WO2015092567A1

WO2015092567A1 - Ultrasound imaging system with stress-echocardiography protocol and method of operation thereof

Info

Publication number: WO2015092567A1
Application number: PCT/IB2014/065843
Authority: WO
Inventors: George Daniel Rom; Daniel G. MAIER
Original assignee: Koninklijke Philips N.V.
Priority date: 2013-12-20
Filing date: 2014-11-06
Publication date: 2015-06-25

Abstract

An ultrasound imaging apparatus include at least one controller that may be configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress-echo test workflow: acquire ultrasound echo information for a plurality of ultrasound images in real-time, store the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system, render, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and/or generate at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

Description

ULTRASOUND IMAGING SYSTEM WITH STRESS-ECHOCARDIOGRAPHY

PROTOCOL AND METHOD OF OPERATION THEREOF

The present system relates to an ultrasound imaging system for performing an stress-echocardiography protocol, more particularly, to an ultrasound imaging system with a protocol for performing a stress echocardiography test workflow with rich data capture, rich data post-processing, and a method of operation thereof.

Stress echocardiography is a technique that is used to determine whether a heart of subject under test (hereafter patient for the sake of clarity) is receiving sufficient blood flow, particularly when the heart is stressed. Typical stress echocardiography (stress- echo) techniques compromise image quality for speed and may provide few, if any, image processing options post acquisition. For example, typical stress-echo techniques only provide simple color and/or grayscale remapping adjustments post acquisition. Accordingly, a user such as clinician, a doctor, an ultrasound technician, or the like, has a limited ability to change image settings to optimize images post acquisition.

The system(s), device(s), method(s), arrangements(s), user interface(s), computer program(s), processes, etc. (hereinafter each of which will be referred to as the system, unless the context indicates otherwise), described herein address problems in prior art systems.

In accordance with some embodiments of the present system, there is disclosed an ultrasound imaging apparatus, which may include a controller that may be configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for one or more of determined acquisition stages of the stress-echo test workflow: acquire ultrasound echo information for a plurality of image planes in real-time, store the acquired ultrasound echo information for the plurality of image planes in association with a corresponding stage of the plurality of stages of the stress-test workflow in a memory of the system, generate image information for only a single selected image plane of the plurality of image planes in accordance with the acquired ultrasound echo information, and/or render the generated image information on a display.

In accordance with yet other embodiments, there is disclosed an ultrasound imaging apparatus which may include a controller that may be configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress-echo test workflow: acquire ultrasound echo information for a plurality of ultrasound images in real-time, store the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system, render, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and/or generate at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

It is further envisioned that the stored acquired ultrasound echo information may include echo information which is stored in a rich data format. Moreover, it is envisioned that the generated at least one image may have image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images. It is also envisioned that the controller may be further configured to determine whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow. It is also envisioned that the controller may be further configured to determine whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. Moreover, in accordance with some embodiments, the controller may be further configured to set the current stage equal to a next stage when it is determined that the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

In some embodiments, the controller may be further configured to determine a single selected image plane in accordance with a selection of a user. It is also envisioned that the controller may be further configured to: determine whether the plurality of stages of the acquisition phase of the stress-echo test workflow has ended; and perform post acquisition processing upon the acquired ultrasound echo information that is stored when it is determined that the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. It is further envisioned that in some embodiments the controller may be further configured to: select representative image information for a single selected image plane of the plurality of image planes; and associate the selected representative image information with the acquired ultrasound echo information that is stored.

In accordance with yet other embodiments of the present system, there is provided a method of performing a stress-test workflow. The method may be performed by at least one controller of an ultrasound imaging system, and may include one or more acts of: determining a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for one or more determined acquisition stages of the stress-echo test workflow: acquiring ultrasound echo information for a plurality of image planes in real-time, storing the acquired ultrasound echo information for the plurality of image planes in association with a corresponding stage of the plurality of stages of the stress-test workflow in a memory of the system, generating image information for only a single selected image plane of the plurality of image planes in accordance with the acquired ultrasound echo information, and/or rendering the generated image information on a display of the system.

In accordance with further embodiments of the present system, there is provided a method of performing a stress-test workflow. The method may be performed by at least one controller of an ultrasound imaging system, and may include one or more acts of: determining a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress- echo test workflow: acquiring ultrasound echo information for a plurality of ultrasound images in real-time, storing the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system, rendering, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and generating at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

It is further envisioned that the act of storing the acquired ultrasound echo information may include an act of storing the acquired ultrasound echo information in a rich data format. Further, it is envisioned that the generated at least one image may have image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images. Moreover, the method may include an act of: determining whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow. It is further envisioned that in some embodiments the method may include act of determining whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. It is also envisioned that the method may include an act of: setting the current stage equal to a next stage when it is determined that the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. Some embodiments may further include an act of determining a single selected image plane in accordance with a selection of a user. It is also envisioned that some embodiments may include an act of determining whether the plurality of stages of the acquisition phase of the stress-echo test workflow has ended; and/or performing post acquisition processing upon the acquired ultrasound echo information that is stored when it is determined that the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

It is further envisioned that the method may include acts of: selecting representative image information for a single selected image plane of the plurality of image planes; and/or associating the selected representative image information with the acquired ultrasound echo information that is stored.

In accordance with yet other embodiments of the present system, there is provided a computer program stored on a computer readable memory medium, the computer program may be configured to perform a stress-test workflow, the computer program may include a program portion which may be configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress- echo) test workflow, and for one or more determined acquisition stages of the stress- echo test workflow: acquire ultrasound echo information for a plurality of image planes in real-time, store the acquired ultrasound echo information for the plurality of image planes in association with a corresponding stage of the plurality of stages of the stress- test workflow in a memory of the system, generate image information for only a single selected image plane of the plurality of image planes in accordance with the acquired ultrasound echo information, and/or render, in real-time, the generated image information on a display of the system.

In accordance with yet further embodiments of the present system, there is provided a computer program stored on a computer readable memory medium, the computer program may be configured to perform a stress-test workflow, the computer program may include a program portion which may be configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress- echo) test workflow, and for at least one stage of the stress-echo test workflow: acquire ultrasound echo information for a plurality of ultrasound images in real-time, store the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system, render, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and/or generate at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

It is further envisioned that the program portion may be further configured to: store the acquired ultrasound echo information in a rich data format. It is also envisioned that the program portion may be further configured to: generate the at least one image to have image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images. It is also envisioned that the program portion may be further configured to: determine whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow. It is also envisioned that the program portion may be further configured to: determine whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. It is further envisioned that the program portion may be further configured to: set the current stage equal to a next stage when it is determined that the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

In accordance with yet other embodiments, it is envisioned that the program portion may be further configured to: determine a single selected image plane in accordance with a selection of a user. It is also envisioned that the program portion may be further configured to: determine whether the plurality of stages of the acquisition phase of the stress-echo test workflow has ended; and/or perform post acquisition processing upon the acquired ultrasound echo information that is stored when it is determined that the plurality of stages of the acquisition phase of the stress-echo test workflow has ended. It is further envisioned that the program portion may be further configured to: select representative image information for a single selected image plane of the plurality of image planes; and/or associate the selected representative image information with the acquired ultrasound echo information that is stored.

The present invention is explained in further detail in the following exemplary embodiments and with reference to the figures, where identical or similar elements are partly indicated by the same reference numerals, and the features of various exemplary embodiments being combinable. In the drawings:

FIG. 1 shows a flow diagram of a stress-echo process performed in accordance with embodiments of the present system;

FIG. 2 shows a schematic diagram of stress-echo system for performing a stress-echo process in accordance with embodiments of the present system;

FIG. 3 is a flow diagram that illustrates a stress-echo process performed by a system in accordance with embodiments of the present system;

FIG. 4 shows a screenshot of graphical user interface formed in accordance with embodiments of the present system; and

FIG. 5 shows a portion of a system in accordance with embodiments of the present system.

The following are descriptions of illustrative embodiments that when taken in conjunction with the following drawings will demonstrate the above noted features and advantages, as well as further ones. In the following description, for purposes of explanation rather than limitation, illustrative details are set forth such as architecture, interfaces, techniques, element attributes, etc. However, it will be apparent to those of ordinary skill in the art that other embodiments that depart from these details would still be understood to be within the scope of the appended claims. Moreover, for the purpose of clarity, detailed descriptions of well known devices, circuits, tools, techniques, and methods are omitted so as not to obscure the description of the present system. It should be expressly understood that the drawings are included for illustrative purposes and do not represent the entire scope of the present system. In the accompanying drawings, like reference numbers in different drawings may designate similar elements.

Objectives for an ultrasound Stress exam include assessing cardiac and cardiovascular function by observation of heart anatomy and function as viewed in ultrasound images captured both at resting and elevated heart rates. To view heart anatomy and function in ultrasound images, the images should have sufficient image quality, and achieving this image quality involves carefully adjusting the system controls to optimal settings for a given situation. In the case of certain protocols involving patient exercise, images are captured during a very short period of time when the heart rate is sufficiently high, and there often is not enough time to ensure that system controls are set to optimal settings during image acquisition, thereby compromising the appearance of the ultrasound images. Among many aspects described further herein, the present invention includes capturing stress images in rich data format during a Stress exam. By acquiring and storing the images in rich data form, a user can adjust system controls during post-acquisition review to achieve the optimal image quality required to confidently assess cardiac and cardiovascular function.

A stress echocardiography (hereinafter stress-echo) process in accordance with embodiments of the present system may follow one or more protocols each of which may include a plurality of stages (e.g., M stages, where M is an integer greater than two, for example three or more in the current embodiments) of an acquisition phase which must be performed in rapid succession to ensure that the patient's heart rate remains within a target range during acquisition of echo information. The stress-echo processes in accordance with embodiments of the present system may be used to perform a stress-echo test workflow such as an exercise stress-echo test or stress-echo exam (hereinafter both of which will be commonly referred to as a stress-test for the sake of clarity unless the context indicates otherwise). For example, when performing an stress-test, each of these (e.g., M) stages may correspond with a different workload (e.g., patient workload) that the patient is subject to using any suitable exertion device (e.g., exercise equipment) such as a treadmill, a bicycle, stationary stairs, an elliptical trainer, or the like. Further, in accordance with embodiments of the present system, the stress-test may be a pharmacological stress-test in which a pharmacological agent, such as Dobutamine is injected in order to elevate the heart rate of the patient. In accordance with embodiments of the present system, either or both of physical and pharmacological stressors may be suitably applied. To simply the following discussion, the stress-test will be described generally however, it should be understood that the description and claims that follow encompasses any such stress-test.

One example of a set of stages is provided in the FIG. 1 which shows a flow diagram of a stress-echo process 100 (hereinafter the process 100 for the sake of clarity) performed in accordance with embodiments of the present system. The process 100 may include first through fourth stages 101 through 107, respectively. The first stage 101 is a rest stage (RS), the second stage 103 is a peak heart rate stage (PHR) (which may also be referred to as a peak exercise stage), and the third stage 105 is a post exercise stage. During each of the first through third stages 101 -105, respectively, echo information is acquired from an ultrasonic probe (e.g., a probe) of the system and thereafter stored in a memory of the system. Accordingly, these stages are referred to as acquisition stages. During each of the stages, the patient is put through a regiment that may include a baseline acquisition, e.g., during the rest stage, and acquisition during a stress period for the patient, such as during the peak exercise stage when the patient may be put though one or more activities as discussed further herein. The echo information may include echo information which corresponds with a plurality of imaging planes (e.g., N imaging planes) and may be stored in a rich data format in a memory of the system for later use such as for real-time image reconstruction and/or post- acquisition processing (e.g., image processing, data processing, etc.) as will be described elsewhere.

As is readily appreciated, rich data, rich data format, and other formatives thereof corresponds to digitized ultrasound data samples from a stage early in the ultrasound data signal path processing pipeline. For example, rich data may correspond to data that is pre- or post-beamformed, pre-detected, pre-filtered, pre-decimated, or from other steps in the processing pipeline that eventually generates pixels for a display unit. Significantly, the storing of the echo information in a rich data format enables further processing of the images after acquisition and storage than heretofore was available as described herein. For example, while the echo information may be a Cartesian space image of pixels, the rich data format is produced by sampling response to acoustic impulses organized into a line of samples emanating from the probe face independent of the final Cartesian output. Illustratively, there may be 1000 samples for a line to produce a 500 pixel high output digitized ultrasound data sample. The output of a single frame may even be comprised of multiple rich data frames, each angled slightly differently. The choice of initial acoustic impulse and sampling is typically not changed during acquisition, however in accordance with the present system, all processing after this point may be changed since rich data is stored.

Further, in accordance with embodiments of the present system, the rich data may be stored in association with one or more of, for example, meta-data including other information such as identifiers for the stress-test protocol that was utilized, identifiers for the stage of the stress-test, identifiers for the view, control sets that identify the system control settings active at the time of the image acquisition, such as settings for image gain, dynamic range, transmit-gain-compensation (tgc) curve information, image depth, focus depth, region-of-interest location, heart rate at time of acquisition, etc. For example, when a control is adjusted by the user, identifiers for the new consistent set of controls (e.g., the control set) may be stored in association with the stored rich data. In this way, each rich data frame may be "tagged" with a number that identifies the control set which was the impetus for the corresponding image. As may be readily appreciated, part of the control set is inherent to the rich data such as the information controlling the acoustic impulse and initial sampling while other parts may be changed by the user after storage of the rich data to alter the transformation from rich data to a displayed image.

During the first through third stages 101 through 105, respectively, the process may reconstruct image information based upon echo information which corresponds with only a single selected plane of the plurality of planes. Thereafter, the reconstructed image information for the single selected plane may be rendered on a display of the system for the convenience of a user in real time. Accordingly, a user such as, a clinician, a doctor, an ultrasound technician, or the like (hereinafter a user for the sake of clarity), and/or the system may compare results of the stress-echo process with norms and contrast function between similar views of different stages to determine whether any abnormalities exist. Thereafter, results of this comparison may be rendered on a user interface (Ul) of the system for the convenience of the user and/or stored in a memory of the system for later use.

At each of the first through third stages 101 through 105, respectively, a number of loops of a desired imaging plane may be captured (e.g., a loop may be a sequence of ultrasound data frames representing a portion or all of the time for one heart beat), stored, and rendered so that a user may select a preferred loop.

In accordance with embodiments of the present system, the selection of the protocol and some configuration options provided during protocol selection) will generally determine the acquired loops. For example, in a first stage, the operator may determine loop start (through operation of a user control (such as through operation of an enter/acquire key, footswitch, through the Ul, etc.), loop end may be automatically set for example based on protocol configuration. Further, a view end may be automatically set for example based on protocol configuration (e.g., X number of loops desired). During peak/exercise, loops may be continuously generated based on the protocol configuration. Further, loop start and termination may be based on an ECG detected Rwave (e.g., with or without some offset and inferred timing from detected heart rate). For example, during the peak heart rate stage 103, loops may be captured continuously, for example switching imaging planes (e.g., views) on the fly as desired and selectable by the user since all the acquisition stages are to be performed before the heart rate of the patient decreases.

The control settings that may be applied to each image plane (e.g., view) of the plurality of image planes (e.g., N image planes) during the peak heart rate stage 103 may be set in accordance with control settings that were applied to corresponding image planes of the plurality of image planes that were in applied during the rest stage 101. This methodology may eliminate any need for the user to modify imaging parameters during time-sensitive stages such as during the second and third stages 103 and 105, respectively. However, it is also envisioned that the control settings that may be applied to one or more of the image planes during one or more selected stages may be set in accordance with settings stored in a memory of the system and/or set by a user. The first through third states 101 through 103, respectively, may be referred to as acquisition stages during which echo information may be obtained and the fourth stage 104 may be referred to as a post-acquisition stage in which post image acquisition processing may be performed. It is further envisioned that the acquisition stage may include one or more stages which may differ from the first through third stages 101 , 103 and 105, respectively, if desired. For example, the acquisition stage may include stages defined by the user and stored in a memory of the system.

FIG. 2 shows a schematic diagram of stress-echo system 200 (hereinafter system for the sake of clarity) for performing a stress-echo process in accordance with embodiments of the present system. The stress-echo process may further be used to perform a stress-test in accordance with embodiments of the present system. The system 200 may include one or more of a controller 202, actuators 204, a probe 206, sensors 208, a memory 210, a user input device 212, and a rendering device such as a display 214 which may include a speaker. The sensors 208 may include an ECG/EKG device hooked up to the patient to deliver physio waveforms and/or indications of Rwaves (e.g., to indicate a start of each heart beat) to the controller 202. In this way, the Controller may be notified of each Rwave to ensure that each captured loop corresponds to a single heart beat. The actuators 204 may include actuators which may drive and/or restrain user exercise equipment (UEE). The UEE may include any suitable type of exercise equipment such as stationary stair (step) climbing equipment, a treadmill 205, a stationary bicycle, an elliptical trainer, etc. In accordance with embodiments of the present system, the ECG/EKG device may be part of a treadmill device or other UEE. For example, the actuators 104 may be configured to the type of the UEE. For example, if using a treadmill such as a treadmill 205, the actuators 104 may include inclination actuators for inclining a belt 207 of the treadmill 205 at a desired angle, one or more motors for driving the belt 207 of the treadmill 205 at a desired speed, and/or one or more for resistance actuators for providing resistance to the belt 207. However, if the UEE includes stationary stair climbing equipment, the actuators 104 may include resistance actuators for controllably providing resistance to the stairs. Similarly, if the UEE includes a stationary bicycle, the actuators 104 may include resistance actuators which may controllably provide a resistive force to, for example, a flywheel or crankshaft of the UEE. As may be readily appreciated and as discussed herein, in accordance with embodiments of the present system, pharmacological stressors may be used in addition to the actuators or in place of them.

The probe 206 may include any suitable ultrasound probe such as an ultrasound transducer array probe configured to acquire ultrasound echo information from a plurality of planes in a scanning volume in which a region-of-interest (ROI) may be located in a case wherein the probe is a 3-D probe. In accordance with embodiments of the present system, a 2-D probe may be utilized where there is just one 2-D plane captured at a time and the ROI is a 2- D region. The acquired echo information may then be stored in a memory of the system such as the memory 210.

The sensors 208 may include sensors which may provide sensor information to the controller 202. The sensor information may include information related to the user such as heart-rate, blood pressure, EKG, temperature, etc. and/or information related to the UEE such as information related to operating speed (e.g., speed of the belt 207), resistance settings, power output (in any suitable units such as watts), etc.

The memory 210 may include any suitable memory such as a non-transitory memory, etc. which may be situated in one or more locations. For example, the memory 210 may include local and/or distributed memories.

The user input device 212 may include any suitable user interface for interacting with the system 100 so as to facilitate entrance of one or more inputs such as alphanumeric inputs, commands, menu selections, etc. Accordingly, the user input device 212 may include a keyboard, a mouse, a rollerball, a touchpad, a touchscreen, a pointing device, a haptic input device, etc. The rendering device 214 may include any suitable rendering device for rendering audio and/or visual information generated by the system 200 such as reconstructed image information, a user interface (Ul) with which a user may interact, etc. Accordingly, the rendering device 214 may include one or more of a display, a touchscreen display, a speaker, a haptic device, etc. and may form a part of the user input device 212.

The controller 202 may control the overall operation of the system 200 and may load a desired stress-echo process from a plurality of stress-echo processes stored in a memory of the system and which may define corresponding protocols in accordance with embodiments of the present system for performing a stress-test in accordance with embodiments of the present system. The controller 202 may also provide an initialization routine in which a user may select one or more operating parameters, one or more desired scanning plane(s) for different parts of the process, a region-of-interest (ROI), etc. that defines the control set for image generation and acquisition that is generally used in during subsequent stages. In this way, the control set for each view may be saved during the less urgent first stage of the exam so that in later stages, such as during peak exercise, the user determines the rich data stored for each view, loop, etc.

During the initialization routine, the process may acquire echo information, reconstruct this echo information to form image information, and render this image information in real time on a display of the system for the convenience of a user. The controller 202 may further determine timing for performing one or more of stages of the stress-echo process in accordance with the embodiments of the present system. The controller 202 may further await an input from a user to begin a current stage of a plurality of stages of the process. Accordingly, the controller 202 may generate and render a user interface (Ul) on the display 202 requesting a user to determine when to begin a current stage of the plurality of stages. The controller 202 may further control the actuators 204 in accordance with time as may be defined by the process. For example, the controller 202 may determine a desired speed and/or inclination of the belt 207 of a treadmill 205 in accordance with time, stage, and/or sensory input from the UEE and/or patient (e.g., heart rate, blood pressure, etc.) and control the actuators 204 accordingly.

FIG. 3 is a flow diagram that illustrates a stress-echo process 300 performed by a system in accordance with embodiments of the present system. The stress-echo process 300 (hereinafter process 300 for the sake of clarity) may be performed using one or more computers communicating over a network and may obtain information from, and/or store information to one or more memories which may be local and/or remote from each other. The process 300 may include one of more of the following acts. Further, one or more of these acts may be combined and/or separated into sub- acts, if desired. Further, one or more of these acts may be skipped depending upon settings. The process 300 may be used to perform a stress-test which may acquire information from a stress-test performed on a patient or other subject-of-interest. In operation, the process may start during act 301 and then proceed to act 305. During act 305, the process may determine whether to begin a stress-test operating in accordance with embodiments of the present system. Accordingly, the process may await an input of the user which may indicate a desire to begin the stress- test. If it is determined to begin the stress-test, the process may continue to act 307. However, if it is determined not to begin the stress-test, the process may repeat act 305. Generally, during this act the process will determine whether to begin the acquisition stages of the process. Accordingly, preparation time may be provided to prepare the patient and/or system. In some embodiments, the process may render a user interface with a menu such as a start menu item which may be selected by the user. Accordingly, when the process determines that the user has selected the start menu item, the process may begin the stress-test in accordance with embodiments of the present system. In yet other embodiments, the process may determine to begin the stress-test when a delay time has elapsed and/or based upon actions of the user such as initiation in use of exercise equipment, acquisition of ultrasound echo information, etc.

During act 307, the process may obtain one or more protocols corresponding with the stress-test. The one or more protocols may include information such as number of stages (e.g., M), actions to perform during each corresponding stage of the plurality of stages, timing such as related to duration of stages, actions, etc., actuator settings (e.g., speed, inclination, resistance), imaging parameters (e.g., number of imaging planes N to acquire, timing of acquisition, probe settings, imaging parameters, default selected image plane, timing of plane selection, etc.), etc. After completing act 307, the process may continue to act 31 1 . During act 31 1 , the process may set a current stage equal to a first stage of a plurality of stages (e.g., M stages) of the stress-test. Then, the process may determine the actions to perform in accordance with the current stage. For example, the process may set the actuator settings in accordance with the current stage. Thus, if the current stage is determined to be the peak stage and the UEE is a treadmill, then the process may control actuators of the treadmill such as the motor to drive the treadmill in accordance with treadmill speed settings for the peak stage which may be stored in a memory of the system. This stage will correspond with one of the plurality of acquisition stages. After completing act 31 1 , the process may continue to act 315.

During act 315, the process may determine whether to begin the current stage of the stress-test. The process may determine whether to begin the current stage in accordance with an input request of the user (e.g., begin current stage). Thus, if it is for example determined that the user has requested to begin the current stage, the process may continue to act 319. However, if it is determined that the user has not requested to begin the current stage, the process may repeat act 315. In accordance with yet other embodiments, the process may determine to begin the current stage when, for example, an elapsed time is determined to have expired (e.g., 30 seconds which begins at the end of a previous stage or when the protocol is loaded). However, in yet other embodiments, the process may determine to begin the current stage based upon analysis of echo information. For example, if the process determines that valid echo information is being acquired from the patient, the process may begin a current stage. However, if it is determined that valid echo information is not being acquired (e.g., indicative of the probe not being positioned correctly on the patient), the process may repeat act 315. In yet other embodiments, the process may determine to begin the current stage based upon sensor information obtained from the UEE. For example, speed information from the UEE (e.g., treadmill information) may be obtained from the UEE. Then, this sensor information may be compared to a corresponding threshold value (e.g., treadmill speed threshold value, etc.). Then, if it is determined that this sensor information is greater than, or equal to, the corresponding threshold value, the process may determine to begin the current stage. However, if it is determined that this sensor information is less than the corresponding threshold value, the process may determine not to begin the current stage and may, for example, repeat act 315. In accordance with embodiments of the present system, act 315 may provide preparation time between stages of the stress-test.

During act 319, the process may acquire ultrasound echo information from a plurality (e.g., M) of image planes simultaneously from a probe of the system in realtime. The user and/or system may set a value of M which may define a number of the plurality of image planes (views) and may be an integer with a value which is one or greater (e.g., in a case where a 2-D or 3-D probe is utilized). The acquired ultrasound echo information (e.g., image frames within a loop that correspond to all or a portion of a single heart beat) may further be stored in association with information (e.g., meta information) indicative of a current stage of the stress-test. As described further herein, the echo information may be stored in rich data format, thereby allowing for optimization of the images after the stress exam is performed. This may for example enable the process to provide reconstructed images corresponding with a selected stage and/or a selected place within a stage (e.g., as may be selected by a user) of the acquisition stages of the stress-test post acquisition. The ultrasound echo information may correspond with echo information from a scanning volume of the probe. After completing act 319, the process may continue to act 323.

During act 323, the process may store the acquired ultrasound echo information in a memory of the system such as a disk-based storage system. The acquired ultrasound echo information may be stored in a rich data format in a memory of the system for later use such as for image reconstruction and post-acquisition processing. Further, the acquired ultrasound echo information may be stored in association with information identifying a corresponding stage and/or portion thereof (e.g., 5 minutes from start of second stage) of the plurality of stages of the stress-test workflow in which the ultrasound echo information was acquired. After completing act 323, the process may continue to act 325.

During act 325, the process may control optional actuators according to actuator settings. These actuator settings may be stored in a memory of the system and/or may be set and/or reset by a user. The actuator settings may define actuator settings according to stage and/or time with relation to the stress-test. For example, in the second stage (e.g., the peak stage), the actuators which control a portion of the UEE that effect operation of the UEE, such as a belt (e.g., in a case where the UEE is a treadmill) may be controlled to start at 0 mph (equivalent belt speed) and thereafter gradually increase the belt speed to 2.5 mph and hold this speed (e.g., for five minutes) until the end of the second stage at which time the speed should be gradually reduced back to 0 mph. In addition, during the second stage, the actuators which control belt inclination may be controlled to increase the inclination from 0 degrees (horizontal) to 10 degrees (e.g., over a three minute span) and hold it there until the end of the second stage at which time the inclination should be gradually reduced back to 0 degrees. The actuator settings may be stored in accordance with a corresponding stress-test. As may be readily appreciated, the speed and inclination of the UEE may be varied during one or more stages such that for example, prior to the end of stage 2, the speed of the belt may increase to 5 mph from 2.5 mph. Similarly, the inclination may be altered during a stage to include two of more different inclinations, speeds, etc. during a stage (e.g., for example at designated times within a stage). The settings for the stress-test may be set as a portion of the corresponding protocols in accordance with embodiments of the present system. After completing act 325, the process may continue to act 327.

During act 327, the process may determine whether an image plane from the plurality of image planes has been selected for viewing. This image plane may be known as a selected image plane or a view and may be selected by the process and/or the user. Accordingly, if it is determined that an image plane has been selected, the process may continue to act 353. However, if it is determined that the image plane has not been selected, the process may continue to act 331. In accordance with some embodiments, the process may generate and render a request for the user to enter or otherwise select an image plane from the plurality of image planes to be a selected image plane. Thereafter, a user may select, for example, an image plane from the M image planes to be the selected image plane. In accordance with some embodiments, the user may select an image plane from the M image planes using a menu selection item or graphic representation from a menu rendered as a user interface (Ul) on a display of the system. For example, the operator may select an image when the image has sufficient image quality to visualize a desired anatomical structure desired for the view.

During act 331 , the process may set the image plane from the plurality of image planes or a subset of the plurality of image planes (e.g., the M image planes) to be the selected image plane in accordance with system settings. For example, in some embodiments the selected image plane may correspond with a default image plane selected from the plurality of image planes. However, in yet other embodiments, the default image plane may be set in accordance with a current stage, running time, a previous default plane (e.g., toggle default plane =previous selected plane +1 ), etc. as may be set by the use and/or system. However, in yet other embodiments, a default image plane may be selected in accordance with stored user settings that may be obtained from a memory of the system and may correspond with stored settings of the user. Accordingly, the process may obtain user settings from a memory of the system, if available, and set the image plane in accordance with the user settings. After completing act 331 , the process may continue to act 353.

During act 353, the process may generate image information corresponding with the (e.g., single) selected image plane in accordance with the acquired ultrasound echo information. Accordingly, the process may obtain the ultrasound echo information stored in a memory of the system in the rich data format and reconstruct corresponding image information using any suitable method. After completing act 353, the process may continue to act 359. During act 359, the process may render the generated image information corresponding with the selected image plane on a user interface of the system such as a display. The generated image information may then be viewed in real-time during the Stress exam or after the stress exam has been performed. As described further herein, the image information can be in rich data format, thereby allowing for optimization of the images after the stress exam is performed. A user may select any of the rendered images and perform desired operations upon these images at this point. For example, these operations may be used to improve the visual quality of the image so as to better visualize the anatomic structures of the image. These operations may include operations to adjust image quality such as gain, compression, dynamic range, and Transmit Gain Compensation (TGC), edge enhancements, smoothing, speckle reduction, zooming based on acoustic lines (e.g., scan converting to a higher resolution), and thresholding, turbulence, baseline, etc. in a case wherein stress color flow imaging is being performed. Thereafter, the process may generate corresponding images based on the performed operations having a format (e.g., a compressed format) which is different from the format of the ultrasound echo information which is stored in the rich data format. The generated images may be stored in a memory of the system for later use. For example, the generated images may be stored in a compressed format that is lossy or lossless, such as run length encoded (RLE), MPEG, JPEG, BMP, AVI, etc. After completing act 359, the process may continue to act 363.

During act 363, the process may determine whether the current stage of the plurality of stages of the process has ended. Accordingly, if it is determined that the current stage of the plurality of stages of the stress-test process has ended, the process may continue to act 367. However, if it determined that the current stage of the plurality of stages of the process has not ended, the process may for example repeat act 319. The process may determine that the current stage of the plurality of stages of the process has ended when, for example, an elapsed time for the current stage has elapsed (e.g., each stage = 2 minutes; first stage = 1 minute, second stage = 2 minutes, third stage = 1 minute, etc.). The process may determine an elapsed time for a stage by starting a timer reset to 0 when the stage is begun. However, in yet other embodiments, the process may determine that a current stage has ended based upon other variable such as a user input (e.g., current stage end input by a user), acquired sensor information (e.g., sensor such as the probe removed from patient, etc. or no longer acquiring corresponding sensor information).

During act 367, the process may determine whether the current stage is a last stage of the acquisition stages (e.g., a last stage for acquiring ultrasound echo information as opposed to the post-image acquisition stage such as stage 4 in the current embodiments which may be used to reconstruct image information). Accordingly, if it is determined that the current stage is the last stage of the acquisition stages, the process may continue to act 375. However, if it is determined that the current stage is not the last stage of the acquisition stages, the process may continue to act 379. To determine whether the current state is a last stage for acquiring ultrasound image information, the processes may compare a value of the current stage (e.g., stage 3) with a threshold image acquisition stage (e.g., 3 in the current embodiments) obtained from a memory of the system (e.g., stored with the protocol information). Accordingly, in some embodiments, if it is determined that a value of the current stage is equal to, or greater than, the threshold image acquisition stage, the process may determine that the current stage is the last stage of the acquisition stages. However, if it is determined that the value of the current stage is less than the threshold image acquisition stage, the process may determine that the current stage is not the last stage of the acquisition stages. However, in yet other embodiments, the process may determine whether the images acquisition stages have ended and continue to act 375 based upon results of this determination.

During act 379, the process may set the current stage equal to the next stage of the plurality of stages. For example, if the current stage (e.g., m) is stage 2, then the process may set the current stage to stage 3 (e.g., m = m+1 = 2+1 ). Accordingly, the process may advance to the next stage. However, in yet other embodiments, the process may enter the next stage using any suitable method. After completing act 379, the process may repeat act 315 in accordance with the (updated) current stage.

During act 375, the process may perform one of more post-acquisition processing techniques upon the acquired echo information for the plurality of image planes which is stored in the memory of the system. Accordingly, the process may reconstruct image information based upon the stored echo information (or parts thereof). The image information may then be rendered on a display of the system using for example a graphical user interface (GUI) or the like. After completing act 375, the process may continue to act 381 where the process may end.

In some embodiments, the process may enter a desired phase directly. For example, a user may select to enter the post-exam processing phase directly. Further, a viewing phase may be provided to view image information reconstructed from the echo information. For example, for a "typical protocol configuration", the system may be configured to acquire a numbers of images per view (e.g., per loop) for a stage, such as during the rest stage. Thereafter, at the end of the view, the system may transition to a review screen for the operator to confirm a good loop is acquired before transitioning to a next view. In this way, confidence may be provided to the user (e.g., the operator) that good images are acquired and settings are optimized for future (exercise) stages.

Post-acquisition processing techniques will now be discussed with reference to FIG. 4 which shows a screenshot 400 of graphical user interface (GUI) 401 formed in accordance with embodiments of the present system. The GUI 401 may be rendered post-acquisition and/or post-exam and may include one or more reconstructed images formed into image loops 403-1 through 403-3 that show the motion of the heart walls during the playback of a heart cycle worth of frames. The one or more loops may be acquired during corresponding stages 1 through 3, respectively, of the stress-test as may be performed by a stress-echo process operating in accordance with embodiments of the present system such as the process 300. The exam portion of the stress-echo process may correspond with portions of the stress-echo process in which echo information is acquired such as stages 1 through 3 in the present embodiments (e.g., image acquisition stages). A menu 405 may be provided for a user to select images, image planes, image loops, "best" images, and/or to manipulate image characteristics singularly and/or in groups. For example, the user may interact with one or more menus of the GUI 401 so as to select a region-of-interest (ROI), a desired loop, and/or a desired stage of the exam, etc. Further, the menu may provide a user with a user interface to select options associated with the stress-test such as scan conversion, region-of-interest (ROI), filtering, smoothing, etc., at any time. Further, the process may provide image, study, and/or control adornments. Thereafter, the process may form processing information (PI) in accordance with the user's selection(s) and/or settings and store the PI in association with the corresponding echo information which corresponds with the associated image(s), the desired loop(s), stage(s), group(s) of images, etc., in a memory of the system for later use. Thereafter, the process may obtain the PI and reconstruct image information from the echo information accordingly. The process may further obtain the generated images which are generated during act 359 and render these images on the display. A user may then select any of the rendered generated images and perform one or more actions upon the selected generated images, if desired. Thereafter, the process may form corresponding image information and store this image information in a compressed format in a memory of the system for later use.

For example, the PI may identify or otherwise point to one or more desired images, echo information which may correspond with the desired images, the desired loop, the desired image which may represent the desired loop, etc. Thereafter, in accordance with the selected PI, the process may obtain the corresponding echo information from a memory of the system, reconstruct image information from the echo information and render the reconstructed image information on a display of the system. Accordingly, rich data information such as the echo information may be stored in a memory of the system in association with the PI and may be reconstructed to obtain the image information that may be used to render the desired images, loops, etc. In yet other embodiments, it is envisioned the desired images, the desired loop, the desired image which may represent the desired loop, etc., may be stored as image information in any suitable format (e.g., as JPEG or bitmapped image information, etc.) and associated with corresponding echo information.

Thus, embodiments of the present system may acquire echo information during a stress-echo test and store this acquired information for example in a rich data format without prior image processing. Accordingly, embodiments of the present system may provide for operations associated with the stress-echo process such as scan conversion, region-of-interest, filtering, smoothing, etc., to be performed post-exam. This provides additional benefit over systems which may store only Cartesian-type post- processed images. For example, embodiments of the present system may provide a user interface with which a user may interact post acquisition, such as the GUI 401. For example, the GUI 401 may be utilized to select a number of images that form an image group 403-x (e.g., an image loop) corresponding with a selected image plane (e.g., a view) 405 (of a plurality of image planes whose relative temporal positions within the stages of the stress-test are shown as 409) of a selected stage 407-1 through 407-3 (generally 407-x) of the stress-test. Further, the user may apply a "short axis view" setting to that image group 403-x rather than having to perform these actions during the acquisition portion of the stress-echo process. Embodiments of the present system may further provide a user interface (Ul) with which the user may interact to modify one or more settings of a selected image plane so that one or more rendered and/or stored images in the selected image plane 405 may be correspondingly modified singularly or as a group. Further, by working with the rich form of data, embodiments of the present system may provide high frame rates to be captured at reduced cost when compared with conventional methods. In accordance with embodiments of the present system, during portions of the stress-echo process, reference images (e.g., frames) corresponding to a selected image plane may be generated from image information reconstructed from the acquired echo information. Then post-acquisition (e.g., post exam), reference images which are desired for an evaluation may be reconstructed from the stored echo information and rendered on a display of the system. For example, post-acquisition, the process may reconstruct and/or render images serially in order of acquisition. Accordingly, when a user selects a first image of a plurality of images of a selected image plane as a "best image" then none of the other images associated with the image plane have to be reconstructed or processed until a request to do otherwise is received such as when a request to play a selected loop including images from the selected image plane is received from a user. The selected loop may then be processed to reconstruct image information based upon corresponding echo information stored in a memory of the system and may be played in a corresponding loop window 41 1 . The reconstructed image information may be formed in a suitable format for display such as in a bitmap or JPEG format. Thereafter, the reconstructed image information may be rendered at a desired frame rate such as a full frame rate. For example, a full frame rate may correspond to the rate at which ultrasound frames are generated by the scanner. This may also be referred to as the acoustic frame rate, typically expressed in Hz, such as 60 Hz. The acoustic frame rate is typically different from the rate at which the display can display frames. Illustratively, if the display frame rate is slower than the acoustic frame rate, such as 30 Hz, then during live imaging, previously the user would not see every other frame generated by the ultrasound scanner. However, in accordance with embodiments of the present system, the reconstructed image information may be rendered to enable viewing of those frames that were heretofore not viewable. In this way, an advantage is provided over prior systems since the acoustic frame rate is available for example during times of a high heart rate (e.g., during the exercise stage, for a pediatric study, etc.).

The process may further determine characteristics of a display of the system which will render the reconstructed image information and form the reconstructed image information in a suitable format. Thus, image information may be reconstructed using stored echo information (e.g., rich data information) in accordance with a display type. This has a sustainability advantage of requiring fewer resources for the task with greater resulting performance than if using stored image information in a bitmap format. Further, a user may select a region-of-interest before, during, and/or after image acquisition and thereafter a "best" image may be selected.

In yet other embodiments, the group of images may include images which may be used as reference images and which may correspond with different image planes. Selecting one of the reference images may cause the process to generate and/or render a loop (e.g., an image loop including a plurality of image and/or video information) which is associated with the reference image.

Further, in accordance with embodiments of the present system, a new instance of an image processing chain (or mutual exclusive or interleaved access to existing live chain) GUI may be constructed during review and/or final image generation. The GUI may be "rich data aware". In this way, the GUI is enabled to provide appropriate selection based on the preset, beamformer settings, correction control set selection, etc. that is attached to the rich data. For example, controls may be provided to re- categorize an image plane (e.g., a view) or change the controls for any selection of images corresponding with the acquired echo information.

FIG. 5 shows a portion of a system 500 in accordance with embodiments of the present system. For example, a portion of the present system 500 may include a processor 510 (e.g., a controller) operationally coupled to a memory 520, a user interface 530, a probe 540, sensors 550, and a user input device 570. As previously discussed, the sensors 550 may include an ECG device and ECG leads connectable to a patient that together may deliver physio-waveform information including Rwaves for a patient to the processor 510.

The memory 520 may be any type of device for storing application data as well as other data related to the described operation. The application data and other data are received by the processor 510 for configuring (e.g., programming) the processor 510 to perform operation acts in accordance with the present system. The processor 510 so configured becomes a special purpose machine particularly suited for performing in accordance with embodiments of the present system.

The operation acts may include configuring the system 500 by, for example, configuring the processor 510 to obtain information from user inputs, the probe 540, the sensors 550, and/or the memory 520 and processing this information in accordance with embodiments of the present system to generate image information based upon acquired echo information in accordance with embodiments of the present system. The user input portion 570 may include a keyboard, a mouse, a trackball and/or other device, including touch-sensitive displays, which may be stand alone or be a part of a system, such as part of a UEE (e.g., a stress-test device) and/or other device for communicating with the processor 510 via any operable link. The user input portion 570 may be operable for interacting with the processor 510 including enabling interaction within a Ul as described herein. Clearly the processor 510, the memory 520, the Ul 530, the sensors 550, the probe 540 and/or user input device 570 may all or partly be a portion of a computer system or other device as described herein.

Operation acts may include generating, requesting, providing, and/or rendering of information such as, for example, image information of a volume in whole or part. The processor 510 may render the information on the Ul 530 such as on a display of the system. The probe 540 may include sensors such as an ultrasound transducer array to provide desired ultrasound echo information to the processor 510 for storage and further processing in accordance with embodiments of the present system. The probe 540 may include any suitable transducer(s) such as matrix transducers or the like operating under the control of the processor 510. The system may further be compatible with any suitable stress-echocardiography system which may acquire ultrasound echo information and reconstruct image information based upon the acquired ultrasound echo information.

The methods of the present system are particularly suited to be carried out by processor programmed by a computer software program, such program containing modules corresponding to one or more of the individual steps or acts described and/or envisioned by the present system.

The processor 510 is operable for providing control signals and/or performing operations in response to input signals from the user input device 570 as well as in response to other devices of a network and executing instructions stored in the memory 520. For example, the processors 510 may obtain feedback information from the probe 540 and may process this information to determine when to start a current stage of the stress-test exam. The processor 510 may include one or more of a microprocessor, an application-specific or general-use integrated circuit(s), a logic device, etc. Further, the processor 510 may be a dedicated processor for performing in accordance with the present system or may be a general-purpose processor wherein only one of many functions operates for performing in accordance with the present system. The processor 510 may operate utilizing a program portion, multiple program segments, and/or may be a hardware device utilizing a dedicated or multi-purpose integrated circuit.

Accordingly, embodiments of the present system may provide methods to perform stress echocardiography protocols rapidly so as to ensure that a patient's heart rate remains in a desired target range. By storing echo information (e.g., as rich data as opposed to, for example, bitmapped image information) in a memory of the system, image processing attributes may be modified post-exam when time constraints are less disruptive to both the physician and the patient. In accordance with embodiments of the present system, an ultrasound stress test is provided to assess cardiac and cardiovascular function by observation of heart anatomy and function as viewed in ultrasound images stored in a rich format both at resting and elevated heart rates. As appreciated, the viewing of heart anatomy and function in ultrasound images requires that the images have sufficient image quality. Achieving this image quality requires the system controls be carefully adjusted to optimal settings for a given situation. In the case of certain protocols during the stress test, such as during a stage involving patient exercise, it is required that images are captured during a very short period of time when the heart rate is sufficiently high. However, in prior systems, there often is not enough time to ensure that system controls are set to optimal settings during image acquisition, which previously resulted in compromising the appearance of the ultrasound images. However, in accordance with embodiments of the present system, since the images are stored in rich data format, it is possible to adjust system controls during post-acquisition review to achieve an optimal image quality, thereby increasing the confidence of cardiac and cardiovascular function assessment.

While the present invention has been shown and described with reference to particular exemplary embodiments, it will be understood by those skilled in the art that present invention is not limited thereto, but that various changes in form and details, including the combination of various features and embodiments, may be made therein without departing from the spirit and scope of the invention.

Further variations of the present system would readily occur to a person of ordinary skill in the art and are encompassed by the following claims. Finally, the above-discussion is intended to be merely illustrative of the present system and should not be construed as limiting the appended claims to any particular embodiment or group of embodiments. Thus, while the present system has been described with reference to exemplary embodiments, it should also be appreciated that numerous modifications and alternative embodiments may be devised by those having ordinary skill in the art without departing from the broader and intended spirit and scope of the present system as set forth in the claims that follow. Accordingly, the specification and drawings are to be regarded in an illustrative manner and are not intended to limit the scope of the appended claims.

In interpreting the appended claims, it should be understood that: a) the word "comprising" does not exclude the presence of other elements or acts than those listed in a given claim; b) the word "a" or "an" preceding an element does not exclude the presence of a plurality of such elements; c) any reference signs in the claims do not limit their scope; d) several "means" may be represented by the same item or hardware or software implemented structure or function; e) any of the disclosed elements may be comprised of hardware portions (e.g., including discrete and integrated electronic circuitry), software portions (e.g., computer programming), and any combination thereof; f) hardware portions may be comprised of one or both of analog and digital portions; g) any of the disclosed devices or portions thereof may be combined together or separated into further portions unless specifically stated otherwise; h) no specific sequence of acts or steps is intended to be required unless specifically indicated; and i) the term "plurality of an element includes two or more of the claimed element, and does not imply any particular range of number of elements; that is, a plurality of elements may be as few as two elements, and may include an immeasurable number of elements.

Claims

1. An ultrasound imaging apparatus, comprising:

a controller configured to:

determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress-echo test workflow:

acquire ultrasound echo information for a plurality of ultrasound images in real-time,

store the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system,

render, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and

generate at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

2. The apparatus of claim 1 , wherein the generated at least one image has image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images.

3. The apparatus of claim 1 , wherein the controller is further configured to determine whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow.

4. The apparatus of claim 3, the controller is further configured to determine whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

5. The apparatus of claim 4, wherein the controller is further configured to set the current stage equal to a next stage when it is determined that the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

6. The apparatus of claim 1 , wherein the controller is further configured to determine a single selected image plane in accordance with a selection of a user.

7. The apparatus of claim 1 , further wherein the controller is further configured to:

determine whether the plurality of stages of the acquisition phase of the stress- echo test workflow has ended; and

perform post acquisition processing upon the acquired ultrasound echo information that is stored when it is determined that the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

8. The apparatus of claim 1 , wherein the controller is further configured to:

select representative image information for a single selected image plane of the plurality of image planes; and

associate the selected representative image information with the acquired ultrasound echo information that is stored.

9. A method of performing a stress-test workflow, the method performed by at least one controller of an ultrasound imaging system, and comprising acts of:

determining a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress-echo test workflow:

acquiring ultrasound echo information for a plurality of ultrasound images in real-time,

storing the acquired ultrasound echo information for the plurality of images in a rich data format in a memory of the system,

rendering, on a display, a representation of at least one of the plurality of ultrasound images stored in the rich data format, and generating at least one image having a compressed format and which is based upon a selected one of the plurality of ultrasound images which are stored in the rich data format.

10. The method of claim 9, wherein the generated at least one image has image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images.

1 1 . The method of claim 9, further comprising an act of: determining whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow.

12. The method of claim 1 1 , further comprising an act of: determining whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

13. The method of claim 12, further comprising an act of: setting the current stage equal to a next stage when it is determined that the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

14. The method of claim 9, further comprising an act of: determining a single selected image plane in accordance with a selection of a user.

15. The method of claim 9, further comprising acts of:

determining whether the plurality of stages of the acquisition phase of the stress- echo test workflow has ended; and

performing post acquisition processing upon the acquired ultrasound echo information that is stored when it is determined that the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.

16. The method of claim 9, further comprising acts of: selecting representative image information for a single selected image plane of the plurality of image planes; and

associating the selected representative image information with the acquired ultrasound echo information that is stored.

17. A computer program stored on a computer readable memory medium, the computer program configured to perform a stress-test workflow, the computer program comprising:

a program portion configured to: determine a stage of a plurality of stages of an acquisition phase of a stress echocardiography (stress-echo) test workflow, and for at least one stage of the stress-echo test workflow:

18. The computer program of claim 17, wherein he program portion is further configured to: generate the at least one image to have image characteristics which are different from image characteristics of the selected one of the plurality of ultrasound images.

19. The computer program of claim 17, wherein the program portion is further configured to: determine whether to begin a current stage of a plurality of stages of the acquisition phase of the stress-echo test workflow.

20. The computer program of claim 19, wherein the program portion is further configured to: determine whether the current stage of the plurality of stages of the acquisition phase of the stress-echo test workflow has ended.