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Wada N, Li Y, Gagne S, Hino T, Valtchinov VI, Gay E, Nishino M, Hammer MM, Madore B, Guttmann CRG, Ishigami K, Hunninghake GM, Levy BD, Kaye KM, Christiani DC, Hatabu H. Incidence and severity of pulmonary embolism in COVID-19 infection: Ancestral, Alpha, Delta, and Omicron variants. Medicine (Baltimore) 2023; 102:e36417. [PMID: 38050198 PMCID: PMC10695578 DOI: 10.1097/md.0000000000036417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Little information is available regarding incidence and severity of pulmonary embolism (PE) across the periods of ancestral strain, Alpha, Delta, and Omicron variants. The aim of this study is to investigate the incidence and severity of PE over the dominant periods of ancestral strain and Alpha, Delta, and Omicron variants. We hypothesized that the incidence and the severity by proximity of PE in patients with the newer variants and vaccination would be decreased compared with those in ancestral and earlier variants. Patients with COVID-19 diagnosis between March 2020 and February 2022 and computed tomography pulmonary angiogram performed within a 6-week window around the diagnosis (-2 to +4 weeks) were studied retrospectively. The primary endpoints were the associations of the incidence and location of PE with the ancestral strain and each variant. Of the 720 coronavirus disease 2019 patients with computed tomography pulmonary angiogram (58.6 ± 17.2 years; 374 females), PE was diagnosed among 42/358 (12%) during the ancestral strain period, 5/60 (8%) during the Alpha variant period, 16/152 (11%) during the Delta variant period, and 13/150 (9%) during the Omicron variant period. The most proximal PE (ancestral strain vs variants) was located in the main/lobar arteries (31% vs 6%-40%), in the segmental arteries (52% vs 60%-75%), and in the subsegmental arteries (17% vs 0%-19%). There was no significant difference in both the incidence and location of PE across the periods, confirmed by multivariable logistic regression models. In summary, the incidence and severity of PE did not significantly differ across the periods of ancestral strain and Alpha, Delta, and Omicron variants.
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Affiliation(s)
- Noriaki Wada
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Staci Gagne
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Vladimir I. Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth Gay
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mark M. Hammer
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Bruno Madore
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Charles R. G. Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Gary M. Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Bruce D. Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Kenneth M. Kaye
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - David C. Christiani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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2
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Meisel JL, Chen DCR, Cohen GM, Bernard SA, Carmona H, Petrusa ER, Opole IO, Navedo D, Valtchinov VI, Nahas AH, Eiduson CM, Papps N. Listen Before You Auscultate: An Active-Learning Approach to Bedside Cardiac Assessment. MedEdPORTAL 2023; 19:11362. [PMID: 37915746 PMCID: PMC10615901 DOI: 10.15766/mep_2374-8265.11362] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
Introduction Bedside cardiac assessment (BCA) is deficient across a spectrum of noncardiology trainees. Learners not taught BCA well may become instructors who do not teach well, creating a self-perpetuating problem. To improve BCA teaching and learning, we developed a high-quality, patient-centered curriculum for medicine clerkship students that could be flexibly implemented and accessible to other health professions learners. Methods With a constructivist perspective, we aligned learning goals, activities, and assessments. The curriculum used a "listen before you auscultate" framework, capturing patient history as context for a six-step, systematic approach. In the flipped classroom, short videos and practice questions preceded two 1-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, jugular venous pressure evaluation, heart sound competitions, and simulated conversations with patients. Two hundred sixty-eight students at four US and international medical schools participated. We incorporated feedback, performed thematic analysis, and assessed learners' confidence and knowledge. Results Low posttest data capture limited quantitative results. Students reported increased confidence in BCA ability. Knowledge increased in both BCA and control groups. Thematic analysis suggested instructional design strategies were effective and peer encounters, skills practice, and encounters with educators were meaningful. Discussion The curriculum supported active learning of day-to-day clinical competencies and promoted professional identity formation alongside BCA ability. Feedback and increased confidence on the late-clerkship posttest suggested durable learning. We recommend approaches to confirm this and other elements of knowledge, skill acquisition, or behaviors and are surveying impacts on professional identity formation-related constructs.
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Affiliation(s)
- James L. Meisel
- Associate Chief of Staff for Education, VA Bedford Healthcare System; Associate Professor of Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
| | - Daniel C. R. Chen
- Assistant Dean of Student Affairs and Clinical Associate Professor of Medicine, General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
| | | | - Sheilah A. Bernard
- Associate Professor of Medicine, Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
| | - Hugo Carmona
- Assistant Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Emil R. Petrusa
- Professor of Surgery, Harvard Medical School, and Department of Surgery, Learning Lab, Massachusetts General Hospital
| | - Isaac O. Opole
- Professor of Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center
| | - Deborah Navedo
- Director of Education, STRATUS Center for Simulation, Brigham and Women's Hospital
| | - Vladimir I. Valtchinov
- Assistant Professor of Radiology, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, and Department of Biomedical Informatics, Harvard Medical School
| | - Ahmed H. Nahas
- Advanced Geriatric Medicine Fellow, New England Geriatric Research Education and Clinical Center, VA Boston Health Care System, and Harvard Medical School Multicampus Geriatrics Fellowship, Beth Israel Deaconess Medical Center; Family Physician and Geriatrician, Family Medicine Clinic, Yakima Valley Farm Workers Clinic
| | - Carly M. Eiduson
- Fourth-Year Medical Student, University of Rochester School of Medicine & Dentistry
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3
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Hino T, Nishino M, Valtchinov VI, Gagne S, Gay E, Wada N, Tseng SC, Madore B, Guttmann CR, Ishigami K, Li Y, Christiani DC, Hunninghake GM, Levy BD, Kaye KM, Hatabu H. Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans. Eur J Radiol Open 2023; 10:100483. [PMID: 36883046 PMCID: PMC9981527 DOI: 10.1016/j.ejro.2023.100483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Purpose To investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA). Methods COVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA). Results Out of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6-24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA. Conclusions Higher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6-24 months of SARS-CoV-2 infection.
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Key Words
- 2019-nCoV, 2019 novel coronavirus
- ARDS, acute respiratory distress syndrome
- Abnormalities
- COVID-19
- COVID-19 pneumonia
- COVID-19 related lung abnormalities
- COVID-19, coronavirus disease 2019
- Chest CT
- Co-LA, post-COVID-19 lung abnormalities
- DAD, diffuse alveolar damage
- GGO, ground-glass opacity
- ILA, interstitial lung abnormalities
- ILD, interstitial lung disease
- Lung
- OP, organizing pneumonia
- PE, pulmonary embolism
- SARS-CoV2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3–1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vladimir I. Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Staci Gagne
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Elizabeth Gay
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Noriaki Wada
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Shu Chi Tseng
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Bruno Madore
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Charles R.G. Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3–1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan
| | - Yi Li
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - David C. Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Gary M. Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Bruce D. Levy
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Kenneth M. Kaye
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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4
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Hata A, Hino T, Putman RK, Yanagawa M, Hida T, Menon AA, Honda O, Yamada Y, Nishino M, Araki T, Valtchinov VI, Jinzaki M, Honda H, Ishigami K, Johkoh T, Tomiyama N, Christiani DC, Lynch DA, San José Estépar R, Washko GR, Cho MH, Silverman EK, Hunninghake GM, Hatabu H. Traction Bronchiectasis/Bronchiolectasis on CT Scans in Relationship to Clinical Outcomes and Mortality: The COPDGene Study. Radiology 2022; 304:694-701. [PMID: 35638925 PMCID: PMC9434811 DOI: 10.1148/radiol.212584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/15/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/16/2023]
Abstract
Background The clinical impact of interstitial lung abnormalities (ILAs) on poor prognosis has been reported in many studies, but risk stratification in ILA will contribute to clinical practice. Purpose To investigate the association of traction bronchiectasis/bronchiolectasis index (TBI) with mortality and clinical outcomes in individuals with ILA by using the COPDGene cohort. Materials and Methods This study was a secondary analysis of prospectively collected data. Chest CT scans of participants with ILA for traction bronchiectasis/bronchiolectasis were evaluated and outcomes were compared with participants without ILA from the COPDGene study (January 2008 to June 2011). TBI was classified as follows: TBI-0, ILA without traction bronchiectasis/bronchiolectasis; TBI-1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; TBI-2, ILA with mild to moderate traction bronchiectasis; and TBI-3, ILA with severe traction bronchiectasis and/or honeycombing. Clinical outcomes and overall survival were compared among the TBI groups and the non-ILA group by using multivariable linear regression model and Cox proportional hazards model, respectively. Results Overall, 5295 participants (median age, 59 years; IQR, 52-66 years; 2779 men) were included, and 582 participants with ILA and 4713 participants without ILA were identified. TBI groups were associated with poorer clinical outcomes such as quality of life scores in the multivariable linear regression model (TBI-0: coefficient, 3.2 [95% CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95% CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95% CI: 4.0, 11; P < .001]; TBI-3: coefficient, 32 [95% CI: 17, 48; P < .001]). The multivariable Cox model demonstrated that ILA without traction bronchiectasis (TBI-0-1) and with traction bronchiectasis (TBI-2-3) were associated with shorter overall survival (TBI-0-1: hazard ratio [HR], 1.4 [95% CI: 1.0, 1.9; P = .049]; TBI-2-3: HR, 3.8 [95% CI: 2.6, 5.6; P < .001]). Conclusion Traction bronchiectasis/bronchiolectasis was associated with poorer clinical outcomes compared with the group without interstitial lung abnormalities; TBI-2 and 3 were associated with shorter survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Im in this issue.
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Affiliation(s)
- Akinori Hata
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Takuya Hino
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Rachel K. Putman
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Masahiro Yanagawa
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Tomoyuki Hida
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Aravind A. Menon
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Osamu Honda
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Yoshitake Yamada
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Mizuki Nishino
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Tetsuro Araki
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Vladimir I. Valtchinov
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Masahiro Jinzaki
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Hiroshi Honda
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Kousei Ishigami
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Takeshi Johkoh
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Noriyuki Tomiyama
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - David C. Christiani
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - David A. Lynch
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Raúl San José Estépar
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - George R. Washko
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Michael H. Cho
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Edwin K. Silverman
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Gary M. Hunninghake
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Hiroto Hatabu
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - for the COPDGene Investigators
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
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5
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Valtchinov VI, Murphy SN, Lacson R, Ikonomov N, Zhai BK, Andriole K, Rousseau J, Hanson D, Kohane IS, Khorasani R. Analytics to monitor local impact of the Protecting Access to Medicare Act's imaging clinical decision support requirements. J Am Med Inform Assoc 2022; 29:1870-1878. [PMID: 35932187 PMCID: PMC9552289 DOI: 10.1093/jamia/ocac132] [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: 12/29/2021] [Revised: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed is to: (1) extend the Integrating the Biology and the Bedside (i2b2) data and application models to include medical imaging appropriate use criteria, enabling it to serve as a platform to monitor local impact of the Protecting Access to Medicare Act's (PAMA) imaging clinical decision support (CDS) requirements, and (2) validate the i2b2 extension using data from the Medicare Imaging Demonstration (MID) CDS implementation. MATERIALS AND METHODS This study provided a reference implementation and assessed its validity and reliability using data from the MID, the federal government's predecessor to PAMA's imaging CDS program. The Star Schema was extended to describe the interactions of imaging ordering providers with the CDS. New ontologies were added to enable mapping medical imaging appropriateness data to i2b2 schema. z-Ratio for testing the significance of the difference between 2 independent proportions was utilized. RESULTS The reference implementation used 26 327 orders for imaging examinations which were persisted to the modified i2b2 schema. As an illustration of the analytical capabilities of the Web Client, we report that 331/1192 or 28.1% of imaging orders were deemed appropriate by the CDS system at the end of the intervention period (September 2013), an increase from 162/1223 or 13.2% for the first month of the baseline period, December 2011 (P = .0212), consistent with previous studies. CONCLUSIONS The i2b2 platform can be extended to monitor local impact of PAMA's appropriateness of imaging ordering CDS requirements.
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Affiliation(s)
- Vladimir I Valtchinov
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shawn N Murphy
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,i2b2 tranSMART Foundation, Wakefield, Massachusetts, USA
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikolay Ikonomov
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Bingxue K Zhai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Andriole
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Rousseau
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Dick Hanson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,i2b2 tranSMART Foundation, Wakefield, Massachusetts, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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6
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Svoboda E, Bořil T, Rusz J, Tykalová T, Horáková D, Guttmann CRG, Blagoev KB, Hatabu H, Valtchinov VI. Assessing clinical utility of machine learning and artificial intelligence approaches to analyze speech recordings in multiple sclerosis: A pilot study. Comput Biol Med 2022; 148:105853. [PMID: 35870318 DOI: 10.1016/j.compbiomed.2022.105853] [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: 12/28/2021] [Revised: 04/09/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An early diagnosis together with an accurate disease progression monitoring of multiple sclerosis is an important component of successful disease management. Prior studies have established that multiple sclerosis is correlated with speech discrepancies. Early research using objective acoustic measurements has discovered measurable dysarthria. METHOD The objective was to determine the potential clinical utility of machine learning and deep learning/AI approaches for the aiding of diagnosis, biomarker extraction and progression monitoring of multiple sclerosis using speech recordings. A corpus of 65 MS-positive and 66 healthy individuals reading the same text aloud was used for targeted acoustic feature extraction utilizing automatic phoneme segmentation. A series of binary classification models was trained, tuned, and evaluated regarding their Accuracy and area-under-the-curve. RESULTS The Random Forest model performed best, achieving an Accuracy of 0.82 on the validation dataset and an area-under-the-curve of 0.76 across 5 k-fold cycles on the training dataset. 5 out of 7 acoustic features were statistically significant. CONCLUSION Machine learning and artificial intelligence in automatic analyses of voice recordings for aiding multiple sclerosis diagnosis and progression tracking seems promising. Further clinical validation of these methods and their mapping onto multiple sclerosis progression is needed, as well as a validating utility for English-speaking populations.
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Affiliation(s)
- E Svoboda
- Institute of Formal and Applied Linguistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic; Institute of Phonetics, Faculty of Arts, Charles University, Prague, Czech Republic
| | - T Bořil
- Institute of Phonetics, Faculty of Arts, Charles University, Prague, Czech Republic
| | - J Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic; Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - T Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - D Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - C R G Guttmann
- Center for Neurological Imaging, Brigham & Women's Hospital and Harvard Medical School, USA
| | - K B Blagoev
- Department of Biophysics, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - H Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - V I Valtchinov
- Center for Evidence-Based Imaging, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
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7
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Valtchinov VI, Zhai BK, Hida T, Lacson R, Raja A, Hatabu H, Khorasani R. A Case-control Study of Major Genetic Predisposition Risk Alleles in Developing DDD in the Northeast US Population: Effects of Gene-gene Interactions. Spine (Phila Pa 1976) 2021; 46:1525-1533. [PMID: 33973562 DOI: 10.1097/brs.0000000000004104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case-control study of risk alleles for degenerative disc disease (DDD) using magnetic resonance (MR) imaging for phenotyping. OBJECTIVE We aim to provide the first statistically adequately powered study of the relationship between the presence of common risk alleles and occurrence of DDD in Eastern US population. SUMMARY OF BACKGROUND DATA Many genetic predisposing factors have been identified in elevating the risk of DDD, including common variants in VDR, COL1A1, AGC1, COL9A2/3 genes. METHODS We utilized the Mass General Brigham (MGB) Biobank in which subjects' Medical Record is linked with genotyped data from single-nucleotide polymorphism (SNP) arrays. Subjects with lumbosacral spine MR imaging studies were used to construct the Cases cohort; the Biobank's Controls cohort was used as the Control cohort. Odds ratios (OR) and False-discovery-rate (FDR) q values from multiple-hypotheses-testing corrections were used to assess the likelihood of DDD given occurrence of the listed DDD risk alleles. RESULTS Four-hundred-fourteen subjects (mean age = 64, range = 27 to 94) were Cases and 925 Controls (mean age = 46, range = 21-61). A systematic search has identified 25 SNPs in 18 genes in the SNP arrays. At univariate level, rs1544410 in VDR was significantly associated with DDD for male subjects (odds ratio [OR] = 0.594, P = 0.011). After adjustment for all significant variants and demographics, three predictor variables had a significant association with the outcome, age (OR = 1.130, q < 0.0001), rs143383 (OR = 1.951, q = 0.056), and rs3737821 (OR = 2.701, q = 0.069). A novel variant-to-variant correlation rs143383:rs763110 had a significant adjusted OR = 7.933, q = 0.070). CONCLUSION In this large-scale study of common variants' correlation with the presence of DDD in the Northeast United States, we have found a novel and significant variant-to-variant interaction to be associated with the risk of developing DDD, corroborating and necessitating the inclusion of gene-gene interactions in predictive risk model development for DDD.Level of Evidence: 4.
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Affiliation(s)
- Vladimir I Valtchinov
- Center for Evidence-Based Imaging (CEBI)
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Bingxue K Zhai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tomoyuki Hida
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ronilda Lacson
- Center for Evidence-Based Imaging (CEBI)
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ali Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hiroro Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging (CEBI)
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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8
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Hino T, Hida T, Nishino M, Lu J, Putman RK, Gudmundsson EF, Hata A, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Kamitani T, Jinzaki M, Tomiyama N, Ishigami K, Honda H, San Jose Estepar R, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H. Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study. Eur J Radiol Open 2021; 8:100334. [PMID: 33748349 PMCID: PMC7960545 DOI: 10.1016/j.ejro.2021.100334] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/04/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA). METHODS Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model. RESULTS The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001). CONCLUSION TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Corresponding author.
| | - Tomoyuki Hida
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Junwei Lu
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Rachel K. Putman
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Vladimir I. Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Osamu Honda
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - George R. Washko
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan,Department of Radiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 6608511, Japan
| | - David C. Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - David A. Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201, Kópavogur, Iceland,University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland
| | - Gunnar Gudmundsson
- University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland,Department of Respiratory Medicine, Landspitali University Hospital, Fossvogur 108, Reykjavík, Iceland
| | - Gary M. Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Valtchinov VI, Siegelman J, Zhai BK, Khorasani R, Sodickson A. One size does not fit all: Factors associated with increased frequency of radiation overexposure alerts based on fixed-alert thresholds. Phys Med 2021; 82:79-86. [PMID: 33601164 DOI: 10.1016/j.ejmp.2021.02.003] [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: 09/30/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Quantify the expected rate of CT radiation dose alerts for three body regions using accepted radiation dose benchmarks and assess key determinants of alert frequency. METHODS This IRB-approved retrospective cohort study evaluated consecutive CT examinations performed between July and December 2013 within an academic medical system. CTDIvol x-ray tube output metrics were compared to the body-region-specific benchmark levels, Achievable Doses (AD), Diagnostic Reference Levels (DRL), and Dose Notification Values (DNV). A logistic regression model for the simulated alerts was fit as a function of the independent predictors: scanner, body region, gender, weight, and age. RESULTS For 17,000 exams, the proportion of events triggering alerts increased with patient weight. Significant covariates were scanner, body region, patient weight and patient age (all p < 0.0001). Odds of alert generation for the AD, DRL, and DNV benchmarks increased by 7.6%, 6.6% and 2.9% per kilogram, respectively, and by 0.8%, 1.1% and -2.7% per year of age (all p < 0.0001). Compared to the most highly optimized scanner, odds of alert generation varied by a factor of 595 for AD, 1126 for DRL, and 13 for DNV. CONCLUSION Alert frequency was significantly correlated with weight, age, body region and scanner. Controllable factors include scanner functionality and associated protocol optimization. Patient factors driving alert frequency are predominantly weight, and to a lesser degree, age. Size-agnostic fixed dose thresholds can frequently produce false positive alerts in appropriately performed exams of large patients, while missing opportunities to identify outlier scans of higher-than-expected dose in small patients.
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Affiliation(s)
- Vladimir I Valtchinov
- Center for Evidence-Based Imaging (CEBI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Takeda Pharmaceuticals, Boston, MA, USA
| | - Bingxue K Zhai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging (CEBI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Sodickson
- Center for Evidence-Based Imaging (CEBI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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10
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Hida T, Hata A, Lu J, Valtchinov VI, Hino T, Nishino M, Honda H, Tomiyama N, Christiani DC, Hatabu H. Interstitial lung abnormalities in patients with stage I non-small cell lung cancer are associated with shorter overall survival: the Boston lung cancer study. Cancer Imaging 2021; 21:14. [PMID: 33468255 PMCID: PMC7816399 DOI: 10.1186/s40644-021-00383-w] [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: 05/14/2020] [Accepted: 01/08/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILA) can be detected on computed tomography (CT) in lung cancer patients and have an association with mortality in advanced non-small cell lung cancer (NSCLC) patients. The aim of this study is to demonstrate the significance of ILA for mortality in patients with stage I NSCLC using Boston Lung Cancer Study cohort. METHODS Two hundred and thirty-one patients with stage I NSCLC from 2000 to 2011 were investigated in this retrospective study (median age, 69 years; 93 males, 138 females). ILA was scored on baseline CT scans prior to treatment using a 3-point scale (0 = no evidence of ILA, 1 = equivocal for ILA, 2 = ILA) by a sequential reading method. ILA score 2 was considered the presence of ILA. The difference of overall survival (OS) for patients with different ILA scores were tested via log-rank test and multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) including ILA score, age, sex, smoking status, and treatment as the confounding variables. RESULTS ILA was present in 22 out of 231 patients (9.5%) with stage I NSCLC. The presence of ILA was associated with shorter OS (patients with ILA score 2, median 3.85 years [95% confidence interval (CI): 3.36 - not reached (NR)]; patients with ILA score 0 or 1, median 10.16 years [95%CI: 8.65 - NR]; P < 0.0001). In a Cox proportional hazards model, the presence of ILA remained significant for increased risk for death (HR = 2.88, P = 0.005) after adjusting for age, sex, smoking and treatment. CONCLUSIONS ILA was detected on CT in 9.5% of patients with stage I NSCLC. The presence of ILA was significantly associated with a shorter OS and could be an imaging marker of shorter survival in stage I NSCLC.
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Affiliation(s)
- Tomoyuki Hida
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akinori Hata
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.136593.b0000 0004 0373 3971Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junwei Lu
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Vladimir I. Valtchinov
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Takuya Hino
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuki Nishino
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.65499.370000 0001 2106 9910Department of Imaging, Dana Farber Cancer Institute, Boston, MA USA
| | - Hiroshi Honda
- grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Tomiyama
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David C. Christiani
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA USA ,Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA USA
| | - Hiroto Hatabu
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
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Abstract
Abstract
Currently, high-dimensional data is ubiquitous in data science, which necessitates the development of techniques to decompose and interpret such multidimensional (aka tensor) datasets. Finding a low dimensional representation of the data, that is, its inherent structure, is one of the approaches that can serve to understand the dynamics of low dimensional latent features hidden in the data. Moreover, decomposition methods with non-negative constraints are shown to extract more insightful factors. Nonnegative RESCAL is one such technique, particularly well suited to analyze self-relational data, such as dynamic networks found in international trade flows. Particularly, non-negative RESCAL computes a low dimensional tensor representation by finding the latent space containing multiple modalities. Furthermore, estimating the dimensionality of this latent space is crucial for extracting meaningful latent features. Here, to determine the dimensionality of the latent space with non-negative RESCAL, we propose a latent dimension determination method which is based on clustering of the solutions of multiple realizations of non-negative RESCAL decompositions. We demonstrate the performance of our model selection method on synthetic data. We then apply our method to decompose a network of international trade flows data from International Monetary Fund and shows that with a correct latent dimension determination, the resulting features are able to capture relevant empirical facts from economic literature.
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Hida T, Nishino M, Hino T, Lu J, Putman RK, Gudmundsson EF, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Hata A, Jinzaki M, Tomiyama N, Honda H, Estepar RSJ, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H. Traction Bronchiectasis/Bronchiolectasis is Associated with Interstitial Lung Abnormality Mortality. Eur J Radiol 2020; 129:109073. [PMID: 32480316 DOI: 10.1016/j.ejrad.2020.109073] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/10/2020] [Revised: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA. METHOD The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA. RESULTS The median OS was 12.93 years (95%CI; 12.67 - 13.43) in the subjects without ILA; 11.95 years (10.03 - not reached) in TBI-0 group; 8.52 years (7.57 - 9.30) in TBI-1 group; 7.63 years (6.09 - 9.10) in TBI-2 group; 5.40 years (1.85 - 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status. CONCLUSIONS The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.
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Affiliation(s)
- Tomoyuki Hida
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Junwei Lu
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Rachel K Putman
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Elias F Gudmundsson
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201 Kópavogur, Iceland
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vladimir I Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Osamu Honda
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Akinori Hata
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 8128582, Japan
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - David C Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201 Kópavogur, Iceland; University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101 Reykjavík, Iceland
| | - Gunnar Gudmundsson
- University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101 Reykjavík, Iceland; Department of Respiratory Medicine, Landspitali University Hospital, University of Iceland, Faculty of Medicine, Hringbraut, 101 Reykjavík, Iceland
| | - Gary M Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Palmer NP, Silvester JA, Lee JJ, Beam AL, Fried I, Valtchinov VI, Rahimov F, Kong SW, Ghodoussipour S, Hood HC, Bousvaros A, Grand RJ, Kunkel LM, Kohane IS. Concordance between gene expression in peripheral whole blood and colonic tissue in children with inflammatory bowel disease. PLoS One 2019; 14:e0222952. [PMID: 31618209 PMCID: PMC6795427 DOI: 10.1371/journal.pone.0222952] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022] Open
Abstract
Background Presenting features of inflammatory bowel disease (IBD) are non-specific. We hypothesized that mRNA profiles could (1) identify genes and pathways involved in disease pathogenesis; (2) identify a molecular signature that differentiates IBD from other conditions; (3) provide insight into systemic and colon-specific dysregulation through study of the concordance of the gene expression. Methods Children (8–18 years) were prospectively recruited at the time of diagnostic colonoscopy for possible IBD. We used transcriptome-wide mRNA profiling to study gene expression in colon biopsies and paired whole blood samples. Using blood mRNA measurements, we fit a regression model for disease state prediction that was validated in an independent test set of adult subjects (GSE3365). Results Ninety-eight children were recruited [39 Crohn’s disease, 18 ulcerative colitis, 2 IBDU, 39 non-IBD]. There were 1,118 significantly differentially (IBD vs non-IBD) expressed genes in colon tissue, and 880 in blood. The direction of relative change in expression was concordant for 106/112 genes differentially expressed in both tissue types. The regression model from the blood mRNA measurements distinguished IBD vs non-IBD disease status in the independent test set with 80% accuracy using only 6 genes. The overlap of 5 immune and metabolic pathways in the two tissue types was significant (p<0.001). Conclusions Blood and colon tissue from patients with IBD share a common transcriptional profile dominated by immune and metabolic pathways. Our results suggest that peripheral blood expression levels of as few as 6 genes (IL7R, UBB, TXNIP, S100A8, ALAS2, and SLC2A3) may distinguish patients with IBD from non-IBD.
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Affiliation(s)
- Nathan P. Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jocelyn A. Silvester
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jessica J. Lee
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrew L. Beam
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inbar Fried
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vladimir I. Valtchinov
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Evidence Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Massachusetts, United States of America
| | - Fedik Rahimov
- Division of Genetics and Genomics, Boston Children’s Hospital, Departments of Genetics and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sek Won Kong
- Computational Health Informatics Program, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Saum Ghodoussipour
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Helen C. Hood
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Athos Bousvaros
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richard J. Grand
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Louis M. Kunkel
- Division of Genetics and Genomics, Boston Children’s Hospital, Departments of Genetics and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
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14
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Valtchinov VI, Lacson R, Wang A, Khorasani R. Comparing Artificial Intelligence Approaches to Retrieve Clinical Reports Documenting Implantable Devices Posing MRI Safety Risks. J Am Coll Radiol 2019; 17:272-279. [PMID: 31415740 DOI: 10.1016/j.jacr.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/07/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Assess sensitivity, specificity, and accuracy of two approaches to identify patients with implantable devices that pose safety risks for MRI-an expert-derived approach and an ontology-derived natural language processing (NLP). Determine the proportion of clinical data that identify these implantable devices. METHODS This Institutional Review Board-approved retrospective study was performed at a 793-bed academic hospital. The expert-derived approach used an open-source software with a list of curated terms to query for implantable devices posing high safety risk ("MRI-Red") in patients undergoing MRI. The ontology-derived approach used an NLP system with terms mapped to Systematized Nomenclature of Medicine-Clinical Terms. Queries were performed in three clinical data types-25,000 radiology reports, 174,769 emergency department (ED) notes, and 41,085 other clinical reports (eg, cardiology, operating room, physician notes, radiology reports, pathology reports, patient letters). Sensitivity, specificity, and accuracy of both methods against manual review of a randomly sampled 465 reports were assessed and tested for significant differences between expert-derived and ontology-derived approaches using t test. RESULTS Accuracy, sensitivity, and specificity of expert-versus ontology-derived approaches were similar (0.83 versus 0.91, P = .080; 0.88 versus 0.96, P = .178; 0.82 versus 0.92, P = .110). The proportion of radiology reports, ED notes, and other clinical reports retrieved containing implantable devices with high safety risks for MRI ranged from 1.47% to 1.88%. DISCUSSION Artificial intelligence approaches such as expert-driven NLP and ontology-driven NLP have similar accuracy in identifying patients with implantable devices that pose high safety risks for MRI.
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Affiliation(s)
- Vladimir I Valtchinov
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aijia Wang
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Chen R, Paschalidis IC, Hatabu H, Valtchinov VI, Siegelman J. Detection of unwarranted CT radiation exposure from patient and imaging protocol meta-data using regularized regression. Eur J Radiol Open 2019; 6:206-211. [PMID: 31194104 PMCID: PMC6551377 DOI: 10.1016/j.ejro.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Variability in radiation exposure from CT scans can be appropriate and driven by patient features such as body habitus. Quantitative analysis may be performed to discover instances of unwarranted radiation exposure and to reduce the probability of such occurrences in future patient visits. No universal process to perform identification of outliers is widely available, and access to expertise and resources is variable. OBJECTIVE The goal of this study is to develop an automated outlier detection procedure to identify all scans with an unanticipated high radiation exposure, given the characteristics of the patient and the type of the exam. MATERIALS AND METHODS This Institutional Review Board-approved retrospective cohort study was conducted from June 30, 2012 - December 31, 2013 in a quaternary academic medical center. The de-identified dataset contained 28 fields for 189,959 CT exams. We applied the variable selection method Least Absolute Shrinkage and Selection Operator (LASSO) to select important variables for predicting CT radiation dose. We then employed a regression approach that is robust to outliers, to learn from data a predictive model of CT radiation doses given important variables identified by LASSO. Patient visits whose predicted radiation dose was statistically different from the radiation dose actually received were identified as outliers. RESULTS Our methodology identified 1% of CT exams as outliers. The top-5 predictors discovered by LASSO and strongly correlated with radiation dose were Tube Current, kVp, Weight, Width of collimator, and Reference milliampere-seconds. A human expert validation of the outlier detection algorithm has yielded specificity of 0.85 [95% CI 0.78-0.92] and sensitivity of 0.91 [95% CI 0.85-0.97] (PPV = 0.84, NPV = 0.92). These values substantially outperform alternative methods we tested (F1 score 0.88 for our method against 0.51 for the alternatives). CONCLUSION The study developed and tested a novel, automated method for processing CT scanner meta-data to identify CT exams where patients received an unwarranted amount of radiation. Radiation safety and protocol review committees may use this technique to uncover systemic issues and reduce future incidents.
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Affiliation(s)
- Ruidi Chen
- Department of Biomedical Engineering, Boston University, United States
- Department of Electrical and Computer Engineering, Boston University, 8 St. Mary’s Street, Boston, MA 02215, USA
| | - Ioannis Ch. Paschalidis
- Department of Biomedical Engineering, Boston University, United States
- Department of Electrical and Computer Engineering, Boston University, 8 St. Mary’s Street, Boston, MA 02215, USA
| | - Hiroto Hatabu
- Center for Evidence-Based Imaging (CEBI), Brigham and Women’s Hospital, United States
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, United States
| | - Vladimir I. Valtchinov
- Center for Evidence-Based Imaging (CEBI), Brigham and Women’s Hospital, United States
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, United States
- Department of Biomedical Informatics, Harvard Medical School, United States
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16
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Rousseau JF, Ip IK, Raja AS, Valtchinov VI, Cochon L, Schuur JD, Khorasani R. Can Automated Retrieval of Data from Emergency Department Physician Notes Enhance the Imaging Order Entry Process? Appl Clin Inform 2019; 10:189-198. [PMID: 30895573 PMCID: PMC6426724 DOI: 10.1055/s-0039-1679927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND When a paucity of clinical information is communicated from ordering physicians to radiologists at the time of radiology order entry, suboptimal imaging interpretations and patient care may result. OBJECTIVES Compare documentation of relevant clinical information in electronic health record (EHR) provider note to computed tomography (CT) order requisition, prior to ordering of head CT for emergency department (ED) patients presenting with headache. METHODS In this institutional review board-approved retrospective observational study performed between April 1, 2013 and September 30, 2014 at an adult quaternary academic hospital, we reviewed data from 666 consecutive ED encounters for patients with headaches who received head CT. The primary outcome was the number of concept unique identifiers (CUIs) relating to headache extracted via ontology-based natural language processing from the history of present illness (HPI) section in ED notes compared with the number of concepts obtained from the imaging order requisition. RESULTS Our analysis was conducted on cases where the HPI note section was completed prior to image order entry, which occurred in 23.1% (154/666) of encounters. For these 154 encounters, the number of CUIs specific to headache per note extracted from the HPI (median = 3, interquartile range [IQR]: 2-4) was significantly greater than the number of CUIs per encounter obtained from the imaging order requisition (median = 1, IQR: 1-2; Wilcoxon signed rank p < 0.0001). Extracted concepts from notes were distinct from order requisition indications in 92.9% (143/154) of cases. CONCLUSION EHR provider notes are a valuable source of relevant clinical information at the time of imaging test ordering. Automated extraction of clinical information from notes to prepopulate imaging order requisitions may improve communication between ordering physicians and radiologists, enhance efficiency of ordering process by reducing redundant data entry, and may help improve clinical relevance of clinical decision support at the time of order entry, potentially reducing provider burnout from extraneous alerts.
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Affiliation(s)
- Justin F Rousseau
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Population Health, Dell Medical School, Austin, Texas, United States.,Department of Neurology, Dell Medical School, Austin, Texas, United States
| | - Ivan K Ip
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ali S Raja
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Vladimir I Valtchinov
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States
| | - Laila Cochon
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract
Motivation: We investigate and quantify the generalizability of the white blood cell (WBC) transcriptome to the general, multiorgan transcriptome. We use data from the NCBI's Gene Expression Omnibus (GEO) public repository to define two datasets for comparison, WBC and OO (Other Organ) sets. Results: Comprehensive pair-wise correlation and expression level profiles are calculated for both datasets (with sizes of 81 and 1463, respectively). We have used mapping and ranking across the Gene Ontology (GO) categories to quantify similarity between the two sets. GO mappings of the most correlated and highly expressed genes from the two datasets tightly match, with the notable exceptions of components of the ribosome, cell adhesion and immune response. That is, 10 877 or 48.8% of all measured genes do not change >10% of rank range between WBC and OO; only 878 (3.9%) change rank >50%. Two trans-tissue gene lists are defined, the most changing and the least changing genes in expression rank. We also provide a general, quantitative measure of the probability of expression rank and correlation profile in the OO system given the expression rank and correlation profile in the WBC dataset. Contact:vvaltchinov@partners.org Supplementary information:Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Isaac S Kohane
- National Center for Biomedical Computing Informatics for Integrating Biology and the Bedside (i2b2), Boston, MA 02115, USA
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