DOUGLAS GREEN, MD

READING ROOM WITH A VIEW

Do We Need a Radiology Zoo? There already exists a Galaxy Zoo. Maybe we need a Radiology Zoo, too. The Galaxy Zoo was born at a pub in Oxford in 2007 [1]. Two physicists wrestling with how to classify the 930,000 galaxies in the Sloan Digital Sky Survey came up with Galaxy Zoo, a website where interested amateurs could help out. After an online tutorial, amateurs were ready to classify galaxies by whether they were elliptical or spiral, the directions in which their arms spiraled, and other particulars. The volunteers’ results closely matched those of professional astronomers. When they were let loose on all 930,000 galaxies, the volunteers classified them in a small fraction of the time it would have taken the two physicists. Galaxy Zoo is a “collective intelligence platform,” a digital space where volunteers can help solve a challenging problem [2]. This kind of platform is often associated with an “affinity space,” a digital community where people with a shared interest post ideas and ask questions. The Galaxy Zoo volunteers made discoveries that led to peer-reviewed publications [3]. The volunteers’ reward was their own satisfaction and pride in contributing to important science, as well as a strengthened sense of community in the affinity space. Clear scientific importance is a requirement if researchers expect enthusiastic and dedicated help on their collective intelligence projects. Also needed are good instructional tools [4], which can be taped lectures, documents, or even direct communication with experts. Could collective intelligence platforms help with radiology research? Probably. Consider the example of the National Lung Screening Trial, in which 75,126 thoracic CT scans were performed over 3 rounds of screening, with positive results (a

noncalcified nodule 4 mm in diameter or other abnormalities that were suspicious for lung cancer) in 18,146 scans [5]. Radiologists reviewed CT scans and characterized lung nodules larger than the 4-mm threshold by location, size, margin (spiculated, smooth, poorly defined, indeterminate), and attenuation (soft tissue, ground glass, mixed, fluid or water, fat) [6]. The National Lung Screening Trial required large amounts of time from highly paid medical professionals. Given the high monetary and political stakes, the participation of radiologists was essential. However, with modern technology, such as maximum-intensity projection images to facilitate nodule detection and clear instructions on nodule characterization, one wonders whether nonmedical amateurs might have been able to analyze the thousands of nodules in this Radiology Zoo at a fraction of the cost. The importance of the scientific question at the heart of this Radiology Zoo was clear and compelling: we needed to know if early detection could reduce cancer mortality. Volunteers for future Radiology Zoos on this same issue could be recruited from a pool of citizen stakeholders: heavy smokers, cancer patients, or family members of cancer victims. Volunteers might be engaged by educational material posted on an affinity space, where discussion threads might range from smoking cessation to regional variation in incidence of fungal granulomas. The success of the Galaxy Zoo project depended on access to images from the Sloan Digital Sky Survey. Open access to medical images would be needed for a Radiology Zoo, and of course, HIPAA requirements for privacy would have to be addressed. Not every question can be addressed with collective intelligence;

networked volunteers are not going to come up with a unified field theory for physics, but they crunched through 930,000 galaxies, and they might put a dent in a work list of 75,126 thoracic CT scans. Tech pundit Clay Shirky calls this force of amateur volunteers the “cognitive surplus” and estimates that the networked public has 1 trillion hours of free time at its disposal every year [7]. The challenge for medical scientists, radiologists included, is to harness this force with compelling and well-designed projects. Coming soon to a Zoo near you?

ACKNOWLEDGMENT The author would like to acknowledge David Godwin, MD, for his help with manuscript review.

REFERENCES 1. Nielsen M. Reinventing discovery: the new era of networked science. Princeton, New Jersey: Princeton University Press; 2012. 2. Gee JP. Feature: games and impact. February 12, 2013. Available at: http://www.astd.org/ Publications/Newsletters/LX-Briefing/LXBArchives/2013/02/Feature-Games-and-Impact. Accessed August 26, 2013. 3. Galaxy Zoo. The story so far. Available at: http:// www.galaxyzoo.org/#/story. Accessed May 5, 2012. 4. Gee JP. What video games have to teach us about learning and literacy. Presented at: ASU/ GSV Education Innovation Summit; 2012. Available at: http://vimeo.com/channels/3 90827/40633166. Accessed June 21, 2013. 5. The National Lung Cancer Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409. 6. Aberle DR, Berg CD, Black WC, et al. The National Lung Screening Trial: overview and study design. Radiology 2011;258:243-53. 7. Shirky C. How cognitive surplus will change the world. TED. June 2010. Available at: http://www.ted.com/talks/clay_shirky_how_ cognitive_surplus_will_change_the_world. html. Accessed August 26, 2013.

Douglas Green, MD, University of Washington, Department of Radiology, 1959 NE Pacific Street, Seattle, WA 98195-0001; e-mail: [email protected]. 84

ª 2014 American College of Radiology 1546-1440/13/$36.00  http://dx.doi.org/10.1016/j.jacr.2013.08.007

Do we need a radiology zoo?

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