One of the output screens from INSPECT ^TM .The normal files (left column); the patient data (second column from left), the standard deviation map (second from right), and the patient data with abnormal area indicated by the yellow region ( at 2.5 S.D. from the normal file) are shown. Row 1 is the Stress data; Row 2 shows the Reinjection data while Row 3 shows the reversibility data.

The SUMMARY from INSPECT ^TM shows all the short axis, horizontal long axis and vertical long axis slices from the SPECT study along with the Bull's-eyes and the quantitative output. Operator can point at any slice plane and see corresponding point on the Bull's-eye display.

INSPECT^TM Overview:

Complete processing and review package for SPECT TL ²⁰¹ myocardial perfusion imaging.
With NEW Normal files for SPECT dual isotope myocardial perfusion imaging.

• Doctor-friendly: fast and effective
• All images and quantitative information are contained in the clinical review module--never a need to leave the program and waste time.
• Quantitative Bull's-eye analysis and display using Gender-specific normal files
  • 50 males for SPECT TL²⁰¹
  • 50 females for SPECT Tl²⁰¹
  • 29 females for dual isotope.
  • 25 males for dual isotope.
• Quantification of stress/delay or rest or redistribution images.
• 3D bullet display
• Diagnosis of coronary artery disease by correlating clinical data with noninvasive test results.
• "HELP" menus aid the physician in the interpretation of the studies, and provide a methodolgy for sequential review of the qualitative and quantitative image data.

* Features

• Optimal cine display for stress/rest comparison:
  • Correct normalization of stress and rest cine displays to the region of the heart---no need to fiddle with the contrast adjustments
  • Rocking-chair display for enhanced 3-D viewing.
• Optimized bull's-eye processsing
  • Automatic apical and basal slice selection. Bull's-eye displays have decreased noise contamination.
  • To reduce noise: circumferential profile arrays acquired with interpolation algorithm. Bull's-eyes displayed using interpolation algorithm.
• Optimized SA, VLA and HLA slice review
  • QC display shows apical and basal slices selected for Bull's-eye processing
  • Fast alignment of stress and delay slices for optimal viewing.
• Enhanced features for comparison against normal files
  • Comparisons of patient data versus normal files can be performed at various standard deviations (SDs): To account for variations in, for example, breast tissue attenuation in women.
• Apical cap display for enhanced look at the apical region
• Optimized quantitative analysis provides:
  • Unique defect (not region) identification - Quantification of
    • Extent of Defect
    • Severity of Defect
    • Abnormal/normal count ratios
    • Ischemic score.
• Optimized quantitative analysis provides:
  • Unique analysis for reversibility (SMAP) which maps defect and normal zones from stress to rest
  • Provides quantitative measure of change in contrast and severity of defect between stress and rest to decide reversible versus fixed defect.
  • Unique analysis for reversibility (DMAP) which maps defect and normal zones from rest to stress
  • Provides quantitative maeasure of change in contrast and severity of defect between rest and stress to decide reversible versus fixed defect.
• Reversibility bull's-eye in conjunction with "region scale" provides a unique methodology to assess reversibility.
• Interactive summary screen to ensure that bullseyes "agree" with slice information.
• Three dimensional bullet display for better appreciation of the extent of the defect.
• Sequential bayesian analysis correlates clinical and noninvasive test data to evaluate patients for coronary arterydisease.
  • Provides post-test probability of disease using results of the SPECT Tl-201 scan [i.e. abnormal or normal or equivocal] in conjunction with clinical data and the results of the exercise treadmill test [i.e. patient have chest pain (??); developed >1.0 mm flat or downsloping ST-segment depression (??)].

End of INSPECT^TM Overview

PROSPECT ^TM Overview:

Quantitative analysis is performed on each of the short axis slices. From apex to base, each short axis slice is subjected to a maximal count circumferntial profile analysis. For all slices, except for the first two apical slices, the analysis is performed in "cylindrical" coordinates -- the maximum count is determined along 40 radial vectors (i.e. nine degree angular increments) which emanate from the center of the left ventricular cavity. For the first two slices, which do not have the doughnut-shaped appearance of the other short axis slices the maximum count in the slice is obtained. After short axis slice selection and the placement of a cursor at the center of the left ventricular cavity, the only other operator interaction involved in the analysis is the drawing of a circular region of interest about the left ventricular myocardial wall on the short axis image located 2/3 of the way from the apex to the base. The circle establishes the boundary for the radial search procedure.

The number of circumferential profile curves corresponds to the number of short axis slices. To simplify the analysis program we have fixed the patient Bull's-eye data to consist of 15 slices. Patient data having more than 15 slices are automatically minified, and those with less than fifteen slices are magnified to conform to this convention. Bull'e-eye image has counts correponding to the apical region in the center while the counts in the basal region are shown in the outer portion.

In addition to the conventional Bull's-eye display (from apex to base) we provide a better sampling of the apical region of the patient study. In this approach, the apical portion of the vertical long-axis array is sampled by radial vectors emanating from the center of the LV at a distance of 20% of the apcial to basal extent of the LV. Maximal counts were obtained at five different angular (theta) intervals (i.e. theta varied from 0 degrees to 90 degrees in 22.5 degree steps) with 40 phi values (i.e. phi varied from 0 degrees to 360 degrees in 9 degree angular intervals). The apical samples ( 5 x 40 = 200 values) are displayed in a two-dimensional bull's-eye representation (CAP display) with samples along the line passing through the center of the left ventricle (LV) (theta =0 degrees) shown in the center of the display.

On entry into PROSPECT^TM, apical and basal slice selection and the center selection at stress and delay are determined automatically. The operator should confirm that the program has performed the selections correctly. If not the operator can manually override any of the automatically determined values. The circle establishing the boundary of the maximal count search may need to be changed by the operator to surrond the LV myocardium and not touch any surrounding high count structures.

End of PROSPECT^TM Overview