Researchers at the Princess Alexandra Hospital (Australia) recently published a study demonstrating the potential for the clinical implementation of CT texture analysis (CTTA) in the assessment of tumour heterogeneity in lung cancer. The publication highlighted possible applications of CTTA including; distinguishing between benign and malignant lesions, providing correlates for biological features of the lesions such as gene mutations, indications of tumour aggression and response to treatment. The 18-month prospective observational study provided the TexRAD research software to five radiology and nuclear medicine specialists as a tool to quantify texture parameters in lung tumours. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to identify potential barriers to the clinical implementation of this method into clinical workﬂows. Furthermore, the subsequent delivery of heterogeneity information to the multidisciplinary team (MDT) meeting at which clinical decisions were made was also observed. Survival data was available for 150 of the patients and these outcomes were correlated to reported texture values. In particular, Kurtosis values above the threshold of 0 (n = 78) demonstrated signiﬁcantly poorer survival (P = 0.004). Of a total of 152 lung cancer patients analysed for heterogeneity, 124 (82%) were discussed at the MDT meeting. The TexRAD results were used for research purposes only and were not used to alter any individual patient’s treatment. The study suggests that there is a huge potential for the implementation of quantitative imaging in the assessment of tumour heterogeneity and engagement from radiologists is key to its success.
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