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81% (P .001) for R and -0.38% (P = .037) for R . The reproducibility between human and the ANN (A vs C) resulted in a DSC of 0.89 ± 0.03 and a systematic absolute difference of -0.36% for R (P = .017) and -0.35% for R (P = .002). The ICC was 0.98 for all variables and comparisons. Despite high overall agreement, there were systematic differences in lung segmentation between observers. This needs to be considered for longitudinal studies and could be overcome by using an ANN, which performs as good as human observers and fully aut