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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