Purpose:The development of computer-aided diagnostic ͑CAD͒ methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography ͑CT͒ scans. The Lung Image Database Consortium ͑LIDC͒ and Image Database Resource Initiative ͑IDRI͒ completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute ͑NCI͒, further advanced by the Foundation for the National Institutes of Health ͑FNIH͒, and accompanied by the Food and Drug Administration ͑FDA͒ through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process. Methods: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two-phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded-read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories ͑"noduleՆ 3 mm," "noduleϽ 3 mm," and "non-noduleՆ 3 mm"͒. In the subsequent unblinded-read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus. Results:The Database contains 7371 lesions marked "nodule" by at least one radiologist. 2669 of these lesions were marked "noduleՆ 3 mm" by at least one radiologist, of which 928 ͑34.7%͒ received such marks from all four radiologists. These 2669 lesions include nodule outlines and subjective nodule characteristic ratings. Conclusions:The LIDC/IDRI Database is expected to provide an essential medical imaging research resource to spur CAD development, validation, and dissemination in clinical practice.

Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing ‘translational gaps’ through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored ‘roadmap’. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.

This paper has reviewed, with somewhat variable coverage, the nine MR image segmentation techniques itemized in Table II. A wide array of approaches have been discussed; each has its merits and drawbacks. We have also given pointers to other approaches not discussed in depth in this review. The methods reviewed fall roughly into four model groups: c-means, maximum likelihood, neural networks, and k-nearest neighbor rules. Both supervised and unsupervised schemes require human intervention to obtain clinically useful results in MR segmentation. Unsupervised techniques require somewhat less interaction on a per patient/image basis. Maximum likelihood techniques have had some success, but are very susceptible to the choice of training region, which may need to be chosen slice by slice for even one patient. Generally, techniques that must assume an underlying statistical distribution of the data (such as LML and UML) do not appear promising, since tissue regions of interest do not usually obey the distributional tendencies of probability density functions. The most promising supervised techniques reviewed seem to be FF/NN methods that allow hidden layers to be configured as examples are presented to the system. An example of a self-configuring network, FF/CC, was also discussed. The relatively simple k-nearest neighbor rule algorithms (hard and fuzzy) have also shown promise in the supervised category. Unsupervised techniques based upon fuzzy c-means clustering algorithms have also shown great promise in MR image segmentation. Several unsupervised connectionist techniques have recently been experimented with on MR images of the brain and have provided promising initial results. A pixel-intensity-based edge detection algorithm has recently been used to provide promising segmentations of the brain. This is also an unsupervised technique, older versions of which have been susceptible to oversegmenting the image because of the lack of clear boundaries between tissue types or finding uninteresting boundaries between slightly different types of the same tissue. To conclude, we offer some remarks about improving MR segmentation techniques. The better unsupervised techniques are too slow. Improving speed via parallelization and optimization will improve their competitiveness with, e.g., the k-nn rule, which is the fastest technique covered in this review. Another area for development is dynamic cluster validity. Unsupervised methods need better ways to specify and adjust c, the number of tissue classes found by the algorithm. Initialization is a third important area of research. Many of the schemes listed in Table II are sensitive to good initialization, both in terms of the parameters of the design, as well as operator selection of training data.(ABSTRACT TRUNCATED AT 400 WORDS)

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To stimulate the advancement of computer-aided diagnostic (CAD) research for lung nodules in thoracic computed tomography (CT), the National Cancer Institute launched a cooperative effort known as the Lung Image Database Consortium (LIDC). The LIDC is composed of five academic institutions from across the United States that are working together to develop an image database that will serve as an international research resource for the development, training, and evaluation of CAD methods in the detection of lung nodules on CT scans. Prior to the collection of CT images and associated patient data, the LIDC has been engaged in a consensus process to identify, address, and resolve a host of challenging technical and clinical issues to provide a solid foundation for a scientifically robust database. These issues include the establishment of (a) a governing mission statement, (b) criteria to determine whether a CT scan is eligible for inclusion in the database, (c) an appropriate definition of the term qualifying nodule, (d) an appropriate definition of "truth" requirements, (e) a process model through which the database will be populated, and (f) a statistical framework to guide the application of assessment methods by users of the database. Through a consensus process in which careful planning and proper consideration of fundamental issues have been emphasized, the LIDC database is expected to provide a powerful resource for the medical imaging research community. This article is intended to share with the community the breadth and depth of these key issues.

Magnetic resonance (MR) brain section images are segmented and then synthetically colored to give visual representations of the original data with three approaches: the literal and approximate fuzzy c-means unsupervised clustering algorithms, and a supervised computational neural network. Initial clinical results are presented on normal volunteers and selected patients with brain tumors surrounded by edema. Supervised and unsupervised segmentation techniques provide broadly similar results. Unsupervised fuzzy algorithms were visually observed to show better segmentation when compared with raw image data for volunteer studies. For a more complex segmentation problem with tumor/edema or cerebrospinal fluid boundary, where the tissues have similar MR relaxation behavior, inconsistency in rating among experts was observed, with fuzz-c-means approaches being slightly preferred over feedforward cascade correlation results. Various facets of both approaches, such as supervised versus unsupervised learning, time complexity, and utility for the diagnostic process, are compared.

When clustering algorithms are applied to image segmentation, the goal is to solve a classification problem. However, these algorithms do not directly optimize classification quality. As a result, they are susceptible to two problems: P1) the criterion they optimize may not be a good estimator of "true" classification quality, and P2) they often admit many (suboptha€) solutions. This paper introduces an algorithm that uses cluster validity to mitigate P1 and P2. The validity-guided (re)clustering (VGC) algorithm uses cluster-validity information to guide a fuzzy (re)clustering process toward better solutions. It starts with a partition generated by a soft or fuzzy clustering algorithm. Then it iteratively alters the partition by applying (novel) splitand-merge operations to the clusters. Partition modifications that result in improved partition validity are retained. VGC is tested on both synthetic and real-world data. For magnetic resonance image (MRI) segmentation, evaluations by radiologists show that VGC outperforms the (unsupervised) fuzzy c-means algorithm, and VGC's performance approaches that of the (supervised) k-nearest-neighbors algorithm.

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