ACR Data and AnalyticsDART and the Informatics data Platform

Michael TilkinChief Information OfficerAmerican College of Radiology

Laura CoombsSr. Director InformaticsAmerican College of Radiology

Making imaging safe, effective and accessible to those who need it.

36Kmembers

75+years

Core PurposeTo serve patients and society by empowering members to advance

the practice, science, and professions of radiological care.

15Kdigital facilities

ACR Clinical Research Center• NCI-sponsored Research: ECOG-ACRIN, NRG, IROC, …

• World-class core laboratory: Advanced imaging processing tools and workstations; cloud-based image management, quality assessment and interpretation; site and modality qualification; reader study training

• Expert clinical trial support: Protocol design; data management; statistical analysis and results reporting

• Network of research leaders: Experts in specific diseases, modalities, trial design

• Network of qualified sites: Demonstrated competence to perform advanced imaging

• Fully regulatory-compliant research environment (CFR 21 Part 11)

3

ECONOMICSCPT CODING

VALUATION OF PHYSICIAN SERVICES AND PRACTICE EXPENSE

MACRA METRICS AND PAYMENT MODELS

GOVERNMENT RELATIONSCONGRESS

HHS

QUALITY AND SAFETYREGISTRIES AND ACCREDITATION

APPROPRIATENESS CRITERIA

TECHNICAL STANDARDS AND PRACTICE PARAMETERS

INFORMATICSTECHNOLOGY STANDARDS - DICOM

CLINICAL DECISION SUPPORT

COMPUTER ASSISTED REPORTING

MODALITYACCREDITED FACILITIES*

MAMMOGRAPHY 8252

MRI 7099

CT 6991

ULTRASOUND 4970

Nuclear Medicine 3558

Breast Ultrasound 2222

PET 1542

Stereotactic Breast Biopsy 1473

Breast MRI 1612

Radiation Oncology 678

Total*as of April 5, 2016

38,397

EDUCATIONAMERICAN INSTITUTE FOR RADIOLOGIC PATHOLOGY

ACR EDUCATION CENTER

ONLINE LEARNING

ACR Data and Analytic Needs

• Manage images and data for a broad-range of purposes

• Re-use increasingly critical both to leverage assets and address costs

• Blurring of lines between operational and research data needs• Use of Real World Data / Real World Evidence for Research

• Increasing desire for hybrid quality and research registries

• Time-to-value and the opportunity to explore data prior to public release of data sets

Research Data Life-Cycle

Data Ingestion• De-identification• Validation• Automation/System Integration

Processing & Quality Control

• Review Tools• Review Workflow

Data Storage & Curation

• Archiving• Tools for clean-up and harmonization

Data Sharing• Interactive Portal• Automation/Federation• Security and Access Control

Analytics & Data Creation

• Online Analysis• Tool Building• Distributed Access

Object Store

QA ProcessesTRIAD Central

Processing

PACSSite Submission

Cloud-Based Analytic

Environment (e.g. Imaging

Pipeline)

Data Ecosystem: TRIAD and DART

Advanced Search

DART Portal

Access to Analytics

Authentication

Authorization

Reporting Portal DB

Users

DataPathology

Clinical Data Imaging

Integrated Meta Data

DART Integrated Repository

Review Workflow

Image Interpretation & Assessment

Clinical Data / EDCClinical Data /

EDCEMR/ EDC

Image Ingestion and QC Workflow

Radiologist Review and Image MarkupIntegrated Repository (Images, Clinical, Other)

Access, Reporting,Search, and Discovery

Advanced Analytics

Data Transfer - TRIAD• TRIAD (Transfer of Images and Data) – Developed to support image-sharing and workflow needs

• Standards-friendly (DICOM, IHE) and FDA Compliant (CFR 21 Part 11)

• Intelligent Workflow• Provides Data Context and Structure via Integration with Control Systems

• Profile-based De-Identification and Verification at ingestion

• Rules-Based Validation and Advanced Processing at ingestion

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Registries

Accreditation

Clinical Trials

ACRConnect

• Unified interface to ACR Projects and Initiatives• API for seamless data exchange with vendor

products at local facilities

ACR DART – Data Analysis and Research Toolkit

• DART motivated by the need for an integrated platform to facilitate the identification of imaging biomarkers and support advanced clinical research

• Access to data across domains and flexible tools for search and discovery

• Tools such as TRIAD to facilitate the end-to-end workflow associated with managing data in an operational environment

• Cloud-based environment for analytics, tool development, and closed-loop storage

• Federated Access

DART – Data discovery

Imaging Pipeline and Machine Learning

Feedback to Registries

Example: TRIAD / NCTN Workflow

RSS(LPO Roster)

CTSU

Enterprise

Database

(RSS/OPEN)

CEWS

TRIADCTEP-IAM

CEWSCEWSRAVE

DICOM – Metadata andURL to Imaging Study

Patient Info

Study InfoSite Info

User

Au

then

tication

Submitting Site

Protocol Coordinator

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TRIAD Rich Client

Core Lab QC/QA

User Login

Image QC

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User Login

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Core Lab QC/QA

Time Point Info5

Researcher

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Access Images and Integrated Forms

DART

12 12or

Scanner

PACS

Localizer or Scout Image

DICOM Dose Structured Report

Dose Sheet

DICOM

1. De-identification

2. Normalization3. Authentication4. Transmission

TRIAD Site Server

TRIA

D C

entral

ServicesWeb

Services

Dose Registry

Imaging Facility ACR

Post Processing

Facility and Benchmark

Reports• Over 1,500 facilities active across the US

• Over 1 million scans per month

Example Projects:Example of TRIAD Site Server Auto-Populating Dose Registry

DART

Analytic Engine Dose

RegistryDose Registry

UserPortal

Optimize efficiency of qualification and QA/QC processes to reduce costs and improve the quantitative accuracy of multi-center trials using advanced imaging

QIN site 1CTMRPET

QIN site 2CTMRPET

QIN site nCTMRPET

Triad client

Triad client

Triad client

Triad server

VNA

DART

DICOM images

auto-process CT, MR or PET phantom datausing QIN tools

phantom DICOM images

modified DICOM headers

request

retrieve

results back to QIN sites

WIP with EA QIN grant

Example Projects:IR Structured Report Submission Using TRIAD

• HL7 Submission of Reports• Local Processing (parsing, de-

identification)• Delivery to DART for analysis and

reporting