VISION: Toward a Standardized Process for Radiology Image Management at the National Level

The compilation and analysis of radiological images poses numerous challenges for researchers. The sheer volume of data as well as the computational needs of algorithms capable of operating on images are extensive. Additionally, the assembly of these images alone is difficult, as these exams may differ widely in terms of clinical context, structured annotation available for model training, modality, and patient identifiers. In this paper, we describe our experiences and challenges in establishing a trusted collection of radiology images linked to the United States Department of Veterans Affairs (VA) electronic health record database. We also discuss implications in making this repository research-ready for medical investigators. Key insights include uncovering the specific procedures required for transferring images from a clinical to a research-ready environment, as well as roadblocks and bottlenecks in this process that may hinder future efforts at automation.

Leveraging Large Language Models to Extract Information on Substance Use Disorder Severity from Clinical Notes: A Zero-shot Learning Approach

Substance use disorder (SUD) poses a major concern due to its detrimental effects on health and society. SUD identification and treatment depend on a variety of factors such as severity, co-determinants (e.g., withdrawal symptoms), and social determinants of health. Existing diagnostic coding systems used by American insurance providers, like the International Classification of Diseases (ICD-10), lack granularity for certain diagnoses, but clinicians will add this granularity (as that found within the Diagnostic and Statistical Manual of Mental Disorders classification or DSM-5) as supplemental unstructured text in clinical notes. Traditional natural language processing (NLP) methods face limitations in accurately parsing such diverse clinical language. Large Language Models (LLMs) offer promise in overcoming these challenges by adapting to diverse language patterns. This study investigates the application of LLMs for extracting severity-related information for various SUD diagnoses from clinical notes. We propose a workflow employing zero-shot learning of LLMs with carefully crafted prompts and post-processing techniques. Through experimentation with Flan-T5, an open-source LLM, we demonstrate its superior recall compared to the rule-based approach. Focusing on 11 categories of SUD diagnoses, we show the effectiveness of LLMs in extracting severity information, contributing to improved risk assessment and treatment planning for SUD patients.