Multi-Agent AI System for Radiology Report Structuring and Quality Assurance with Independent Radiologist Evaluation

Purpose: To develop and evaluate a locally deployed multi-agent AI system for radiology report structuring and quality assurance. Materials and Methods: This retrospective study included 638 radiology reports from CT examinations of the chest, abdomen, and pelvis dictated by 15 board-certified radiologists in 2023 and 2024. A multi-agent AI pipeline was developed to perform report structuring and quality assurance (QA). The system structured the report into standardized anatomical sections at the sentence level using regex rules and local large language models. It also detected mismatches between the Findings and Impression sections, or within sections; gender-anatomy conflicts; and undocumented communication of critical findings. Two board-certified radiologists independently evaluated a 45-report subset. Results: The multi-agent system structured the Findings sections of all reports (22,270 sentences) into a predefined anatomical format while retaining the original report content. The system flagged 90 (14.1%) reports, most commonly for section mismatches (80 reports, 12.5%). In the radiologist evaluation, both reviewers agreed that 31 (69%) were correctly restructured, 2 reports (4%) were incorrectly restructured, and disagreed on the remaining 12 reports (27%). Both reviewers agreed that no clinically important information was omitted and no fabricated content was introduced. Overall QA performance was rated as "excellent" or "good" in 84% of the evaluated reports, with the remaining reports rated as "fair". Conclusion: A locally deployed multi-agent AI system combined radiology report structuring and quality assurance within a single workflow. The system demonstrated favorable performance in radiologist evaluation. Such systems may support standardization of reporting and quality assurance in radiology practice.

Improving Radiology Report Conciseness and Structure via Local Large Language Models

In this study, we aim to enhance radiology reporting by improving both the conciseness and structured organization of findings (also referred to as templating), specifically by organizing information according to anatomical regions. This structured approach allows physicians to locate relevant information quickly, increasing the report's utility. We utilize Large Language Models (LLMs) such as Mixtral, Mistral, and Llama to generate concise, well-structured reports. Among these, we primarily focus on the Mixtral model due to its superior adherence to specific formatting requirements compared to other models. To maintain data security and privacy, we run these LLMs locally behind our institution's firewall. We leverage the LangChain framework and apply five distinct prompting strategies to enforce a consistent structure in radiology reports, aiming to eliminate extraneous language and achieve a high level of conciseness. We also introduce a novel metric, the Conciseness Percentage (CP) score, to evaluate report brevity. Our dataset comprises 814 radiology reports authored by seven board-certified body radiologists at our cancer center. In evaluating the different prompting methods, we discovered that the most effective approach for generating concise, well-structured reports involves first instructing the LLM to condense the report, followed by a prompt to structure the content according to specific guidelines. We assessed all prompting strategies based on their ability to handle formatting issues, reduce report length, and adhere to formatting instructions. Our findings demonstrate that open-source, locally deployed LLMs can significantly improve radiology report conciseness and structure while conforming to specified formatting standards.