CRISS: A Retrieval-Augmented AI Chatbot for Assisting Cancer Registrars
Authors: Vani Seth, Mohammad Beheshti, Anirudh Kambhampati, Vishwa Bhayani, Lucinda Ham, Prasad Calyam, Iris Zachary
Organizations: Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, USA · Missouri Cancer Registry and Research Center, Department of Public Health, College of Health Sciences, University of Missouri, Columbia, USA · MU Institute for Data Science and Informatics, University of Missouri, Columbia, USA
Cancer registrars, including Oncology Data Specialists (ODSs), must interpret complex and frequently updated coding and staging standards. We developed CRISS (Cancer Registry Intelligent Support System), a retrieval-augmented generation (RAG) conversational assistant that provides rapid, citation-supported access to registry guidance. This study evaluated whether CRISS could (1) support accurate and citation-supported responses, (2) improve access to and interpretation of relevant guidance, and (3) support training/helpdesk use while preserving human oversight of final abstraction decisions. We built a domain-specific knowledge base from national cancer registry standards, segmented into metadata-tagged passages and indexed as dense embeddings. Retrieved passages were used to generate citation-grounded responses through a large language model (LLM). Open-weight, proprietary, and non-RAG baseline models across Gemini and GPT families were evaluated on easy, medium, and hard registry questions using an LLM-as-a-Judge protocols. RAG configurations consistently outperformed non-RAG approaches, especially as question difficulty increased. Mean grounding scores for RAG were 0.62/0.56/0.59 across easy/medium/hard tiers versus 0.29/0.26/0.29 for non-RAG. RAG models also achieved higher semantic-similarity scores overall. Proprietary RAG models performed strongest on easy and medium questions, while local RAG models ranked highest on hard questions and proprietary models were generally more cautious. Domain-specific RAG improved evidence grounding and response quality for cancer registry questions while enabling citation-supported assistance across complexity levels. CRISS demonstrates the potential of human-centered, citation-grounded AI to support cancer registrars while preserving human oversight for final coding decisions.
Large language models (LLMs) are increasingly being explored for clinical decision support, but their reliability in complex oncology treatment planning remains unclear. We evaluated agentic LLM systems for breast cancer treatment recommendation generation using 72 real clinical cases across stages I to IV and 1,147 case-specific rubrics generated through Asymmetric Information Rubric Generation (AIRG), in which the rubric generator had access to real clinical decisions unavailable to the evaluated models. Seven pipelines were compared, including single-LLM baselines, tool-augmented systems, and multi-agent architectures with fact checking and autonomous subagent spawning. The best-performing configuration, Claude Opus 4.8 with the D&C+SA pipeline, achieved a global score of 0.594 ± 0.025. Tool use and increased agent autonomy had mixed effects, improving performance in some settings but degrading it in others. Performance varied by clinical domain and disease stage, and oncologist-led error analysis revealed persistent clinically relevant failures, including incorrect or missing recommendations, flawed justifications, citation errors, outdated claims, and overconfidence. These findings suggest that agentic LLM systems can generate clinically relevant breast cancer recommendations, but remain insufficient for unsupervised clinical use.
Vinicius Anjos de Almeida, Nícolas Henrique Borges, Leonardo Vicenzi +5
Treatment planning in precision oncology requires synthesizing heterogeneous patient information with rapidly evolving clinical guidelines to ensure guideline-concordant care. While large language models (LLMs) show promise in many diagnostic tasks, their adoption for high-stakes treatment planning is hindered by complex reasoning, adherence to timely clinical guidelines, and safety concerns. In this study, we present GatorOnco, an agentic LLM for colorectal cancer (CRC) treatment planning. GatorOnco is developed using a total of 282 billion tokens of biomedical text, including healthcare system-scale clinical text comprising 166 billion tokens from UF Health. We implemented a domain-adaptation method that integrates pre-training, model merging, a two-stage post-training approach, and agent-based reinforcement learning. An agentic retrieval-augmented generation (RAG) approach dynamically integrates time-sensitive clinical guidelines into the reasoning process. In a blind, randomized clinical evaluation conducted by five UF Health oncologists, GatorOnco significantly outperformed open-source LLMs (P < 0.01) and achieved expert-level performance comparable to UF Health oncologists. Compared with expert oncologists, GatorOnco received significantly higher ratings for readability (4.46 vs. 4.19, P < 0.01) and completeness (3.91 vs. 3.52, P < 0.01), while showing statistically comparable performance in correctness (4.09 vs. 4.11, P = 0.921), currency (4.04 vs. 3.98, P = 0.478), and safety (4.22 vs. 4.22, P = 0.999). These findings demonstrate that integrating agentic reasoning with large-scale domain adaptation can help bridge the gap for generative AI in high-stakes cancer treatment planning.
Automated radiology report generation (RRG) can ease radiologist workload, yet most existing systems produce a report in a single forward pass, with no mechanism to check a claim against the image or revisit a finding once stated. We present CogRad, a cognitively inspired multi-agent framework that structures generation around four stages of a radiologist's reading process. A Scout agent discovers anatomical regions directly from image patches via slot attention and assigns region and disease-level triage scores; an Investigator agent concentrates representational capacity on the regions Scout flags as suspicious; a Writer agent compiles these signals into a disease gated visual prefix for a large language model; and a Verifier agent supervises training with a visual entailment loss and, at inference, re-examines its own draft sentence by sentence, regenerating any report it judges insufficiently grounded. On CheXpert Plus, CogRad attains a BLEU-4 of 0.316 and a CIDEr of 0.322, the best scores among the methods we compare against. On IU X-Ray, it attains a BLEU-4 of 0.201 and a CIDEr of 0.724, leading every baseline on every standard NLG metric. We further evaluate CogRad with RadGraph F1, CheXbert F1, and a hallucination analysis to assess clinical accuracy beyond standard text-overlap metrics, complemented by ablation studies and Grad-CAM-based visualizations that characterize each agent's contribution and the model's visual grounding.
Saif Ur Rehman Khan, Hasaan Maqsood, Sebastian Vollmer +2