Edson Amaro Junior

Louis Blankemeier, Ashwin Kumar, Joseph Paul Cohen et al.

The large volume of abdominal computed tomography (CT) scans coupled with the shortage of radiologists have intensified the need for automated medical image analysis tools. Previous state-of-the-art approaches for automated analysis leverage vision-language models (VLMs) that jointly model images and radiology reports. However, current medical VLMs are generally limited to 2D images and short reports. Here to overcome these shortcomings for abdominal CT interpretation, we introduce Merlin, a 3D VLM that learns from volumetric CT scans, electronic health record data and radiology reports. This approach is enabled by a multistage pretraining framework that does not require additional manual annotations. We trained Merlin using a high-quality clinical dataset of paired CT scans (>6 million images from 15,331 CT scans), diagnosis codes (>1.8 million codes) and radiology reports (>6 million tokens). We comprehensively evaluated Merlin on 6 task types and 752 individual tasks that covered diagnostic, prognostic and quality-related tasks. The non-adapted (off-the-shelf) tasks included zero-shot classification of findings (30 findings), phenotype classification (692 phenotypes) and zero-shot cross-modal retrieval (image-to-findings and image-to-impression). The model-adapted tasks included 5-year chronic disease prediction (6 diseases), radiology report generation and 3D semantic segmentation (20 organs). We validated Merlin at scale, with internal testing on 5,137 CT scans and external testing on 44,098 CT scans from 3 independent sites and 2 public datasets. The results demonstrated high generalization across institutions and anatomies. Merlin outperformed 2D VLMs, CT foundation models and off-the-shelf radiology models. We also release our trained models, code, and dataset, available at: https://github.com/StanfordMIMI/Merlin.

Cesar Augusto Madid Truyts, Amanda Gomes Rabelo, Gabriel Mesquita de Souza et al.

Artificial intelligence (AI) has shown the potential to revolutionize healthcare by improving diagnostic accuracy, optimizing workflows, and personalizing treatment plans. Large Language Models (LLMs) and Multimodal Large Language Models (MLLMs) have achieved notable advancements in natural language processing and medical applications. However, the evaluation of these models has focused predominantly on the English language, leading to potential biases in their performance across different languages. This study investigates the capability of six LLMs (GPT-4.0 Turbo, LLaMA-3-8B, LLaMA-3-70B, Mixtral 8x7B Instruct, Titan Text G1-Express, and Command R+) and four MLLMs (Claude-3.5-Sonnet, Claude-3-Opus, Claude-3-Sonnet, and Claude-3-Haiku) to answer questions written in Brazilian spoken portuguese from the medical residency entrance exam of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) - the largest health complex in South America. The performance of the models was benchmarked against human candidates, analyzing accuracy, processing time, and coherence of the generated explanations. The results show that while some models, particularly Claude-3.5-Sonnet and Claude-3-Opus, achieved accuracy levels comparable to human candidates, performance gaps persist, particularly in multimodal questions requiring image interpretation. Furthermore, the study highlights language disparities, emphasizing the need for further fine-tuning and data set augmentation for non-English medical AI applications. Our findings reinforce the importance of evaluating generative AI in various linguistic and clinical settings to ensure a fair and reliable deployment in healthcare. Future research should explore improved training methodologies, improved multimodal reasoning, and real-world clinical integration of AI-driven medical assistance.