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<meta name="DC.Title" content="Deep Learning-Based ASPECTS Algorithm Enhances Reader Performance and Reduces Interpretation Time" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8491" />
<meta name="DC.Date" content="2024-09-10" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: ASPECTS is a long-standing and well documented selection criteria for acute ischemic stroke treatment, however, the interpretation of ASPECTS is a challenging and time-consuming task for physicians with significant interobserver variabilities. We conducted a multi-reader, multi-case study in which readers assessed ASPECTS without and with the support of a deep learning (DL)-based algorithm in order to analyze the impact of the software on clinicians' performance and interpretation time.

MATERIALS AND METHODS: A total of 200 NCCT scans from 5 clinical sites (27 scanner models, 4 different vendors) were retrospectively collected. Reference standard was established through the consensus of three expert neuroradiologists who had access to baseline CTA and CTP data. Subsequently, eight additional clinicians (four typical ASPECTS reader and four senior neuroradiologists) analyzed the NCCT scans without and with the assistance of CINA-ASPECTS (Avicenna.AI, La Ciotat, France), a DLbased FDA-cleared and CE-marked algorithm designed to automatically compute ASPECTS. Differences were evaluated in both performance and interpretation time between the assisted and unassisted assessments.

RESULTS: With software aid, readers demonstrated increased region-based accuracy from 72.4% to 76.5% (p&lt;0.05), and increased ROC AUC from 0.749 to 0.788 (p&lt;0.05). Notably, all readers exhibited an improved ROC AUC when utilizing the software. Moreover, use of the algorithm improved the score-based inter-observer reliability and correlation coefficient of ASPECTS evaluation by 0.222 and 0.087 (p&lt;0.0001), respectively. Additionally, the readers’ mean time spent analyzing a case was significantly reduced by 6% (p&lt;0.05) when aided by the algorithm.

CONCLUSIONS: With the assistance of the algorithm, readers' analyses were not only more accurate but also faster. Additionally, the overall ASPECTS evaluation exhibited greater consistency, less variabilities and higher precision compared to the reference standard. This novel tool has the potential to enhance patient selection for appropriate treatment by enabling physicians to deliver accurate and timely diagnosis of acute ischemic stroke.

ABBREVIATIONS: ASPECTS = Alberta Stroke Program Early Computed Tomography Score; DL = Deep Learning; EIC = Early Ischemic Changes; ICC = Intraclass Correlation Coefficient; IS = Ischemic Stroke; ROC AUC = Receiver Operating Characteristics Area Under the Curve." />
<meta name="DC.Contributor" content="Angela Ayobi" />
<meta name="DC.Contributor" content="Adam Davis" />
<meta name="DC.Contributor" content="Peter D Chang" />
<meta name="DC.Contributor" content="Daniel S Chow" />
<meta name="DC.Contributor" content="Kambiz Nael" />
<meta name="DC.Contributor" content="Maxime Tassy" />
<meta name="DC.Contributor" content="Sarah Quenet" />
<meta name="DC.Contributor" content="Sylvain Fogola" />
<meta name="DC.Contributor" content="Peter Shabe" />
<meta name="DC.Contributor" content="David Fussell" />
<meta name="DC.Contributor" content="Christophe Avare" />
<meta name="DC.Contributor" content="Yasmina Chaibi" />
<meta name="article:published_time" content="2024-09-10" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Deep Learning-Based ASPECTS Algorithm Enhances Reader Performance and Reduces Interpretation Time" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;ASPECTS is a long-standing and well documented selection criteria for acute ischemic stroke treatment, however, the interpretation of ASPECTS is a challenging and time-consuming task for physicians with significant interobserver variabilities. We conducted a multi-reader, multi-case study in which readers assessed ASPECTS without and with the support of a deep learning (DL)-based algorithm in order to analyze the impact of the software on clinicians9 performance and interpretation time.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A total of 200 NCCT scans from 5 clinical sites (27 scanner models, 4 different vendors) were retrospectively collected. Reference standard was established through the consensus of three expert neuroradiologists who had access to baseline CTA and CTP data. Subsequently, eight additional clinicians (four typical ASPECTS reader and four senior neuroradiologists) analyzed the NCCT scans without and with the assistance of CINA-ASPECTS (Avicenna.AI, La Ciotat, France), a DLbased FDA-cleared and CE-marked algorithm designed to automatically compute ASPECTS. Differences were evaluated in both performance and interpretation time between the assisted and unassisted assessments.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;With software aid, readers demonstrated increased region-based accuracy from 72.4% to 76.5% (p&amp;lt;0.05), and increased ROC AUC from 0.749 to 0.788 (p&amp;lt;0.05). Notably, all readers exhibited an improved ROC AUC when utilizing the software. Moreover, use of the algorithm improved the score-based inter-observer reliability and correlation coefficient of ASPECTS evaluation by 0.222 and 0.087 (p&amp;lt;0.0001), respectively. Additionally, the readers’ mean time spent analyzing a case was significantly reduced by 6% (p&amp;lt;0.05) when aided by the algorithm.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;With the assistance of the algorithm, readers9 analyses were not only more accurate but also faster. Additionally, the overall ASPECTS evaluation exhibited greater consistency, less variabilities and higher precision compared to the reference standard. This novel tool has the potential to enhance patient selection for appropriate treatment by enabling physicians to deliver accurate and timely diagnosis of acute ischemic stroke.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: ASPECTS = Alberta Stroke Program Early Computed Tomography Score; DL = Deep Learning; EIC = Early Ischemic Changes; ICC = Intraclass Correlation Coefficient; IS = Ischemic Stroke; ROC AUC = Receiver Operating Characteristics Area Under the Curve.&lt;/p&gt;" />
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<meta name="citation_author_institution" content="From the Departments of Clinical Affairs and Research &amp; Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA." />
<meta name="citation_author" content="Yasmina Chaibi" />
<meta name="citation_author_institution" content="From the Departments of Clinical Affairs and Research &amp; Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA." />
<meta name="twitter:title" content="Deep Learning-Based ASPECTS Algorithm Enhances Reader Performance and Reduces Interpretation Time" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: ASPECTS is a long-standing and well documented selection criteria for acute ischemic stroke treatment, however, the interpretation of ASPECTS is a challenging and time-consuming task for physicians with significant interobserver variabilities. We conducted a multi-reader, multi-case study in which readers assessed ASPECTS without and with the support of a deep learning (DL)-based algorithm in order to analyze the impact of the software on clinicians' performance and interpretation time.

MATERIALS AND METHODS: A total of 200 NCCT scans from 5 clinical sites (27 scanner models, 4 different vendors) were retrospectively collected. Reference standard was established through the consensus of three expert neuroradiologists who had access to baseline CTA and CTP data. Subsequently, eight additional clinicians (four typical ASPECTS reader and four senior neuroradiologists) analyzed the NCCT scans without and with the assistance of CINA-ASPECTS (Avicenna.AI, La Ciotat, France), a DLbased FDA-cleared and CE-marked algorithm designed to automatically compute ASPECTS. Differences were evaluated in both performance and interpretation time between the assisted and unassisted assessments.

RESULTS: With software aid, readers demonstrated increased region-based accuracy from 72.4% to 76.5% (p&lt;0.05), and increased ROC AUC from 0.749 to 0.788 (p&lt;0.05). Notably, all readers exhibited an improved ROC AUC when utilizing the software. Moreover, use of the algorithm improved the score-based inter-observer reliability and correlation coefficient of ASPECTS evaluation by 0.222 and 0.087 (p&lt;0.0001), respectively. Additionally, the readers’ mean time spent analyzing a case was significantly reduced by 6% (p&lt;0.05) when aided by the algorithm.

CONCLUSIONS: With the assistance of the algorithm, readers' analyses were not only more accurate but also faster. Additionally, the overall ASPECTS evaluation exhibited greater consistency, less variabilities and higher precision compared to the reference standard. This novel tool has the potential to enhance patient selection for appropriate treatment by enabling physicians to deliver accurate and timely diagnosis of acute ischemic stroke.

ABBREVIATIONS: ASPECTS = Alberta Stroke Program Early Computed Tomography Score; DL = Deep Learning; EIC = Early Ischemic Changes; ICC = Intraclass Correlation Coefficient; IS = Ischemic Stroke; ROC AUC = Receiver Operating Characteristics Area Under the Curve." />
<meta name="og-title" property="og:title" content="Deep Learning-Based ASPECTS Algorithm Enhances Reader Performance and Reduces Interpretation Time" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/09/10/ajnr.A8491" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: ASPECTS is a long-standing and well documented selection criteria for acute ischemic stroke treatment, however, the interpretation of ASPECTS is a challenging and time-consuming task for physicians with significant interobserver variabilities. We conducted a multi-reader, multi-case study in which readers assessed ASPECTS without and with the support of a deep learning (DL)-based algorithm in order to analyze the impact of the software on clinicians' performance and interpretation time.

MATERIALS AND METHODS: A total of 200 NCCT scans from 5 clinical sites (27 scanner models, 4 different vendors) were retrospectively collected. Reference standard was established through the consensus of three expert neuroradiologists who had access to baseline CTA and CTP data. Subsequently, eight additional clinicians (four typical ASPECTS reader and four senior neuroradiologists) analyzed the NCCT scans without and with the assistance of CINA-ASPECTS (Avicenna.AI, La Ciotat, France), a DLbased FDA-cleared and CE-marked algorithm designed to automatically compute ASPECTS. Differences were evaluated in both performance and interpretation time between the assisted and unassisted assessments.

RESULTS: With software aid, readers demonstrated increased region-based accuracy from 72.4% to 76.5% (p&lt;0.05), and increased ROC AUC from 0.749 to 0.788 (p&lt;0.05). Notably, all readers exhibited an improved ROC AUC when utilizing the software. Moreover, use of the algorithm improved the score-based inter-observer reliability and correlation coefficient of ASPECTS evaluation by 0.222 and 0.087 (p&lt;0.0001), respectively. Additionally, the readers’ mean time spent analyzing a case was significantly reduced by 6% (p&lt;0.05) when aided by the algorithm.

CONCLUSIONS: With the assistance of the algorithm, readers' analyses were not only more accurate but also faster. Additionally, the overall ASPECTS evaluation exhibited greater consistency, less variabilities and higher precision compared to the reference standard. This novel tool has the potential to enhance patient selection for appropriate treatment by enabling physicians to deliver accurate and timely diagnosis of acute ischemic stroke.

ABBREVIATIONS: ASPECTS = Alberta Stroke Program Early Computed Tomography Score; DL = Deep Learning; EIC = Early Ischemic Changes; ICC = Intraclass Correlation Coefficient; IS = Ischemic Stroke; ROC AUC = Receiver Operating Characteristics Area Under the Curve." />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node110484--7" data-node-nid="110484" id="top-node-110484--81640165468" data-pisa="ajnr;ajnr.A8491v1" data-pisa-master="ajnr;ajnr.A8491" data-apath="/ajnr/early/2024/09/10/ajnr.A8491.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ORIGINAL RESEARCH</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A8491" data-atom-uri="/ajnr/early/2024/09/10/ajnr.A8491.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Deep Learning-Based ASPECTS Algorithm Enhances Reader Performance and Reduces Interpretation Time</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Angela Ayobi</span>, <span class="highwire-citation-author" data-delta="1">Adam Davis</span>, <span class="highwire-citation-author" data-delta="2">Peter D Chang</span>, <span class="highwire-citation-author" data-delta="3">Daniel S Chow</span>, <span class="highwire-citation-author" data-delta="4">Kambiz Nael</span>, <span class="highwire-citation-author" data-delta="5">Maxime Tassy</span>, <span class="highwire-citation-author" data-delta="6">Sarah Quenet</span>, <span class="highwire-citation-author" data-delta="7">Sylvain Fogola</span>, <span class="highwire-citation-author" data-delta="8">Peter Shabe</span>, <span class="highwire-citation-author" data-delta="9">David Fussell</span>, <span class="highwire-citation-author" data-delta="10">Christophe Avare</span> and <span class="highwire-citation-author" data-delta="11">Yasmina Chaibi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8491; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8491 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-110484--81640165468" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Angela Ayobi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Angela%2BAyobi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ayobi%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAngela%2BAyobi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Adam Davis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Adam%2BDavis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Davis%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAdam%2BDavis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Peter D Chang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Peter%2BD%2BChang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chang%20PD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APeter%2BD%2BChang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Daniel S Chow </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Daniel%2BS%2BChow%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chow%20DS&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADaniel%2BS%2BChow%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Kambiz Nael </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Kambiz%2BNael%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nael%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKambiz%2BNael%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Maxime Tassy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Maxime%2BTassy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tassy%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMaxime%2BTassy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Sarah Quenet </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Sarah%2BQuenet%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Quenet%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ASarah%2BQuenet%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Sylvain Fogola </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Sylvain%2BFogola%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fogola%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ASylvain%2BFogola%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Peter Shabe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Peter%2BShabe%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shabe%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APeter%2BShabe%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">David Fussell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=David%2BFussell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fussell%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADavid%2BFussell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">Christophe Avare </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Christophe%2BAvare%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Avare%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AChristophe%2BAvare%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">Yasmina Chaibi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Clinical Affairs and Research & Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Yasmina%2BChaibi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chaibi%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AYasmina%2BChaibi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Angela Ayobi</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-2"><span class="name">Adam Davis</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-3"><span class="name">Peter D Chang</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-4"><span class="name">Daniel S Chow</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-5"><span class="name">Kambiz Nael</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-6"><span class="name">Maxime Tassy</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-7"><span class="name">Sarah Quenet</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-8"><span class="name">Sylvain Fogola</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-9"><span class="name">Peter Shabe</span><a id="xref-aff-1-9" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-10"><span class="name">David Fussell</span><a id="xref-aff-1-10" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-11"><span class="name">Christophe Avare</span><a id="xref-aff-1-11" class="xref-aff" href="#aff-1"></a> and </li><li class="last" id="contrib-12"><span class="name">Yasmina Chaibi</span><a id="xref-aff-1-12" class="xref-aff" href="#aff-1"></a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>From the Departments of Clinical Affairs and Research &amp; Development (A.A., M.T., S.Q., S.F., C.A., Y.C.), Avicenna.AI, La Ciotat, France. From the Department of Engineering (A.D.), Amalgamated Vision, LLC, Brentwood, TN, USA. From the Department of Radiological Sciences (P.D.C., D.S.C., D.F.), University of California Irvine, Orange, CA, USA. From the Center for Artificial Intelligence in Diagnostic Medicine (P.D.C., D.S.C.), University of California Irvine, Orange, CA, USA. From the David Geffen School of Medicine (K.N.), UCLA, Los Angeles, CA, USA. From Advance Research Associates (P.S.) Santa Clara, CA, USA.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Angela Ayobi, MEng, MSc, Department of Clinical Affairs, Avicenna.AI, 375 Avenue du Mistral, La Ciotat, 13600, France; <span class="em-link"><span class="em-addr">angela.ayobi{at}avicenna.ai</span></span>.</li></ol></div></div></div>  </div>

  
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