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Moslemi A, Osapoetra LO, Dasgupta A, Alberico D, Trudeau M, Gandhi S, Eisen A, Wright F, Look-Hong N, Curpen B, Kolios MC, Czarnota GJ. Apriori prediction of chemotherapy response in locally advanced breast cancer patients using CT imaging and deep learning: transformer versus transfer learning. Front Oncol 2024; 14:1359148. [PMID: 38756659 PMCID: PMC11096486 DOI: 10.3389/fonc.2024.1359148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objective Neoadjuvant chemotherapy (NAC) is a key element of treatment for locally advanced breast cancer (LABC). Predicting the response to NAC for patients with Locally Advanced Breast Cancer (LABC) before treatment initiation could be beneficial to optimize therapy, ensuring the administration of effective treatments. The objective of the work here was to develop a predictive model to predict tumor response to NAC for LABC using deep learning networks and computed tomography (CT). Materials and methods Several deep learning approaches were investigated including ViT transformer and VGG16, VGG19, ResNet-50, Res-Net-101, Res-Net-152, InceptionV3 and Xception transfer learning networks. These deep learning networks were applied on CT images to assess the response to NAC. Performance was evaluated based on balanced_accuracy, accuracy, sensitivity and specificity classification metrics. A ViT transformer was applied to utilize the attention mechanism in order to increase the weight of important part image which leads to better discrimination between classes. Results Amongst the 117 LABC patients studied, 82 (70%) had clinical-pathological response and 35 (30%) had no response to NAC. The ViT transformer obtained the best performance range (accuracy = 71 ± 3% to accuracy = 77 ± 4%, specificity = 86 ± 6% to specificity = 76 ± 3%, sensitivity = 56 ± 4% to sensitivity = 52 ± 4%, and balanced_accuracy=69 ± 3% to balanced_accuracy=69 ± 3%) depending on the split ratio of train-data and test-data. Xception network obtained the second best results (accuracy = 72 ± 4% to accuracy = 65 ± 4, specificity = 81 ± 6% to specificity = 73 ± 3%, sensitivity = 55 ± 4% to sensitivity = 52 ± 5%, and balanced_accuracy = 66 ± 5% to balanced_accuracy = 60 ± 4%). The worst results were obtained using VGG-16 transfer learning network. Conclusion Deep learning networks in conjunction with CT imaging are able to predict the tumor response to NAC for patients with LABC prior to start. A ViT transformer could obtain the best performance, which demonstrated the importance of attention mechanism.
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Affiliation(s)
- Amir Moslemi
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Archya Dasgupta
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - David Alberico
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Maureen Trudeau
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonal Gandhi
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances Wright
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nicole Look-Hong
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael C. Kolios
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Gregory J. Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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9
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DĂaz AA, Nardelli P, Wang W, San JosĂ© EstĂ©par R, Yen A, Kligerman S, Maselli DJ, Dolliver WR, Tsao A, Orejas JL, Aliberti S, Aksamit TR, Young KA, Kinney GL, Washko GR, Silverman EK, San JosĂ© EstĂ©par R. Artificial Intelligence-based CT Assessment of Bronchiectasis: The COPDGene Study. Radiology 2023; 307:e221109. [PMID: 36511808 PMCID: PMC10068886 DOI: 10.1148/radiol.221109] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Background CT is the standard method used to assess bronchiectasis. A higher airway-to-artery diameter ratio (AAR) is typically used to identify enlarged bronchi and bronchiectasis; however, current imaging methods are limited in assessing the extent of this metric in CT scans. Purpose To determine the extent of AARs using an artificial intelligence-based chest CT and assess the association of AARs with exacerbations over time. Materials and Methods In a secondary analysis of ever-smokers from the prospective, observational, multicenter COPDGene study, AARs were quantified using an artificial intelligence tool. The percentage of airways with AAR greater than 1 (a measure of airway dilatation) in each participant on chest CT scans was determined. Pulmonary exacerbations were prospectively determined through biannual follow-up (from July 2009 to September 2021). Multivariable zero-inflated regression models were used to assess the association between the percentage of airways with AAR greater than 1 and the total number of pulmonary exacerbations over follow-up. Covariates included demographics, lung function, and conventional CT parameters. Results Among 4192 participants (median age, 59 years; IQR, 52-67 years; 1878 men [45%]), 1834 had chronic obstructive pulmonary disease (COPD). During a 10-year follow-up and in adjusted models, the percentage of airways with AARs greater than 1 (quartile 4 vs 1) was associated with a higher total number of exacerbations (risk ratio [RR], 1.08; 95% CI: 1.02, 1.15; P = .01). In participants meeting clinical and imaging criteria of bronchiectasis (ie, clinical manifestations with ≥3% of AARs >1) versus those who did not, the RR was 1.37 (95% CI: 1.31, 1.43; P < .001). Among participants with COPD, the corresponding RRs were 1.10 (95% CI: 1.02, 1.18; P = .02) and 1.32 (95% CI: 1.26, 1.39; P < .001), respectively. Conclusion In ever-smokers with chronic obstructive pulmonary disease, artificial intelligence-based CT measures of bronchiectasis were associated with more exacerbations over time. Clinical trial registration no. NCT00608764 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Schiebler and Seo in this issue.
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Affiliation(s)
- Alejandro A. DĂaz
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Pietro Nardelli
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Wei Wang
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Rubén San José Estépar
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Andrew Yen
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Seth Kligerman
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Diego J. Maselli
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Wojciech R. Dolliver
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Andrew Tsao
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - José L. Orejas
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Stefano Aliberti
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Timothy R. Aksamit
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Kendra A. Young
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Gregory L. Kinney
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Edwin K. Silverman
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
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