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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34Image Upload
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7
10
2
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