2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


From Jargon to Clarity: Improving the Readability of Foot and Ankle Radiology Reports With an Artificial Intelligence Large Language Model

James J Butler, MB BCh, New York, New York UNITED STATES
Michael Harrington, MD, Albany UNITED STATES
Yixuan Tony, MD, New York UNITED STATES
Andrew Rosenbaum, Albany, NY UNITED STATES
Alan P. Samsonov, BS, New York, NY UNITED STATES
Raymond J. Walls, MD, FRCS(Tr&Orth), FAAOS, Staten Island, NY UNITED STATES
John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS (Orth), New York UNITED STATES

NYU Langone Health, New York, New York, UNITED STATES

FDA Status Not Applicable

Summary

Artificial Intelligence Large Language Models Improves the Readability of Foot and Ankle Radiology Reports

Abstract

Background

The purpose of this study was to evaluate the efficacy of an Artificial Intelligence Large Language Model (AI-LLM) at improving the readability foot and ankle orthopedic radiology reports.

Methods

The radiology reports from 100 foot or ankle X-Rays, 100 computed tomography (CT) scans and 100 magnetic resonance imaging (MRI) scans were randomly sampled from the institution’s database. The following prompt command was inserted into the AI-LLM: “Explain this radiology report to a patient in layman's terms in the second person: [Report Text]”. The mean report length, Flesch reading ease score (FRES) and Flesch-Kincaid reading level (FKRL) were evaluated for both the original radiology report and the AI-LLM generated report. The accuracy of the information contained within the AI-LLM report was assessed via a 5-point Likert scale. Additionally, any “hallucinations” generated by the AI-LLM report were recorded.

Results

There was a statistically significant improvement in mean FRES scores in the AI-LLM generated X-Ray report (33.8 ± 6.8 to 72.7 ± 5.4), CT report (27.8 ± 4.6 to 67.5 ± 4.9) and MRI report (20.3 ± 7.2 to 66.9 ± 3.9), all p<0.001. There was also a statistically significant improvement in mean FKRL scores in the AI-LLM generated X-Ray report (12.2 ± 1.1 to 8.5 ± 0.4), CT report (15.4 ± 2.0 to 8.4 ± 0.6) and MRI report (14.1 ± 1.6 to 8.5 ± 0.5), all p < 0.001. Superior FRES scores were observed in the AI-LLM generated X-Ray report compared to the AI-LLM generated CT report and MRI report, p<0.001. The mean Likert score for the AI-LLM generated X-Ray report, CT report and MRI report was 4.0 ± 0.3, 3.9 ± 0.4, and 3.9 ± 0.4, respectively. The rate of hallucinations in the AI-LLM generator X-Ray report, CT report and MRI report was 4%, 7% and 6%, respectively.

Conclusion

AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. Superior FRES scores together with superior Likert scores were observed in the X-Ray AI-LLM reports compared to the CT and MRI AI-LLM reports. This study demonstrates the potential use of AI-LLMs as a new patient-centric approach for enhancing patient understanding of their foot and ankle radiology reports.