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Response Assessment
Ricardo S. Avila
?
Tumor Size
4 cm lesion
Dt
Progressive
Disease
DD = +20%
RECIST: Sum of LD
Disease
Stable
Interpretation
DD = -30%
Response
weeks
Partial
Erasmus et. al., JCO 2003
Erasmus et. al., JCO 2003
Intra-observer error
Intra-observer error
PD:
PD:9.5%
9.5% ofoftumors
tumors
Response
Complete
PR: 3% of tumors
Time PR: 3% of tumors
Inter-observer
Inter-observererror
error
PD: 30% of tumors
PD: 30% of tumors
Baseline PR:
PR:14%
14% ofoftumors
tumors
& Treat
Assess
Response
We Can Do Better
Improve
• Accuracy
• Precision
To Improve
Target Lesion Measurement
Progressive
• Interval (Dt)
Disease
• Study N
RECIST: Sum of LD
4cm lesion
Disease
Stable
Aided 3D
Interpretation
Response
Partial
Dt
Response
Time Complete
Early Detection
& Nodule Sizing
Detecting a 50 Micron
Displacement
Siemens Emotion 16
16 Slice Scanner
1.00mm Slice Thickness
GE LightSpeed Ultra
8 Slice Scanner
1.25mm Slice Thickness
Scanners
– Hardware (collimation)
– Software (releases)
Protocols
– ScanRx
– Contrast
– Patient position
Observer
– Seed points/ROI 5mm 2.5mm
– Data Interpretation
Volumetric Algorithm Challenges
Boundary Identification Challenges
• Vascular network (Ev)
No/Small DI
ra
depends on lesion size and
eu
Pl
slice thickness Es
Technical Focus Areas
• Open Image Archives
– LCA’s Give-A-Scan Project
– OSA’s Interactive Science Publishing
– RSNA’s Ad Hoc Committee on Open Image Archives
– Drug Efficacy
• Lung Damage Assessment
– COPD impacts aerosolized drug delivery
– Lung Cancer Risk
– Safety
• Cardiovascular damage
Lung Cancer Alliance’s
Give-A-Scan Project
A Lung Cancer Alliance Project
• Pilot project started in 2008
• Process and procedures were created for
accepting and anonymizing datasets
• ~30 individuals expressed interest in participating
• 17 scans received, but 2 were not readable
• Over 6 GB of image and meta data was collected
• 9 patient scans have been prepared for public
dissemination on a LCA website.
Give-A-Scan Website
Dataset includes:
• Age
• Gender
• Cancer Type
• Cancer Stage
• Family History
4 of the 9
subjects are
never smokers
Legal Documents
A large amount of effort spent on developing
the legal framework
• Informed Consent
• End User License
Urethane
New CT Pocket Phantom
Manufactured 21 phantoms and deployed
them into the Abigail phase II clinical trial
Fully Automated Phantom Analysis
Several Studies Underway
Resolution vs. Distance to Isocenter
In-Plane PSF s
s = 0.53 mm s = 0.45 mm s = 0.47 mm s = 0.54 mm
D = 112 mm D = 49 mm D = 62 mm D = 118 mm
Standard Kernel
Bone Kernel
Lung Kernel
Comparison of the New Pocket
Phantom with a Catphan Phantom
Calibration Study
– Siemens Sensation 64 CT Scanner
– 6 pocket phantoms placed in/near an
anthropomorphic chest phantom
– Catphan phantom also scanned
– Varied slice thickness, mA, kVp, and
pitch
http://public.kitware.com/LesionSizingKit/
The
The Lesion
Lesion Sizing
Sizing Toolkit
Toolkit (LST)
(LST) is
is aa free
free and
and open
open source
source
software
software architecture
architecture designed
designed toto accelerate
accelerate thethe development
development
and
and evaluation
evaluation of
of quantitative
quantitative lesion
lesion sizing
sizing algorithms.
algorithms.
Developed in 2008
Focused on Dissemination in 2009
RSNA
Quantitative Reading
Room of the Future
Showcase
Benchmarks
Volcano 2009
OSA ISP Special Issue on
Imaging for Early Lung Cancer Detection
Lung Cancer Risk
Lung Cancer Formation
• Significant tissue damage occurs as
a result of particulate matter (PM)
deposition Hyaline
Cartilage
2. FEV1/FVC
• Decline associated with lung cancer risk
• Follow ATS spirometry guidelines
BD CD
Classifier
• Linear
r
ghe
Hi
r
we
Lo
er
gh
Hi
r
we
Lo
OR = 1.84
108 Cases 67% sensitive
CI: 1.18-2.85
Full Dataset 72% specific
p-value = 0.0067
OR = 2.89
79 Cases 100% sensitive
CI: 1.02-8.19
1mm Only 74% specific
p-value = 0.0467
Conclusion:
Individuals with higher LCRI are more likely to have lung cancer
Data on 21 Cancers and 121 Controls
COPD
COPD
Lung Cancer Risk Findings
• Investigating a new quantitative imaging biomarker
2.5mm
2.5mm Scan
Scan
Standard
Standard
Kernel
Kernel
Left
Measuring Progress 7 Workshops since 2004
1 Interim COPD Meeting
Interim PCF/Cornell Database
Meetings
Annual NCIA
QIBA Workshop Give-A-Scan
FDA COPDGene?
NIST
PY = 5 15 20 28 30 40 45 59 60 63 66 68 72 75 92
Age = 64 51 59 51 57 48 58 60 69 54 64 57 68 74 62
1.0 mm CT
Thickness
Threshold
1.25 mm CT
Thickness
Threshold
PY = 5 15 20 28 30 40 45 59 60 63 66 68 72 75 92
Age = 64 51 59 51 57 48 58 60 69 54 64 57 68 74 62
Thymoma
Carcinoid of
the Thymus
AAH