1. Standard Response Evaluation Criteria in Solid Tumors (RECIST) using 3D Slicer Slicer3 Training Compendium Image here. Jeffrey Yap, PhD Wendy Plesniak, PhD

2. Materials This tutorial requires the following installation: 3D Slicer version 3.5 Software, which can be installed from http://www.slicer.org/pages/Special:SlicerToBeNamed Tutorial data can be downloaded from: http://www.slicer.org/pages/Special:DataToBeNamed Disclaimer It is the responsibility of the user of 3DSlicer to comply with both the terms of the license and with the applicable laws, regulations and rules.

3. Response Evaluation Criteria in Solid Tumors (RECIST) Clinical relevance : (jeff) (get description from ron about meningioma case) Tutorial context : (jeff desc. how addresses clinical needs) -standard (RECIST) ways to evaluate response to treatment -tutorial walks thru how studies at two timepoints are analyzed -same study data is used in the ChangeTracker tutorial, for method comparison.

4. Learning objective Following this tutorial, you’ll be able to use 3D Slicer to: Load a MRML Scene file, Visually assess the response to therapy, Make quantitative linear measurements across tumor cross sections, and Make quantitative volume measurements of tumor anatomy.

5. Response Evaluation Criteria in Solid Tumors (RECIST) Description of Tutorial Data: This tutorial was tested on Axial 3D SPGR T1 post Gadolinium scans (Voxel dimension: 0.94mm x 0.94mm x 1.20mm, FOV: 240mm, Matrix: 256 x 256) MR Scan 1 + tumor label map MR Scan 2 + tumor label map

6. Workflow Overview 1.Load two post-treatment datasets 2.Adjust display of both studies in Slicer’s Volumes Module 3.Switch Layouts (to Axial (Red) Slice Layout) 4.Compare opposing diameters of largest tumor cross section using fiducial markers. 5.Compare volumetric measures of tumor using label map statistics. Workflow for linear and volumetric measurements

7. The Graphical User Interface (GUI) of Slicer3 integrates five components: the Menu Toolbar the Module GUI Panel the 3D Viewer the Slice Viewer the Slice and 3D View Controller Slice Viewer 3DViewer Module GUI Panel Slice and 3D View Controller Menu Toolbar Quick overview of Slicer3 GUI

8. Select File  Load Scene in the Main Menu. Load the file RECIST- Tutorial-Scene.mrml Loading data using a MRML scene file Update with new screenshots!!!!

9. fyi: What is “MRML”? MRML (pronounced mur-muhl) stands for the "Medical Reality Markup Language"; and is an XML-based representation of a MRML Scene. MRML Scene description is the XML-based file (with extension.mrml) that contains the complete MRML Scene specification, and which references all datasets present in the MRML Scene. MRML Scene is the collection of datasets and their current state, viewing parameters, semantic descriptions, and algorithm parameterization.

10. Loading data Post-TX T1 shown in “Four-up” Layout (Axial, Saggital, Coronal, & 3D Views) Stuart: for testing using these draft slides, substitute: For PreTreatment_T1 use 2006-sprg.nrrd For PostTreatment_T1 use 2007-sprg.nrrd

11. Displaying data Volumes Module GUIPre-TX study Post-TX study

12. Changing layouts

13. Linear measurement Fiducials Module: Create Fiducial List Create two fiducials Click & drag fiducials to endpoints of longest diameter Record distance readout Linear Measurement: D1 pre =48.7073mm

14. Linear measurement Fiducials Module: Click & drag fiducials to endpoints of orthogonal diameter Record distance readout Linear Measurement: D2 pre =48.6839 mm

15. Linear measurement Or: Make only Axial Slice visible in 3D Viewer Select Four-Up Layout Use Measurements Module to turn on Ruler Widget; click & drag line & endpoints. (Currently being extended to work in Slice Viewers too)

16. Linear measurement Linear Measurement on Post-TX volume: D1 post =26.123mm

17. Linear measurement Linear Measurement on Post-TX volume: D2 post =17.8873mm

18. VOI comparison Skip the editor: Use 2006-spgr-label And 2007-spgr-label

19. VOI comparison Statistics Module: Specify: Pre-TX Volume Label Map Apply Save output to file Volume Measurement: V pre = 7877.268 mm 3 (computed for single slice)

20. VOI comparison Similar workflow applied to Post-TX volume: Volume Measurement: V post = 38.192 mm 3 (computed for single slice)

21. Final volumetric comparisons Change in Tumor metrics: Post-TX Pre-TX VD2D1 38.192 mm 3 7877.268 mm 3 17.8873mm26.123mm 48.6839 mm 48.7073mm

22. Summary Summary of activity: Used interactive interface to load a scene Performed a workflow to make quantitative measures of tumor response to therapy --linear measurements --volume measurements

23. Acknowledgments Harvard Clinical and Translational Science Center National Alliance for Medical Image Computing NIH U54EB005149 add nac, ncigt and spl acknowledgements