The largest military neuroimaging TBI study ever conducted—capturing and codifying 41,000-image MRI studies into structured, analysis-ready findings.
Established in 2010 at Walter Reed National Military Medical Center, the National Intrepid Center of Excellence (NICoE) advances the Military Health System’s understanding of “invisible wounds” from war, including TBI. NICoE partnered with QuesGen to handle the scale and complexity of neuroimaging—transforming large MRI image volumes into structured findings usable for both clinical care and research.
From the Principal Investigator“It was all about the data…and dealing with the large amounts of it we were acquiring… We had to somehow interpret and codify all that into something that was useful for our patients, and useful for our research.”— Dr. Gerard Riedy, PhD, MD (Chief of Neuroimaging, NICoE)
NICoE’s main imaging platform was an MRI exam that collected 41,000 images per patient study. The team needed a way to interpret and codify that volume into structured data—fast enough for radiologist workflows, and clean enough for research-grade analysis.
“The key was making it useful for both the research and the clinical interpretation of the results. It was a truly collaborative process.”— Dr. Gerard Riedy, PhD, MDWhat QuesGen builtStructured findings captureEasy entry, validation, search, and reporting for imaging findings.Adjudication modelTwo independent reads + a third adjudicator workflow.Expanded CDEsBuilt from NINDS CDEs; expanded for chronic-mild military TBI.Radiologist efficiencyStreamlined workflow and reduced time spent on reporting.This work forms the foundation of QuesGen’s current neuroimaging platform.
Neuroimaging studies face the challenge of consistent reads across radiologists. NICoE’s protocol required each imaging set to be read by two independent radiologists and adjudicated by a third. QuesGen implemented a comparison system that visually presented matching and mismatching findings to reduce adjudication effort and improve data reliability.
“By creating a user-friendly adjudication model, QuesGen helped us define study standards that are critical to research on this scale.”— Dr. Gerard Riedy, PhD, MD
With a study of this magnitude, it was imperative that everyone defined imaging findings the same way. QuesGen created an easy-to-use system based on an expanded set of Common Data Elements (CDEs), starting with NINDS neuroimaging CDEs (24 finding types) and expanding to fit NICoE’s chronic-mild TBI population (+14 additional finding types). The final model defined 38 finding types and 891 data points.
“Because of what QuesGen set up for us, we can really detect patterns and sub-types of TBI and how patients respond to treatment.”— Dr. Gerard Riedy, PhD, MDStreamlined for radiologistsRadiologists typically produce long narrative write-ups. QuesGen observed the real workflow, then streamlined data entry into structured CDE-based capture—expediting evaluation, capture, analysis, and communication of findings.
Searchable dataQuickly assess counts/patterns across cohorts and findings.Clean presentationStructured outputs make analysis and clinical review faster.Example benefits described: quickly compare how many subjects have a given finding (e.g., midline shift, hemorrhage) and other patterns.
The study’s strength is objectivity: structured imaging patterns can help determine treatment paths and support new treatments. NICoE’s advanced imaging is intended to help objectively determine who has TBI and who doesn’t, improving outcomes for patients and families.
“I believe the answers are in the data, and QuesGen played a big part in allowing us to effectively capture and efficiently analyze this game-changing data.”— Dr. Gerard Riedy, PhD, MD
Whether you’re running a multi-site study, building a population health program, or enabling person-centered care, QuesGen delivers planning, tracking, and outcomes measurement on one coherent platform.