Virtual imaging trials in medicine: A brief takeaway of the lessons from the first international summit.

Abstract

Background

The rapid advancement of medical technologies presents significant challenges for researchers and practitioners. While traditional clinical trials remain the gold standard, they are often limited by high costs, lengthy durations, and ethical constraints. In contrast, in-silico trials and digital twins have emerged not only as efficient and ethical alternatives but also as a complementary technology that can extend beyond classical trials to predict and design new strategies. The successful application of digital twins in industries like nuclear energy, automotive engineering, and aviation underscores their potential in human health.

Methods

In April 2024, Duke University hosted the first international summit on Virtual Imaging Trials in Medicine (VITM). The summit brought together over 130 experts from academia, industry, and regulatory bodies to discuss the latest developments, challenges, and future directions in this field. The event featured plenary speakers, presentations, and panel discussions, emphasizing the integration of clinical and in-silico methods to enhance medical evaluations.

Results

Key takeaways included the necessity of diverse and realistic digital patient representations, the integration of physics and biology in simulations, and the development of robust validation frameworks. The summit also highlighted the importance of regulatory science and the establishment of Good Simulation Practices to ensure the credibility and reliability of virtual trials.

Conclusion

The key discussions and insights from the VITM summit underscore the potential of in-silico trials to revolutionize medical research and patient care through personalized, efficient, and ethical evaluation methods. The collaborative efforts and recommendations from this summit aim to drive future advancements in virtual imaging trials in medicine.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1002/mp.17587

Publication Info

Samei, Ehsan, Ehsan Abadi, Predrag Bakic, Kristina Bliznakova, Hilde Bosmans, Ann-Katherine Carton, Alejandro F Frangi, Stephen Glick, et al. (2024). Virtual imaging trials in medicine: A brief takeaway of the lessons from the first international summit. Medical physics. 10.1002/mp.17587 Retrieved from https://hdl.handle.net/10161/31984.

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Scholars@Duke

Abadi

Ehsan Abadi

Associate Professor in Radiology

Ehsan Abadi, PhD is an imaging scientist at Duke University. He serves as an Associate Professor in the departments of Radiology and Electrical & Computer Engineering, a faculty member in the Medical Physics Graduate Program and Carl E. Ravin Advanced Imaging Laboratories, and a co-Lead in the Center for Virtual Imaging Trials. Ehsan’s research focuses on quantitative imaging and optimization, computational human modeling, medical imaging simulation, and CT imaging in cardiothoracic and musculoskeletal applications. He is actively involved in developing computational anthropomorphic models with various diseases such as COPD, and scanner-specific simulation platforms (e.g., DukeSim) for imaging systems. Currently, his work is centered on identifying and optimizing imaging systems to ensure accurate and precise quantifications of lung and bone diseases.

Lo

Joseph Yuan-Chieh Lo

Professor in Radiology

My research is at the intersection of computer vision, machine learning, and medical imaging, with a dual focus on mammography and computed tomography (CT). Together with our industry partner, we developed deep learning algorithms for breast cancer screening with 2D/3D mammography, and that product is now undergoing FDA approval with anticipated rollout to clinics worldwide. We also pioneer the creation of "digital twin" anatomical models from patient imaging data, using these models to forge new paths in CT scan analysis through virtual readers and deep learning techniques. Additionally, we're developing a computer-aided triage system for detecting diseases across multiple organs in body CT scans, leveraging hospital-scale datasets and integrating natural language processing with deep learning for comprehensive disease classification.

Ria

Francesco Ria

Assistant Professor of Radiology

Dr. Francesco Ria is a medical physicist and he serves as an Assistant Professor in the Department of Radiology. Francesco has an extensive expertise in the assessment of procedure performances in radiology. In particular, his research activities focus on the simultaneous evaluation of radiation dose and image quality in vivo in computed tomography providing a comprehensive evaluation of radiological exams. Moreover, Francesco is developing and investigating novel mathematical models that, uniquely in the radiology field, can incorporate a comprehensive and quantitative risk-to-benefit assessment of the procedures; he is continuing to apply his expertise towards the definition of new patient specific risk metrics, and in the assessment of image quality in vivo also using state-of-the-art imaging technology, such as photon counting computed tomography scanners, and machine learning reconstruction algorithms.

Dr. Ria is a member of the American Association of Physicists in Medicine task group 392 (Investigation and Quality Control of Automatic Exposure Control System in CT), of the American Association of Physicists in Medicine Public Education working group (WGATE), and of the Italian Association of Medical Physics task group Dose Monitoring in Diagnostic Imaging.

Segars

William Paul Segars

Professor in Radiology

Our current research involves the use of computer-generated phantoms and simulation techniques to investigate and optimize medical imaging systems and methods. Medical imaging simulation involves virtual experiments carried out entirely on the computer using computational models for the patients as well as the imaging devices. Simulation is a powerful tool for characterizing, evaluating, and optimizing medical imaging systems. A vital aspect of simulation is to have realistic models of the subject's anatomy as well as accurate models for the physics of the imaging process. Without this, the results of the simulation may not be indicative of what would occur in actual clinical studies and would, therefore, have limited practical value. We are leading the development of realistic simulation tools for use toward human and small animal imaging research.

These tools have a wide variety of applications in many different imaging modalities to investigate the effects of anatomical, physiological, physical, and instrumentational factors on medical imaging and to research new image acquisition strategies, image processing and reconstruction methods, and image visualization and interpretation techniques. We are currently applying them to the field of x-ray CT. The motivation for this work is the lack of sufficiently rigorous methods for optimizing the image quality and radiation dose in x-ray CT to the clinical needs of a given procedure. The danger of unnecessary radiation exposure from CT applications, especially for pediatrics, is just now being addressed. Optimization is essential in order for new and emerging CT applications to be truly useful and not represent a danger to the patient. Given the relatively high radiation doses required of current CT systems, thorough optimization is unlikely to ever be done in live patients. It would be prohibitively expensive to fabricate physical phantoms to simulate a realistic range of patient sizes and clinical needs especially when physiologic motion needs to be considered. The only practical approach to the optimization problem is through the use of realistic computer simulation tools developed in our work.


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