ALCA Project The Simulation User`s Manual
Contents
1. Detected SA Do D Screening CT fig 20 14 ALCA Project The Simulation Part 4 Threshold Checker Detection Self Assessment Click on the Part 4 line on the menu page to display the folder icon for Part 4 fig 21 Clicking part 4 Threshold Checker on either the folder icon or the Start button will take you to the first of 36 screening CT images from 10 different cases presented in sequence After identifying and clicking on one location where a nodule is suspected on each of the fig 21 36 screening CI images fig 22 the result for Threshold Checker your readings will be shown as 36 dots on a graph based on the size of the nodules and the differences in mean CT number between each nodule and the surrounding lung field fig 23 Clicking on any dot on the graph will allow you to review the CT images corresponding to that particular case based on the timeline indicated at the bottom of the screen fig 25 fig 22 Low Dose Helical CT Screening for Lung Cancer New Case Order Learning Objectives To assess reader s threshold of detectability of minute lung cancer 10 cases of minute lung cancer measuring less than 15mm 36 screening CT Images including retrospective nodules Threshold output sizes and CT numbers of the minute lung cancer nodules case of total 36 cases Lung Cancer Nodule Cancel 15 acarrea he Simulation tabs Hell CT Sreening for Lung Cancer Clicking on any of2. field fig 5 parl Hares ae SS a Within the case selection benign and cancerous lesions are present Please click on the folder icon to enter the test mode New Case Order as Learning Objectives To assess reader s threshold of detectability of minute lung cancer 10 cases of minute lung cancer measuring less than 15mm 36 screening CT images Including retrospective nodules Threshold output sizes and CT numbers of the minute lung cancer nodules 4 acaRge I he Simulation towpose Hel CT screening fr Lung Cancer Teaching Files E lass Part I Teaching Files Atlas of Small Lung Cancers The menu page lists two separate folders for Part 1 Each folder contains eight cases Clicking on either of the folder icons allows you to enter the test mode Clicking on the Go Index button takes you to the Index page which lists all 16 cases and allows you to sort them by diagnosis extent of ground glass opacity GGO size and Noguchi type6 fig 2 A single lung cancer nodule is present in each test mode case Please try to detect the lung jung cancer nodule cancer nodule as you use the toggle and speed bante buttons located on the upper right side of the screen to read through the screening CT images from top apex to bottom diaphragm fig 6 7 When you think you have detected the cancer nodule click on the location of the nodule and a Select Diagnosis box will appear on the scre
3. for Lung Cancer In part 3 the CT image control button is slightly different from that in the other parts When you part 3 Small Nodule move the cursor to the location of the small arrow the color of the arrow changes from dark to bright yellow By clicking on the small arrow in the upper part or in the lower part of the button CT images move 1 slice up or I slice down per click By clicking on the large arrow in the middle part of the button CT images move Upward or downward continuously When you move the cursor outside of the large arrow the CT images Smali Nodule will stop moving There are two red striped ane rectangular areas on both sides of the arrows If you click one side of the red area it will turn dark and CT images on that side will not move This allows you to move CT images on the opposite Side independently eT When you think you have detected a nodule Detection 6 months prior click on the location of the nodule on the By using the above buttons CT Images can be moved downward or upward Please click on the new small nodule or new nodules after reading though the images from top to the bottom A pulldown menu Diagnosis will then appear Please select Small Nodule After selection click on the Go to Answer button to review YOur answer Detection image on the left side of the screen and you will see a Diagnosis box fig 19 Click on Diagnosis and then o
4. the case buttons in the column at the right side of the screen will enable you to review the exact location of the actual nodules on the graph in any particular case in Part 4 or in all 10 cases fig 23 Clicking on new case order will alter the sequence of the 36 screening CT images and you can try another test mode fig 24 Blue circle means V could not detect an nodule of lung cane Orange circle mean Difference in CT could detect a minu Number mean CT nodule of lung cane number of the Please click the circ nodule mean CT 200 300 review the minute n number of the lung cancer on the STN lung difference in CT number screening CT Image issue fig 23 New Case Order Learning Objectives To assess reader s threshold of detectability of minute lung cancer part 4 Threshold Checker fig 24 10 cases of minute lung cancer measuring less than 15mm 16 Aarre he Simulation tom Dose Helical Cr Screening for Lung Cancer 29 Detection he ha he bh h Thin section CT 36 months 30 months 24 months 18 months 12 months 6 months Detection screening CT fig 25 ALCA Project I NE Simulation Low Dose Helical CT Screening for Lung Cancer Acknowledgements This work was supported in part by grants from Scientific Research Expenses for Health and Welfare Programs Foundation for the Promotion of Cancer Research and 2nd Term Comprehensive 10 year Strategy for Cancer Control and by a G
5. Answer page Adenocarcinoma 12mm pT1NOMO IA 6 acaroea Ne Simulation towDose Hell CT Screening for Lung Cancer If you would like to see an index of the cases you can proceed to the Index page by clicking eS on the Go Index button As indicated above the cases In the index can be sorted by diagnosis extent of ground glass opacity GGO size and Noguchi type fig 10 Clicking on each line allows Adenocarcinoma Solid you to review the screening CT images and thin by GGO Solid Adenocarcinoma Mixed GGO Noguchi type C section CT images for each case and compare Ses Si pea ES Adenocarcinoma Mixed GGO Noguchi type C your answer with the correct answer Adenocarcinoma Solid Noguchi type D Adenocarcinoma i Noguchi type F Adenocaricnoma i Noguchi type D Bronchioloalveolar Carcinoma Noguchi type A Bronchioloalveolar Carcinoma Noguchi type A Bronchioloalveolar Carcinoma Noguchi type A Bronchioloalveolar Carcinoma Noguchi type A Bronchioloalveolar Carcinoma a Noguchi type A Bronchioloalveolar Carcinoma ixed Noguchi type B Bronchioloalveolar Carcinoma E Noguchi type B Bronchioloalveolar Carcinoma Noguchi type B Squamous Cell Carcinoma Solid GGO Localized ground glass opacity Mixed GOO GGO with solid component fig 10 7 Acarroect I he Simulation towpose Helical CT Screening for Lung Cancer Part 2 Screening Simulation Practical CT Screening Click on the Part 2 line on t
6. I care I he Simulation tow ose Hell Cr Screening for Lung Cancer Low Dose Helical CT Screening for Lung Cancer Anti Lung Cancer Association Project The Simulation User s Manual Introduction 2 Part I Teaching Files Atlas of Small Lung Cancers 4 Part 2 Screening Simulation Low Dose Helical CT Screening for Lung Cancer Practical CT Screening 7 KE ALCA Project The Simulation Detection Self Assessment 14 Acknowledgements 7 References 7 Ryutaro Kakinuma Hironobu Ohmatsu Masahiro Kaneko Masahiko Kusumoto Kenji Eguchi Noriyuki Moriyama 2000 2005 Ryutaro Kakinuma Japan All rights reserved Tokyo Health Service Association The Society of Thoracic CT Screening 2 acaroea Ne Simulation towDose Hell CT Screening for Lung Cancer Introduction Low Dose Helical CT Screening for Lung Cancer Jen Make ALCA Project The Simulation Project 1 5 we recently developed a teaching software program entitled The Simulation that runs on both Macintosh and Windows fig I part 1 Teaching Files The software consists of four parts Part 1 Teaching Files an atlas of small lung cancers Part 2 pe Sen oe pe Please click on the folder icon to enter the test mode screening Part 3 Small Nodules a dataset for the Objective To become famillar with the recognition of detection of small nodules either in retrospective small sized lung cancers detectable only by helical CT screening or prosp
7. d inflammatory change Nodule Nodule Less than 5 mm Old Inflammatory Chane eee tory cna hot Old Inflammatory Chane the answer page where folder icons of the ten SS E ee cases are displayed fig 14 If the color of a folder is gray your diagnosis for that case was correct and if it is pink your diagnosis was incorrect You fig 14 can re examine the screening CT images and correct answers by simply clicking on the folder icon of that case fig 15 After you have completed one or more of the screening simulation trial folders clicking on the de Go to List will take you to the Index page for Part 2 fig 16 which contains a listing of the ML actual lung cancer cases in all of the screening Bronchioloalveolar Carcinoma simulation trial folders that have been completed eee By clicking on each line of the Index page you can review the screening CT images and thin section CT images for each case fig 15 10 ALCA Project The Simulation It should be noted that clicking on the Reset button on the main Screening Simulation page will automatically change the order of all 100 cases in Part 2 fig 16 fig 16 Low Dose Helical CT Screening for Lung Cancer ALCA Project The Simulation Part 3 Small Nodules Detection Click on the Part 3 line on the menu page to display the folder icon for Part 3 fig 17 Clicking on either the folder icon or the Start button will enab
8. ective chronological order and Part 4 In the past lung cancer nodules of the type ground glass opacity GGO underwent surgical resection However at present cases of small sized GGO less than 10 mmtend to be followed up by CT rather than resection Thus these files are presented as a teaching aide for the recognition of these nodules Threshold Checker a dataset for self assessment of the threshold of the user s ability to detect small nodules on screening CT images Part consists of two folders each of which includes eight cases with a single lung cancer nodule present in each case fig 2 In Part 2 10 randomly chosen cases are presented in each of 10 screening simulation trial TT Objective To gain experience In screening for lung cancer using helical CT screening data folders for a total of 100 cases fig 3 Within this screening simulation 10 randomly chosen cases are presented 3 acaroea he Simulation tabs Hell CT Screening for Lung Cancer Part 3 includes a number of pitfall cases fig 4 The dataset in Part 4 consists of 36 screening CT images that include retrospective nodules from 10 cases of minute lung cancer The user s threshold output Is evaluated on a graph based on the sizes part 3 small Nodule and differences in mean CT number between each Objective To learn how to identify new small nodule s using l gt time lapsed screenings nodule and the surrounding lung
9. en fig 6 Click on Select Diagnosis then on Lung Cancer fig 7 Nodule and you will automatically proceed to the next case Click the left side arrows small arrows for manual upward and downward scrolling control Click the right side arrows large arrows for automatic upward and downward scrolling control The smaller button is for speed control Click the right arrow to increase scrolling speed Click the left arrow to decrease scrolling speed 5 acargea he Simulation torDoseHelel CT Screening for Lung Cancer _ Answer When you finish reading all eight cases a GO Answer button will appear on the screen Click on it to proceed to the Answer page fig 8 Orange bordered boxes on the Answer page indicate re VIG that your response was correct for that particular 7 Eronchioloalweolar Squamous Cell Carcinoma Bronchioloalveolar Adenocarcinoma Carcinoma lmm Carcinoma mm 15mm pTINOMHO TA L mm pTINOMO A pTINOMO LA pTINOMO IA case Clicking on any CT image thumbnail allows you to review the screening CT images and thin section CT images for that case fig 9 You also can compare your answer with the correct After reviewing the screening CT images for the Adenocarcinoma Adenocarcinoma Adenocarcinoma Adenocarcinoma i 10mm 17mm 12mm 10mm eight cases YOU can return to the menu page Dy pTINOMO IA pTINOMO IA pTINOMO IA pTINOMO IA clicking on the Menu button on the
10. he menu page to display the folder icon for Part 2 fig 1 1 Clicking on either the folder icon or the Start button will take you to the main Screening Simulation part 2 Screening Simulation page which contains a total of 10 different folders fig 12 Clicking on one of the folders enables you to proceed to the screening simulation trial for that folder Ten cases are presented within each ng screening simulation trial folder but only one of the 10 cases is actually lung cancer fig 13 In the other nine cases there are one or more benign part 2 Screening Simulation 1 2 3 4 5 nodules or no nodules at all Waiting Waiting Waiting Waiting Waiting 6 T 8 9 10 Waiting Waiting Waiting Waiting Waiting fig 12 8 aaret Ne Simulation tovDese Hele CT Screening for Lung Cancer After completely reading through the screening CT images of a case and identifying a location of G interest click on the location and a Diagnosis 3 box will appear on the screen Click on Diagnosis and a pull down menu of four diagnostic choices will be displayed for your consideration If you J suspect a lung cancer nodule at the location Other Finding select Lung Cancer remembering that each screening simulation folder of 10 cases will contain only one lung cancer nodule If you want to Lung Cancer change your answer click on your diagnosis and Nodule Other Finding then on the Delete butt
11. le you to proceed to the main Small Nodules page fig 18 which is divided into Lung Cancer at tne top and containing 15 separate folders and Inflammation at the bottom and containing 8 other folders If you click on any of the folders you will proceed to the test mode for that folder The screening CT image on which the nodule was first detected or the nodule increased in size or opacity will be shown on the left side of the screen and a screening CT image taken earlier will be shown on the right side fig 19 Please try to detect a new or an enlarged nodule in each of the lung cancer cases and a new nodule or nodules in each of the inflammation cases after reading through the screening CI images from top apex to bottom diaphragm in each folder The buttons located in the upper center portion of the screen allow you to move the CT images up towards the apex or down towards the diaphragm Low Dose Helical CT Screening for Lung Cancer ALCA Project The Simulation Objective To learn how to Identify new small nodule s using time lapsed screenings Within the case selection benign and cancerous lesions are present Please click on the folder icon to enter the test mode fig 17 Please click on the new small nodule or new nodules on the left CT images after reading through the images from top to the bottom Lung Cancer Inflammation fig 18 12 care he Simulation tom Dose Helical Cr Screening
12. n Small Nodule and a Correct or New or Enlarged Nodule answer will be immediately displayed in the lower center fig 19 portion of the screen If you want to change the location that you selected for the nodule click on Cancel and start over again 13 acarrea he Simulation LowDose Helt CT Screening for Lung Cancer Clicking on the Go Answer button will take you to the answer page fig 20 The screening part 3 Small Nodule Sani CT image on which the nodule was first detected will be shown on the left side and a screening CT image taken earlier or thin section CT image will be shown on the right side By clicking on the CT image thumbnail boxes at the bottom of the screen you can compare screening CT images taken earlier with the screening CT image on which the nodule was first detected If you click on the Quick Tour button in the upper center portion of the screen Next button will appear Repeated clicking of the Next button will display the key CT images of the case in sequence After completing one or more of the 23 folders clicking on the Go to List will take you to the Index page for Part 3 which contains a list of the Detection 6 months prior cases in all of the folders that you have completed Sl gt Clicking on each line of the Index page will allow Thin section GT you to review the screening CT images and thin section CI images in each case m
13. on If you identify one or more nodules that you do not suspect of being lung cancer select Nodule from the diagnostic choices on the pull down menu The circle cursor on the CT images is 5 mm in diameter If you identify one or more other findings for example old inflammatory change fig 13 bulla emphysema old tuberculosis etc select Other findings from the diagnostic choices on the pulldown menu If you do not observe any abnormal findings in a case select None from the pull down menu 9 carro Ne Simulation torDose Hell CT Screening for Lung Cancer Wh Fe wih liel he S p On this answer page folder icons of the ten cases are shown If the color of the folder Is red It indicates your en you tinish with a Case cick on the save diagnosis was wrong If the color of the folder Is black It Indicates your dlagnosls was correct F You can re evaluate the CT Images by clicking on the case folder s Icon button to proceed to the next case After reading Je 8 the images of all 10 cases presented in each enn screening simulation trial folder an Answer Old Inflammatory Chang ET lt Your Diagnosis gt lt Your Diagnosis gt lt Your Diagnosis gt lt Your Diagnosis gt button will appear on the page Clicking on it will Nodule is incorrect None is correct None is incorrect None is incorrect NSWE lt ANSWER gt lt ANSWER gt lt ANSWER gt enable you to view the results of your readings on l
14. rant in Aid for Cancer Research from the Ministry of Health Labor and Welfare References Kaneko M Eguchi K Ohmatsu H et al Peripheral lung cancer screening and detection with low dose spiral CT versus radiography Radiology 1996 201 798 802 Kakinuma R Ohmatsu H Kaneko M et al Detection failures in spiral CT screening for lung cancer analysis of CT findings Radiology 1999 212 61 66 Kaneko M Kusumoto M Kobayashi T et al Computed tomography screening for lung carcinoma in Japan Cancer 2000 89 11 Suppl 2485 2488 Sobue T Moriyama N Kaneko M et al Screening for lung cancer with low dose helical computed tomography anti lung cancer association project J Clin Oncol 2002 20 91 1 920 Kakinuma R Ohmatsu H Kaneko M et al Progression of focal pure ground glass opacity detected by low dose helical computed tomography screening for lung cancer J Comput Assist Tomogr 2004 28 1 7 25 Noguchi M Morikawa A Kawasaki M et al Small adenocarcinoma of the lung histologic characteristics and prognosis Cancer 1995 75 2844 2852 2000 2005 Ryutaro Kakinuma All rights reserved 2005 Tokyo Health Service Association 2005 The Society of Thoracic CT Screening
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