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Identifying Imaging Follow-Up in Radiology Reports: A Comparative Analysis of Traditional ML and LLM Approaches

Large language models (LLMs) have shown considerable promise in clinical natural language processing, yet few domain-specific datasets exist to rigorously evaluate their performance on radiology tasks. In this work, we introduce an annotated corpus of 6,393 radiology reports from 586 patients, each labeled for follow-up imaging status, to support the development and benchmarking of follow-up adherence detection systems. Using this corpus, we systematically compared traditional machine-learning classifiers—logistic regression (LR), support vector machines (SVM), Longformer, and a fully fine-tuned Llama3-8B-Instruct—with recent generative LLMs. To evaluate generative LLMs, we tested GPT-4o and the open-source GPT-OSS-20B under two configurations: a baseline (Base) and a task-optimized (Advanced) setting that focused inputs on metadata, recommendation sentences, and their surrounding context. A refined prompt for GPT-OSS-20B further improved reasoning accuracy. Performance was assessed using precision, recall, and F1 scores with 95% confidence intervals estimated via non-parametric bootstrapping. Inter-annotator agreement was high (F1 = 0.846). GPT-4o (Advanced) achieved the best performance (F1 = 0.832), followed closely by GPT-OSS-20B (Advanced; F1 = 0.828). LR and SVM also performed strongly (F1 = 0.776 and 0.775), underscoring that while LLMs approach human-level agreement through prompt optimization, interpretable and resource-efficient models remain valuable baselines.