{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:30:30Z","timestamp":1790375430291,"version":"4.1.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The pandemic of Coronavirus Disease 2019 (COVID-19) is causing enormous loss of life globally. Prompt case identification is critical. The reference method is the real-time reverse transcription PCR (RT-PCR) assay, whose limitations may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that the application of deep learning (DL) to 3D CT images could help identify COVID-19 infections. Using data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 pneumonia patients, COVIDNet achieved an accuracy rate of 94.3% and an area under the curve of 0.98. As of March 23, 2020, the COVIDNet system had been used 11,966 times with a sensitivity of 91.12% and a specificity of 88.50% in six hospitals with PCR confirmation. Application of DL to CT images may improve both efficiency and capacity of case detection and long-term surveillance.<\/jats:p>","DOI":"10.1038\/s41598-021-83424-5","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T04:14:59Z","timestamp":1613794499000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Assisting scalable diagnosis automatically via CT images in the combat against COVID-19"],"prefix":"10.1038","volume":"11","author":[{"given":"Bohan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutao","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqing","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jicheng","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Shan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenghui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xixiang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xizhou","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhui","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhibing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqing","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meifang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaou","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingbo","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhua","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuelong","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weipeng","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongpin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongchong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongkang","family":"Nie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuquan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongren","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minchao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haipeng","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peifang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimin","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunlun","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"83424_CR1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","volume":"382","author":"N Zhu","year":"2020","unstructured":"Zhu, N. et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 382, 727\u2013733 (2020).","journal-title":"N. Engl. J. Med."},{"key":"83424_CR2","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1056\/NEJMoa2001316","volume":"382","author":"Q Li","year":"2020","unstructured":"Li, Q. et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N. Engl. J. Med. 382, 1199\u20131207 (2020).","journal-title":"N. Engl. J. Med."},{"key":"83424_CR3","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/jmv.25678","volume":"92","author":"H Lu","year":"2020","unstructured":"Lu, H., Stratton, C. W. & Tang, Y. W. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J. Med. Virol. 92, 401\u2013402 (2020).","journal-title":"J. Med. Virol."},{"key":"83424_CR4","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/S0140-6736(20)30154-9","volume":"395","author":"JF Chan","year":"2020","unstructured":"Chan, J. F. et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395, 514\u2013523 (2020).","journal-title":"Lancet"},{"key":"83424_CR5","unstructured":"WHO. Coronavirus disease 2019 (COVID-19) Situation Report (2020)."},{"key":"83424_CR6","doi-asserted-by":"publisher","first-page":"m1090","DOI":"10.1136\/bmj.m1090","volume":"368","author":"JH Tanne","year":"2020","unstructured":"Tanne, J. H. et al. Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide. BMJ 368, m1090 (2020).","journal-title":"BMJ"},{"key":"83424_CR7","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1126\/science.abb5793","volume":"368","author":"SM Kissler","year":"2020","unstructured":"Kissler, S. M., Tedijanto, C., Goldstein, E., Grad, Y. H. & Lipsitch, M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 368, 860\u2013868 (2020).","journal-title":"Science"},{"key":"83424_CR8","doi-asserted-by":"publisher","first-page":"E41","DOI":"10.1148\/radiol.2020200343","volume":"296","author":"X Xie","year":"2020","unstructured":"Xie, X. et al. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 296, E41\u2013E45\u00a0(2020).","journal-title":"Radiology"},{"key":"83424_CR9","doi-asserted-by":"publisher","first-page":"E115","DOI":"10.1148\/radiol.2020200432","volume":"296","author":"Y Fang","year":"2020","unstructured":"Fang, Y. et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 296, E115\u2013E117 (2020).","journal-title":"Radiology"},{"key":"83424_CR10","doi-asserted-by":"publisher","first-page":"E32","DOI":"10.1148\/radiol.2020200642","volume":"296","author":"T Ai","year":"2020","unstructured":"Ai, T. et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 296, E32\u2013E40 (2020).","journal-title":"Radiology"},{"key":"83424_CR11","doi-asserted-by":"publisher","first-page":"e200034","DOI":"10.1148\/ryct.2020200034","volume":"2","author":"MY Ng","year":"2020","unstructured":"Ng, M. Y. et al. Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiol. Cardiothorac. Imaging 2, e200034 (2020).","journal-title":"Radiol. Cardiothorac. Imaging"},{"key":"83424_CR12","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/S1473-3099(20)30086-4","volume":"20","author":"H Shi","year":"2020","unstructured":"Shi, H. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect. Dis. 20, 425\u2013434 (2020).","journal-title":"Lancet Infect. Dis."},{"key":"83424_CR13","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1016\/S2589-7500(19)30058-5","volume":"1","author":"B Lou","year":"2019","unstructured":"Lou, B. et al. An image-based deep learning framework for individualising radiotherapy dose: a retrospective analysis of outcome prediction. Lancet Digit. Health 1, e136\u2013e147 (2019).","journal-title":"Lancet Digit. Health"},{"key":"83424_CR14","doi-asserted-by":"publisher","first-page":"e353","DOI":"10.1016\/S2589-7500(19)30159-1","volume":"1","author":"P Huang","year":"2019","unstructured":"Huang, P. et al. Prediction of lung cancer risk at follow-up screening with low-dose CT: a training and validation study of a deep learning method. Lancet Digit. Health 1, e353\u2013e362 (2019).","journal-title":"Lancet Digit. Health"},{"key":"83424_CR15","doi-asserted-by":"publisher","first-page":"e192","DOI":"10.1016\/S2589-7500(20)30025-X","volume":"2","author":"PJ Pickhardt","year":"2020","unstructured":"Pickhardt, P. J. et al. Automated CT biomarkers for opportunistic prediction of future cardiovascular events and mortality in an asymptomatic screening population: a retrospective cohort study. Lancet Digit. Health 2, e192\u2013e200 (2020).","journal-title":"Lancet Digit. Health"},{"key":"83424_CR16","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/S2213-2600(20)30003-5","volume":"8","author":"SLF Walsh","year":"2020","unstructured":"Walsh, S. L. F., Humphries, S. M., Wells, A. U. & Brown, K. K. Imaging research in fibrotic lung disease; applying deep learning to unsolved problems. Lancet Respir. Med. 8, 1144\u20131153 (2020).","journal-title":"Lancet Respir. Med."},{"key":"83424_CR17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1148\/radiol.2020200236","volume":"295","author":"J Lei","year":"2020","unstructured":"Lei, J., Li, J., Li, X. & Qi, X. CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 295, 18 (2020).","journal-title":"Radiology"},{"key":"83424_CR18","doi-asserted-by":"publisher","first-page":"E65","DOI":"10.1148\/radiol.2020200905","volume":"296","author":"L Li","year":"2020","unstructured":"Li, L. et al. Using artificial intelligence to detect COVID-19 and community-acquired pneumonia based on pulmonary CT: evaluation of the diagnostic accuracy. Radiology 296, E65\u2013E71 (2020).","journal-title":"Radiology"},{"key":"83424_CR19","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/S2213-2600(18)30286-8","volume":"6","author":"SLF Walsh","year":"2018","unstructured":"Walsh, S. L. F., Calandriello, L., Silva, M. & Sverzellati, N. Deep learning for classifying fibrotic lung disease on high-resolution computed tomography: a case-cohort study. Lancet Respir. Med. 6, 837\u2013845 (2018).","journal-title":"Lancet Respir. Med."},{"key":"83424_CR20","doi-asserted-by":"crossref","unstructured":"WHO. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected (2019).","DOI":"10.1155\/2019\/6491738"},{"key":"83424_CR21","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1056\/NEJMp2015897","volume":"383","author":"S Woloshin","year":"2020","unstructured":"Woloshin, S., Patel, N. & Kesselheim, A. S. False negative tests for SARS-CoV-2 infection\u2014challenges and implications. N. Engl. J. Med. 383, e38 (2020).","journal-title":"N. Engl. J. Med."},{"key":"83424_CR22","first-page":"2579","volume":"9","author":"LVD Maaten","year":"2008","unstructured":"Maaten, L. V. D. & Hinton, G. Visualizing data using t-SNE. J. Mach. Learn. Res. 9, 2579\u20132605 (2008).","journal-title":"J. Mach. Learn. Res."},{"key":"83424_CR23","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1093\/nsr\/nwaa036","volume":"7","author":"X Tang","year":"2020","unstructured":"Tang, X. et al. On the origin and continuing evolution of SARS-CoV-2. Natl. Sci. Rev. 7, 1012\u20131023 (2020).","journal-title":"Natl. Sci. Rev."},{"key":"83424_CR24","doi-asserted-by":"crossref","unstructured":"Huang, G., Liu, Z., van der Maaten, L., Weinberger, K. Q. Densely Connected Convolutional Networks. https:\/\/arxiv.org\/abs\/1608.06993 (2016).","DOI":"10.1109\/CVPR.2017.243"},{"key":"83424_CR25","unstructured":"Ulyanov, D., Vedaldi, A. & Lempitsky, V. Instance Normalization: The Missing Ingredient for Fast Stylization. https:\/\/arxiv.org\/abs\/1607.08022 (2016)."},{"key":"83424_CR26","unstructured":"Kingma, D.P. & Ba, J. Adam: A Method for Stochastic Optimization. https:\/\/arxiv.org\/abs\/1412.6980 (2014)."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-83424-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-83424-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-83424-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,18]],"date-time":"2022-12-18T03:39:41Z","timestamp":1671334781000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-83424-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,18]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["83424"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-83424-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.05.11.20093732","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,18]]},"assertion":[{"value":"19 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"4145"}}