LAUSR

PURPOSE The coronary artery calcium (CAC) score is an independent marker for the risk of cardiovascular events. Automatic methods for quantifying CAC could reduce workload and assist radiologists in clinical decision making. However, large annotated datasets are needed for training to achieve very good model performance, which is an expensive process and requires expert knowledge. The number of training data required can be reduced in an active learning scenario, which requires only the most informative samples to be labeled. Multi-task learning techniques can improve model performance by joint learning of multiple related tasks and extraction of shared informative features. METHODS We propose an uncertainty-weighted multi-task learning model for coronary calcium scoring in ECG-gated, non-contrast enhanced cardiac calcium scoring CT. The model was trained to solve the two tasks of coronary artery region segmentation (weak labels) and coronary artery calcification segmentation (strong labels) simultaneously in an active learning scenario to improve model performance and reduce the number of samples needed for training. We compared our model with a single-task U-Net and a sequential-task model as well as other state-of-the-art methods. The model was evaluated on 1275 individual patients in three different datasets (DISCHARGE, CADMAN, orCaScore), and the relationship between model performance and various influencing factors (image noise, metal artifacts, motion artifacts, image quality) was analyzed. RESULTS Joint learning of multiclass coronary artery region segmentation and binary coronary calcium segmentation improved calcium scoring performance. Since shared information can be learned from both tasks for complementary purposes, the model reached optimal performance with only 12% of the training data and one-third of the labeling time in an active learning scenario. We identified image noise as one of the most important factors influencing model performance along with anatomical abnormalities and metal artifacts CONCLUSIONS: Our multi-task learning approach with uncertainty-weighted loss improves calcium scoring performance by joint learning of shared features and reduces labeling costs when trained in an active learning scenario. This article is protected by copyright. All rights reserved.