Applying large language model for automated quality scoring of radiology requisitions using a standardized criteria

To create and test a locally adapted large language model (LLM) for automated scoring of radiology requisitions based on the reason for exam imaging reporting and data system (RI-RADS), and to evaluate its performance based on reference standards.

This retrospective, double-center study included 131,683 radiology requisitions from two institutions. A bidirectional encoder representation from a transformer (BERT)-based model was trained using 101,563 requisitions from Center 1 (including 1500 synthetic examples) and externally tested on 18,887 requisitions from Center 2. The model's performance for two different classification strategies was evaluated by the reference standard created by three different radiologists. Model performance was assessed using Cohen's Kappa, accuracy, F1-score, sensitivity, and specificity with 95% confidence intervals.

A total of 18,887 requisitions were evaluated for the external test set. External testing yielded a performance with an F1-score of 0.93 (95% CI: 0.912-0.943); κ = 0.88 (95% CI: 0.871-0.884). Performance was highest in common categories RI-RADS D and X (F1 ≥ 0.96) and lowest for rare categories RI-RADS A and B (F1 ≤ 0.49). When grouped into three categories (adequate, inadequate, and unacceptable), overall model performance improved [F1-score = 0.97; (95% CI: 0.96-0.97)].

The locally adapted BERT-based model demonstrated high performance and almost perfect agreement with radiologists in automated RI-RADS scoring, showing promise for integration into radiology workflows to improve requisition completeness and communication.

Question Can an LLM accurately and automatically score radiology requisitions based on standardized criteria to address the challenges of incomplete information in radiological practice? Findings A locally adapted BERT-based model demonstrated high performance (F1-score 0.93) and almost perfect agreement with radiologists in automated RI-RADS scoring across a large, multi-institutional dataset. Clinical relevance LLMs offer a scalable solution for automated scoring of radiology requisitions, with the potential to improve workflow in radiology. Further improvement and integration into clinical practice could enhance communication, contributing to better diagnoses and patient care.