Streamlining the Quantitative Metrics Workflow at a Comprehensive Cancer Center.

INTRODUCTION: The objective of the project was to describe an efficient workflow for quantifying and disseminating tumor imaging metrics essential for assessing tumor response in clinical therapeutic trials. The clinical research utility of integration of the workflow into the electronic health record for radiology reporting was measured before and after the intervention. MATERIALS AND METHODS: A search of institutional clinical trial databases was performed to identify trials with radiology department collaborators. Investigator initiated trials, or those which lacked a standardized or automated system of collaboration with the research team were selected for the study. A web based application integrated in the electronic health record platform, the Quantitative Imaging Analysis Core (QIAC) initiative was established as a divisional resource with institutional support to provide standardized and reproducible imaging metrics across the institution. The turnaround time for radiology reports before (phase 1) and after web based application workflow (phase 2) was measured. During our test period (November 2014 to June 2015), a total of 68 requests with 37 from phase 1 and 31 from phase 2 were analyzed for patients who were enrolled in prospective clinical therapeutic interventional trials. RESULTS: The mean turnaround time for generation of quantitative tumor metric results after implementation of the web based QIAC workflow (phase 2) was significantly lower than prior (phase 1) (15.9 ± 21.3 vs 31.7 ± 35.4 hours, p= 0.0005). The mean time from the scan to the preliminary assessment was 19.6 ± 25.6 hours before and significantly reduced to 8.0 ± 9.9 hours with implementation of web based QIAC workflow. CONCLUSION: Implementation of a web based QIAC workflow platform enabled significantly improved turnaround time for quantitative tumor metrics reports and enabled faster access to the reports.

Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies.

PURPOSE: To evaluate C-arm computed tomography (CT) and assess its potential impact on hepatic arterial interventions. MATERIALS AND METHODS: Between May 2005 and March 2006, all hepatic arterial interventions for hepatic malignancies were retrospectively reviewed. C-arm CT acquisitions were performed as an adjunct to conventional digital subtraction angiography (DSA). The number of procedures with C-arm CT, the acquisitions per intervention, and the procedure time for all interventions were recorded. The added information provided by C-arm CT was scored as category 1 (no additional information); category 2 (added information without impact on procedure management); or category 3 (added information with impact on procedure management). Intervention types included infusions, radioembolization, embolization, and chemoembolization. A two-sided, two-sample t test was used to compare interventions with and without C-arm CT, and P values less than .05 were considered significant. RESULTS: C-arm CT was used in 86 of 240 interventions (36%) in 135 patients. The mean number of acquisitions per study was 1.9 (range, 1-4). Thirty-five interventions (40.7%) were scored as category 2 and 16 interventions (18.6%) were scored as category 3. Chemoembolization was associated with the highest percentage of C-arm CT investigations classified as category 2 and 3 assessed per intervention. The mean procedure time was significantly longer (18 minutes) when C-arm CT was used (P<.001). CONCLUSIONS: C-arm CT provides additional imaging information beyond DSA during hepatic arterial interventions (approximately 60%), and this information impacted procedure management in 19% of cases. C-arm CT offers the greatest opportunity for additional information during chemoembolization procedures and is responsible for a significant but acceptable increase in procedure time for this type of hepatic intervention.