Professional Documents
Culture Documents
Day 1 - Thursday - 1630 PM - John Reilly
Day 1 - Thursday - 1630 PM - John Reilly
• Eligibility
• Outcome
• “Ancillary”
Examples of Past
• Trials/Studies using imaging as an endpoint or
disease marker
– Streptomycin for tuberculosis 1948-50’s
– Scoring system for pneumoconioses
• Trials/Studies of imaging
– Studies of screening CXR’s for lung cancer 1980’s
Examples of Present
• Eligibility
●
NETT: emphysema on CT
●
FORTE: emphysema on CT
●
Oncology trials: “evaluable” disease on imaging
●
Pulmonary embolism: demonstration on CT angio
• Outcome
●
FORTE: change in lung density
●
Alpha 1 AT trials: change in lung density
Examples of Present (2)
• Trials of imaging
– NLST: role of serial CT scans in lung cancer detection
– PET-CT in lung cancer
NEJM 2009; 361: 32-9
NEJM 2009; 361: 32-9
Future?
• Technological Changes
• Challenges
• Opportunities
• Change in the economics and paradigm
– 10 years ago: $ genotyping >> $ phenotyping
– Now: $ phenotyping >> $ genotyping
Define specific subsets within a diagnosis (‘phenotypes’)
-920
Median Tracher Air CT Number [HU]
-930
-940
GE/LS 1
-950 GE/VCT
-960 Philips/6
-970 Siemens
-980 Siemens
-990 Siemens
-1000
-1010
15 20 25 30 35 40 45 50
Data analysisBody Massby
and slides Index
Phil Judy, BWH
Near Term Issues:
Develop Metrics
• Emphysema
– Perc 15 vs. %LAA -910 (-950)
– Also establish norms, reproducibility, effect of lung volume
• Airways
– Nomenclature of airway generations
– Correction for patient size
– WA% vs. Thickness
– Role of attenuation
– Is it possible to summarize the information from the entire tree in one
(or a couple) parameter?
• Bronchiectasis
Near Term Issues:
High Throughput Data Analysis
• Current approaches require a fair amount of
human labor
– Semiquantitative reading and scoring
– Software Programs that require airway editing
• How do we convert the ‘radiologist’s eye’ to an
automatable process?
– Texture Analysis
– ‘Learning’ algorithms in software
– Reference data set (COPDGene workshop)
Near Term Issues:
Cross-Platform Interchangability
• Convince manufacturers to focus on quantitation and to
share data and/or adopt common standards- unlikely
-or-
• Develop protocols that allow valid comparisons between
different scanners
– NLST
– COPDGene
• Develop a common phantom to facilitate
calibration/correction
Conclusions