EHR-MCP: Real-world Evaluation of Clinical Information Retrieval by Large Language Models via Model Context Protocol

Background: Large language models (LLMs) show promise in medicine, but their deployment in hospitals is limited by restricted access to electronic health record (EHR) systems. The Model Context Protocol (MCP) enables integration between LLMs and external tools. Objective: To evaluate whether an LLM connected to an EHR database via MCP can autonomously retrieve clinically relevant information in a real hospital setting. Methods: We developed EHR-MCP, a framework of custom MCP tools integrated with the hospital EHR database, and used GPT-4.1 through a LangGraph ReAct agent to interact with it. Six tasks were tested, derived from use cases of the infection control team (ICT). Eight patients discussed at ICT conferences were retrospectively analyzed. Agreement with physician-generated gold standards was measured. Results: The LLM consistently selected and executed the correct MCP tools. Except for two tasks, all tasks achieved near-perfect accuracy. Performance was lower in the complex task requiring time-dependent calculations. Most errors arose from incorrect arguments or misinterpretation of tool results. Responses from EHR-MCP were reliable, though long and repetitive data risked exceeding the context window. Conclusions: LLMs can retrieve clinical data from an EHR via MCP tools in a real hospital setting, achieving near-perfect performance in simple tasks while highlighting challenges in complex ones. EHR-MCP provides an infrastructure for secure, consistent data access and may serve as a foundation for hospital AI agents. Future work should extend beyond retrieval to reasoning, generation, and clinical impact assessment, paving the way for effective integration of generative AI into clinical practice.

Validation of musculoskeletal segmentation model with uncertainty estimation for bone and muscle assessment in hip-to-knee clinical CT images

Deep learning-based image segmentation has allowed for the fully automated, accurate, and rapid analysis of musculoskeletal (MSK) structures from medical images. However, current approaches were either applied only to 2D cross-sectional images, addressed few structures, or were validated on small datasets, which limit the application in large-scale databases. This study aimed to validate an improved deep learning model for volumetric MSK segmentation of the hip and thigh with uncertainty estimation from clinical computed tomography (CT) images. Databases of CT images from multiple manufacturers/scanners, disease status, and patient positioning were used. The segmentation accuracy, and accuracy in estimating the structures volume and density, i.e., mean HU, were evaluated. An approach for segmentation failure detection based on predictive uncertainty was also investigated. The model has shown an overall improvement with respect to all segmentation accuracy and structure volume/density evaluation metrics. The predictive uncertainty yielded large areas under the receiver operating characteristic (AUROC) curves (AUROCs>=.95) in detecting inaccurate and failed segmentations. The high segmentation and muscle volume/density estimation accuracy, along with the high accuracy in failure detection based on the predictive uncertainty, exhibited the model's reliability for analyzing individual MSK structures in large-scale CT databases.

Identifying Suspicious Regions of Covid-19 by Abnormality-Sensitive Activation Mapping

This paper presents a fully-automated method for the identification of suspicious regions of a coronavirus disease (COVID-19) on chest CT volumes. One major role of chest CT scanning in COVID-19 diagnoses is identification of an inflammation particular to the disease. This task is generally performed by radiologists through an interpretation of the CT volumes, however, because of the heavy workload, an automatic analysis method using a computer is desired. Most computer-aided diagnosis studies have addressed only a portion of the elements necessary for the identification. In this work, we realize the identification method through a classification task by using a 2.5-dimensional CNN with three-dimensional attention mechanisms. We visualize the suspicious regions by applying a backpropagation based on positive gradients to attention-weighted features. We perform experiments on an in-house dataset and two public datasets to reveal the generalization ability of the proposed method. The proposed architecture achieved AUCs of over 0.900 for all the datasets, and mean sensitivity $0.853 \pm 0.036$ and specificity $0.870 \pm 0.040$. The method can also identify notable lesions pointed out in the radiology report as suspicious regions.

COVID-19 Infection Segmentation from Chest CT Images Based on Scale Uncertainty

This paper proposes a segmentation method of infection regions in the lung from CT volumes of COVID-19 patients. COVID-19 spread worldwide, causing many infected patients and deaths. CT image-based diagnosis of COVID-19 can provide quick and accurate diagnosis results. An automated segmentation method of infection regions in the lung provides a quantitative criterion for diagnosis. Previous methods employ whole 2D image or 3D volume-based processes. Infection regions have a considerable variation in their sizes. Such processes easily miss small infection regions. Patch-based process is effective for segmenting small targets. However, selecting the appropriate patch size is difficult in infection region segmentation. We utilize the scale uncertainty among various receptive field sizes of a segmentation FCN to obtain infection regions. The receptive field sizes can be defined as the patch size and the resolution of volumes where patches are clipped from. This paper proposes an infection segmentation network (ISNet) that performs patch-based segmentation and a scale uncertainty-aware prediction aggregation method that refines the segmentation result. We design ISNet to segment infection regions that have various intensity values. ISNet has multiple encoding paths to process patch volumes normalized by multiple intensity ranges. We collect prediction results generated by ISNets having various receptive field sizes. Scale uncertainty among the prediction results is extracted by the prediction aggregation method. We use an aggregation FCN to generate a refined segmentation result considering scale uncertainty among the predictions. In our experiments using 199 chest CT volumes of COVID-19 cases, the prediction aggregation method improved the dice similarity score from 47.6% to 62.1%.

Lung infection and normal region segmentation from CT volumes of COVID-19 cases

This paper proposes an automated segmentation method of infection and normal regions in the lung from CT volumes of COVID-19 patients. From December 2019, novel coronavirus disease 2019 (COVID-19) spreads over the world and giving significant impacts to our economic activities and daily lives. To diagnose the large number of infected patients, diagnosis assistance by computers is needed. Chest CT is effective for diagnosis of viral pneumonia including COVID-19. A quantitative analysis method of condition of the lung from CT volumes by computers is required for diagnosis assistance of COVID-19. This paper proposes an automated segmentation method of infection and normal regions in the lung from CT volumes using a COVID-19 segmentation fully convolutional network (FCN). In diagnosis of lung diseases including COVID-19, analysis of conditions of normal and infection regions in the lung is important. Our method recognizes and segments lung normal and infection regions in CT volumes. To segment infection regions that have various shapes and sizes, we introduced dense pooling connections and dilated convolutions in our FCN. We applied the proposed method to CT volumes of COVID-19 cases. From mild to severe cases of COVID-19, the proposed method correctly segmented normal and infection regions in the lung. Dice scores of normal and infection regions were 0.911 and 0.753, respectively.

Semantic Segmentation of Thigh Muscle using 2.5D Deep Learning Network Trained with Limited Datasets

Purpose: We propose a 2.5D deep learning neural network (DLNN) to automatically classify thigh muscle into 11 classes and evaluate its classification accuracy over 2D and 3D DLNN when trained with limited datasets. Enables operator invariant quantitative assessment of the thigh muscle volume change with respect to the disease progression. Materials and methods: Retrospective datasets consist of 48 thigh volume (TV) cropped from CT DICOM images. Cropped volumes were aligned with femur axis and resample in 2 mm voxel-spacing. Proposed 2.5D DLNN consists of three 2D U-Net trained with axial, coronal and sagittal muscle slices respectively. A voting algorithm was used to combine the output of U-Nets to create final segmentation. 2.5D U-Net was trained on PC with 38 TV and the remaining 10 TV were used to evaluate segmentation accuracy of 10 classes within Thigh. The result segmentation of both left and right thigh were de-cropped to original CT volume space. Finally, segmentation accuracies were compared between proposed DLNN and 2D/3D U-Net. Results: Average segmentation DSC score accuracy of all classes with 2.5D U-Net as 91.18% and Average Surface distance (ASD) accuracy as 0.84 mm. We found, mean DSC score for 2D U-Net was 3.3% lower than the that of 2.5D U-Net and mean DSC score of 3D U-Net was 5.7% lower than that of 2.5D U-Net when trained with same datasets. Conclusion: We achieved a faster computationally efficient and automatic segmentation of thigh muscle into 11 classes with reasonable accuracy. Enables quantitative evaluation of muscle atrophy with disease progression.