In the next session, Dr. John Childs and Mr. Avila reviewed the significant progress that they have made jointly in developing infrastructure to support open publication of imaging research, including the publication and review of large collections of CT data. Dr. Charles Clark from the physics group at NIST presented new approaches to image evaluation standardization and outlined NIST plans and opportunities.
Next, Dr. Brian Duchinsky of GE Healthcare, Dr. Lee, and Dr. Guendel discussed the future of CT-imaging progress. The presentations all suggested a bright future for sustained imaging progress based on enhanced resolution, faster image-processing times, and tighter integration of image-analysis capabilities into workflows. This session ended with a panel discussion that outlined the importance of developing better image archival resources to ensure the optimal clinical integration of the future generation of CT scanners.
Dr. Joseph Reinhardt of University of Iowa discussed progress with image processing in COPD. This is an area of rapid progress, and while there were some similarities in analysis approach, he also outlined a very powerful approach to measuring deformations of the lung between inspiration and expiration. This approach has the potential for identifying and quantifying compromised areas of the lung parenchyma and may help support a range of lesion-sizing and analysis methods in the future.
A panel of accomplished imaging scientists then reviewed the topic: How to collaborate to accelerate response assessment for lung cancer. Panelists included Dr. Fenimore, Mr. Avila, Dr. Terry Yoo of NIH, Dr. Reeves, and Dr. Thomas Baer of the OSA. Dr. Yoo provided a presentation on the importance of open science—the movement dedicated to sharing of scientific data and collaboration within a global community of researchers—and urged the lung cancer research community to adopt open publication of datasets and algorithms. The group was uniform in endorsing the importance of open publication and aggregation of published imaging files and associated meta-data as a foundation for success in this new field.
Molecularly Targeted Drug Therapy and Regional Drug Delivery Dr. Phil Bonomi of Rush University Medical Center presented an overview on the current state of progress with lung cancer drug development. His presentation outlined the mechanistic targets for the major ongoing clinical trials in lung cancer. Dr. Bonomi’s presentation emphasized the need for new drug options for advanced-staged disease but echoed the sentiment that the greatest hope for major breakthroughs exists for strategies associated with treating early cancer.
Dr. John Patton of Nektar Therapeutics reviewed recent progress in approaches to regional lung delivery as a strategy for more efficient drug therapy for early disease. Dr. Patton used his extensive experience with the development of aerosolized insulin as a model of the aerosolized drug development process. Lung cancer arises from the chronic deposition of tobacco combustion products in the airway through the aerosolized delivery of carcinogens. Having efficient pulmonary drug delivery capability to deposit targeted therapeutics to the same cells that have been transformed by tobacco smoke is a conceptually attractive tool to explore for early lung cancer management.
In a related presentation, Dr. Jack Lee of the University of Texas M.D. Anderson Cancer Center presented a new and potentially more efficient trial design for the evaluation of new targeted therapeutics. Dr. Lee outlined how patients can be allocated to different randomized arms of a clinical trial using information derived from evaluation of the baseline biopsy to the tumor biology specific to each patient. This biologic information can be used to predict potential patient response and increase the probability of a favorable clinical response to the drug therapy. This adaptive Bayesian design has the potential to maximize the efficient use of volunteer participants and improve overall drug response.
The status of cardiac imaging was presented by Dr. Stanley Clark of Midwest Heart Center. This topic reflects the shared tobacco-related pathogenesis of lung cancer and COPD with coronary artery disease.
In the final set of presentations, Dr. Reeves reviewed preliminary results of a comparison of approaches to determining lung nodule volume and showed an interesting array of cases that exemplify the types of challenges anticipated in this field. Dr. Nick Petrick of the FDA presented on the assessment of nodule volume error and presented preliminary results obtained with his group’s anthropomorphic phantom. Finally, Dr. Fenimore outlined initial results comparing software algorithms for lung cancer and discussed plans for NIST to develop additional capabilities to facilitate quantitative imaging processes.