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Frank RA, Salameh JP, Islam N, Yang B, Murad MH, Mustafa R, Leeflang M, Bossuyt PM, Takwoingi Y, Whiting P, Dawit H, Kang SK, Ebrahimzadeh S, Levis B, Hutton B, McInnes MDF. How to Critically Appraise and Interpret Systematic Reviews and Meta-Analyses of Diagnostic Accuracy: A User Guide. Radiology 2023; 307:e221437. [PMID: 36916896 PMCID: PMC10140638 DOI: 10.1148/radiol.221437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 03/16/2023]
Abstract
Systematic reviews of diagnostic accuracy studies can provide the best available evidence to inform decisions regarding the use of a diagnostic test. In this guide, the authors provide a practical approach for clinicians to appraise diagnostic accuracy systematic reviews and apply their results to patient care. The first step is to identify an appropriate systematic review with a research question matching the clinical scenario. The user should evaluate the rigor of the review methods to evaluate its credibility (Did the review use clearly defined eligibility criteria, a comprehensive search strategy, structured data collection, risk of bias and applicability appraisal, and appropriate meta-analysis methods?). If the review is credible, the next step is to decide whether the diagnostic performance is adequate for clinical use (Do sensitivity and specificity estimates exceed the threshold that makes them useful in clinical practice? Are these estimates sufficiently precise? Is variability in the estimates of diagnostic accuracy across studies explained?). Diagnostic accuracy systematic reviews that are judged to be credible and provide diagnostic accuracy estimates with sufficient certainty and relevance are the most useful to inform patient care. This review discusses comparative, noncomparative, and emerging approaches to systematic reviews of diagnostic accuracy using a clinical scenario and examples based on recent publications.
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Affiliation(s)
| | | | - Nayaar Islam
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Bada Yang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Mohammad Hassan Murad
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Reem Mustafa
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Mariska Leeflang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Patrick M. Bossuyt
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Yemisi Takwoingi
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Penny Whiting
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Haben Dawit
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Stella K. Kang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Sanam Ebrahimzadeh
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Brooke Levis
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Brian Hutton
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Matthew D. F. McInnes
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
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