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Natural language-based machine learning models for the annotation of clinical radiology reports
Abstract
Purpose To compare different methods for generating features from radiology reports and to develop a method to automatically identify findings in these reports. Materials and Methods In this study, 96 303 head computed tomography (CT) reports were obtained. The linguistic complexity of these reports was compared with that of alternative corpora. Head CT reports were preprocessed, and machine-analyzable features were constructed by using bag-of-words (BOW), word embedding, and Latent Dirichlet allocation–based approaches. Ultimately, 1004 head CT reports were manually labeled for findings of interest by physicians, and a subset of these were deemed critical findings. Lasso logistic regression was used to train models for physician-assigned labels on 602 of 1004 head CT reports (60%) using the constructed features, and the performance of these models was validated on a held-out 402 of 1004 reports (40%). Models were scored by area under the receiver operating characteristic curve (AUC), and aggregate AUC statistics were reported for (a) all labels, (b) critical labels, and (c) the presence of any critical finding in a report. Sensitivity, specificity, accuracy, and F1 score were reported for the best performing model’s (a) predictions of all labels and (b) identification of reports containing critical findings. Results The best-performing model (BOW with unigrams, bigrams, and trigrams plus average word embeddings vector) had a held-out AUC of 0.966 for identifying the presence of any critical head CT finding and an average 0.957 AUC across all head CT findings. Sensitivity and specificity for identifying the presence of any critical finding were 92.59% (175 of 189) and 89.67% (191 of 213), respectively. Average sensitivity and specificity across all findings were 90.25% (1898 of 2103) and 91.72% (18 351 of 20 007), respectively. Simpler BOW methods achieved results competitive with those of more sophisticated approaches, with an average AUC for presence of any critical finding of 0.951 for unigram BOW versus 0.966 for the best-performing model. The Yule I of the head CT corpus was 34, markedly lower than that of the Reuters corpus (at 103) or I2B2 discharge summaries (at 271), indicating lower linguistic complexity. Conclusion Automated methods can be used to identify findings in radiology reports. The success of this approach benefits from the standardized language of these reports. With this method, a large labeled corpus can be generated for applications such as deep learning. © RSNA, 2018 Online supplemental material is available for this article.
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“Recently, deep learning methods have also been used for automated generation of radiology reports , typically incorporating long-short-term-memory (LSTM) network models to generate the textual paragraphs [314, 315, 316, 317], and also to identify findings in radiology reports [318, 319, 320].”
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Toward a Psychology of Deep Reinforcement Learning Agents Using a Cognitive Architecture
Mitsopoulos, K., Somers, S., Schooler, J. N., Lebiere, C. J., Pirolli, P. L. T., & Thomson, R. (2021) · Topics in Cognitive Science · doi:10.1111/tops.12573 · Cited by 17
Rule-based natural language processing for automation of stroke data extraction: a validation study
Gunter, D., Puac, P., Miguel, O., Thornhill, R. E., Yu, A., Liu, Z. A., Mamdani, M., Pou-Prom, C., & Aviv, R. I. (2022) · Neuroradiology · doi:10.1007/s00234-022-03029-1 · Cited by 16
Galbusera, F., Cina, A., Bassani, T., Panico, M., & Sconfienza, L. M. (2021) · Global Spine Journal · doi:10.1177/21925682211026910 · Cited by 16
“The scope of the present automated diagnosis was limited to the following radiological findings: (1) presence of spinal implants such as pedicle screws, posterior rods, cages, artificial discs (“instrumentation”); (2) reduced, absent or inverted lumbar lordosis (“loss of lordosis”); (3) sclerosis, hypertrophy or degen…”
MethodShelmerdine, S. C., Singh, M., Norman, W., Jones, R., Sebire, N. J., & Arthurs, O. J. (2019) · Clinical Radiology · doi:10.1016/j.crad.2019.04.021 · Cited by 15
Ahmad, R. G. (2021) · Acta Radiologica Open · doi:10.1177/2058460121990296 · Cited by 19
“24 The lack of structured reporting can be a strong hindrance behind this technology.”
BackgroundOverview of Algorithms for Natural Language Processing and Time Series Analyses
Feghali, J., Jimenez, A. E., Schilling, A. T., & Azad, T. D. (2021) · Acta neurochirurgica. Supplementum · doi:10.1007/978-3-030-85292-4_26 · Cited by 14
Radiology Report Annotation Using Generative Large Language Models: Comparative Analysis
Altalla’, B., Ahmad, A., Bitar, L., Al-Bssol, M. O., Al‐Omari, A., & Sultan, I. Y. (2025) · International Journal of Biomedical Imaging · doi:10.1155/ijbi/5019035 · Cited by 14
Assessment of actionable findings in radiology reports
Visser, J. J., de Vries, M., & Kors, J. A. (2020) · European Journal of Radiology · doi:10.1016/j.ejrad.2020.109109 · Cited by 13
Li, M., Deng, F. M., Chang, K., Kalpathy–Cramer, J., & Huang, A. J. (2021) · Academic Radiology · doi:10.1016/j.acra.2021.01.017 · Cited by 13
Abdullah, A., & Kim, S. T. (2025) · JMIR Medical Informatics · doi:10.2196/68618 · Cited by 15
“They demonstrate improvement over previous fixed embedding and word2vec-based [27] models [28] CheXbert labeler [3].”
Santomartino, S. M., Zech, J. R., Hall, K., Jeudy, J. J., Parekh, V. S., & Yi, P. H. (2024) · Radiology · doi:10.1148/radiol.232746 · Cited by 11
Kou, Y., Ye, S., Tian, Y., Yang, K., Qin, L., Huang, Z., Luo, B., Ha, Y., Zhan, L., Ye, R., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/67346 · Cited by 11
“Decision curve analysis (DCA) was conducted to evaluate the clinical use of the models [17].”
Templated Text Synthesis for Expert-Guided Multi-Label Extraction from Radiology Reports
Schrempf, P., Watson, H. I., Park, E., Pajak, M., MacKinnon, H., Muir, K. W., Harris‐Birtill, D., & O’Neil, A. Q. (2021) · Machine Learning and Knowledge Extraction · doi:10.3390/make3020015 · Cited by 11
“Simple approaches have been demonstrated using word embeddings or bag of words feature representations followed by logistic regression [12] or decision trees [13].”
MethodLiu, W., Zhang, X., Lv, H., Li, J., Liu, Y., Yang, Z., Weng, X., Lin, Y., Song, H., & Wang, Z. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.913806 · Cited by 10
“Cases were excluded according to the following criteria (1): follow-up reports, (2) covered liver surgery, (3) incomplete reports.”
BackgroundZhang, J., Mazurowski, M. A., Allen, B. C., & Wildman‐Tobriner, B. (2023) · Artificial Intelligence in Medicine · doi:10.1016/j.artmed.2023.102553 · Cited by 12
“Natural language processing (NLP) algorithms have been applied to radiology reports for document classification [13–17] and clinical entity recognition [18].”
MethodData Engineering for Machine Learning in Women's Imaging and Beyond
Chen, C., Chou, S.-H. S., Brattain, L. J., Lehman, C. D., & Samir, A. E. (2019) · American Journal of Roentgenology · doi:10.2214/ajr.18.20464 · Cited by 9
“Although the vast majority of data in the world are unlabeled, relatively few medical ML studies use unlabeled data [15, 16].”
BackgroundJujjavarapu, C., Pejaver, V. R., Cohen, T., Mooney, S. D., Heagerty, P. J., & Jarvik, J. G. (2021) · Academic Radiology · doi:10.1016/j.acra.2021.09.005 · Cited by 9
Crombé, A., Seux, M., Bratan, F., Bergerot, J.-F., Banaste, N., Thomson, V., Lecomte, J.-C., & Gorincour, G. (2022) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-022-00619-6 · Cited by 8
Artificial Intelligence in Radiology: Overview of Application Types, Design, and Challenges
Moassefi, M., Faghani, S., Khosravi, B., Rouzrokh, P., & Erickson, B. J. (2023) · Seminars in Roentgenology · doi:10.1053/j.ro.2023.01.005 · Cited by 8
Lanfredi, R. B., Mukherjee, P., & Summers, R. M. (2024) · Medical Image Analysis · doi:10.1016/j.media.2024.103383 · Cited by 10
Visser, J. J., de Vries, M., & Kors, J. A. (2022) · European Radiology · doi:10.1007/s00330-021-08467-8 · Cited by 8
“More sophisticated features have been proposed, including those based on topic modeling and word embeddings, but bag-of-words-based models achieved competitive results in a comparative study of different feature sets for the classification of critical findings in head CT reports [8].”
BackgroundGoyal, S. (2021) · Reports in Medical Imaging · doi:10.2147/rmi.s295205 · Cited by 8
The Utility of General Domain Transfer Learning for Medical Language TasksPreprint
Ranti, D. L., Hanss, K., Zhao, S., Arvind, V., Titano, J. J., Costa, A. B., & Oermann, E. K. (2020) · arXiv (Cornell University) · doi:10.48550/arxiv.2002.06670 · Cited by 8
Şanlı, D. E. T., Şanlı, A. N., Ozmen, G., Ozmen, A., Cihan, I., Kurt, A., & Esmerer, E. U. (2025) · Academic Radiology · doi:10.1016/j.acra.2025.08.026 · Cited by 7
Artificial Intelligence in Healthcare: Doctor as a Stakeholder
Bhavaraju, S. (2023) · Artificial intelligence · doi:10.5772/intechopen.111490 · Cited by 8
Benger, M., Wood, D. A., Kafiabadi, S., Busaidi, A. A., Guilhem, E., Lynch, J., Townend, M., Montvila, A., Siddiqui, J., Gadapa, N., et al. (2023) · Frontiers in Radiology · doi:10.3389/fradi.2023.1251825 · Cited by 7
“Numerous neuroradiology-focused studies have employed multi-category NLP models as part of computer vision model training (15 – 17).”
BackgroundPaying Per-Label Attention for Multi-label Extraction from Radiology Reports
Schrempf, P., Watson, H. I., Mikhael, S. S., Pajak, M., Falis, M., Lisowska, A., Muir, K. W., Harris‐Birtill, D., & O’Neil, A. Q. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-61166-8_29 · Cited by 7
Martín‐Noguerol, T., Úbeda, P. L., Paulano‐Godino, F., & Luna, A. (2024) · Magnetic Resonance Imaging · doi:10.1016/j.mri.2024.110280 · Cited by 7
Artificial intelligence, machine learning and deep learning for eye care specialists
Sayres, R., Hammel, N., & Liu, Y. (2020) · Annals of Eye Science · doi:10.21037/aes.2020.02.05 · Cited by 7
“, color fundus photographs, optical coherence tomography (OCT) scans, visual field maps (13,14)], or other types of data such as text-based radiology reports (15,16).”
BackgroundDecoding the brain through research—the future of brain health
Wang, D. Z., Schwamm, L. H., Qian, T., & Dai, Q. (2020) · BMJ · doi:10.1136/bmj.m3735 · Cited by 7
Labeling Noncontrast Head CT Reports for Common Findings Using Natural Language Processing
Iorga, M., Drakopoulos, M., Naidech, A. M., Katsaggelos, A. K., Parrish, T. B., & Hill, V. B. (2022) · American Journal of Neuroradiology · doi:10.3174/ajnr.a7500 · Cited by 8
“Simple models that combine n-grams and logistic regression classifiers have shown strong performance on radiology report labeling, comparable with the performance of deep learning or generative models.(23,24) N-gram counts were not scaled by document length (to n-gram frequency) because the language used to describe a…”
MethodApplications of AI Beyond Image Interpretation
Morey, J., Haney, N. M., & Kim, W. (2019) · Springer eBooks · doi:10.1007/978-3-319-94878-2_11 · Cited by 6
Metadata
- Authors
- Zech, J., Pain, M., Titano, J., Badgeley, M., Schefflein, J., Su, A., Costa, A., Bederson, J., Lehar, J., & Oermann, E. K.
- Affiliations
- Boston University (US)
- From the Departments of Radiology (J.Z., J.T., J.S., A.S.) and Neurosurgery (M.P., M.B., A.C., J.B., E.K.O.), Icahn School of Medicine, 1 Gustave Levy Pl, New York, NY 10029; and Department of Bioengineering and Bioinformatics, Boston University, Boston, Mass (J.L.).
- ORCID
- Venue
- Radiology
- Published
- 2018-05
- Volume
- 287
- Issue
- 2
- Pages
- 570-580
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- OpenAlex
- W2785863263
- Cited by
- 142
- References
- 37
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 8 · 2023: 18 · 2022: 14 · 2021: 28 · 2020: 27 · 2019: 21 · 2018: 9
- FWCI
- 11.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- State University of New York
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Health Sciences › Medicine › Health Informatics › Biomedical Text Mining and Ontologies
- Physical Sciences › Computer Science › Artificial Intelligence › Text and Document Classification Technologies
- Keywords
- head CT, bag-of-words features, word embeddings, latent Dirichlet allocation, LASSO logistic regression, linguistic complexity
- MeSH terms
- Machine Learning, Humans, Natural Language Processing, Radiology, Sensitivity and Specificity, Tomography, X-Ray Computed, Databases, Factual, Area Under Curve, Electronic Health Records
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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