Takeharu Yoshikawa

Tomohiro Kikuchi, Shouhei Hanaoka, Takahiro Nakao et al.

The generation of synthetic medical records using Generative Adversarial Networks (GANs) is becoming crucial for addressing privacy concerns and facilitating data sharing in the medical domain. In this paper, we introduce a novel method to create synthetic hybrid medical records that combine both image and non-image data, utilizing an auto-encoding GAN (alphaGAN) and a conditional tabular GAN (CTGAN). Our methodology encompasses three primary steps: I) Dimensional reduction of images in a private dataset (pDS) using the pretrained encoder of the αGAN, followed by integration with the remaining non-image clinical data to form tabular representations; II) Training the CTGAN on the encoded pDS to produce a synthetic dataset (sDS) which amalgamates encoded image features with non-image clinical data; and III) Reconstructing synthetic images from the image features using the alphaGAN's pretrained decoder. We successfully generated synthetic records incorporating both Chest X-Rays (CXRs) and thirteen non-image clinical variables (comprising seven categorical and six numeric variables). To evaluate the efficacy of the sDS, we designed classification and regression tasks and compared the performance of models trained on pDS and sDS against the pDS test set. Remarkably, by leveraging five times the volume of sDS for training, we achieved classification and regression results that were comparable, if slightly inferior, to those obtained using the native pDS. Our method holds promise for publicly releasing synthetic datasets without undermining the potential for secondary data usage.

Yosuke Yamagishi, Shouhei Hanaoka, Tomohiro Kikuchi et al.

Objectives: To evaluate the zero-shot performance of Segment Anything Model 2 (SAM 2) in 3D segmentation of abdominal organs in CT scans, and to investigate the effects of prompt settings on segmentation results. Materials and Methods: In this retrospective study, we used a subset of the TotalSegmentator CT dataset from eight institutions to assess SAM 2's ability to segment eight abdominal organs. Segmentation was initiated from three different z-coordinate levels (caudal, mid, and cranial levels) of each organ. Performance was measured using the Dice similarity coefficient (DSC). We also analyzed the impact of "negative prompts," which explicitly exclude certain regions from the segmentation process, on accuracy. Results: 123 patients (mean age, 60.7 \pm 15.5 years; 63 men, 60 women) were evaluated. As a zero-shot approach, larger organs with clear boundaries demonstrated high segmentation performance, with mean DSCs as follows: liver 0.821 \pm 0.192, right kidney 0.862 \pm 0.212, left kidney 0.870 \pm 0.154, and spleen 0.891 \pm 0.131. Smaller organs showed lower performance: gallbladder 0.531 \pm 0.291, pancreas 0.361 \pm 0.197, and adrenal glands, right 0.203 \pm 0.222, left 0.308 \pm 0.234. The initial slice for segmentation and the use of negative prompts significantly influenced the results. By removing negative prompts from the input, the DSCs significantly decreased for six organs. Conclusion: SAM 2 demonstrated promising zero-shot performance in segmenting certain abdominal organs in CT scans, particularly larger organs. Performance was significantly influenced by input negative prompts and initial slice selection, highlighting the importance of optimizing these factors.

Yosuke Yamagishi, Tomohiro Kikuchi, Shouhei Hanaoka et al.

Objective: This study aims to evaluate and compare the performance of two Japanese language models-conventional Bidirectional Encoder Representations from Transformers (BERT) and the newer ModernBERT-in classifying findings from chest CT reports, with a focus on tokenization efficiency, processing time, and classification performance. Methods: We conducted a retrospective study using the CT-RATE-JPN dataset containing 22,778 training reports and 150 test reports. Both models were fine-tuned for multi-label classification of 18 common chest CT conditions. The training data was split in 18,222:4,556 for training and validation. Performance was evaluated using F1 scores for each condition and exact match accuracy across all 18 labels. Results: ModernBERT demonstrated superior tokenization efficiency, requiring 24.0% fewer tokens per document (258.1 vs. 339.6) compared to BERT Base. This translated to significant performance improvements, with ModernBERT completing training in 1877.67 seconds versus BERT's 3090.54 seconds (39% reduction). ModernBERT processed 38.82 samples per second during training (1.65x faster) and 139.90 samples per second during inference (1.66x faster). Despite these efficiency gains, classification performance remained comparable, with ModernBERT achieving superior F1 scores in 8 conditions, while BERT performed better in 4 conditions. Overall exact match accuracy was slightly higher for ModernBERT (74.67% vs. 72.67%), though this difference was not statistically significant (p=0.6291). Conclusion: ModernBERT offers substantial improvements in tokenization efficiency and training speed without sacrificing classification performance. These results suggest that ModernBERT is a promising candidate for clinical applications in Japanese radiology reports analysis.

Yosuke Yamagishi, Atsushi Takamatsu, Yasunori Hamaguchi et al.

Background: Accurate translation of radiology reports is important for multilingual research, clinical communication, and radiology education, but the validity of LLM-based evaluation remains unclear. Objective: To evaluate the educational suitability of LLM-generated Japanese translations of chest CT reports and compare radiologist assessments with LLM-as-a-judge evaluations. Methods: We analyzed 150 chest CT reports from the CT-RATE-JPN validation set. For each English report, a human-edited Japanese translation was compared with an LLM-generated translation by DeepSeek-V3.2. A board-certified radiologist and a radiology resident independently performed blinded pairwise evaluations across 4 criteria: terminology accuracy, readability, overall quality, and radiologist-style authenticity. In parallel, 3 LLM judges (DeepSeek-V3.2, Mistral Large 3, and GPT-5) evaluated the same pairs. Agreement was assessed using QWK and percentage agreement. Results: Agreement between radiologists and LLM judges was near zero (QWK=-0.04 to 0.15). Agreement between the 2 radiologists was also poor (QWK=0.01 to 0.06). Radiologist 1 rated terminology as equivalent in 59% of cases and favored the LLM translation for readability (51%) and overall quality (51%). Radiologist 2 rated readability as equivalent in 75% of cases and favored the human-edited translation for overall quality (40% vs 21%). All 3 LLM judges strongly favored the LLM translation across all criteria (70%-99%) and rated it as more radiologist-like in >93% of cases. Conclusions: LLM-generated translations were often judged natural and fluent, but the 2 radiologists differed substantially. LLM-as-a-judge showed strong preference for LLM output and negligible agreement with radiologists. For educational use of translated radiology reports, automated LLM-based evaluation alone is insufficient; expert radiologist review remains important.

Ana Lawry Aguila, Ayodeji Ijishakin, Juan Eugenio Iglesias et al.

Applying machine learning to real-world medical data, e.g. from hospital archives, has the potential to revolutionize disease detection in brain images. However, detecting pathology in such heterogeneous cohorts is a difficult challenge. Normative modeling, a form of unsupervised anomaly detection, offers a promising approach to studying such cohorts where the ``normal'' behavior is modeled and can be used at subject level to detect deviations relating to disease pathology. Diffusion models have emerged as powerful tools for anomaly detection due to their ability to capture complex data distributions and generate high-quality images. Their performance relies on image restoration; differences between the original and restored images highlight potential abnormalities. However, unlike normative models, these diffusion model approaches do not incorporate clinical information which provides important context to guide the disease detection process. Furthermore, standard approaches often poorly restore healthy regions, resulting in poor reconstructions and suboptimal detection performance. We present CADD, the first conditional diffusion model for normative modeling in 3D images. To guide the healthy restoration process, we propose a novel inference inpainting strategy which balances anomaly removal with retention of subject-specific features. Evaluated on three challenging datasets, including clinical scans, which may have lower contrast, thicker slices, and motion artifacts, CADD achieves state-of-the-art performance in detecting neurological abnormalities in heterogeneous cohorts.

Yosuke Yamagishi, Yuta Nakamura, Tomohiro Kikuchi et al.

Background: Recent advances in large language models highlight the need for high-quality multilingual medical datasets. While Japan leads globally in CT scanner deployment and utilization, the lack of large-scale Japanese radiology datasets has hindered the development of specialized language models for medical imaging analysis. Objective: To develop a comprehensive Japanese CT report dataset through machine translation and establish a specialized language model for structured finding classification. Additionally, to create a rigorously validated evaluation dataset through expert radiologist review. Methods: We translated the CT-RATE dataset (24,283 CT reports from 21,304 patients) into Japanese using GPT-4o mini. The training dataset consisted of 22,778 machine-translated reports, while the validation dataset included 150 radiologist-revised reports. We developed CT-BERT-JPN based on "tohoku-nlp/bert-base-japanese-v3" architecture for extracting 18 structured findings from Japanese radiology reports. Results: Translation metrics showed strong performance with BLEU scores of 0.731 and 0.690, and ROUGE scores ranging from 0.770 to 0.876 for Findings and from 0.748 to 0.857 for Impression sections. CT-BERT-JPN demonstrated superior performance compared to GPT-4o in 11 out of 18 conditions, including lymphadenopathy (+14.2%), interlobular septal thickening (+10.9%), and atelectasis (+7.4%). The model maintained F1 scores exceeding 0.95 in 14 out of 18 conditions and achieved perfect scores in four conditions. Conclusions: Our study establishes a robust Japanese CT report dataset and demonstrates the effectiveness of a specialized language model for structured finding classification. The hybrid approach of machine translation and expert validation enables the creation of large-scale medical datasets while maintaining high quality.