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Satchwell L, Wedlake L, Greenlay E, Li X, Messiou C, Glocker B, Barwick T, Barfoot T, Doran S, Leach MO, Koh DM, Kaiser M, Winzeck S, Qaiser T, Aboagye E, Rockall A. Development of machine learning support for reading whole body diffusion-weighted MRI (WB-MRI) in myeloma for the detection and quantification of the extent of disease before and after treatment (MALIMAR): protocol for a cross-sectional diagnostic test accuracy study. BMJ Open 2022; 12:e067140. [PMID: 36198471 PMCID: PMC9535185 DOI: 10.1136/bmjopen-2022-067140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Whole-body MRI (WB-MRI) is recommended by the National Institute of Clinical Excellence as the first-line imaging tool for diagnosis of multiple myeloma. Reporting WB-MRI scans requires expertise to interpret and can be challenging for radiologists who need to meet rapid turn-around requirements. Automated computational tools based on machine learning (ML) could assist the radiologist in terms of sensitivity and reading speed and would facilitate improved accuracy, productivity and cost-effectiveness. The MALIMAR study aims to develop and validate a ML algorithm to increase the diagnostic accuracy and reading speed of radiological interpretation of WB-MRI compared with standard methods. METHODS AND ANALYSIS This phase II/III imaging trial will perform retrospective analysis of previously obtained clinical radiology MRI scans and scans from healthy volunteers obtained prospectively to implement training and validation of an ML algorithm. The study will comprise three project phases using approximately 633 scans to (1) train the ML algorithm to identify active disease, (2) clinically validate the ML algorithm and (3) determine change in disease status following treatment via a quantification of burden of disease in patients with myeloma. Phase 1 will primarily train the ML algorithm to detect active myeloma against an expert assessment ('reference standard'). Phase 2 will use the ML output in the setting of radiology reader study to assess the difference in sensitivity when using ML-assisted reading or human-alone reading. Phase 3 will assess the agreement between experienced readers (with and without ML) and the reference standard in scoring both overall burden of disease before and after treatment, and response. ETHICS AND DISSEMINATION MALIMAR has ethical approval from South Central-Oxford C Research Ethics Committee (REC Reference: 17/SC/0630). IRAS Project ID: 233501. CPMS Portfolio adoption (CPMS ID: 36766). Participants gave informed consent to participate in the study before taking part. MALIMAR is funded by National Institute for Healthcare Research Efficacy and Mechanism Evaluation funding (NIHR EME Project ID: 16/68/34). Findings will be made available through peer-reviewed publications and conference dissemination. TRIAL REGISTRATION NUMBER NCT03574454.
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Affiliation(s)
| | | | | | - Xingfeng Li
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Christina Messiou
- Royal Marsden Hospital NHS Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Tara Barwick
- Department of Cancer and Surgery, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Dow Mu Koh
- Royal Marsden Hospital NHS Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Martin Kaiser
- Royal Marsden Hospital NHS Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Stefan Winzeck
- Department of Computing, Imperial College London, London, UK
| | - Talha Qaiser
- Department of Computing, Imperial College London, London, UK
| | - Eric Aboagye
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Andrea Rockall
- Department of Cancer and Surgery, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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