ACRIN's Digital Imaging Research Network


From its inception, the American College of Radiology Imaging Network was conceived as a digital cooperative group. It is the first group ever to establish a complete multi-institutional electronics informatics infrastructure. This infrastructure, ACRIN''s digital imaging network, allows ACRIN participants to enter patients and submit data electronically 24 hours a day, 365 days of the year. Most importantly, this digital imaging network also permits the archiving of every trial-related image in our electronic database.

ACRIN''s digital imaging research network allows participants to acquire images from diverse digital imaging modalities and equipment manufacturers and transmit them over the Internet to a centralized archive located at ACRIN headquarters in Philadelphia, Pa. Primarily, these images are used by the protocol trial teams for quality assurance, off-line interpretations and comparisons with standards of evidence intrinsic to the goals of the respective trials. ACRIN also intends to make the images available to other investigators who wish to perform their own research using images acquired from prior trials.

To facilitate digital image transmission, the ACR developed software, titled Preview, and installed it at each site participating in ACRIN clinical trials. The digital network went online in June 2001 when Preview was installed at the University of North Carolina, Chapel Hill and the University of Toronto. Today more than 50 facilities throughout the United States participate in ACRIN clinical trials and submit images via ACRIN''s digital imaging research network (map showing facilities across the country who participate in ACRIN clinical trials). The network also extends internationally to participating institutions in Toronto and Bonn, Germany.

Already more than 1.8 million images from six diagnostic imaging modalities have been acquired and stored in ACRIN''s central archive, which has approximately 5.8 terabytes of storage capacity. The archive currently includes images from the following modalities: MRI, MR spectroscopy, computed radiography, digital mammography, CT and digital radiography. In addition, image processing and electronic transmission for ultrasound and PET are under way for several upcoming ACRIN clinical trials.

How It Works

When a new site is identified as a participant in an ACRIN clinical trial, ACRIN technology support staff work with the site''s IT personnel to address the technical issues associated with transmitting digital images to the ACRIN database from the institution''s local area network via the Internet. Computer hardware and the Preview software are sent to the facility. An ACRIN technical support person installs the equipment and works with site personnel to ensure images are sent successfully from the digital modality to the ACRIN computer at the site, and then on to the image archive at ACRIN headquarters.

Once a trial is open at the site, a technologist sends raw images to the site''s ACRIN computer after each imaging study is completed. The site research associate reviews the images and confirms that they conform to protocol specifications. The Preview software automatically removes patient identifiers from the DICOM header and inserts study, case and site identification numbers on each image. All images are archived on the participating institution''s computer, and a DVD backup is created. The images are then encrypted, compressed and automatically transmitted overnight via the Internet to the database at ACRIN headquarters.

Once the images arrive at ACRIN headquarters, they are subjected to stringent quality assurance measures. Certified ACRIN imaging technologists execute a protocol-specific utilities program that scans the DICOM header of each image to ensure all facility identifiers are present and that the image follows the scanning parameters specified in the protocol. In addition, a random selection of images from each institution is manually reviewed for quality assurance. Institutions are notified about any image that does not conform to the quality standards and are asked to resubmit.

Network Benefits

The network offers many benefits to imaging research, including:

  • Cost-effectiveness: The digital network eliminates costs associated with the mailing, processing and storage of films as well as the high costs associated with locating and replacing lost cases.
  • Efficiency: The standardization of the image format facilitates the use of images for follow-up research. It also allows the images to be sent to remote locations for review and reading or to a central server location for retrieval by authorized persons. The site can also use its network link to participate in multiple research studies.
  • Additional research support: With proper consent, images obtained and archived for a clinical trial can be used for additional research efforts.
  • Enhanced quality control: The Preview software provides for efficient review of a high volume of images, and automated quality control helps to ensure a high standard of image quality.

Future Direction

Exciting projects are under way to expand the capabilities and research activities of the digital imaging research network. Work is in progress to transmit and archive ultrasound images and cine sequences, and in the coming year a PET core laboratory for the analysis, post-processing and storage of PET images will be established. ACRIN will also work with the National Cancer Institute''s Cancer Imaging Program to develop a centralized image archive that will include diagnostic images from all cooperative groups. In addition, ACRIN looks forward to using its technical knowledge and experience to support imaging research efforts sponsored by government agencies, corporate foundations and industry. It is hoped that ACRIN''s electronic informatics infrastructure will facilitate the timely development and verification of effective imaging applications that will enhance the screening, staging and treatment of cancer patients.

For More Information

ACRIN is a cooperative group funded by the National Cancer Institute to provide administrative, data management and statistical support for multi-institutional clinical trials of imaging and related disciplines applied to cancer. ACRIN Network Chair Bruce Hillman, M.D., is at the University of Virginia and can be reached at (804) 982-0211 or bjh8a@virginia.edu. The Biostatistical and Data Management Center is at Brown University and is directed by Constantine Gatsonis, Ph.D. [gatsonis@stat.brown. edu, (401) 863-9183]. The administrative headquarters is in the ACR''s Philadelphia office under the leadership of Charles Apgar, the group administrator [capgar@phila.acr. org, (215) 574-3231]. Further information about ACRIN also can be found at www.acrin.org.

 

ACRIN Sponsors Fellowships in Clinical Trials

The American College of Radiology Imaging Network has secured funding from the National Cancer Institute and the Avon Foundation to annually train four fellows in how to conduct rigorous, multicenter trials of diagnostic imaging and image-guided interventional technologies. The goals of the fellowships are to develop successful, independent clinical researchers and future scientific leadership for ACRIN.

Fellows may be of any age and in any career stage (in training or in practice). The three NCI-funded fellows may have an interest in any aspect of medical imaging; the single Avon-funded fellow must be interested in pursuing clinical trials of breast imaging.

Fellows spend the initial three months in didactic training at ACRIN core sites. The subsequent 19 months are spent at the fellow''s home institution, where he or she can engage in usual clinical, research and teaching activities while also participating in ACRIN trials. For the last two months of the 2-year fellowship, the fellows return to ACRIN core sites, where each fellow completes work on a protocol for an ACRIN trial that he or she will lead as principal investigator. Fellows are provided $26,500 over two years to support travel and living expenses while at ACRIN core sites.

Applications for the September 2004 – August 2006 fellowship period are due Jan. 3, 2004. Complete information and an application are available on the ACRIN Web site, www.acrin.org. Please direct questions to Bruce J. Hillman, M.D., ACRIN chair, at bjh8a@virginia.edu or (434) 982-0211.