North American Multicenter Volumetric CT Study for Clinical Staging of Malignant Pleural Mesothelioma: Feasibility and Logistics of Setting Up a Quantitative Imaging Study  Ritu R. Gill, MD, MPH, David P. Naidich, MD, Alan Mitchell, MS, Michelle Ginsberg, MD, Jeremy Erasmus, MD, Samuel G. Armato, PhD, Christopher Straus, MD, Sharyn Katz, MD, PhD, Demetrois Patios, MD, BA, William G. Richards, PhD, Valerie W. Rusch, MD Valerie Rusch, MD, Michelle Ginsberg, MD, David Rice, MD, Jeremy Erasmus, MD, Harvey Pass, MD, David Naidich, MD, Hedy L. Kindler, MD, Samuel Armato, PhD, Christopher Straus, MD, Wickii Vigneshwaran, MD, Joseph Friedberg, MD, Sharyn Katz, MD, PhD, Marc de Perrot, MD, Demetrios Patios, MD, BA, Dori Giroux, MS, Dr. Lynn Shemanski, PhD, Alan Mitchell, MS, William G. Richards, PhD, Ritu R. Gill, MD, MPH Ritu R. Gill, MD, MPH, David P. Naidich, MD, Alan Mitchell, MS, Michelle Ginsberg, MD, Jeremy Erasmus, MD, Samuel G. Armato, PhD, Christopher Straus, MD, Sharyn Katz, MD, PhD, Demetrois Patios, MD, BA, William G. Richards, PhD, Valerie W. Rusch, MD Valerie Rusch, MD, Michelle Ginsberg, MD, David Rice, MD, Jeremy Erasmus, MD, Harvey Pass, MD, David Naidich, MD, Hedy L. Kindler, MD, Samuel Armato, PhD, Christopher Straus, MD, Wickii Vigneshwaran, MD, Joseph Friedberg, MD, Sharyn Katz, MD, PhD, Marc de Perrot, MD, Demetrios Patios, MD, BA, Dori Giroux, MS, Dr. Lynn Shemanski, PhD, Alan Mitchell, MS, William G. Richards, PhD, Ritu R. Gill, MD, MPH  Journal of Thoracic Oncology  Volume 11, Issue 8, Pages 1335-1344 (August 2016) DOI: 10.1016/j.jtho.2016.04.027 Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Flowchart showing the organizational setup of the study. CT, computed tomography; IASLC/IMIG, International Association for the Study of Lung Cancer/International Mesothelioma Interest Group; MPM, malignant pleural mesothelioma; DICOM, Digital Imaging and Communications in Medicine; TNM, tumor, node, and metastasis. Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Correlation of volumetric computed tomography (VolCT) analysis estimates of reader A compared with those of reader B. Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 3 Comparison of tumor volume from both reference radiologists with pathological tumor (T) category. VolCT, volumetric computed tomography. Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 4 Example of perception error. Axial computed tomography images with contrast from a patient with malignant pleural mesothelioma with a large right pleural effusion and discontinuous areas of pleural thickening representing tumor. Areas perceived as tumor by the two reviewers are represented by yellow (A) and red (B) contour lines, respectively, and the resulting difference in calculated tumor volume is as depicted in the three-dimensional volume-rendered images (C). Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 4 Example of perception error. Axial computed tomography images with contrast from a patient with malignant pleural mesothelioma with a large right pleural effusion and discontinuous areas of pleural thickening representing tumor. Areas perceived as tumor by the two reviewers are represented by yellow (A) and red (B) contour lines, respectively, and the resulting difference in calculated tumor volume is as depicted in the three-dimensional volume-rendered images (C). Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 5 Example of limited distinction between tumor and adjacent structures. (A and D) Depiction of corresponding sets of axial computed tomography images obtained without intravenous contrast in a patient with right-sided malignant pleural mesothelioma with similar density and therefore poor contrast among tumor, chest wall musculature, liver, and the mediastinal vascular structures (white arrows) demonstrating discrepant tumor delineation by the two reference radiologists, respectively. The resulting difference in calculated tumor volume is apparent by comparing the respective three-dimensional volume-rendered images (B and C). Journal of Thoracic Oncology 2016 11, 1335-1344DOI: (10.1016/j.jtho.2016.04.027) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions