Christopher T. Whitlow

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.

Qing Lyu, Josh Tan, Michael E. Zapadka et al.

The large language model called ChatGPT has drawn extensively attention because of its human-like expression and reasoning abilities. In this study, we investigate the feasibility of using ChatGPT in experiments on using ChatGPT to translate radiology reports into plain language for patients and healthcare providers so that they are educated for improved healthcare. Radiology reports from 62 low-dose chest CT lung cancer screening scans and 76 brain MRI metastases screening scans were collected in the first half of February for this study. According to the evaluation by radiologists, ChatGPT can successfully translate radiology reports into plain language with an average score of 4.27 in the five-point system with 0.08 places of information missing and 0.07 places of misinformation. In terms of the suggestions provided by ChatGPT, they are general relevant such as keeping following-up with doctors and closely monitoring any symptoms, and for about 37% of 138 cases in total ChatGPT offers specific suggestions based on findings in the report. ChatGPT also presents some randomness in its responses with occasionally over-simplified or neglected information, which can be mitigated using a more detailed prompt. Furthermore, ChatGPT results are compared with a newly released large model GPT-4, showing that GPT-4 can significantly improve the quality of translated reports. Our results show that it is feasible to utilize large language models in clinical education, and further efforts are needed to address limitations and maximize their potential.

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.

Jin Young Kim, Jeremy Hudson, Jeongchul Kim et al.

Tau positron emission tomography (PET) is a critical diagnostic modality for Alzheimer's disease (AD) because it visualizes and quantifies neurofibrillary tangles, a hallmark of AD pathology. However, its widespread clinical adoption is hindered by significant challenges, such as radiation exposure, limited availability, high clinical workload, and substantial financial costs. To overcome these limitations, we propose Multi-scale CBAM Residual Vector Quantized Generative Adversarial Network (MCR-VQGAN) to synthesize high-fidelity tau PET images from structural T1-weighted MRI scans. MCR-VQGAN improves standard VQGAN by integrating three key architectural enhancements: multi-scale convolutions, ResNet blocks, and Convolutional Block Attention Modules (CBAM). Using 222 paired structural T1-weighted MRI and tau PET scans from Alzheimer's Disease Neuroimaging Initiative (ADNI), we trained and compared MCR-VQGAN with cGAN, WGAN-GP, CycleGAN, and VQGAN. Our proposed model achieved superior image synthesis performance across all metrics: MSE of 0.0056 +/- 0.0061, PSNR of 24.39 +/- 4.49 dB, and SSIM of 0.9000 +/- 0.0453. To assess the clinical utility of the synthetic images, we trained and evaluated a CNN-based AD classifier. The classifier achieved comparable accuracy when tested on real (63.64%) and synthetic (65.91%) images. This result indicates that our synthesis process successfully preserves diagnostically relevant features without significant information loss. Our results demonstrate that MCR-VQGAN can offer a reliable and scalable surrogate for conventional tau PET imaging, potentially improving the accessibility and scalability of tau imaging biomarkers for AD research and clinical workflows.

Zhen Lin, Hongyu Yuan, Richard Barcus et al.

Non-human primates (NHPs) serve as critical models for understanding human brain function and neurological disorders due to their close evolutionary relationship with humans. Accurate brain tissue segmentation in NHPs is critical for understanding neurological disorders, but challenging due to the scarcity of annotated NHP brain MRI datasets, the small size of the NHP brain, the limited resolution of available imaging data and the anatomical differences between human and NHP brains. To address these challenges, we propose a novel approach utilizing STU-Net with transfer learning to leverage knowledge transferred from human brain MRI data to enhance segmentation accuracy in the NHP brain MRI, particularly when training data is limited. The combination of STU-Net and transfer learning effectively delineates complex tissue boundaries and captures fine anatomical details specific to NHP brains. Notably, our method demonstrated improvement in segmenting small subcortical structures such as putamen and thalamus that are challenging to resolve with limited spatial resolution and tissue contrast, and achieved DSC of over 0.88, IoU over 0.8 and HD95 under 7. This study introduces a robust method for multi-class brain tissue segmentation in NHPs, potentially accelerating research in evolutionary neuroscience and preclinical studies of neurological disorders relevant to human health.

Qing Lyu, Christopher T. Whitlow, Ge Wang

Recently, deep learning has achieved remarkable successes in medical image analysis. Although deep neural networks generate clinically important predictions, they have inherent uncertainty. Such uncertainty is a major barrier to report these predictions with confidence. In this paper, we propose a novel yet simple Bayesian inference approach called SoftDropConnect (SDC) to quantify the network uncertainty in medical imaging tasks with gliomas segmentation and metastases classification as initial examples. Our key idea is that during training and testing SDC modulates network parameters continuously so as to allow affected information processing channels still in operation, instead of disabling them as Dropout or DropConnet does. When compared with three popular Bayesian inference methods including Bayes By Backprop, Dropout, and DropConnect, our SDC method (SDC-W after optimization) outperforms the three competing methods with a substantial margin. Quantitatively, our proposed method generates substantial improvements in prediction accuracy (by 3.4%, 2.5%, and 6.7% respectively for whole tumor segmentation in terms of dice score; and by 11.7%, 3.9%, and 8.7% respectively for brain metastases classification) and greatly reduced epistemic and aleatoric uncertainties. Our approach promises to deliver better diagnostic performance and make medical AI imaging more explainable and trustworthy.

Qing Lyu, Sanjeev V. Namjoshi, Emory McTyre et al.

Treatment decisions for brain metastatic disease rely on knowledge of the primary organ site, and currently made with biopsy and histology. Here we develop a novel deep learning approach for accurate non-invasive digital histology with whole-brain MRI data. Our IRB-approved single-site retrospective study was comprised of patients (n=1,399) referred for MRI treatment-planning and gamma knife radiosurgery over 21 years. Contrast-enhanced T1-weighted and T2-weighted Fluid-Attenuated Inversion Recovery brain MRI exams (n=1,582) were preprocessed and input to the proposed deep learning workflow for tumor segmentation, modality transfer, and primary site classification into one of five classes. Ten-fold cross-validation generated overall AUC of 0.878 (95%CI:0.873,0.883), lung class AUC of 0.889 (95%CI:0.883,0.895), breast class AUC of 0.873 (95%CI:0.860,0.886), melanoma class AUC of 0.852 (95%CI:0.842,0.862), renal class AUC of 0.830 (95%CI:0.809,0.851), and other class AUC of 0.822 (95%CI:0.805,0.839). These data establish that whole-brain imaging features are discriminative to allow accurate diagnosis of the primary organ site of malignancy. Our end-to-end deep radiomic approach has great potential for classifying metastatic tumor types from whole-brain MRI images. Further refinement may offer an invaluable clinical tool to expedite primary cancer site identification for precision treatment and improved outcomes.