• Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. y.nagaraj@umcg.nl.
• Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• Faculty of Electrical Engineering, Mathematics Computer Science (EWI), Data Management Biometrics (DMB), University of Twente, Enschede, The Netherlands.
• Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.
• Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

The objective of this study is to evaluate the feasibility of a disease-specific deep learning (DL) model based on minimum intensity projection (minIP) for automated emphysema detection in low-dose computed tomography (LDCT) scans. LDCT scans of 240 individuals from a population-based cohort in the Netherlands (ImaLife study, mean age ± SD = 57 ± 6 years) were retrospectively chosen for training and internal validation of the DL model. For independent testing, LDCT scans of 125 individuals from a lung cancer screening cohort in the USA (NLST study, mean age ± SD = 64 ± 5 years) were used. Dichotomous emphysema diagnosis based on radiologists' annotation was used to develop the model. The automated model included minIP processing (slab thickness range: 1 mm to 11 mm), classification, and detection maps generation. The data-split for the pipeline evaluation involved class-balanced and imbalanced settings. The proposed DL pipeline showed the highest performance (area under receiver operating characteristics curve) for 11 mm slab thickness in both the balanced (ImaLife = 0.90 ± 0.05) and the imbalanced dataset (NLST = 0.77 ± 0.06). For ImaLife subcohort, the variation in minIP slab thickness from 1 to 11 mm increased the DL model's sensitivity from 75 to 88% and decreased the number of false-negative predictions from 10 to 5. The minIP-based DL model can automatically detect emphysema in LDCTs. The performance of thicker minIP slabs was better than that of thinner slabs. LDCT can be leveraged for emphysema detection by applying disease specific augmentation.