RECIST uses unidimensional measurements of the sum of the longest lesion diameters of target lesions. At our institution we use a commercially available software for RECIST analysis (mint Lesion?, Mint Medical GmbH, Heidelberg, Gemany), which will be discussed below. Software based follow-up Proper response assessment and reporting of metastatic lesions are crucial. A www.selleckchem.com/products/Oligomycin-A.html major pitfall in tumor response monitoring is the increasing incidence of mixed response to chemotheraphy and subjective measurements of the lesions, e.g., liver and lung metastases, also lesion measurements are time-consuming and can be investigator dependent. Computerized tools able to optimize the radiologist��s workflow of the image reading process are spreading as the need for a systematic, standardized follow-up procedure grows.

For example, the syngo? CT Oncology software (Siemens Healtcare, Erlangen, Germany) is able to perform automated measurement of neoplastic lesions helping to solve the long-standing issue of interobserver variability. Another automated tool is mint Lesion? (Mint Medical GmbH, Heidelberg, Gemany), developed at the German Cancer Research Center (Heidelberg, Germany) which is currently routinely used at our institution for oncological assessment. Connected with our Picture Archiving Computer System (PACS) the mint Lesion software is able to continually synchronize and upgrade its worklist retrieving and matching precedent patients�� related studies allowing a workflow optimization.

It covers management of patient cohorts in terms of disease and treatment, assessment of lesions with respect to the overall patient treatment course, statistical response evaluation in line with response criteria, and consistent and comprehensive automated reporting. In the initial baseline assessment target and non-target lesions are defined. In subsequent follow-up exams the software is able to correlate and match images of the previous studies allowing a faster recognition of previously described lesions; by showing exactly how quantitative measurements (i.e., volumetry, density and intensity) were performed in previous studies, interobserver variability is thus reduced. Apart from the reproducible measurements, assessment notes, treatment outcome statistics for patient cohorts and individual patients, mint Lesion? provides an automatically generated, consolidated visual and textual overview of a single treatment course (Figure (Figure6).6). Graphical charts help to identify the dimensions of tumor load change with respect to baseline, Brefeldin_A nadir and previous exams. Therapy course overview is clearly depicted in the results and can be sent as digital imaging and communications in medicine to the PACS as well as actively included in the report.