Image analysis

Chest CT related outcome measures are becoming increasingly important for clinical trials in CF and for research studies. Sensitive, reproducible image analysis techniques have been developed to quantify CF lung disease related structural changes. Examples of such techniques are PRAGMA-CF and the airway-artery method. To date, image analysis of chest CTs is executed manually. Automated methods are in development. Chest CTs can be analyzed for a cohort at a given time point (cross sectional analysis) or longitudinally to asses structural changes over time. LungAnalysis serves as core laboratory for the ECFS-CTN for the centralized image analysis of chest CTs for investigator initiated trials, clinical studies, and for patient registries. 

Standardization of chest CT protocols

As chest CT involves ionizing radiation it is important to standardize chest CT protocols to optimize the balance between radiation used and diagnostic quality. To get robust and reproducible results from quantitative image analysis, chest CT images need to be acquired in a standardized manner and have adequate image quality. As chest CT core laboratory, LungAnalysis aims to standardize chest CTs protocols across all ECFS-CTN sites. This will lower the threshold to run clinical studies within the ECFS-CTN that include chest CT related outcome measures. Furthermore, standardization of routine chest CTs made in ECFS-CTN sites for monitoring CF lung disease will allow analysis of these CTs using automated image analysis systems. This will make it possible to include chest CT outcomes in the ECFS patient registry.

Standardization of lung volume

For the acquisition of chest CTs in cooperative subjects for clinical care and for clinical studies the lung volume needs to be standardized. Inspiratory chest CT needs to be acquired at a lung volume near total lung capacity and expiratory scans at a volume level near residual volume. As part of the SCIFI-II project, LungAnalysis will assist sites in implementing volume controlled chest CT for clinical care and clinical studies.