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Exploring AI-based System Design for Pixel-level Protected Health Information Detection in Medical Images

Purpose: This study aims to evaluate different setups of an AI-based solution to detect Protected Health Information (PHI) in medical images. Materials and Methods: Text from eight PHI and eight non-PHI categories are simulated and incorporated into a curated dataset comprising 1,000 medical images across four modalities: CT, X-ray, bone scan, and MRI. The proposed PHI detection pipeline comprises three key components: text localization, extraction, and analysis. Three vision and language models, YOLOv11, EasyOCR, and GPT-4o, are benchmarked in different setups corresponding to three key components. The performance is evaluated with classification metrics, including precision, recall, F1 score, and accuracy. Results: All four setups demonstrate strong performance in detecting PHI imprints, with all metrics exceeding 0.9. The setup that utilizes YOLOv11 for text localization and GPT-4o for text extraction and analysis achieves the highest performance in PHI detection. However, this setup incurs the highest cost due to the increased number of generated tokens associated with GPT-4o model. Conversely, the setup using solely GPT-4o for the end-to-end pipeline exhibits the lowest performance but showcases the feasibility of multi-modal models in solving complex tasks. Conclusion: For optimal text localization and extraction, it is recommended to fine-tune an object detection model and utilize built-in Optical Character Recognition (OCR) software. Large language models like GPT-4o can be effectively leveraged to reason about and semantically analyze the PHI content. Although the vision capability of GPT-4o is promising for reading image crops, it remains limited for end-to-end pipeline applications with whole images.

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