1. National Cancer Institute U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NCI Perspective on Informatics and Clinical Decision Support April 14, 2015

2. NCI CBIIT: Mission Statement The NCI Center for Biomedical Informatics and Information Technology (CBIIT) provides and advocates for the appropriate use of data science, informatics, and information technology (IT) to support and accelerate the NCI Mission to prevent and cure cancer. 2

3. CBIIT Investments in Imaging and Clinical Decision Support Extramural Research Community Engagement –NCIP Community Calls –AIM Working Group NCI Collaboration –CBIIT IIWG to coordinate with other NCI division imaging activities Contracts for Imaging Informatics –NBIA –CTIIP Pathology/Integrated Queries Co-clinical trials Challenges 3

4. NCI Perspective What are the goals What are the obstacles What is the role of NCI

5. Goals Support personalized and precision medicine by developing a Cancer Imaging Informatics Infrastructure Support research Explore scalability to clinical decision support Encourage and support collaboration

6. Clinical Decision Support Data Repositories and Integrative Queries Knowledge base Results / Output In-vivo Images Pathology Images Annotation and Markup Genomics Metadata Demographics Other Data types Data Input

7. Cancer Imaging Informatics Infrastructure Integrative Queries Image Analysis Challenges Data Store Data Store Data Store Image meta data Clinical Data Other Data RadiologyPathologyGenomicOther data Other Data Stores (Broker) Data Store Viewer API Query User interface Annotation, Segmentation, Markup Clinical Systems Vendors Analytics Packages

8. Imaging and Cancer Concepts Cancer Imaging Informatics Infrastructure –Open source –Interoperable Long term goal: create a framework of integration –Clinical and pre-clinical participant data –Archiving of multiple imaging modalities e.g. radiology, pathology –Annotations, segmentation, and markup –Genomics –Integrative queries across multiple imaging and data types –Integration and evaluation of experimental clinical decision support systems.

9. Obstacles Data sharing Software sharing Communications tools are needed Missing global oncology data standards

10. Lack of broadly defined and accepted standards DICOM –Not well adopted outside “clinical care” Lack of true image format standards –Pathology multiple proprietary image standards Vendor lock-in –Image Markup – feature annotation Multiple standards –AIM –DICOM –Pathology – proprietary nonstandard

11. Lack of broadly defined and accepted standards (cont.) Image viewing –DICOM – various viewing platforms Many require users to download image sets –Lack of standard robust “streaming” clients Markup Mash-ups Annotations

12. Role of NCI What can NCI do to support these developments –Project Support CTIIP QIN ITCR TCIA –NCI intramural collaboration –Long-term support of data archives including curation –Long-term support of software operations and maintenance including adopting of new technology –Strong collaboration with open source communities –Support of Academia / Industry partnerships –Support of communications tools

13. NCIP/ IIWG Clinical and Translational Imaging Informatics Project (CTIIP) CTIIP is supported by the Imaging Informatics Working Group (IIWG), a project under the National Cancer Informatics Program (NCIP) Digital Pathology and Integrative Query System –Emory University (Ashish Sharma, PhD) Make proprietary WSI formats viewable without conversion Building an integrative query system Draft a pathology annotation and markup model DICOM WG-30 –Essex Management (SME David Clunie, MD) Developing DICOM supplement for small animal images

14. Clinical and Translational Imaging Informatics Project (CTIIP) cont. Pilot Challenges –Massachusetts General Hospital (Jayashree Kalpathy-Cramer, PhD) Evaluate challenge management systems Execute challenges Co-clinical and animal model data –UC Davis (Robert Cardiff, MD, PhD) Evaluation of data submission and query systems for preclinical models and co-clinical data sets

15. Thank you!