FAQ
NeuroQ was developed to aid in the assessment of human brain scans through quantification of mean pixel values lying within standardized regions of interest, and to provide quantified comparisons with brain scans derived from FDG-PET, SPECT, Amyloid, and DatScan studies of asymptomatic control (AC) subjects. The Program provides automated analysis of these scans, with output that includes quantification of relative activity in 240 different brain regions (S-ROI’s), as well as measures of the magnitude and statistical significance with which activity in each region differs from mean activity values of brain regions in the AC database. Any region with an uptake below 1.65 S.D of the mean, established from the normal database is considered abnormal.
Are there any education or
training programs available for
NeuroQ?
Are there any education or training programs available for
NeuroQ?
At Syntermed we feel it is our obligation and mission not only to supply diagnostic medical imaging software but to help educate the medical community on how to properly use these techniques to improve the overall interpretation process of the patients studies. Experience and education are the tools that are required right now to improve the level of interpretation for brain PET/SPECT/Amyloid studies. Syntermed has teamed with Dr. Daniel Silverman at UCLA to offer a number of methods to receive this training and education.
Syntermed usually conducts a ½ day, no-cost familiarization workshop Saturday morning before the SNMMI annual meeting typically held in June. This workshop is designed for both existing and prospective NeuroQ users and is moderated by Dr. Dan Silverman. Feel free to contact us for more information. In addition Dr. Silverman conducts preceptor ships at UCLA, typically 2 times a year, that review brain cases and utilize NeuroQ as part of the curriculum. You can contact UCLA at their web site, http://nuc.uclahealth.org/body.cfm?id=30&oTopID=22, for information on these sessions.Syntermed along with UCLA provides an over read service where customers can send the difficult studies to Dr. Silverman and he will provide an over read with a report on his interpretation of the study. Many of our current customers have used this service and they are very impressed with world class interpretative skills Dr. Silverman offers for interpreting brain PET studies. Through this process they gradually increase their level of interpretative skills and their need for the over read service is reduced as their skills improve. There is a fee associated with this service.
Describe the basic workflow for
completing a final study.
Describe the basic workflow for completing a final study.
The workflow is described below:
PET DICOM data is transferred from the PET workstation to the Windows PC.
A file manager program called MCP which is running a DICOM store routine stores the data and displays the patient files on its screen.
The patient is selected and launched into NeuroQ for processing.
Initially the study needs to have the 3 Quality Control routines performed on the patient data prior to reformatting the study using 10 iterations (about a minute of processing) and this step could be performed by a technologist prior to the time the physician reviews the study. When it is done reformatting the processed results are stored as a separate file.
The physician then opens this processed file and the NeuroQ display comes up immediately.
The physician then looks at the NeuroQ results which flags the areas of low metabolic uptake and compares those areas to the areas on the patient's actual transaxial slices to visually confirm the decreased metabolic activity. Various options for normalization and changing color scales are available during the interpretation process.
All screens can be saved in multiple file formats and printed.
The spatial transformation was accomplished by a published method for elastic transformation developed by Tai, Lin, Hoh, Huang and Hoffman (IEEE Trans. Nucl. Sci. NS-44 1997, 4:1606-1612.)
The S-ROI’s were defined (and refined) by careful comparison with multiple sources including MRI, PET, and Talairach/Tournoux cross-sectional atlases and structural features of the normal template brain utilized in the Program, which were then saved as permanent ROI files to be applied to spatially transformed brains of other subjects. The resulting data output of the above processes was compacted into a smaller set of regional Clusters, allowing comparison to published values for normal brain activity as previously established by independent methods. Each Cluster value is defined by the average of the subset of all S-ROI’s pertaining to a given brain structure (e.g., inferior frontal cortex, thalamus, cerebellum) in all planes in which those S-ROI’s appears, weighted by the number of pixels contained within each S-ROI in each plane.
Is there a specific Imaging/Acquisition
Protocol which needs to be followed
if using the NeuroQ application for
analysis of brain PET studies?
Is there a specific Imaging/Acquisition Protocol which needs to
be followed if using the NeuroQ application for analysis of
brain PET studies?
Below is listed some information obtained from the UCLA group related to their clinical brain PET protocol for evaluation of dementia, with which the databases used in NeuroQ and associated research tools were generated. Beyond the parameters noted here, specific protocol/acquisition details have minimal impact on NeuroQ analysis, as all regional data are internally normalized to brain reference regions and whole-brain activity.
Acquisition Protocol: 18FDG (10 mCi for 2D acquisitions, 3.5-10 mCi for 3D acquisitions) administered i.v., 40 min uptake period with eyes open in dimly lit quiet room; followed by transmission and emission scans, reconstructed with attenuation correction.
Interpretation: A pattern of focal cortical inhomogeneities on PET, all accounted for by areas of infarction on MRI, implies dementia secondary to cerebrovascular disease, which also often affects cerebellum and subcortical structures. A pattern of focal cortical inhomogeneities on PET unmatched by MRI findings is consistent with a neurodegenerative disorder (e.g., Alzheimer's disease, Pick's disease, other frontotemporal dementia, dementia with Lewy bodies, dementia of Parkinson's disease, Huntington's disease, Creutzfeldt-Jacob disease, progressive subcortical gliosis.)
Can MRI and CT be used as an
overlay or fusion option?
Can MRI and CT be used as an overlay or fusion option?
At the current time we do not provide these options. We are working on the ability to overlay the CT image on the PET dataset and that will be released in a subsequent version of NeuroQ.
Can other modalities be viewed by
the radiologists on your system
(CT, MRI)?
Can other modalities be viewed by the radiologists on your
system (CT, MRI)?
No, NeuroQ is specific for the display and quantitative analysis of PET FDG brain studies.
Can exam reports/results be viewed
from this platform?
Can exam reports/results be viewed from this platform?
Not at the current time. There are plans to release an integrated report generation tool in a subsequent release of NeuroQ.
Can your system query other
locations for other exams?
Can your system query other locations for other exams?
No, the DICOM data must be pushed from the PET workstation to the PC where NeuroQ resides.
Do you have options for printing
from your software images and tables
or demographics, is there an additional cost for
this feature?
Do you have options for printing from your software images
and tables or demographics, is there an additional cost for
this feature?
NeuroQ can print any of the screens to a connected printer. In addition, NeuroQ provides the capability to save digital images of the screens using the following file formats: DICOM SC, JPEG, Windows BMP, TIFF, PNG, and PPM. These digital files can be sent via email to the referring physician or used in slide presentations. The print and digital save features are all included in the standard NeuroQ package. In addition, we are working on implementing the ability to send the images to a DICOM printer.
Would we have the options to save the
images generated by this program as
part of the patient’s digital file?
Would we have the options to save the images generated by this
program as part of the patient’s digital file?
NeuroQ will have the capability to save the screen file as a DICOM secondary capture file which can be stored with the patient’s digital file. In addition, NeuroQ will save the processed file which contains the reformatted study that is also stored with the patients study. Having the reformatted file available eliminates the need to reprocess the study each time with NeuroQ.
Is it possible to burn the results to a
CD burner and, if so, can the referring
physician view the results in a format
that would show enhanced images and
demographics or results of analysis?
Is it possible to burn theresults to a CD burner and, if so, can
the referring physician view the results in a format that would
show enhanced images and demographics or results of analysis?
NeuroQ offers the ability to save the display screens in various image file formats, i.e. DIOCM SC, JPEG, TIFF, BMP, etc.. These files can be burned on a CD or can be sent via email to the referring physician and then they can opened and viewed with any standard display program: Internet Explorer, Photoshop, Paint, etc…
What acquisition parameters were
used for the normal database and
were the images that make up the
reference data reconstructed using
measured or calculated attenuation
correction?
What acquisition parameters were used for the normal database and
were the images that make upthe reference data reconstructed using
measured or calculated attenuation correction?
The normal database studies were acquired using a Siemens/CTI HR scanner. Some of the data was acquired in 2D and some in 3D mode and the data was tested against patient data acquired in both modes also. Scans were reconstructed with measured attenuation correction. Also, in the UCLA experience, patient scans which have been reconstructed with calculated attenuation correction algorithms give reasonable quantification results in NeuroQ (as we would expect, since the two methods yield very similar images except in cases where there has been gross structural deformation).
Does NeuroQ require calibrated
SUV data for processing?
Does NeuroQ require calibrated SUV data for processing?
No, NeuroQ is analyzing relative uptake (the program normalizes the uptake to the average gray matter uptake) so an absolute calibration is not necessary.
What registration algorithm is used
for registering the patient data?
What registration algorithm is used for registering the patient
data?
The registration algorithm is a robust spatial transformation method published by Henry Huang and Ed Hoffman, along with their collaborators. It was originally described in IEEE (Tai et al., IEEE Trans. Nucl. Sci. NS-44 1997; 4: 1606-1612.)
What standard atlas reference is
used for defining the warp of the
patient data?
What standard atlas reference is used for defining the warp of
the patient data?
The template image upon which the standardized regions of interest are defined (middle of the 3 image windows on the NeuroQ Analysis screen) is a high-quality normal brain FDG PET scan, acquired at UCLA.
How will the reformatting method
work with data that has been oriented
parallel to the temporal lobes?
How will the reformatting method work with data that has
been oriented parallel to the temporal lobes?
We've used NeuroQ to analyze hundreds of scans from other centers, including many that routinely slice their brains along the temporal axis, rather than the more canthomeatal slice angle used routinely at UCLA (and in the normal template) -- generally with very satisfactory results. Because of the spatial reformatting pre-processing, the standardized ROI (sROI) values will reflect activity in the regions of the brain to which the sROI names refer regardless of the slice angle inputted. As with any spatial reformatting program, however, the closer the patient scan (input) resembles the template, the closer the output will resemble the template after a fixed number of iterations, and I have noticed in a few side-by-side trials of using NeuroQ to analyze patients' brains reformatted along both temporal and canthomeatal axes, that there is a little better conformance of NeuroQ output to our visual impressions when the slice angle of the patient is the same as the slice angle of the template... but whether that is more a reflection of NeuroQ output or of our visual impression 'output,' I cannot say for sure, as we have collected no systematic data against some kind of external gold standard by which to assess this.
Does IV contrast affect the
numerical values or outcome of
the results?
Does IV contrast affect the numerical values or outcome of
the results?
We have no direct data bearing on the IV contrast issue, but I would not expect it to significantly affect output when normalizing to whole brain. (It would theoretically be possible for it to affect output when normalizing to pons or cerebellum, if a contrast CT is being used for attenuation correction, but only in the direction of increasing the sensitivity for defining areas of abnormally low metabolism.)
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