Imaging Core
• Aim 1: To ensure uniformity and high quality of test
performance, image acquisition and image interpretation
throughout the trial
• Aim 2: To develop/deploy technical systems for test
transmission and archiving, including creation of a unique
data resource for ancillary studies by combining diagnostic
tests and clinical data
TRIAD Installation
Sample Data Transfer
• TRIAD is the American College of Radiology Imaging
Network’s (ACRIN) image acquisition and
management software. In brief, TRIAD-OA offers a
web-based software solution which allows sites
participating in the RESCUE trial a secure method to
review and submit clinical trial images. For a more
detailed explanation of the capabilities and benefits of
TRIAD, you may visit the TRIAD learning center at:
• Identify the following key individuals at your site:
• TRIAD user – the individual(s) who will use TRIAD regularly
• IT contact – the individual(s) who will assist with the basic
installation and testing of the TRIAD software
• PACS administrator (if necessary) – the individual(s) who will
assist with transporting case images from the scanner/PACS
system to TRIAD
• Register for a TRIAD account – this may be done by clicking on the
following link:
• Determine the computer(s) which you would like TRIAD installed on
(this machine does not need to be used solely for TRIAD)
• Determine a time and date that would work best to schedule the
TRIAD installation
•Prior to a TRIAD
installation please
register for a username
& password @
• If you feel your site is ready to proceed with the TRIAD
installation, please submit an e-mail to [email protected] Include the following information
with your e-mail: 1) date and time you would like the
installation to take place, 2) individuals who plan to
participate in the installation, 3) site name and number
and 4) contact information.
Selecting TRIAD Options
• TRIAD: TRansfer of Image and Archive Data
• TRIAD setup is customizable with two (2) basic
options for submission of images originating from, or
routed through, the Clinical Site
TRIAD Client
• Installation of TRIAD client application only
• For submission of images directly from CD or
• Recommended for low volume sites
-Fewer than five (5) CCTA submissions/month
TRIAD Site Server
• Installation of TRIAD client application and TRIAD
site server
• For submission of images transferred directly
from a site’s PACS or Scanner on the same local
area network
• Recommended for high volume sites
- five (5) or more CTA submissions/month
TRIAD Client Hardware and Network Requirements:
• Model: PC
• Processor: Intel P-IV 3 GHz minimum, Intel Core 2 Duo 2GHz is recommended
• RAM: 1GB is minimum, 4GB is recommended
• HDD: 200Mb for Rich GUI client application itself up to 200Gb- for local image
cache, its size will depend on amount of images stored by the system
• Video: Graphic adapter and Monitor with True Color mode support 1024 x 768
pixels x 32 bit color mode
• Supported Operating systems and Software Requirements: Workstation running
Rich GUI client must be: MS Windows XP SP3, MS Windows 7, MS.NET
Framework 3.5
• Network Requirements: Internet connection- minimum Client connection speed
should be at least 256 kbps. Desired connection speed is 1 Mbps.
Site Server Supported Operating Systems and Software
• Windows XP SP3, Windows 7 and Windows Server 2003 SP2
• Microsoft .NET Framework 3.5 ,SQL Express 2005
• Model: PC
• Processor: Intel P-IV 3GHz minimum, Intel Core 2 Duo 2GHz is
• RAM: 1GB minimum, 4GB is recommended
• HDD: Its size depends on amount of images received from Scanner
before they are sent to TRIAD Image Storage.100 Gb minimum,
200Gb is recommended.
TRIAD Letter
Consultation Call
• TRIAD Greeting Letter is sent (via e-mail) to Site Study Coordinator
• Prepares your organization by providing requirements for an
• ACRIN holds site consultation call with each site
• Site Study Coordinator should be prepared to confirm the following
• Installation plan/process for image transfer
• Number of TRIAD installs required
• TRIAD Installation occurs on scheduled date/time
• Site will be required to submit a test exam during installation to confirm
successful TRIAD deployment
Preparing QA Datasets
• One (1) CCTA and One (1) SPECT MPI should be submitted
to ACRIN core lab for qualification
• For sites with inadequate studies, the ACRIN core lab will
review the protocol recommendations with the site, and
request an additional study until the site fulfills all
• Once a modality’s requirements are met, an ACRIN Imaging
Technologist will send a modality specific approval letter via
email to the site Study Coordinator
• Once all imaging modalities are approved, the RESCUE PM
will send an official letter of acceptance for
accrual via email to the site Study Coordinator
CCTA Quality Control
 Image Transmittal Worksheet (ITW) must be fully
completed & submitted for every CCTA exam
 Datasets should be consistent with Diagnostic Testing
Protocol Recommendations
 ACRIN Image Technologists will complete Quality
Control (QC) form, review data for completeness of
dataset, and quality of images
CCTA Image Transmittal
Worksheet (ITW) Form
 The ITW Form contains studyspecific information (i.e.,
Subject ID, Scan Date, Image
 Once images have been
uploaded to TRIAD, the ITW
should be faxed to ACRIN
 This form indicates that the
images are on TRIAD and
ready for evaluation by ACRIN
• CCTA Quality Assessment:
Absence of major motion artifacts
 Sufficient contrast enhancement
 <15 mSv radiation dose
CCTA Completeness:
 Scout
 Dose Report
 Prospective gated non-contrast Calcium Score series
 Prospectively or retrospectively gated contrast enhanced
 If global and regional LV function is assessed, use of
multiphase axial reconstructions (1.5mm) throughout
cardiac cycle are required
 If routinely performed at your site, a full field
of view chest scan for incidental findings
CCTA Core Lab, the Cardiovascular Imaging
Core Lab (CVIC)
at Massachusetts General Hospital
• CCTA Core Lab at MGH will assist ACRIN in the development
of general and specific protocol recommendations.
• The CCTA images from the first two study subjects at each
site will be reviewed by the Core Lab at MGH as well as a
random sample of 10% of all cases thereafter.
• CCTA questions related to image acquisition or interpretation
e-mail: [email protected]
• Erin Corsini, Clinical Research Associate, Cardiovascular
Imaging Core Lab, MGH
Control Procedures
Image Submission for QA
and Trial data
 Images are sent to ACRIN electronically via TRIAD (de-identified
data sets)
 ACRIN requests submission of images within 5 days of test
 RAW, Data (Rest and Stress) in DICOM format are evaluated along
with results pages
 100% Qualitative Evaluation is to be performed by qualified ACRIN
 ACRIN Technologists will provide feedback as
needed to sites on image quality and
data completeness
Criteria for SPECT Submissions:
• Completeness:
 Rest and Stress images with complete coverage of the LV
 Screen Captures of processed results pages
 Beat Length Histogram (if available)
 High-quality raw data projection images with attention to minimal
motion and acceptably low levels of hepatic
and bowel uptake
 High-quality processed SPECT data
 High-quality gated SPECT images with attention to
beat-length histogram
SPECT Image Submission
SPECT Image Transmittal Worksheet
(ITW) Form
Nuclear Medicine
Image Transmittal Worksheet
ACRIN 4701
Instructions: All subject study images are transmitted to the ACRIN-Image Management Center using a predefined
transfer method established with each site prior to enrollment. Each subject’s raw data is sent in an uncompressed format
within 5 business days of the SPECT visit. All Protected Health Identifiers are removed from the digital images and
replaced with the study subject identifiers. An Image Transmittal Worksheet (ITW) is completed during imaging and
faxed to the ACRIN-Image Management Center on the day the images are transferred. If using attenuation correction it is
necessary to submit BOTH the non attenuated-corrected images and the attenuated-corrected images. Please use the
comments section to record images not sent or imaging limitations.
The completed and signed Image Transmittal Worksheet (ITW) is faxed to the ACRIN Image Management Center fax
number 215-923-1737.
For further information or questions email: Rebecca Scaven, CNMT [email protected]
Section I: Image Data Demographics
•The ITW Form contains study-specific
information (i.e., Injection Times, Isotope
and Activity used, etc.)
•Once images have been uploaded to
TRIAD, the ITW form is faxed to ACRIN
Institution Name:
Test Submission:
(Check only if QA Submission)
Subject ID No.:
ACRIN Institution No.:
Subject’s Year of Birth:
Gender: M
Section II: SPECT Image Submission
Exam Series
File Type
Check all files that are included:
Acquisition Guidelines
High quality SPECT MPI will be performed using the
imaging parameters optimized within each laboratory
for their particular camera and computer system
reviewed during pre-enrollment by the ACRIN-Image
Management Center. Each subject’s gated and nongated cardiac tomograms (the raw projection images)
are sent to the ACRIN-Image Management Center for
technical adequacy and completeness. If possible for
the gated images include an image of the heart rate
histogram for review of the beat length uniformity. If
attenuation correction is used both non attenuatedcorrected images and attenuated-corrected images are
submitted. If a question or problem regarding the
submitted data arises the ACRIN-Image Management
Center will follow-up with the site’s designated contact
Non Attenuated-Corrected Files
□ Raw Rest Projection File(s)
□ Raw Gated Rest Projection File(s)
□ Raw Stress Projection File(s)
□ Raw Gated Stress Projection File(s)
□ Reconstructed, Processed File(s) and/or display
Attenuated Corrected Files
□ Raw Rest Projection File(s)
□ Raw Gated Rest Projection File(s)
□ Raw Stress Projection File(s)
□ Raw Gated Stress Projection File(s)
□ Reconstructed, Processed File(s) and/or display
□ Heart Rate Histogram (if available)
•This form indicates that the images are on
TRIAD and ready for review by ACRIN
Image Submission
• Each SPECT Scan submitted to ACRIN must contain the
following datasets in DICOM format:
 RAW Rest and Stress Projection and all Gated files
 If Attenuation Correction is used, BOTH Non AttenuationCorrected and Attenuation-Corrected images are to be submitted
 Display and/or Result Series Images in Screen Capture format
 Beat Length Histogram (if available)
 A fully completed ITW form will be faxed to
ACRIN once the required datasets have been
uploaded to TRIAD
Collaborative SPECT Core
Lab, Tufts New England
Medical Center
The SPECT Core Lab at Tufts New England Medical Center will assist
ACRIN in the development of general and specific protocol
The SPECT MPI images from the first two study subjects at each site will be
reviewed by the Core Lab at Tufts as well as a random sample of 10% of all
cases thereafter.
For SPECT questions relating to image acquisition or interpretation, sites
may contact the SPECT MPI Core Lab Technologist, Debra Kinan, RT(N):
Email: [email protected]
Phone: 617-636-2357
SPECT Core Lab Hotline: 617-604-4848 (pager)
Image Queries
• Case Query
Notification (Z5)
• Response
ACRIN Core Lab Contact Information
Dena Flamini RT(R)(MR)(M)
[email protected]
P: (215) 940-8880
F: (215) 923-1737
Cyndi Price RT(R)(MR)
[email protected]
P: (215) 940-8863
F: (215) 923-1737
Rebecca Scaven, CNMT
[email protected]
P: (215) 574-3175
F: (215) 923-1737

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