# Evidence Is All You Need: Ordering Imaging Studies via Language Model Alignment with the ACR Appropriateness Criteria

arXiv: https://arxiv.org/abs/2409.19177 · HTML: https://mlsanity.com/paper/2409.19177/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical LLM alignment, one of 10 directions in LLM alignment / RLHF / preference optimisation.
- Builds on 17 of its 110 references that are in the map.
- First posted on arXiv 27 Sep 2024.

## Placed in

- LLM alignment / RLHF / preference optimisation / [Medical LLM alignment](https://mlsanity.com/alignment/medical-llm-alignment/)

## Builds on (most cited first, 17 of 17)

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- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [TruthfulQA: Measuring How Models Mimic Human Falsehoods](https://mlsanity.com/paper/2109.07958/) (2021)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Mixtral of Experts](https://mlsanity.com/paper/2401.04088/) (2024)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [MPNet: Masked and Permuted Pre-training for Language Understanding](https://mlsanity.com/paper/2004.09297/) (2020)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [MedCPT: Contrastive Pre-trained Transformers with Large-scale PubMed Search Logs for Zero-shot Biomedical Information Retrieval](https://mlsanity.com/paper/2307.00589/) (2023)
- [Benchmarking Large Language Models on Answering and Explaining Challenging Medical Questions](https://mlsanity.com/paper/2402.18060/) (2024)
- [Faithfulness vs. Plausibility: On the (Un)Reliability of Explanations from Large Language Models](https://mlsanity.com/paper/2402.04614/) (2024)
- [Diagnostic Reasoning Prompts Reveal the Potential for Large Language Model Interpretability in Medicine](https://mlsanity.com/paper/2308.06834/) (2023)
- [MedExQA: Medical Question Answering Benchmark with Multiple Explanations](https://mlsanity.com/paper/2406.06331/) (2024)
- [DOLOMITES: Domain-Specific Long-Form Methodical Tasks](https://mlsanity.com/paper/2405.05938/) (2024)

## Abstract (arXiv)

Diagnostic imaging studies are an increasingly important component of the workup and management of acutely presenting patients. However, ordering appropriate imaging studies according to evidence-based medical guidelines is a challenging task with a high degree of variability between healthcare providers. To address this issue, recent work has investigated if generative AI and large language models can be leveraged to help clinicians order relevant imaging studies for patients. However, it is challenging to ensure that these tools are correctly aligned with medical guidelines, such as the American College of Radiology's Appropriateness Criteria (ACR AC). In this study, we introduce a framework to intelligently leverage language models by recommending imaging studies for patient cases that are aligned with evidence-based guidelines. We make available a novel dataset of patient "one-liner" scenarios to power our experiments, and optimize state-of-the-art language models to achieve an accuracy on par with clinicians in image ordering. Finally, we demonstrate that our language model-based pipeline can be used as intelligent assistants by clinicians to support image ordering workflows and improve the accuracy of imaging study ordering according to the ACR AC. Our work demonstrates and validates a strategy to leverage AI-based software to improve trustworthy clinical decision making in alignment with expert evidence-based guidelines.