Imaging Workspace

RoadmapEliot Siegel, M.D.

Professor and Vice Chair University of Maryland School of Medicine Department

of Diagnostic Radiology

Chief Imaging VA Maryland Healthcare System

Lead caBIG® Imaging Workspace, NBIA

May 2010

• Paul, Ed, Robert and particularly Patti

• Congratulations which we don’t get to say as often as we should!

Thanks

• Original mission and goals—How Are We Doing?

Outline

Workspace wasn’t sure what to do with imaging so we were able to create our own mission initially which allowed us to extend well beyond caBIG® to more broad research and clinical support which is where CBIIT is going today

Mission Goals of the Imaging Workspace

• To advance imaging informatics for treatment of patients with cancer

• Facilitate

• Secure sharing of images and software for the retrieval of imaging data and metadata

• Leverage the caBIG® technology to share images in a variety of settings

Original Mission and Goals

• Projects such as AIM and XIP and AVT were created with clinical care as well as imaging research in mind, were not tailored to only work in caBIG® world

• These have had a major impact

Initial Project and Impact

Top 10 Challenges in Imaging Informatics for Research

• Without an acquisition template or “standard” measurements will be of limited value

• We have demonstrated major differences in image analysis based on different acquisition parameters

• UPICT (uniform protocols in clinical trials)• We should re-engage UPICT colleagues• Can we enter these into caDSR?

#10 Lack of Acquisition “Standards”

• Limited radiology terminology in Snomed CT (Systematized Nomenclature of Medicine Clinical Terms) or UMLS (Unified Medical Language System)• Current general medical lexicons only include about 20% of terms used in

radiology reports

• Don’t have consensus on acquisition parameters such as MRI sequences including GRASS, ROAST, etc. to describe acquisition standards

• Where are we currently with the “Playbook”? What can we do to support and accelerate this effort?

#9 Lack of Diagnostic Imaging Lexicon

Baseline 1 month follow up

-50

-40

-30

-20

-10

0

% Change

1 2

Measurement technique

Percentage Change in the measurement

RECIST Volume

-3.4%

-40.7%

#8 Imaging Quantification: Imaging Quantification Use Case Difficulty Measuring Lesion Size & Change Over Time

• If imaging is to be successful as a biomarker it is critical that change in an image over time can be quantified

• Has there been a significant change (30% decrease using RECIST criteria) after chemotherapy?

#7 Lack of Annotation and Mark-up Standards How can we continue to promote AIM?

• Should we have a small number of vendors incorporating AIM in their products and interest expressed by Philips CT, is IHE meeting next steps?

• There is currently no consensus on image mark ups and annotation making anything done on one workstation unlikely to be accessible by another

• Clinical Picture Archiving and Communication Systems (PACS) are patient centric and are not designed to facilitate export of images for clinical trials or other research purposes

• Major opportunity here for work with RSNA’s NIBIB effort and sharing images for clinical care and research without use of CD’s

#6 Difficulty in Acquiring and Submitting Cases in a Secure Way

• There is a wide variation in imaging software in quantitative analysis and minimal interoperability

• DICOM Working Group 23 XIP (Extensible Imaging Platform)

#5 Multiple Image Interpretation Platforms with Different Software Makes Comparison of Results and Sharing of Results Difficult

#4 Lack of Standardized Reference Image Sets and Phantoms- Increasing Number of Datasets but Need more Workspace Input About What to Include

• Middleware project caBIG® in vivo Imaging Workspace

#3 Disconnect Between GRID and XML World and DICOM and HL7 Excellent work thus far but what about implications of Service Oriented Architecture?

• Need to work with designers of the patient electronic medical record and PACS to begin to think of ways to index and search through data without compromising patient privacy and security• How can we create tools to utilize AIM, for example to allow local user to

search through his/her PACS/RIS databases?

#2 Patent-centric Electronic Medical Record and PACS makes Data Mining Difficult

• Images associated with clinical trials should be available for users after the study is completed and when approved by the principal investigators, while the study is underway

• This could make images available to investigators and industry without the huge expenses and amount of time and dollars typically required for a study involving clinical images

#1 Challenge to Promote Sharing of Images and Related Data- Still Struggling With this, but we can serve as paragon by sharing TCGA Images and Interpretations as well as In Silico Data

• Originally concept was to purchase large commercial storage from IBM with Oracle Database for LIDC study with idea of adding RIDER data later

• Evolved into image repository for multiple image datasets for different purposes and software development project

• Now we should look at how to create a modular, system that can be easily installed and modified and consider how we would accomplish this if we had to start from scratch today

NBIA

• Use of caBIG software and standards by ACRIN

• Engagement of national imaging community with demonstration of ability to work cooperatively

• Major increase in understanding of role and importance of imaging informatics by caBIG community and even by CIP

• Incorporation of need to utilize informatics tools for research involving imaging and specifically caBIG tools into major NCI grants given out over wide scope including, of course, QIN

Major Accomplishments

• Engagement of major communities with leaders who are interested in caBIG tools such as Radiation Oncology, Quantitative Imaging, Optical and Quantitative Imaging network communities

• Ability to conduct “real” science and research and play role as model for sharing of information in collaborative way in TCGA project

• The imaging workspace is seen as model of effectiveness thanks to excellent administration and organization and incredible energy and expertise and enthusiasm of members of imaging workspace, especially to Paul Mulhern

• Strong interest and use of NBIA by organizations such as Osteoarthritis Initiative

Major Accomplishments cont.

• Uncertainties about budget and issues related to getting budget for workspace has occupied far too much time

• Lack of ability to plan for budget beyond yearly basis

• Mismatch between model for funding SME’s and late funding for projects

• Lack of knowledge Center or equivalent to reach out to imaging community

• Continued lack of sharing of data from sources we hoped would be more interested in sharing such as ACRIN, (e.g. DMIST, etc), TCGA, and others

Challenges

• Knowledge Center

• BIRN concept of sharing imaging resources including software, computational resources, data from studies, etc. in open and non-proprietary manner using “grid” or services model

• IHE engagement for AIM to truly make standard• Need to approach RSNA about this

• Continue to work closely with ACRIN and foster good working relationship with them including testing and co-development of software potentially

Next Steps

• Pathology AIM we need to develop from our workspace or encourage something from Path and Tissue banking

• Improved budget process to facilitate planning for future given constraints of federal government/NIH

• Re-evaluation of DICOM working group 23 Host imaging workstation

• Provide NBIA using services model including RIS/PACS services such as ordering, reporting, archival, communication, and visualization services

Next Steps cont.

• Improved software/tools to allow clinical/research applications that utilize diagnostic imaging data that not only cross correlate with genomic/proteomic data which is harder to come by for now but all other data in patient electronic medical record including pathology, clinical data, etc.• Great to link with molecular data for personalized medicine but we can’t

currently even link to pathology data, clinical data, etc. We need more focus on these and understand how we need to get imaging information into medical and research electronic medical records in highly structured machine readable format

Next Steps cont.

• Move forward as quickly as possible with use cases

• CD imaging sharing which is high profile• Extend work done on edge server by RSNA as part of NIBIB project

and make available• Consider working with existing patient centric providers such as

Microsoft Healthvault etc.

• Create Part 11 compliant image submission for clinical trials • Larry Schwartz indicated that this, in his opinion, would have the

biggest impact on the research and clinical trials community

• Extend and promote engagement of imaging community that develops algorithms and look at ways to incorporate these algorithms into caDSR

Next Steps cont.

• Generalize template creator so others can use it with clear canvas, etc.

• Work with RSNA to formalize relationship of radiology reports in reporting effort with automated template first for oncology but later for other things such as knee MRI etc.

Next Steps cont.

Questions/Discussion