Artificial intelligence-generated smart impression from 9.8-million radiology reports as training datasets from multiple sites and imaging modalities

Importance: Automatic generation of the impression section of radiology report can help make radiologists efficient and avoid reporting errors. Objective: To evaluate the relationship, content, and accuracy of an Powerscribe Smart Impression (PSI) against the radiologists reported findings and impression (RDF). Design, Setting, and Participants: The institutional review board approved retrospective study developed and trained an PSI algorithm (Nuance Communications, Inc.) with 9.8 million radiology reports from multiple sites to generate PSI based on information including the protocol name and the radiologists-dictated findings section of radiology reports. Three radiologists assessed 3879 radiology reports of multiple imaging modalities from 8 US imaging sites. For each report, we assessed if PSI can accurately reproduce the RDF in terms of the number of clinically significant findings and radiologists style of reporting while avoiding potential mismatch (with the findings section in terms of size, location, or laterality). Separately we recorded the word count for PSI and RDF. Data were analyzed with Pearson correlation and paired t-tests. Main Outcomes and Measures: The data were ground truthed by three radiologists. Each radiologists recorded the frequency of the incidental/significant findings, any inconsistency between the RDF and PSI as well as the stylistic evaluation overall evaluation of PSI. Area under the curve (AUC), correlation coefficient, and the percentages were calculated. Results: PSI reports were deemed either perfect (91.9%) or acceptable (7.68%) for stylistic concurrence with RDF. Both PSI (mismatched Hallers Index) and RDF (mismatched nodule size) had one mismatch each. There was no difference between the word counts of PSI (mean 33+/-23 words/impression) and RDF (mean 35+/-24 words/impression) (p>0.1). Overall, there was an excellent correlation (r= 0.85) between PSI and RDF for the evolution of findings (negative vs. stable vs. new or increasing vs. resolved or decreasing findings). The PSI outputs (2%) requiring major changes pertained to reports with multiple impression items. Conclusion and Relevance: In clinical settings of radiology exam interpretation, the Powerscribe Smart Impression assessed in our study can save interpretation time; a comprehensive findings section results in the best PSI output. ### Competing Interest Statement Three coauthors (SA, RB, and SE) are employees of Nuance Communications. Two study coinvestigators (MKK and SRD) have received research grant funding for unrelated projects (Coreline Inc., Riverain Tech, Siemens Healthineers; Qure.AI, Lunit Inc., Vuno Inc.). There was no research grant, fund, or support provided for this study. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Our retrospective study was approved by the institutional review board at Massachusetts General Brigham (IRB protocol number: 2020P003950) with a waiver of informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes N/A