Abigail See

Automated radiology report generation has the potential to improve patient care and reduce the workload of radiologists. However, the path toward real-world adoption has been stymied by the challenge of evaluating the clinical quality of artificial intelligence (AI)-generated reports. We build a state-of-the-art report generation system for chest radiographs, called Flamingo-CXR, and perform an expert evaluation of AI-generated reports by engaging a panel of board-certified radiologists. We observe a wide distribution of preferences across the panel and across clinical settings, with 56.1% of Flamingo-CXR intensive care reports evaluated to be preferable or equivalent to clinician reports, by half or more of the panel, rising to 77.7% for in/outpatient X-rays overall and to 94% for the subset of cases with no pertinent abnormal findings. Errors were observed in human-written reports and Flamingo-CXR reports, with 24.8% of in/outpatient cases containing clinically significant errors in both report types, 22.8% in Flamingo-CXR reports only and 14.0% in human reports only. For reports that contain errors we develop an assistive setting, a demonstration of clinician–AI collaboration for radiology report composition, indicating new possibilities for potential clinical utility.

Large language models (LLMs) have enabled the generation of high-quality synthetic text, often indistinguishable from human-written content, at a scale that can markedly affect the nature of the information ecosystem^1–3. Watermarking can help identify synthetic text and limit accidental or deliberate misuse⁴, but has not been adopted in production systems owing to stringent quality, detectability and computational efficiency requirements. Here we describe SynthID-Text, a production-ready text watermarking scheme that preserves text quality and enables high detection accuracy, with minimal latency overhead. SynthID-Text does not affect LLM training and modifies only the sampling procedure; watermark detection is computationally efficient, without using the underlying LLM. To enable watermarking at scale, we develop an algorithm integrating watermarking with speculative sampling, an efficiency technique frequently used in production systems⁵. Evaluations across multiple LLMs empirically show that SynthID-Text provides improved detectability over comparable methods, and standard benchmarks and human side-by-side ratings indicate no change in LLM capabilities. To demonstrate the feasibility of watermarking in large-scale-production systems, we conducted a live experiment that assessed feedback from nearly 20 million Gemini⁶ responses, again confirming the preservation of text quality. We hope that the availability of SynthID-Text⁷ will facilitate further development of watermarking and responsible use of LLM systems.