Presentation at Nov 6, 2017 community call

1. ACR Data and Analytics
DART and the Informatics data Platform
Michael Tilkin
Chief Information Officer
American College of Radiology
Laura Coombs
Sr. Director Informatics
American College of Radiology

2. Making imaging safe, effective and accessible
to those who need it.
36K
members
75+
years
Core Purpose
To serve patients and society by empowering members to advance
the practice, science, and professions of radiological care.
15K
digital facilities

3. ACR Clinical Research Center
• NCI-sponsored Research: ECOG-ACRIN, NRG, IROC, …
• World-class core laboratory: Advanced imaging processing
tools and workstations; cloud-based image management,
quality assessment and interpretation; site and modality
qualification; reader study training
• Expert clinical trial support: Protocol design; data
management; statistical analysis and results reporting
• Network of research leaders: Experts in specific diseases,
modalities, trial design
• Network of qualified sites: Demonstrated competence to
perform advanced imaging
• Fully regulatory-compliant research environment (CFR 21 Part
11)
3

4. ECONOMICS
CPT CODING
VALUATION OF PHYSICIAN SERVICES AND PRACTICE EXPENSE
MACRA METRICS AND PAYMENT MODELS
GOVERNMENT RELATIONS
CONGRESS
HHS
QUALITY AND SAFETY
REGISTRIES AND ACCREDITATION
APPROPRIATENESS CRITERIA
TECHNICAL STANDARDS AND PRACTICE PARAMETERS
INFORMATICS
TECHNOLOGY STANDARDS - DICOM
CLINICAL DECISION SUPPORT
COMPUTER ASSISTED REPORTING
MODALITY
ACCREDITED
FACILITIES*
MAMMOGRAPHY 8252
MRI 7099
CT 6991
ULTRASOUND 4970
Nuclear Medicine 3558
Breast Ultrasound 2222
PET 1542
Stereotactic Breast Biopsy 1473
Breast MRI 1612
Radiation Oncology 678
Total
*as of April 5, 2016
38,397
EDUCATION
AMERICAN INSTITUTE FOR RADIOLOGIC PATHOLOGY
ACR EDUCATION CENTER
ONLINE LEARNING

5. ACR Data and Analytic Needs
• Manage images and data for a broad-range of purposes
• Re-use increasingly critical both to leverage assets and address costs
• Blurring of lines between operational and research data needs
• Use of Real World Data / Real World Evidence for Research
• Increasing desire for hybrid quality and research registries
• Time-to-value and the opportunity to explore data prior to public release of
data sets

6. Research Data Life-Cycle
Data Ingestion
• De-identification
• Validation
• Automation/System Integration
Processing &
Quality Control
• Review Tools
• Review Workflow
Data Storage &
Curation
• Archiving
• Tools for clean-up and harmonization
Data Sharing
• Interactive Portal
• Automation/Federation
• Security and Access Control
Analytics & Data
Creation
• Online Analysis
• Tool Building
• Distributed Access

7. Object
Store
QA
ProcessesTRIAD Central
Processing
PACSSite
Submission
Cloud-Based
Analytic
Environment
(e.g. Imaging
Pipeline)
Data Ecosystem: TRIAD and DART
Advanced
Search
DART Portal
Access to
Analytics
Authentication
Authorization
Reporting Portal DB
Users
DataPathology
Clinical Data Imaging
Integrated Meta Data
DART Integrated Repository
Review
Workflow
Image
Interpretation
& Assessment
Clinical Data /
EDCClinical Data /
EDCEMR/ EDC
Image Ingestion and QC
Workflow
Radiologist Review and
Image Markup
Integrated Repository
(Images, Clinical, Other)
Access, Reporting,
Search, and Discovery
Advanced Analytics

8. Data Transfer - TRIAD
• TRIAD (Transfer of Images and Data) – Developed to support image-sharing and workflow needs
• Standards-friendly (DICOM, IHE) and FDA Compliant (CFR 21 Part 11)
• Intelligent Workflow
• Provides Data Context and Structure via Integration with Control Systems
• Profile-based De-Identification and Verification at ingestion
• Rules-Based Validation and Advanced Processing at ingestion
0
2000
4000
6000
8000
10000
12000
14000
16000
2012Q4
2013Q1
2013Q2
2013Q3
2013Q4
2014Q1
2014Q2
2014Q3
2014Q4
2015Q1
2015Q2
2015Q3
2015Q4
2016Q1
2016Q2
2016Q3
2016Q4
2017Q1
2017Q2
2017Q3
Registries
Accreditation
Clinical Trials

9. ACRConnect
• Unified interface to ACR Projects and Initiatives
• API for seamless data exchange with vendor
products at local facilities

10. ACR DART – Data Analysis and Research Toolkit
• DART motivated by the need for an integrated platform
to facilitate the identification of imaging biomarkers
and support advanced clinical research
• Access to data across domains and flexible tools for
search and discovery
• Tools such as TRIAD to facilitate the end-to-end
workflow associated with managing data in an
operational environment
• Cloud-based environment for analytics, tool
development, and closed-loop storage
• Federated Access

11. DART – Data discovery

12. Imaging Pipeline and Machine Learning

13. Feedback to Registries

14. Example: TRIAD / NCTN Workflow
RSS
(LPO Roster)
CTSU
Enterprise
Database
(RSS/OPEN)
CEWS
TRIADCTEP-IAM
CEWSCEWS
RAVE
DICOM – Metadata and
URL to Imaging Study
Patient Info
Study Info
Site Info
User
Authentication
Submitting Site
Protocol Coordinator
1
3 4Image Upload
6
7
10
2
TRIAD Rich
Client
Core Lab QC/QA
User Login
Image QC
8
User Login
9
Core Lab QC/QA
Time Point Info
5
Researcher
11
Access Images and
Integrated Forms
DART
12 12or

15. Scanner
PACS
Localizer
or Scout
Image
DICOM Dose
Structured Report
Dose
Sheet
DICOM
1. De-identification
2. Normalization
3. Authentication
4. Transmission
TRIAD Site Server
TRIADCentral
Services
Web
Services
Dose
Registry
Imaging Facility ACR
Post
Processing
Facility and
Benchmark
Reports
• Over 1,500 facilities active across the US
• Over 1 million scans per month
Example Projects:
Example of TRIAD Site Server Auto-Populating Dose Registry
DART
Analytic
Engine Dose
RegistryDose
Registry
User
Portal

16. Optimize efficiency of qualification and QA/QC processes to reduce costs and
improve the quantitative accuracy of multi-center trials using advanced imaging
QIN site 1
CT
MR
PET
QIN site 2
CT
MR
PET
QIN site n
CT
MR
PET
Triad client
Triad client
Triad client
Triad
server
VNA
DART
DICOM images
auto-process
CT, MR or PET
phantom data
using QIN tools
phantom
DICOM
images
modified
DICOM
headers
request
retrieve
results back to QIN sites
WIP with EA QIN grant

17. Example Projects:
IR Structured Report Submission Using TRIAD
• HL7 Submission of Reports
• Local Processing (parsing, de-
identification)
• Delivery to DART for analysis and
reporting