ACRIN trials run on a Web network

Nationally accessible electronic image archives have become an integral part of medical research. One of the most prominent is the American College of Radiology Imaging Network (ACRIN), a National Cancer Institute-sponsored cooperative group established to perform multi-institutional clinical trials in diagnostic imaging related to cancer.

ACRIN is unique in that it has no fixed members, giving it a flexibility designed to encourage participation of investigators at all facilities.

Now in its fourth year, ACRIN is accruing images from 17 clinical trials. Two are closed with all the images in, and seven are open and still generating data. Eight trials are gearing up.

"The two most prominent studies are the large national screening trials," said network chair Dr. Bruce Hillman of the radiology department at the University of Virginia.

The Digital Mammographic Imaging Screening Trial has accrued close to 14,000 patients - with a goal of 49,500 - in a comparison of the accuracy of digital and conventional mammography. The massive National Lung Screening Test that will eventually involve 50,000 patients is looking at CT versus chest x-ray for lung cancer screening.

"The basic philosophy here is trying to run a paperless network," Hillman said. "The development of the trials, the accrual of data and images, the quality assurance of data - all of that is handled over the Web."

Images and data are transmitted in real-time from onsite computers from over 110 sites now signed up for ACRIN trials, with about 60 sites participating in at least one trial each.

ACRIN has established a complete informatics infrastructure that allows it to recruit patients, randomize them into trials, submit data and images, and monitor activities of the organization around the clock.

"The infrastructure also permits the archiving of every image for every trial in our database," Hillman said.

The images are used primarily to permit the trial team to perform quality assurance, offline interpretations, and comparisons with standards of evidence intrinsic in the goals of the respective trials. But ACRIN also makes the images available to other investigators who wish to perform their own research.

All images and data are archived in Philadelphia at the headquarters of the ACR Research Office, the same organization that has been responsible for managing the Radiation Therapy Oncology Group for nearly 30 years.

To improve visibility throughout the industry, ACRIN is publishing its own newsletter and has a booth at the RSNA annual meeting in Chicago as well as its own Web site ( http://www.acrin.org ).