{"id":"https://openalex.org/W7216176255","doi":"https://doi.org/10.64898/2026.09.30.26364432","title":"Multimodal Ultrasound and Clinical Data for Pediatric Appendicitis: Evaluating Label-Construction Circularity in the Regensburg Benchmark","display_name":"Multimodal Ultrasound and Clinical Data for Pediatric Appendicitis: Evaluating Label-Construction Circularity in the Regensburg Benchmark","publication_year":2026,"publication_date":"2026-10-02","ids":{"openalex":"https://openalex.org/W7216176255","doi":"https://doi.org/10.64898/2026.09.30.26364432"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.30.26364432","doi":"https://doi.org/10.64898/2026.09.30.26364432","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.30.26364432","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/02/2026.09.30.26364432.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/02/2026.09.30.26364432.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5090907046","display_name":"Md. Mahbubul Islam","orcid":"https://orcid.org/0000-0002-2410-7983","observed_orcids":["https://orcid.org/0000-0002-2410-7983","https://orcid.org/0009-0009-1910-1980"]},"institutions":[{"id":"https://openalex.org/I185571130","display_name":"Al-Farabi Kazakh National University","ror":"https://ror.org/03q0vrn42","country_code":"KZ","type":"education","lineage":["https://openalex.org/I185571130"]}],"countries":["KZ"],"is_corresponding":true,"raw_author_name":"Md. Mahbubul Islam","raw_affiliation_strings":["Al-Farabi Kazakh National University, Almaty, Kazakhstan"],"raw_orcid":"https://orcid.org/0009-0009-1910-1980","affiliations":[{"raw_affiliation_string":"Al-Farabi Kazakh National University, Almaty, Kazakhstan","institution_ids":["https://openalex.org/I185571130"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5035649923","display_name":"Ainur Yerkos","orcid":"https://orcid.org/0000-0001-5949-6942","observed_orcids":["https://orcid.org/0000-0001-5949-6942"]},"institutions":[{"id":"https://openalex.org/I185571130","display_name":"Al-Farabi Kazakh National University","ror":"https://ror.org/03q0vrn42","country_code":"KZ","type":"education","lineage":["https://openalex.org/I185571130"]}],"countries":["KZ"],"is_corresponding":false,"raw_author_name":"Ainur Yerkos","raw_affiliation_strings":["Al-Farabi Kazakh National University, Almaty, Kazakhstan"],"raw_orcid":"https://orcid.org/0000-0001-5949-6942","affiliations":[{"raw_affiliation_string":"Al-Farabi Kazakh National University, Almaty, Kazakhstan","institution_ids":["https://openalex.org/I185571130"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5090907046"],"corresponding_institution_ids":["https://openalex.org/I185571130"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11473","display_name":"Appendicitis Diagnosis and Management","score":0.9243000149726868,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11473","display_name":"Appendicitis Diagnosis and Management","score":0.9243000149726868,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.039799999445676804,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11714","display_name":"Multimodal Machine Learning Applications","score":0.009800000116229057,"subfield":{"id":"https://openalex.org/subfields/1707","display_name":"Computer Vision and Pattern Recognition"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/pediatric-appendicitis","display_name":"pediatric appendicitis","score":0.9980000257492065},{"id":"https://openalex.org/keywords/multimodal-learning","display_name":"multimodal learning","score":0.5220000147819519},{"id":"https://openalex.org/keywords/biomedclip","display_name":"BiomedCLIP","score":0.9259999990463257},{"id":"https://openalex.org/keywords/alvarado-score","display_name":"Alvarado score","score":0.9589999914169312},{"id":"https://openalex.org/keywords/pediatric-appendicitis-score","display_name":"Pediatric Appendicitis Score","score":0.9649999737739563},{"id":"https://openalex.org/keywords/diagnostic-performance","display_name":"diagnostic performance","score":0.4000000059604645},{"id":"https://openalex.org/keywords/image-text-fusion","display_name":"image-text fusion","score":0.39899998903274536},{"id":"https://openalex.org/keywords/equivalence-testing","display_name":"equivalence testing","score":0.35199999809265137}],"concepts":[{"id":"https://openalex.org/C185798385","wikidata":"https://www.wikidata.org/wiki/Q1161707","display_name":"Benchmark (surveying)","level":2,"score":0.5903000235557556},{"id":"https://openalex.org/C2780069185","wikidata":"https://www.wikidata.org/wiki/Q7977945","display_name":"Equivalence (formal languages)","level":2,"score":0.5321000218391418},{"id":"https://openalex.org/C143753070","wikidata":"https://www.wikidata.org/wiki/Q162564","display_name":"Ultrasound","level":2,"score":0.4611000120639801},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.4478999972343445},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.4221000075340271},{"id":"https://openalex.org/C4441509","wikidata":"https://www.wikidata.org/wiki/Q6418787","display_name":"Multimodal therapy","level":2,"score":0.40619999170303345},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.3804999887943268},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.36250001192092896},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.33489999175071716},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.3215999901294708},{"id":"https://openalex.org/C43521106","wikidata":"https://www.wikidata.org/wiki/Q2165493","display_name":"Pipeline (software)","level":2,"score":0.32019999623298645},{"id":"https://openalex.org/C2780016130","wikidata":"https://www.wikidata.org/wiki/Q121041","display_name":"Appendicitis","level":2,"score":0.31790000200271606},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.30979999899864197},{"id":"https://openalex.org/C129848803","wikidata":"https://www.wikidata.org/wiki/Q2564360","display_name":"Sample size determination","level":2,"score":0.30239999294281006},{"id":"https://openalex.org/C33923547","wikidata":"https://www.wikidata.org/wiki/Q395","display_name":"Mathematics","level":0,"score":0.2888999879360199},{"id":"https://openalex.org/C3018023364","wikidata":"https://www.wikidata.org/wiki/Q425265","display_name":"Significant difference","level":2,"score":0.28850001096725464},{"id":"https://openalex.org/C3018581240","wikidata":"https://www.wikidata.org/wiki/Q121041","display_name":"Acute appendicitis","level":2,"score":0.28450000286102295},{"id":"https://openalex.org/C2776364125","wikidata":"https://www.wikidata.org/wiki/Q9656","display_name":"Appendix","level":2,"score":0.27709999680519104},{"id":"https://openalex.org/C529618451","wikidata":"https://www.wikidata.org/wiki/Q234904","display_name":"Ultrasonography","level":2,"score":0.2736999988555908},{"id":"https://openalex.org/C105054674","wikidata":"https://www.wikidata.org/wiki/Q3707381","display_name":"Mean difference","level":3,"score":0.2694000005722046},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.2687999904155731},{"id":"https://openalex.org/C2985213535","wikidata":"https://www.wikidata.org/wiki/Q1626599","display_name":"Reference values","level":2,"score":0.265500009059906},{"id":"https://openalex.org/C12725497","wikidata":"https://www.wikidata.org/wiki/Q810247","display_name":"Baseline (sea)","level":2,"score":0.2599000036716461},{"id":"https://openalex.org/C2989005","wikidata":"https://www.wikidata.org/wiki/Q214963","display_name":"Nuclear medicine","level":1,"score":0.2542000114917755}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.30.26364432","doi":"https://doi.org/10.64898/2026.09.30.26364432","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.30.26364432","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/02/2026.09.30.26364432.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.30.26364432","doi":"https://doi.org/10.64898/2026.09.30.26364432","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.30.26364432","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/02/2026.09.30.26364432.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9537000060081482}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7216176255.pdf","grobid_xml":"https://content.openalex.org/works/W7216176255.grobid-xml"},"referenced_works_count":2,"referenced_works":["https://openalex.org/W4323066559","https://openalex.org/W4366208220"],"related_works":["https://openalex.org/W7154724764","https://openalex.org/W7163876517","https://openalex.org/W4416308303","https://openalex.org/W7172028176","https://openalex.org/W4322760031","https://openalex.org/W7133359160","https://openalex.org/W7221763212","https://openalex.org/W4415296754","https://openalex.org/W4413129210","https://openalex.org/W4410231184"],"abstract_inverted_index":{"Abstract":[0],"On":[1],"the":[2,25,48,70,147,162,178,192,198,214,220,224,254,292,302,341,349,361,391,414,419],"public":[3],"Regensburg":[4],"Pediatric":[5,201],"Appendicitis":[6,202],"Dataset,":[7],"several":[8],"recent":[9],"studies":[10],"report":[11],"near-ceiling":[12],"diagnostic":[13,42,433],"performance":[14,39],"using":[15,122],"radiologist-interpreted":[16],"ultrasound":[17,281],"findings":[18],"as":[19,69,79,93,207,378,429],"tabular":[20],"model":[21,77,85,89,109,138,164,226,256,344,364,386],"inputs,":[22],"without":[23],"processing":[24],"underlying":[26],"images.":[27],"This":[28],"raises":[29],"a":[30,80,83,87,94,102,107,236,288,309,356],"question":[31],"worth":[32],"answering":[33],"carefully:":[34],"how":[35,45],"much":[36,46],"of":[37,191,276,422],"that":[38,177,274,314,335,423],"reflects":[40,47],"genuine":[41,432],"information,":[43,434],"and":[44,106,119,132,154,200,304,329],"way":[49],"this":[50,381,396],"dataset\u2019s":[51,179,415],"outcome":[52],"labels":[53],"were":[54],"constructed?":[55],"We":[56,174],"defined":[57],"four":[58],"modeling":[59],"arms":[60],"-":[61,118,189,195,204,339],"an":[62,74],"image-only":[63,149,303],"arm":[64],"(a":[65],"backbone-matched":[66,148],"BiomedCLIP":[67,112],"pipeline":[68],"primary":[71],"comparator,":[72],"with":[73,115],"originally-planned":[75],"ResNet18":[76],"retained":[78,206],"secondary":[81],"baseline),":[82],"clinical/laboratory-only":[84],"(XGBoost),":[86],"radiologist-findings":[88,163,193,215,363],"(Random":[90],"Forest,":[91],"treated":[92],"reference":[95],"built":[96],"from":[97,223,232,241,438],"expert-recorded":[98],"features":[99,409],"rather":[100],"than":[101,146,390],"live":[103],"expert":[104],"comparator),":[105],"multimodal":[108,137,225,255,305,343,385],"fusing":[110],"frozen":[111],"image":[113],"embeddings":[114],"clinical/laboratory":[116],"data":[117,440],"compared":[120],"them":[121],"paired":[123],"DeLong":[124],"tests,":[125],"bootstrap":[126],"confidence":[127],"intervals,":[128],"TOST":[129],"equivalence":[130],"testing,":[131],"pooled":[133,401],"repeated":[134,402],"cross-validation.":[135],"The":[136,384],"(pooled":[139],"AUC":[140,216,229],"0.894)":[141],"showed":[142,387],"significantly":[143,258,299,398],"higher":[144,259,388],"discrimination":[145,389],"(0.789,":[150],"p":[151,157,171,245,263,366],"<":[152,158],"0.0001)":[153,159],"clinical-only":[155],"(0.855,":[156],"models.":[160],"Against":[161],"(0.934),":[165],"it":[166],"initially":[167],"fell":[168],"short":[169],"(":[170,244,365],"=":[172,246,264,367],"0.034).":[173],"then":[175],"found":[176,273,355],"own":[180],"rule":[181],"for":[182,380],"labeling":[183],"non-surgically-managed":[184],"patients":[185,278],"uses":[186],"appendix":[187,211],"diameter":[188,212],"one":[190],"predictors":[194],"and,":[196],"separately,":[197],"Alvarado":[199],"Scores":[203],"both":[205,301,337],"clinical/multimodal":[208],"predictors.":[209],"Removing":[210],"dropped":[213],"to":[217,234,320,345,413,426,431],"0.790;":[218],"removing":[219],"two":[221,250],"scores":[222],"changed":[227],"its":[228,404],"only":[230],"marginally,":[231],"0.894":[233],"0.890,":[235],"difference":[237,359],"not":[238,375],"statistically":[239],"distinguishable":[240],"no":[242],"change":[243],"0.25).":[247],"Comparing":[248],"these":[249,297,439],"corrected":[251],"models":[252],"directly,":[253],"remained":[257],"(0.890":[260],"vs.":[261],"0.790,":[262],"6.2":[265],"\u00d7":[266],"10":[267],"\u22126":[268],").":[269],"A":[270],"supplementary":[271],"check":[272,334],"137":[275],"578":[277],"(24%)":[279],"have":[280],"images":[282,298,347],"containing":[283],"burned-in":[284],"caliper":[285],"measurements;":[286],"on":[287,348,395],"matched":[289,351],"comparison":[290,373],"holding":[291],"patient":[293,352],"set":[294],"fixed,":[295],"excluding":[296],"reduced":[300],"models\u2019":[306],"AUC,":[307],"indicating":[308],"second,":[310],"image-level":[311],"information":[312],"pathway":[313],"our":[315,370],"design":[316],"cannot":[317,435],"fully":[318],"attribute":[319],"on-screen":[321],"numeric":[322],"values":[323],"versus":[324],"other":[325],"differences":[326],"between":[327],"marked":[328],"unmarked":[330],"views.":[331],"An":[332],"exploratory":[333],"combined":[336],"corrections":[338],"restricting":[340],"doubly-corrected":[342,372],"annotation-free":[346],"smaller,":[350,357],"subset":[353],"\u2013":[354],"non-significant":[358],"against":[360,407],"diameter-removed":[362],"0.176),":[368],"so":[369,399],"main":[371],"should":[374],"be":[376,436],"read":[377],"controlling":[379],"second":[382],"pathway.":[383],"unimodal":[392],"automated":[393],"baselines":[394],"benchmark,":[397],"in":[400],"cross-validation;":[403],"apparent":[405],"shortfall":[406,424],"radiologist-derived":[408],"is":[410],"highly":[411],"sensitive":[412],"outcome-definition":[416],"procedure,":[417],"although":[418],"exact":[420],"fraction":[421],"attributable":[425],"label-construction":[427],"dependence,":[428],"opposed":[430],"determined":[437],"alone.":[441]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-10-03T00:00:00"}