Welcome to the Delphi Panel Questionnaire Fifth Round · Welcome to the Delphi Panel Questionnaire...
Transcript of Welcome to the Delphi Panel Questionnaire Fifth Round · Welcome to the Delphi Panel Questionnaire...
Welcome to the
Delphi Panel Questionnaire
Fifth Round
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About the questionnaire ABOUT THE QUESTIONNAIRE
LAST ISSUE
The four Delphi rounds that have been run succeeded in achieving a consensus on the definition of landmarks, and
segmentation modalities.
Here you can find the results of the previous Delphi rounds, represented in the Tables and Figures selected for the
next paper, that you will co-author (consistently with the policy of the journal to which the work will be submitted).
Only one issue remains open: image orientation*.
In the following pages we provide you new evidence, and ask again your opinion.
* Please note that “orientation” does not relate to the position of the head in the gantry during
MRI acquisition, but to the post-processing procedure of re-orienting image stacks.
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Image Orientation: results of the Delphi rounds so far ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so farIn Round II, significant agreement was achieved on the fact that images should be aligned along the long axis of the
hippocampus, to properly visualize the coronal slices that will be used for the manual segmentation of the
hippocampus (agreement 62.5%, p=0.012).
As you may remember, we did not provide quantitative data to base your decision on, and your choice was driven
by personal experience, which you supported with a number of satisfactory reasons.
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Image orientation: methodological problem ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
All of the quantitative information used to support decisions for landmark definition in the previous rounds was
collected on images oriented along the AC-PC line.
Therefore, the methodological problem arises that the shift of the whole protocol on the hippocampal axis might
invalidate all previous decisions.
This is a major methodological problem. The solution would consist in re-running the whole process, including the
collection of quantitative info on Segmentation Units on images orthogonal to the long axis of the hippocampus,
and all Delphi rounds. Unfortunately, this is not feasible.
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Image orientation: NEW DATA ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
In order to address this problem, three expert tracers have performed whole hippocampal segmentations on 10
ADNI images oriented in both ways (hippo long axes and AC-PC). Segmentations were based in both cases on the
harmonized landmark definition.
ICC values for intra- and inter-rater agreement on global volumes show that both orientations lead to very good
results (table).
Nonetheless, the examination of spatial overlapping showed an advantage of AC-PC oriented images. Here you can
see the results of the Dice analyses on spatial agreement, and below the movies showing the tracings made by the
three tracers that produced these findings.
"Movie 1"
Minimum Dice for Hippocampal Axis (0.7835) computed between Tracer 1 and Tracer 3, and corresponding to
Subject 9, Right hippo.
"Movie 2"
Maximum Dice for Hippocampal Axis (0.8889) computed between Tracer 2 and Tracer 3, and corresponding to
Subject 4, Left hippo.
"Movie 3"
Minimum Dice for AC-PC (0.7987) computed between Tracer 2 and Tracer 3, and corresponding to Subject 9, Left
hippo.
"Movie 4"
Maximum Dice for AC-PC (0.8908) computed between Tracer 2 and Tracer 3, and corresponding to Subject 3, Right
hippo.
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Image orientation: NEW DATA (II) ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
Image orientation: NEW DATA (II)
Why does the AC-PC orientation lead to better agreement than the hippo axis, despite theoretically greater partial
volume effect?
We propose that this may be due to the better visualization on the AC-PC line of the CSF separating the posterior
amygdala from the head of the hippocampus. This can be appreciated on axial slices with the 3D navigation tool
(MultiTracer) that we used for segmentation, as illustrated in this Figure
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Summary ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
Image orientation: NEW DATA (II)
Summary
the decision of the Delphi panel to use the Hippocampal axis orientation for Harmonized Protocol
may invalidate the whole process
new data collected on hippocampal segmentations carried out on both AC-PC and hippocampal axis show
better spatial agreement in AC-PC orientation
a greater amount of information regarding the separation of the caudal amygdala from the
hippocampal head on the axial plane might be the source for better spatial agreement in the AC-PC
orientation
an advantage of AC-PC may also consist in greater availability of algorithms for automatic alignment.
The proposed solution in the light of these new considerations is that the AC-PC orientation
should be maintained for the Harmonized Protocol.
We ask your level of agreement with this solution.
If you do not agree with the above solution (Lickert values <5), please provide an alternative that will support the
hippo axis orientation choice in the reviewing process of the paper, without re-running the whole process.
Proposed alternatives will be submitted to the Steering Committee of the project (GB Frisoni, CR Jack, S
Duchesne), who will take a final decision.
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Agree on maintaining AC-PC
After reviewing the newly presented evidence, please
indicate your level of agreement with maintaining the
AC-PC orientation (1=minimum agreement, 9=maximum
agreement).
1 2 3 4 5 6 7 8 9
If your level of agreement is below 5, please provide
alternative solutions. These will be submitted to the
Steering Committee, that will take the final decision.
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ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
Image orientation: NEW DATA (II)
Summary
QUESTION: Agree on maintaining AC-PC
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QUESTION: Agree on maintaining AC-PC
Thanks for voting, we have recorderedyour answer.
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ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
Image orientation: NEW DATA (II)
Summary
QUESTION: Agree on maintaining AC-PC
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Any further comments?
Please feel free to write any other comments here.You can skip this step by clicking "Final Submission".
None
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ABOUT THE QUESTIONNAIRE
Image Orientation: results of the Delphi rounds
so far
Image orientation: methodological problem
Image orientation: NEW DATA
Image orientation: NEW DATA (II)
Summary
QUESTION: Agree on maintaining AC-PC
Further comments
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Image orientation
Question: After reviewing the newly presented evidence, please indicate your level of agreement with
maintaining the AC-PC orientation (1=minimum agreement, 9=maximum agreement).
Agreement: 9
Eventual alternative
solution:
None
If you click SUBMIT, you will not be able to change your answers anymore. Please click only if you are sure.
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Delphi Panel Questionnaire