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Inform. med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Non-cancer mortality (NCM) accounts for a substantial proportion of deaths in cancer survivors, with cardiovascular disease (CVD) being the leading cause. Abdominal aortic calcification (AAC) is a strong predictor of cardiovascular and all-cause mortality but remains underused due to the burden of manual scoring. Automated pipelines could enable opportunistic CVD risk screening from routine oncology CTs. We benchmarked three widely available AAC tools against manual reference standards in a multi-institutional prostate cancer cohort.\u00a0We retrospectively analysed staging CTs from 99 men in the control arm of the STAMPEDE trial. Manual AAC was quantified using adaptive thresholding and Agatston scoring. Automated AAC scoring was performed using OSCAR (institutional agreement), Comp2Comp (open-source), and DAFS (commercial licence). Agreement with manual reference was assessed using Pearson correlation (r), intraclass correlation coefficients (ICC), Bland\u2013Altman analyses, and categorical risk concordance (Cohen\u2019s \u03ba). Manual scoring was highly reproducible (ICC\u2009=\u20090.99) but required\u2009&gt;\u200912\u00a0min per scan. Automated pipelines reduced processing to\u2009&lt;\u20095\u00a0min. OSCAR achieved the strongest agreement with manual AAC (r\u2009=\u20090.92, \u03ba\u2009=\u20090.93), followed by DAFS (r\u2009=\u20090.88, \u03ba\u2009=\u20090.91) and Comp2Comp (r\u2009=\u20090.75, \u03ba\u2009=\u20090.74). Volumetric measures were reproducible across all tools (r\u2009\u2265\u20090.89). Failure occurred in\u2009&lt;\u200910% of scans, mainly at slice thickness\u2009&lt;\u20091\u00a0mm. OSCAR and DAFS were stable across patient and scan factors, whereas Comp2Comp was more sensitive to acquisition parameters.\u00a0Automated AAC quantification is accurate, reproducible, and significantly faster than manual scoring. These findings support its role in cardiovascular screening for cancer and cancer treatment-related risk in oncology using routine CT scans.<\/jats:p>","DOI":"10.1007\/s10278-026-01891-6","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:59:10Z","timestamp":1774893550000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantification of Abdominal Aortic Calcification on CT: Clinical Validation for Assessment Of Cardiovascular Risk in Oncology"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1788-3669","authenticated-orcid":false,"given":"Omar","family":"El-Taji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donal","family":"McSweeney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Struan","family":"Gray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish","family":"Motwani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahesh K. 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AS reports support for the present manuscript from the Prostate Cancer Foundation-John Black Charitable Foundation Young Investigator Award; grants or contracts from the Prostate Cancer UK Research & Innovation Award, The Urology Foundation, and Cancer Research UK; consulting fees from Veracyte; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Ipsen, Janssen, and Gedeon Richter; and support for attending meetings or travel from AIRA Matrix. All other authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Written consent was obtained from all patients for access to their medical records and study conduct was in accordance with Good Clinical Practice guidelines and the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"All patients provided written informed consent to participate in the STAMPEDE trial, including consent for use of anonymised data in subsequent research analyses and publications.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"The STAMPEDE trial was approved by the national research ethics committee (MREC\/01\/0\/73; ISRCTN78818544). All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Declaration of Helsinki.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}}]}}