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TexRAD - Colorectal Cancer
 

TexRAD - Colorectal Cancer

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TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. Currently applicable to ...

TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. Currently applicable to colorectal, breast and lung cancers and we are offering licensing and collaboration opportunities for commercialisation and development of the technology.

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    TexRAD - Colorectal Cancer TexRAD - Colorectal Cancer Presentation Transcript

    • Colorectal Homepage Colorectal Cancer (Liver / Distant Metastatic Disease) Case Study | Demo | Evidence PACS workstation
    • Colorectal Case Study Colorectal Case Study Typical example: A patient visits a clinic after curative colorectal cancer surgery Undergoes a routine follow-up CT scan The Radiologist considers that the CT looks normal with no focal abnormalities However, 18 months later the patient relapses with focal metastatic disease of the liver – fatal consequence TexRAD could have assisted the radiologist to improve this scenario as part of routine clinical procedure 1 2 3 4 5 6 HOW? 6 7 8 Case Study | Demo | Evidence
    • Colorectal CS 2 Colorectal Case Study How TexRAD supports clinician & patient in case study From the routine CT scans taken in the clinic, TexRAD software uniquely extracts and measures fine , medium and coarse textures - in this example, from the Liver CT. TexRAD highlights texture anomalies which are not apparent to normal visual examination These texture anomalies can be used to predict the risk of metastatic disease From this additional information, radiologist may suggest alternative treatment pathways to the patient 1 2 3 4 5 6 6 7 8 Case Study | Demo | Evidence
    • Colorectal Demo 1 Colorectal - Demo 1 2 3 4 5 6 6 7 TexRAD screen shot of Liver Case Study | Demo | Evidence PACS workstation 8
    • Colorectal Demo 2 Screenshot - Liver TexRAD analysis of apparently normal appearing liver (after curative surgery of primary tumour) as seen on follow-up CT of a patient with colorectal cancer could predict the risk of metastatic disease Colorectal - Demo 1 2 3 4 5 6 6 7 Case Study | Demo | Evidence 8
    • Colorectal Demo 3 Colorectal - Demo 1 2 3 4 5 6 6 7 Screenshot - Work flow demonstration sequence for Liver Case Study | Demo | Evidence 8 Clinician’s Workflow
    • Colorectal Demo 4 STAGE 1 - Display the target clinical image of interest A TexRAD analysis is applied to the appropriate 2D CT image highlighting the liver (tissue of interest - TOI). The specialist clinical consultant (e.g. Radiologist) will select the image containing this TOI. Colorectal - Demo 1 2 3 4 5 6 6 7 Case Study | Demo | Evidence 8 Conventional Abdominal CT Image
    • Colorectal Demo 5 STAGE 2 – Draw region of interest (ROI) to be analysed Using TexRAD’s graphical user interface tools, image window level/width can be altered to clearly delineate this TOI, interactive magnification/panning/centring can be used for better visualization of this TOI. Clinician can choose an appropriate ROI tool (e.g. Polygon ROI) from a list of options based on the application. This ROI is super-imposed on the TOI within the original image. Colorectal - Demo 1 2 3 4 5 6 6 7 Case Study | Demo | Evidence 8
    • Colorectal Demo 6 STAGE 3 – Texture Analysis TexRAD employs a novel algorithm (patent applied for) primarily to extract subtle but prognostic metrics currently not available in clinic. The software also graphically displays clinically relevant fine, medium and coarse liver textures separately (below) in addition to their fusion with the original CT image. Colorectal - Demo 1 2 3 4 5 6 6 7 Case Study | Demo | Evidence 8
    • Colorectal Demo 7 Colorectal - Demo 1 2 3 4 5 6 6 7 Case Study | Demo | Evidence STAGE 4 – TexRAD Spectroscopy Summarises the entire texture results graphically for the colorectal cancer patient. Clinician can easily interpret the results for a quick assessment. 8
    • Colorectal Demo 8 STAGE 5 – Risk Stratification Report A risk stratification report specific to the colorectal cancer is generated, which should be used only to assist the clinician to make an accurate decision. The report contains patient ID and scan details, TexRAD analysis result, explanation and contact information. Colorectal - Demo 1 2 3 4 5 6 6 Case Study | Demo | Evidence 8 7 SAMPLE REPORT ONLY FOR ILLUSTRATION
    • Colorectal Background 1 Colorectal Background Facts about Colorectal Cancer Colorectal cancer is the second most common malignancy in Western societies [1]. 40% of the patients undergoing resection of the primary tumour will relapse and die of their disease, making colorectal cancer the second leading cause of death related to cancer [2]. The liver is the sole site of secondary tumour spread (i.e. metastasis) in 20-40% of patients [3] and therefore it is a common practice to follow-up patients after their curative resection [4]. There is an overall survival benefit for intensifying the follow-up of such patients with imaging of the liver being associated with reduced mortality (Odds ratio = 0.66, 95% confidence limits 0.46-0.95) [5]. 1 2 3 4 5 6 6 7 8 Case Study | Demo | Evidence
    • Colorectal Background 2 Colorectal Background Facts about Colorectal Cancer The American Society of Clinical Oncology (ASCO) now recommends annual CT of the chest and abdomen for 3 years after primary therapy for patients at higher risk of recurrence [6]. However, the risk of recurrence is not uniform for these patients and identification of predictive factors that are linked to outcomes may allow modification of surveillance strategies for particular sub-groups and provide effective and optimum patient care. ASCO has also highlighted the need for research in this area [6]. 1 2 3 4 5 6 6 7 8 Case Study | Demo | Evidence
    • Colorectal Background 3 Colorectal Background Comparison of Risk Stratification techniques Additional physiological imaging techniques such as Doppler ultrasound and quantitative analysis of liver contrast enhancement or perfusion on CT also have the potential to identify patients at higher risk of recurrence [7, 8] These techniques may reflect alterations of liver hemodynamics associated with occult metastases [9, 10]. However, the additional image acquisitions required by these techniques have been a barrier to their adoption into surveillance programs. (cost/additional radiation dosage) 1 2 3 4 5 6 6 Case Study | Demo | Evidence 7 8
    • Colorectal Evidence 1 Colorectal Evidence Why TexRAD is better - evidence TexRAD applied to routinely acquired CT images highlights subtle liver changes that may occur in association with alterations in liver physiology. Furthermore computer simulations and clinical studies have suggested that measurements of liver texture on CT may reflect liver vascularity [11-13]. The ability of Liver TexRAD to detect occult tumour on CT is further supported by studies demonstrating textural differences between normal livers and apparently normal areas of tissue within livers bearing tumours, areas also known to exhibit alterations in blood flow [13-15]. 1 2 3 4 5 6 6 Case Study | Demo | Evidence 7 8
    • Colorectal Evidence 2 Colorectal Evidence Why TexRAD is better - evidence Preliminary results of Liver TexRAD demonstrate the potential for liver texture on contrast-enhanced CT to provide a novel parameter that is not only insensitive to variations in acquisition parameters but can also act as a marker of survival for patients following resection of colorectal cancer [16]. 1 2 3 4 5 6 6 Case Study | Demo | Evidence 7 8
    • Colorectal Evidence 3
      • Clinical evidence
      • European Journal of Radiology 2008 [17]
      Colorectal Evidence The patients with liver metastases (group C) showed significantly decreased trend in ratio values compared with the patients with no recurrence (group A; p=0.0257) and with patients with extra-hepatic metastases (group B; p=0.03). Box-and whisker chart showing median, inter-quartile range and minimum and maximum values . 1 2 3 4 5 6 6 Case Study | Demo | Evidence 7 8 Fine to medium texture ratio - entropy 1 1.05 1.1 1.15 1.2 1.25 1.3 1.35 1.4 1.45 Group A Group B Group C q1 min max q3 Median
    • Colorectal Evidence 4
      • Clinical evidence
      • Academic Radiology 2007 [12]
      Colorectal Evidence This normalized coarse liver textures was significantly different in patients with extra-hepatic metastases compared to patients with no tumour (p<0.04). Hepatic Phosphorylation Fraction Index (HPFI) = Standardized Hepatic Glucose Uptake Value (SUV)/Total Hepatic Perfusion (THP). 1 2 3 4 5 6 6 7 8 Case Study | Demo | Evidence
    • Colorectal Evidence 5
      • Clinical evidence
      • Radiology 2009 [16]
      Colorectal Evidence Kaplan-Meier survival curves for colorectal cancer patients with normal liver appearances on conventional CT separated by (A) Hepatic Texture analysis (HTA) and (B) Liver Perfusion Index (HPI). Survival curves were significantly different for HTA (p<0.005)]. 1 2 3 4 5 8 Case Study | Demo | Evidence 6 7