Abstract
ABSTRACT Introduction In multicenter trials the decision for surgical resection of liver colorectal cancer metastases is based on decentralized CT- or MRI scan reviews. The process for scan sharing and review may be troublesome, lengthy and expensive. We present an integrated web-based system for this purpose. Methods A web-based scan review system that incorporates NIH ImageJ, an open source Java based image analysis and processing software program, was developed. It provides storage of, and convenient access to CT- or MRI scans. De-identified scans available in CD/DVD format combined with specific clinical data are locally uploaded to a central server. Reviewers, notified by email, may assess the files and complete their interpretation online. If an interpretation in not entered in the specified time duration, a reminder is sent by email. A report with all the interpretations can be distributed to decision-makers. The system allows downloads of data associated with each set of scans in an excel spreadsheet and archiving the scans into separated folders with the patient ID as the folder name. Results The scan review system was customized for a multicenter clinical trial (clinicaltrials.gov identifier: NCT01293942) with four different participating hospitals. The members of the Downstaging Surgical Committee (DSC) complete real-time blinded resectability assessments at screening/baseline and after 4, 6 and 8 cycles of downsizing therapy. A scan of 100 DICOM files at 514 KB each is uploaded in 15 minutes. The system will load the same scan on any of the major operating systems and browsers in 13 minutes. Subsequent download require 5 minutes to reload. We did not experience any technical problems using the system. Conclusion The system allows for decentralized image upload, image review on multiple platforms, secure storage of scans and reports and it is easy to use, at affordable costs. We anticipate that web applications, such as described, will make CT- or MRI scans image analysis easy and straightforward in the multicenter, multidisciplinary assessment of downsized and potentially resectable cancer metastases.
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