Standardised lesion segmentation for imaging biomarker quantitation: a consensus recommendation from ESR and EORTC
Insights into Imaging, vol. 13, pp. 159
Abstract
BACKGROUND: Lesion/tissue segmentation on digital medical images enables biomarker extraction, image-guided therapy delivery, treatment response measurement, and training/validation for developing artificial intelligence algorithms and workflows. To ensure data reproducibility, criteria for standardised segmentation are critical but currently unavailable. METHODS: A modified Delphi process initiated by the European Imaging Biomarker Alliance (EIBALL) of the European Society of Radiology (ESR) and the European Organisation for Research and Treatment of Cancer (EORTC) Imaging Group was undertaken. Three multidisciplinary task forces addressed modality and image acquisition, segmentation methodology itself, and standards and logistics. Devised survey questions were fed via a facilitator to expert participants. The 58 respondents to Round 1 were invited to participate in Rounds 2-4. Subsequent rounds were informed by responses of previous rounds. RESULTS/CONCLUSIONS: Items with ≥ 75% consensus are considered a recommendation. These include system performance certification, thresholds for image signal-to-noise, contrast-to-noise and tumour-to-background ratios, spatial resolution, and artefact levels. Direct, iterative, and machine or deep learning reconstruction methods, use of a mixture of CE marked and verified research tools were agreed and use of specified reference standards and validation processes considered essential. Operator training and refreshment were considered mandatory for clinical trials and clinical research. Items with a 60-74% agreement require reporting (site-specific accreditation for clinical research, minimal pixel number within lesion segmented, use of post-reconstruction algorithms, operator training refreshment for clinical practice). Items with ≤ 60% agreement are outside current recommendations for segmentation (frequency of system performance tests, use of only CE-marked tools, board certification of operators, frequency of operator refresher training). Recommendations by anatomical area are also specified.
Authors 29
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Nandita M. deSouza corresponding
Royal Marsden NHS Foundation Trust · Institute of Cancer Research
Affiliation as printed
Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK. nandita.deSouza@icr.ac.uk
Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Affiliation as printed
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Universitair Ziekenhuis Leuven · KU Leuven
Affiliation as printed
Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
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Affiliation as printed
Quantitative Imaging Biomarkers in Medicine (QUIBIM), Valencia, Spain
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Affiliation as printed
College of Science, University of Lincoln, Lincoln, Lincoln, LN6 7TS, UK
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Inserm · Université Paris Cité · Assistance Publique – Hôpitaux de Paris · Hôpital Européen Georges-Pompidou · Paris Cardiovascular Research Center
Affiliation as printed
INSERM, Radiology Department, AP-HP, Hopital Europeen Georges Pompidou, Université de Paris, PARCC, 75015, Paris, France
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Affiliation as printed
School of Medicine, University of Patras, University Campus, Rio, 26 500, Patras, Greece
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Radiology and Nuclear Medicine, Amsterdam, UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
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Affiliation as printed
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Memorial Sloan Kettering Cancer Center · Medical University of Vienna
Affiliation as printed
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Memorial Sloan Kettering Cancer Centre, New York, NY, USA
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Radiology and Nuclear Medicine, Amsterdam, UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Mario Negri Institute for Pharmacological Research
Affiliation as printed
Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
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Leiden University Medical Center · University of Twente
Affiliation as printed
Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Affiliation as printed
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Cliniques Universitaires Saint-Luc · UCLouvain
Affiliation as printed
Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), 10 Avenue Hippocrate, 1200, Brussels, Belgium
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Universidade do Porto · Instituto de Ciências Biomédicas Albel Salazar
Affiliation as printed
Department of Radiology, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas de Abel Salazar, University of Porto, Porto, Portugal
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Affiliation as printed
Division of Cardiovascular and Interventional Radiology, Department for Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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IRCCS Humanitas Research Hospital
Affiliation as printed
Nuclear Medicine, IRCCS - Humanitas Research Hospital, via Manzoni 56, Rozzano, MI, Italy
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Université Paris-Saclay · Hôpital Marie Lannelongue
Affiliation as printed
Radiology Department, Hôpital Marie Lannelongue, Institut d'Oncologie Thoracique, Université Paris-Saclay, Le Plessis-Robinson, France
Radiology Department, Hôpital Marie Lannelongue, Institut d’Oncologie Thoracique, Université Paris-Saclay, Le Plessis-Robinson, France
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Affiliation as printed
Department of Radiology, and Department of Health, Medicine and Caring Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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UCL Queen Square Institute of Neurology · University College London
Affiliation as printed
Queen Square Institute of Neurology, University College London, London, UK
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Royal Marsden NHS Foundation Trust · Institute of Cancer Research
Affiliation as printed
Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Radiology and Nuclear Medicine, Amsterdam, UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Department of Radiology, University of Tubingen, Tübingen, Germany
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Radiological Society of North America
Affiliation as printed
Radiological Society of North America (RSNA), Oak Brook, IL, USA
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