NCI establishes unique imaging network for trial

The National Cancer Institute has become the hub of an unusual imaging network linking several top U.S. pediatric hospitals in support of an ambitious multiyear pediatric cancer trial.

The objective of the trial is to learn more about the natural history of plexiform neurofibromas in patients with neurofibromatosis type 1 (NF1) and to evaluate the usefulness of volumetric MRI analysis of these tumors.

The volumetric MRI measurements are to be performed centrally by NCI experts on images generated locally. A network connecting participating institutions had to be set up to allow them to transfer the images to NCI.

The network, believed to be the first of its kind, captures imaging studies generated on a variety of vendor modalities at participating pediatric hospitals scattered around the country, then stores and distributes the images via a secure Web connection to the NCI for image analysis and evaluation.

"This is the first trial in which we have used electronic transmission of MRI data to a central location to evaluate responses and size of tumors," said Dr. Brigitte Widemann, a pediatric oncologist in NCI's Pediatric Oncology Branch.

The images, acquired from a number of different PACS (Agfa, GE, Fuji, and Siemens), are first pushed to proxy servers located at each hospital, then transmitted to a central data center in Wallingford, CT. There, DVDs are burned for long-term storage and the images are transferred to NCI.

"We don't really care how the images get to our proxy servers," said Jeff Pasquale, director of sales for InSiteOne, a provider of digital image storage and archiving solutions contracted to install and maintain the trial network. "They can be from the PACS or just a push directly from the modality, as long as they're in DICOM format."

There are no dedicated lines. Images are transmitted over the Internet using standard 120-bit encryption and VPN (virtual private network) technology.

The imaging portion of the study involves the storage and distribution of MRI studies from 10 U.S. pediatric hospitals:

?Johns Hopkins Oncology Center of Baltimore
?Children's Hospital of Philadelphia
?Health Science Center of Syracuse
?Texas Children's Hospital of Houston
?Children's Hospital/Dana Farber Cancer Institute of Boston
?Children's National Medical Center of Washington, DC
?St. Louis Children's Hospital
?Children's Hospital of Los Angeles
?Children's Hospital of Pittsburgh
?Children's Memorial Hospital of Chicago

Once at NCI, the images are evaluated using volumetric MRI analysis by Widemann and Dr. Nicholas Patronas of the National Institutes of Health Clinical Center Diagnostic Radiology Department, the responsible neuroradiologist for the study.

"We calculate the volume of an entire tumor using software called MEDx," Widemann said. "Dr. Patronas interprets the images for us, and also confirms that the volumetric analysis is performed correctly."