{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:11:19Z","timestamp":1783566679176,"version":"3.55.0"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017540","name":"NHLBI Division of Intramural Research","doi-asserted-by":"publisher","award":["R01HL149877"],"award-info":[{"award-number":["R01HL149877"]}],"id":[{"id":"10.13039\/100017540","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017540","name":"NHLBI Division of Intramural Research","doi-asserted-by":"publisher","award":["5R21LM013670"],"award-info":[{"award-number":["5R21LM013670"]}],"id":[{"id":"10.13039\/100017540","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008052","name":"Fundaci\u00f3n Alfonso Mart\u00edn Escudero","doi-asserted-by":"publisher","award":["Fellowship"],"award-info":[{"award-number":["Fellowship"]}],"id":[{"id":"10.13039\/100008052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and objectives<\/jats:title>\n<jats:p>The scarcity of data for training deep learning models in pediatrics has prompted questions about the feasibility of employing CNNs trained with adult images for pediatric populations. In this work, a pneumonia classification CNN was used as an exploratory example to showcase the adaptability and efficacy of such models in pediatric healthcare settings despite the inherent data constraints.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>To develop a curated training dataset with reduced biases, 46,947 chest X-ray images from various adult datasets were meticulously selected. Two preprocessing approaches were tried to assess the impact of thoracic segmentation on model attention outside the thoracic area. Evaluation of our approach was carried out on a dataset containing 5,856 chest X-rays of children from 1 to 5 years old.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>An analysis of attention maps indicated that networks trained with thorax segmentation placed less attention on regions outside the thorax, thus eliminating potential bias. The ensuing network exhibited impressive performance when evaluated on an adult dataset, achieving a pneumonia discrimination AUC of 0.95. When tested on a pediatric dataset, the pneumonia discrimination AUC reached 0.82.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results of this study show that adult-trained CNNs can be effectively applied to pediatric populations. This could potentially shift focus towards validating adult models over pediatric population instead of training new CNNs with limited pediatric data. To ensure the generalizability of deep learning models, it is important to implement techniques aimed at minimizing biases, such as image segmentation or low-quality image exclusion.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0306703","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T17:27:46Z","timestamp":1721928466000},"page":"e0306703","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["CNNs trained with adult data are useful in pediatrics. 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Chollet","year":"2017","journal-title":"Published online"},{"key":"pone.0306703.ref014","article-title":"Inception-v4, Inception-ResNet and the Impact of Residual Connections on Learning","author":"C Szegedy","year":"2016","journal-title":"Published online"},{"key":"pone.0306703.ref015","article-title":"EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks.","author":"M Tan","year":"2020","journal-title":"Published online"},{"key":"pone.0306703.ref016","article-title":"MANGO: A Python Library for Parallel Hyperparameter Tuning.","author":"SS Sandha","year":"2020","journal-title":"Published online"},{"key":"pone.0306703.ref017","first-page":"770","article-title":"Deep residual learning for image recognition","author":"K He","year":"2016","journal-title":"InProceedings of the IEEE conference on computer vision and pattern recognition"},{"key":"pone.0306703.ref018","volume-title":"Innovation in Medicine and Healthcare. KES InMed 2023. 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