The inaugural ECOG-ACRIN Imaging Researchers’ Workshop brought together a diverse group of attendees who share a common interest in advancing oncologic imaging clinical trials. Nearly 150 people, including radiology and nuclear medicine physicians, oncologists, clinical trial methodologists, imaging technologists, and research associates, attended the October 4, 2012 workshop that was held in Arlington, VA.
The two-tracked meeting offered separate, concurrent programs for technologists and investigators. One track convened leaders from throughout the imaging research community to hear perspectives presented by imaging research experts affiliated with ECOG-ACRIN and other groups within the National Clinical Trials Network. The other track offered a unique educational opportunity for technologists working in the clinical setting with computed tomography (CT), positron emission tomography (PET), and/or magnetic resonance imaging (MRI). All participants joined over lunch for a panel discussion on what it takes to be a successful imaging research site, with representatives from both the academic and community settings sharing their experiences.
“The workshop’s concept was to bring together investigators and leaders from all facets of the National Cancer Institute to engage in a dialogue about the current and future role of imaging in oncology clinical trials,” says workshop Co-Chair Mitchell Schnall, MD, PhD, ECOG-ACRIN Co-Chair and Department of Radiology Chair at the University of Pennsylvania (Philadelphia, PA). “Several common themes surfaced during the day that will serve to focus follow-up discussion and activities, and our intent is to make this information broadly available.”
Considerable discussion took place about the potential of quantitative imaging methods with PET and MRI to provide oncologists with information about which patients are likely to respond to a specific treatment regimen and how best to utilize these methods to individualize treatment.
Quantitative imaging biomarkers are unique in that they place information in an anatomic context and provide more information than structural imaging alone. One example presented at the workshop was the use of advanced quantitative MRI in the ACRIN 6698 study. The study has two scientific aims: (1) to evaluate whether diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) is effective for measuring breast tumor response to neoadjuvant treatment; and (2) to compare DWI-MRI to dynamic contrast-enhanced MRI (DCE-MRI) measurements of tumor microvascular behavior.
The challenges posed by advanced quantitative imaging were a major topic of discussion among imaging leaders. Scanner manufacturers do not have standards by which they can assure compliance with image acquisition and processing algorithms. At the site level, there is a lack of “standard of care” image protocols, and adherence to protocol imaging parameters is an issue. The workshop provided a forum for presenters and attendees to discuss specific solutions to these challenges. A unified approach to clinical trial qualification and site education were among the suggestions put forth. Another proposed solution was to engage manufacturers to support standardization of protocols via quantitative imaging networks, such as the Quantitative Imaging Network, the Quantitative Imaging and Biomarker Alliance, and others.
“The workshop’s collaborative tone establishes a positive precedence for how the National Cancer Institute envisions groups working together in the National Clinical Trials Network model,” says workshop Co-Chair Michael Knopp, MD, PhD, Professor and Vice Chair of Research in the Department of Radiology at Ohio State University (Columbus, OH). “The interest in future similar forums was echoed by many in attendance.”
The educational track for imaging technologists, which was a “first,” provided perspectives about the key components of successful clinical trial conduct, study participation from the patient viewpoint, and a discussion of “the good, bad, and the ugly” related to image acquisition techniques (with case examples of both poorly executed and excellent imaging).
“The important role of the technologists performing research scans cannot be overstated,” says Wendy Smith, BS, RTRCV, CCRP, Research Associate at Rhode Island Hospital (Providence, RI), who led the development of the technologists’ educational program. “Their commitment to being an active member of the research team and understanding the larger picture is crucial.”
Workshop presenters also helped attendees gain an increased understanding of the importance of minority inclusion in research studies, human subject protection regulations, and informed consent.
“The response was fantastic,” reports Tracy Sitton-Petro, CTR, CCRP, Research Associate from Clinical Radiologists, SC (Springfield, IL), who served on the workshop planning committee. “The opportunity to network and share experiences was particularly appreciated.”