Evidence-Linked Radiology Reporting: A Human-Supervised Reference Architecture for Structured Imaging Intelligence

Radiology reports remain the primary mechanism by which imaging findings are communicated to clinical teams. However, much of the structured information behind these reports, including measurements, image evidence, prior comparisons, lesion identity, uncertainty, and terminology, often remains trapped in free text or fragmented across picture archiving and communication systems, radiology information systems, reporting workstations, worksheets, advanced visualization tools, and electronic health records. This paper proposes a human-supervised, evidence-linked reference architecture for structured radiology reporting. The framework combines exam-specific templates, speech-to-structure processing, measurement and segmentation capture, controlled AI-assisted drafting, and standards-based interoperability using DICOM, DICOM Structured Reporting, DICOM Segmentation, HL7 FHIR, RadLex, SNOMED CT, LOINC, and UCUM. The system is positioned not as an autonomous report generator, but as a structured intelligence layer for enterprise imaging that supports reviewed reporting, longitudinal comparison, clinical data reuse, governance, and integration with PACS, RIS, EHR, analytics, and registry workflows. The paper also discusses modality-specific deployment considerations, clinical safety risks, validation requirements, cybersecurity, privacy, quality management, and regulatory boundaries for AI-assisted radiology reporting systems.

EHRSummarizer: A Privacy-Aware, FHIR-Native Architecture for Structured Clinical Summarization of Electronic Health Records

Clinicians routinely navigate fragmented electronic health record (EHR) interfaces to assemble a coherent picture of a patient's problems, medications, recent encounters, and longitudinal trends. This work describes EHRSummarizer, a privacy-aware, FHIR-native reference architecture that retrieves a targeted set of high-yield FHIR R4 resources, normalizes them into a consistent clinical context package, and produces structured summaries intended to support structured chart review. The system can be configured for data minimization, stateless processing, and flexible deployment, including local inference within an organization's trust boundary. To mitigate the risk of unsupported or unsafe behavior, the summarization stage is constrained to evidence present in the retrieved context package, is intended to indicate missing or unavailable domains where feasible, and avoids diagnostic or treatment recommendations. Prototype demonstrations on synthetic and test FHIR environments illustrate end-to-end behavior and output formats; however, this manuscript does not report clinical outcomes or controlled workflow studies. We outline an evaluation plan centered on faithfulness, omission risk, temporal correctness, usability, and operational monitoring to guide future institutional assessments.