Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

A Pre - Purchase Evaluation and Comparative Study of Solutions from A WS, Google, Azure, John Snow Labs, and Open - Source Models on an Independent Pediatric Dataset Shruti Hegde MS, Mabon Manoj Ninan BS, Jonathan R. Dillman MD, MSc, Shireen Hayatghaibi PhD, Lynn Babcock MD, Elanchezhian Somasundaram PhD Abstract Purpose: General purpose clinical natural language processing tools are increasingly used for the automatic labeling of clinical reports to support various clinical, research and quality improvement applications. However, independent performance evaluations for specific tasks, such as labeling pediatric chest radiograph reports, remain scarce. This study aims to compare four leading commercial clinical NLP systems for entity extraction and assertion detection of clinically relevant findings in pediatric chest radiog raph reports . In addition, the study evaluates two dedicated chest radiograph report labelers, CheXpert and CheXbert, to provide a comprehensive performance comparison of the systems in extracting disease labels defined by CheXpert. Methods: A total of 95,008 pediatric chest radiograph (CXR) reports were obtained from a large academic pediatric hospital for this IRB - waived study. Clinically relevant terms were extracted using four general - purpose clinical NLP systems: Amazon Comprehend Medical (AWS), Google Healthcare NLP (GC), Azure Clinical NLP (AZ), and SparkNLP (SP) from John Snow Labs. After standardization, entities and their assertion statuses (positive, negative, uncertain) from the findings and impression sec tions were analyzed using descriptive statistics, paired t - tests, and Chi - square tests . Entities from the I mpression sections were mapped to 12 disease categories plus a No Findin gs category using a regular expression algorithm. In parallel, CheXpert and CheXbert processed the same reports to extract the same 13 categories (12 disease categories and a No Findings category) . Outputs from all six models were compared using Fleiss' Kappa across the assertion categories .

Automated labeling of chest X-ray reports is essential for enabling downstream tasks such as training image-based diagnostic models, population health studies, and clinical decision support. However, the high variability, complexity, and prevalence of negation and uncertainty in these free-text reports pose significant challenges for traditional Natural Language Processing methods. While large language models (LLMs) demonstrate strong text understanding, their direct application for large-scale, efficient labeling is limited by computational cost and speed. This paper introduces DeBERTa-RAD, a novel two-stage framework that combines the power of state-of-the-art LLM pseudo-labeling with efficient DeBERTa-based knowledge distillation for accurate and fast chest X-ray report labeling. We leverage an advanced LLM to generate high-quality pseudo-labels, including certainty statuses, for a large corpus of reports. Subsequently, a DeBERTa-Base model is trained on this pseudo-labeled data using a tailored knowledge distillation strategy. Evaluated on the expert-annotated MIMIC-500 benchmark, DeBERTa-RAD achieves a state-of-the-art Macro F1 score of 0.9120, significantly outperforming established rule-based systems, fine-tuned transformer models, and direct LLM inference, while maintaining a practical inference speed suitable for high-throughput applications. Our analysis shows particular strength in handling uncertain findings. This work demonstrates a promising path to overcome data annotation bottlenecks and achieve high-performance medical text processing through the strategic combination of LLM capabilities and efficient student models trained via distillation.

The automation of writing imaging reports is a valuable tool for alleviating the workload of radiologists. Crucial steps in this process involve the cross-modal alignment between medical images and reports, as well as the retrieval of similar historical cases. However, the presence of presentation-style vocabulary (e.g., sentence structure and grammar) in reports poses challenges for cross-modal alignment. Additionally, existing methods for similar historical cases retrieval face suboptimal performance owing to the modal gap issue. In response, this paper introduces a novel method, named Factual Serialization Enhancement (FSE), for chest X-ray report generation. FSE begins with the structural entities approach to eliminate presentation-style vocabulary in reports, providing specific input for our model. Then, uni-modal features are learned through cross-modal alignment between images and factual serialization in reports. Subsequently, we present a novel approach to retrieve similar historical cases from the training set, leveraging aligned image features. These features implicitly preserve semantic similarity with their corresponding reference reports, enabling us to calculate similarity solely among aligned features. This effectively eliminates the modal gap issue for knowledge retrieval without the requirement for disease labels. Finally, the cross-modal fusion network is employed to query valuable information from these cases, enriching image features and aiding the text decoder in generating high-quality reports. Experiments on MIMIC-CXR and IU X-ray datasets from both specific and general scenarios demonstrate the superiority of FSE over state-of-the-art approaches in both natural language generation and clinical efficacy metrics.

Free-text radiology reports present a rich data source for various medical tasks, but effectively labeling these texts remains challenging. Traditional rule-based labeling methods fall short of capturing the nuances of diverse free-text patterns. Moreover, models using expert-annotated data are limited by data scarcity and pre-defined classes, impacting their performance, flexibility and scalability. To address these issues, our study offers three main contributions: 1) We demonstrate the potential of GPT as an adept labeler using carefully designed prompts. 2) Utilizing only the data labeled by GPT, we trained a BERT-based labeler, CheX-GPT, which operates faster and more efficiently than its GPT counterpart. 3) To benchmark labeler performance, we introduced a publicly available expert-annotated test set, MIMIC-500, comprising 500 cases from the MIMIC validation set. Our findings demonstrate that CheX-GPT not only excels in labeling accuracy over existing models, but also showcases superior efficiency, flexibility, and scalability, supported by our introduction of the MIMIC-500 dataset for robust benchmarking. Code and models are available at https://github.com/kakaobrain/CheXGPT.