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Abstract

We thank Drs Zhang and Zhang for their Correspondence discussing our manuscript and are grateful for their comments regarding the limitations of our first application of ultrasound radiomics-based prediction of high-risk endometrial cancer.They open their commentary referring to the radiomics quality score (RQS), a practical tool proposed in 2017 by one of the leading radiomics research groups 1 , and calculated a score of 15 (maximum score = 36) points for our paper 2 . Questionably, they did not consider the potential clinical utility of our model (RQS + 2 points) and the availability of the open-source code (RQS + 1 points) (as stated in the cited Moddicom 2015 publication, https://github.com/kbolab/moddicom), which would have increased our RQS to 18. This value is significantly higher than the RQS for the majority of retrospective studies dealing with traditional volumetric imaging (i.e. computed tomography and magnetic resonance imaging), these being reported as, on average, 11 (lungs), 7 (heart) and 10 (liver) [3][4][5] .We are fully aware that image preprocessing is a crucial step prior to feature extraction in the framework of traditional radiomics, and our group was among the first to describe the variability between different ultrasound equipment used for radiomics purposes in gynecology 6 . Nevertheless, in this first large, multicenter study, we decided to focus on unfiltered real-world data images, excluding only very low-quality images that did not permit clear and reliable identification of the endometrial lesion, as we chose to rely on examiner expertise for