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Xu K, Khan MS, Li TZ, Gao R, Terry JG, Huo Y, Lasko TA, Carr JJ, Maldonado F, Landman BA, Sandler KL. AI Body Composition in Lung Cancer Screening: Added Value Beyond Lung Cancer Detection. Radiology 2023; 308:e222937. [PMID: 37489991 PMCID: PMC10374937 DOI: 10.1148/radiol.222937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/26/2023]
Abstract
Background An artificial intelligence (AI) algorithm has been developed for fully automated body composition assessment of lung cancer screening noncontrast low-dose CT of the chest (LDCT) scans, but the utility of these measurements in disease risk prediction models has not been assessed. Purpose To evaluate the added value of CT-based AI-derived body composition measurements in risk prediction of lung cancer incidence, lung cancer death, cardiovascular disease (CVD) death, and all-cause mortality in the National Lung Screening Trial (NLST). Materials and Methods In this secondary analysis of the NLST, body composition measurements, including area and attenuation attributes of skeletal muscle and subcutaneous adipose tissue, were derived from baseline LDCT examinations by using a previously developed AI algorithm. The added value of these measurements was assessed with sex- and cause-specific Cox proportional hazards models with and without the AI-derived body composition measurements for predicting lung cancer incidence, lung cancer death, CVD death, and all-cause mortality. Models were adjusted for confounding variables including age; body mass index; quantitative emphysema; coronary artery calcification; history of diabetes, heart disease, hypertension, and stroke; and other PLCOM2012 lung cancer risk factors. Goodness-of-fit improvements were assessed with the likelihood ratio test. Results Among 20 768 included participants (median age, 61 years [IQR, 57-65 years]; 12 317 men), 865 were diagnosed with lung cancer and 4180 died during follow-up. Including the AI-derived body composition measurements improved risk prediction for lung cancer death (male participants: χ2 = 23.09, P < .001; female participants: χ2 = 15.04, P = .002), CVD death (males: χ2 = 69.94, P < .001; females: χ2 = 16.60, P < .001), and all-cause mortality (males: χ2 = 248.13, P < .001; females: χ2 = 94.54, P < .001), but not for lung cancer incidence (male participants: χ2 = 2.53, P = .11; female participants: χ2 = 1.73, P = .19). Conclusion The body composition measurements automatically derived from baseline low-dose CT examinations added predictive value for lung cancer death, CVD death, and all-cause death, but not for lung cancer incidence in the NLST. Clinical trial registration no. NCT00047385 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Fintelmann in this issue.
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Affiliation(s)
- Kaiwen Xu
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Mirza S. Khan
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Thomas Z. Li
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Riqiang Gao
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - James G. Terry
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Yuankai Huo
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Thomas A. Lasko
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - John Jeffrey Carr
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Fabien Maldonado
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Bennett A. Landman
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Kim L. Sandler
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
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2
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Singh R, Kalra MK, Homayounieh F, Nitiwarangkul C, McDermott S, Little BP, Lennes IT, Shepard JAO, Digumarthy SR. Artificial intelligence-based vessel suppression for detection of sub-solid nodules in lung cancer screening computed tomography. Quant Imaging Med Surg 2021; 11:1134-1143. [PMID: 33816155 DOI: 10.21037/qims-20-630] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Lung cancer screening (LCS) with low-dose computed tomography (LDCT) helps early lung cancer detection, commonly presenting as small pulmonary nodules. Artificial intelligence (AI)-based vessel suppression (AI-VS) and automatic detection (AI-AD) algorithm can improve detection of subsolid nodules (SSNs) on LDCT. We assessed the impact of AI-VS and AI-AD in detection and classification of SSNs [ground-glass nodules (GGNs) and part-solid nodules (PSNs)], on LDCT performed for LCS. Methods Following regulatory approval, 123 LDCT examinations with sub-solid pulmonary nodules (average diameter ≥6 mm) were processed to generate three image series for each examination-unprocessed, AI-VS, and AI-AD series with annotated lung nodules. Two thoracic radiologists in consensus formed the standard of reference (SOR) for this study. Two other thoracic radiologists (R1 and R2; 5 and 10 years of experience in thoracic CT image interpretation) independently assessed the unprocessed images alone, then together with AI-VS series, and finally with AI-AD for detecting all ≥6 mm GGN and PSN. We performed receiver operator characteristics (ROC) and Cohen's Kappa analyses for statistical analyses. Results On unprocessed images, R1 and R2 detected 232/310 nodules (R1: 114 GGN, 118 PSN) and 255/310 nodules (R2: 122 GGN, 133 PSN), respectively (P>0.05). On AI-VS images, they detected 249/310 nodules (119 GGN, 130 PSN) and 277/310 nodules (128 GGN, 149 PSN), respectively (P≥0.12). When compared to the SOR, accuracy (AUC) for detection of PSN on the AI-VS images (AUC 0.80-0.81) was greater than on the unprocessed images (AUC 0.70-0.76). AI-VS images enabled detection of solid components in five nodules deemed as GGN on the unprocessed images. Accuracy of AI-AD was lower than both the radiologists (AUC 0.60-0.72). Conclusions AI-VS improved the detection and classification of SSN into GGN and PSN on LDCT of the chest for the two radiologist (R1 and R2) readers.
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Affiliation(s)
- Ramandeep Singh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Fatemeh Homayounieh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Chayanin Nitiwarangkul
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brent P Little
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Inga T Lennes
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Division of Thoracic Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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4
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Gazourian L, Durgana CS, Huntley D, Rizzo GS, Thedinger WB, Regis SM, Price LL, Pagura EJ, Lamb C, Rieger-Christ K, Thomson CC, Stefanescu CF, Sanayei A, Long WP, McKee AB, Washko GR, Estépar RSJ, Wald C, Liesching TN, McKee BJ. Quantitative Pectoralis Muscle Area is Associated with the Development of Lung Cancer in a Large Lung Cancer Screening Cohort. Lung 2020; 198:847-853. [PMID: 32889594 DOI: 10.1007/s00408-020-00388-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies have demonstrated an inverse relationship between body mass index (BMI) and the risk of developing lung cancer. We conducted a retrospective cohort study evaluating baseline quantitative computed tomography (CT) measurements of body composition, specifically muscle and fat area in a large CT lung screening cohort (CTLS). We hypothesized that quantitative measurements of baseline body composition may aid in risk stratification for lung cancer. METHODS Patients who underwent baseline CTLS between January 1st, 2012 and September 30th, 2014 and who had an in-network primary care physician were included. All patients met NCCN Guidelines eligibility criteria for CTLS. Quantitative measurements of pectoralis muscle area (PMA) and subcutaneous fat area (SFA) were performed on a single axial slice of the CT above the aortic arch with the Chest Imaging Platform Workstation software. Cox multivariable proportional hazards model for cancer was adjusted for variables with a univariate p < 0.2. Data were dichotomized by sex and then combined to account for baseline differences between sexes. RESULTS One thousand six hundred and ninety six patients were included in this study. A total of 79 (4.7%) patients developed lung cancer. There was an association between the 25th percentile of PMA and the development of lung cancer [HR 1.71 (1.07, 2.75), p < 0.025] after adjusting for age, BMI, qualitative emphysema, qualitative coronary artery calcification, and baseline Lung-RADS® score. CONCLUSIONS Quantitative assessment of PMA on baseline CTLS was associated with the development of lung cancer. Quantitative PMA has the potential to be incorporated as a variable in future lung cancer risk models.
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Affiliation(s)
- Lee Gazourian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
| | | | | | | | | | - Shawn M Regis
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA.,Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - Elizabeth J Pagura
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Carla Lamb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Kimberly Rieger-Christ
- Cancer Research, Sophia Gordon Cancer Center, Lahey Hospital & Medical Center, Burlington, USA
| | - Carey C Thomson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Auburn Hospital, Cambridge, USA.,Harvard Medical School, Boston, USA
| | | | - Ava Sanayei
- Tufts University School of Medicine, Boston, USA
| | | | - Andrea B McKee
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, USA.,Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Raul San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, USA
| | - Timothy N Liesching
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Brady J McKee
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, USA
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