with the heart beat, or insufficient temporal
resolution.
Because of the small size of the coronary vessels, the acquisition parameters (image resolution, inter-slice
distance) should be chosen carefully with respect to the dimensions features to be examined. Insufficient
acquisition resolution may result in degraded measurement results and the appearance of artifacts such as false
stenosis. Insufficient contrast may have the same consequences, and may also result in vessel identification
errors.
Any errors in the acquisition and reconstruction process such as calibration and slice interpolation errors will be
added to the same extent to the measurement error.
Before using an image set for vessel analysis, the user should check for the presence of heart
CAUTION beat motion and other artifacts on axial and coronal images. 7
It is the user's responsibility to insure that sufficiently accurate acquisition parameters are
used with respect to the dimensions of the features to be analyzed.
Insufficient acquisition resolution (temporal, dimensional and contrast) may result in
pathologies or other anatomical features not being visible on the images. It may also result
in degraded measurement results and the appearance of artifacts.

Multi-Phase Measurement Accuracy
In multi-phase datasets, the quality of the vessel analysis, quantification and measurement results for a given
phase is critically dependent on the quality of the original acquisition for this specific phase. Before applying a
vessel analysis protocol to a multi-phase dataset, the user should check for the presence of heart beat motion
artifacts and other artifacts on axial and coronal images for all loaded phases.
Quantification Algorithm
The vessel quantification algorithm computes the vessel cross-section contour at each point along the centerline.
These contours are displayed on the oblique X-section and L-section views. The corresponding computed
measurements (cross-section area and mean diameter) are shown by the curve on the Lumen view, and can be
included in the report.
The algorithm provides a best fit to the data available in the exam. However, the user should be aware that the
limited spatial and density resolution of the clinical images processed with CardIQ Xpress also imposes limitations
on the attainable measurement accuracy.
Correct vessel quantification is critically dependent on such factors as acquisition image quality and voxel size
(image resolution and inter-slice distance), and anomalies may occur because of the limitations in the available
data. It is the responsibility of the user to verify the result of the vessel identification and quantification process 7
before using the data for analysis.
Several factors may combine to degrade the accuracy of the quantification:
- The small size of the cardiac vessels (the vessel cross section is defined by only a limited number of voxels),
- Low contrast between the vessel and the surrounding tissue,

- Statistical variations in both the concentration of the contrast product in the vessel and the density of the
surrounding tissue, resulting in variations in the apparent diameter of the vessel from point to point,
- Variations in the original image data resulting from the acquisition and subsequent reconstruction process,
- Partial volume effects, in particular where calcifications are present,
- Motion artifacts.
Assess the quality of the quantification by correlating the curve (mean area or mean diameter) on the Lumen view
with the display of the vessel on the views.
Some indications of degraded quantification are:
- Large variations ("noise" and other irregularities) in the curve that do not correspond to clearly visible
anatomical features,
- Irregular cross-section contours on the oblique X-section views, that do not match the outline of the vessel.
If the anomalies are only local, you can correct these using the Edit, Register and Save functions (see page 78).
Otherwise, it is preferable to consider the automatic measurements as approximate, and perform measurements
manually (see Step 4 - Add a New Measurement in Chapter 5 - Vessel Analysis - Procedures, page 88 onwards).
Note: The factors that tend to degrade the quantification results do not affect the vessel centerline tracking
process to anywhere near the same degree. As a result, you can generally obtain satisfactory vessel
identification and display, even when the quantification results may be indicative only.
If you are performing multi-phase vessel quantification, assessment of the quality of quantification must be done 7
for each phase.
Partial Volume Effects

In CT exams, the value of a voxel is the weighted average for all materials in the voxel. Because of the high
attenuation coefficient of calcium, even a small amount of calcium in a voxel will weigh its value towards that of
calcifications or bone, so that the entire voxel appears to be calcifications or bone.
In vessel analysis, this partial volume effect will tend to make calcifications in the vessels appear larger than they
are in reality, and hence affect the measurement accuracy.
Another partial volume effect occurs at the interface between two tissue types with different densities. The
transition between the two densities is not a step, but partial volume voxels with intermediate values occur at the
interface. This affects the measurement accuracy, because the dimension of a feature is not sharply and
unequivocally defined, but depends on to what extent the partial volume voxels are taken into account.
Display Settings and Display Resolution

Since anatomical features are rarely of a uniform density, the apparent dimension of an anatomical feature can
change when you change the display settings (window width and level).
The automatic measurements computed by the CardIQ Xpress software are not affected by this, because the
software does not rely on the display settings for vessel identification and quantification.
However, when you place the measurement points yourself, e.g., for an additional diameter measurement, the
apparent diameter can differ by one or more voxels depending on the W/L settings, thereby adding another factor
of uncertainty.
When four views are displayed on the workstation screen, each view has a display resolution of 512x512 pixels,
and you obviously cannot place a manual measurement point with a precision better than a single pixel. Since
most exams used for vessel analysis are based on a 512x512 acquisition matrix, display resolution normally does
not impose a further limitation on accuracy, the more so because in most cases the display field of view (DFOV)
7
used during analysis is smaller than the acquisition field of view.

7

CHAPTER 8 - VESSEL ANALYSIS - CONFIGURING PROTOCOLS
CardIQ Xpress is supplied with five pre-defined Vessel Analysis protocols: Left Coronary and Right
Coronary for the imaging and quantitative analysis of the left and the right coronary artery,
respectively, with sub-branches; Coronary for the imaging and quantitative analysis of individual
coronary arteries; Tree VR [Pro only] and Angiographic View for the extraction of the coronary
vessel tree structure and aorta (and myocardium for Angiographic View) from the surrounding
tissues. Use these protocols as they are, or use them as a starting point to configure your own custom
protocols, to account for individual differences in patient pathology.
This chapter describes how to create custom Vessel Analysis protocols as required, by configuring
the pre-defined protocols through adding, modifying or removing points.

1 PRE-DEFINED PROTOCOLS
The Left Coronary, Right Coronary and Coronary protocols have been defined for the analysis of the coronary
arteries.
The tracking (vessel definition) points in Step 1 of these protocols comprise the start of the section to be analyzed
and a number of branches.
The pre-defined Left Coronary protocol contains seven tracking points (six branches): Start of section, Left main
artery, Left anterior descending artery, First diagonal, Second diagonal, Left circumflex artery and Left marginal
branch.
The pre-defined Right Coronary protocol contains four points: Start of section, Right Coronary Artery, Posterior
Descending Artery and Posterior Lateral Branch.
Neither of these pre-defined protocols contains intermediate tracking points (see page 151 for details).
The pre-defined Coronary protocol contains one branch; it allows to deposit intermediate points to improve the
reliability of the tracking process.
The pre-defined Tree VR and Angiographic View protocols contain nine tracking points: Start, Left Anterior
Descending Artery, First Diagonal, Second Diagonal, Left Circumflex Artery, Left Marginal Branch, Right Coronary
Artery, Post Descending Artery and Post Lateral Branch.
The measurement points in Step 3 of these protocols comprise a proximal reference point, a distal reference point
and a generic set of section-of-interest points identified as A-Z. 8
The associated measurements in the report include the mean diameter and the cross section area at each of these
points, expressed in mm / mm2 and in % relative to the reference.

2 CUSTOM PROTOCOLS
Overview
You can re-configure the pre-defined protocols to meet your own particular requirements.
For incidental changes, simply re-configure the protocol before or during the current analysis session.
To set up a custom protocols, re-configure an existing protocol using a representative exam, then save the
protocol under a new name.
To add, modify or remove tracking points (used to define the vessel to be analyzed), re-configure the protocol in
Step 1 "Define Section to Analyze". See page 150 onwards.
To add, modify or remove measurement points or related measurements between points, re-configure the protocol
in Step 3 "Select Section of Interest". See page 155 onwards.
If your changes are only to be used for the current exam, use the modified protocol to perform the analysis, then
save or film the report as required. If you also intend to re-use the modified protocol for future sessions, save the
protocol under a new name before closing it. See page 166.
Note: To quickly add one or more basic measurements (such as diameter, area, distance, angle or volume),
to be included in the report of the current session only, you do not need to re-configure the protocol: use
Step 4 "Add a New Measurement" of the current protocol. See Chapter 5 - Vessel Analysis -
Procedures.
8

Configuring Tracking (Vessel Definition) Points
To configure the tracking points:
• Display Step 1 "Define Section to Analyze" (if necessary use the (Back) button).
• Select (Configure Protocol) to open the Configure Tracking Points panel.
The list of existing tracking (vessel definition) points is displayed.
List of tracking points
Click on label to select a point Point type

(to add a point under the selected
point, or to modify or remove a
point)
Select (Add), (Modify) or (Remove)
Close panel Save protocol

There are three types of points:
Root
- Root: this is the start of the section to be analyzed. This point cannot be
Interme-
modified or removed.
diate - Intermediate: use this type to better define the vessel, and in particular to
remove ambiguities where the vessel identification algorithm might not identify
the correct volume of interest.
Branch
- Branch: use this type to define branches. The vessel identification algorithm
Branch will track the vessel from the start ("root") point up to each branch point
separately.
Note: When adding or modifying points, "Intermediate" and "Branch" are the only options available.
Note: Occasionally, in complex situations, it may occur that the vessel tracking algorithm does not succeed in
identifying the volume of interest correctly (this may be indicated by an error message, or it may be
obvious from the display).
This can be resolved by adding one or more intermediate tracking points. These will be used by the
vessel tracking algorithm as additional information while determining the volume of interest. They are
not used by the subsequent vessel identification process, so that the computed vessel centerline may
not pass exactly through such intermediate points.

• Select the point in the list under which you want to add a point, by clicking on its label.
• Select (Add) to open the Add a Tracking Point panel.
Enter name for point Enter abbreviation for point
Select tracking type from menu
Enter prompt text for point
Cancel and return Accept entries and

to previous panel return to previous panel

• Select the Tracking type: [Intermediate] or [Branch].
• Enter the necessary information in the three text fields. Click inside each field to select it, then enter the text
from the keyboard. For corrections, move the text cursor with the left and right arrow keys or by clicking with
the mouse. You can insert characters from the keyboard, or delete the character before the text cursor with
the <BackSpace> or <Del> key.
Point name: enter the full descriptive name of the point. Try to avoid names longer than the width of the text
entry field (40 characters max.).
Abbreviation name: enter an abbreviation for the name (or the full name if it is short enough). The
abbreviation will be displayed on the views. Limit the length to about ten to twelve characters at most.
Prompt text for point: enter the instructions ("prompt") that will be shown in the "Define Section to Analyze"
panel, indicating how and where to place the point.
The prompt text does not need to fit inside the text field: when you reach the right edge it will scroll
automatically. Type the text as one long sentence: when displayed afterwards it will wrap round automatically.
Do not use the <Enter> key.
Note: If you are adding a new point for the current session only, the prompt text can be a brief reminder to
yourself, such as "Above bifurc.", or can even be left blank.
However, if you intend to save the protocol for future use, it is advisable to write out the prompt text fully,
such as "Click with the left mouse button to select a point just above the bifurcation". This avoids any
ambiguity during later use of the protocol, either by yourself or by another user.
• Select (Accept) to validate the new point and return to the Configure Tracking Points panel, or (Cancel) to
annul the operation. 8
Note: If you entered a name or abbreviation that already exists, a message will alert you to this and the new point
will not be entered in the list.

To modify a point:
• Select the point in the list by clicking on its label.
• Select (Modify) to open the Modify a Tracking Point panel.
• Modify the Tracking type and the information in the three text fields (point name, abbreviation and prompt
text) in the same manner as described above for a new point.
• Select (Accept) to validate the modification and return to the Configure Tracking Points panel, or (Cancel)
to annul the operation.
To remove a point:
• Select (Remove).
The point is deleted from the list without requiring user confirmation.
Notes: Take care when removing points. Once deleted they cannot be restored.
The starting point (type "Root") cannot be removed.
At this stage you can save the protocol (see page 166) or return to the panel for Step 1 "Define Section to Analyze"
by clicking on the (Back) button.

Configuring Reference Points and Measurements
Overview
When configuring the protocol, a distinction is made between measurement points and related measurements.
The reference points are located on the centerline of the vessel and associated with measurements such as
diameters and cross section area at that point.
The measurements refer to measurements between points, such as angles, or the length or volume of a section
between two points. If the points do not already exist in the protocol you must add them before you can add the
related measurement.
You add, remove or modify reference points and measurements separately (see page 156 and page 161,
respectively).

Configuring Reference Points
To configure the reference points:
• Display Step 3 "Select Section of Interest" (if necessary use the (Back|Next) buttons).
• Select (Configure Protocol) to open the Protocol Configuration panel with the Ref Points tab selected by
default.
Add, modify, remove points
Close panel
Save protocol

The list of existing reference points is displayed. There are three types of points:
- No Diameter: no diameter or cross section area measurements will be associated with the point.
You may want to define such a point for a related measurement (such as an angle, length or volume,
see page 161), if the diameter and area measurement at the point itself are not required in the report.
- Auto Diameter: all diameter and area measurements for the point will be computed automatically by the
software and included in the report.
- Manual Diameter: only a manually defined diameter (distance) measurement will be associated with the
point. To perform such a measurement during analysis, move the 3D cursor to the appropriate cross
section, then place two points on the oblique X-section view. You may want to include these instructions
in the "prompt" text (see below).
An example would be the presence of a thrombus or calcification, where an automatic measurement will
show the diameter of the lumen, and the user may want to add a measurement of the actual vessel
diameter.

To add a new point:
• Select (Add) to open the Add a New Point panel.
Enter name for point Enter abbreviation for point

Select measurement type
("diameter") from menu
Enter prompt text for point
Cancel and return Accept entries and

to previous panel return to previous panel
• Select the Diameter Type: [No Diameter], [Auto Diameter] or [Manual Diameter].
• Enter the necessary information in the three text fields. Click inside each field to select it, then enter the text
Point name: enter the full descriptive name of the point. Try to avoid names longer than the width of the text 8
entry field (40 characters max.).

abbreviation will be used in the report lists, and displayed on the views. Limit the length to about ten to twelve
characters at most.
Prompt text for point: enter the instructions ("prompt") that will be shown in the "Select Section of Interest"
panel, indicating how and where to place the point.
The prompt text does not need to fit inside the text field: when you reach the right edge it will scroll
automatically. Type the text as one long sentence: when displayed afterwards it will wrap round automatically.
Do not use the <Enter> key.
Note: If you are adding a new point for the current session only, the prompt text can be a brief reminder to
yourself, such as "Mark bifurc.", or can even be left blank.
However, if you intend to save the protocol for future use, it is advisable to write out the prompt text fully,
such as "Click with the left mouse button to select a point just above the bifurcation". This avoids any
ambiguity during later use of the protocol, either by yourself or by another user.
• Select (Accept) to validate the new point and return to the Protocol Configuration panel, or (Cancel) to annul
the operation.
Note:If you entered a name or abbreviation that already exists, a message will alert you to this and the new point
will not be entered in the list.
To modify a point:
• Select (Modify) to open the Modify a Point panel.
• Modify the Diameter type and the information in the three text fields (point name, abbreviation and prompt 8
text) in the same manner as described above for a new point.

• Select (Accept) to validate the modification and return to the Protocol Configuration panel, or (Cancel) to
annul the operation.
To remove a point:
The point is deleted from the list without requiring user confirmation.
Note: Take care when removing points. Once deleted they cannot be restored.
At this stage you can configure the related measurements (see page 161), save the protocol (see page 166) or
return to the panel for Step 3 "Select Section of Interest" by clicking the (Close) button.

Configuring Measurements
To configure the measurements:
• Display Step 3 "Select Section of Interest" or Step 4 “Measurements” (if necessary use the (Back|Next)
buttons).
• Select (Configure Protocol) to open the Protocol Configuration panel.
Add, modify, remove

measurement

• Select the Measurements tab.
List of measurements
Measurement type
Click on label to select a measurement
(to add a measurement under the selected one,
or to modify or remove a measurement)
Select (Add), (Modify) or (Remove)
The list of existing measurements is displayed. There are three types of measurements:
- Length: distance measured along the vessel centerline between the two points.
- Volume: volume of the section of the vessel between the two points.
- Angle: angle between a straight line connecting the two points and the vertical (RAS coordinate system).

To add a new measurement:
• Select (Add) to open the Add a New Measurement panel.
Enter abbreviation
Enter name for measurement
Select measurement type from menu Images in report on/off
Select start point in "From point" list

Scroll list if necessary
Select end point in "To point" list
Cancel and return Accept entries and return

to previous panel to previous panel
• Enter the necessary information in the two text fields. Click inside each field to select it, then enter the text
Measurement name: enter a descriptive name for the measurement. Try to avoid names longer than the
width of the text entry field (40 characters max.). 8

abbreviation will be used in the report lists, and displayed on the views. Limit the length to about ten to twelve
characters at most.
• Select the measurement type: Measure a [Length], [Volume] or [Angle].
• To include only the measurement values in the report: set (Film) to off.
To include both the measurement values and the corresponding images in the report: set (Film) to on.
• In the side-by-side lists, select (highlight) the start point in the From Point list, and the end point in the To Point
list. If necessary use the up/down buttons under each list to scroll through the list.
You can only set up measurements between existing points. To set up measurements between points not yet
in the list, first return to the Protocol Configuration panel and create the new points as described earlier
(page 156).
• Select (Accept) to validate the new measurement and return to the Protocol Configuration panel, or
(Cancel) to annul the operation.

To modify a measurement:
• Select the measurement in the list by clicking on its label.
• Select (Modify) to open the Modify a Measurement panel.
• Modify the information in the two text fields (measurement name and abbreviation), the measurement type,
the From and To points, and select whether to include the images in the report ( (Film) button), in the same
manner as described above for a new measurement.
• Select (Accept) to validate the modification and return to the Protocol Configuration panel, or (Cancel) to
annul the operation.
To remove a measurement:
• Select the measurement in the list by clicking on its label.
The measurement is deleted from the list without requiring user confirmation.
Note: Take care when removing measurements. Once deleted they cannot be restored.
At this stage you can configure the measurement points (see page 156), save the protocol (see page 166) or
return to the panel for Step 3 "Select Section of Interest" by clicking the (Close) button.

Saving the Protocol
If you intend to use the modifications of the protocol only for the current analysis session, return to Step 2 or Step 4
after you have made the modifications, perform the analysis and save or film the report, then close the protocol.
The modifications of the protocol will not be saved.
If you want to save the modified protocol for future use, you can do this at any stage before you actually close the
protocol. To do so:
• Select (Save Protocol) in the Configure Tracking Points or Configure Protocol panel.
If necessary, first move to either Step 2 or Step 4 and select (Configure Protocol).
• In the Save Configuration as New Protocol panel that is displayed, click inside the Name: text entry field,
and enter the new name from the keyboard.
• Select (Save) to save the protocol, or (Cancel) to annul the operation.
If the name already exists, a message will alert you to this. In the message window, select (Cancel) to repeat
the operation with a different name, or (Overwrite) to replace the existing protocol with the modified one.
The protocol will be saved in the same Volume Viewer 3 protocol category as the original protocol.
If the original protocol is a multi-phase protocol, the saved protocol will also be multi-phase. The chosen name of
the new protocol will automatically be followed by “MP”.
After saving the protocol, return to the Step 2 or Step 4 panel using the (Back) buttons. 8

Deleting a Protocol
If you regularly create customized protocols, you may at some point want to delete one or more protocols, in
particular if you have created successive versions of the same protocol and you want to delete the earlier versions.
To delete a protocol:
• From the Patient List: first start Volume Viewer 3 or CardIQ Xpress.
If Volume Viewer 3 or CardIQ Xpress is already running, close the current protocol and select (New Protocol).
• In the Select a protocol category panel, select the required category ("Cardiac" for CardIQ Xpress protocols).
• In the Select a protocol panel, click on (Delete Protocol) under the list. The panel changes to Select a
protocol to be removed.
• Click on the icon of the protocol you want to delete. A confirmation message "Do you really want to delete this
protocol?" is displayed. Click on (Yes) to confirm, or on (No) to cancel the operation.
If required you can remove more than one protocol by selecting and deleting them one after the other.
• Click on (Cancel) to close the panel and return to the Select a protocol category panel.
Note: The pre-defined protocols supplied with CardIQ Xpress cannot be deleted.

8

9
CHAPTER 9 - EJECTION FRACTION [PRO]
CardIQ Xpress Pro is supplied with the Ejection Fraction protocol, for the imaging and quick computation
of the left ventricle ejection fraction parameters.
This protocol contains the successive steps required to perform left ventricle segmentation: cardiac
reformat, (ES) and (ED) phase selection, cut plane selection, edition of the segmented volume, display of
the heart functional parameters.
The Ejection Fraction protocol steps include the Cardiac Reformat protocol (as a first step) to the
computation of the left ventricle ejection fraction.
The Ejection Fraction protocol uses several view types: Short Axis, Long Axis, Vertical Long Axis that come
in addition to the standard view types available in Volume Viewer 3.
This chapter describes the view types and associated controls used with the Ejection Fraction protocol.
All standard and optional tools, view types, etc. that are part of the Volume Viewer 3 application are also
fully available at all times. Refer to the Volume Viewer 3 user documentation for full information on those
functions.
For more information about the Cardiac Reformat step, refer to Section 2 of Chapter 9, Image Review.

9
1 EJECTION FRACTION PROTOCOL

The Ejection Fraction protocol is a multiphase protocol dedicated to the calculation of the ejection fraction from
the left ventricle volume at end systole and end diastole.
Launching the Ejection Fraction protocol automatically launches Cardiac Reformat that displays oblique views of
the heart oriented along Short Axis and Long Axis.
Note: The orientation of the Short Axis, the Long Axis and the Vertical Long axis is locked by default.
• Adjust the Short Axis and Long Axis views if necessary (see Chapter 9, Section 2 Cardiac Reformat batch
protocol) and click (Next): the Sagittal view turns into an Axial view and the ES/ED Phase Selection panel is
displayed,

9
• Click the arrow buttons on the panel to display the different phases on all views,
Note: To display the different phases, you can also right-click the phase annotation or press and hold <ALT>
while hitting <Page Up> or <Page Down> .
Note: By default, the first phase to select is the End Systole phase.
• Once you have selected the End Systole phase, click (Store Phase) to validate. The panel switches
automatically to End Diastole selection mode allowing you to select the End Diastole phase,
• Select the End Diastole phase and click (Store Phase) to validate,
• Click (Next): the Prepare Segmentation panel is displayed,

9
• For the End Systole phase, place the cursor on the mitral valve using the 4-chamber long axis view for
• For the End Diastole phase, place the cursor on the mitral valve using the 4-chamber long axis view for
• Click (Next): the left ventricle is automatically extracted for both the ES and the ED phases according to the
cut planes defined above, and is displayed in the upper left viewport. The left ventricle contours appear in
green in the Short and Long Axis views. The Left Ventricle Model Edition panel is displayed allowing you to
improve the left ventricle segmentation if necessary,
Note: Papillary muscles are automatically excluded from model.

9
• Use (Add Structure), (Remove Structure) or (Scalpel) buttons in case left ventricle contours are not accurate
for ES and ED phases,
• Click (Next) to display the results:
• ED volume (EDV),
• ES volume (ESV),
• Stroke volume (SV = EDV - ESV),
• Ejection Fraction (EF = SV/ED).
Note: Results are displayed on both the Ejection Fraction results panel and the VR view.

9

CHAPTER 10 - IMAGE REVIEW
10
The primary CardIQ Xpress tools for the review and analysis of CT cardiac exams are the Vessel Analysis
protocols described in the previous chapters.
Additionally, CardIQ Xpress is supplied with:
- An Ejection Fraction protocol [Pro only] to calculate the ejection fraction from the left ventricle volume at
end systole and end diastole (see Chapter 8 - Ejection Fraction protocol),
- Volume Rendering protocols customized for cardiac image review,
- A Batch protocol to view, save and film batch series of reformatted images aligned with the short and long
axes of the heart.
- A Phase Registration protocol (for multi-phase datasets) to align a ventricle or a coronary vessel.
This chapter describes the use of the Volume Rendering, Batch and Phase Registration functions.
All standard and optional tools, view types, etc. that are part of the Volume Viewer 3 application are also
fully available at all times. Refer to the Volume Viewer 3 user documentation for full information on those
functions.

10
1 VOLUME RENDERING PROTOCOLS
Chapter 1.
CardIQ Xpress is supplied with a set of Volume Rendering (VR) protocols (Cardiac, Heart, Heart Graft and
Cardiac Transparency) optimized for cardiac imaging.
VR "Heart" protocols (where the name of the protocol begins with "Heart") first automatically segment the exam
to extract the cardiac region, then display it using VR presets optimized for cardiac imaging. The other VR
protocols in CardIQ Xpress use volume rendering to display the entire exam, without segmentation.
Use these protocols to obtain a global view of the cardiac region, to examine the overall spatial relations and those
parts of the vasculature located on the outside of the region. You will mostly use the protocols as a starting point,
then adjust the settings to optimize the display.
To examine the vessels separately in more detail, use the Vessel Analysis protocols.
See Chapter 5, Chapter 7 and Chapter 8.
This section describes the protocols and provides a summary of the principles of Volume Rendering and its
controls, with particular reference to its use for cardiac imaging. For a full description of volume rendering, consult
the Volume Viewer 3 user documentation.

On views displayed in volume rendering mode, the visibility of anatomical features is
CAUTION determined by curve type (threshold mode), opacity thresholds and maximum opacity settings. 10
Essential anatomy or pathologies may not be visible for a given setting of these parameters.
Views that use volume rendering should always be correlated with the original acquisition
images.
"Heart" Protocols
The CardIQ Volume Rendering protocols with names that begin with "Heart" include an automatic segmentation
feature.
They automatically segment the exam to extract the cardiac region by removing surrounding structures such as
the sternum, ribs, spine and lungs, and unconnected blood vessels such as the descending aorta, from the 3D
volume. The remaining cardiac region is then displayed using volume rendering.
The volume rendering settings are determined by the VR preset included in the protocol. You can select other VR
presets, or use the Volume Viewer 3 VR Tools to modify the settings.
When used with a multi-phase dataset, the Heart protocols perform the extraction of the cardiac region for all the
phases. They can be used to generate a cine loop (movie) of a beating heart. For more information, refer to
Chapter 10 “Movie Creation”.
Note: To include the automatic segmentation feature in a custom protocol created by modifying an existing VR
protocol, save the protocol under a new name that also begins with "Heart".

Note: The segmentation process removes the external structures from the 3D model in the workstation
memory. To return to the original exam volume, select [Restore volume] in the on-view menu (right
mouse button) or switch to another protocol. 10
Note: Using the Heart Graft protocol is recommended for an optimized segmentation of the heart in presence
of grafts. This protocol uses various VR presets for a better heart imaging.
Cardiac Transparency protocol
The Cardiac Transparency protocol displays a VR view containing:

• the left chambers,
• the right chambers,
• the VR tree (i.e. aorta + coronaries),
• the heart muscle,
• the surrounding bones.

The Cardiac Transparency protocol uses an automatic segmentation algorithm to separate
CAUTION heart cavities from cardiac muscle and bones. An insufficient contrast in the heart cavities can
lead the algorithm to display only a transparency view of the heart with Tree VR and bones. 10
For some exams, the identification of the heart cavities may fail. After computation, perform a
visual check of the different volumes and correct them using the Autoselect tool (Add/Remove
vessels).
In the Automatic Vessel Selection panel:

• click (Display Vessels) to grow coronary vessels (refer to the Tree VR protocol),
• click (Adjust) to refine vessel display via the Automatic Selection panel,
• click (Next) to bring back the cardiac chambers and myocardium. If modifications to the model are necessary,
highlight the object that requires editing then edit it.
• Drag the sliders of the 3D Visualization panel to adjust the transparency of:
• the left chambers,
• the right chambers,
• the VR tree,
• the heart muscle,
• the surrounding bones.

Other Protocols
CardIQ Volume Rendering protocols with names that begin with "Cardiac" will load and display the complete exam 10
volume using volume rendering, without segmentation.
Volume Rendering
In brief, volume rendering is used to display 3D objects by allocating different levels of "opacity" to different voxel
values. Additional information can be shown by using color shading, i.e., displaying different voxel value ranges
in the image in different colors.
The use of volume rendering takes into account that tissue density is not uniform and that the distinction between
two features of different density is determined by a range of voxel values rather than by a single fixed value.
An example is the display of contrast-enhanced vessels with typical voxel values in a range of 200 to 450 HU (but
some as low as 100 HU) embedded in soft tissue with typical voxel values in a range of -100 to +100 HU.

By setting the opacity to 0% (transparent) at 0 HU and to 100% (opaque) at 200 HU, tissue below 0 HU will be
displayed as fully transparent and tissue above 200 HU as fully opaque. Soft tissue above 0 HU will still be
displayed as mostly transparent, vascular tissue below 200 HU still mostly as opaque. As a result, the vessels are 10
displayed clearly separate from the surrounding tissue.
Volume Rendering is well suited to separating features with such adjacent voxel value ranges because it does not
rely on a fixed single threshold value to distinguish the two. By contrast, the conventional technique of
thresholding combined with surface shading is much more sensitive to the threshold setting: too low a threshold
and "pieces" of soft tissue start appearing around the vessels, too high a threshold and part of the vessels is no
longer displayed.
Presets
The settings of the VR presets in the CardIQ Volume Rendering protocols are primarily aimed at displaying
contrast-enhanced blood within the exam, i.e., the arterial vasculature and the large volumes such as atriums,
ventricles and aorta. You can adjust the settings in these presets to optimize the display.
While you can use these presets as they are, their primary purpose is to act as a starting point: after applying a
preset, adjust the settings to optimize the display of the anatomical features and/or pathologies being examined.
The settings you will be using may vary from exam to exam, depending both on the characteristics and quality of
the acquisition data and on the particular features and pathologies in the exam.
When you change any of the control settings the display is updated each time, allowing you to rapidly determine
the best settings for the features you are currently examining.
You can save the settings that best match your particular requirements as new custom protocols.

You can also study features other than vasculature by using Volume Rendering settings different from those in the
CardIQ VR presets.
10
Controls
For a detailed description of the volume rendering controls (VR Tools in the Volume Viewer 3 control panel) refer
to the Volume Viewer 3 user documentation.
This section summarizes the controls and their use for cardiac imaging.
In brief, there are two techniques:
- Use the VR Opacity panel to set the curve type, opacity values and maximum opacity, and the VR Colors panel
to define the color style and the colors used for color shading,
or:
- Use the VR Colors panel to defined one or more "attached objects". All controls for this function (opacity
values, maximum opacity and color) are combined in the VR Colors panel and the VR Opacity panel is
inoperative.
To display the VR Tools control panels, click on the (VR Tools) button in the Volume Viewer 3 main control panel,
and select the panel in the menu. After opening one of the panels, you can move between them with the
(Back|Next) buttons.
The panels are displayed on top of the lower left view. You can move them by clicking and dragging on the title
bar, or close and recall them as necessary via the VR Tools menu.

VR Presets Panel
The VR Presets panel contains the controls to select VR presets, to delete/save VR presets and to switch to VR
color and VR opacity panels.
10
Anatomy: menu to select VR preset

from other anatomical categories
("Cardiac" category by default)
Preset list: click on icon to select
Scroll preset list

Delete/Save Preset
Close VR Tools panels

Next to Opacity/Color panel
The VR presets supplied with CardIQ Xpress use color shading for added contrast between anatomical features
(e.g., to accentuate calcifications).

VR Opacity Panel
The VR Opacity panel contains the controls to set the opacity (curve type, voxel values, maximum opacity).
10
Transparency sliders: drag slider to

adjust object transparency
Object preview
Maximum Opacity: move

Delete Object thumbwheel to adjust or click up/
down arrows
Color: color shading on or off

Curve Type buttons
Close VR Tools panels Switch to Preset/Color panel
Select the curve type with the buttons below the Opacity control bar, then move the two diamond-shaped sliders
to set the control points for the selected curve type, i.e., the voxel values of the endpoints of the curve.
- The (upramp) is the most commonly used curve type. It is used in the CardIQ VR presets.
- The (show range) curve type can be used to "hollow out" the vessels and blood volumes. Select a voxel
range corresponding to the outer limits of the vessels and blood volumes only, then apply a cut plane (see
page 189) and rotate the 3D volume as required. This can allow you to examine some interior features.

The (downramp) and (hide range) curve types have no practical application in cardiac imaging.
Two features are available to help match the opacity curve settings to the voxel values (HU numbers) in the exam:
- The small red triangular cursor marker below the scale on the control bar continuously indicates the voxel
10
value (HU number) at the position of the 3D cursor. By moving the 3D cursor to different positions on an
anatomical feature, you can rapidly assess the voxel value range that defines it.
- Whenever you move one of the sliders, all voxels with HU numbers higher than the slider setting are shown
with green hatching on the baseline views.
Use the {Maximum Opacity} thumbwheel to set the opacity (in percent) of the point of maximum opacity of the
selected curve.
- When lowering the maximum opacity to a value below 100%, voxels in the maximum opacity range of the
curve are no longer displayed as fully opaque but as transparent to a degree determined by the maximum
opacity setting. Displayed features are now built up from the contribution of several voxels along the "line of
sight", and the effects of incidental high-value voxels (noise, small intervening anatomical features) on the final
image are attenuated.
- The maximum opacity setting also affects the color shading. See VR Colors Panel, page 188.
When saving the current setup as a new custom protocol via (Save Preset), you can include the automatic
segmentation feature (see page 177) in the custom protocol by using a name for the new protocol beginning
with "Heart".

VR Colors Panel
The VR Colors panel contains the controls used to set up color shading, and also to create "objects" defined by
the range of voxels corresponding to a color control point (slider).
10
You can switch between normal and enhanced resolution images. The use of normal resolution accelerates the
display of changes to the image while enhanced one improves the display of small features. Use normal resolution
to set up the image, then switch to enhanced resolution to view the final result.
The Partial Volume Filter function is described in detail in the Volume Viewer 3 user documentation. It has little
effect on cardiac-type images and can usually be left off.

Color style: set style of color transition 10
between control points to [Ramp] or [Step]
Color palette: move marker
to set color hue and saturation
for selected color slider Attach Object: display voxel range defined
by selected color slider as separate "object"
Brightness: adjust to vary Add/Delete Color

overall image brightness
Color control bar: click on slider to
select it, click and move slider to set color
control point
Close VR Tools panels Back to Opacity/Preset panel
Color shading can be turned on or off with the (Color) button.

The use of color shading allows you to differentiate features in the image defined by different voxel values within
the visible voxel range.
As an example, by displaying a lower range of voxel values in red and a higher range in white (as in one of the VR
presets) it becomes possible to accentuate the presence of calcifications.

The effect is more pronounced at lower maximum opacity settings: this makes "outside" voxels more transparent
so that underlying features become visible.
The choice of the actual colors depends on your requirements. For instance, for images to be used for 10
presentations or documentation you may prefer "natural" colors (such as red for the blood volumes and white for
calcifications and bone) while under different circumstances you may want to use contrasting "false" colors to
accentuate a particular feature. The CardIQ VR presets show examples of both.
Two features are available to help match the color settings to the voxel values (HU numbers) in the exam (similar
to those on the opacity control bar, see previous paragraph):
- The small red triangular cursor marker below the scale on the color control bar continuously indicates the
voxel value (HU number) at the position of the 3D cursor. By moving the 3D cursor to different positions on
an anatomical feature, you can rapidly assess the voxel value range that defines it.
- Whenever you move one of the color sliders, all voxels with HU numbers higher than the slider setting are
shown hatched on the baseline views with the color corresponding to that slider.
The Attach Object function uses a technique of defining "objects" by a range of voxel values "attached" to a color
slider. This function is described in detail in the Volume Viewer 3 user documentation.
For a single object the result is directly comparable to that obtained with the "show range" opacity curve mode.
The difference is that the opacity curve and maximum opacity are now set up on the color control bar at the same
time as the colors. The opacity control bar is inoperative if any attached objects are defined.
When you define more than one object, you can adjust maximum opacity for the voxel range of each object
separately.

Other Functions
Some of the display and 3D processing tools from Volume Viewer 3 available on the 3D view may be useful in
10
special cases.
Cut planes: you can apply a front cut or back cut plane to the 3D view.
- A front cut will remove all features in front of a plane perpendicular to the line-of-sight passing through the 3D
cursor. Such a cut plane, together with appropriate rotation of the 3D volume and suitable VR settings, can
for instance be used to view a 3D cross section of a region of interest.
- To select a cut plane, use the drop-down menu of the cut plane active annotation ("No cut" by default).
Cut planes are a display feature only, they do not change the 3D volume.
Note: In VR "Heart" protocols (where the name of the protocol begins with "Heart"), the automatic
segmentation removes external features such as sternum and ribs.
- If for any reason you use a VR protocol without automatic segmentation, the sternum and ribs tend to obstruct
the display of features on anterior views. If you cannot bring a feature of interest into view by simply rotating
the 3D volume, placing a front cut plane just behind the sternum on an anterior view will remove the sternum
and most of the ribs without affecting the display of the cardiac region.
3D shutter: you can apply a 3D "shutter", i.e., a spherical cut plane centered on the 3D cursor, to the 3D view.
- Only the part of the exam located inside the sphere is displayed.
- To apply a 3D shutter, select [Shutter on Cursor] in the drop-down menu of the shutter mode active
annotation ("No VOI" by default). Use the shutter size active annotation (which appears when the shutter is
present) to adjust the diameter of the sphere.
The 3D shutter is a display feature only, it does not change the 3D volume.
10
2 CARDIAC REFORMAT BATCH PROTOCOL
Launching the Cardiac Reformat protocol automatically displays oblique views of the heart oriented along Short
Axis, Long Axis and Vertical Long Axis:
• Sagittal (S),
• Long Axis (LA),
• Vertical Long Axis (VLA),
• Short Axis (SA).
Sagittal Long Axis
Vertical Long Axis

Short Axis
(behind panel)

- Adjusting Long and Short Axis views
The orientations of the Short and Long Axis views are locked by default. However, you can manually correct these 10
orientations by adjusting:
• the Long Axis view in the Sagittal view,
• the Short Axis view in the Long Axis view.
- Adjusting Long Axis view

• Click the Long Axis button. The Sagittal view is selected and the Long Axis view is unlocked,
• Page through the images in the Sagittal (upper left) viewport and find the image with the mitral valve and apex
of the heart,
• Rotate the yellow line so it goes through the mitral valve and apex: the result can be seen in the Oblique (upper
right) viewport.
- Adjusting Short Axis view

• Click the Short Axis button. The Long Axis view is selected and the Short Axis view is unlocked,
• Position the cursor on the mitral valve on the Long Axis view,
• Rotate the yellow line so it is perpendicular to the Long Axis of the left ventricle.
• Click the Short Axis button again to deactivate the edit mode and to display batch icons.

Note: The batch buttons described below are not available in the Cardiac Reformat panel of the Ejection
Fraction protocol.
10
Using Batch buttons
CardIQ Xpress is supplied with Batch buttons to view, save and film batch series of reformatted images aligned
with the short and long axes of the heart.
The Short Axis batch button is used to prescribe batch series of short axis views only.
The Long Axis batch button is used to prescribe batch series of long axis views only.
The Vertical Long Axis batch button is used to prescribe batch series of vertical long axis views only.
These batch images can be used as input for the Function package.

Short Axis batch
• Click the Short Axis Batch button: the batch lines are automatically displayed perpendicular to the long axis
10
of the heart.
Batch lines
Batch center.
Batch rotation points (red dots) Click and drag to move batch
Click and drag to rotate batch

Modify, film and/or save batch
The Batch Film panel that is now displayed is identical to that used elsewhere in Volume Viewer 3.
10
Refer to the Volume Viewer 3 user documentation for a full description of the controls and functions in this panel.
The Short Axis protocol uses the following default batch setup:
- Parallel oblique batch of 25 views with 4.0mm spacing,
- Field of view 20.0cm,
- The views are 4.0mm thick slices (MPVR), using Average rendering mode,
- Output mode is defaulted to Save.
• To view the batch images, select (Preview).

This sets up a movie loop of the batch images. You can run through the loop, or pause and step to examine
individual images.
• To modify any of the default settings, select (Modify).
The use of the Modify Batch panel is described in full in the Volume Viewer 3 user documentation. The basic
features are:
• To change any of the numerical parameters, click inside the corresponding field to select it,, delete the existing
value using the <BackSpace> or <Del> key, and type in the new value. Confirm with <Enter>.
• The number of views and the spacing between views are linked: changing one automatically changes the
other, so that the depth of the "stack" stays the same.
To change the depth of the batch "stack", click and drag on the red arrows that are displayed on the first
and last batch line.

• To view the modified batch before accepting it, select (Preview).
• When you are satisfied with the changes, select (Accept). To cancel the changes, select (Cancel). Either
command returns you to the Batch Film panel. 10
• To save the batch images as a new series on the workstation hard disk, select (Save).
Note: The default output mode for the protocol is Save.
To film the batch images, select (Modify) and change the mode to [Film] in the Output pull-out menu.
To both film and save the batch at the same time, set the mode to [Film/Save].
Select (Accept) to close the panel. The legend of the button in the Batch Film panel will reflect the new
setting.

Long Axis batch
• Click the Long Axis batch button: the batch lines are automatically displayed parallel with the oblique long 10
axis plane.
Batch center.
Click and drag to move batch
Batch lines Batch rotation points (red dots)


• Check and if necessary modify the resulting batch, then save and/or film it, as described for the Short Axis
batch above (page 194).

Vertical Long Axis batch
• Click the Vertical Long Axis Batch button: the batch lines are automatically displayed parallel with the long
10
axis.
Batch rotation points (red dots)

Batch center.
Click and drag to move batch
Batch lines

• Check and if necessary modify the resulting batch, then save and/or film it, as described for the Short Axis
batch (page 194).

Using the Double Oblique Protocol
10
The CardIQ Xpress Short Axis and Short Long Axis protocols allow you to prescribe, view and save/film batches
of reformatted short and long axis views. You may want to use the same techniques to view a particular location
in a cardiac exam, without needing to film or save an entire batch.
In such cases, use the Double Oblique protocol from the Additional Guides protocol category, using the
procedure described below.
Note: You can save individual images at any time, using [Save Image] in the on-view menus or the <S> key
on the keyboard. The format of the saved images will be either Rfmt (reformat) or SSave (screen save)
depending on the setting of the Film/Save Options in the Volume Viewer 3 Filming Tools menu.
• Select (Additional Guides) in the main Volume Viewer 3 control panel, then select [Double Oblique] in the
protocol panel. Initially, an oblique, axial, sagittal and coronal view is displayed. The coronal view is hidden
below the protocol panel, but you can move the panel by clicking and dragging on its title bar, if required.
• Click on the sagittal view to select it.
• On the sagittal view, use the image location active annotation, or the slider of the {review controller} (with
Card. mode off), to move through the images, and display the image showing the mitral valve and the apex of
the heart.
• On the sagittal view, move and rotate the oblique reference line (solid yellow), so that it passes through the
mitral valve and the apex. You move the reference line by moving the 3D cursor, and rotate the line by clicking
and dragging anywhere on it except at the location of the 3D cursor.
The oblique view shows the corresponding long axis image.

Second oblique
• Select (Next). 10
A second oblique view is now displayed. The first oblique view is selected automatically, and displays the
reference line for the second oblique.
Short axis views
• Rotate the reference line on the first oblique view until it is perpendicular to the long axis.
The second oblique view now shows a short axis view.
• Move the 3D cursor to examine different locations.
Two-chamber long axis views
• Rotate the reference line on the first oblique view until it is parallel to the long axis.
The second oblique view now shows a two-chamber long axis view.
• Move the 3D cursor to examine different locations.
Four-chamber long axis views
• Re-select the sagittal view by clicking on it. If necessary return the 3D cursor to the initial position (see above).
The first oblique view now shows the four-chamber long axis view.
• Move the 3D cursor on the sagittal view to examine different locations in planes parallel to the long axis.
Note: When you re-select the sagittal view, the setup of the second oblique view is canceled and both oblique
views show the same image. To again display a short axis or two-chamber long axis view on the second
oblique view, re-select the first oblique view and re-align the reference line on that view.

10
3 PHASE REGISTRATION
Overview
The Phase Registration protocol is a protocol used with multiphase datasets, which allows the user to align a
ventricle or a coronary vessel, using images taken from different phases to create a new series dataset.
From time to time, cardiac images can show some misregistration artifacts, due to irregular heart motions, EKG
imperfections or other factors.
To correct these defects, this protocol allows you to replace misregistered slices by ones taken in other phases.
Registration will in particular allow you to obtain a better image quality of the coronary vessel before using a Vessel
Analysis protocol, or when creating a Cine Loop.
The protocol takes you through the following steps:
- Preparation of the registration,
- Registration of the structure,
- Saving of the result of the registration.
The protocol steps are described in more detail below.

Step 1 - Prepare Registration
10
• Select the reference phase using the Phase active annotation at the top of the views to page through all the
loaded phases.
• Use the oblique tool (yellow lines on the top right view) or the cursor to position the oblique view so as to be
able to properly view the artifacts to be corrected. (For more information on how to position the oblique view,
refer to Volume Viewer 3 User Guide, GE document ref. 5169457-100, Chapter 8 “Reformatting”, Section 2
“Oblique Reformatting”).
• Select (Next).

Step 2 - Phase Registration
10
Between Lines Around Cursor
The green lines displayed on the views represent groups of slices. The percentage displayed on the right of the
lines correspond to the phase associated with the group located beneath the line. Each group is composed of
slices which were reconstructed during the same heart cycle and at the same cardiac phase. Therefore
misregistration artifacts appear only between groups of slices rather than within a group. To start with, all groups
of slices belong to the same phase. If you want a better vision of the views, you can hide them by deselecting the
(Identify Slices) button.
• Select the registration mode, (Between Lines) or (Around Cursor), depending on wether you want to use
the red lines or the cursor to define the section to be registered.

• If you have selected Between Lines, move the red lines to select a region (group of slices) to be registered.
You can then require either an Automatic or a Manual Registration. You can use both modes one after the
other, and thus manually adjust an automatically registered image. 10
With an Automatic registration, the software will look at all the surrounding phases and replace the
misregistered slices by others taken in other phases. In this mode, the result of the registration is computed
to globally minimize misregistration for the whole heart region comprised within the selected slices.
In a Manual registration, click on the (Previous Phase) or (Next Phase button). The software will replace all
the slices included between the two lines by those of the phase you have requested. You will then visually
decide whether the image is registered. Repeat the changes as often as needed.
When performing a Manual registration, the result of the registration can only be visualized on
CAUTION a small part of the volume (the axial, oblique and coronal views for the current location).
Note: An automatic registration is performed on the whole heart region comprised within the selected slices.
For the same reasons as above, the result might not be optimal for the slices which are currently
visualized. If you want to optimize a specific region, you can use the Around Cursor mode. If you, want
to optimize a specific vessel branch using Phase Registration, you can also use the Register option in
the Step 3 of the Vessel Analysis protocols (refer to Chapter 5 - Vessel Analysis - Procedures ).

• If you have selected Around Cursor, place the cursor in the middle of the area you want to register. Click on
the (Automatic Registration) button. The software will then try to minimize the misregistration artifacts in the
region surrounding the cursor by looking at slices in other phase locations. Only slices located up to 2cm from 10
the current cursor position will be modified.
In the Around Cursor mode, the software looks only at the misregistration in a small region
CAUTION surrounding the cursor.
Annotations on Axial Views
Some annotations specific to the registration are displayed on the views:
- The name of the phase is displayed at the top of the views (percentage).
Note: Whenever wanted, the user can use the Phase active annotation to change the current phase and start
registering another phase. All the phases can be registered independently. On the Active Annotation pull
down menu, the name of the registered phases is followed by (Reg).
- The (Reg) annotation next to the name of the current phase shows that at least one slice of the volume has
been registered.
- Reg. Ph: 70% on the left of the view: original phase of a registered slice (on the Axial view only).

At this level you can close the Registration protocol and apply to the volume any protocol you need or any Volume
Viewer 3 tool. They will then be applied to the registered volume(s).The (Reg) annotation remains to inform the
user that the current volume has been registered. If you have, for example, registered different phases you can 10
create a Movie.
• Select (Undo) to cancel the last performed operation for the current phase.
• Select (Restore Original Volume) when you are not satisfied with the result of the registration and want to
start it again from scratch.
• Select (Next) if you want to save the registration for later session.
Step 3 - Saving Results

The Save Registration panel is now displayed. It will allow you to save the registered volume in the Patient List as
a new 3D object. Only the current phase is saved, with its registration and all the existing annotations, which
means that you will later be able to apply any single-phase protocol on this “modified” volume.
• Select (Save Registered Volume).
• A pop-up window is displayed requesting you to enter the name of the new object. This name will appear in the
Description of the new object in the Patient List.
• Select (OK).

4 CARDIAC SPECIFIC REVIEW FUNCTIONS 10
Layout Presets
Not all available layout presets and protocols may be shown in the Review Steps window. To see the full list of
layout presets and protocols, click on the Options/More button.
For more information on the Layout Presets, refer to the Volume Viewer 3 User Manual, Chapter 6 “Display and
Controls”, Section 2 “Panel Controls”.
Customizing the default layout preset [Pro only]

Note: The factory default layout for vessel analysis protocols is AVA Layout 3. Two additional layouts are
available in the Review Steps window: AVA Layout 1 and AVA Layout 2.
For every AVA protocol, you have the ability to select any other layout from the Layout Presets list (or to create a
new layout), and to save it as default.
The (Save Default Layout) button on the Display Preferences panel (available in Display Tools > Preferences)
will allow you to save the current layout so as to display it automatically when launching the same AVA protocol.
Using the Oblique Review layout preset

The Oblique Review layout preset allows you to define manually double oblique cross section snake views of the
vessels: orientate the first oblique from the axial view (first screen upper left view port) and the second oblique
cross section snake views from the first oblique view (first screen upper right viewport).

Using the 2D Cardiac Review scenario
The 2D Cardiac Review scenario allows you to review the exam in reference orientations for cardiac vessels study.
10
The available layouts are the following:
• Great Vessels: allows you to see the ostium and the beginning of the LAD and of the RCA.
• Grafts: allows you to see the mammary veins.
• RCA/LAD/CIRC Reviews: allow you to study the coronary arteries from the ostium to the distality part.
• Oblique Review: as described above, allows you to focus on the area of interest of a vessel without tracking.

3DPOS Active Annotation
A new active annotation line is provided in several of the CardIQ Xpress protocols to display LAO/RAO, CRA/CAU 10
angles on 3D views and oblique views. It is automatically updated each time the orientation of the view is modified.
LAO and RAO stand for Left Anterior Oblique and Right Anterior Oblique. They indicate a rotation from an initial
anterior view in the left and right direction, respectively.
CRA and CAU stand for Cranial and Caudal. They indicate an additional rotation in the up-down or down-up
direction, respectively.
It also allows the user to manually modify the orientation of the view, by changing the LAO or CRA active angle
value with the mouse buttons.
In several CardIQ Xpress protocols, clicking the 3DPOS active annotation text (LAO/RAO, CRA/CAU) displays a
list of predefined angles presets in a drop down menu. Clicking these angles presets allows the user to
automatically tilt the views in typical cardiac cath orientations (without changing the view type or the layout). The
orientations are shown in terms of LAO/RAO and CRA/CAU angles, e.g., “60 LAO” or “30 LAO 30 CRA”.
Cardiac Annotation
Some specific annotations are displayed on the left-hand side of axial images. These annotations are linked to
each view and change when you page through the views.
- Average heart rate
- BPM: cardiac rythm (in beats per minute)
- SSEG (Snapshot Segment), SSB (Snapshot Burst), SEGM (non gated reconstruction) : used cardiac
reconstruction algorithms
- 330 ms: temporal resolution.

Cardiac Filters
To apply a filter reducing the banding artifacts in a cardiac dataset, click the active annotation and select a filter. 10
By default, no filters are applied : the annotation is set to ‘(No filt.)’. The filters are described in the table below.
Table 1: Cardiac Filters
Filter Action
Card 1 Replaces the first slice of each band with an interpolated slice
Card 2 Replaces the last slice of each band with an interpolated slice
Card 3 Replaces both the first and last slices of each band with an interpolated slice
When a cardiac filter is active, all views showing the filtered volume have the string “(Card 1)” (resp. 2 or 3)
appended to the phase annotation.
Note: The current filter remains active when switching to another protocol.
Note: [Pro only] If a cardiac filter is applied, statistics for Color Identification will not be available. You must
remove the cardiac filter in order to display statistics to ensure accuracy.
Note: Cardiac filters can not be used in conjunction with phase registration.

Color Identification [Pro only]
The Color Identification function enables you to depict the plaque on all reformatted views by depositing two 10
points.
Check the instructions below for a detailed description:
• Click the (Color Identification) button (available in the Verification of the Results panel),
• Click on view to deposit the first point,
• Click on view to deposit a second point: a color ramp is automatically applied around the segment defined by
the two deposited points. It is displayed in all reformatted views as well as curved and oblique views,
• Click the plaque annotations (start pos., end pos. and diameter) to modify the length and the diameter of the
plaque,
• Click the plaque name annotation to display a drop-down menu allowing you to send the plaque to the Report,
to delete the plaque, or to select another deposited plaque.
A discrete color ramp with four segments is displayed on the left hand side of each view (except Lumen). The color
ramp defines a color for a range of voxel values.
Note: To adjust the color ramp, refer to the Color Ramp paragraph below.
Note: Statistics will not be displayed if cardiac filters are applied.

Color ROI
Depositing a 3D color ROI on view will allow you closer local study. 10
Click the 3D Color ROI button and click the image of interest: a rectangular graphic will display representing the
area of interest in three dimensions on axial, sagittal and coronal views.
Click the green box at the center and drag to reposition the ROI. Click the green boxes at the corners to resize.
Note: Size and position must be checked on the orthogonal views.
A default color ramp will display at the left border of the image. The color ramp defines a color for a range of voxel
values. To adjust the color ramp, refer to the Color Ramp paragraph below.
Color Ramp
Once a color plaque or color ROI is deposited, it is possible to see volumetric statistics and to adjust the color ramp
displayed on the left of the viewport.
Click the color ramp: the Color Map Table panel containing three tabs is displayed.
The Statistics tab displays a table containing the volumetric statistics of each range of voxels corresponding to a
color. The third column shows for each color the percentage of colorized volume inside the region of interest. If
several color structures have been deposited on the same exam, they can be compared in the same table.
The Configuration tab enables you to configure the color ramp. You can:
• Add/Remove color segments. By default, a new segment has no color.
• Change the color of a segment by clicking the color cell. A range of colors will display allowing you to select a
new color or to switch to “Black and White”.

Note: If you select “Black and White”, the voxels belonging to this segment will not be colorized but will display
their own grey level values. It allows you to create a gap between two color regions.
• Enter a name for a segment to personalize the color ramp. 10
• Adjust the limits of a segment.
Note: These limits can also be adjusted by middle mouse clicking and dragging to left or right the red
annotations on the ramp.
Note: Color segments are adjacent : the maximum value for a segment is the minimum value for the next
segment.
• Switch the color ramp from steps to continuous mode. In continuous mode, the color ramp is smoothed to better
detect repartition of grey values within each segment.
Note: Volumetric statistics are not available in continuous mode.
• Click the Presets tab once the color ramp is adjusted.
The Presets tab allows you to:

• Save the current color ramp as a preset.
• Remove the last applied preset.
• Apply a different preset.

Other Volume Viewer 3 Functions
Since CardIQ Xpress is part of the Volume Viewer 3 application, all standard and optional Volume Viewer 3 tools, 10
view types, etc. (such as Reformat and Navigator, and 3D processing, display and filming tools) are fully available
at all times.
These functions are described in the Volume Viewer 3 user documentation.
Certain separate applications that can be used for cardiac image analysis (such as the SmartScore and Function
packages) can be invoked directly from the Cardiac category protocol panel.
For the use of such applications, refer to their specific user documentation.

10

CHAPTER 11 - MOVIE CREATION
In CardIQ Xpress, all the Volume Viewer 3 filming tools are available. However, the software offers specific 11
additional features.
With multi-phase datasets, the user will be able to create movies of a beating heart with the Movie function.
For more information regarding the Movie function, refer to section Movie of the Volume Viewer 3 User
Guide, GE Ref. 5169457-100.
The Batch Loop function offers the possibility of creating a batch film focused on a specific vessel branch
(see section below).
All the animations can be saved in the Patient List or exported.

1 BATCH LOOP
In addition to the Batch Loop features of Volume Viewer 3, CardIQ Xpress offers the possibility of creating and
saving batch loops focused on a specific vessel branch. 11
These loops are created exactly in the same way as standard Volume Viewer 3 loops (refer to the Volume Viewer
3 user documentation). However, CardIQ Xpress offers new choices of batch loops:
• Loops on Curved or Lumen views that occur in rotation around the vessel branch. To create this type of loops,
specify a different angle for the (First View) and the (Last View) and possibly adjust the step (by acting on the
Angle active annotation).
• Loops on Oblique views, for X-section, L-section and Best-L-section modes that occur along the vessel branch.
To create this type of loop, specify the (First View) and the (Last View) linear position along the vessel (by acting
on the LP active annotation or using the Vertical Slider of the Review Controller) and possibly adjust the step.

CHAPTER 12 - OUTPUT
The regular AW Basic Display and Volume Viewer 3 tools are available within CardIQ Xpress to
save and film images.
The CardIQ Vessel Analysis protocols automatically generate a report that can be filmed and
saved as required. To fill in a Report with any CardIQ Xpress Pro protocol, refer to Section 2 in
this chapter.
12
You should take due care that saved or filmed images always include the necessary annotations.

1 SAVING AND FILMING IMAGES
Use the regular AW and Volume Viewer 3 tools to save and film images at any time during image review and
analysis with CardIQ Xpress.
• To save individual images, use either the <S> key on the keyboard or the [Save Image] menu item in the on-
view menus. 12
• To assemble a set of images that can be saved and filmed as required, use the Filmer.
• To save and/or film a batch of regularly spaced oblique images, or 3D images rotated in steps, use the Volume
Viewer 3 Batch Film function.
This Batch Film function is also included in the Cardiac Reformat protocol to save and/or film batch series of
short and long axis views. See Chapter 10 - Image Review.
Reformatted views (2D oblique and baseline views) are saved either in Rfmt or SSave format. Select the desired
format using (Filming Tools) > [Film/Save Options] in the control panel.
Refer to the AW Basic Display and Volume Viewer 3 user documentation.

2 FILLING IN A REPORT [PRO]
Every protocol of the CardIQ Xpress package includes a Reporting feature allowing you to fill in and save a Report.
To fill in a report, open the Report panel by clicking (Report) in the main panel and (Data Input).
The Report panel is made of three types of data entered manually by the user:
• [Pre-Exam tab] Pre-Exam data, 12
• [Findings tab] Exam Analysis data,
• [Conclusion tab] Post-Exam data.
Pre-Exam Data
Click the Pre-Exam tab in the Report panel and fill in the following areas:
• Family and Patient history,
• Exam procedure,
• Patient follow up,
• Patient form.

Exam Analysis data
The Findings tab allows you to:
• Create/Delete/Navigate through findings,
• Add information, measurements and comments related to a finding,
• Add images to a finding.
There are four types of findings:

12
• Plaque, Stent, Bypass or Anomalous,
• Normal,
• Ancillary or Other,
• Aneurysm.
Depending on the type of finding you create, the finding information area to fill in will be different.
Sending images, measurements and ROI's manually to the Report

Click the (Send to Report) button on the Review Controller to send the image to the Report. An icon for this image
is displayed in the Findings Image area. Clicking this icon will display a panel allowing you to rename, delete,
preview this image and add comment.
Right click a measurement/ROI on-view annotation and select (Send to Report) in the drop down menu to send
this measurement/ROI to the Report. It will attach the image with its associated measurement/ROI to the current
finding and display the measurement/ROI value in the Findings Measurement area. Clicking the image icon will

display a panel allowing you to rename, delete or preview this image, to add comment and to display
measurement/ROI statistics.
Sending automatic images to the Report

During the protocol workflow, you are enabled to send some data to the Report directly via the protocol panels.
The (Send to Report) button on the step 1 protocol panel will automatically:
• Create a finding with the name of the current protocol,
• Send the upper left viewport in six different orientations to the Report in the Automatic Images area. 12
The (Report Finding) button on the step 3 of vessel analysis protocol panel will allow you to select a finding type.
Once it is selected, a finding will be created in the Report with the name of the branch and the name of the current
finding.
Vessel Analysis summary images

When using CardIQ Vessel Analysis, the protocols automatically generate a report that contains the
measurements performed during the analysis and the associated images. This report can be filmed and saved
as required. See Chapter 5 - Vessel Analysis - Procedures.
In the course of a vessel analysis you can use the same tools as during review (see page 218) to film and save
images separately, but you can also "queue" images that will be added to the report.
To add images to the "report queue":
• Click with the right mouse button on the image to be saved, to open the on-view menu.
• Select [Queue Report Image] in the menu.

The queued images are added automatically at the end of the report when it is saved or filmed.
Post-Exam data
Click the Conclusion tab in the Report panel to display Post-Exam data:
• General images (images sent to the report when no findings have been created),
• Conclusion selector,
• Conclusion.
12
The conclusion selector allows you to select how the conclusion will appear in the Conclusion area. To customize
the report conclusion, click the (Report) button in the main panel, click (Configure) and follow the panel
instructions.
Saving the Report

The (Save Report) button displayed at the bottom of all Report panels will create in the AW database a new series
containing a Structured Report DICOM file (SR). All images are saved in the database separately as SCPT or
Reformatted series. As these images are linked to the SR file, removing them from the database will remove them
from the final Report.
This Report can be edited and modified in PDF or HTML with the Reporting Tool software application. For more
information regarding this application, refer to the Reporting Tool User Guide, GE ref. 5135929-100.

3 ANNOTATIONS
Reformatted views (2D oblique and baseline views) can be saved either in Rfmt or SSave format.
When using the Rfmt format, system information (patient name, location, etc.) is saved together with the image
and recovered by other viewing applications as required. Only user annotations (text, graphics) become part of
the image. 12
When using the SSave format, the saved images are of type SCPT (secondary captures). On such images all
annotations become part of the saved image and cannot be modified by another viewing application at a later
stage.
Using this format, all annotations (such as system annotations, text annotations, etc.) that are displayed on the
screen will also appear on the filmed or saved images. In the vessel analysis reports, extra annotations that
identify the images are also added automatically by the software.
If the annotations on the screen have been turned off (see the Volume Viewer 3 user documentation) they will not
be present on the filmed or saved images either.
Although images without annotation may be suitable for teaching purposes, diagnosis
CAUTION should not be performed with such images.

While working on an exam, you can hide the patient name on the views for increased confidentiality. If you have
done so, make sure to show the patient name again on the views BEFORE filming or saving images for diagnostic
purposes. To do this, refer to the Volume Viewer 3 User Guide.
When filming or saving images for diagnostic purposes, always make sure the patient name
CAUTION is displayed on all views.
12

4 SAVE STATE
The Save State allows you to save the current layout, the current protocol panel and the performed segmentations
listed below.
Layout
12
Loading a Save State will display the same layout as the one displayed when the Save State was performed.
Segmentations
The Save State allows you to save the following segmentations if previously computed:
• Tree VR
• Angiographic View
• Heart
• Heart Graft
Recalling them (when Save State is loaded) will not take additional computation time.

Protocol panels
The current protocol panel will be restored when reloading a Save State:
Cardiac Reformat
• main Cardiac Reformat panel and the orientations will be restored
Ejection Fraction
• current protocol panel for each step will be restored
Heart, Heart Graft, Cardiac
• current protocol panel will be restored
12
Cardiac Transparency
• current protocol panel and segmentations will be restored
Vessel Analysis protocols (Left Coronary, Right Coronary, Coronary, Tree VR, Angiographic View)
• Definition of Section to Analyze panel will be restored if tracking has not been performed before the Save State
• Verification of the Results panel will be restored if tracking has been performed before the Save State
Vessel Analysis protocols / Save Tracking

• multiphase centerline will be restored
• editions of the centerline will be restored if the centerline was edited
Save State will not restore the editions of the contours. Contours and quantifications will be recomputed.

Appendix 1 - Landmark Examples
To obtain satisfactory identification (tracking) of the coronary vessels, you need to mark the points at the
right location in the vessels.
This appendix illustrates some examples of suitable points for the left and right coronary arteries in a typical
exam.
These images are not intended as anatomical references but only as examples of how to
NOTICE place the points on the images. A1

1 LEFT CORONARY ARTERIES
3D MIP view, with the following points marked in the
left coronary arteries:
-Start of section (Start)
-Left main artery (LMA)
-Left anterior descending artery (LAD)
-First diagonal artery (1st Diag., branching off the left
anterior descending artery)
-Left circumflex artery (LCA) A1
-Left marginal branch (LMB, branching off the
circumflex artery)
The illustrations on the following pages show the

corresponding axial views.
Note: The 3D MIP view is oriented the same way as
the axial views (inferior-to-superior view) but
uses a smaller DFOV.

Start of section (Start)
The start-of-section point should be placed inside the
vessel near its origin, not in the aorta, to avoid vessel
identification errors.
A1

Left main artery (LMA)
A1

Left anterior descending artery (LAD)
A1

First diagonal artery (1st Diag.)
A1

Left circumflex artery (LCA)
A1

Left marginal branch (LMB)
A1

2 RIGHT CORONARY ARTERIES
3D MIP view, with the following points marked in the
right coronary arteries:
-Start of section (Start)
-Distal point in the right coronary artery (RCA)
-Posterior descending artery (PDA)
The illustrations on the following pages show the

corresponding axial views. A1
Note: The 3D MIP view is oriented the same way as
the axial views (inferior-to-superior view) but
uses a smaller DFOV.

Start of section (Start)
The start-of-section point should be placed inside the
vessel near its origin, not in the aorta, to avoid vessel
identification errors.
A1

Distal point in the right coronary artery (RCA)
A1

Posterior descending artery (PDA)
A1

Posterior Lateral Branch (PLB)
A1

A1

GLOSSARY
Note: Words in italics refer to terms defined elsewhere in the Glossary.

For general terms concerning the workstation and the AW Basic Display software, also refer to the
Glossary in the AW Basic Display Operator Manual.
3D Model - The representation of the 3D (three-dimensional) image data in the workstation computer memory.
3D models can be saved, archived and networked.
Active Annotation - A system annotation on a view that can be modified by the user to control certain viewing
parameters (e.g., window width and level), either by adjusting a numerical value, or by selecting an item from a
drop-down menu. Active annotations are displayed in red.
Algorithm - A step-by-step process used to solve a problem. In the CardIQ Vessel Analysis protocols, this refers
in particular to the process used to identify (track) and quantify the vessel section to be analyzed.
Annotation - Generally, workstation-supplied text which accompanies an image when it is displayed on-screen, G
describing when and how that image was acquired, with what parameters. Also, text and measurement
information added on a view by the user.
Artefact - Feature in an image resulting either from the initial data acquisition or subsequent computer processing
that does not correspond to a real feature in the original anatomical structure. Also see Partial Volume Effect.
Baseline view - A basic axial, coronal or sagittal view, aligned parallel to the main axes of the RAS coordinate
system.
Browser - The panel used in the AW 3.1 Basic Display application to select available images for display and
manipulation. Referred to as the Patient List in AW 4.0 or later.

CT (Computed Tomography) - Process of deriving anatomical information by computer synthesis of X-ray data,
acquired by means of a CT scanner in the form of parallel "slices".
DFOV (Display Field Of View) - The real dimensions of a view (width and height) with reference to the RAS
coordinates.
DICOM - Abbreviation for Digital Imaging and Communications in Medicine. Standard for the formatting and
exchange of medical images and associated information.
Display matrix - The number of pixels in a displayed image, expressed in terms of number per axis - e.g., 512 x
512.
Exam - In CT, all images made from data taken of a patient after entering a particular scan cycle.
Field of View (Acquisition FOV) - The area of the anatomy being imaged, usually expressed in centimeters. FOV
image size is a function of the acquisition matrix times the pixel size.
HU (Hounsfield Unit) - Scale unit denoting the density within a voxel in a CT data set.
Image - In this document the term "image" is used to designate the part of the exam data being processed and G
displayed on the workstation screen. Depending on the display settings, a view (q.v.) can display an entire image,
or part of it (zoom).
Image Display Area - During use of a viewing application, the portion of the screen where images are displayed.
Measurement Annotation - A user annotation on a view that shows the result of a measurement.
MPVR (Multi-Projection Volume Reconstruction) - A technique that allows you to define and display a "thick"
slice that encompasses a feature of interest, instead of using baseline and oblique views that represent slices that
are only one voxel thick.

On-view menu - Menu displayed either on a view or on a particular feature of a view such as a user annotation
by pressing the right mouse button.
Partial Volume Effect - The appearance of voxels with intermediate values at the interface (separating surface)
between two tissue types with clearly distinct and different densities, where these voxels do not correspond to a
real feature in the original anatomical structure.
Patient List - The panel used in the AW Basic Display application to select available images for display and
manipulation. Referred to as the Browser in AW 3.1.
Pixel - Abbreviation for "picture element", the smallest distinguishable component of a digital image display.
RAS - Abbreviation for Right/Anterior/Superior. Designation for the patient-linked coordinate system used in
CT data sets.
Rendering - Techniques used to represent a three-dimensional object on a two-dimensional surface.
Review Controller - On-screen tool to rapidly move through the images of an exam using a slider and arrow
buttons or display them in cine mode. Also allows to mark images of interest ("bookmarks"), then return rapidly to G
a marked image. The slider can be used to set slice thickness in MPVR mode.
Roam - Another term for "Scroll".
Scroll - An on-view control, used to view a particular part of an image by moving the image around within a view,
when the image has been enlarged ("zoomed") and hence the complete image no longer fits in the view.
System Annotation - An annotation on a view added by the system software, containing data concerning the
displayed image. Certain system annotations can be active, i.e., they can be modified by the user.

Text Annotation - A user annotation on a view containing text. Text annotations can be used to add comments,
or to add a legend to an anatomical feature on a view.
Title Bar - A bar at the top of a window that provides information about that window, and also allows you to move
the window to a different position on the screen by clicking and dragging on it with the mouse.
Toggle - The act of switching a function from on to off, or off to on, with a single mouse click of the pointer on the
function's button. Toggle buttons usually appear within windows and other monitor screen areas, but some keys
on the keyboard may also provide toggle functions.
User Annotation - An annotation on a view added by the user, containing either text or the result of a
measurement.
Vessel Tree - In the context of CardIQ Xpress, refers to the coronary arteries and all connected vessels, that can
be displayed separate from the surrounding tissue and large blood volumes by the Tree VR protocol.
View - Part of the workstation screen, used to display image data. The view area of the CardIQ Xpress screen
normally contains four views. A view can display an entire image, or part of it (zoom).
View Area - During use of a viewing application, the portion of the screen(s) where images are displayed. The G
view area normally contains four views, but a single view can be enlarged so as to take up the entire view area.
VOI (Volume Of Interest) - In CardIQ Xpress, the volume displayed in the 3D view that contains the selected
section of the vessel to be analyzed.
Volume Rendering - Rendering technique that links voxel values to varying degrees of opacity. Used in the
Volume Rendering protocols to display anatomical features (vasculature in particular) separate from the
surrounding tissue.
Voxel - Abbreviation for “volume element,” the basic element in a CT data set.

Window (1) - Describes the range of pixel values that are assigned a shade of grey. Narrow windows offer greater
resolution and contrast of anatomy having similar densities. It also helps you find the values for anatomy in which
you are interested. See window width and level.
Window (2) - "Window" is also the term used for an on-screen graphical tool used to display information.
Window Width and Level (W/L) - In this context, "window" refers to the range of pixel values within the image
data, that is assigned a shade of grey for display. "Level" refers to the center value. "Width" refers to the range of
pixel values displayed around this central level (the value corresponds to twice the number of intensities above
and below the currently set level).
The adjustment is marginally similar to adjusting brightness and contrast controls: a narrow window (low width)
translates to a high contrast of the display, and similarly a low level translates to a high value of brightness.
See the AW Basic Display Operator Manual for more details.

G

REVISION HISTORY
REV DATE REASON FOR CHANGE PAGES
1 September 2006 M3 release 248
2 January 2007 M4 release 248
3 April 2007 Post M4 release 248
NUMBER SIZE REVISION

5180542-100TPH Letter A5 3


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CardIQ Xpress Pro

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CardIQ Xpress 5180542-100 Rev. 3 i

CardIQ Xpress 5180542-100 Rev. 3 iii

6 How to use this Document ................................................................ 17

CardIQ Xpress 5180542-100 Rev. 3 iv

CHAPTER 3 - SUMMARY OF FUNCTIONS .............................................. 33

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CHAPTER 6 - VESSEL ANALYSIS - FEATURES ..................................... 95

3 Curved View .................................................................................... 122

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4 Oblique View ................................................................................... 129

5 Other Views ..................................................................................... 134

6 Density Measurement ..................................................................... 138

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CHAPTER 8 - VESSEL ANALYSIS - CONFIGURING PROTOCOLS ..... 147

CHAPTER 9 - EJECTION FRACTION [PRO] .......................................... 169

2 Cardiac Reformat Batch Protocol .................................................. 190

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4 Cardiac Specific Review Functions ............................................... 206

CHAPTER 11 - MOVIE CREATION ......................................................... 215

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CardIQ Xpress 5180542-100 Rev. 3 1

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3 CARDIQ XPRESS OPTIONS

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Table 1 - Protocols applicability

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Table 2 - Features applicability

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4 USING CARDIQ XPRESS

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Vessel Analysis protocols

Tree VR and Angiographic View

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Using CardIQ Xpress with Multi-phase Datasets

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6 HOW TO USE THIS DOCUMENT

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7 CONVENTIONS FOR THIS MANUAL

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Safety notice legends:

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Correct vessel quantification is critically dependent on factors such as acquisition image

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Tree VR and Angiographic View Images

Volume Rendering Images

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