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@ARTICLE{Lim:129055,
      author       = {H.-j. Lim and O. Weinheimer and M. O. Wielpütz and J.
                      Dinkel and T. Hielscher$^*$ and D. Gompelmann and H.-U.
                      Kauczor and C. P. Heussel},
      title        = {{F}ully {A}utomated {P}ulmonary {L}obar {S}egmentation:
                      {I}nfluence of {D}ifferent {P}rototype {S}oftware {P}rograms
                      onto {Q}uantitative {E}valuation of {C}hronic {O}bstructive
                      {L}ung {D}isease.},
      journal      = {PLoS one},
      volume       = {11},
      number       = {3},
      issn         = {1932-6203},
      address      = {Lawrence, Kan.},
      publisher    = {PLoS},
      reportid     = {DKFZ-2017-05060},
      pages        = {e0151498 -},
      year         = {2016},
      abstract     = {Surgical or bronchoscopic lung volume reduction (BLVR)
                      techniques can be beneficial for heterogeneous emphysema.
                      Post-processing software tools for lobar emphysema
                      quantification are useful for patient and target lobe
                      selection, treatment planning and post-interventional
                      follow-up. We aimed to evaluate the inter-software
                      variability of emphysema quantification using fully
                      automated lobar segmentation prototypes.66 patients with
                      moderate to severe COPD who underwent CT for planning of
                      BLVR were included. Emphysema quantification was performed
                      using 2 modified versions of in-house software (without and
                      with prototype advanced lung vessel segmentation; programs 1
                      [YACTA v.2.3.0.2] and 2 [YACTA v.2.4.3.1]), as well as 1
                      commercial program 3 [Pulmo3D $VA30A_HF2]$ and 1
                      pre-commercial prototype 4 [CT COPD ISP ver7.0]). The
                      following parameters were computed for each segmented
                      anatomical lung lobe and the whole lung: lobar volume (LV),
                      mean lobar density (MLD), 15th percentile of lobar density
                      (15th), emphysema volume (EV) and emphysema index (EI).
                      Bland-Altman analysis (limits of agreement, LoA) and linear
                      random effects models were used for comparison between the
                      software.Segmentation using programs 1, 3 and 4 was
                      unsuccessful in 1 $(1\%),$ 7 $(10\%)$ and 5 $(7\%)$
                      patients, respectively. Program 2 could analyze all
                      datasets. The 53 patients with successful segmentation by
                      all 4 programs were included for further analysis. For LV,
                      program 1 and 4 showed the largest mean difference of 72 ml
                      and the widest LoA of [-356, 499 ml] (p<0.05). Program 3 and
                      4 showed the largest mean difference of $4\%$ and the widest
                      LoA of [-7, $14\%]$ for EI (p<0.001).Only a single software
                      program was able to successfully analyze all scheduled
                      data-sets. Although mean bias of LV and EV were relatively
                      low in lobar quantification, ranges of disagreement were
                      substantial in both of them. For longitudinal emphysema
                      monitoring, not only scanning protocol but also
                      quantification software needs to be kept constant.},
      cin          = {C060},
      ddc          = {500},
      cid          = {I:(DE-He78)C060-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27029047},
      pmc          = {pmc:PMC4814108},
      doi          = {10.1371/journal.pone.0151498},
      url          = {https://inrepo02.dkfz.de/record/129055},
}