Zhengliang Liu

Lian Zhang, Zhengliang Liu, Lu Zhang et al.

In this study, we evaluate the performance of the Segment Anything Model (SAM) in clinical radiotherapy. Our results indicate that SAM's 'segment anything' mode can achieve clinically acceptable segmentation results in most organs-at-risk (OARs) with Dice scores higher than 0.7. SAM's 'box prompt' mode further improves the Dice scores by 0.1 to 0.5. Considering the size of the organ and the clarity of its boundary, SAM displays better performance for large organs with clear boundaries but performs worse for smaller organs with unclear boundaries. Given that SAM, a model pre-trained purely on natural images, can handle the delineation of OARs from medical images with clinically acceptable accuracy, these results highlight SAM's robust generalization capabilities with consistent accuracy in automatic segmentation for radiotherapy. In other words, SAM can achieve delineation of different OARs at different sites using a generic automatic segmentation model. SAM's generalization capabilities across different disease sites suggest that it is technically feasible to develop a generic model for automatic segmentation in radiotherapy.

Jason Holmes, Lian Zhang, Yuzhen Ding et al.

Purpose: To introduce the concept of using large language models (LLMs) to re-label structure names in accordance with the American Association of Physicists in Medicine (AAPM) Task Group (TG)-263 standard, and to establish a benchmark for future studies to reference. Methods and Materials: The Generative Pre-trained Transformer (GPT)-4 application programming interface (API) was implemented as a Digital Imaging and Communications in Medicine (DICOM) storage server, which upon receiving a structure set DICOM file, prompts GPT-4 to re-label the structure names of both target volumes and normal tissues according to the AAPM TG-263. Three disease sites, prostate, head and neck, and thorax were selected for evaluation. For each disease site category, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50) and 50 patients were randomly selected for evaluation. Structure names that were considered were those that were most likely to be relevant for studies utilizing structure contours for many patients. Results: The overall re-labeling accuracy of both target volumes and normal tissues for prostate, head and neck, and thorax cases was 96.0%, 98.5%, and 96.9% respectively. Re-labeling of target volumes was less accurate on average except for prostate - 100%, 93.1%, and 91.1% respectively. Conclusions: Given the accuracy of GPT-4 in re-labeling structure names of both target volumes and normal tissues as presented in this work, LLMs are poised to be the preferred method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.

Yue Huang, Lichao Sun, Haoran Wang et al.

Large language models (LLMs), exemplified by ChatGPT, have gained considerable attention for their excellent natural language processing capabilities. Nonetheless, these LLMs present many challenges, particularly in the realm of trustworthiness. Therefore, ensuring the trustworthiness of LLMs emerges as an important topic. This paper introduces TrustLLM, a comprehensive study of trustworthiness in LLMs, including principles for different dimensions of trustworthiness, established benchmark, evaluation, and analysis of trustworthiness for mainstream LLMs, and discussion of open challenges and future directions. Specifically, we first propose a set of principles for trustworthy LLMs that span eight different dimensions. Based on these principles, we further establish a benchmark across six dimensions including truthfulness, safety, fairness, robustness, privacy, and machine ethics. We then present a study evaluating 16 mainstream LLMs in TrustLLM, consisting of over 30 datasets. Our findings firstly show that in general trustworthiness and utility (i.e., functional effectiveness) are positively related. Secondly, our observations reveal that proprietary LLMs generally outperform most open-source counterparts in terms of trustworthiness, raising concerns about the potential risks of widely accessible open-source LLMs. However, a few open-source LLMs come very close to proprietary ones. Thirdly, it is important to note that some LLMs may be overly calibrated towards exhibiting trustworthiness, to the extent that they compromise their utility by mistakenly treating benign prompts as harmful and consequently not responding. Finally, we emphasize the importance of ensuring transparency not only in the models themselves but also in the technologies that underpin trustworthiness. Knowing the specific trustworthy technologies that have been employed is crucial for analyzing their effectiveness.

Peilong Wang, Zhengliang Liu, Yiwei Li et al.

Background: The radiation oncology clinical practice involves many steps relying on the dynamic interplay of abundant text data. Large language models have displayed remarkable capabilities in processing complex text information. But their direct applications in specific fields like radiation oncology remain underexplored. Purpose: This study aims to investigate whether fine-tuning LLMs with domain knowledge can improve the performance on Task (1) treatment regimen generation, Task (2) treatment modality selection (photon, proton, electron, or brachytherapy), and Task (3) ICD-10 code prediction in radiation oncology. Methods: Data for 15,724 patient cases were extracted. Cases where patients had a single diagnostic record, and a clearly identifiable primary treatment plan were selected for preprocessing and manual annotation to have 7,903 cases of the patient diagnosis, treatment plan, treatment modality, and ICD-10 code. Each case was used to construct a pair consisting of patient diagnostics details and an answer (treatment regimen, treatment modality, or ICD-10 code respectively) for the supervised fine-tuning of these three tasks. Open source LLaMA2-7B and Mistral-7B models were utilized for the fine-tuning with the Low-Rank Approximations method. Accuracy and ROUGE-1 score were reported for the fine-tuned models and original models. Clinical evaluation was performed on Task (1) by radiation oncologists, while precision, recall, and F-1 score were evaluated for Task (2) and (3). One-sided Wilcoxon signed-rank tests were used to statistically analyze the results. Results: Fine-tuned LLMs outperformed original LLMs across all tasks with p-value <= 0.001. Clinical evaluation demonstrated that over 60% of the fine-tuned LLMs-generated treatment regimens were clinically acceptable. Precision, recall, and F1-score showed improved performance of fine-tuned LLMs.

Peilong Wang, Jason Holmes, Zhengliang Liu et al.

Purpose: We present an updated study evaluating the performance of large language models (LLMs) in answering radiation oncology physics questions, focusing on the recently released models. Methods: A set of 100 multiple-choice radiation oncology physics questions, previously created by a well-experienced physicist, was used for this study. The answer options of the questions were randomly shuffled to create "new" exam sets. Five LLMs -- OpenAI o1-preview, GPT-4o, LLaMA 3.1 (405B), Gemini 1.5 Pro, and Claude 3.5 Sonnet -- with the versions released before September 30, 2024, were queried using these new exam sets. To evaluate their deductive reasoning ability, the correct answer options in the questions were replaced with "None of the above." Then, the explain-first and step-by-step instruction prompts were used to test if this strategy improved their reasoning ability. The performance of the LLMs was compared with the answers from medical physicists. Results: All models demonstrated expert-level performance on these questions, with o1-preview even surpassing medical physicists with a majority vote. When replacing the correct answer options with 'None of the above', all models exhibited a considerable decline in performance, suggesting room for improvement. The explain-first and step-by-step instruction prompts helped enhance the reasoning ability of the LLaMA 3.1 (405B), Gemini 1.5 Pro, and Claude 3.5 Sonnet models. Conclusion: These recently released LLMs demonstrated expert-level performance in answering radiation oncology physics questions, exhibiting great potential to assist in radiation oncology physics education and training.