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Kiraly AP, Cunningham CA, Najafi R, Nabulsi Z, Yang J, Lau C, Ledsam JR, Ye W, Ardila D, McKinney SM, Pilgrim R, Liu Y, Saito H, Shimamura Y, Etemadi M, Melnick D, Jansen S, Corrado GS, Peng L, Tse D, Shetty S, Prabhakara S, Nadich DP, Beladia N, Eswaran K. Assistive AI in Lung Cancer Screening: A Retrospective Multinational Study in the United States and Japan. Radiol Artif Intell 2024; 6:e230079. [PMID: 38477661 PMCID: PMC11140517 DOI: 10.1148/ryai.230079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/07/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Purpose To evaluate the impact of an artificial intelligence (AI) assistant for lung cancer screening on multinational clinical workflows. Materials and Methods An AI assistant for lung cancer screening was evaluated on two retrospective randomized multireader multicase studies where 627 (141 cancer-positive cases) low-dose chest CT cases were each read twice (with and without AI assistance) by experienced thoracic radiologists (six U.S.-based or six Japan-based radiologists), resulting in a total of 7524 interpretations. Positive cases were defined as those within 2 years before a pathology-confirmed lung cancer diagnosis. Negative cases were defined as those without any subsequent cancer diagnosis for at least 2 years and were enriched for a spectrum of diverse nodules. The studies measured the readers' level of suspicion (on a 0-100 scale), country-specific screening system scoring categories, and management recommendations. Evaluation metrics included the area under the receiver operating characteristic curve (AUC) for level of suspicion and sensitivity and specificity of recall recommendations. Results With AI assistance, the radiologists' AUC increased by 0.023 (0.70 to 0.72; P = .02) for the U.S. study and by 0.023 (0.93 to 0.96; P = .18) for the Japan study. Scoring system specificity for actionable findings increased 5.5% (57% to 63%; P < .001) for the U.S. study and 6.7% (23% to 30%; P < .001) for the Japan study. There was no evidence of a difference in corresponding sensitivity between unassisted and AI-assisted reads for the U.S. (67.3% to 67.5%; P = .88) and Japan (98% to 100%; P > .99) studies. Corresponding stand-alone AI AUC system performance was 0.75 (95% CI: 0.70, 0.81) and 0.88 (95% CI: 0.78, 0.97) for the U.S.- and Japan-based datasets, respectively. Conclusion The concurrent AI interface improved lung cancer screening specificity in both U.S.- and Japan-based reader studies, meriting further study in additional international screening environments. Keywords: Assistive Artificial Intelligence, Lung Cancer Screening, CT Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Atilla P. Kiraly
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Corbin A. Cunningham
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Ryan Najafi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Zaid Nabulsi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Jie Yang
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Charles Lau
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Joseph R. Ledsam
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Wenxing Ye
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Diego Ardila
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Scott M. McKinney
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Rory Pilgrim
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Yun Liu
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Hiroaki Saito
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Yasuteru Shimamura
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Mozziyar Etemadi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - David Melnick
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Sunny Jansen
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Greg S. Corrado
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Lily Peng
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Daniel Tse
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Shravya Shetty
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Shruthi Prabhakara
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - David P. Nadich
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Neeral Beladia
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Krish Eswaran
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
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