Evaluating GPT-4 with Vision on Detection of Radiological Findings on Chest Radiographs

The study examines the application of GPT-4V, a multi-modal large language model equipped with visual recognition, in detecting radiological findings from a set of 100 chest radiographs and suggests that GPT-4V is currently not ready for real-world diagnostic usage in interpreting chest radiographs.

Uncovering Misattributed Suicide Causes through Annotation Inconsistency Detection in Death Investigation Notes

Data accuracy is essential for scientific research and policy development. The National Violent Death Reporting System (NVDRS) data is widely used for discovering the patterns and causes of death. Recent studies suggested the annotation inconsistencies within the NVDRS and the potential impact on erroneous suicide-cause attributions. We present an empirical Natural Language Processing (NLP) approach to detect annotation inconsistencies and adopt a cross-validation-like paradigm to identify problematic instances. We analyzed 267,804 suicide death incidents between 2003 and 2020 from the NVDRS. Our results showed that incorporating the target state's data into training the suicide-crisis classifier brought an increase of 5.4% to the F-1 score on the target state's test set and a decrease of 1.1% on other states' test set. To conclude, we demonstrated the annotation inconsistencies in NVDRS's death investigation notes, identified problematic instances, evaluated the effectiveness of correcting problematic instances, and eventually proposed an NLP improvement solution.

Hidden Flaws Behind Expert-Level Accuracy of GPT-4 Vision in Medicine

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4V's rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges - an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals. Evaluation results confirmed that GPT-4V outperforms human physicians regarding multi-choice accuracy (88.0% vs. 77.0%, p=0.034). GPT-4V also performs well in cases where physicians incorrectly answer, with over 80% accuracy. However, we discovered that GPT-4V frequently presents flawed rationales in cases where it makes the correct final choices (27.3%), most prominent in image comprehension (21.6%). Regardless of GPT-4V's high accuracy in multi-choice questions, our findings emphasize the necessity for further in-depth evaluations of its rationales before integrating such models into clinical workflows.

A Span-based Model for Extracting Overlapping PICO Entities from RCT Publications

Objectives Extraction of PICO (Populations, Interventions, Comparison, and Outcomes) entities is fundamental to evidence retrieval. We present a novel method PICOX to extract overlapping PICO entities. Materials and Methods PICOX first identifies entities by assessing whether a word marks the beginning or conclusion of an entity. Then it uses a multi-label classifier to assign one or more PICO labels to a span candidate. PICOX was evaluated using one of the best-performing baselines, EBM-NLP, and three more datasets, i.e., PICO-Corpus, and RCT publications on Alzheimer's Disease or COVID-19, using entity-level precision, recall, and F1 scores. Results PICOX achieved superior precision, recall, and F1 scores across the board, with the micro F1 score improving from 45.05 to 50.87 (p << 0.01). On the PICO-Corpus, PICOX obtained higher recall and F1 scores than the baseline and improved the micro recall score from 56.66 to 67.33. On the COVID-19 dataset, PICOX also outperformed the baseline and improved the micro F1 score from 77.10 to 80.32. On the AD dataset, PICOX demonstrated comparable F1 scores with higher precision when compared to the baseline. Conclusion PICOX excels in identifying overlapping entities and consistently surpasses a leading baseline across multiple datasets. Ablation studies reveal that its data augmentation strategy effectively minimizes false positives and improves precision.

Towards long-tailed, multi-label disease classification from chest X-ray: Overview of the CXR-LT challenge

Many real-world image recognition problems, such as diagnostic medical imaging exams, are "long-tailed" $\unicode{x2013}$ there are a few common findings followed by many more relatively rare conditions. In chest radiography, diagnosis is both a long-tailed and multi-label problem, as patients often present with multiple findings simultaneously. While researchers have begun to study the problem of long-tailed learning in medical image recognition, few have studied the interaction of label imbalance and label co-occurrence posed by long-tailed, multi-label disease classification. To engage with the research community on this emerging topic, we conducted an open challenge, CXR-LT, on long-tailed, multi-label thorax disease classification from chest X-rays (CXRs). We publicly release a large-scale benchmark dataset of over 350,000 CXRs, each labeled with at least one of 26 clinical findings following a long-tailed distribution. We synthesize common themes of top-performing solutions, providing practical recommendations for long-tailed, multi-label medical image classification. Finally, we use these insights to propose a path forward involving vision-language foundation models for few- and zero-shot disease classification.