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Imaging Informatics

Ann Scherzinger, PhD, CIIP


C-TRIC Lecture Series, May 18, 2011
Science of Information and
Information Processing

!   Breadth, depth of current activities in human medical


imaging informatics

!   Research Imaging versus Clinical Imaging

!   National and Local Initiatives

!   C-TRIC web site as an AMC imaging information


resource
Imaging Chain
Issue which affect Image Information
!   Visual system

!   Subject

!   Energy source and capture device

!   Image reconstruction and processing

!   Display

!   Storage and Transmission

!   Reporting
Visual Systems

THE HUMAN THE COMPUTER


•  Analysis of eye movements in performing diagnosis.
•  Enhance speed
•  Reduce fatigue
•  Training
•  Variations in sensitivity and specificity across users and/or algorithms.
•  Variations in manually determined numerical results.
Vision Experiments

Evaluating Eyegaze Targeting to


Improve Mouse Pointing
for Radiology Tasks

Journal of Digital Imaging, Vol 24, No 1 (February), 2011: pp 96-106


Subject
!   Obvious is normal versus
abnormal
!   Less obvious is: subject
complexity
!   Anatomical variations
!   Contrast tolerance
!   Body habitus
!   Radiation exposure

!   When data is used for


!   Inter- and intra-subject
comparisons
!   Inter-modality comparisons
!   Determine image content
Automated Correspondence

Retinal Images Used in this Study


Automatic Correspondence on Medical Images: A Comparative Study
of Four Methods for Allocating Corresponding Points

Economopoulos TL. etal. Journal of Digital Imaging, Vol 23, No 4 (August), 2010: pp 399-421
Image Fusion

CT (UL), PET (UR), Fused (LL)


Takes advantage of the high spatial resolution anatomy of CT and the
functional information of PET
Energy Source and Capture Device
!   Obvious: appropriate for
condition (MR/CT for
MS)
!   Less obvious:
!   Radiation concerns
!   Imaging protocol
variation
!   Resolution/noise
variation
!   Scanner variation
!   Availability and accuracy
of metadata
Acquisition variation

Bone scan images acquired at varying time points. Bone scan images after a histogram matching technique.

Comparison of Image Enhancement Methods for the Effective Diagnosis


in Successive Whole-Body Bone Scans

Jeong CB. Journal of Digital Imaging, Vol 24, No 3 (June), 2011: pp 424-436
Acquisition variation
Variation in Protocol labels for Brain MRI study.

2009 Study of protocol name variations for a sample of Brain


MRI studies from 3 scanners
Slice Thickness Variation

3D models of the heart from 5mm and 1mm


slice thickness, CT acquisitions
Image Reconstruction and Processing

!   Filters
Variation in CT Number Obtained for Three Scanners
1.200

1.150
•  Reconstruction
1.100
•  Post-processing
Electron Density

1.050
Soft Tissue
1.000 !   Noise corrections
0.950

0.900
!   Compression

!   CAD
0.850

0.800
-150.0 -100.0 -50.0 0.0 50.0 100.0 150.0 200.0 250.0 300.0
CT Number
Display
!   Hanging protocols
!   Efficient reading
!   Multi-spectral
comparison
!   Serial comparisons

!   Data visualization

!   Display characteristics

!   Atlases
Display - Atlas

An Online Evidence-Based Decision Support System for Distinguishing


Benign from Malignant Vertebral Compression Fractures by Magnetic
Resonance Imaging Feature Analysis

Wang KC. Journal of Digital Imaging, Vol 24, No 3 (June), 2011: pp 507-515
Storage and Transmission
!   File format variations
•  DICOM (clinical)
•  tiff, gif, jpg, zvi, lscm…
•  pdf, xml, doc, bmp…
•  Proprietary
•  Compression

!   Recall needs
!   Metadata
!   Data organization
!   Sharing

!   Architecture and size


Mouse μCT, 3GB study Human CT, 1.6G study
!   Cloud vrs local
!   Research workflow

!   Sharing and security needs


!   Anonymization
!   Sufficient labeling to be of use
!   Testing of new algorithms
Data Sharing
Reporting
!   Clinical eports
!   Typically free text
!   ACR templates
!   DICOM-SR
!   BIRADS, OB reports…
!   Limited standardization of
terminology

!   Research
!   NLP
!   Integration of ontologies
!   Creation of domain specific
ontology
!   Integration into reports: AIM
RadLex - RSNA

http://www.rsna.org/radlex/

The IR Radlex Project: An Interventional Radiology Lexicon—A


Collaborative Project of the Radiological Society of North America
and the Society of Interventional Radiology.

Kundu S. etal. J Vasc Interv Radiol 2009; 20:S275–S277


Annotated Image Markup
NCI

Automated Structured Reporting of Imaging Findings


Using the AIM Standard and XML

Zimmermann SL. etal. RadioGraphics 2011; 31:881–887


Society for Imaging Informatics in
Medicine (SIIM)
!   Medical imaging and
informatics professionals

!   CIIP
!   ABII Certification
Process
!   Educational materials

!   Journal, technical
publications, on-line
materials
!   Networking community
Research versus Clinical
Clinical Trials as Research

!   Standard protocols !   Patient variable protocols

!   Organize by project !   Organize by patient

!   Quantitation more common !   Limited quantitation

!   Requires standard !   Typically free text, not


terminology standardized language

!   Requires standard reporting !   Reporting templates


becoming more common
!   Non-standard image formats
!   DICOM images
C-TRIC Participation in
Quantitative Imaging Initiatives
!   Clinical and Translational Science Awards Imaging Working Group (IWG)
!   “The CTSA Imaging Working Group is dedicated to sharing ideas, visions, and expertise to
enhance the utility of imaging in translational research.”
!   Subgroups: Education, Informatics Resources, Protocol Standardization

!   NCI-Centers for Qualitative Imaging Excellence (CQIE)

!   NIBIB – Quantitative Imaging Biomarkers Alliance (QIBA)


!   “…advance quantitative imaging and the use of imaging biomarkers in clinical trials and
clinical practice..”
!   Quantitative CT, MRI, PET and COPD-Asthma working groups

!   NCI-Quantitative Imaging Network (QIN)


!   “improve the role of quantitative imaging for clinical decision making in oncology by the
development and validation of data acquisition, analysis methods, and tools to tailor
treatment to individual patients and to predict or monitor the response to drug or radiation
therapy.”
!   Informatics, Data Sharing, Clinical Trial Design, Data Collection, Image Analysis
and Performance Metrics, Outreach
CTSA-IWG
Issues facing translational imaging research
!   Fee Schedules: range of typical fees for research imaging
expenses at CTSA sites – human and animal.

!   Uniform Protocol for Imaging in Clinical Trials


(UPICT) template. 18FDG PET/CT template.

!   Description of Imaging Cores at CTSA sites.

!   Overview of research informatics infrastructure needs.


How can they work?

!   Whitepapers on research informatics needs


http://www.ctsa-imaging.org/
NCI Centers for Quantitative Imaging Excellence (CQIE) goals

!   Detect tumors early, monitor


disease and guide therapy using
the most advanced quantitative
imaging techniques.

!   Establish a resource of “trial


ready” sites within NCI Cancer
Centers, with the ability to
perform accurate and consistent
quantitative imaging protocols

!   Pre-qualify sites to promote rapid


start-up of clinical trials.

!   Promote collaboration among


imaging and treatment teams.

Zhao etal. Radiology: Volume 252: Number 1—July 2009


UCCC-UCD-UCH NCI-CQIE collaboration activities
!   Member of the first group of Cancer
Centers chosen for pre-qualification.

!   Qualified in February 2011 to conduct


clinical trials utilizing
!   CT/MRI volumetric studies
!   MRI dynamic contrast enhanced
(DCE) imaging protocols
!   MRI diffusion weighted imaging
!   Static and Dynamic PET-PET/CT
imaging protocols

!   UCH Department of Radiology


Marchiano A etal. Radiology: Volume 251: physics and technologist teams
performing on-going testing to
Number 3—June 2009 maintain yearly qualification.
NIBIB-QIBA
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Measurement Variability in the
Assessment of Part-Solid Lung Nodules
OBJECTIVE

!   Evaluate intra- and inter-observer variability of volumetric and longest


diameter measures of part-solid lung nodules using a low-dose CT screening
protocol.

BACKGROUND AND SIGNIFICANCE


!   Part-Solid nodules (PSN) have much higher malignancy rate (62.5 %) than
GGN (19%) or solid nodules (7%)

!   Solid portion correlates with the invasive component


!   Staging and treatment implications

K. GARG, PI
a b c
Invasive Adenocarcinoma. Axial CT image (a) shows a part solid nodule in the left
upper lobe. Corresponding sagittal CT images (b) and (c) show automated estimation of
the volume of solid component (1.188 ml) the entire lesion (8.312 ml) . In this case, if
tumor size were measured only by the invasive component, the size T factor would
change from T2a to T1a

Henschke C, et al. AJR Am J Roentgenol 2002;178(5):1053–1057.


Travis W, Brambilla E, Noguchi M, et al. IASLC/ATS/ERS International multidisciplinary
classification of lung adenocarcinoma. J Thoracic Oncol 2011;6:244-285
Image Acquisition
!   30 Subject Scans
!   A combination of retro- (20) and prospective (10) part-solid lung nodule
cases
!   Acquired on a Siemens 16 or Siemens 64 CT
!   Low Dose Imaging Protocol, B60 (sharp) reconstruction kernel
!   1 nodule per patient

!   Phantom Scans
!   Scanning parameters identical to those for human subjects, performed on
both Siemens 16 and Siemens 64 CT systems.
!   Imaging of Lungman phantom with synthetic part-solid nodules from Dr.
Nicholas Petrick (1A Group). Performed on the Siemens 16 and Siemens
64 CT.
!   Evaluation of synthetic nodules using same metrics as for human subjects.
!   Imaging of ACR phantom to assess noise and spatial resolution, for
comparison with data from Dr. Charles Fenimore (1C Group)
Measures
!   Analysts
!   4 radiologists, repeating each measurement

!   Software
!   Vitrea 3D volumetry

!   Phantom calibration
!   Intra- and Inter-observer variability
!   Metrics Whole Solid Component Low Density
Lesion Component
Volume Volume Volume (Derived)
Mean CT Density Mean CT Density Mean CT Density
(Derived)
RECIST RECIST RECIST (derived)
NCI-QIN Bioinformatics
!   Develop specifications for research archive
!   Central archive, access control
!   Support research and clinical file formats
!   User interface
!   Maintenance, documentation and support
!   Open source, user community support

!   Review existing systems:


!   NBIA - NCI
!   XNAT – Washington University SOM
!   MIDAS – Kitware open source

https://wiki.nci.nih.gov/display/CIP/Analysis+of+the+available+bio-imaging+archiving+tools
C-TRIC Web Site

  Scheduled to launch July 1, 2011


  Purpose
  Access to information on imaging resources on campus
  Access to consultation and educational materials for those who
would like to incorporate imaging into their research

Mouse image courtesy N. Serkova

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