The Early Origins
The concept of a medical imaging research network evolved from several initiatives that occurred in the mid 1990s. The Radiologic Diagnostic Oncology Group conducted a series of multicenter clinical trials, individually applied for and funded by the National Cancer Institute (NCI), that were the first to address imaging-related questions of importance to cancer diagnosis and care. In 1997, Dr. Robert Wittes, then the Director of the Division of Cancer Treatment and Evaluation Program (CTEP) at the NCI, convened two meetings which brought together imaging research stakeholders to explore the establishment of a research network to conduct a broad spectrum of medical imaging trials. A consensus emerged to endorse the endeavor given the growing importance of imaging to cancer care.
Importantly, at about the same time, NCI established an imaging program within the Institute, the Cancer Imaging Program (CIP). Directed by Dr. Daniel Sullivan, CIP provided a home for what was to be the new clinical trials network. NCI issued a request for application (RFA) to establish the network early in 1998. The RFA specified the formation of a “non-member” network that allowed for the flexibility of imaging facilities to choose in which trials they would participate. This open membership concept represented a significant structural and operational departure from the other established NCI clinical trials cooperative groups.
ACR Board Chairman Ronald Evans, MD, tapped Bruce Hillman, MD, as principle investigator to submit an application on behalf of the American College of Radiology. Dr. Hillman organized a team to develop the first grant application, including the recruitment of Constantine Gatsonis, PhD, to lead the development of the statistical and data management component – a separate but linked grant under the terms of the RFA. In September 1998, NCI awarded the grant to Drs. Hillman and Gatsonis to establish the American College of Radiology Imaging Network (ACRIN).
The Network Formation
By March 1999, Drs. Hillman and Gatsonis had put in place a nascent organization with the mission to conduct clinical trials of imaging research to lengthen and improve the quality of cancer patients lives. An initial small staff supported the development of bylaws and procedures to guide the network’s growth. Early on, a commitment to electronic data gathering and communication was established, which was a first among the NCI clinical trial cooperative groups. To this day, ACRIN remains the only all electronic NCI clinical trials cooperative group.
Approximately 42 sites agreed to participate in the fledgling research network and other NCI cooperative groups committed to providing a liaison to help prioritize the research aims ACRIN should first pursue. By 2007, the last year of Dr. Hillman’s leadership, approximately 190 academic and community sites had qualified to participate and literally hundreds of the premier scientists, physicians, statisticians and other methodologists were working on ACRIN trial teams and committees.
The First Trials
True to the original response to the RFA, among the first trials ACRIN launched were two major screening trials. The Digital Mammographic Imaging Screening Trial (DMIST) comparing the benefits, if any, of digital to standard film mammography, was activated in October 2001 and accrued over 49,000 volunteers in less than two years. In August 2002, ACRIN initiated accrual of patients onto the National Lung Screening Trial (NLST) designed to determine if using imaging to screen persons at risk for lung cancer helps to save lives. Nearly 20,000 patients were enrolled in this longitudinal trial performed in cooperation with an intramural group at NCI..
Examples of other imaging questions tackled early on included the use of radiofrequency ablation for painful bone metastasis, CT colonography for identifying colorectal polyps and cancers, and use of MRI and MRS to stage prostate cancer.
The amazing growth of ACRIN in its first decade of operation is testament to the important role the organization has played in furthering imaging in cancer research and care. By September 2008, ACRIN had initiated 30 clinical trials involving over 100 imaging facilities including academic centers, community hospitals and freestanding imaging centers. Furthermore, during this time, ACRIN distributed over $100 million dollars to participating facilities to support the carrying out ACRIN’s research protocols.
Study results from ACRIN trials have been published in the New England Journal of Medicine, Journal of the American Medical Association, the Annals of Internal Medicine and radiology professional journals. These results have been published to wide acclaim and have had a major impact on healthcare policy and clinical practice.
In addition to its impressive contribution to the imaging literature, important secondary achievements include establishment of an archive of data and images for secondary research, dissemination of standards for conducting imaging trials, the development of imaging researchers, and improved awareness of the importance of imaging to cancer research and care. Perhaps most significantly, ACRIN has become an integrated and critical component of NCI’s clinical trials endeavor and a respected part of the cancer research and advocacy community.