Automated chest X-ray disease screening using large language models and deep convolutional neural networks on the MIMIC-CXR dataset

Abstract

Introduction Radiologists in resource-limited settings often face high workloads, especially in chest X-ray interpretation. Manual annotation of large-scale imaging datasets remains costly and time-consuming. This study aims to explore the feasibility of using large language models (LLMs), specifically GPT-4o, to generate binary disease presence labels from free-text radiology reports, and to use these labels to train deep learning models for automated chest X-ray classification. Methods A two-stage supervised learning pipeline was developed using the publicly available MIMIC-CXR v2.1.0 dataset. First, GPT-4o was prompted with a structured clinical protocol to classify each radiology report as either “diseased” or “no disease.” Second, the generated labels were used to supervise the training of four convolutional neural networks: ResNet-18, DenseNet-121, EfficientNet-B1, and ConvNeXt-Tiny. A patient-level 70/10/20 split was employed to prevent data leakage across sets. Each model was trained across five random seeds (42–46), and 95% confidence intervals were computed using the t-distribution. Label quality was evaluated by comparing 210 generated labels against radiologist annotations from a board-certified radiologist. Results GPT-4o achieved an overall accuracy of 92.9% with expert labels on the 210-report validation set. For the “diseased” class, the precision was 97.4% and recall was 90.5%; for “no disease,” precision was 87.1% and recall was 96.4%. Among the CNN models evaluated on the held-out test set, ConvNeXt-Tiny achieved the highest area under the curve (AUC=0.832, 95% CI [0.801, 0.863]) and balanced accuracy (0.739), significantly outperforming EfficientNet-B1 (AUC=0.797; paired t-test, p=0.014). ResNet-18 (AUC=0.822) and DenseNet-121 (AUC=0.808) showed intermediate performance. All models demonstrated AUC values above 0.79, confirming the viability of LLM-derived weak supervision. Discussion This study demonstrates that LLMs can be effectively employed to generate supervision labels for medical imaging tasks. The proposed approach offers a scalable and low-cost solution for preliminary disease screening, particularly in healthcare environments with limited expert availability. The multi-seed evaluation with confidence intervals provides a rigorous assessment of model stability. Further work is needed to improve label reliability and expand to multi-label classification.