IROC experience in NCTN clinical trials working with the TRIAD image uploading platform

Objectives: Several different image uploading and secure transmission platforms are currently in use across various clinical organizations. Transmission of Imaging and Data (TRIAD) is one such platform developed by ACR and is currently being implemented as the preferred standard across the NCI National Clinical Trial Network (NCTN) served by the Imaging and Radiation Oncology Core (IROC) as core service cooperative (U24). This study assesses the benefits and challenges that accompany using the TRIAD platform as a primary means of submitting and de-identifying imaging studies with a focus on nuclear medicine. Within this study, IROC is also seeking feedback and suggestions for improvements to these processes to advance its goal of convenient image uploading for sites participating in clinical trials. Methods: Since June 2015, over 3000 exams and other non-DICOM data have been processed using TRIAD at IROC Ohio. While tracking trial data, comparisons were made between managing data transmission with TRIAD versus conventional methods (shipment of physical CDs and standalone uploads via a file transfer protocol (FTP)). IROC, ACR, and TRIAD’s developers have established training, education, and communication best practices for direct site linkage. This includes iterating on the TRIAD software for continual improvement. All communication was also logged and tracked to aid this analysis. Results: TRIAD brings several notable benefits to clinical trial management. Site users electronically select a clinical trial, institution name and trial-specific patient ID. They are able to de-identify images during online data submission. The information is logged and readily available for sorting by a variety of categories. Data submission triggers automatic email notifications to IROC QA centers for an instant imaging data retrieval and quality check. A robust and flexible profile-based DICOM tag de-identification tool can be defined with trial-specific requirements to clean and remove protected health information (PHI) during submission. TRIAD is not without challenges. TRIAD account access, user education, non-DICOM data management, lack of multi-tasking ability, and overall access speed remain issues. Details and statistical analysis on TRIAD advantages and disadvantages will be presented. Conclusion: Use of TRIAD as a platform for data transmission has been shown to be beneficial. The structured submissions reduce human errors and provide a secure pathway to the QC core