The QIN Program: Origins and GoalsRobert J. Nordstrom, PhD: QIN Director and Branch Chief, CIP
November 4, 2016
The Goal: Create the condition where all imaging scanners
perform as measuring instruments.:
APresentationtoITCR
The Quantitative Imaging Network (QIN)
§ What is the QIN?§ How is it structured?§ How will it benefit cancer researchand clinical decision making?
Mission Statement
The mission of the QIN is to 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 in individual patients and to predict or monitor the response to drug or radiation therapy.
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Defining QIN: A process
§ Evaluation of imaging hardware performance§ Creation of harmonization methods (software and protocol)§ Reduce bias & variance during data collection
§ Creation of robust algorithms to extract quantitative information from images
§ Testing and validating performance of algorithms and protocols§ Introducing candidate processes into clinical workflow§ FDA and industrial interactions
A Quantitative Measure
Baseline 21 day post therapy:Gefitinib
Long axis=17.7 mmShort axis= 9.6 mm
Long axis=17.1 mmShort axis= 7.4 mm
3% reduction in linear
dimensions
RECIST: Response Evaluation Criteria in Solid Tumors
Data from MSKCCZhao, Oxnard, Schwartz
A Quantitative Measure Revisited
Baseline 21 day post therapy:Gefitinib
41% change in volume
Volume=886.2 mm3 Volume=525.4 mm3
Data from MSKCCZhao, Oxnard, Schwartz
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QIN Analysis Tool Progress Examples
§ A & B: T1 (CE) and T2 weighted MRI images
§ No obvious abnormality§ C: MR Spectroscopy
§ Shows local metabolites
§ Quantitative ratio Cho/NAA§ Shows definite infiltration
§ Biopsy (gold square) shows confirmation suggestive of GBM
ClinicallyusefulMRSpectroscopy
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pCR in NAT Beast Therapy
§ Quantitative MRI§ Patient 1 (Left): shows pCR
§ Significant decrease in parameter kep (a to b) pre-NAT to post cycle 1,
§ And, a large increase in ADC (d to e) over same time
§ Patient 2 (Right): residual disease
§ Increase in kep (g to h) pre-NAT to post cycle 1
§ ADC relatively unchanged (j to k) over same time Patient1showspathologicalcompleteresponse(pCR)
Earlybiomarkers:decreaseinkep parameterwithanincreaseinADC
Patient2showsresidualdiseaseEarlybiomarkersmissingT.Yankeelov,VanderbiltUniv.2014
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The Need for Standardization in Clinical Imaging
For14scannersat8sites(scannerdataonly)
showsthatscannerbiasdriftsatmultiplesitesindifferentpatterns(SUVbiasunderevaluation)
PET/CTScannervariationsovertime
DatafromPaulKinahan
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UCLA is looking at dose reduction
CTimagesofonenodulereconstructedusingthreedifferentkernels(columns)andfourdoselevels(rows),wherethedoselevelsrepresenttheoriginal(toprow)andthreesimulateddoselevels(nextthreerowsrepresenting25%,10%and3%oftheoriginaldose).Theoverlaidredlinesintheimagesarethehistogramofthedensitieswithinthenodule.
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QIN Analysis Tool Progress Examples
§ ePAD: quantitative imaging platform.
§ Plug-in architecture brings many tools into the hands of the clinician
§ Serves a number of clinical workflow scenarios
§ Features algorithms developed by other QIN research teams
Imaginginclinicalworkflow
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PET Imaging in QIN
11 PET/CT Sites
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MR Imaging in QIN
14 MRI Sites
QIN: Uni of Iowa: Architecture
Image Annotation Repository
Image Repository
Clinical Data Management
System
Clinical Data
Repository
Response Assessment
Methods
Presen
tatio
nLayer
Metho
ds
DataStorage
Image Processing Algorithms
Data Visualization
DICOM Viewer with Image
Annotation Tool
Statistical Methods
Know
ledgeBa
se
OntologyCommon
Data Elements
Annotation Template
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Data Sharing on TCIA
http://cancerimagingarchive.net
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ECOG-ACRIN Data Sharing with QINECOG-ACRIN QIN GRANT (U01CA190254): PROPOSED LIST OF TRANSFERS TO TCIA Prepared by: ECOG-ACRIN Team Members; Finalized: February 10, 2016
Response Endpoint/TX Imaging Data Clinical DataPrimary Endpoint Published
SPECIAL REQUIREMENTS Reason for priority level What's to be transferred? When will data transfer start?
Detection Dig Mammogram ACRIN yesFilm Screen images not available. FFDM images available for ~45590 cases
Request by Stanford QIN site, but otherwise probably more limited use.
mammography, pathology data detected tumors
Can start as soon as permissions worked out (perhaps right away?)
Detection CT ACRIN yes data currently available through NCI
Image and data available. Great radiomics dataset.
serial screening CT, pathology on tumors larger dataset already on TCIA?
Detection MRI/MRs ACRIN yesHighly specialized dataset but could be good for prostate QINs. Data on pathology available.
prostate MR/MRS; pathology data Can start as soon as permissions worked out (perhaps right away?)
Pathologic Response/ Chemotherapy
Serial Breast MRI (1273 studies)
ISPY-CALGB 150007 Pending
Key secondary aim available. Endpoint data must be requested from ISPY
This is a response dataset with outcomes for breast cancer propose for several QIN sites. UCSF QIN site played an active role. Very useufl for breast MRI QINs.
serial contrast breast MRI with limited time sampling, response data (pathologic response)
should be quick; active analysis of data for publication in process
Detection CT ACRIN yes Not clear if this is relevant to QIN Can start as soon as permissions worked out (perhaps right away?)
Detection MRI ACRIN yes
Detection study, but could be very good for breast radiomics. Not for response. All data in ACRIN and available.
bilateral breast MRI; pathology data
Can start as soon as permissions worked out (perhaps right away?)
Response, PFS, OS/ Rad Therapy
Serial FDG PET/CT (840 studies) RTOG 0235 yes Outcome data must be requested
from RTOG.
High priority dataset for PET response assesment, with good outcome data. Only reason for priority 2 is data need to come from RTOG.
serial FDG PET/CT for patient undergoing radiation for lung cancer; response data and other outcomes form RTOG
images available quickly; need RTOG data sharing for data
PFS, OS/Rad Therapy, Chemotherapy, Anti-vascular agents
Serial MRI (537 studies)/MRs RTOG 0625 yes might take some work to get data
from RTOG
High priority dataset for MRI brain reposnse, with good outcome data. Highly requested. Only reason for priority 2 is data need to come from RTOG.
Serial brain MRI, some with perfusion MRI data; response data - PFS, OS form RTOG)
images available quickly; need RTOG data sharing for data
Response and Outcomes/ Chemotherapy
Serial FDG PET/CT (194 FDG PET 150 CT, repeatability
ACRIN No
Can release the test/retest dataMerck data may not be available(would have to get approval from Merck)
Test/re-test data immediately available and coould be very good test of PET precision for PET analysis tools.
So far just test/re-test FDG PET/CT for lung cancer
ACRIN images available now, need to request clinical data
PFS, OS/Rad Therapy, Chemotherapy
FMISO (44) DCE MRI (47) DSC MRI (47) MRS (37)
ACRIN No Poster presented at ASCO, primary aim not quite finished
High value data set; ACRIN has outcomes data. Primary manuscript in revision. Should make available with data as soon as accepted. Applicable to almost all brain QIN centers.
Perfusion MRI, FMISO PET, MRS; PFS, OS (N~35)
quickly, all data in place for the paper; dataset transferred to outside core lab once published
PFS, OS/Rad Therapy, Chemotherapy, Anti- vascular Agents
Serial MRI (184) ACRIN No
Waiting on RTOG for a data; Outcome data must be requested from RTOG.Imaging dataset only
Another good brain dataset, but need RTOG outcome data.
Serial brain MRI, some with perfusion MRI data; response data - PFS, OS form RTOG)
images available quickly; need RTOG data sharing for data
PFS, Skeletal Events, Dasatinib
Serial PET Fluoride 32) Bone (30) CT (29)
BMS Study CA 180-263, P Febbo, PI. yes Outcome data must be requested
from Febbo/DOD
Specialized data set with dynamic and WB fluoride. Limited but very good for PET tesitng and QIN sites doing dynamic PET mage analysis. Outcome data would not be hard to get.
Serial dynamic and WB fluoride PET/CT (~15), outcome data - labs and response
images available quickly; we have some data; need sharing permission.
Pathologic Response and Tumor KI-67? Chemotherapy
Serial FLT (199) Serial FDG (19) ACRIN yes
Great data set with serial PET, some dynamic data, status uptake measures and a well accepted outcome (pathologic CR). Very useful for PET QIN sites.
Serial FLT PET/CT (up to 3 per patient), ~ 20 dynamic studies, pathologic response data, tissue biomarker (Ki-67) pre and post-therapy (N~ 50 for response; N ~60 for biomaker correlation.
Can start as soon as permissions worked out (perhaps right away?)
Response, PFS? Chemotherapy/ plus Anti-vascular Therapy Detection
Perfusion CT GOG-0262 almostfirst draft of manuscript Outcome data must be requested from GOG
Great dataset for perfusion CT once primary manuscript is published.
Data and images available now or within next 6 months.Images available now. Data available subject to additional review (may involve a collaborating entity)Primary aim data and images expected to be available within 1 year.
Looks like it will be useful to QIN with imaging components (e.g. response) and data is ready or close to ready
not sure these are relevant for QIN at all or primary publication not close to done
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QIN Challenges and Collaborative Projects
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QIN Challenge and Collaborative Projects: Examples
The Quantitative Imaging Network (QIN)
§ What is the QIN?§ How is it structured?§ How will it benefit cancer researchand clinical decision making?
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Network Organization to Reduce Silo Creation
Technical Teams
Executive Committee
Coordinating CommitteeWorking Groups
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The Working Groups in QIN
§ Clinical Trial Design & Development§ Moving QIN tools to NCTN clinical trials
§ Bioinformatics & Data Sharing§ Bringing informatics tools to QIN and imaging
§ Image Analysis & Performance Metrics§ Building analytical tool inventory through challenges and validation
§ PET/CT Subgroup and MRI Subgroup§ Expanding imaging capabilities through challenges
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Networkintent:buildconsensus,sharedataandtools.
Networkorganizedtobreakdownsilosandtoadvancetranslationintoclinicaluse.
The Growth History of QIN
In 2015: Only 6%of CIP portfolio
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QIN Team Participation
Teams enter Teams LeavingAssociate MembersNational and International
International Extension of QIN
Canada2 Teams, full membership Sweden, Denmark, Bulgaria
Associate Members
South KoreaAssociate Member
India2 Teams, Associate
Members
South AfricaAssociate Member
The Quantitative Imaging Network (QIN)
§ What is the QIN?§ How is it structured?§ How will it benefit cancer researchand clinical decision making?
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From Dr. Lowy
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Quantitativeimagingcanbeanimportantplayerinstratifyingpatientcharacteristicsforappropriateinterventions.
Butthiscanonlyhavevalueifquantitativeimagingtakesaplaceprovidingreliabletoolsinclinicalworkflow.
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Program success is measured from here
Development
Test & Validate
Clinical Workflow
Patientaccess.Whatpopulationwillitserve?Whatisthereimbursement?Howdoesitfitclinicalworkflow?
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Tracking QIN Team Progress
Institution Concept Development Testing & Optimization
Clinical Testing Commercialization Clinical Workflow
Early-Stage Teams( Years 1to 2)
Middle-Stage Teams(Years late-2 to early 4)
Late-Stage Teams(Years 4 to 5)
Basic Research Clinical Research Community
Forthemostpart….
…therearesomeexceptionstothis
How are QIN successes being propagated
§ Over 300 peer reviewed publications from QIN§ Countless presentations at international symposia§ Special issues of journals focusing on QIN results§ Annual reports from the Network
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The Pipeline for Quantitative Image Processing
Informatics
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ProgramStaffInvolvedwithQIN:RobertNordstrom,QINDirectorPushpaTandon,ProgramDirector,CIPYantianZhang,ProgramDirector,CIPHuimingZhang,ProgramDirector,CIPKeyvanFarahani,ProgramDirector,CIPLoriHenderson,ProgramDirector,CIPGeorgeRedmond,ProgramDirector,CIPGaryKelloff,SpecialAdvisor,CIPJacekCapala,ProgramDirector,RRPBhadrasainVikram,BranchChief,RRPJamesDeye,ProgramDirector(Ret),RRPJohnFreymann,ContractorJustinKirby,Contractor
Thanks
www.cancer.gov www.cancer.gov/espanol
