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Sujit SJ, Aminu M, Karpinets TV, Chen P, Saad MB, Salehjahromi M, Boom JD, Qayati M, George JM, Allen H, Antonoff MB, Hong L, Hu X, Heeke S, Tran HT, Le X, Elamin YY, Altan M, Vokes NI, Sheshadri A, Lin J, Zhang J, Lu Y, Behrens C, Godoy MCB, Wu CC, Chang JY, Chung C, Jaffray DA, Wistuba II, Lee JJ, Vaporciyan AA, Gibbons DL, Heymach J, Zhang J, Cascone T, Wu J. Enhancing NSCLC recurrence prediction with PET/CT habitat imaging, ctDNA, and integrative radiogenomics-blood insights. Nat Commun 2024; 15:3152. [PMID: 38605064 PMCID: PMC11009351 DOI: 10.1038/s41467-024-47512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
While we recognize the prognostic importance of clinicopathological measures and circulating tumor DNA (ctDNA), the independent contribution of quantitative image markers to prognosis in non-small cell lung cancer (NSCLC) remains underexplored. In our multi-institutional study of 394 NSCLC patients, we utilize pre-treatment computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to establish a habitat imaging framework for assessing regional heterogeneity within individual tumors. This framework identifies three PET/CT subtypes, which maintain prognostic value after adjusting for clinicopathologic risk factors including tumor volume. Additionally, these subtypes complement ctDNA in predicting disease recurrence. Radiogenomics analysis unveil the molecular underpinnings of these imaging subtypes, highlighting downregulation in interferon alpha and gamma pathways in the high-risk subtype. In summary, our study demonstrates that these habitat imaging subtypes effectively stratify NSCLC patients based on their risk levels for disease recurrence after initial curative surgery or radiotherapy, providing valuable insights for personalized treatment approaches.
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Affiliation(s)
- Sheeba J Sujit
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatiana V Karpinets
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maliazurina B Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morteza Salehjahromi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John D Boom
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Mohamed Qayati
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James M George
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Haley Allen
- Natural Sciences, Rice University, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lingzhi Hong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Hu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simon Heeke
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hai T Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie Lin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Lu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Behrens
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David A Jaffray
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Lung Cancer Genomics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Lung Cancer Interception Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Salehjahromi M, Karpinets TV, Sujit SJ, Qayati M, Chen P, Aminu M, Saad MB, Bandyopadhyay R, Hong L, Sheshadri A, Lin J, Antonoff MB, Sepesi B, Ostrin EJ, Toumazis I, Huang P, Cheng C, Cascone T, Vokes NI, Behrens C, Siewerdsen JH, Hazle JD, Chang JY, Zhang J, Lu Y, Godoy MCB, Chung C, Jaffray D, Wistuba I, Lee JJ, Vaporciyan AA, Gibbons DL, Gladish G, Heymach JV, Wu CC, Zhang J, Wu J. Synthetic PET from CT improves diagnosis and prognosis for lung cancer: Proof of concept. Cell Rep Med 2024; 5:101463. [PMID: 38471502 PMCID: PMC10983039 DOI: 10.1016/j.xcrm.2024.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/07/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
[18F]Fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) are indispensable components in modern medicine. Although PET can provide additional diagnostic value, it is costly and not universally accessible, particularly in low-income countries. To bridge this gap, we have developed a conditional generative adversarial network pipeline that can produce FDG-PET from diagnostic CT scans based on multi-center multi-modal lung cancer datasets (n = 1,478). Synthetic PET images are validated across imaging, biological, and clinical aspects. Radiologists confirm comparable imaging quality and tumor contrast between synthetic and actual PET scans. Radiogenomics analysis further proves that the dysregulated cancer hallmark pathways of synthetic PET are consistent with actual PET. We also demonstrate the clinical values of synthetic PET in improving lung cancer diagnosis, staging, risk prediction, and prognosis. Taken together, this proof-of-concept study testifies to the feasibility of applying deep learning to obtain high-fidelity PET translated from CT.
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Affiliation(s)
| | | | - Sheeba J Sujit
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Qayati
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Maliazurina B Saad
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lingzhi Hong
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - Julie Lin
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin J Ostrin
- Department of General Internal Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Iakovos Toumazis
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
| | - Peng Huang
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Chao Cheng
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Behrens
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - John D Hazle
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Lu
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C B Godoy
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David Jaffray
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Gladish
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA; Lung Cancer Genomics Program, MD Anderson Cancer Center, Houston, TX, USA; Lung Cancer Interception Program, MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Wu
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA.
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3
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Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. J Am Coll Radiol 2024; 21:473-488. [PMID: 37820837 DOI: 10.1016/j.jacr.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
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Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
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4
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Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. Chest 2024; 165:738-753. [PMID: 38300206 DOI: 10.1016/j.chest.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
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Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
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Martin MD, Henry TS, Berry MF, Johnson GB, Kelly AM, Ko JP, Kuzniewski CT, Lee E, Maldonado F, Morris MF, Munden RF, Raptis CA, Shim K, Sirajuddin A, Small W, Tong BC, Wu CC, Donnelly EF. ACR Appropriateness Criteria® Incidentally Detected Indeterminate Pulmonary Nodule. J Am Coll Radiol 2023; 20:S455-S470. [PMID: 38040464 DOI: 10.1016/j.jacr.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Incidental pulmonary nodules are common. Although the majority are benign, most are indeterminate for malignancy when first encountered making their management challenging. CT remains the primary imaging modality to first characterize and follow-up incidental lung nodules. This document reviews available literature on various imaging modalities and summarizes management of indeterminate pulmonary nodules detected incidentally. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | | | - Mark F Berry
- Stanford University Medical Center, Stanford, California; Society of Thoracic Surgeons
| | - Geoffrey B Johnson
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Jane P Ko
- New York University Langone Health, New York, New York; IF Committee
| | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Reginald F Munden
- Medical University of South Carolina, Charleston, South Carolina; IF Committee
| | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | | | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin F Donnelly
- Specialty Chair, Ohio State University Wexner Medical Center, Columbus, Ohio
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Font C, Gomez-Mesa JE, López-Núñez JJ, Calderón C, Galindo-Coral S, Wu CC, Ma J, Kroll MH, Rojas-Hernandez CM. Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study. Support Care Cancer 2023; 31:615. [PMID: 37801086 DOI: 10.1007/s00520-023-08073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Therapy for cancer-associated venous thromboembolism (VTE) includes long-term anticoagulation, which may have substantial impact on the health-related quality of life (HRQL) of patients. We assessed patient-reported outcomes to characterize the HRQL associated with VTE treatment and to begin to examine those HRQL elements impacting anticoagulation adherence (AA). METHODS Participants were adult cancer patients with confirmed symptomatic acute lower extremity deep venous thrombosis. Patients were excluded if there was an indication for anticoagulation other than VTE, ECOG performance status >3, or life expectancy < 3 months. Participants were assessed with a self-reported adherence tool. HRQL was measured with a 6-domain questionnaire using a seven-point Likert scale. Evaluations were performed at 30 days and 3 months after enrollment. For the primary objective, an overall adherence rate was calculated at each time point of evaluation. For the HRQL domains, non-parametric testing was used to compare results between subgroups. RESULTS Seventy-four patients were enrolled. AA and HRQL at 30 days and 3 months were assessed in 50 and 36 participants, respectively. At 30 days the AA rate was 90%, and at 3 months it was 83%. In regard to HRQL, patients suffered frequent and moderate-severe distress in the domains of emotional and physical symptoms, sleep disturbance, and limitations to physical activity. An association between emotional or physical distress and AA was observed. CONCLUSION Patients with VTE suffer a substantial impairment of their HRQL. Increased emotional distress correlated with better long-term AA. These results can be used to inform additional research aimed at developing novel strategies to improve AA.
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Affiliation(s)
- Carme Font
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Esteban Gomez-Mesa
- Departamento de Cardiología, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan J López-Núñez
- Hospital Germans i Trias Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Junsheng Ma
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Kroll
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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de Groot PM, Jimenez CA, Godoy MCB, Wu CC. Pleural Effusions: Clues for Diagnosis and Characterization. Semin Roentgenol 2023; 58:431-439. [PMID: 37973272 DOI: 10.1053/j.ro.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Patricia M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Kokossis D, Wei HJ, Gallitto M, Yoh N, McQuillan N, Tazhibi M, Berg X, Zhang X, Szalontay L, Gartrell R, Jovana P, Zhang Z, Molotkov A, Mintz A, Konofagou EE, Wu CC. Focused Ultrasound for Blood-Brain Barrier Opening and Delivery of Anti-PD1 in Diffuse Midline Gliomas. Int J Radiat Oncol Biol Phys 2023; 117:e523-e524. [PMID: 37785629 DOI: 10.1016/j.ijrobp.2023.06.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Diffuse midline glioma with H3K27 mutation is a fatal pediatric brain tumor, most commonly arising in the brainstem. This tumor remains universally fatal, despite a multitude of clinical trials, with a median overall survival of only 9-12 months. While immune-checkpoint inhibitors (ICIs) have transformed the treatment landscape of multiple solid tumors, delivery past the blood brain barrier (BBB) remains challenging. Programmed cell death protein 1 (PD1) is an immune checkpoint protein expressed on the surface of activated T cells; interaction with its ligand, PDL1, is tumor-protective, dampening T cell response. Recent phase I clinical trials have shown that ICIs targeting proteins along the PD1/PDL1 axis are well tolerated in patients with DMG; however, efficacy remains low. The blood-brain barrier (BBB) poses a major challenge to the efficacious delivery of therapeutic agents with large molecular size, such as anti-PD1. We hypothesize that BBB opening (BBBO) using focused ultrasound (FUS), a form of non-ionizing acoustic radiation, can enhance delivery and efficacy of anti-PD1 for treatment of DMG. MATERIALS/METHODS We established a syngeneic mouse DMG model with intracranial injection of cell line 4423 (PDGFB+, H3.3K27M, p53-/-). Magnetic resonance imaging (MRI) was utilized to evaluate BBBO and tumor progression. We measured delivery of anti-PD1 after BBBO using Western Blot and 3D in vivo optical fluorescent imaging/CT (OI/CT) of Cy7 labeled anti-PD1. RESULTS We demonstrate that delivery of anti-PD1 can be enhanced over 3.5-fold after reversible BBBO with FUS and concurrent microbubble administration. OI/CT revealed enhanced real-time antibody distribution peritumorally. Furthermore, we demonstrate that combined treatment of FUS and anti-PD1 led to benefit in local control of tumor growth using volumetric analysis of MRI. Preliminary survival studies suggest a positive trend for overall survival. CONCLUSION Our results support that FUS-mediated BBBO can increase treatment efficacy of anti-PD1 in a DMG murine model, due to improved targeted delivery to the tumoral region after systemic antibody administration. We consider these findings strong rationale for further investigation of the therapeutic effects of combinatorial treatment using FUS-mediated BBBO and ICIs for the treatment of DMG.
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Affiliation(s)
- D Kokossis
- Columbia University Irving Medical Center, New York, NY
| | - H J Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - M Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - N Yoh
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY
| | - N McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | | | - X Berg
- Columbia University Irving Medical Center, New York, NY
| | - X Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - L Szalontay
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York, NY
| | - R Gartrell
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York, NY
| | - P Jovana
- Columbia University Irving Medical Center, New York, NY
| | - Z Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - A Molotkov
- Columbia University Irving Medical Center, New York, NY
| | - A Mintz
- Columbia University Irving Medical Center, New York, NY
| | - E E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - C C Wu
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
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9
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Al-Tashi Q, Saad MB, Sheshadri A, Wu CC, Chang JY, Al-Lazikani B, Gibbons C, Vokes NI, Zhang J, Lee JJ, Heymach JV, Jaffray D, Mirjalili S, Wu J. SwarmDeepSurv: swarm intelligence advances deep survival network for prognostic radiomics signatures in four solid cancers. Patterns (N Y) 2023; 4:100777. [PMID: 37602223 PMCID: PMC10435962 DOI: 10.1016/j.patter.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/18/2023] [Accepted: 05/26/2023] [Indexed: 08/22/2023]
Abstract
Survival models exist to study relationships between biomarkers and treatment effects. Deep learning-powered survival models supersede the classical Cox proportional hazards (CoxPH) model, but substantial performance drops were observed on high-dimensional features because of irrelevant/redundant information. To fill this gap, we proposed SwarmDeepSurv by integrating swarm intelligence algorithms with the deep survival model. Furthermore, four objective functions were designed to optimize prognostic prediction while regularizing selected feature numbers. When testing on multicenter sets (n = 1,058) of four different cancer types, SwarmDeepSurv was less prone to overfitting and achieved optimal patient risk stratification compared with popular survival modeling algorithms. Strikingly, SwarmDeepSurv selected different features compared with classical feature selection algorithms, including the least absolute shrinkage and selection operator (LASSO), with nearly no feature overlapping across these models. Taken together, SwarmDeepSurv offers an alternative approach to model relationships between radiomics features and survival endpoints, which can further extend to study other input data types including genomics.
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Affiliation(s)
- Qasem Al-Tashi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Maliazurina B. Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Carol C. Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bissan Al-Lazikani
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christopher Gibbons
- Section of Patient-Centered Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Natalie I. Vokes
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - John V. Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David Jaffray
- Office of the Chief Technology and Digital Officer, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Seyedali Mirjalili
- Centre for Artificial Intelligence Research and Optimization, Torrens University Australia, Fortitude Valley, Brisbane, QLD 4006, Australia
- Yonsei Frontier Lab, Yonsei University, Seoul 03722, Korea
- University Research and Innovation Center, Obuda University, 1034 Budapest, Hungary
| | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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10
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Saad MB, Hong L, Aminu M, Vokes NI, Chen P, Salehjahromi M, Qin K, Sujit SJ, Lu X, Young E, Al-Tashi Q, Qureshi R, Wu CC, Carter BW, Lin SH, Lee PP, Gandhi S, Chang JY, Li R, Gensheimer MF, Wakelee HA, Neal JW, Lee HS, Cheng C, Velcheti V, Lou Y, Petranovic M, Rinsurongkawong W, Le X, Rinsurongkawong V, Spelman A, Elamin YY, Negrao MV, Skoulidis F, Gay CM, Cascone T, Antonoff MB, Sepesi B, Lewis J, Wistuba II, Hazle JD, Chung C, Jaffray D, Gibbons DL, Vaporciyan A, Lee JJ, Heymach JV, Zhang J, Wu J. Predicting benefit from immune checkpoint inhibitors in patients with non-small-cell lung cancer by CT-based ensemble deep learning: a retrospective study. Lancet Digit Health 2023; 5:e404-e420. [PMID: 37268451 PMCID: PMC10330920 DOI: 10.1016/s2589-7500(23)00082-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/28/2023] [Accepted: 04/04/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Only around 20-30% of patients with non-small-cell lung cancer (NCSLC) have durable benefit from immune-checkpoint inhibitors. Although tissue-based biomarkers (eg, PD-L1) are limited by suboptimal performance, tissue availability, and tumour heterogeneity, radiographic images might holistically capture the underlying cancer biology. We aimed to investigate the application of deep learning on chest CT scans to derive an imaging signature of response to immune checkpoint inhibitors and evaluate its added value in the clinical context. METHODS In this retrospective modelling study, 976 patients with metastatic, EGFR/ALK negative NSCLC treated with immune checkpoint inhibitors at MD Anderson and Stanford were enrolled from Jan 1, 2014, to Feb 29, 2020. We built and tested an ensemble deep learning model on pretreatment CTs (Deep-CT) to predict overall survival and progression-free survival after treatment with immune checkpoint inhibitors. We also evaluated the added predictive value of the Deep-CT model in the context of existing clinicopathological and radiological metrics. FINDINGS Our Deep-CT model demonstrated robust stratification of patient survival of the MD Anderson testing set, which was validated in the external Stanford set. The performance of the Deep-CT model remained significant on subgroup analyses stratified by PD-L1, histology, age, sex, and race. In univariate analysis, Deep-CT outperformed the conventional risk factors, including histology, smoking status, and PD-L1 expression, and remained an independent predictor after multivariate adjustment. Integrating the Deep-CT model with conventional risk factors demonstrated significantly improved prediction performance, with overall survival C-index increases from 0·70 (clinical model) to 0·75 (composite model) during testing. On the other hand, the deep learning risk scores correlated with some radiomics features, but radiomics alone could not reach the performance level of deep learning, indicating that the deep learning model effectively captured additional imaging patterns beyond known radiomics features. INTERPRETATION This proof-of-concept study shows that automated profiling of radiographic scans through deep learning can provide orthogonal information independent of existing clinicopathological biomarkers, bringing the goal of precision immunotherapy for patients with NSCLC closer. FUNDING National Institutes of Health, Mark Foundation Damon Runyon Foundation Physician Scientist Award, MD Anderson Strategic Initiative Development Program, MD Anderson Lung Moon Shot Program, Andrea Mugnaini, and Edward L C Smith.
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Affiliation(s)
- Maliazurina B Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lingzhi Hong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morteza Salehjahromi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kang Qin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheeba J Sujit
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuetao Lu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elliana Young
- Department of Enterprise Data Engineering and Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qasem Al-Tashi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rizwan Qureshi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Percy P Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, CA, USA
| | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA
| | - Hyun-Sung Lee
- Systems Onco-Immunology Laboratory, David J Sugarbaker Division of Thoracic Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Chao Cheng
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Vamsidhar Velcheti
- Department of Hematology and Oncology, New York University Langone Health, New York, NY, USA
| | - Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Waree Rinsurongkawong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vadeerat Rinsurongkawong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Spelman
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcelo V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carl M Gay
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeff Lewis
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Jaffray
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Dyer DS, White C, Conley Thomson C, Gieske MR, Kanne JP, Chiles C, Parker MS, Menchaca M, Wu CC, Kazerooni EA. A Quick Reference Guide for Incidental Findings on Lung Cancer Screening CT Examinations. J Am Coll Radiol 2023; 20:162-172. [PMID: 36509659 DOI: 10.1016/j.jacr.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The US Preventive Services Task Force has recommended lung cancer screening (LCS) with low-dose CT (LDCT) in high-risk individuals since 2013. Because LDCT encompasses the lower neck, chest, and upper abdomen, many incidental findings (IFs) are detected. The authors created a quick reference guide to describe common IFs in LCS to assist LCS program navigators and ordering providers in managing the care continuum in LCS. METHODS The ACR IF white papers were reviewed for findings on LDCT that were age appropriate for LCS. A draft guide was created on the basis of recommendations in the IF white papers, the medical literature, and input from subspecialty content experts. The draft was piloted with LCS program navigators recruited through contacts by the ACR LCS Steering Committee. The navigators completed a survey on overall usefulness, clarity, adequacy of content, and user experience with the guide. RESULTS Seven anatomic regions including 15 discrete organs with 45 management recommendations were identified as relevant to the age of individuals eligible for LCS. The draft was piloted by 49 LCS program navigators from 32 facilities. The guide was rated as useful and clear by 95% of users. No unexpected or adverse experiences were reported in using the guide. On the basis of feedback, relevant sections were reviewed and edited. CONCLUSIONS The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide outlines the common IFs in LCS and can serve as an easy-to-use resource for ordering providers and LCS program navigators to help guide management.
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Affiliation(s)
- Debra S Dyer
- Chair, Department of Radiology, Director, Lung Cancer Screening Program, and Director, Incidental Lung Nodule Program & Lung Nodule Registry, National Jewish Health, Denver, Colorado.
| | - Charles White
- Vice Chair, Clinical Affairs, University of Maryland School of Medicine, Baltimore, Maryland. https://twitter.com/
| | - Carey Conley Thomson
- Chair, Department of Medicine and Director, Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program, Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Michael R Gieske
- Director, Lung Cancer Screening Physician, Director, Virtual Health Director, Primary Care East Department, Lead Provider, Ft. Mitchell St. Elizabeth Primary Care, Physician Director, Policy and Government Relations, St Elizabeth Healthcare, Edgewood, Kentucky
| | - Jeffrey P Kanne
- Chief, Thoracic Imaging and Vice Chair, Quality and Safety, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/
| | - Caroline Chiles
- Director, Lung Cancer Screening Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina. https://twitter.com/
| | - Mark S Parker
- Director, Thoracic Imaging Section and Director, Thoracic Imaging Fellowship Program, Early Detection Lung Screening Program, VCU Health Systems, Richmond, Virginia
| | - Martha Menchaca
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Carol C Wu
- Deputy Chair Ad Interim, Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas. https://twitter.com/
| | - Ella A Kazerooni
- Associate Chief Clinical Officer for Diagnostics and Clinical Information Management, University of Michigan Medical School, Ann Arbor, Michigan. https://twitter.com/
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12
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He JS, Duan JB, Li SC, Xiao ZL, Wang L, Li D, Ze F, Wu CC, Yuan CZ, Li XB. [Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1214-1219. [PMID: 36517443 DOI: 10.3760/cma.j.cn112148-20220523-00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.
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Affiliation(s)
- J S He
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - S C Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - Z L Xiao
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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13
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Duan JB, He JS, Wu CC, Wang L, Li D, Ze F, Zhou X, Yuan CZ, Yang DD, Li XB. [Safety and efficacy of high-power, short-duration superior vena cava isolation in combination with conventional radiofrequency ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1069-1073. [PMID: 36418274 DOI: 10.3760/cma.j.cn112148-20220501-00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: For patients with paroxysmal atrial fibrillation, superior vena cava isolation on the basis of pulmonary vein isolation may further improve the long-term success rate of radiofrequency ablation. We aimed to explore the efficacy and safety of superior vena cava isolation by high-power and short-duration (HPSD) ablation plus conventional radiofrequency ablation (RA) in patients with paroxysmal atrial fibrillation. Methods: It was a prospective randomized controlled study. From January 1, 2019 to June 1, 2020, 180 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in our center were consecutively screened. Patients were eligible if there was a trigger potential and the muscle sleeve length was greater than 3 cm. A total of 60 eligible patients were finally included and randomly divided into HPSD group (HPSD plus RA) and common power and duration (CPD) group (CPD plus RA) by random number table method (n=30 in each group). Efficacy was evaluated by ablation points, isolation time and ablation time. Safety was evaluated by the incidence of POP, cardiac tamponade, phrenic nerve injury, sinoatrial node injury and all-cause. Results: Superior vena cava isolation was achieved by 14 (13, 15) points in the HPSD group, which was significantly less than that in the CPD group (20(18, 22), P<0.001). The superior vena cava isolation time was 8 (7, 9) minutes in the HPSD group, which was significantly shorter than in the CPD group (17(14, 20) minutes, P<0.001). The average ablation time significantly shorter in HPSD group than in CPD group (78.0(71.1, 80.0) s vs. 200(167.5, 212.5)s, P<0.001). The average impedance drop was more significant in the HPSD group than in the CPD group (20.00(18.75, 21.00)Ω (and the percentage of impedance drop was 15%) vs. 12.00(11.75, 13.25)Ω (the percentage of impedance decrease was 12%), P<0.001). There was 1 POP (3.3%) in the HPSD group, and 3 POPs (10.0%) in the CPD group (P>0.05). There was no cardiac tamponade, phrenic nerve injury, sinoatrial node injury and death in both groups. Conclusions: HPSD technique for the isolation of superior vena cava is safe and effective in patients with paroxysmal atrial fibrillation undergoing conventional radiofrequency ablation.
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Affiliation(s)
- J B Duan
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - J S He
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - X Zhou
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - D D Yang
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
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14
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Chen LW, Yang SM, Chuang CC, Wang HJ, Chen YC, Lin MW, Hsieh MS, Antonoff MB, Chang YC, Wu CC, Pan T, Chen CM. ASO Visual Abstract: Solid Attenuation Components Attention Deep Learning Model to Predict Micropapillary and Solid Patterns in Lung Adenocarcinomas on Computed Tomography. Ann Surg Oncol 2022; 29:7483-7484. [PMID: 35963903 DOI: 10.1245/s10434-022-12273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Li-Wei Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shun-Mao Yang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital Biomedical Park Hospital, Zhubei City, Hsinchu County, Taiwan
| | - Ching-Chia Chuang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Hao-Jen Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Yi-Chang Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tinsu Pan
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Chung-Ming Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
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Kirsch J, Wu CC, Bolen MA, Henry TS, Rajiah PS, Brown RKJ, Galizia MS, Lee E, Rajesh F, Raptis CA, Rybicki FJ, Sams CM, Verde F, Villines TC, Wolf SJ, Yu J, Donnelly EF, Abbara S. ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update. J Am Coll Radiol 2022; 19:S488-S501. [PMID: 36436972 DOI: 10.1016/j.jacr.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. MR angiography can be useful in some clinical scenarios and lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Travis S Henry
- Panel Chair, Division Chief of Cardiothoracic Imaging, Duke University, Durham, North Carolina; Co-Director, ACR Education Center HRCT Course; Chair
| | | | - Richard K J Brown
- Vice Chair of Clinical Operations, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School; Associated Program Director Diagnostic Radiology Michigan Medicine; Director of Residency Education Cardiothoracic Division Michigan
| | - Fnu Rajesh
- MetroHealth Medical Center, Cleveland, Ohio; Primary care physician
| | | | | | | | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Stephen J Wolf
- Denver Health, Denver, Colorado; American College of Emergency Physicians; Director of Service for Emergency Medicine, Denver Health Medical Center, Denver Colorado; Co-Chair, American College of Emergency Physicians Clinical Policies Committee
| | - Jeannie Yu
- Deputy Chief of Medicine, VA Medical Center, University of California-Irvine, Irvine, California; Society for Cardiovascular Magnetic Resonance
| | - Edwin F Donnelly
- Specialty Chair, Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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16
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Chen MM, Terzic A, Becker AS, Johnson JM, Wu CC, Wintermark M, Wald C, Wu J. Artificial intelligence in oncologic imaging. Eur J Radiol Open 2022; 9:100441. [PMID: 36193451 PMCID: PMC9525817 DOI: 10.1016/j.ejro.2022.100441] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/07/2023] Open
Abstract
Radiology is integral to cancer care. Compared to molecular assays, imaging has its advantages. Imaging as a noninvasive tool can assess the entirety of tumor unbiased by sampling error and is routinely acquired at multiple time points in oncological practice. Imaging data can be digitally post-processed for quantitative assessment. The ever-increasing application of Artificial intelligence (AI) to clinical imaging is challenging radiology to become a discipline with competence in data science, which plays an important role in modern oncology. Beyond streamlining certain clinical tasks, the power of AI lies in its ability to reveal previously undetected or even imperceptible radiographic patterns that may be difficult to ascertain by the human sensory system. Here, we provide a narrative review of the emerging AI applications relevant to the oncological imaging spectrum and elaborate on emerging paradigms and opportunities. We envision that these technical advances will change radiology in the coming years, leading to the optimization of imaging acquisition and discovery of clinically relevant biomarkers for cancer diagnosis, staging, and treatment monitoring. Together, they pave the road for future clinical translation in precision oncology.
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Affiliation(s)
- Melissa M. Chen
- Department of Neuroradiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Admir Terzic
- Department of Radiology, Dom Zdravlja Odzak, Odzak, Bosnia and Herzegovina
| | - Anton S. Becker
- Department Radiology, Memorial Sloan Kettering, New York, NY, USA
| | - Jason M. Johnson
- Department of Neuroradiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C. Wu
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jia Wu
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
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17
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Qdaisat A, Wechsler AH, Cruz Carreras MT, Menendez JR, Lipe D, Highsmith EA, Kamal M, Al-Breiki A, Rojas Hernandez CM, Wu CC, Yeung SCJ. Concomitant Deep Vein Thrombosis in Cancer Patients with Unsuspected Pulmonary Embolism. Cancers (Basel) 2022; 14:cancers14184510. [PMID: 36139673 PMCID: PMC9496711 DOI: 10.3390/cancers14184510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cancer patients have a significantly higher risk of developing venous thromboembolism during their disease course when compared with the general population. During routine staging or follow-up imaging studies, incidental venous thromboemboli, including incidental pulmonary embolisms, can be identified. Identifying factors associated with incidental or unsuspected venous thromboembolism is important and can improve the management plan. In the current study, we found that 20.9% of patients with unsuspected pulmonary embolisms had concomitant deep vein thrombosis, and most of these patients were asymptomatic. In addition, we found that concomitant deep vein thrombosis increases the odds of venous thrombosis recurrence in cancer patients presenting with unsuspected pulmonary emboli. Therefore, for patients with isolated incidental subsegmental pulmonary embolism and concomitant deep vein thrombosis, initiating anticoagulants if no contraindications exist is recommended. In addition, the presence of concomitant deep vein thrombosis among cancer patients with unsuspected pulmonary embolisms is associated with poor short- and long-term outcomes in these patients. Abstract Incidental venous thromboembolism (VTE) is common in cancer patients and identifying factors associated with these events can improve the management plan. We studied the characteristics of concomitant deep vein thrombosis (C-DVT) in cancer patients presenting with unsuspected pulmonary embolism (PE) and the association of C-DVT with VTE recurrence and survival outcomes. Patients presenting to our emergency department with confirmed unsuspected/incidental PE between 1 January 2006 and 1 January 2016, were identified. Radiologic reports were reviewed to confirm the presence or absence of C-DVT. Logistic regression analyses and cox regression modeling were used to determine the effect of C-DVT on VTE recurrence and survival outcomes. Of 904 eligible patients, 189 (20.9%) had C-DVT. Patients with C-DVT had twice the odds of developing VTE recurrence (odds ratio 2.07, 95% confidence interval 1.21–3.48, p = 0.007). The mortality rates among C-DVT were significantly higher than in patients without. C-DVT was associated with reduced overall survival in patients with unsuspected PE (hazard ratio 1.33, 95% confidence interval 1.09–1.63, p = 0.005). In conclusion, C-DVT in cancer patients who present with unsuspected PE is common and is associated with an increased risk of VTE recurrence and poor short- and long-term survival. Identifying other venous thrombi in cancer patients presenting with unsuspected PE is recommended and can guide the management plan. For patients with isolated incidental subsegmental pulmonary embolism and concomitant deep vein thrombosis, initiating anticoagulants if no contraindications exist is recommended.
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Affiliation(s)
- Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adriana H. Wechsler
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Maria T. Cruz Carreras
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jazmin R. Menendez
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Demis Lipe
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Emily A. Highsmith
- Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aisha Al-Breiki
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Emergency Medicine, Sultan Qaboos University Hospital, Al Seeb 121, Oman
| | | | - Carol C. Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-745-9911
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18
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He JS, Duan JB, Li SC, Wang L, Li D, Ze F, Wu CC, Zhou X, Yuan CZ, Li XB. [Effect of Li's catheter in the cardiac resynchronization therapy implantation]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:799-804. [PMID: 35982013 DOI: 10.3760/cma.j.cn112148-20220309-00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To evaluate the effect of Li's catheter in cardiac resynchronization therapy (CRT) implantation. Methods: This study was a retrospective cohort study. Patients with indications for CRT implantation who visited the Department of Cardiology, Peking University People's Hospital from January 1, 2016 to January 1, 2022 were enrolled. Patients were divided into Li's catheter group (CRT implantation with Li's catheter) and control group (CRT implantation with the traditional method). The general clinical data of the patients were obtained through the electronic medical record system. Li's catheter is a new type of coronary sinus angiography balloon catheter independently developed by Dr. Li Xuebin (patent number: 201320413174.1). The primary outcome was the success rate of CRT device implantation, and the secondary outcomes included efficacy and safety parameters. Efficacy indicators included operation time, coronary sinus angiography time, left ventricular lead implantation time, X-ray exposure time, left ventricular lead threshold, and diaphragm stimulation. Safety outcomes included incidence of coronary sinus dissection, cardiac tamponade, and pericardial effusion. Results: A total of 170 patients were enrolled in this study, including 90 in Li's catheter group and 80 in control group. Age, male proportion of patients, proportion of patients with ischemic cardiomyopathy, hypertension, diabetes mellitus, chronic renal insufficiency, New York Heart Association (NYHA) functional classification, left ventricular ejection fraction, left ventricular end-diastolic diameter, proportion of left bundle branch block, and preoperative QRS wave width were similar between the two groups (all P>0.05). In Li's catheter group, 34 cases (37.8%) implanted with CRT defibrillators, and 28 cases (35.0%) implanted with CRT defibrillators in control group, the difference was not statistically significant (P=0.710). The success rate of CRT device implantation in Li's catheter group was 100% (90/90), which was significantly higher than that in control group (93.8%, 75/80, P=0.023).The operation time was 57.0 (52.0, 62.3) minutes, the time to complete coronary sinus angiography was 8.0 (6.0, 9.0) minutes, and the time of left ventricular electrode implantation was 8.0 (7.0, 9.0) minutes in Li's catheter group, and was 91.3 (86.3, 97.0), 18.0 (16.0, 20.0), 25.0 (22.0, 27.7) minutes respectively in control group, all significantly shorter in Li's catheter group (all P<0.05). The exposure time of X-ray was 15.0 (14.0, 17.0) minutes in Li's catheter group, which was also significantly shorter than that in control group (32.5 (29.0, 36.0) minutes, P<0.001). There was no coronary sinus dissection and cardiac tamponade in Li's catheter group, and 1 patient (1.1%) had diaphragmatic stimulation in Li's catheter group. In control group, 6 patients (6.7%) had coronary sinus dissection, and 1 patient (1.1%) developed pericardial effusion, and 3 patients (3.3%) had diaphragmatic stimulation. The incidence of coronary sinus dissection in Li's catheter group was significantly lower than that in control group (P=0.011). The postoperative left ventricular thresholds in Li's catheter group and control group were similar (1.80 (1.60, 2.38) V/0.5 ms vs. 1.80 (1.60, 2.40) V/0.5 ms, P=0.120). Conclusions: Use of Li's catheter is associated with higher success rate of CRT implantation, short time of coronary sinus angiography and left ventricular electrode implantation, reduction of intraoperative X-ray exposure, and lower incidence of coronary vein dissection in this patient cohort.
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Affiliation(s)
- J S He
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - S C Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X Zhou
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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19
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Nakata M, Miwa, Wu CC, Chambers JK, Uchida K, Shiga, Nakayama H, Sasaki. Spontaneous intranasal tumours in degus (Octodon degus): 20 cases (2007-2020). J Small Anim Pract 2022; 63:829-833. [PMID: 35965417 DOI: 10.1111/jsap.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this retrospective study was to describe the clinical and histopathological findings associated with intranasal tumours in degus. MATERIALS AND METHODS Medical records of degus diagnosed with intranasal neoplasms on histopathological examination between the years 2007 and 2020 at one hospital were included in the study. RESULTS MEDICAL RECORDS OF DEGUS Twenty degus (10 males and 10 females) were eligible for inclusion. Initial clinical signs included sneezing, abnormal nasal sounds, and nasal discharge, followed by anorexia and frequent nose rubbing. On radiography, 15 out of 20 animals showed space-occupying lesions in the nasal cavity. CT was performed in 16 animals and revealed various degrees of changes, including abnormal radiopacity within the nasal cavity and damaged nasal septum. Rhinostomy and excisional biopsy was performed in all 20 animals. Six out of 20 patients died during the perioperative period. Six and seven degus survived for 3 months and 1 year, respectively. One animal was lost to follow-up. In 16 cases the histological diagnosis was consistent with fibromas, while in 4 cases with osteomas. CLINICAL SIGNIFICANCE Intranasal neoplasms in degus are mostly benign mesenchymal tumours with various degrees of bone formation, which is unique to this animal species. This occurrence should be considered as an important differential diagnosis for upper respiratory tract disease in degus.
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Affiliation(s)
- M Nakata
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan.,VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - Miwa
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan.,VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - C C Wu
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan
| | - J K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, 1138657, Japan
| | - K Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, 1138657, Japan
| | - Shiga
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - H Nakayama
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - Sasaki
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
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20
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Chen LW, Yang SM, Chuang CC, Wang HJ, Chen YC, Lin MW, Hsieh MS, Antonoff MB, Chang YC, Wu CC, Pan T, Chen CM. Solid Attenuation Components Attention Deep Learning Model to Predict Micropapillary and Solid Patterns in Lung Adenocarcinomas on Computed Tomography. Ann Surg Oncol 2022; 29:7473-7482. [PMID: 35789301 DOI: 10.1245/s10434-022-12055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND High-grade adenocarcinoma subtypes (micropapillary and solid) treated with sublobar resection have an unfavorable prognosis compared with those treated with lobectomy. We investigated the potential of incorporating solid attenuation component masks with deep learning in the prediction of high-grade components to optimize surgical strategy preoperatively. METHODS A total of 502 patients with pathologically confirmed high-grade adenocarcinomas were retrospectively enrolled between 2016 and 2020. The SACs attention DL model was developed to apply solid-attenuation-component-like subregion masks (tumor area ≥ - 190 HU) to guide the DL model for predicting high-grade subtypes. The SACA-DL was assessed using 5-fold cross-validation and external validation in the training and testing sets, respectively. The performance, which was evaluated using the area under the curve (AUC), was compared between SACA-DL and the DL model without SACs attention (DLwoSACs), the prior radiomics model, or the model based on the consolidation/tumor (C/T) diameter ratio. RESULTS We classified 313 and 189 patients into training and testing cohorts, respectively. The SACA-DL achieved an AUC of 0.91 for the cross-validation, which was significantly superior to those of the DLwoSACs (AUC = 0.88; P = 0.02), prior radiomics model (AUC = 0.85; P = 0.004), and C/T ratio (AUC = 0.84; P = 0.002). An AUC of 0.93 was achieved for external validation in the SACA-DL and was significantly better than those of the DLwoSACs (AUC = 0.89; P = 0.04), prior radiomics model (AUC = 0.85; P < 0.001), and C/T ratio (AUC = 0.85; P < 0.001). CONCLUSIONS The combination of solid-attenuation-component-like subregion masks with the DL model is a promising approach for the preoperative prediction of high-grade adenocarcinoma subtypes.
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Affiliation(s)
- Li-Wei Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shun-Mao Yang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital Biomedical Park Hospital, Zhubei City, Hsinchu County, Taiwan
| | - Ching-Chia Chuang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Hao-Jen Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Yi-Chang Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tinsu Pan
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Chung-Ming Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
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21
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Saad MB, Hong L, Aminu M, Vokes NI, Chen P, Wu CC, Rinsurongkawong W, Spelman AR, Negrao MV, Cascone T, Lin SH, Lee P, Sepesi B, Gibbons DL, Vaporciyan AA, Lee JJ, Le X, Zhang J, Wu J, Heymach J. Deep learning signature from chest CT and association with immunotherapy outcomes in EGFR/ALK-negative NSCLC. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9061 Background: Many clinicopathological and molecular features are associate with clinical benefit from immune checkpoint inhibitors (ICIs) for patients with non-small-cell lung cancer (NSCLC), yet none was exclusive underscoring the heterogeneity of lung cancers. As images may provide a holistic view of cancer, we attempted deep learning to chest CT scans to derive a predictor of response to ICIs and test its benefit relative to known clinicopathological factors. Methods: 928 stage IV, EGFR/ALK-negative NSCLC patients treated with ICIs alone or in combination (MD Anderson GEMINI Database) were divided into training (CTtr = 572), validation (CTva = 78), and testing (CTte = 278) cohorts, balancing the distribution of clinicopathological and radiological factors. Progression-free (PFS) and overall survival (OS) were defined as outcomes. We analyzed whole lung, including tumor and normal parenchyma of chest CT images ≤ 3 months prior to ICI treatment. An ensemble learning model (CT-deep-learning) to clustering patients into high vs low risk groups of PFS or OS was developed by fusing risk scores from four independent deep learning networks (supervised, unsupervised, and hybrid). This CT-deep-learning model was further evaluated in different clinicopathological subgroups. Finally, a composite model (CT-Clinic-path) was built by combining image model with clinicopathological factors. Antolini's concordance index (C-index) was used to assess model performance. Results: Median PFS and OS were shorter in the high-risk vs low-risk group as defined by CT-deep-learning: PFS (CTtr: 4.2 vs 9.6 mons; HR 1.96; 95% CI 1.62-2.38; P < 0.0001; CTva: 3.7 vs 10.2 mons; HR 2.32; 95% CI 1.32-4.07; P = 0.0025; CTte: 3.6 vs 9.1 mons; HR 1.89; 95% CI 1.39-2.56; P < 0.0001) and OS (CTtr: 16.0 vs 31.4 mons; HR 2.19; 95% CI 1.72-2.79; P < 0.0001; CTva: 12.7 vs 28.6 mons; HR 2.01; 95% CI 1.04-3.88; P = 0.035; CTte: 14.8 vs 32.0 mons; HR 1.84; 95% CI 1.31-2.60; P = 0.0004). CT-deep-learning outperformed clinicopathologic features known to associate with ICI benefit, such as histology, smoking status, PD-L1 expression, and remained to be an independent (P < 0.001) prognostic factor on multivariate analysis. Furthermore, integrating CT-deep-learning to clinicopathological variables improved prediction performance with a net reclassification up to 7% (Clinic-path model, C-indices 0.60 – 0.62 vs CT-clinic-path model, 0.64 - 0.65 for PFS; Clinic-path model 0.64 – 0.67 vs CT-clinic-path model 0.69 – 0.71 for OS). Conclusions: We have developed and validated a deep learning signature associated with PFS and OS in ICI-treated NSCLC patients, which appears to be independent of and superior to known clinicopathological biomarkers. If validated, this signature may strengthen the predictive value of clinicopathological factors and facilitate selecting appropriate patients for ICI-based therapies.
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Affiliation(s)
- Maliazurina B Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lingzhi Hong
- Department of Thoracic and Head and Neck Medical Oncology, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Muhammad Aminu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Pingjun Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Waree Rinsurongkawong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy R. Spelman
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcelo Vailati Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tina Cascone
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven H. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Boris Sepesi
- Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Don Lynn Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara A. Vaporciyan
- 4Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Jack Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiuning Le
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Zhang
- Department of Thoracic and Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jia Wu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Ahuja J, Palacio D, Jo N, Strange CD, Shroff GS, Truong MT, Wu CC. Pitfalls in the imaging of pulmonary embolism. Semin Ultrasound CT MR 2022; 43:221-229. [PMID: 35688533 DOI: 10.1053/j.sult.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary embolism (PE) can present with a wide spectrum of clinical symptoms that can overlap considerably with other cardiovascular diseases. To avoid PE related morbidity and mortality, it is vital to identify this disease accurately and in a timely fashion. Several clinical criteria have been developed to standardize the diagnostic approach for patients with suspected PE. Computed tomographic pulmonary angiogram has significantly improved the detection of pulmonary embolism and is considered the imaging modality of choice to diagnose this disease. However, there are several potential pitfalls associated with this modality which can make diagnosis of PE challenging. In this review, we will discuss various pitfalls routinely encountered in the diagnostic work up of patients with suspected PE, approaches to mitigate these pitfalls and incidental pulmonary embolism.
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Affiliation(s)
- Jitesh Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Diana Palacio
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Nahyun Jo
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Chad D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Shroff GS, Wu CC, Ocazionez D, Carter BW, Shivaprasad A, Chai T, Supsupin EP, Truong MT, Shroff S. It's Not All in Your Head: Thoracic Manifestations of Neurologic Diseases and Disorders. Acad Radiol 2022; 29:736-747. [PMID: 32622741 PMCID: PMC7329291 DOI: 10.1016/j.acra.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
Abstract
Myriad conditions may affect both the neurologic system and the thorax, while other diseases primarily affecting the thorax may manifest with neurologic abnormalities. Correlation of signs, symptoms, and imaging findings in the neurological system with those in the thorax can help diagnose certain conditions and/or guide further diagnostic work-up and treatment. We will review and illustrate the imaging appearance of several systemic/neurological diseases with thoracic manifestations as well as discuss conditions in the thorax that can lead to neurologic symptoms.
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Affiliation(s)
- Girish S Shroff
- MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX.
| | - Carol C Wu
- MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX
| | | | - Brett W Carter
- MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX
| | | | - Thomas Chai
- MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX
| | | | - Mylene T Truong
- MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1478, Houston, TX
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24
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Mongan J, Vagal A, Wu CC. Imaging AI in Practice: Introducing the Special Issue. Radiol Artif Intell 2022; 4:e220039. [PMID: 35391763 DOI: 10.1148/ryai.220039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
- John Mongan
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (J.M.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (A.V.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Achala Vagal
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (J.M.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (A.V.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Carol C Wu
- Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (J.M.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (A.V.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
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25
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Gooch CR, Jain MK, Petranovic M, Chow DZ, Muse VV, Gagne SM, Wu CC, Stowell JT. Thoracic Imaging Manifestations of Treated Lymphomas: Response Evaluation, Posttherapeutic Sequelae, and Complications. J Thorac Imaging 2022; 37:67-79. [PMID: 35191861 DOI: 10.1097/rti.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lymphoma is the most common hematologic malignancy comprising a diverse group of neoplasms arising from multiple blood cell lineages. Any structure of the thorax may be involved at any stage of disease. Imaging has a central role in the initial staging, response assessment, and surveillance of lymphoma, and updated standardized assessment criteria are available to assist with imaging interpretation and reporting. Radiologists should be aware of the modern approaches to lymphoma treatment, the role of imaging in posttherapeutic surveillance, and manifestations of therapy-related complications.
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Affiliation(s)
- Cory R Gooch
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Manoj K Jain
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | | | - David Z Chow
- Department of Radiology, Massachusetts General Hospital
| | | | - Staci M Gagne
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Carol C Wu
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Wu CC, Li XB, Duan JB, He JS, Zhu TG, Yu C, Li D, Ze F, Guo JH, Wang L. [Value of D-dimer and left atrial size combined with CHA 2DS 2-VASc score in excluding left atrial thrombosis in patients with non-valvular atrial fibrillation]. Zhonghua Yi Xue Za Zhi 2021; 101:3938-3943. [PMID: 34954995 DOI: 10.3760/cma.j.cn112137-20210608-01303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the related factors of thrombosis in patients with non-valvular atrial fibrillation (NVAF), and whether the combination of D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score can be used to exclude left atrial thrombosis. Methods: A total of 75 NVAF patients with left atrial thrombosis confirmed by transesophageal echocardiography in Peking University People's Hospital from January 1, 2015 to December 31, 2019 were enrolled as the thrombus group. From January 1 to October 31, 2019, 80 patients with NVAF without left atrial thrombosis were enrolled as the control group. The clinical data, CHA2DS2-VASc score, hematological biomarkers, ultrasound data of two groups were compared. The independent factors associated with left atrial thrombosis were screened by univariate analysis and multivariate logistic regression analysis. The positive predictive value and negative predictive value for the diagnosis of left atrial thrombosis were gained by the score calculated based on the independent related factors. Results: There were no significant differences in age, gender, proportion of persistent atrial fibrillation and duration of atrial fibrillation between the two groups. The CHA2DS2-VASc score [M (Q1, Q3)] of the thrombus group was higher than that of the control group [2.5 (1.0, 3.0) vs 1.8 (1.0, 3.0), P=0.012]. The prothrombin time activity [M (Q1, Q3)] of the thrombus group was 81.1 (72.0, 93.0)%, which was lower than that of the control group 88.8 (83.0,96.0)% (P=0.008). The activated partial thromboplastin time (APTT) of the thrombus group was longer than that of the control group [(32.1±4.8) s vs (30.2±3.7) s, P=0.006]. D-dimer [M (Q1, Q3)] of the thrombus group was 231.0 (71.5, 272.2) ng/ml, which was higher than that of the control group 121.7 (49.0, 140.0) ng/ml (P<0.001). The left atrial anteroposterior diameter in thrombus group was larger [(44.6±6.6) mm vs (38.9±5.3) mm, P<0.001], the proportion of mitral regurgitation was higher (58.1% vs 26.8%, P<0.001). The left ventricular ejection fraction [M (Q1, Q3)] of the thrombus group was 56.7% (45.8%, 66.3%), which was lower than that of the control group 63.3% (60.5%, 70.2%) (P=0.003). Multivariate logistic regression analysis showed that the factor related to left atrial thrombosis was left atrial anteroposterior diameter (OR=4.480, 95%CI: 1.616-12.423). The negative predictive value of the new scoring system combined with D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score for left atrial thrombosis was 100%. Conclusions: In NVAF patients, the factor independently associating with left atrial thrombosis is left atrial anteroposterior diameter. The combination of D-dimer, left atrial anteroposterior diameter, and CHA2DS2-VASc score can help exclude left atrial thrombosis before ablation of NVAF.
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Affiliation(s)
- C C Wu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J S He
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - T G Zhu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Yu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J H Guo
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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27
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Strange CD, Vlahos I, Truong MT, Shroff GS, Ahuja J, Wu CC, Ko JP. Pearls and Pitfalls in Postsurgical Imaging of the Chest. Semin Ultrasound CT MR 2021; 42:563-573. [PMID: 34895612 DOI: 10.1053/j.sult.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of surgical procedures are utilized to treat a spectrum of cardiopulmonary diseases. In the imaging of patients in the post-operative period, it is important to have an understanding of surgical techniques including invasive and minimally invasive procedures and the expected postsurgical findings. Knowledge of certain patient risk factors, various complications associated with specific surgical procedures, and a keen attention to detail are essential to avoid misinterpretation and delay diagnosis. Prompt detection of potential complications allows timely intervention, thereby, optimizing patient outcomes in the post-operative period.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ioannis Vlahos
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane P Ko
- Department of Radiology, New York University Langone Health, New York, NY
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28
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Lewis WE, Hong L, Mott FE, Simon G, Wu CC, Rinsurongkawong W, Lee JJ, Lam VK, Heymach JV, Zhang J, Le X. Efficacy of Targeted Inhibitors in Metastatic Lung Squamous Cell Carcinoma With EGFR or ALK Alterations. JTO Clin Res Rep 2021; 2:100237. [PMID: 34820641 PMCID: PMC8600084 DOI: 10.1016/j.jtocrr.2021.100237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The efficacy of targeted therapies in oncogene-driven lung adenocarcinomas (LUADs) has been well established; however, the benefit for EGFR-mutant or ALK-rearranged lung squamous cell carcinomas (LUSCs) is less known, partially owing to the rarity of the incidence. Methods We reviewed the database of the MD Anderson Cancer Center and identified metastatic LUSC with classic EGFR or ALK alterations. Results There were eight patients with EGFR-mutant LUSC (median age = 58 y) and six patients with EML4-ALK LUSC (median age = 50 y) who received tyrosine kinase inhibitors (TKIs) that were identified. Of the 14 patients, 11 (79%) were females and 12 (86%) were never smokers, similar to the demographics of EGFR or ALK LUAD. With TKI treatment, seven of eight cases of EGFR LUSC and four of six cases of ALK LUSC achieved partial response or stable disease, but the progression-free survival was 4.9 months and 2.9 months for EGFR-mutant and ALK-rearranged LUSC, respectively. In addition, we compared comutation profile of EGFR-mutant LUAD (The Cancer Genome Atlas, n = 46) versus LUSC (n = 19) and found that the comutation patterns are more consistent with squamous disease with a higher incidence of PIK3CA (p = 0.02) and KRAS or BRAF (p = 0.04) alterations. Conclusions EGFR or ALK alterations occur in patients with LUSC, especially never-smoker females. TKI treatments render clinical benefit in disease control, but the duration was considerably truncated compared with those historically observed in LUAD.
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Affiliation(s)
- Whitney E Lewis
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lingzhi Hong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frank E Mott
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Simon
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Medical Oncology at Advent Health, Moffitt Cancer Center, Tampa, Florida
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Waree Rinsurongkawong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vincent K Lam
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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29
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Kuzniewski CT, Kizhner O, Donnelly EF, Henry TS, Amin AN, Kandathil A, Kelly AM, Laroia AT, Lee E, Martin MD, Morris MF, Raptis CA, Sirajuddin A, Wu CC, Kanne JP. ACR Appropriateness Criteria® Chronic Cough. J Am Coll Radiol 2021; 18:S305-S319. [PMID: 34794590 DOI: 10.1016/j.jacr.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022]
Abstract
Chronic cough is defined by a duration lasting at least 8 weeks. The most common causes of chronic cough include smoking-related lung disease, upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. The etiology of chronic cough in some patients may be difficult to localize to an isolated source and is often multifactorial. The complex pathophysiology, clinical presentation, and variable manifestations of chronic cough underscore the challenges faced by clinicians in the evaluation and management of these patients. Imaging plays a role in the initial evaluation, although there is a lack of high-quality evidence guiding which modalities are useful and at what point in time the clinical evaluation should be performed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair and Chief, Thoracic Imaging, The Ohio State University Wexner Medical Center, Columbus, Ohio; and Co-Chair, Physics Module Committee, RSBA
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California; Course Co-Director, HRCT Course, ACR Education Center, Reston Virginia; and Division Chief, Cardiothoracic Radiology, Duke University Hospital
| | - Alpesh N Amin
- University of California Irvine, Irvine, California; American College of Physicians
| | | | | | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan
| | - Maria D Martin
- Director of Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | - Carol C Wu
- Deputy Chair Ad Interim, The University of Texas MD Anderson Cancer Center, Houston, Texas; Chair, Society of Thoracic Radiology Big Data Committee; and Chair, Thoracic Use Cases Panel - ACR DSI
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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30
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Mobiny A, Yuan P, Cicalese PA, Moulik SK, Garg N, Wu CC, Wong K, Wong ST, He TC, Nguyen HV. Memory-Augmented Capsule Network for Adaptable Lung Nodule Classification. IEEE Trans Med Imaging 2021; 40:2869-2879. [PMID: 33434126 DOI: 10.1109/tmi.2021.3051089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Computer-aided diagnosis (CAD) systems must constantly cope with the perpetual changes in data distribution caused by different sensing technologies, imaging protocols, and patient populations. Adapting these systems to new domains often requires significant amounts of labeled data for re-training. This process is labor-intensive and time-consuming. We propose a memory-augmented capsule network for the rapid adaptation of CAD models to new domains. It consists of a capsule network that is meant to extract feature embeddings from some high-dimensional input, and a memory-augmented task network meant to exploit its stored knowledge from the target domains. Our network is able to efficiently adapt to unseen domains using only a few annotated samples. We evaluate our method using a large-scale public lung nodule dataset (LUNA), coupled with our own collected lung nodules and incidental lung nodules datasets. When trained on the LUNA dataset, our network requires only 30 additional samples from our collected lung nodule and incidental lung nodule datasets to achieve clinically relevant performance (0.925 and 0.891 area under receiving operating characteristic curves (AUROC), respectively). This result is equivalent to using two orders of magnitude less labeled training data while achieving the same performance. We further evaluate our method by introducing heavy noise, artifacts, and adversarial attacks. Under these severe conditions, our network's AUROC remains above 0.7 while the performance of state-of-the-art approaches reduce to chance level.
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31
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Ahrar K, Tam AL, Kuban JD, Wu CC. Imaging of the thorax after percutaneous thermal ablation of lung malignancies. Clin Radiol 2021; 77:31-43. [PMID: 34384562 DOI: 10.1016/j.crad.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Image-guided thermal ablation is a minimally invasive treatment option for patients with early stage non-small cell lung cancer or metastatic disease to the lungs. Percutaneous ablation treats malignant tumours in situ, which precludes histopathological evaluation of the ablated tumours. Imaging studies are used as surrogates to assess technical and clinical success. Although it is not universally accepted, a common protocol for surveillance imaging includes contrast-enhanced computed tomography (CT) at 1, 3, 6, 9, 12, 18, 24 months, and yearly thereafter. Integrated 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (PET)/CT imaging is recommended at 3 and 12 months and when recurrent disease is suspected. There is a complex evolution of the ablation zone on CT and PET imaging studies. The zone of ablation, initially larger than the ablated tumour, undergoes gradual involution. In the process, it may cavitate and resemble a lung abscess. Different contrast-enhancement and radionuclide uptake patterns in and around the ablation zone may indicate a wide range of diagnostic possibilities from a normal physiological response to local progression. Ultimately, the zone of ablation may be replaced by a variety of findings including linear bands of density, pleural thickening, or residual necrotic tumour. Diagnostic and interventional radiologists interpreting post-ablation imaging studies must have a clear understanding of the ablation process and imaging findings on surveillance studies. Accurate and timely recognition of complications and/or local recurrence is necessary to guide further therapy. The purpose of this article is to review imaging protocols and salient imaging findings after thermal ablation of lung malignancies.
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Affiliation(s)
- K Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA.
| | - A L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - J D Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
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Rassiah P, Esiashvili N, Olch AJ, Hua CH, Ulin K, Molineu A, Marcus K, Gopalakrishnan M, Pillai S, Kovalchuk N, Liu A, Niyazov G, Peñagarícano JA, Cheung F, Olson AC, Wu CC, Malhotra H, MacEwan IJ, Faught J, Breneman JC, Followill DS, FitzGerald TJ, Kalapurakal JA. Practice patterns of pediatric total body irradiation techniques: A Children's Oncology Group survey. Int J Radiat Oncol Biol Phys 2021; 111:1155-1164. [PMID: 34352289 DOI: 10.1016/j.ijrobp.2021.07.1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among xxx member institutions. METHODS AND MATERIALS Between Nov 2019 and Feb 2020 a questionnaire, containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 xxx institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 xxx member radiation oncologists at the same institutions. RESULTS Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions responded (69% response rate). The AP/PA technique was the most common (49 institutions - 56%); 44 institutions (50%) used the lateral technique and 14 institutions (16%) used volumetric modulated arc therapy (VMAT)/Tomotherapy. Mid-plane dose rates of 6-15 cGy/min were most commonly used. The most common specification for lung dose was the mid lung dose for both AP/PA (71%) and lateral (63%) techniques. All physician responders agreed with the need to refine current TBI techniques and 79% supported the investigation of new TBI techniques to further lower the lung dose. CONCLUSION There is no consistency in the practice patterns, methods for dose measurement and reporting of TBI doses among xxx institutions. The lack of a standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The xxx radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all xxx centers.
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Affiliation(s)
- P Rassiah
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
| | - N Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - A J Olch
- Department of Radiation Oncology, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, CA
| | - C H Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - K Ulin
- Imaging and Radiation Oncology Core, Rhode Island QA Center, University of Massachusetts Medical School, Lincoln, RI
| | - A Molineu
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - K Marcus
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - M Gopalakrishnan
- Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - S Pillai
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope, Los Angeles, CA
| | - G Niyazov
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J A Peñagarícano
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - F Cheung
- Medical Physics division, Princess Margaret Cancer Center, Toronto, Canada
| | - A C Olson
- Department of Radiation Oncology, Children's Hospital of Pittsburgh, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine Pittsburgh, PA
| | - C C Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - H Malhotra
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - I J MacEwan
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA
| | - J Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - J C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - D S Followill
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - T J FitzGerald
- Department of Radiation Oncology, University of Massachusetts, Worcester, MA
| | - J A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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34
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Jo N, Shroff GS, Wu CC, Ahuja J, Strange CD, Marom EM, Truong MT. Imaging of the mediastinum: Mimics of malignancy. Semin Diagn Pathol 2021; 39:92-98. [PMID: 34167848 DOI: 10.1053/j.semdp.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/11/2022]
Abstract
In the imaging of the mediastinum, benign lesions mimicking malignancy constitute potential pitfalls in interpretation. Localization and characteristic imaging features are key to narrow the differential diagnosis and avoid potential pitfalls in interpretation. Based on certain anatomic landmarks, the mediastinal compartment model enables accurate localization. Depending on the anatomic origin, mediastinal lesions can have various etiologies. The anatomic location and structures contained within each mediastinal compartment are helpful in generating the differential diagnoses. These structures include thyroid, thymus, parathyroid, lymph nodes, pericardium, embryogenic remnants, and parts of the enteric tracts, vessels, and nerves. Imaging characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT), including attenuation (fluid, fat, calcification), contrast enhancement, and metabolic activity, aid in narrowing the differential diagnoses. Understanding the roles and limitations of various imaging modalities is helpful in the evaluation of mediastinal masses. In this review, we present potential pitfalls in the imaging of mediastinal lesions with emphasis on the mimics of malignancy.
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Affiliation(s)
- Nahyun Jo
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Girish S Shroff
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Carol C Wu
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Jitesh Ahuja
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Chad D Strange
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Edith M Marom
- Chaim Sheba Medical Center, Department of Radiology, Tel Hashomer, Israel
| | - Mylene T Truong
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008.
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35
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Laroia AT, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Kuzniewski CT, Maldonado F, Olsen KM, Raptis CA, Shim K, Wu CC, Kanne JP. ACR Appropriateness Criteria® Intensive Care Unit Patients. J Am Coll Radiol 2021; 18:S62-S72. [PMID: 33958119 DOI: 10.1016/j.jacr.2021.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
Chest radiography is the most frequent and primary imaging modality in the intensive care unit (ICU), given its portability, rapid image acquisition, and availability of immediate information on the bedside preview. Due to the severity of underlying disease and frequent need of placement of monitoring devices, ICU patients are very likely to develop complications related to underlying disease process and interventions. Portable chest radiography in the ICU is an essential tool to monitor the disease process and the complications from interventions; however, it is subject to overuse especially in stable patients. Restricting the use of chest radiographs in the ICU to only when indicated has not been shown to cause harm. The emerging role of bedside point-of-care lung ultrasound performed by the clinicians is noted in the recent literature. The bedside lung ultrasound appears promising but needs cautious evaluation in the future to determine its role in ICU patients. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee. Chief, Division of Thoracic Radiology, Department of Radiology, Ohio State University Wexner Medical Center
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California, The Society of Thoracic Surgeons
| | - Phillip M Boiselle
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee, American College of Chest Physicians
| | | | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, American College of Physicians
| | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas, Chair of Thoracic Use Case Panel of ACR DSI, Deputy Chair ad interim, Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Tsai EB, Simpson S, Lungren MP, Hershman M, Roshkovan L, Colak E, Erickson BJ, Shih G, Stein A, Kalpathy-Cramer J, Shen J, Hafez M, John S, Rajiah P, Pogatchnik BP, Mongan J, Altinmakas E, Ranschaert ER, Kitamura FC, Topff L, Moy L, Kanne JP, Wu CC. The RSNA International COVID-19 Open Radiology Database (RICORD). Radiology 2021; 299:E204-E213. [PMID: 33399506 PMCID: PMC7993245 DOI: 10.1148/radiol.2021203957] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a global health care emergency. Although reverse-transcription polymerase chain reaction testing is the reference standard method to identify patients with COVID-19 infection, chest radiography and CT play a vital role in the detection and management of these patients. Prediction models for COVID-19 imaging are rapidly being developed to support medical decision making. However, inadequate availability of a diverse annotated data set has limited the performance and generalizability of existing models. To address this unmet need, the RSNA and Society of Thoracic Radiology collaborated to develop the RSNA International COVID-19 Open Radiology Database (RICORD). This database is the first multi-institutional, multinational, expert-annotated COVID-19 imaging data set. It is made freely available to the machine learning community as a research and educational resource for COVID-19 chest imaging. Pixel-level volumetric segmentation with clinical annotations was performed by thoracic radiology subspecialists for all COVID-19-positive thoracic CT scans. The labeling schema was coordinated with other international consensus panels and COVID-19 data annotation efforts, the European Society of Medical Imaging Informatics, the American College of Radiology, and the American Association of Physicists in Medicine. Study-level COVID-19 classification labels for chest radiographs were annotated by three radiologists, with majority vote adjudication by board-certified radiologists. RICORD consists of 240 thoracic CT scans and 1000 chest radiographs contributed from four international sites. It is anticipated that RICORD will ideally lead to prediction models that can demonstrate sustained performance across populations and health care systems.
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Affiliation(s)
| | | | - Matthew P. Lungren
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Michelle Hershman
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Leonid Roshkovan
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Errol Colak
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Bradley J. Erickson
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - George Shih
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Anouk Stein
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jayashree Kalpathy-Cramer
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jody Shen
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Mona Hafez
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Susan John
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Brian P. Pogatchnik
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - John Mongan
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Emre Altinmakas
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Erik R. Ranschaert
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Felipe C. Kitamura
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Laurens Topff
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Linda Moy
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jeffrey P. Kanne
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Carol C. Wu
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
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Tsai EB, Simpson S, Lungren MP, Hershman M, Roshkovan L, Colak E, Erickson BJ, Shih G, Stein A, Kalpathy-Cramer J, Shen J, Hafez M, John S, Rajiah P, Pogatchnik BP, Mongan J, Altinmakas E, Ranschaert ER, Kitamura FC, Topff L, Moy L, Kanne JP, Wu CC. The RSNA International COVID-19 Open Radiology Database (RICORD). Radiology 2021. [PMID: 33399506 DOI: 10.7937/91ah-v663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a global health care emergency. Although reverse-transcription polymerase chain reaction testing is the reference standard method to identify patients with COVID-19 infection, chest radiography and CT play a vital role in the detection and management of these patients. Prediction models for COVID-19 imaging are rapidly being developed to support medical decision making. However, inadequate availability of a diverse annotated data set has limited the performance and generalizability of existing models. To address this unmet need, the RSNA and Society of Thoracic Radiology collaborated to develop the RSNA International COVID-19 Open Radiology Database (RICORD). This database is the first multi-institutional, multinational, expert-annotated COVID-19 imaging data set. It is made freely available to the machine learning community as a research and educational resource for COVID-19 chest imaging. Pixel-level volumetric segmentation with clinical annotations was performed by thoracic radiology subspecialists for all COVID-19-positive thoracic CT scans. The labeling schema was coordinated with other international consensus panels and COVID-19 data annotation efforts, the European Society of Medical Imaging Informatics, the American College of Radiology, and the American Association of Physicists in Medicine. Study-level COVID-19 classification labels for chest radiographs were annotated by three radiologists, with majority vote adjudication by board-certified radiologists. RICORD consists of 240 thoracic CT scans and 1000 chest radiographs contributed from four international sites. It is anticipated that RICORD will ideally lead to prediction models that can demonstrate sustained performance across populations and health care systems.
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Affiliation(s)
- Emily B Tsai
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Scott Simpson
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Matthew P Lungren
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Michelle Hershman
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Leonid Roshkovan
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Errol Colak
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Bradley J Erickson
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - George Shih
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Anouk Stein
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jayashree Kalpathy-Cramer
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jody Shen
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Mona Hafez
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Susan John
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Brian P Pogatchnik
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - John Mongan
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Emre Altinmakas
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Erik R Ranschaert
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Felipe C Kitamura
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Laurens Topff
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Linda Moy
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Jeffrey P Kanne
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
| | - Carol C Wu
- From the Department of Radiology, Stanford University, Stanford, Calif (E.B.T., J.S., B.P.P.); Department of Radiology, University of Pennsylvania Hospital, Philadelphia, Pa (S.S., M. Hershman, L.R.); Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, CA 94305-5913 (M.P.L.); Department of Medical Imaging, University of Toronto, Unity Health Toronto, Toronto, Canada (E.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E., P.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (G.S.); MD.ai, New York, NY (A.S.); Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (J.K.C.); Department of Diagnostic and Interventional Radiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt (M. Hafez); Department of Radiology, The Ottawa Hospital, Ottawa, Canada (S.J.); Department of Radiology and Biomedical Imaging, Center for Intelligent Imaging, San Francisco, Calif (J.M.); Department of Radiology, Koç University School of Medicine, Koç University Hospital, Istanbul, Turkey (E.A.); Department of Radiology, ETZ Hospital, Tilburg, the Netherlands (E.R.R.); Department of Radiology, University of Ghent, Ghent, Belgium (E.R.R.); Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil (F.C.K.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (L.T.); Department of Radiology, NYU Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.)
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Mobiny A, Yuan P, Moulik SK, Garg N, Wu CC, Van Nguyen H. DropConnect is effective in modeling uncertainty of Bayesian deep networks. Sci Rep 2021; 11:5458. [PMID: 33750847 PMCID: PMC7943811 DOI: 10.1038/s41598-021-84854-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/17/2021] [Indexed: 12/26/2022] Open
Abstract
Deep neural networks (DNNs) have achieved state-of-the-art performance in many important domains, including medical diagnosis, security, and autonomous driving. In domains where safety is highly critical, an erroneous decision can result in serious consequences. While a perfect prediction accuracy is not always achievable, recent work on Bayesian deep networks shows that it is possible to know when DNNs are more likely to make mistakes. Knowing what DNNs do not know is desirable to increase the safety of deep learning technology in sensitive applications; Bayesian neural networks attempt to address this challenge. Traditional approaches are computationally intractable and do not scale well to large, complex neural network architectures. In this paper, we develop a theoretical framework to approximate Bayesian inference for DNNs by imposing a Bernoulli distribution on the model weights. This method called Monte Carlo DropConnect (MC-DropConnect) gives us a tool to represent the model uncertainty with little change in the overall model structure or computational cost. We extensively validate the proposed algorithm on multiple network architectures and datasets for classification and semantic segmentation tasks. We also propose new metrics to quantify uncertainty estimates. This enables an objective comparison between MC-DropConnect and prior approaches. Our empirical results demonstrate that the proposed framework yields significant improvement in both prediction accuracy and uncertainty estimation quality compared to the state of the art.
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Affiliation(s)
- Aryan Mobiny
- Department of Electrical and Computer Engineering, University of Houston, Houston, TX, 77004, USA.
| | - Pengyu Yuan
- Department of Electrical and Computer Engineering, University of Houston, Houston, TX, 77004, USA
| | | | - Naveen Garg
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hien Van Nguyen
- Department of Electrical and Computer Engineering, University of Houston, Houston, TX, 77004, USA
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Colak E, Kitamura FC, Hobbs SB, Wu CC, Lungren MP, Prevedello LM, Kalpathy-Cramer J, Ball RL, Shih G, Stein A, Halabi SS, Altinmakas E, Law M, Kumar P, Manzalawi KA, Nelson Rubio DC, Sechrist JW, Germaine P, Lopez EC, Amerio T, Gupta P, Jain M, Kay FU, Lin CT, Sen S, Revels JW, Brussaard CC, Mongan J. The RSNA Pulmonary Embolism CT Dataset. Radiol Artif Intell 2021; 3:e200254. [PMID: 33937862 PMCID: PMC8043364 DOI: 10.1148/ryai.2021200254] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 01/11/2023]
Abstract
Supplemental material is available for this article.
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Lam VK, Zhang J, Wu CC, Tran HT, Li L, Diao L, Wang J, Rinsurongkawong W, Raymond VM, Lanman RB, Lewis J, Roarty EB, Roth J, Swisher S, Lee JJ, Gibbons DL, Papadimitrakopoulou VA, Heymach JV. Genotype-Specific Differences in Circulating Tumor DNA Levels in Advanced NSCLC. J Thorac Oncol 2020; 16:601-609. [PMID: 33388476 DOI: 10.1016/j.jtho.2020.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Plasma-based circulating tumor DNA (ctDNA) is an established biomarker for molecular profiling with emerging applications in disease monitoring in multiple tumor types, including, NSCLC. However, determinants of ctDNA shedding and correlation with tumor burden are incompletely understood, particularly in advanced-stage disease. METHODS We retrospectively analyzed ctDNA-based and tissue-based genomic data and imaging from 144 patients with NSCLC. Tumor burden was quantified with computed tomography (CT) and brain magnetic resonance imaging for the overall cohort and 18F-fludeoxyglucose positron emission tomography-CT in a subset of patients. RESULTS There was a moderate but statistically significant correlation between ctDNA variant allele frequency and multiple imaging measures of tumor burden such as CT volume (rho = 0.34, p ≤ 0.0001) and metabolic tumor volume (rho = 0.36, p = 0.003). This correlation was strongest in KRAS-mutant tumors (rho = 0.56, p ≤ 0.001), followed by TP53 mutants (rho = 0.43, p ≤ 0.0001), and weakest in EGFR-mutated (EGFR+) tumors (rho = 0.24, p = 0.077). EGFR+ tumors with EGFR copy number gain had significantly higher variant allele frequency than EGFR+ without copy number gain (p ≤ 0.00001). In multivariable analysis, TP53 and EGFR mutations, visceral metastasis, and tumor burden were independent predictors of increased ctDNA shedding. CONCLUSIONS Levels of detectable ctDNA were affected not only by tumor burden but also by tumor genotype. The genotype-specific differences observed may be due to variations in DNA shedding and cellular turnover. These findings have implications for the emerging use of ctDNA in NSCLC disease monitoring and early detection.
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Affiliation(s)
- Vincent K Lam
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol C Wu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hai T Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lerong Li
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lixia Diao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Waree Rinsurongkawong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jeff Lewis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily B Roarty
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Roth
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Swisher
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Wang Y, Jin C, Wu CC, Zhao H, Liang T, Liu Z, Jian Z, Li R, Wang Z, Li F, Zhou J, Cai S, Liu Y, Li H, Liang Y, Tian C, Yang J. Organizing pneumonia of COVID-19: Time-dependent evolution and outcome in CT findings. PLoS One 2020; 15:e0240347. [PMID: 33175876 PMCID: PMC7657520 DOI: 10.1371/journal.pone.0240347] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background As a pandemic, a most-common pattern resembled organizing pneumonia (OP) has been identified by CT findings in novel coronavirus disease (COVID-19). We aimed to delineate the evolution of CT findings and outcome in OP of COVID-19. Materials and methods 106 COVID-19 patients with OP based on CT findings were retrospectively included and categorized into non-severe (mild/common) and severe (severe/critical) groups. CT features including lobar distribution, presence of ground glass opacities (GGO), consolidation, linear opacities and total severity CT score were evaluated at three time intervals from symptom-onset to CT scan (day 0–7, day 8–14, day > 14). Discharge or adverse outcome (admission to ICU or death), and pulmonary sequelae (complete absorption or lesion residuals) on CT after discharge were analyzed based on the CT features at different time interval. Results 79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8–50) after symptom-onset. Of 67 patients with revisit CT at 2–4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30–53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8–14. Conclusion Most OP cases had good prognosis. Approximately one-third of cases had complete absorption of lesions during 1–2 months after symptom-onset while those with increased frequency of consolidation, number of involved lobe > 3, and CT score > 4 at week 2 after symptom-onset may indicate lesion residuals on CT.
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Affiliation(s)
- Yan Wang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Carol C. Wu
- Department of Thoracic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States of America
| | - Huifang Zhao
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Zhe Liu
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Runqing Li
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Zekun Wang
- Department of Radiology, The Eighth Hospital of Xi’an, Xi’an, P.R. China
| | - Fen Li
- Department of Radiology, The Eighth Hospital of Xi’an, Xi’an, P.R. China
| | - Jie Zhou
- Department of Radiology, Xi’an Chest Hospital, Xi’an, P.R. China
| | - Shubo Cai
- Department of Radiology, Xi’an Chest Hospital, Xi’an, P.R. China
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Hao Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Yukun Liang
- Department of Radiology, Ankang Center Hospital, Ankang, P.R. China
| | - Cong Tian
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
- * E-mail:
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Jin C, Tian C, Wang Y, Wu CC, Zhao H, Liang T, Liu Z, Jian Z, Li R, Wang Z, Li F, Zhou J, Cai S, Liu Y, Li H, Li Z, Liang Y, Zhou H, Wang X, Ren Z, Yang J. A Pattern Categorization of CT Findings to Predict Outcome of COVID-19 Pneumonia. Front Public Health 2020; 8:567672. [PMID: 33072703 PMCID: PMC7531052 DOI: 10.3389/fpubh.2020.567672] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background: As global healthcare system is overwhelmed by novel coronavirus disease (COVID-19), early identification of risks of adverse outcomes becomes the key to optimize management and improve survival. This study aimed to provide a CT-based pattern categorization to predict outcome of COVID-19 pneumonia. Methods: One hundred and sixty-five patients with COVID-19 (91 men, 4–89 years) underwent chest CT were retrospectively enrolled. CT findings were categorized as Pattern 0 (negative), Pattern 1 (bronchopneumonia pattern), Pattern 2 (organizing pneumonia pattern), Pattern 3 (progressive organizing pneumonia pattern), and Pattern 4 (diffuse alveolar damage pattern). Clinical findings were compared across different categories. Time-dependent progression of CT patterns and correlations with clinical outcomes, i.e.„ discharge or adverse outcome (admission to ICU, requiring mechanical ventilation, or death), with pulmonary sequelae (complete absorption or residuals) on CT after discharge were analyzed. Results: Of 94 patients with outcome, 81 (86.2%) were discharged, 3 (3.2%) were admitted to ICU, 4 (4.3%) required mechanical ventilation, 6 (6.4%) died. 31 (38.3%) had complete absorption at median day 37 after symptom onset. Significant differences between pattern-categories were found in age, disease severity, comorbidity and laboratory results (all P < 0.05). Remarkable evolution was observed in Pattern 0–2 and Pattern 3–4 within 3 and 2 weeks after symptom-onset, respectively; most of patterns remained thereafter. After controlling for age, CT pattern significantly correlated with adverse outcomes [Pattern 4 vs. Pattern 0–3 [reference]; hazard-ratio [95% CI], 18.90 [1.91–186.60], P = 0.012]. CT pattern [Pattern 3–4 vs. Pattern 0–2 [reference]; 0.26 [0.08–0.88], P = 0.030] and C-reactive protein [>10 vs. ≤ 10 mg/L [reference]; 0.31 [0.13–0.72], P = 0.006] were risk factors associated with pulmonary residuals. Conclusion: CT pattern categorization allied with clinical characteristics within 2 weeks after symptom onset would facilitate early prognostic stratification in COVID-19 pneumonia.
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Affiliation(s)
- Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cong Tian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Huifang Zhao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhe Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Runqing Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zekun Wang
- Department of Radiology, The Eighth Hospital of Xi'an, Xi'an, China
| | - Fen Li
- Department of Radiology, The Eighth Hospital of Xi'an, Xi'an, China
| | - Jie Zhou
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Shubo Cai
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhongyi Li
- Department of Critical Care Medicine, Wuhan No.9 Hospital, Wuhan, China
| | - Yukun Liang
- Department of Radiology, Ankang Center Hospital, Ankang, China
| | - Heping Zhou
- Department of Radiology, Ankang Center Hospital, Ankang, China
| | - Xibin Wang
- Department of Radiology, Hanzhong Center Hospital, Hanzhong, China
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, Baoji, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Henry TS, Donnelly EF, Boiselle PM, Crabtree TD, Iannettoni MD, Johnson GB, Kazerooni EA, Laroia AT, Maldonado F, Olsen KM, Restrepo CS, Shim K, Sirajuddin A, Wu CC, Kanne JP. ACR Appropriateness Criteria ® Rib Fractures. J Am Coll Radiol 2020; 16:S227-S234. [PMID: 31054749 DOI: 10.1016/j.jacr.2019.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
Abstract
Rib fractures are the most common thoracic injury after minor blunt trauma. Although rib fractures can produce significant morbidity, the diagnosis of injuries to underlying organs is arguably more important as these complications are likely to have the most significant clinical impact. Isolated rib fractures have a relatively low morbidity and mortality and treatment is generally conservative. As such, evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes. Cardiopulmonary resuscitation frequently results in anterior rib fractures and chest radiographs are usually appropriate (and sufficient) as the initial imaging modality in these patients. In patients with suspected pathologic fractures, chest CT or Tc-99m bone scans are usually appropriate and complementary modalities to chest radiography based on the clinical scenario. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Travis S Henry
- Panel Vice Chair, University of California San Francisco, San Francisco, California.
| | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip M Boiselle
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Traves D Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; Society of Thoracic Surgeons
| | | | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Carlos S Restrepo
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | | | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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44
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Harada K, Wu CC, Wang X, Mizrak Kaya D, Amlashi FG, Iwatsuki M, Blum Murphy MA, Maru DM, Weston B, Lee JH, Rogers JE, Thomas I, Shanbhag N, Bhutani MS, Hofstetter WL, Nguyen QN, Ajani JA. Total Lesion Glycolysis Assessment Identifies a Patient Fraction With a High Cure Rate Among Esophageal Adenocarcinoma Patients Treated With Definitive Chemoradiation. Ann Surg 2020; 272:311-318. [PMID: 32675544 DOI: 10.1097/sla.0000000000003228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to determine whether tumor metabolism could be prognostic of cure in L-EAC patients who receive definitive chemoradiation. SUMMARY BACKGROUND DATA Patients with inoperable localized esophageal adenocarcinoma (L-EAC) often receive definitive chemoradiation; however, biomarkers and/or imaging variables to prognosticate cure are missing. METHODS Two hundred sixty-six patients with L-EAC who had chemoradiation but not surgery were analyzed from the prospectively maintained EAC databases in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center (Texas, USA) between March 2002 and April 2015. Maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) from the positron emission tomography data were evaluated. RESULTS Of 266 patients, 253 (95%) were men; the median age was 67 years (range 20-91 yrs) and 153 had poorly differentiated L-EAC. The median SUVmax was 10.3 (range 0-87) and the median TLG was 85.7 (range 0-3227). Both SUVmax and TLG were higher among those with: tumors >5 cm in length, high clinical stage, and high tumor and node categories by TNM staging (all P < 0.0001). Of 234 patients evaluable for cure, 60 (25.6%) achieved cure. In the multivariable logistic regression model, low TLG (but not low SUVmax) was associated with cure (continuous TLG value: odds ratio 0.70, 95% confidence interval (CI) 0.54-0.92). TLG was quantified into 4 quartile categorical variables; first quartile (Q1; <32), second quartile (Q2; 32.0-85.6), third quartile (Q3; 85.6-228.4), and fourth quartile (Q4; >228.4); the cure rate was only 10.3% in Q4 and 5.1% in Q3 but increased to 28.8% in Q2, and 58.6% in Q1. The cross-validation resulted in an average accuracy of prediction score of 0.81 (95% CI, 0.75-0.86). CONCLUSIONS In this cross-validated model, 59% of patients in the 1st quartile were cured following definitive chemoradiation. Baseline TLG could be pursued as one of the tools for esophageal preservation.
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Affiliation(s)
- Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dilsa Mizrak Kaya
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fatemeh G Amlashi
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Masaaki Iwatsuki
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Mariela A Blum Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dipen M Maru
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Weston
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey H Lee
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irene Thomas
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Namita Shanbhag
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manoop S Bhutani
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Liu Z, Jin C, Wu CC, Liang T, Zhao H, Wang Y, Wang Z, Li F, Zhou J, Cai S, Zeng L, Yang J. Association between Initial Chest CT or Clinical Features and Clinical Course in Patients with Coronavirus Disease 2019 Pneumonia. Korean J Radiol 2020; 21:736-745. [PMID: 32410412 PMCID: PMC7231612 DOI: 10.3348/kjr.2020.0171] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS Baseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge. RESULTS Thirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18-0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03-0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge. CONCLUSION Lung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.
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Affiliation(s)
- Zhe Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Carol C Wu
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huifang Zhao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zekun Wang
- Department of Radiology, the Eighth Hospital of Xi'an, Xi'an, China
| | - Fen Li
- Department of Radiology, the Eighth Hospital of Xi'an, Xi'an, China
| | - Jie Zhou
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Shubo Cai
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Little BP, Mendoza DP, Fox A, Wu CC, Ackman JB, Shepard JA, Muniappan A, Digumarthy SR. Direct and indirect CT imaging features of esophago-airway fistula in adults. J Thorac Dis 2020; 12:3157-3166. [PMID: 32642237 PMCID: PMC7330784 DOI: 10.21037/jtd-20-244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Esophago-airway fistula (EAF) is an abnormal connection between the esophagus and the trachea or a major bronchus. While contrast esophagography remains the primary radiographic tool for the diagnosis of EAF, computed tomography (CT) is often employed in its evaluation. A systematic analysis of CT findings of EAF in adults has not been previously published. The goal of our study is to determine the direct and indirect CT findings of EAF in adults. Methods We identified patients with EAF detected on CT at our institution between January 1, 2001 and December 31, 2019, with endoscopic or surgical confirmation. We collected patient clinicopathologic characteristics and assessed CTs for direct and indirect imaging features of EAF in these patients. Results Twenty-six patients (median age: 56 years; range, 25–79 years; F=13, 50% and M=13, 50%) with confirmed EAF were identified. Half of the patients had an underlying malignancy. On CT, a direct connection between the esophagus and the airway was identified in most cases (22/26; 85%). Common indirect CT findings of EAF included esophageal wall thickening (21/26, 81%), mediastinal fatty stranding (21/26, 81%), airway wall thickening (20/26, 77%), fluid or debris within the airways (17/26, 65%), and focal or diffuse esophageal dilation with air (17/26, 65%). Mediastinal fluid collections were infrequently seen (4/26, 15%), but findings of aspiration or other pneumonia were common (19/26, 73%). Conclusions CT plays an essential role in both the primary and secondary evaluation of adult EAF resulting from both malignant and benign etiologies. CT may be the first diagnostic exam to suggest and detect the presence of EAF and may precede clinical suspicion, and it can detect a subset of fistulas not demonstrated on esophagography. There are several direct and indirect imaging findings on CT that can help in the detection of EAF.
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Affiliation(s)
- Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Dexter P Mendoza
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Fox
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | - Carol C Wu
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeanne B Ackman
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jo-Anne Shepard
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ashok Muniappan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Qdaisat A, Wu W, Lin JZ, Al Soud R, Yang Z, Hu Z, Gao S, Wu CC, Liu X, Silvestre J, Hita AG, Viets-Upchurch J, Al Adwan S, Al Haj Qasem N, Cruz Carreras MT, Jacobson KL, Chaftari PS, Abdel-Razeq H, Reyes-Gibby CC, Jim Yeung SC. Clinical and Cancer-Related Predictors for Venous Thromboembolism in Cancer Patients Presenting to the Emergency Department. J Emerg Med 2020; 58:932-941. [PMID: 32376060 DOI: 10.1016/j.jemermed.2020.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/02/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests. OBJECTIVE We sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE. METHODS We retrospectively analyzed all consecutive patients who presented with suspicion of VTE to The University of Texas MD Anderson Cancer Center ED between January 1, 2009, and January 1, 2013. Logistic regression models were used to identify risk factors that were associated with VTE. The ability of these factors to predict VTE was externally validated using a second cohort of patients who presented to King Hussein Cancer Center ED between January 1, 2009, and January 1, 2016. RESULTS Cancer-related covariates associated with the occurrence of VTE were high-risk cancer type (odds ratio [OR] 3.64 [95% confidence interval {CI} 2.37-5.60], p < 0.001), presentation within 6 months of the cancer diagnosis (OR 1.92 [95% CI 1.62-2.28], p < 0.001), active cancer (OR 1.35 [95% CI 1.10-1.65], p = 0.003), advanced stage (OR 1.40 [95% CI 1.01-1.94], p = 0.044), and the presence of brain metastasis (OR 1.73 [95% CI 1.32-2.27], p < 0.001). When combined, these factors along with other clinical factors showed high prediction performance for VTE in the external validation cohort. CONCLUSIONS Cancer risk group, presentation within 6 months of cancer diagnosis, active and advanced cancer, and the presence of brain metastases along with other related clinical factors can be used to predict VTE in patients with cancer presenting to the ED.
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Affiliation(s)
- Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Weixin Wu
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Oncology, Zhong Shan Hospital, Xiamen Medical University, Xiamen, People's Republic of China
| | - Jun-Zhong Lin
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Rawan Al Soud
- Department of Emergency Medicine, King Hussein Cancer Center, Amman, Jordan; Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Zhi Yang
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Intensive Care, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhihuang Hu
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Shujun Gao
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Center of Diagnosis and Treatment of Cervical Disease, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiangdong Liu
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Laboratory Medicine, Qilu Hospital, Qilu Medical University, Jinan, Shandong, People's Republic of China
| | - Julio Silvestre
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - A Guido Hita
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jayne Viets-Upchurch
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saif Al Adwan
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Nafi' Al Haj Qasem
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Maria T Cruz Carreras
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kalen L Jacobson
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick S Chaftari
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Olsen KM, Manouchehr-Pour S, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Harrison NE, Kuzniewski CT, Laroia AT, Maldonado F, Pinchot JW, Raptis CA, Shim K, Tong BC, Wu CC, Kanne JP. ACR Appropriateness Criteria® Hemoptysis. J Am Coll Radiol 2020; 17:S148-S159. [PMID: 32370959 DOI: 10.1016/j.jacr.2020.01.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Phillip M Boiselle
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Nicholas E Harrison
- Beaumont Health System, Royal Oak, Michigan; American College of Emergency Physicians
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Liang T, Liu Z, Wu CC, Jin C, Zhao H, Wang Y, Wang Z, Li F, Zhou J, Cai S, Liang Y, Zhou H, Wang X, Ren Z, Yang J. Evolution of CT findings in patients with mild COVID-19 pneumonia. Eur Radiol 2020; 30:4865-4873. [PMID: 32291502 PMCID: PMC7156291 DOI: 10.1007/s00330-020-06823-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
Objectives To delineate the evolution of CT findings in patients with mild COVID-19 pneumonia. Methods CT images and medical records of 88 patients with confirmed mild COVID-19 pneumonia, a baseline CT, and at least one follow-up CT were retrospectively reviewed. CT features including lobar distribution and presence of ground glass opacities (GGO), consolidation, and linear opacities were analyzed on per-patient basis during each of five time intervals spanning the 3 weeks after disease onset. Total severity scores were calculated. Results Of patients, 85.2% had travel history to Wuhan or known contact with infected individuals. The most common symptoms were fever (84.1%) and cough (56.8%). The baseline CT was obtained on average 5 days from symptom onset. Four patients (4.5%) had negative initial CT. Significant differences were found among the time intervals in the proportion of pulmonary lesions that are (1) pure GGO, (2) mixed attenuation, (3) mixed attenuation with linear opacities, (4) consolidation with linear opacities, and (5) pure consolidation. The majority of patients had involvement of ≥ 3 lobes. Bilateral involvement was more prevalent than unilateral involvement. The proportions of patients observed to have pure GGO or GGO and consolidation decreased over time while the proportion of patients with GGO and linear opacities increased. Total severity score showed an increasing trend in the first 2 weeks. Conclusions While bilateral GGO are predominant features, CT findings changed during different time intervals in the 3 weeks after symptom onset in patients with COVID-19. Key Points • Four of 88 (4.5%) patients with COVID-19 had negative initial CT. • Majority of COVID-19 patients had abnormal CT findings in ≥ 3 lobes. • A proportion of patients with pure ground glass opacities decreased over the 3 weeks after symptom onset.
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Affiliation(s)
- Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Zhe Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Carol C Wu
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Huifang Zhao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Zekun Wang
- Department of Radiology, the Eighth Hospital of Xi'an, Xi'an, 710061, People's Republic of China
| | - Fen Li
- Department of Radiology, the Eighth Hospital of Xi'an, Xi'an, 710061, People's Republic of China
| | - Jie Zhou
- Department of Radiology, Xi'an Chest Hospital, Xi'an, 710100, People's Republic of China
| | - Shubo Cai
- Department of Radiology, Xi'an Chest Hospital, Xi'an, 710100, People's Republic of China
| | - Yukun Liang
- Department of Radiology, Ankang Center Hospital, Ankang, 725000, People's Republic of China
| | - Heping Zhou
- Department of Radiology, Ankang Center Hospital, Ankang, 725000, People's Republic of China
| | - Xibin Wang
- Department of Radiology, Hanzhong Center Hospital, Hanzhong, 723000, People's Republic of China
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, Baoji, 721008, People's Republic of China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
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Filice RW, Stein A, Wu CC, Arteaga VA, Borstelmann S, Gaddikeri R, Galperin-Aizenberg M, Gill RR, Godoy MC, Hobbs SB, Jeudy J, Lakhani PC, Laroia A, Nayak SM, Parekh MR, Prasanna P, Shah P, Vummidi D, Yaddanapudi K, Shih G. Crowdsourcing pneumothorax annotations using machine learning annotations on the NIH chest X-ray dataset. J Digit Imaging 2020; 33:490-496. [PMID: 31768897 PMCID: PMC7165201 DOI: 10.1007/s10278-019-00299-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Pneumothorax is a potentially life-threatening condition that requires prompt recognition and often urgent intervention. In the ICU setting, large numbers of chest radiographs are performed and must be interpreted on a daily basis which may delay diagnosis of this entity. Development of artificial intelligence (AI) techniques to detect pneumothorax could help expedite detection as well as localize and potentially quantify pneumothorax. Open image analysis competitions are useful in advancing state-of-the art AI algorithms but generally require large expert annotated datasets. We have annotated and adjudicated a large dataset of chest radiographs to be made public with the goal of sparking innovation in this space. Because of the cumbersome and time-consuming nature of image labeling, we explored the value of using AI models to generate annotations for review. Utilization of this machine learning annotation (MLA) technique appeared to expedite our annotation process with relatively high sensitivity at the expense of specificity. Further research is required to confirm and better characterize the value of MLAs. Our adjudicated dataset is now available for public consumption in the form of a challenge.
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Affiliation(s)
- Ross W Filice
- Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW CG201, Washington, DC, 20007, USA.
| | | | - Carol C Wu
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, Houston, TX, 77030, USA
| | - Veronica A Arteaga
- Department of Medical Imaging, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
| | | | - Ramya Gaddikeri
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Parkway, Chicago, Illinois, 60612, USA
| | - Maya Galperin-Aizenberg
- Department of Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02112, USA
| | - Myrna C Godoy
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, Houston, TX, 77030, USA
| | - Stephen B Hobbs
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA
| | - Jean Jeudy
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Paras C Lakhani
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107, USA
| | - Archana Laroia
- Department of Radiology, University of Iowa, 3868 JPP 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Sundeep M Nayak
- Division of Thoracic Imaging, Department of Diagnostic Radiology, The Permanente Medical Group, Inc., San Leandro, CA, 94577, USA
| | - Maansi R Parekh
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107, USA
| | - Prasanth Prasanna
- Diagnostic Imaging Associates, 698 12th St SE, Suite 145, Salem, OR, 97301, USA
| | - Palmi Shah
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Parkway, Chicago, Illinois, 60612, USA
| | - Dharshan Vummidi
- Department of Radiology, University of Michigan Health System, CVC 5581 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kavitha Yaddanapudi
- Department of Medical Imaging, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - George Shih
- Department of Radiology, Weill Cornell Medicine, 525 E. 68th St., New York, NY, 10065, USA
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