This article was originally written for publication during ECR 2020 in March 2020 on the occasion of a planned ‘Advanced Course on AI’ session ‘Making visible the invisible: pushing the boundaries in multimodality radiomic quantification’ and updated in June 2020.

Prof. Nandita deSouza from the Institute of Cancer Research, London, is Chair of the European Imaging Biomarkers Alliance (EIBALL) Subcommittee.

Under the leadership of Prof. Nandita deSouza from the Institute of Cancer Research, London, the European Imaging Biomarkers Alliance (EIBALL) Subcommittee adopted the mission statement: ‘To facilitate imaging biomarker development and standardisation and promote their use in clinical trials and in clinical practice by collaboration with specialist societies, international standards agencies and trials organisations to develop a network of excellence’.

This statement “embodies the goals of EIBALL and helps direct [the Subcommittee’s] future plans,” noted Prof. deSouza.

One of EIBALL’s primary objectives is getting more biomarkers into clinical trials. To encourage this, in 2019, the EIBALL Subcommittee worked closely with other specialist societies to develop an online ‘inventory’ of biomarkers that can be accessed by clinicians and imagers to inform them about biomarkers currently available, their effectiveness, their appropriateness for particular trials, and how to use them:

This inventory is the first step in realising EIBALL’s two-year roadmap of: i) establishing a functional biomarker profile that is current and relevant; ii) enabling clinical use of biomarkers by setting standards for data acquisition and image processing; iii) education on appropriate use of functional imaging biomarkers and their interpretation.

In relation to pillar one, the EIBALL Subcommittee also produced an article on imaging biomarkers, titled ‘Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL Subcommittee of the European Society of Radiology (ESR), which was published in Insights into Imaging in August 2019. This article reviews current evidence for the use of quantitative biomarkers in clinical settings at various stages of the disease pathway, including diagnosis, prognosis and treatment response. It suggests that the observer-driven pattern recognition that is standard in the interpretation of medical images ought, increasingly, to be supplemented by “quantitative biomarkers that inform on disease detection, characterisation and assessment of response to treatment [that] will achieve quantitative and objective decision-support tools in the patients’ management pathway”.

However, quantitation remains a challenge: semi-quantitative scoring systems have been developed to overcome this, but “the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis and, crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome”. On this basis, the article makes recommendations for employing imaging objectively to drive patient management decisions.

In relation to pillar two, Dr. Alberich-Bayarri, of La Fe Health Research Institute, Valencia, has submitted a position paper on the validation of imaging biomarkers for Insights into Imaging. This article will be published shortly.

Prof. Laure Fournier, of Hôpital Européen Georges Pompidou, Paris, worked on taking forward pillar three in 2019, with a hands-on biomarkers workshop being held in Vienna in November in conjunction with the European School of Radiology (ESOR). The workshop received extremely positive feedback so keep your eyes open for the next edition of the course!