ACRIN fine-tunes research strategy outside oncology

The American College of Radiology Imaging Network has announced the first of two trials on clinical protocols for the use of coronary CTA in patients presenting to the emergency room with acute chest pain. It also plans to expand its clinical applications research on neurological science outside oncology, according to Dr. Mitchell Schnall, executive director of the international imaging cooperative.

Many physicians and commercial interests with a stake in cardiac imaging were encouraged when the Centers for Medicare and Medicaid Services ruled last year against a national coverage determination that would have required a Coverage with Evidence Development approach to cardiac CT and coronary CT angiography. The cardiac CT reimbursement controversy not only riled clinicians and industry, it highlighted the need for authoritative studies to establish the clinical effectiveness of budding imaging technologies.

ACRIN started its noncancer imaging research efforts in 2006 when it launched a multicenter trial on MR imaging of articular cartilage damage of the knee in osteoarthritis. It also created a cardiovascular committee with funding provided by the ACR and corporate donors. Since then, the committee has been considering specific imaging applications that have potential for clinical use but have not yet been validated.

The first two trials will focus on the role of coronary CTA in patients presenting to the emergency room with acute chest pain, according to Schnall, who received fresh funding of nearly $26 million for further imaging research just a few months after taking over as ACRIN's new boss in January 2008.

“The concept of coronary CTA for acute chest pain is a very focused application and has immediate potential clinical implications,” Schnall told Diagnostic Imaging.

One study will be run out of ACRIN's scientific headquarters in Philadelphia and will receive funding from (Pennsylvania) state tobacco settlement dollars, said Schnall, who is also a professor of radiology at the University of Pennsylvania. A complementary trial to be run by a research consortium led by Dr. Uddo Hoffmann, director of cardiovascular imaging at Massachusetts General Hospital, will be sponsored by the ACRIN Foundation and the National Heart, Lung and Blood Institute.

The studies should provide multicenter data that may not only establish the value of coronary CTA in the acute chest pain setting but will also help plan trials for more challenging indications such as chronic chest pain, Schnall said.

In addition to cardiovascular imaging research, ACRIN will consider neuroscience research beyond cancers of the head and neck. A newly formed neuroscience committee, led by Dr. Gregory Sorensen, a professor of radiology at Harvard University, will lead the effort with a focus on neurovascular disease and stroke.

“I would expect that, much in the way we saw a strategy for cardiovascular imaging research emerge in the past year, this year we will start to see a strategy about the role of imaging in neurovascular disease,” Schnall said.

In 2005, along with the Academy for Molecular Imaging, ACRIN launched the National Oncologic PET Registry with the aim of expanding reimbursement for PET imaging of cancer. Their efforts were rewarded recently by CMS with a national coverage determination that grants reimbursement for most solid cancers and myeloma.