Ik Jae Lee

Sangjoon Park, Chan Woo Wee, Seo Hee Choi et al.

Accurate survival prediction in radiotherapy (RT) is critical for optimizing treatment decisions. This study developed and validated the RT-Surv framework, which integrates general-domain, open-source large language models (LLMs) to structure unstructured electronic health records alongside structured clinical data. Using data from 34,276 patients and an external cohort of 852, the framework successfully transformed unstructured clinical information into structured formats. Incorporating LLM-structured clinical features improved the concordance index from 0.779 to 0.842 during external validation, demonstrating a significant performance enhancement. Key LLM-structured features, such as disease extent, general condition, and RT purpose, showed high predictive importance and aligned closely with statistically significant predictors identified through conventional statistical analyses, thereby improving model interpretability. Furthermore, the framework enhanced risk stratification, enabling more distinct differentiation among low-, intermediate-, and high-risk groups (p < 0.001) using LLM-structured clinical features. These findings highlight the potential of LLMs to convert unstructured data into actionable insights, improving predictive modeling and patient outcomes in clinics.

Yujin Oh, Sangjoon Park, Hwa Kyung Byun et al.

Target volume contouring for radiation therapy is considered significantly more challenging than the normal organ segmentation tasks as it necessitates the utilization of both image and text-based clinical information. Inspired by the recent advancement of large language models (LLMs) that can facilitate the integration of the textural information and images, here we present a novel LLM-driven multimodal AI, namely LLMSeg, that utilizes the clinical text information and is applicable to the challenging task of target volume contouring for radiation therapy, and validate it within the context of breast cancer radiation therapy target volume contouring. Using external validation and data-insufficient environments, which attributes highly conducive to real-world applications, we demonstrate that the proposed model exhibits markedly improved performance compared to conventional unimodal AI models, particularly exhibiting robust generalization performance and data efficiency. To our best knowledge, this is the first LLM-driven multimodal AI model that integrates the clinical text information into target volume delineation for radiation oncology.

Yujin Oh, Sangjoon Park, Xiang Li et al.

Clinical decision-making reflects diverse strategies shaped by regional patient populations and institutional protocols. However, most existing medical artificial intelligence (AI) models are trained on highly prevalent data patterns, which reinforces biases and fails to capture the breadth of clinical expertise. Inspired by the recent advances in Mixture of Experts (MoE), we propose a Mixture of Multicenter Experts (MoME) framework to address AI bias in the medical domain without requiring data sharing across institutions. MoME integrates specialized expertise from diverse clinical strategies to enhance model generalizability and adaptability across medical centers. We validate this framework using a multimodal target volume delineation model for prostate cancer radiotherapy. With few-shot training that combines imaging and clinical notes from each center, the model outperformed baselines, particularly in settings with high inter-center variability or limited data availability. Furthermore, MoME enables model customization to local clinical preferences without cross-institutional data exchange, making it especially suitable for resource-constrained settings while promoting broadly generalizable medical AI.

Sangjoon Park, Yong Bae Kim, Jee Suk Chang et al.

As advancements in the field of breast cancer treatment continue to progress, the assessment of post-surgical cosmetic outcomes has gained increasing significance due to its substantial impact on patients' quality of life. However, evaluating breast cosmesis presents challenges due to the inherently subjective nature of expert labeling. In this study, we present a novel automated approach, Attention-Guided Denoising Diffusion Anomaly Detection (AG-DDAD), designed to assess breast cosmesis following surgery, addressing the limitations of conventional supervised learning and existing anomaly detection models. Our approach leverages the attention mechanism of the distillation with no label (DINO) self-supervised Vision Transformer (ViT) in combination with a diffusion model to achieve high-quality image reconstruction and precise transformation of discriminative regions. By training the diffusion model on unlabeled data predominantly with normal cosmesis, we adopt an unsupervised anomaly detection perspective to automatically score the cosmesis. Real-world data experiments demonstrate the effectiveness of our method, providing visually appealing representations and quantifiable scores for cosmesis evaluation. Compared to commonly used rule-based programs, our fully automated approach eliminates the need for manual annotations and offers objective evaluation. Moreover, our anomaly detection model exhibits state-of-the-art performance, surpassing existing models in accuracy. Going beyond the scope of breast cosmesis, our research represents a significant advancement in unsupervised anomaly detection within the medical domain, thereby paving the way for future investigations.