The Quantitative Disconnect

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Nowhere was the disconnect between exhibit floor and session room more apparent than in the realm of quantitative imaging. It is a disconnect that has played out before in medical imaging informatics: Standards versus proprietary solutions. The pull for standards is coming from researchers working with imaging biomarkers and those engaged in pharmaceutical trials: Standardized quantitative measurement tools will ameliorate the problem of inter- and intra-reader—and machine—variability in measurement of tumor response. The push back is coming from vendors who are already miles down the development road when it comes to advanced visualization. The standard bearers are lobbying for the Annotation & Image Markup standard developed within the Cancer Biomedical Information Grid (caBIG) Project. Now a home-grown tool has emerged that promises to help make quantitation methods more practical for routine use. The Open Source cloud-based ePAD was developed at Stanford under the direction of Daniel Rubin, MD. Studies evaluating an earlier version of ePad (called iPAD) demonstrated that the tool shaved 2.9 minutes off the interpretation of a follow-up exam using RECIST 1.1 criteria. Rubin described the tool in a press release issued by the ACR during the show: “The radiologist simply opens an exam, and the tool presents a tabular summary of what was seen and recorded for a prior exam— the specific abnormalities, how were they measured and the measurements. By clicking on any of the measurements, the annotation and its associated image are presented to the radiologist. Any new measurements are automatically added to a summary table and a mini quantitative report is generated, so the quantitative imaging interpretation workflow is greatly enhanced.” Debra Willrett, MA, a software developer at Stanford, demonstrated the ePAD in the Quantitative Imaging Reading Showroom section at Lakeside. Developed primarily for research, the ePAD is a browser-based tool that displays images and collects image lesion measurements in compliance with AIM, she explains. The standards-based approach will enable researchers using the caBIG database to go in later and add genetic information, so the push is on to get PACS vendors to import and export via AIM. “That’s what it’s about,” she explains. “Sharing data.” Research aside, the quality and efficiency ramifications of standardized quantitative imaging are likely to resonate with physicians engaged in routine practice. This is good for patient care.