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Information about cancer stage in a patient is crucial when clinicians assess treatment progress. Determining cancer stage is a process that takes into account the description, location, characteristics and possible metastasis of cancerous tumors in a patient. It should follow classification standards, such as TNM Classification of Malignant Tumors. However, in clinical practice, the implementation of this process can be tedious and error-prone and create uncertainty. In order to alleviate these problems, we intend to assist radiologists by providing a second opinion in the evaluation of cancer stage in patients. For doing this, Semantic Web technologies, such as ontologies and reasoning, will be used to automatically classify cancer stages. This classification will use semantic annotations, made by radiologists (using the ePAD tool) and stored in the AIM format, and rules of an ontology representing the TNM standard. The whole process will be validated through a proof of concept with users from the Radiology Dept. of the Stanford University.

Quantitative and semantic information about medical images are vital parts of a radiological report. However, current image viewing systems do not record it in a format that permits machine interpretation. The ePAD tool can generate machine-computable image annotations on 2D images as part of a radiologist's routine workflow. The tool has been evaluated in image studies with good results. Since ePAD currently only provides 2D visualization and annotation of images, we developed a plugin to ePAD for the visualization of volumetric image datasets, using the three planes: axial, frontal and sagittal. A study with 6 radiologists was carried out to determine the best interface for also marking 3D ROIs. Video prototypes were created for 3 options: join pixels based on intensity similarity, detect borders around image features, and paint ROIs using a spheric 3D cursor. The 3D cursor was the preferred option. We present these results and also show the final 3D cursor implementation.