Therefore, we either work with “old validated” technology that may be less effective or put patients potentially at risk with newer unvalidated technology. By the time we have consummated the ideal trials, the technology has moved on again. Meanwhile, the complexity of medical imaging technologies has continued to accelerate, outpacing our ability to assess them and optimize their design and clinical use. Most current approaches to assess imaging technologies outside of clinical trials rely on simplistic physical phantoms, the results from which cannot readily predict clinical efficacy. Doing so through clinical trials (experiments using human subjects) is often not practical or definitive due to ethical limitations, expense, time requirements, difficulty in accruing enough subjects, or a fundamental lack of ground truth (knowledge of the exact anatomy and condition of the patient). However, the design and implementation of new imaging technology is incredibly complex. Medical imaging involves some of the most beneficial and advanced technologies used in medicine today. We also highlight some of the applications of VCTs across various imaging modalities.
We review the core components of a VCT: computational phantoms, simulators of different imaging modalities, and interpretation models. We summarize the major developments and current status of the field of VCTs in medical imaging. The field of VCTs has been constantly advanced over the past decades in multiple areas. They do so by simulating the patients, imaging systems, and interpreters. Virtual clinical trials (VCTs) (also known as in silico imaging trials or virtual imaging trials) offer an alternative means to efficiently evaluate medical imaging technologies virtually. These experiments, however, are often not practical due to ethical limitations, expense, time requirements, or lack of ground truth. Evaluations would ideally be done using clinical imaging trials. This is a significant and increasing challenge for both scientific investigations and clinical applications. The accelerating complexity and variety of medical imaging devices and methods have outpaced the ability to evaluate and optimize their design and clinical use.
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