Paul E Kinahan

University of Washington | UW · Department of Radiology

Background The rapid advancement of medical technologies presents significant challenges for researchers and practitioners. While traditional clinical trials remain the gold standard, they are often limited by high costs, lengthy durations, and ethical constraints. In contrast, in‐silico trials and digital twins have emerged not only as efficient a...

The rapid advancement in the field of medical imaging presents a challenge in keeping up to date with the necessary objective evaluations and optimizations for safe and effective use in clinical settings. These evaluations are traditionally done using clinical imaging trials, which while effective, pose several limitations including high costs, eth...

Background In modern positron emission tomography (PET) with multi‐modality imaging (e.g., PET/CT and PET/MR), the attenuation correction (AC) is the single largest correction factor for image reconstruction. One way to assess AC methods and other reconstruction parameters is to utilize software‐based simulation tools, such as a lesion insertion to...

The need for improved diagnostic methods in ophthalmology is acute, especially in the less developed regions with limited access to specialists and advanced equipment. Therefore, we introduce VisionUnite, a novel vision-language foundation model for ophthalmology enhanced with clinical knowledge. VisionUnite has been pretrained on an extensive data...

The MFFNet using natural language processing (i.e. BERT) is a novel and effective solution for harmonizing radiology study descriptions to LOINC codes. By facilitating the harmonization of radiological descriptions, MFFNet demonstrates potential for substantial improvements in selection of large patient patient cohorts through standardized study de...

Background Lesion detection is one of the most important clinical tasks in positron emission tomography (PET) for oncology. An anthropomorphic model observer (MO) designed to replicate human observers (HOs) in a detection task is an important tool for assessing task‐based image quality. The channelized Hotelling observer (CHO) has been the most pop...

8622 Background: Chemotherapy and immune checkpoint inhibitors (chemoICI) for stage IV NSCLC without driver mutations produce variable response patterns and outcomes. Early assessment could establish selective benefit from treatment (de)escalation, consolidation, or adaptation. We evaluated FDG PET imaging and circulating T cell repertoire biomarke...

This submission comprises the proceedings of the 1st Virtual Imaging Trials in Medicine conference, organized by Duke University on April 22-24, 2024. The listed authors serve as the program directors for this conference. The VITM conference is a pioneering summit uniting experts from academia, industry and government in the fields of medical imagi...

Radiomics, the science of extracting quantifiable data from routine medical images, is a powerful tool that has many potential applications in oncology. The Response Evaluation Criteria in Solid Tumors Working Group (RWG) held a workshop in May 2022, which brought together various stakeholders to discuss the potential role of radiomics in oncology...

Background Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deo...

BACKGROUND Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients with bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-...

The clinical management of patients with indeterminate pulmonary nodules is associated with unintended harm to patients and better methods are required to more precisely quantify lung cancer risk in this group. Here, we combine multiple noninvasive approaches to more accurately identify lung cancer in indeterminate pulmonary nodules. We analyzed 94...

Preclinical imaging is a critical component in translational research with significant complexities in workflow and site differences in deployment. Importantly, the National Cancer Institute’s (NCI) precision medicine initiative emphasizes the use of translational co-clinical oncology models to address the biological and molecular bases of cancer p...

Providing method descriptions that are more detailed than currently available in typical peer reviewed journals has been identified as an actionable area for improvement. In the biochemical and cell biology space, this need has been met through the creation of new journals focused on detailed protocols and materials sourcing. However, this format i...

The availability of high-fidelity animal models for oncology research has grown enormously in recent years, enabling preclinical studies relevant to prevention, diagnosis, and treatment of cancer to be undertaken. This has led to increased opportunities to conduct co-clinical trials, which are studies on patients that are carried out parallel to or...

Background: 18F-FES is an FDA-approved estrogen analogue PET imaging tracer (Cerianna) which measures tumor estrogen receptor (ER) expression at multiple tumor sites simultaneously and predicts response to endocrine therapy. 18F-FDG is a commonly used glucose PET imaging tracer which measures glycolytic metabolic activity in tumors. Elevated plasma...

Relevant to co-clinical trials, the goal of this work was to assess repeatability, reproducibility, and bias of the apparent diffusion coefficient (ADC) for preclinical MRIs using standardized procedures for comparison to performance of clinical MRIs. A temperature-controlled phantom provided an absolute reference standard to measure spatial unifor...

Purpose The main goal of this work is to describe a phantom design, data acquisition and data analysis methodology enabling comparison of small lesion detectability between PET imaging systems and reconstruction algorithms. Several methods are currently available to characterize intrinsic and image quality performance, but none focus exclusively on...

Historically, patient datasets have been used to develop and validate various reconstruction algorithms for PET/MRI and PET/CT. To enable such algorithm development, without the need for acquiring hundreds of patient exams, in this paper we demonstrate a deep learning technique to generate synthetic but realistic whole-body PET sinograms from abund...

The SNMMI Artificial Intelligence (SNMMI-AI) Summit, organized by the SNMMI AI Task Force, took place in Bethesda, MD on March 21-22, 2022. It brought together various community members and stakeholders from academia, healthcare, industry, patient representatives, and government (NIH, FDA), and considered various key themes to envision and facilita...

Purpose The purpose of this guideline is to provide comprehensive information on best practices for robust radiomics analyses for both hand-crafted and deep learning-based approaches. Methods In a cooperative effort between the EANM and SNMMI, we agreed upon current best practices and recommendations for relevant aspects of radiomics analyses, inc...

Computer-extracted tumour characteristics have been incorporated into medical imaging computer-aided diagnosis (CAD) algorithms for decades. With the advent of radiomics, an extension of CAD involving high-throughput computer-extracted quantitative characterization of healthy or pathological structures and processes as captured by medical imaging,...

Combinations of multiple quantitative imaging biomarkers (QIBs) are often able to predict the likelihood of an event of interest such as death or disease recurrence more effectively than single imaging measurements can alone. The development of such multiparametric quantitative imaging and evaluation of its fitness of use differs from the analogous...

A standardized approach to acquiring amyloid PET images increases their value as disease and drug response biomarkers. The majority of 18F PET amyloid brain scans often are assessed only visually (per regulatory labels), with a binary decision indicating the presence or absence of Alzheimer's disease amyloid pathology. Minimizing technical variance...

Background Patients undergoing chemoradiation and immune checkpoint inhibitor (ICI) therapy for locally advanced non-small cell lung cancer (NSCLC) experience pulmonary toxicity at higher rates than historical reports. Identifying biomarkers beyond conventional clinical factors and radiation dosimetry is especially relevant in the modern cancer imm...

Multiparameter quantitative imaging incorporates anatomical, functional, and/or behavioral biomarkers to characterize tissue, detect disease, identify phenotypes, define longitudinal change, or predict outcome. Multiple imaging parameters are sometimes considered separately but ideally are evaluated collectively. Often, they are transformed as Like...

Historically, patient datasets have been used to develop and validate various reconstruction algorithms for PET/MRI and PET/CT. To enable such algorithm development, without the need for acquiring hundreds of patient exams, in this paper we demonstrate a deep learning technique to generate synthetic but realistic whole-body PET sinograms from abund...

Background: Patients undergoing chemoradiation and immune checkpoint inhibitor (ICI) therapy for locally advanced non-small cell lung cancer (LA-NSCLC) experience pulmonary toxicity at higher rates than historical reports. We investigated the role of novel functional lung radiomics, relative to functional lung dosimetry and clinical characteristics...

AI can improve the quality of CT, MR and PET/CT images, while simultaneously reducing imaging time, and doses of radiation and contrast. AI can improve radiologist workflow and decrease interpretation times. AI may someday be capable of accurately locating, classifying and segmenting bone and soft tissue tumors. The goal of radiomics is to use radi...

Image texture analysis (radiomics) uses radiographic images to quantify characteristics that may identify tumour heterogeneity and associated patient outcomes. Using fluoro‐deoxy‐glucose positron emission tomography/computed tomography (FDG‐PET/CT)‐derived data, including quantitative metrics, image texture analysis and other clinical risk factors,...

State-of-the-art deep survival prediction approaches expand network parameters to accommodate performance over a fine discretization of output time. For medical applications where data are limited, the regression-based Deepsurv approach is more advantageous because its continuous output design limits unnecessary network parameters. Despite the prac...

Introduction: We seek to examine the prognostic value of FDG-PET imaging during chemoradiation for unresectable non-small cell lung cancer (NSCLC) for survival and hypothesize tumor PET response is correlated with peripheral T-cell function. Methods: 45 patients with AJCCv7 stage IIB-IIIB NSCLC enrolled on a phase II trial and received platinum-do...

Objective Simultaneous PET/MRIs vary in their quantitative PET performance due to inherent differences in the physical systems and differences in the image reconstruction implementation. This variability in quantitative accuracy confounds the ability to meaningfully combine and compare data across scanners. In this work, we define image reconstruct...

Purpose/Objective(s) We hypothesized that FDG PET imaging during chemoradiation for unresectable non-small cell lung cancer (NSCLC) is prognostic for survival, and that PET response is correlated with systemic immune response to treatment, as characterized by peripheral immunologic correlates and tumor PD-L1 status. A prognostic test that could pre...

Purpose: One major challenge facing simultaneous positron emission tomography (PET)/ magnetic resonance imaging (MRI) is PET attenuation correction (AC) measurement and evaluation of its accuracy. There is a crucial need for the evaluation of current and emergent PET AC methodologies in terms of absolute quantitative accuracy in the reconstructed P...

Purpose This study evaluated the ability of ¹⁸ F-Fluorodeoxyglucose (FDG) and ¹⁸ F-Fluorothymidine (FLT) imaging with positron emission tomography (PET) to measure early response to endocrine therapy from baseline to just prior to surgical resection in estrogen receptor positive (ER+) breast tumors. Methods In two separate studies, women with earl...

Positron emission tomography and magnetic resonance imaging (PET/MRI) scanners cannot be qualified in the manner adopted for hybrid PET and computed tomography (CT) devices. The main hurdle with qualification in PET/MRI is that attenuation correction (AC) cannot be adequately measured in conventional PET phantoms due to the difficulty in converting...

Purpose of the Report We evaluated the reliability of 18F-FDG PET imaging biomarkers to classify early response status across observers, scanners, and reconstruction algorithms in support of biologically adaptive radiation therapy for locally advanced non–small cell lung cancer. Patients and Methods Thirty-one patients with unresectable locally...

Introduction: We hypothesized that FDG PET imaging during chemoradiation for unresectable non-small cell lung cancer (NSCLC) is prognostic for survival, and that tumor PET response is correlated with peripheral T-cell function. Methods: 45 patients with AJCCv7 stage IIB-IIIB NSCLC enrolled on the phase II FLARE-RT trial and received platinum-double...

Background: The histology and pattern of spread in lobular breast cancer has presented challenges in estimating extent of disease by traditional imaging methods. ¹⁸F-FES is an estrogen analogue PET imaging tracer which measures tumor ER expression at multiple tumor sites simultaneously. It is FDA approved in the US and will be available in 2021, pr...

Purpose A Positron Emission Tomography/Computed Tomography quality assurance program is necessary to ensure that patients receive optimal imaging and care. We summarize the AAPM Task Group (TG) 126 report on acceptance and quality assurance (QA) testing of PET/CT systems. Methods TG 126 was charged with developing PET/CT acceptance testing and QA...

DESCRIPTION This chapter provides a motivation for standardization, quality control, and site qualification, as well as their applications to quantitative imaging biomarkers. Motivating this effort is a comment made in 2011 by George Poste: “A major impediment to progress in the hunt for biomarkers is the lack of standardization in how specimens ar...

We investigated the sensitivity of regional tumor response prediction to variability in voxel clustering techniques, imaging features, and machine learning algorithms in 25 patients with locally advanced non-small cell lung cancer (LA-NSCLC) enrolled on the FLARE-RT clinical trial. Metabolic tumor volumes (MTV) from pre-chemoradiation (PETpre) and...

PURPOSE: Patients undergoing chemoradiation (CRT) for LA-NSCLC are at significant risk of developing radiation pneumonitis. As consolidation checkpoint inhibitor immunotherapy (IO) becomes standard of care after chemoradiation, pneumonitis (either radiation or immune-mediated) is also the most common rationale for cessation of IO and management wit...

The editorial introduces the S`pecial Section on Virtual Clinical Trials for Volume 7 Issue 4 of the Journal of Medical Imaging.

The accelerating complexity and variety of medical imaging devices and methods have outpaced the ability to evaluate and optimize their design and clinical use. This is a significant and increasing challenge for both scientific investigations and clinical applications. Evaluations would ideally be done using clinical imaging trials. These experimen...

In extremely low-dose protocols to reduce radiation dose to patients, computed tomography (CT) images suffer from increased bias and low signal-to-noise ratio in measurements. In this study, we consider three different non-positive corrections, flip, truncation and mean-preserving filter (MPF), affecting the measurement mean, propose a new variance...

Radiomic features are being increasingly studied for clinical applications. We aimed to assess the agreement among radiomic features when computed by several groups by using different software packages under very tightly controlled conditions, which included standardized feature definitions and common image data sets. Ten sites (9 from the NCI's Qu...

Quantitative imaging biomarkers (QIBs) provide medical image-derived intensity, texture, shape, and size features that may help characterize cancerous tumors and predict clinical outcomes. Successful clinical translation of QIBs depends on the robustness of their measurements. Biomarkers derived from positron emission tomography images are prone to...

9040 Background: Patients with unresectable LA-NSCLC are treated with concurrent chemoradiation (CRT) and consolidation immunotherapy with survival that range from months to years or even decades. Early predictive biomarkers have potential to identify patients who are unlikely to benefit from continuing standard of care therapy and require a change...

Background Simultaneous PET/MRIs vary in their quantitative PET performance due to inherent differences in the physical systems and differences in the image reconstruction implementation. This variability in quantitative accuracy confounds the ability to meaningfully combine and compare data across scanners. In this work, we define image reconstruc...

Objective: Simultaneous PET/MRIs vary in their quantitative PET performance due to inherent differences in the physical systems and differences in the image reconstruction implementation. This variability in quantitative accuracy confounds the ability to meaningfully combine and compare data across scanners. In this work, we define image reconstruc...

Acute respiratory distress syndrome and coagulopathy played an important role in morbidity and mortality of severe COVID‐19 patients. A higher frequency of PE than expected in COVID‐19 patients was recently reported. The presenting symptoms for PE were untypical including dyspnea, which is one of the major symptoms in severe COVID‐19, especially in...

We investigated PET image quantification when using a uniform attenuation coefficient (μ) for attenuation correction (AC) of anthropomorphic density phantoms derived from high-resolution breast CT scans. A breast PET system was modeled with perfect data corrections except for AC. Using uniform μ for AC resulted in quantitative errors roughly propor...

Objective: To describe clinical, and imaging findings including the evolution pattern in COVID-19 pneumonia complicated by pulmonary embolism (PE). Methods: Eleven of 1453 patients with a probable diagnosis of COVID-19 pneumonia were retrospectively selected for the presence of PE. Clinical and laboratory data were recorded. All cross-sectional CT...

The accelerating complexity and variety of medical imaging devices and methods have outpaced the ability to evaluate and optimize their design and clinical use. This is a significant and increasing challenge for both scientific investigations and clinical applications. Evaluations would ideally be done using clinical imaging trials. These experimen...

Purpose To develop bone material analogues that can be used in construction of phantoms for simultaneous PET/MRI systems. Methods Plaster was used as the basis for the bone material analogues tested in this study. It was mixed with varying concentrations of an iodinated CT contrast, a gadolinium‐based MR contrast agent, and copper sulfate to modul...

Background: Bone dominant metastatic breast cancer can be difficult to stage using conventional imaging. ¹⁸F-FES is an estrogen analogue PET imaging tracer that measures estrogen receptor (ER) expression at multiple tumor sites simultaneously and predicts response to endocrine therapy. We analyzed FES-PET and FDG-PET SUV uptake within bone in patie...

Purpose Physical and digital phantoms play a key role in the development and testing of nuclear medicine instrumentation and processing algorithms for clinical and research applications, including neuroimaging using positron emission tomography (PET). We have developed and tested a digital reference object (DRO) version of the original segmented ma...

The Quantitative Imaging Biomarkers Alliance (QIBA) Profile for fluorodeoxyglucose (FDG) PET/CT imaging was created by QIBA to both characterize and reduce the variability of standardized uptake values (SUVs). The Profile provides two complementary claims on the precision of SUV measurements. First, tumor glycolytic activity as reflected by the max...

Introduction: Our objective was to develop a prognostic model that predicts progression-free survival (PFS) and overall survival (OS) to enable risk-adapted strategies in patients with previously untreated diffuse large B-cell lymphoma (DLBCL). We retrospectively investigated the value of quantitative image texture features (i.e. 'radiomics' evalua...

Purpose: To develop bone material analogues that can be used in construction of phantoms for simultaneous PET/MRI systems. Methods: Plaster was used as the basis for the bone material analogues tested in this study. It was mixed with varying concentrations of an iodinated CT contrast, a gadolinium-based MR contrast agent, and copper sulfate to modu...