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Purpose
To evaluate whether a deep learning model (DLM) could increase the detection sensitivity of radiologists for intracranial aneurysms on CT angiography (CTA) in aneurysmal subarachnoid hemorrhage (aSAH).
Methods
Three different DLMs were trained on CTA datasets of 68 aSAH patients with 79 aneurysms with their outputs being combined applying ensemble learning (DLM-Ens). The DLM-Ens was evaluated on an independent test set of 104 aSAH patients with 126 aneuryms (mean volume 129.2 ± 185.4 mm3, 13.0% at the posterior circulation), which were determined by two radiologists and one neurosurgeon in consensus using CTA and digital subtraction angiography scans. CTA scans of the test set were then presented to three blinded radiologists (reader 1: 13, reader 2: 4, and reader 3: 3 years of experience in diagnostic neuroradiology), who assessed them individually for aneurysms. Detection sensitivities for aneurysms of the readers with and without the assistance of the DLM were compared.
Results
In the test set, the detection sensitivity of the DLM-Ens (85.7%) was comparable to the radiologists (reader 1: 91.2%, reader 2: 86.5%, and reader 3: 86.5%; Fleiss κ of 0.502). DLM-assistance significantly increased the detection sensitivity (reader 1: 97.6%, reader 2: 97.6%,and reader 3: 96.0%; overall P=.024; Fleiss κ of 0.878), especially for secondary aneurysms (88.2% of the additional aneurysms provided by the DLM).
Conclusion
Deep learning significantly improved the detection sensitivity of radiologists for aneurysms in aSAH, especially for secondary aneurysms. It therefore represents a valuable adjunct for physicians to establish an accurate diagnosis in order to optimize patient treatment.
Continuous norming methods have seldom been subjected to scientific review. In this simulation study, we compared parametric with semi-parametric continuous norming methods in psychometric tests by constructing a fictitious population model within which a latent ability increases with age across seven age groups. We drew samples of different sizes (n = 50, 75, 100, 150, 250, 500 and 1,000 per age group) and simulated the results of an easy, medium, and difficult test scale based on Item Response Theory (IRT). We subjected the resulting data to different continuous norming methods and compared the data fit under the different test conditions with a representative cross-validation dataset of n = 10,000 per age group. The most significant differences were found in suboptimal (i.e., too easy or too difficult) test scales and in ability levels that were far from the population mean. We discuss the results with regard to the selection of the appropriate modeling techniques in psychometric test construction, the required sample sizes, and the requirement to report appropriate quantitative and qualitative test quality criteria for continuous norming methods in test manuals.
Participants trained aiming movements of the right hand to several targets with a prism-like virtual displacement of the location of one of the targets, receiving either terminal or continuous visual feedback. After training, the same targets were to be reached with the untrained left hand under manipulated feedback conditions. The right hand movements continuously adapted to the unnoticed visual displacement, significantly less with continuous than with terminal feedback. Under terminal but not under continuous feedback the adaptation to the manipulated target generalized to targets in the same horizontal direction but not to targets in the opposite direction. Finally, the movements of the untrained left hand showed the same qualitative changes to the targets as the movements of the trained right hand. The data are in line with the notion that the adaptation of the right hand movements is mainly based on a re-interpretation of target locations on which movement control of both hands draws.
In this article, we explain and demonstrate how to model norm scores with the cNORM package in R. This package is designed specifically to determine norm scores when the latent ability to be measured covaries with age or other explanatory variables such as grade level. The mathematical method used in this package draws on polynomial regression to model a three-dimensional hyperplane that smoothly and continuously captures the relation between raw scores, norm scores and the explanatory variable. By doing so, it overcomes the typical problems of classical norming methods, such as overly large age intervals, missing norm scores, large amounts of sampling error in the subsamples or huge requirements with regard to the sample size. After a brief introduction to the mathematics of the model, we describe the individual methods of the package. We close the article with a practical example using data from a real reading comprehension test.