1. Return to Overview Slide A B,C,D,E Possible NCI based status display program Site anonymization computer Secure transfer in-house to LIDC computer Remote “other site” computers Image send of 1 to computers B,C,D,E XML Reading Assignment message sent to computers B,C.D,E) XML Reading Response Message, With Contour file and review data, Sent back only to sending site, computer A, for each case All 4 reads must be received (and at end of unblinded reviews, reconciled) by computer A Marking tools must be available for each computer for radiologist marking Need tracking software at each site for work-list SSH or secure FTP for transfer, with a script developed as required Other Subject data fields Linked to case 1 5 11 6 3 13 2 12 4 LIDC Message System: Development for Phase 1 implementation X 1 (All colors) Denotes tasks to be developed and integrated 7 9 8 10 3,4,5,6 (Gray) Denotes Blinded Review tasks 7,8,9,10 (Yellow) Denotes UnBlinded review tasks

2. Return to Overview Slide 1. Anonymization Such as the U. Michigan software Anonymize –Scrub certain fields –Set others to NULL See Process Model 2.4 for details

3. Return to Overview Slide 2. Broadcast Anonymized Image data In DICOM format Using rsync or other mechanism

4. Return to Overview Slide 3. Initial Reading Assignment XML Message (First Blinded Review) In specified message format With specified message content Coded to Identify as Blinded Review Case id Reader id Etc. Broadcast to Sites B, C, D, E

5. Return to Overview Slide 4. Blinded Review - Marking Tool Assigned reader at each site (B, C, D, E) uses review and marking software –Creates Boundaries for Nodules > =3 mm –Marks centroid for Nodules < 3mm –Marks centroid for Non-Nodules > =3mm –Labels each object (Nodule or Non-Nodule) as described in Process Model 2.4 Software converts boundaries from internal format to LIDC TG-2 specified format in XML

6. Return to Overview Slide 5. Blinded Review Response XML Message In specified message format With specified message content Coded to Identify as Blinded Case id, Reader id Boundary data also in specified XML format Radiologist Reading CDEs (Labelings, etc.)

7. Return to Overview Slide 6. Receive Blinded Reviews Receive Reviews at Originating Site At end of Blinded review Store Individual Reads in local (Level 1) dB Create pMap?? Merge the required number (4) of remote site reviews to create XML file with composite reviews

8. Return to Overview Slide 7. Unblinded Reading Assignment XML Message When all required (4) Blinded Reviews have been received and compiled, then Send Unblinded Reading Assignment Message: In specified message format With specified message content Coded to Identify as UnBlinded Review Case id Reader id Etc. Transmit Composite Blinded Review Data (created in Step 6) as part of message Broadcast to Sites B, C, D, E

9. Return to Overview Slide 8. Unblinded Review - Marking Tool Assigned reader at each site (B, C, D, E) uses review and marking software Each Reader sees all markings of all readers (anonymized) Each Reader sees their own markings uniquely distinguished Each Reader Creates their own Unblinded Review by Editing their Blinded Review results –Accepting or Rejecting Their own Markings –Accepting or Rejecting the Markings of Others –Allow Editing of Boundaries –Allow Editing of Object Labeling (or Labeling of new objects) Software converts boundaries from internal format to LIDC TG-2 specified format in XML

10. Return to Overview Slide 9. UnBlinded Review Response XML Message In specified message format With specified message content Coded to Identify as UnBlinded Case id, Reader id Boundary data in specified XML format Radiologist Reading CDEs (Labelings, etc.)

11. Return to Overview Slide 10. Receive UnBlinded Reviews Receive Reviews at Originating Site At end of UnBlinded review Store Individual UnBlinded Reads in local (Level 1) dB Perform reconciliation. Create pMap

12. Return to Overview Slide 11. Other Subject Data At other points in time, Site A may enter other data that will be linked to case or nodule: –Pathology (of an individual nodule) –Ethnicity –Smoking History To be entered at Local (Level 1) database

13. Return to Overview Slide 12. Monitoring Software needed at each site to Monitor and help manage: –Each case submitted (by Site A), to track Reader Assignments Completion Status –Each Reader (at Site A), to track Case assignments Assignment Type (Blinded/Unblinded) Completion Status

14. Return to Overview Slide 13. Possible NCI Based Status Reporting Centralized location to which all messages are sent Status of all cases centrally displayed