EMeRALDS: Electronic Medical Record Driven Automated Lung Nodule Detection and Classification in Thoracic CT Images

Objective: Lung cancer is a leading cause of cancer-related mortality worldwide, primarily due to delayed diagnosis and poor early detection. This study aims to develop a computer-aided diagnosis (CAD) system that leverages large vision-language models (VLMs) for the accurate detection and classification of pulmonary nodules in computed tomography (CT) scans. Methods: We propose an end-to-end CAD pipeline consisting of two modules: (i) a detection module (CADe) based on the Segment Anything Model 2 (SAM2), in which the standard visual prompt is replaced with a text prompt encoded by CLIP (Contrastive Language-Image Pretraining), and (ii) a diagnosis module (CADx) that calculates similarity scores between segmented nodules and radiomic features. To add clinical context, synthetic electronic medical records (EMRs) were generated using radiomic assessments by expert radiologists and combined with similarity scores for final classification. The method was tested on the publicly available LIDC-IDRI dataset (1,018 CT scans). Results: The proposed approach demonstrated strong performance in zero-shot lung nodule analysis. The CADe module achieved a Dice score of 0.92 and an IoU of 0.85 for nodule segmentation. The CADx module attained a specificity of 0.97 for malignancy classification, surpassing existing fully supervised methods. Conclusions: The integration of VLMs with radiomics and synthetic EMRs allows for accurate and clinically relevant CAD of pulmonary nodules in CT scans. The proposed system shows strong potential to enhance early lung cancer detection, increase diagnostic confidence, and improve patient management in routine clinical workflows.