Visual question answering-based image-finding generation for pulmonary nodules on chest CT from structured annotations

Interpretation of imaging findings based on morphological characteristics is important for diagnosing pulmonary nodules on chest computed tomography (CT) images. In this study, we constructed a visual question answering (VQA) dataset from structured data in an open dataset and investigated an image-finding generation method for chest CT images, with the aim of enabling interactive diagnostic support that presents findings based on questions that reflect physicians' interests rather than fixed descriptions. In this study, chest CT images included in the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) datasets were used. Regions of interest surrounding the pulmonary nodules were extracted from these images, and image findings and questions were defined based on morphological characteristics recorded in the database. A dataset comprising pairs of cropped images, corresponding questions, and image findings was constructed, and the VQA model was fine-tuned on it. Language evaluation metrics such as BLEU were used to evaluate the generated image findings. The VQA dataset constructed using the proposed method contained image findings with natural expressions as radiological descriptions. In addition, the generated image findings showed a high CIDEr score of 3.896, and a high agreement with the reference findings was obtained through evaluation based on morphological characteristics. We constructed a VQA dataset for chest CT images using structured information on the morphological characteristics from the LIDC-IDRI dataset. Methods for generating image findings in response to these questions have also been investigated. Based on the generated results and evaluation metric scores, the proposed method was effective as an interactive diagnostic support system that can present image findings according to physicians' interests.

Generation of Chest CT pulmonary Nodule Images by Latent Diffusion Models using the LIDC-IDRI Dataset

Recently, computer-aided diagnosis systems have been developed to support diagnosis, but their performance depends heavily on the quality and quantity of training data. However, in clinical practice, it is difficult to collect the large amount of CT images for specific cases, such as small cell carcinoma with low epidemiological incidence or benign tumors that are difficult to distinguish from malignant ones. This leads to the challenge of data imbalance. In this study, to address this issue, we proposed a method to automatically generate chest CT nodule images that capture target features using latent diffusion models (LDM) and verified its effectiveness. Using the LIDC-IDRI dataset, we created pairs of nodule images and finding-based text prompts based on physician evaluations. For the image generation models, we used Stable Diffusion version 1.5 (SDv1) and 2.0 (SDv2), which are types of LDM. Each model was fine-tuned using the created dataset. During the generation process, we adjusted the guidance scale (GS), which indicates the fidelity to the input text. Both quantitative and subjective evaluations showed that SDv2 (GS = 5) achieved the best performance in terms of image quality, diversity, and text consistency. In the subjective evaluation, no statistically significant differences were observed between the generated images and real images, confirming that the quality was equivalent to real clinical images. We proposed a method for generating chest CT nodule images based on input text using LDM. Evaluation results demonstrated that the proposed method could generate high-quality images that successfully capture specific medical features.

Generating Findings for Jaw Cysts in Dental Panoramic Radiographs Using GPT-4o: Building a Two-Stage Self-Correction Loop with Structured Output (SLSO) Framework

In this study, we utilized the multimodal capabilities of OpenAI GPT-4o to automatically generate jaw cyst findings on dental panoramic radiographs. To improve accuracy, we constructed a Self-correction Loop with Structured Output (SLSO) framework and verified its effectiveness. A 10-step process was implemented for 22 cases of jaw cysts, including image input and analysis, structured data generation, tooth number extraction and consistency checking, iterative regeneration when inconsistencies were detected, and finding generation with subsequent restructuring and consistency verification. A comparative experiment was conducted using the conventional Chain-of-Thought (CoT) method across seven evaluation items: transparency, internal structure, borders, root resorption, tooth movement, relationships with other structures, and tooth number. The results showed that the proposed SLSO framework improved output accuracy for many items, with 66.9%, 33.3%, and 28.6% improvement rates for tooth number, tooth movement, and root resorption, respectively. In the successful cases, a consistently structured output was achieved after up to five regenerations. Although statistical significance was not reached because of the small size of the dataset, the overall SLSO framework enforced negative finding descriptions, suppressed hallucinations, and improved tooth number identification accuracy. However, the accurate identification of extensive lesions spanning multiple teeth is limited. Nevertheless, further refinement is required to enhance overall performance and move toward a practical finding generation system.

Automated Report Generation for Lung Cytological Images Using a CNN Vision Classifier and Multiple-Transformer Text Decoders: Preliminary Study

Cytology plays a crucial role in lung cancer diagnosis. Pulmonary cytology involves cell morphological characterization in the specimen and reporting the corresponding findings, which are extremely burdensome tasks. In this study, we propose a report-generation technique for lung cytology images. In total, 71 benign and 135 malignant pulmonary cytology specimens were collected. Patch images were extracted from the captured specimen images, and the findings were assigned to each image as a dataset for report generation. The proposed method consists of a vision model and a text decoder. In the former, a convolutional neural network (CNN) is used to classify a given image as benign or malignant, and the features related to the image are extracted from the intermediate layer. Independent text decoders for benign and malignant cells are prepared for text generation, and the text decoder switches according to the CNN classification results. The text decoder is configured using a Transformer that uses the features obtained from the CNN for report generation. Based on the evaluation results, the sensitivity and specificity were 100% and 96.4%, respectively, for automated benign and malignant case classification, and the saliency map indicated characteristic benign and malignant areas. The grammar and style of the generated texts were confirmed as correct and in better agreement with gold standard compared to existing LLM-based image-captioning methods and single-text-decoder ablation model. These results indicate that the proposed method is useful for pulmonary cytology classification and reporting.