Airway Inspector: a chest imaging biomarker software platform for COPD

描述(申请人提供)：慢性阻塞性肺疾病在美国影响多达2400万人，预计到2020年将成为全球第三大死因。COPD传统上被分为肺气肿和慢性支气管炎的临床表型。虽然肺活量测定对慢性阻塞性肺疾病的诊断至关重要，但FEV1在一种旨在阐明个体之间疾病机制差异的分类方案中的价值可能有限。肺的计算机断层扫描(CT)成像是一种可以满足新生物标记物需求的工具，以促进新疗法的创建和测试，作为临床试验的替代终点，并为研究人员提供能力，将COPD患者队列的异质性减少到更同质的亚组，以帮助监测研究终点。Airway Inspector是一种开源软件工具，基于布里格姆妇女医院开发的Slicer 2.x，用于分析胸部CT扫描，用于分析肺气肿和呼吸道疾病。该工具旨在分析低分辨率CT扫描，弥补了回顾数据和新出现的CT技术之间的差距。该工具在COPD临床社区的成功得到了一系列同行评议出版物的支持，这些出版物使用该工具定义了疾病的衡量标准，使假设驱动的研究成为可能。除了存在其他商业应用外，Airway Inspector是唯一免费提供的COPD研究维护平台。尽管取得了成功，但Airway Inspector仅限于Slicer的停产版本。这项提议的广泛目标是支持将Airway Inspector作为基于图像的COPD研究的平台进行重构和发展。这一目标将通过创建胸部成像生物标记平台(CIBP)库来实现，该库将我们实验室开发的新算法解决方案整合到肺图像分析中。这些解决方案包括：稳健的肺提取，基于局部密度的实质组织分类，基于尺度空间粒子的气道、肺裂和肺血管提取，以及基于隐马尔可夫模型的气道标记。该软件平台将用于创建将集成在Slicer 4中的工作流，以便在临床社区中部署。切片器4是NIH支持的开放式软件通用成像软件平台，专门设计用于集成像Airway Inspector这样的解决方案。该工作流程将为临床提供端到端的解决方案，以获得表征肺气肿、呼吸道疾病和肺血管重塑的表型。

DESCRIPTION (provided by applicant): Chronic Obstructive Pulmonary Disease affects up to 24 million people in the United States and is projected to be the 3rd leading cause of death worldwide by 2020. COPD has been traditionally dichotomized into the clinical phenotypes of emphysema and chronic bronchitis. Although spirometry is critical for diagnosis of COPD, FEV1 may be of limited value in a classification scheme designed to illuminate differences in disease mechanism among individuals." Computed tomographic (CT) imaging of the lung is a tool that may fulfill the need of new biomarkers to: facilitate the creation and testing of novel therapies, act as surrogate endpoints for clinical trials and provide researchers with the ability to reduce the heterogeneity of a cohort of subjects with COPD into more homogeneous subgroups to assist in monitoring study endpoints Airway Inspector is a open source software tool based on Slicer 2.x developed at Brigham and Women's Hospital for the analysis of chest CT scans for the analysis of emphysema and airway disease. The tool was conceived to analysis low resolution CT scans bringing the gap between retrospective data and new emerging CT technologies. The success of the tool in the COPD clinical community is supported by the array of peer- review publications that have used the tool to define metrics of disease that enable hypothesis driven research. Beside the existence of alternative commercial applications, Airway Inspector is the only freely available maintained platform for COPD research. In spite of its success, Airway Inspector is limited to a discontinued version of Slicer. The broad objective of this proposal is to support the refactoring and development of Airway Inspector as a platform for image-based COPD research. This goal will be achieved by the creation of the Chest Imaging Biomarker Platform (CIBP) library that integrates novel algorithm solutions to lung image analysis that have been developed in our laboratory. Those solutions include: robust lung extraction, parenchymal tissue classification based on local density, airway, fissure and pulmonary vascular extraction based on scale-space particles and airway labeling based on Hidden Markov Models. That software platform will be used to create workflows that will be integrated in Slicer 4 for their deployment in the clinical community. Slicer 4 is a NIH supported open software general purpose imaging software platform that is specifically designed to integrate solutions like Airway Inspector. The workflows will provide an end-to-end solution for the clinical to obtain phenotypes to characterize emphysema, airway disease and pulmonary vascular remodeling.