Parisa Kaviani

Chuang Niu, Md Sayed Tanveer, Md Zabirul Islam et al.

Current LLMs for creating fully-structured reports face the challenges of formatting errors, content hallucinations, and privacy leakage issues when uploading data to external servers.We aim to develop an open-source, accurate LLM for creating fully-structured and standardized LCS reports from varying free-text reports across institutions and demonstrate its utility in automatic statistical analysis and individual lung nodule retrieval. With IRB approvals, our retrospective study included 5,442 de-identified LDCT LCS radiology reports from two institutions. We constructed two evaluation datasets by labeling 500 pairs of free-text and fully-structured radiology reports and one large-scale consecutive dataset from January 2021 to December 2023. Two radiologists created a standardized template for recording 27 lung nodule features on LCS. We designed a dynamic-template-constrained decoding method to enhance existing LLMs for creating fully-structured reports from free-text radiology reports. Using consecutive structured reports, we automated descriptive statistical analyses and a nodule retrieval prototype. Our best LLM for creating fully-structured reports achieved high performance on cross-institutional datasets with an F1 score of about 97%, with neither formatting errors nor content hallucinations. Our method consistently improved the best open-source LLMs by up to 10.42%, and outperformed GPT-4o by 17.19%. The automatically derived statistical distributions were consistent with prior findings regarding attenuation, location, size, stability, and Lung-RADS. The retrieval system with structured reports allowed flexible nodule-level search and complex statistical analysis. Our developed software is publicly available for local deployment and further research.

Chuang Niu, Qing Lyu, Christopher D. Carothers et al.

Modern medical records include a vast amount of multimodal free text clinical data and imaging data from radiology, cardiology, and digital pathology. Fully mining such big data requires multitasking; otherwise, occult but important aspects may be overlooked, adversely affecting clinical management and population healthcare. Despite remarkable successes of AI in individual tasks with single-modal data, the progress in developing generalist medical AI remains relatively slow to combine multimodal data for multitasks because of the dual challenges of data curation and model architecture. The data challenge involves querying and curating multimodal structured and unstructured text, alphanumeric, and especially 3D tomographic scans on an individual patient level for real-time decisions and on a scale to estimate population health statistics. The model challenge demands a scalable and adaptable network architecture to integrate multimodal datasets for diverse clinical tasks. Here we propose the first-of-its-kind medical multimodal-multitask foundation model (M3FM) with application in lung cancer screening and related tasks. After we curated a comprehensive multimodal multitask dataset consisting of 49 clinical data types including 163,725 chest CT series and 17 medical tasks involved in LCS, we develop a multimodal question-answering framework as a unified training and inference strategy to synergize multimodal information and perform multiple tasks via free-text prompting. M3FM consistently outperforms the state-of-the-art single-modal task-specific models, identifies multimodal data elements informative for clinical tasks and flexibly adapts to new tasks with a small out-of-distribution dataset. As a specialty-oriented generalist medical AI model, M3FM paves the way for similar breakthroughs in other areas of medicine, closing the gap between specialists and the generalist.

Razi Mahmood, Pingkun Yan, Diego Machado Reyes et al. · berkeley

Several evaluation metrics have been developed recently to automatically assess the quality of generative AI reports for chest radiographs based only on textual information using lexical, semantic, or clinical named entity recognition methods. In this paper, we develop a new method of report quality evaluation by first extracting fine-grained finding patterns capturing the location, laterality, and severity of a large number of clinical findings. We then performed phrasal grounding to localize their associated anatomical regions on chest radiograph images. The textual and visual measures are then combined to rate the quality of the generated reports. We present results that compare this evaluation metric with other textual metrics on a gold standard dataset derived from the MIMIC collection and show its robustness and sensitivity to factual errors.

Razi Mahmood, Diego Machado-Reyes, Joy Wu et al. · berkeley

With the emergence of large-scale vision language models (VLM), it is now possible to produce realistic-looking radiology reports for chest X-ray images. However, their clinical translation has been hampered by the factual errors and hallucinations in the produced descriptions during inference. In this paper, we present a novel phrase-grounded fact-checking model (FC model) that detects errors in findings and their indicated locations in automatically generated chest radiology reports. Specifically, we simulate the errors in reports through a large synthetic dataset derived by perturbing findings and their locations in ground truth reports to form real and fake findings-location pairs with images. A new multi-label cross-modal contrastive regression network is then trained on this dataset. We present results demonstrating the robustness of our method in terms of accuracy of finding veracity prediction and localization on multiple X-ray datasets. We also show its effectiveness for error detection in reports of SOTA report generators on multiple datasets achieving a concordance correlation coefficient of 0.997 with ground truth-based verification, thus pointing to its utility during clinical inference in radiology workflows.