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Mar 14

Reshaping Free-Text Radiology Notes Into Structured Reports With Generative Transformers

BACKGROUND: Radiology reports are typically written in a free-text format, making clinical information difficult to extract and use. Recently the adoption of structured reporting (SR) has been recommended by various medical societies thanks to the advantages it offers, e.g. standardization, completeness and information retrieval. We propose a pipeline to extract information from free-text radiology reports, that fits with the items of the reference SR registry proposed by a national society of interventional and medical radiology, focusing on CT staging of patients with lymphoma. METHODS: Our work aims to leverage the potential of Natural Language Processing (NLP) and Transformer-based models to deal with automatic SR registry filling. With the availability of 174 radiology reports, we investigate a rule-free generative Question Answering approach based on a domain-specific version of T5 (IT5). Two strategies (batch-truncation and ex-post combination) are implemented to comply with the model's context length limitations. Performance is evaluated in terms of strict accuracy, F1, and format accuracy, and compared with the widely used GPT-3.5 Large Language Model. A 5-point Likert scale questionnaire is used to collect human-expert feedback on the similarity between medical annotations and generated answers. RESULTS: The combination of fine-tuning and batch splitting allows IT5 to achieve notable results; it performs on par with GPT-3.5 albeit its size being a thousand times smaller in terms of parameters. Human-based assessment scores show a high correlation (Spearman's correlation coefficients>0.88, p-values<0.001) with AI performance metrics (F1) and confirm the superior ability of LLMs (i.e., GPT-3.5, 175B of parameters) in generating plausible human-like statements.

Teach Better or Show Smarter? On Instructions and Exemplars in Automatic Prompt Optimization

Large language models have demonstrated remarkable capabilities, but their performance is heavily reliant on effective prompt engineering. Automatic prompt optimization (APO) methods are designed to automate this and can be broadly categorized into those targeting instructions (instruction optimization, IO) vs. those targeting exemplars (exemplar selection, ES). Despite their shared objective, these have evolved rather independently, with IO recently receiving more research attention. This paper seeks to bridge this gap by comprehensively comparing the performance of representative IO and ES techniques, both isolation and combination, on a diverse set of challenging tasks. Our findings reveal that intelligently reusing model-generated input-output pairs obtained from evaluating prompts on the validation set as exemplars consistently improves performance over IO methods but is currently under-investigated. We also find that despite the recent focus on IO, how we select exemplars can outweigh how we optimize instructions, with ES strategies as simple as random search outperforming state-of-the-art IO methods with seed instructions without any optimization. Moreover, we observe synergy between ES and IO, with optimal combinations surpassing individual contributions. We conclude that studying exemplar selection as a standalone method and its optimal combination with instruction optimization remains a crucial aspect of APO and deserves greater consideration in future research, even in the era of highly capable instruction-following models.