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.

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.

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 results withsubstantially improved prediction accuracy (by 10.0%, 5.4% and 3.7% respectively for segmentation in terms of dice score; by 11.7%, 3.9%, 8.7% on classification in terms of test accuracy) and greatly reduced uncertainty in terms of mutual information (by 64%, 33% and 70% on segmentation; 98%, 88%, and 88% on classification). Our approach promises to deliver better diagnostic performance and make medical AI imaging more explainable and trustworthy.