Pediatric Non-Hodgkin Lymphoma (NHL), a type of lymph node cancer, is the fourth most common tumor in children and adolescents. Radiological examinations, alongside invasive diagnostics like biopsies, lumbar punctures, and bone marrow aspirations, play a crucial role in diagnosing and monitoring responses to treatment in pediatric NHL. However, radiological methods for pediatric NHL lack standardization; there is no established reference evaluation.

The RACOON-RESCUE project aims to address this gap by bringing together researchers in pediatric radiology and oncology from all German university hospitals. The goal is to systematically collect and analyze existing imaging data to improve radiological staging, assess treatment response, and refine follow-up care for pediatric NHL patients.

In the RACOON-RESCUE project, researchers from pediatric radiology and pediatric oncology departments across all German university hospitals aim to systematically collect and analyze existing imaging data. Their goal is to improve radiological staging, assess patient responses to treatment, and enhance follow-up care.

We spoke with the project leads, Prof. Dr. Diane Renz and Prof. Dr. Wilhelm Wößmann, to learn more about the initiative.

What new approaches are you pursuing to improve the diagnosis of pediatric NHL, and what challenges need to be overcome?

Renz: RACOON-RESCUE is a multi-center tandem project involving pediatric oncology and (pediatric) radiology departments from all German university hospitals. The diagnosis of NHL in children and adolescents is being enhanced within the RACOON-RESCUE framework by creating a unique, representative, and multimodal dataset that can be used to develop predictive models for therapy response. This dataset combines clinical data and imaging data. Clinical data from NHL patients are sourced from the NHL-Berlin-Frankfurt-Münster (BFM) registry and paired with corresponding imaging data from local university hospitals. These are then analyzed and evaluated using artificial intelligence (AI) methods. The focus is on developing a standardized workflow, including segmentation techniques, to extract organs and identify pathologies. At the same time, structured reporting is being established as a standardized radiological reporting format. One of RESCUE's objectives is to generate qualitative and quantitative imaging biomarkers and use these, along with other imaging parameters, to develop predictive models for therapy response, ultimately improving care for NHL patients.

Wößmann: One significant challenge in the RACOON-RESCUE project, aside from the varying ethical and legal frameworks at the individual project sites, is ensuring the data protection-compliant processing of imaging and registry data both within and between locations, as well as within the overarching analysis platform, RACOON-CENTRAL. This challenge is being addressed through a multi-stage de-identification process, developed as part of a detailed data protection concept in collaboration with the data protection officer at the MHH. This process ensures the secure and compliant handling of patient data.

How does the RACOON-RESCUE project contribute to improving clinical practice, and what role do the NHL-Berlin-Frankfurt-Münster registry and artificial intelligence play?

Wößmann: RACOON-RESCUE enhances clinical practice by optimizing the diagnosis of NHL patients in children and adolescents, such as through improved initial staging. The NHL-BFM registry contains clinical and biological data about therapies and their responses in pediatric NHL patients. These data are de-identified and combined with corresponding imaging data from local university hospitals into a unified database, allowing AI methods to extract image-based biomarkers. RESCUE establishes the foundation for standardized radiological reporting and an automated image analysis workflow in the radiological diagnostics of pediatric NHL patients. For instance, the automated workflow includes segmentations to detect pathologies, such as tumors. Standardized reporting templates can serve as references for radiologists. RESCUE’s findings aim to facilitate the development of optimized and individualized diagnostic and risk-adapted therapeutic strategies. Moreover, the regulatory framework established by RACOON is being expanded to support future projects with similar data processing requirements, independent of specific diseases. This could make RESCUE a significant benefit for other cancer patients as well.

To what extent does the existing RACOON infrastructure support the project?

Renz: University hospitals already participating in RACOON and having an established regulatory framework are also involved in RACOON-RESCUE. Additionally, the RESCUE project utilizes network infrastructures developed within RACOON. These include hardware nodes (RACOON-NODES) implemented at each university hospital and the cloud-based central analysis platform RACOON-CENTRAL. Furthermore, the support of RACOON infrastructure IT specialists is essential. Their assistance with uploading imaging data from the individual sites makes a crucial contribution to the success of RACOON-RESCUE.

RACOON-RESCUE Study Leadership:

Prof. Dr. Diane Renz is a specialist in radiology with a focus on pediatric and adolescent radiology. She heads the Pediatric Radiology division at the Institute for Diagnostic and Interventional Radiology at Hannover Medical School (MHH). In addition, Prof. Renz serves as Vice President of the Society for Pediatric Radiology.

Prof. Dr. Wilhelm Wößmann is a pediatrician specializing in pediatric hematology and oncology. He is Deputy Director of the Clinic for Pediatric Hematology and Oncology at the University Medical Center Hamburg-Eppendorf. Together with Prof. Burkhardt (Münster), Prof. Wößmann also co-leads the NHL-BFM Study Group.

Additional Members of the “RACOON Rangers” in RACOON-RESCUE:

• Dr. Ann-Katrin Heymann: Research Associate/Project Manager in the Pediatric Radiology division at the Institute for Diagnostic and Interventional Radiology, MHH.
• Dr. Fabian Knörr: Specialist in Pediatrics at the Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf.
• M. Benedikt Krüger: Resident in the Institute for Diagnostic and Interventional Radiology, MHH.
• Marcel Eicke: Research Associate/IT Specialist at the Institute for Diagnostic and Interventional Radiology, MHH.
• Konrad Wienecke: Research Associate/IT Specialist in the Pediatric Radiology division at the Institute for Diagnostic and Interventional Radiology, MHH.

The RACOON-RESCUE Project is coordinated by the Institute for Diagnostic and Interventional Radiology at MHH in collaboration with the Clinic for Pediatric Hematology and Oncology at the University Medical Center Hamburg-Eppendorf. Participants include all German university hospitals within the University Medicine Network (NUM), the German Cancer Research Center (DKFZ) in Heidelberg, and three technical partners, including Mint Medical GmbH.