As radiologists and referrer’s seek better quantitative imaging information to improve confidence in diagnoses, the results of a study evaluating an open-source tool for assessing tumor response to therapy are worth noting.
Daniel Rubin, MD, MS, assistant professor of radiology and medicine, Stanford University, Palo Alto, Calif., and chair of the ACRIN Biomedical Informatics Committee, told an audience at the recent meeting of the RSNA in Chicago that the device developed in OsiriX, an open-source image viewing solution that runs on Mac computers, is intended to improve radiologist efficiency in calculating and reporting tumor measurements, such as the Response Evaluation Criteria In Solid Tumors (RECIST).
Called the iPAD, the device summarizes prior cancer lesion measurements and automates the process of recording and reporting them. When the radiologist opens an exam, and the tool presents a tabular summary of what was seen and recorded for a prior exam. New measurements are automatically added to a summary table and a mini-quantitative report is generated.
According to Rubin, this greatly enhanced workflow improved efficiency across five readers from three different institutions by an average of 23%. The radiologists interpreted 20 cases (CT exams of the chest, abdomen and pelvis) that included baseline and three follow-up imaging exams using RECIST 1.1 criteria. The exams were read initially using the iPAD tool and, after a 30-day washout period, reread unassisted by the tool. The use of iPAD resulted in a savings of 2.9 minutes per case.
Rubin has since updated the iPAD to a new version called the ePAD, or electronic Physician Annotation Device (ePAD). The new version supports the National Cancer Institute’s Annotation and Image Markup Standard, so all appropriate metadata are collected and displayed. Rubin currently is engaged in assessing whether the retooled ePAD can achieve similar efficiencies in radiologists quantitative imaging interpretation workflow.
“While tumor measurement methods such as RECIST are used in clinical research, they are very time-consuming to perform,” he said in a press release issued by the ACR. “Moreover, only about 5% of all patients with cancer participate in clinical trials. Oncologists treating the other 95% of patients make decisions based upon more limited qualitative information routinely provided in radiology reports. There is a major need for tools to streamline the process of reviewing cancer lesions, measuring them and reporting those measurements.”
For more on standardized quantitative imaging and what it means for radiologists engaged in routine practice, read "The Quantitative Disconnect" in our StatRead blog.