FAQ'S Contents

• Processing Sequence
• Deleting Nuquest Wackers-Liu files
• Study Selection
• Preprocessing
• Search Region Placement
• Choosing General Electric Studies
• Choosing ADAC Studies
• Choosing Digirad Studies
• Choosing MIRAGE (Segami) Studies
• Archiving Results
• Protecting Study Names for Demos
• Exporting Studies to a Secondary Workstation
• Reading from a CD
• Common Error Messages

You will be choosing certain files from your primary workstation to input into the Wackers-Liu CQ cardiac suite. Once you are actually in the application, you will be primarily using the horizontal long axis view. The studies you select for input depend on the primary workstation, as well as the way the studies are named. Almost every manufacturer creates the correct views but they all call them something different within their environment. ASNC and SNM are trying to standardize this but, to date, have not been able to get all of the workstation manufacturers to agree. Wackers-Liu CQ was developed to be cross platform and that is why the user needs to choose the correct input studies.

You are asked to choose Study A and then Study B. In general, this will be stress and rest but you can choose current and old if you choose to compare these studies. The software is flexible enough for you to mix and match studies based upon what you want to look at. After Study A is chosen, clicking on NEW PATIENT returns you to the patient listing in order to choose Study B to be different.

You do not have to process a Study A and a Study B if you do not want. In order to process only one study (for instance, only the stress), choose that study as Study A, click DONE and then click DONE again without choosing Study B. Many sites will do the stress study first and, if that study is normal not perform the rest study. If you process the same patient a second time, you will be asked if you want to over write the existing data (replace what you have already done) or rename the result folder. In order to rename, click that option, click the cursor in the name box on the new screen and then proceed as you normally would.

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Preprocessing

The first step in the processing sequence is the preprocessing step. The upper and lower left hand boxes are used for image normalization. A good tip is to make the box smaller so that it includes only normal appearing myocardium. This will insure that your images are all normalized to the myocardium and not to some other area of uptake. This will also help in evaluating the rotating raw data images for attenuation artifacts. You can change the image that you are looking at with the slider located at the bottom of the panel.

The middle set of boxes are your perfusion images. The size of the box is not as important as having the center of the box located in the center of the myocardial cavity. This will also help in cases where there is significantly decreased (or absent) uptake in the apical septum and apex. If the software is having problems located the heart in these cases, move the center of the box closer to where the apex should be located. When you move the center of the box on the perfusion images, the box will move by the same amount on the gated images.

The upper and lower right hand images are your gated images. If you choose only one gated study, only one of these boxes will have an image in the box. Some sites reconstruct the gated images at a different time than the perfusion images so you can center the box on the gated image without having the box move on the perfusion image. One of the features in WLCQ is that it applies the perfusion regions directly to the gated images since they have a lower per frame count density. If you are magnifying your gated images differently from the way that you magnify the perfusion images, you will end up having to adjust the search regions on the gated study every time.

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Search Region Placement

When you are processing a study, remember that you are not making edges but are setting the limits for the program to determine where the hottest pixel is located. The first slice should be located one slice into the cavity. Look at the short axis views displayed along the bottom of the image set. The first slice should be placed on the slice after you are sure that you see myocardial cavity. The last slice on the perfusion images should be two (2) slices from the distal end of the septum, moving toward the apex. A good hint is to change the color displayed to WARM. The last slice marker generally falls at the point where the color changes to blue from yellow at the distal end of the septum. If you place the last slice to far into the valve plane, you will end up with apparent perfusion defects in the base. Make a note of the slice number for the last slice.

The last slice for the gated processing should be two (2) slices distal (into the valve plane) from where you placed it for the perfusion processing. In the current version of the software, you must move this slice manually. In the next release of the package, this step has been automated.

The modeling technique used for volume determinations assumes that the ventricular chamber is straight up and down and the lateral wall and septum are the same length. In many cases, this is not true. When the display is generated showing all of the model search regions on the short axis views, it is important to make sure that the regions are centered on all of the views.

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CHOOSING GENERAL ELECTRIC STUDIES

Your GE system training specialist should have outlined the functions within WLCQ during your system training session. Although there may be differences from computer to computer,in general you will be choosing the horizontal long slices (both gated and non gated) and raw data after it has been exported in Interfile format. You can use the DELETE STUDIES AFTER PROCESSING option in order to keep this folder clean. Please refer to your operators manual to see how to do this.

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CHOOSING ADAC STUDIES

1. When you click on QUANTIFY, you see the list of patients appear that are on your ADAC master system. Click on the patient name that you want to process and then click DONE.
2. You will next see the index of the studies that have been processed for that patient. For the first study (Study A or Stress), choose the following: Projection-S Proc GS Short Axis- S
3. Now click DONE
4. You will see the same study list but the lower box is now empty. Now you will choose the items for the second study (Study B or Rest). Choose the following: Short Axis- R Projection-R
5. After choosing the studies for analysis, click DONE. This will now copy the data from the ADAC to the PC.
6. After the copying phase (which takes just over a minute), you will see a display with three image sets across the top and two on the bottom. The left-most box on the lower display will be empty. Process these studies as instructed with WLCQ.

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DIGIRAD SYSTEMS

1. Process and reconstruct the study using the Mirage software as you always do. At the point where you can save the reconstructed data, you are given two (2) choices, transverse and frontal. Save the FRONTAL series. Complete your processing as normal.
2. After you have completed the processing, you will need to export the saved data using the EXPORT box. Click on this box. You will see a number of choices. You want to export the data using INTERFILE. You should have a pathway set up. The pathway is a number of folders with the last two being \export\eclipse.
3. Minimize the Mirage application and launch WLCQ from the Icon on your desktop. You will get a panel with the standard 4 boxes within the WLCQ application. Choose HOUSEKEEPING. You must first add the new path to the DISK SEARCH LIST. If the path for export set on the Mirage was …\export\eclipse, your disk search path should be one level higher …\export. Add the new path to the list, highlight the new path and click UPDATE LIST. Now click DONE and EXIT.
4. Now click QUANTIFY.
5. You will see the name of the patient that you just exported on the list. Click on that patient and it will be written to the lower box. Click DONE.
6. You will now see a list of the studies that were saved to the export folder. There are instructions at the bottom of the screen. Click on the correct choices for Study A (this is usually the stress study). You need to choose the raw data and the short axis view. If this study was the gated one, your raw data is labeled summed recon. You also need to choose the short axis gated view. After all three (3) sets have been chosen and written to the lower panel, click DONE.
7. The list of studies is identical to the one that you just worked with. This time you will be choosing Study B (usually the rest). Choose the raw data and the short axis view and then click DONE. If both studies were gated or only the rest was gated, this is the point where you would select the gated views along with the non gated views.
8. Process the studies as outlined in the users manual within the WLCQ application.

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MIRAGE (Segami)

1. Process and reconstruct the study using the Mirage software as you always do. At the point where you can save the reconstructed data, you are given two (2) choices, transverse and frontal. Save the FRONTAL series. Complete your processing as normal.
2. After you have completed the processing, you will need to export the saved data using the EXPORT box. Click on this box. You will see a number of choices. You want to export the data using INTERFILE. You should have a pathway set up. The pathway is a number of folders with the last two being \export\eclipse.
3. Minimize the Mirage application and launch WLCQ from the Icon on your desktop. You will get a panel with the standard 4 boxes within the WLCQ application. Choose QUANTIFY.
4. You will see the name of the patient that you just exported on the list. Click on that patient and it will be written to the lower box. Click DONE.
5. You will now see a list of the studies that were saved to the export folder. There are instructions at the bottom of the screen. Click on the correct choices for Study A (this is usually the stress study). You need to choose the raw data and the short axis view. If this study was the gated one, your raw data is labeled summed recon. You also need to choose the short axis gated view. After all three (3) sets have been chosen and written to the lower panel, click DONE.
6. The list of studies is identical to the one that you just worked with. This time you will be choosing Study B (usually the rest). Choose the raw data and the short axis view and then click DONE. If both studies were gated or only the rest was gated, this is the point where you would select the gated views along with the non gated views.
7. Process the studies as outlined in the users manual within the WLCQ application. RETURN TO CONTENTS

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ARCHIVING OF RESULTS

All results files generated are stored in a folder called "cqdata" and are listed alphabetically by the patient last name. After a while, this list will become fairly large. In order to move the results file to the archive, you will temporarily need to do this manually. When you click on the PREVIOUS STUDY button in the READ function, this operation will look at both current and archived results and generate a list of the studies for only that patient.

In order to manually move the results files to the archive, follow these steps.

SHORTENING THE READ LIST AND ARCHIVING STUDIES

As studies are processed, the patient list in the READ function will begin to get very long. There is a simple technique that you can use both to archive the studies and to shorten the list.
· Double click on MY COMPUTER
· Double click on LOCAL DISK
· Double click on WLCQ
· You should see two (2) folders, cqread and cqarchive. If you do not have a cqarchive folder, create it.
· Double click on CQREAD
· On the main menu, click on EDIT and SELECT ALL. You can choose individual studies by clicking on the study while holding down the CONTROL key.
· On any highlighted folder, RIGHT click and choose CUT
· On the desktop, once again double click on MY COMPUTER
· Double click on LOCAL DISK
· Double click on WLCQ
· Double click on CQARCHIVE
· In the folder, right click and choose PASTE.
· This will move the studies from cqdata to cqarchive.
· You should do this at the end of each week so that no more than one months worth of studies are in the cqdata folder.
· After closing all of your windows, add the cqarchive folder to the read list using the HOUSEKEEPING function contained in WLCQ (Processed Studies Disk List). You will be able to change between directories within the READ function to look for old studies and the PREVIOUS STUDIES button in the READ function will also search all directories for studies on the patient currently in the READ display.

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Deleting Nuquest Wackers-Liu files

In the process of running the Wackers-Liu CQ software, you will see two indexes that continue to grow in size until they become so large that they slow you down. These folders are both found in the WLCQ directory on your hard drive. You have the ability to empty them both without destroying or losing your raw data.

The first is the results file where your processed CQ data resides. The name of this folder is 'cqdata' and it is used to generate your list of patients when you enter the program from the READ function. In order to archive this data, you will need to copy the cqdata file.

From your desktop, go to MY COMPUTER>C >WLCQ and open the folder. Find the cqdata folder. Right click on the folder and rename it .Mount your archive device and drag the renamed folder with the left mouse button to your archive. You have now archived the data for later retrieval. To recover the data, just reverse the process. Remember to rename your new cqdata folder before you retrieve the old one.

You can now delete the data files using the HOUSEKEEPING function.

The second folder that you will need to delete is the folder that contains the processed cardiac slices that CQ uses. The process is similar to removing the data files.

From your desktop, go to MY COMPUTER>C>ADQ>AUX2. Open the aux2 folder and you will see a large number of additional folders. These contain the patient data used for CQ, not your original acquired Nuquest patient data. If you want to archive this data, follow the same procedure that you used for the cqdata folder. By moving these folders to your RECYCLE BIN, you will remove these patients from the list generated when you first click QUANTIFY. This will shorten your list and improve your processing efficiency. It is not necessary to archive this data since it has been generated from processing the Nuquest data and could always be recovered but that will require you to recover and reprocess the original data.

There is a second option that you might want to try. Go to HOUSEKEEPING and choose DISK LIST SEARCH LIST. This list is the folders where the WLCQ software looks for files to process. Click on the radial button that says DELETE STUDIES AFTER PROCESSING (at the bottom of the list). This will delete the WLCQ prepared data but not the actual Nuquest data. In the box for PATH, type C:\ADQ\AUX2 and then click ADD NEW PATH.

Go to the box on the left side. You will see your entry at the bottom of the list. Click on it to highlight the entry and then click UPDATE LIST. This will move that entry to the top of the list. Click DONE and EXIT. Now, after processing the Nuquest data it will be eliminated from the folder. Remember, if you want to reprocess the study, you will need to send it to the WLCQ software again.

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INSTRUCTIONS FOR PROTECTING NAMES IN DEMO STUDIES WITH WACKERS-LIU CQ

In order to eliminate names on studies for patient confidentiality without losing the original data, the first step is to add the patient study to the teaching file. This is done by displaying the patient data in the read function and then clicking on ADVANCED FUNCTIONS-TEACHING FILE-ADD. You will be asked a series of questions to categorize the study. The copy of the study is then added to a folder called CQTEAC.

In order to change the patient name, go to MY COMPUTER-C-WLCQ-CQTEAC. You will see a series of folders with patient names. It is not critical to change the folder name since it is not shown but you can if you want. Look into the folder and find a file named PATINFO. This file contains all of the demographics for that patient study. Double click on the patinfo icon and you will be asked to choose software to open the file. Use NOTEPAD. Make sure that the box asking about using this all the time to open the file is not checked.

When you open the file, you will see a line with the patient name. Place the cursor at the end of the line and delete the patient name. Click the X in the corner to close the file. You will be asked if you want to save the changes. Answer YES.

When you now access the study in READ, the categories will be displayed in the information box with no patient name.

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EXPORTING STUDIES TO A SECONDARY WORKSTATION

You can either copy the studies from the cqteac (or any other) file from one system to another over the network or copy the studies onto a CD and read on the second station from the CD.

NETWORK TRANSFER

Place the required studies in the cqteac folder on the second PC. In the Housekeeping portion of WLCQ, choose PROCESSED STUDIES DISK LIST UPDATES. Click in the Enter New input path here box and type C:\wlcq\cqteac and then click Add New Entry. This will place a new path on the drop down list in READ.

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Reading from a CD

Copy the cqteac folder from the primary workstation to the CD using the standard CR writer software supplied on the PC. In the Housekeeping portion of WLCQ, choose PROCESSED STUDIES DISK LIST UPDATES. Click in the Enter New input path here box and type D:\cqteac and then click Add New Entry. This will place a new path on the drop down list in READ.

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Common Error Messages

There will be times when you will get an error message from the software. These fall into two (2) categories- operational errors and fatal errors. Operational errors will give you a prompt telling you what the problem might be - not enough studies chosen, incorrect view chosen or patient names not being the same are just a few. These errors allow you to correct the problem and continue with your processing.

The second group are fatal errors (WLCQ-F error in auto Q attempt to subscript > rot_hl with IX is out of range) which kick you out of the program. The most common reason for these errors is selecting the wrong study from the patient study list. The error will give you a clue as what you did wrong. For instance, in this example, the error was in a routine called auto Q when it looked at the file rot_hl . This would be the rotated horizontal long axis view. The first thing to do is check to make sure the view was correctly centered in the box in the preprocessing step. If you get a fatal error, write down the error and contact us if you cannot fix it yourself. Referring to the study choice sections of FAQ is a good first step.

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UPLOADING NON CARDIAC DICOM IMAGES

You now have the ability to upload non cardiac DICOM formatted images and files to the Wackers-Liu CQ web site for remote reading. In order to access the upload screen for these types of files, you must launch your Internet browser and go to www.wackersliu.com/upload.htm. The files to be uploaded must be zipped prior to the upload. You also need to have a copy of Java (from Sun Microsystems) on your system. This can be downloaded from the Wackers-Liu CQ Home page.

Follow the instructions that you were given prior to the set up of your web site. Remember that you need to ADD the study to the box at the top of the screen before you try to upload.

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