Modeling Clinical Uncertainty in Radiology Reports: From Explicit Uncertainty Markers to Implicit Reasoning Pathways

Paloma Rabaey, Jong Hak Moon, Jung-Oh Lee, Min Gwan Kim, Hangyul Yoon, Thomas Demeester, Edward Choi


Abstract
Radiology reports are invaluable for clinical decision-making and hold great potential for automated analysis when structured into machine-readable formats. These reports often contain uncertainty, which we categorize into two distinct types: (i) Explicit uncertainty reflects doubt about the presence or absence of findings, conveyed through hedging phrases. These vary in meaning depending on the context, making rule-based systems insufficient to quantify the level of uncertainty for specific findings; (ii) Implicit uncertainty arises when radiologists omit parts of their reasoning, recording only key findings or diagnoses. Here, it is often unclear whether omitted findings are truly absent or simply unmentioned for brevity. We address these challenges with a two-part framework. We quantify explicit uncertainty by creating an expert-validated, LLM-based reference ranking of common hedging phrases, and mapping each finding to a probability value based on this reference. In addition, we model implicit uncertainty through an expansion framework that systematically adds characteristic sub-findings derived from expert-defined diagnostic pathways for 14 common diagnoses. Using these methods, we release Lunguage++, an expanded, uncertainty-aware version of the Lunguage benchmark of fine-grained structured radiology reports. This enriched resource enables uncertainty-aware image classification, faithful diagnostic reasoning, and new investigations into the clinical impact of diagnostic uncertainty.
Anthology ID:
2026.lrec-main.928
Volume:
Proceedings of the Fifteenth Language Resources and Evaluation Conference
Month:
May
Year:
2026
Address:
Palma de Mallorca, Spain
Editors:
Stelios Piperidis, Núria Bel, Henk van den Heuvel, Nancy Ide, Simon Krek, Antonio Toral
Venue:
LREC
SIG:
Publisher:
ELRA Language Resource Association
Note:
Pages:
11852–11873
Language:
URL:
https://preview.aclanthology.org/ingest-lrec/2026.lrec-main.928/
DOI:
Bibkey:
Cite (ACL):
Paloma Rabaey, Jong Hak Moon, Jung-Oh Lee, Min Gwan Kim, Hangyul Yoon, Thomas Demeester, and Edward Choi. 2026. Modeling Clinical Uncertainty in Radiology Reports: From Explicit Uncertainty Markers to Implicit Reasoning Pathways. International Conference on Language Resources and Evaluation, main:11852–11873.
Cite (Informal):
Modeling Clinical Uncertainty in Radiology Reports: From Explicit Uncertainty Markers to Implicit Reasoning Pathways (Rabaey et al., LREC 2026)
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PDF:
https://preview.aclanthology.org/ingest-lrec/2026.lrec-main.928.pdf