Large Language Model-Assisted Cleaning of Report-Derived Labels in a Large-Scale Chest CT Dataset

Interpreting quantitative CT biomarkers, such as organ volume and tissue attenuation, requires large-scale healthy reference distributions. However, creating these is challenging because clinical datasets are often heavily enriched with pathology. Here, we develop an evidence-grounded, cross-verified large language model (LLM) ensemble to filter pathological findings from radiology reports, enabling the construction of pathology-reduced cohorts from over 350,000 CT examinations. Five LLMs, first, flag structure-level abnormality candidates grounded in verbatim report evidence and, second, resolve disagreements via cross-verification. Using distribution-aware generalized additive models for location, scale, and shape, we establish comprehensive whole-body reference charts for 106 anatomical structures (volumes and attenuation) across adulthood, accounting for age, sex, contrast enhancement, and acquisition parameters. Longitudinal analyses reveal structure- and contrast-dependent changes distinct from cross-sectional trends. These resources facilitate covariate-adjusted centile scoring from routine CT, supporting standardized quantitative phenotyping, multi-site imaging studies, and scalable opportunistic screening research.

Purpose: Accurate CT protocol selection is critical for diagnostic quality and patient safety, yet the current process is manual, time-consuming, and prone to inconsistencies. Prior Machine Learning methods using keywords or bag-of-words lack contextual understanding and perform poorly on rare protocols. We propose a decision support system using large language model (LLM) features to recommend protocols from free-text clinical indications, capturing clinical nuance and phrasing variation for more consistent, efficient selection. Methods: In this REB-approved retrospective study, 285,123 chest CT imaging requests from a large academic medical center (2017-2024) were split into training (228,099, 80%) and held-out test (57,024, 20%) sets. Each request included procedure names, clinical indication, HIS comments, and the selected protocol. Clinical text was embedded using a fine-tuned LLM, Meta's LLaMA-3.1-70B; these features input a logistic regression classifier predicting 18 protocol labels (e.g., PE, LDCT). Results: The pipeline achieved a weighted precision of 0.84, weighted F1-score of 0.81, and overall accuracy of 79% across 18 CT protocols. On 300 independent cases with expert consensus, the LLM reached an overall accuracy of 80% versus 83% for radiologists, with no significant difference (p = 0.263). Performance was comparable across most classes, with the LLM exceeding radiologists for some challenging categories, and entropy analyses indicated more balanced protocol use, suggesting reduced variability. Conclusion: An LLM-based recommendation system can leverage general knowledge from a large natural-text corpus to accurately assign chest CT protocols from free-text imaging requests, and may serve as a viable foundation for protocol recommendation tools where inputs require language understanding.

Errors in radiology reports can adversely affect patient treatment, yet automated report quality assurance remains challenging because errors are often subtle and require domain expertise to detect. Although large language models (LLMs) have recently been proposed for radiology report verification, their ability to detect clinically meaningful errors beyond chest X-ray datasets remains under-explored. To this end, we present the first systematic evaluation of language models for PET/CT report error detection, comparing compact domain-specific models with SOTA open-weight LLMs. We collected 30,633 oncology FDG PET/CT reports from 23 radiologists over 10 years. We trained domain-specific BERT models to detect clinically motivated synthetic reporting errors and evaluated alongside zero-/few-shot Qwen3-32B, Gemma-3-27B and Llama-3.3-70B on a held-out benchmark of 11,500 reports. A 15M-parameter model achieved 94.4% balanced accuracy with a 5.8% false-positive rate, compared with 84.0% for the strongest prompted LLM. Task-specific adaptation of Llama-3.3-70B closed this performance gap (94.4%) but retained substantially greater computational requirements. Our results suggest that domain-specific training matters more than model scale for PET/CT report error detection, supporting compact models as an accurate and computationally efficient approach to automated radiology report quality assurance.