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 .

Significant methodological strides have been made toward Chest X-ray (CXR) understanding via modern vision-language models (VLMs), demonstrating impressive Visual Question Answering (VQA) and CXR report generation abilities. However, existing CXR understanding frameworks still possess several procedural caveats. (1) Previous methods solely use CXR reports, which are insufficient for comprehensive Visual Question Answering (VQA), especially when additional health-related data like medication history and prior diagnoses are needed. (2) Previous methods use raw CXR reports, which are often arbitrarily structured. While modern language models can understand various text formats, restructuring reports for clearer, organized anatomy-based information could enhance their usefulness. (3) Current evaluation methods for CXR-VQA primarily emphasize linguistic correctness, lacking the capability to offer nuanced assessments of the generated answers. In this work, to address the aforementioned caveats, we introduce WoLF, a Wide-scope Large Language Model Framework for CXR understanding. To resolve (1), we capture multi-faceted records of patients, which are utilized for accurate diagnoses in real-world clinical scenarios. Specifically, we adopt the Electronic Health Records (EHR) to generate instruction-following data suited for CXR understanding. Regarding (2), we enhance report generation performance by decoupling knowledge in CXR reports based on anatomical structure even within the attention step via masked attention. To address (3), we introduce an AI-evaluation protocol optimized for assessing the capabilities of LLM. Through extensive experimental validations, WoLF demonstrates superior performance over other models on MIMIC-CXR in the AI-evaluation arena about VQA (up to +9.47%p mean score) and by metrics about report generation (+7.3%p BLEU-1).

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.

Despite the progress in automatic detection of radiologic findings from chest X-ray (CXR) images in recent years, a quantitative evaluation of the explainability of these models is hampered by the lack of locally labeled datasets for different findings. With the exception of a few expert-labeled small-scale datasets for specific findings, such as pneumonia and pneumothorax, most of the CXR deep learning models to date are trained on global "weak" labels extracted from text reports, or trained via a joint image and unstructured text learning strategy. Inspired by the Visual Genome effort in the computer vision community, we constructed the first Chest ImaGenome dataset with a scene graph data structure to describe $242,072$ images. Local annotations are automatically produced using a joint rule-based natural language processing (NLP) and atlas-based bounding box detection pipeline. Through a radiologist constructed CXR ontology, the annotations for each CXR are connected as an anatomy-centered scene graph, useful for image-level reasoning and multimodal fusion applications. Overall, we provide: i) $1,256$ combinations of relation annotations between $29$ CXR anatomical locations (objects with bounding box coordinates) and their attributes, structured as a scene graph per image, ii) over $670,000$ localized comparison relations (for improved, worsened, or no change) between the anatomical locations across sequential exams, as well as ii) a manually annotated gold standard scene graph dataset from $500$ unique patients.

The chest X-ray (CXR) is by far the most commonly performed radiological examination for screening and diagnosis of many cardiac and pulmonary diseases. There is an immense world-wide shortage of physicians capable of providing rapid and accurate interpretation of this study. A radiologist-driven analysis of over two million CXR reports generated an ontology including the 40 most prevalent pathologies on CXR. By manually tagging a relatively small set of sentences, we were able to construct a training set of 959k studies. A deep learning model was trained to predict the findings given the patient frontal and lateral scans. For 12 of the findings we compare the model performance against a team of radiologists and show that in most cases the radiologists agree on average more with the algorithm than with each other.