QICOM: Open-Source Software for Reproducible Image Quality Evaluation, Blinded Assessment, and Radiomic Comparison

The Natural Image Quality Evaluator (NIQE) scores an image by its statistical distance from a model fitted on pristine images, and its distributed model is fitted on photographs. We release the Radiology Image Quality Evaluator (RIQE), a NIQE-style model fitted on 3,792 full-dose slices from 158 patients of the public LDCT-and-Projection-data collection, with a declared intensity mapping, a manifest of every slice and a script that reproduces the fit. On 40 held-out patients, RIQE ranks reduced-dose reconstructions, simulated by projection-domain noise insertion, worse than the full-dose reconstruction of the same slice in 240 of 240 chest and 230 of 240 abdominal pairs, and ranks images with 20% more noise worse than their source in 97.5-100% of cases. Its preferences among filtered images, however, do not follow lesion signal. With a 4 mm, +10 HU lesion inserted in noisy abdominal slices, RIQE prefers bilateral filtering to the unfiltered image in every image up to a 32 HU residual, at which 29% of the lesion's matched-filter signal remains and its detectability index falls from 0.51 to 0.33; it never prefers Gaussian smoothing, which at the same 32 HU residual leaves 70% of the signal and a detectability index of 0.48. Fitted on photographs with the parameters published for NIQE, the same code ranks every simulated reduced-dose abdominal image better than its full-dose counterpart. RIQE is suited to ranking a degraded image against its source; under the conditions tested it should not be the sole criterion for selecting, comparing or tuning denoisers.

As AI systems are increasingly used to draft radiology reports, reliably evaluating their clinical quality remains a critical challenge. Large language model (LLM)-based metrics are now the best-correlated with radiologist judgment, yet they output a single opaque score that neither a clinician nor a model builder can easily interpret or audit. We introduce RadMatch, a multi-stage, LLM-based metric that decomposes report comparison into a structured finding-level matching with significance-aware scoring and error characterization across seven clinical attribute dimensions (status, location, severity, morphology, certainty, longitudinal comparison, and measurement). The main score is the actionable-error count, both interpretable and auditable. Candidate findings are graded correct, partial, or incorrect, and unmatched findings are counted as missed or hallucinated. Triage and actionable safety recall/precision and per-subset views add complementary, deployment-oriented lenses. Across two expert benchmarks, RadMatch is the most clinically aligned metric, matching inter-radiologist agreement on ReXVal and more than doubling the best prior metric on the harder RadEvalExpert. Relying only on few-shot prompting, it is designed to extend to other modalities and anatomies. We will release RadMatch as open-source code with an interactive dashboard for inspecting results.

Medical image quality plays a critical role in diagnostic accuracy, especially in X-ray-based imaging modalities such as cone-beam computed tomography (CBCT), where image quality must be balanced against radiation dose. While expert visual evaluation remains the clinical standard for image quality evaluation, it is time-consuming, subjective and affected by inter-observer variability, emphasizing the need for reliable quantitative image quality assessment (IQA) methods. However, the development and validation of such IQA methods have been limited by the lack of publicly available CBCT datasets with expert image quality annotations. In this study, we provide the first open-access CBCT IQA dataset containing 1,764 annotated image slices acquired using systematic variations in image acquisition and reconstruction parameters. Three clinical experts graded the overall image quality and a predefined regions of interest (ROI) using a four-level scoring scheme. In addition, we benchmark 26 full reference- and no reference-based IQA measures against expert annotations and introduce an exploratory IQA measure-based ranking capable of distinguishing subtle image quality differences. This dataset introduced a standardized benchmark for future CBCT IQA research and provides a valuable resource for the development and validation of new IQA methods, enabling reproducible research and advancing CBCT IQA.