Best Practices for Multi-Centric, Multi-Modal Clinical Trials with Imaging Endpoints

Multi-centric multi-modal blog post

In the dynamic landscape of clinical research, multi-centric, multi-modal trials with imaging endpoints are increasing in popularity due to their reduced costs vs biopsies and the demand for greater, reduced-bias datasets. From harmonizing diverse data sources to ensuring regulatory compliance, these trials demand meticulous orchestration. In this article, we delve into nine best practices that empower researchers to navigate this intricate terrain effectively.

Standardize Imaging Protocols Across Centers

The challenge here is that each imaging center employs its own acquisition protocols, leading to variations in image quality and consistency. These differences hinder accurate comparisons and compromise the reliability of study results. It's worth spending the effort during trial design and setup to harmonize imaging protocols to enhance data quality, facilitate cross-center collaboration, and strengthen scientific rigor. By standardizing protocols, all centers acquire comparable images. Researchers are therefore able to confidently analyze for example the pathology, enhancement patterns, or treatment response. Results are robust, enabling meaningful comparisons across sites.

Image Quality and Interpretation Accuracy

The quality of acquired medical images significantly affects the accuracy of subsequent interpretations. Inconsistent image quality can lead to misdiagnoses or unreliable research outcomes. To address the issue, start with ensuring the protocol harmonization and equipment calibration discussed above. Establish robust quality control procedures during image acquisition and/or data transfer by monitoring the acquisition process, verifying adherence to protocols, and addressing any deviations as soon as possible. This will allow the trial to detect and correct issues early, improve data reliability, and drive more reliable study results.

Centralized Image Review

What we are looking at here is the variability in Radiologist Interpretations. When multiple radiologists interpret medical images, differences in expertise, biases, and subjective judgments can lead to variability in results. This inconsistency affects the reliability of study outcomes. To overcome the challenge, appoint a team of expert radiologists with specialized knowledge in the relevant field to steer the review effort. Use blinded parallel reads to control for result consistency and minimize bias. Use a centralized toolset the ensure the exact setup and configuration of the reading environment can be controlled and that all experts perform the tasks in the same way. The method will ensure reduced variability, enhanced accuracy, and improved confidence in study findings.

Integrating Multi-Modal Data

In clinical trials, researchers often collect data from various imaging modalities such as MRI, PET, and CT in addition to clinical data and other novel sources. These modalities differ in resolution, acquisition protocols, and information content. Integrating them seamlessly for analysis poses a significant challenge. Use harmonization algorithms to ensure consistent and meaningful analysis across modalities. Develop a clear understanding of the research question and the role of each modality during the trial planning. Extract relevant features from each modality (e.g., tumor volume, intensity values) and transform features into a common space (e.g., standardized intensity scales). The approach enables direct comparison and facilitates statistical modeling further downstream in the research pipeline.
Done correctly, this will for example enable mapping features from one modality to another, adapting models trained on one modality to another and using neural networks to learn modality-specific mappings.

Image Annotation and Segmentation

Manual annotation of medical images is both time-consuming and subjective. Human annotators may introduce variability due to differences in interpretation. To address this challenge, leverage semi-automated segmentation tools, algorithms, or AI (Artificial Intelligence) for fully automated segmentation. AI algorithms are evolving at a rapid pace and can today identify and delineate specific structures within medical images, such as tumor volumes or brain regions. However always make sure to validate AI algorithms used or results against a ground truth. The ground truth typically comes from expert human annotators who meticulously annotate at least a subset of the same images. By comparing AI-generated segmentations with these human annotations, we ensure accuracy and reliability.
Incorporating semi-automation or AI-driven segmentation streamlines the process, enhances consistency, and contributes to more robust clinical trial outcomes.

Regulatory Compliance

Ensuring compliance with regulatory bodies such as the FDA (U.S. Food and Drug Administration) and EMA (European Medicines Agency) standards for imaging endpoints is crucial. First of all, understand the guidelines. Familiarize yourself with the relevant guidelines, particularly ICH E9 (Statistical Principles for Clinical Trials), E17 (General Principles for Planning and Design of Multiregional Clinical Trials), and the FDA Clinical Trial Imaging Endpoint Process Standards Guidance.

Maintain meticulous documentation of imaging processes throughout the trial. This includes details on imaging acquisition, display, archiving, and interpretation. This activity can be very time-consuming and the use of an Imaging Management System such as Collective Minds Research will simplify the trial greatly.

Multi-Centric Data Transfer

Securely and efficiently transferring large imaging datasets from multiple centers or sites is essential for collaborative research. By using a dedicated technology for this situation such as the Collective Minds Connect gateway, the typical issues with high overhead workloads on the Site data managers, partials or failed transfers and adequate cross-modality data linkage can be avoided. Always utilize encrypted channels and storage (such as secure FTP, SFTP, or HTTPS) to safeguard data during transit and at rest. Encryption ensures that data remains confidential and protected from unauthorized access.

Referring to some relevant regulations, HIPAA (Health Insurance Portability and Accountability Act) states that if your clinical trial involves patient data from the United States, adhere to HIPAA regulations. Ensure that data transfers comply with HIPAA privacy and security requirements.

Inside the EU, GDPR (General Data Protection Regulation) similarly states that for trials involving data from the European Union (EU), comply with GDPR guidelines. GDPR emphasizes data protection, consent, and individual rights. Implement measures to protect personal data during transfer.

Regularly validate the integrity of transferred data. Use checksums or hash functions to verify that files remain unchanged during transit.

By following these best practices, clinical trials can securely exchange imaging data across centers while maintaining compliance with privacy regulations. Again, a purpose-built solution will help with all of these hurdles. 

Adaptive Trial Designs

In clinical trials, interim results (such as imaging data) can impact trial decisions. Traditional fixed designs may not adapt well to changing circumstances. By using an adequate adaptive design, you may overcome these hurdles.

Bayesian methods allow for continuous updating of trial parameters based on accumulating data. They incorporate prior knowledge (prior distributions) and posterior distributions to make informed decisions. Bayesian adaptive designs adjust sample size, treatment allocation, or endpoints during the trial.

The benefits include efficient use of data, flexibility to modify trial parameters, ability to stop early for futility or efficacy, and incorporation of external information (e.g., historical data). 
Group Sequential Designs allow for interim analyses at predefined time points. At each analysis, decisions can be made to continue, modify, or terminate the trial. Here the benefits include efficient use of resources, early stopping for efficacy or futility, and reduced patient exposure.

There are multiple other options for Adaptive Designs which may be worth exploring. When implementing adaptive designs, involve statisticians and regulatory experts, specify adaptation rules in advance, monitor trial integrity and safety, and document adaptations transparently.
Remember, adaptive designs enhance trial efficiency, optimize decision-making, and improve the chances of successful clinical outcomes. An Imaging Management System supporting the trial design adaptations is vital for the approach to remain traceable.

Collaboration and Communication

Clinical trials involve a diverse team, including radiologists, clinicians, statisticians, and other experts. Each group brings unique perspectives, but miscommunication or lack of alignment can hinder progress. 
Foster an environment of understanding and alignment through Regular Interdisciplinary Meetings. Schedule regular meetings where team members from different disciplines come together and discuss trial progress, challenges, and findings, share insights, clarify doubts, align goals, and encourage open dialogue and active listening.
Collaboration ensures decisions are well-informed and consider various viewpoints, cross-disciplinary discussions lead to creative solutions, consistent communication helps maintain data quality and adherence to protocols and the practice builds trust and camaraderie among team members.


I hope you enjoyed our best practice summary for Multi-Centric, Multi-Modal Clinical Trials with Imaging Endpoints. Here at Collective Minds, we specialize at helping our customers with these topics and provide the Collective Minds Research solution specifically for this purpose. Should you wish to know more, please get in touch below.


Pär Kragsterman, CTO and Co-Founder at Collective Minds Radiology


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