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Ricardo Avila



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    OA06 - Refining Lung Cancer Screening (ID 131)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      OA06.03 - An Open Source Lung Screening Management System (Now Available) (ID 1467)

      11:00 - 12:30  |  Author(s): Ricardo Avila

      • Abstract
      • Presentation
      • Slides

      Background

      Starting in 1992, the Early Lung Cancer Screening Project (ELCAP) investigators developed the ELCAP Management System (MS) to ensure high quality care and follow-up of the first 1,000 ELCAP participants. The resulting Lancet publication in 1999 created worldwide interest in screening and an updated web-based ELCAP MS was updated to be web-based and provided free of charge to participating institutions, together with the I-ELCAP protocol.

      Method

      The ELCAP MS was designed to be comprehensive and rapidly capture information on each participant to be used by coordinators, navigators, nurses, radiologists, and other medical professionals to ensure appropriate follow-up and care. It provides rapid documentation of telephone or other inquiries, registering, scheduling screening appointments, reporting results, diagnosis of lung cancer, and treatment, and archives all CT images for integrated access of image and patient information. It has been iteratively updated through user feedback, and supports medical reimbursement requirements and continuous quality improvement to minimize harms of lung screening across International ELCAP (I-ELCAP) sites.

      Result

      More than 81,000 participants in 80 institutions worldwide have contributed their LDCT findings and images. The MS has provided efficient data collection for rigorous assessment of screening outcomes which has resulted in some 300 publications and abstracts for protocol updating, comparisons, and continuous quality improvement.

      Having anticipated “open science”, the ELCAP MS has been translated into an open source MS that offers a reference standard for data elements (1,500 data fields, 267 required) for robust and efficient management of lung screening programs. This first open source translation has been adopted by the United States Veterans Administration (VA) and integrated into its VistA Electronic Healthcare System for deployment at 10 VA medical centers through a grant for VA Partnership to increase Access to Lung Screening (VA-PALS). The software is being certified by the Open Source Electronic Health Record Alliance (OSEHRA); source code is available on GitHub.

      Automated quantitative tools have been developed for identification and characterization of nodules, emphysema, major airways, calcification scoring of coronary arteries, aortic valve, thoracic aorta, breast tissue, liver, bone, and image quality. These tools are integrated into the ELCAP MS, and in the future will provide automatically-generated quantitative LDCT reports.

      Conclusion

      The ELCAP MS and I-ELCAP protocol have helped define current global standards for lung screening. Its developers have now made the ELCAP MS publicly available through OSEHRA for support of lung screening programs of any scale throughout the world.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 96)

    • Event: WCLC 2019
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      S01.23 - Evolution of ELIC (Now Available) (ID 3648)

      07:00 - 12:00  |  Presenting Author(s): Ricardo Avila

      • Abstract
      • Presentation
      • Slides

      Abstract

      The Early Lung Imaging Confederation (ELIC) Hub & Spoke Environment (H&SE) is a new globally distributed and open source lung cancer imaging database and computational analysis environment designed to significantly improve the cost, time, and quality of lung cancer imaging research. This IASLC led initiative and computational infrastructure project, when fully deployed, will allow clinical research groups (Spokes) to securely make their locally stored de-identified lung cancer imaging collections available for computational analysis by other research groups (Clients), all coordinated by a central IASLC managed server (Hub). Clinical sites will be able to make lung cancer imaging data available for specific types of computational analysis without transmitting the imaging data over national boundaries to other groups and losing control over how the data is used and further distributed. This allows lung cancer screening research groups to more easily make available datasets to large global lung cancer imaging research studies with far more control over data use. This federated data storage and analysis approach will allow the ELIC H&SE to scale to much larger data sizes than a traditional centralized database, one day allowing lung cancer imaging researchers to quickly and easily perform quantitative analysis on global lung cancer imaging studies with larger collections of high quality, standardized data than is attainable today. This is viewed as a critical next step for the development of next generation Artificial Intelligence algorithms for lung cancer imaging, which require large amounts of data for algorithm development and performance evaluation.

      In preparation for the 2018 IASLC WCLC meeting in Toronto, Canada, a proof-of-concept ELIC Hub and Spoke Environment was developed and set up using Amazon Web Services (AWS) cloud resources. A hub was set up on a Virginia AWS cloud instance and 10 spokes, each pre-populated with an identical set of 100 de-identified CT lung scans, were set up at 10 globally distributed AWS cloud locations including Mumbai, London, Frankfurt, Montreal, Sydney, Tokyo, Paris, Seoul, Sao Paulo, and Virginia (on a separate cloud instance). Two open source lung cancer imaging algorithms, one that automatically computes lung volume for a thoracic CT scan and another for volumetric measurement of small lung nodules, were made available for use by the 10 spoke instances. Live demonstrations of the proof-of-concept system were shown at the 2018 WCLC meeting including the ability to launch computational experiments and receive back quantitative results from the 10 globally distributed spokes. Figure 1 shows the global distribution of the hub and spokes for the 2018 WCLC ELIC proof of concept demonstrations. The live demonstrations showed that the ELIC H&SE could be used to select globally distributed datasets available on the spokes for analysis, run specific computational algorithms on those datasets, and have all of the results aggregated in real-time for viewing on the hub, as shown in Figure 2.

      The ELIC H&SE infrastructure is now undergoing further development in 2019 to bring it from a proof-of-concept demonstration to a functional globally distributed database and computational environment capable of performing useful quantitative lung cancer imaging studies. References to tools and resources for performing data de-identification and encryption are being added to support research groups that will be uploading lung imaging datasets and metadata into the ELIC H&SE. Standards for lung cancer screening data representation, starting with a lung cancer screening data dictionary developed by the VA-Partnership to increase Access to Lung Screening (VA-PALS) project, are also being added to ensure that global analyses can be performed with common terminology and data formats. In addition, the Radiological Society of North America’s Quantitative Imaging Biomarker Alliance (QIBA) small lung nodule conformance certification phantom, specifications, and methods are being used to help lung cancer screening sites prospectively collect, monitor, and optimize lung cancer imaging studies for high quality volume measurements. All of these resources and formats are planned to be reviewed with all ELIC stakeholders on a quarterly basis to receive feedback and refine the systems and methods.

      There are numerous functionality advantages for spokes that use local cloud computing resources including significantly improved security for both clients and spokes, improved computational efficiency through on-demand cloud resourcing, and continuously updated hardware and infrastructure. Additional software development is underway that will allow ELIC to achieve these advantages for cloud-based deployments.

      Live demonstrations are again planned for the 2019 IASLC WCLC meeting in Barcelona, Spain showing an early demonstration of a new iaslc-elic.org website capable of supporting both spokes and clients performing globally distributed lung cancer imaging research studies.

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      Figure 1: The global distribution of the hub and spokes for the 2018 WCLC ELIC proof-of-concept demonstrations.

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      Figure 2: ELIC H&SE live demonstration screenshots showing the ability to view spoke status, select globally distributed datasets for analysis, and view a list of completed experiments (left) as well as drill down and view statistical experiment results including computationally generated images (right).

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