PlusPack is an optional, add-on feature to QGS and QPS.


The following features complement the existing features of QGS/QPS:

  • Prone/Supine

A key advantage of the standard imaging geometry over semi-upright and upright imaging is the ability to perform both prone and supine imaging. This combined imaging has been a hallmark of the Cedars-Sinai approach for a decade, improving observer confidence. Its dissemination to other centers has been slowed to a degree by the lack of quantitative tools for the combined analysis. Prone-supine quantification allows a single measurement to be reported, representing the combination of prone and supine quantifications. This has been documented to improve the accuracy of SPECT interpretation over supine interpretation alone. The clinicians at Cedars-Sinai use this tool on every patient with questionable findings.

  • Stress Rest Registration and Serial Change

The standard methods for perfusion defect analysis compare each acquisition to normal limits. A more sensitive method for defining the difference between two studies is direct quantification of perfusion changes between images by a 3D elastic registration of two myocardial perfusion studies. No databases are required for the calculation of stress-rest changes (ischemia) or serial image changes. This can be particularly useful in assessing changes in perfusion patterns on serial studies or in resolving discrepancies between visual analysis and PFQ.

  • Motion Frozen

This is a novel technique to create cardiac "motion-frozen" perfusion or viability images, by warping ECG-gated images to the end-diastolic position. Such "motion-frozen" perfusion and viability images have improved resolution and contrast since the blurring effect of cardiac motion is removed.

  • QGS Phase Information

A new Phase toggle on the QGS page gives access to phase information for gated datasets, providing information regarding the synchrony of contraction from gated myocardial perfusion SPECT images, and can be of importance in assessing the likelihood of a patient benefiting from the growing procedure of cardiac resynchronization therapy (CRT).

  • Shape Index

This new parameter defines 3D left ventricular (LV) geometry derived from LV contours in end systolic and end diastolic phases. Shape index is defined as the ratio between the maximum dimension of the LV in all short-axis planes and the length of the mid-ventricular long axis. The new parameter has been shown to improve the identification of left ventricular failure.

  • PowerPoint

This feature provides the ability to save results and application configuration for case studies, allowing fast and easy launching directly from a PowerPoint slide. This feature is important in presentations and demonstrations.


Software Availability

Information regarding the availability of PlusPack can be found here.


  • Prone/Supine: Nishina et al, Combined Supine and Prone Quantitative Myocardial Perfusion SPECT: Method Development and Clinical Validation in Patients with no Known Coronary Artery Disease. J Nucl Med 2006; Jan 47(1): 51-8. [PDF]
  • Stress Rest Registration and Serial Change: Slomka et al, Automatic Quantification of Myocardial Perfusion Stress-Rest Change: A New Measure of Ischemia. J Nucl Med 2004; Feb 45(2): 183-91. [PDF]
  • Motion Frozen: Slomka et al. J Nucl Med 2004; 45: 1128-1134. (This technique was featured as the cover image of the JNM.) [PDF]