Development and Validation of a Questionnaire to Evaluate AI-Generated Summaries for Radiologists: ELEGANCE (Expert-Led Evaluation of Generative AI Competence and ExcelleNCE)

Background/Objectives: Large language models (LLMs) are increasingly considered for use in radiology, including the summarization of patient medical records to support radiologists in processing large volumes of data under time constraints. This task requires not only accuracy and completeness but also clinical applicability. Automatic metrics and general-purpose questionnaires fail to capture these dimensions, and no standardized tool currently exists for the expert evaluation of LLM-generated summaries in radiology. Here, we aimed to develop and validate such a tool. Methods: Items for the questionnaire were formulated and refined through focus group testing with radiologists. Validation was performed on 132 LLM-generated summaries of 44 patient records, each independently assessed by radiologists. Criterion validity was evaluated through known-group differentiation and construct validity through confirmatory factor analysis. Results: The resulting seven-item instrument, ELEGANCE (Expert-Led Evaluation of Generative AI Competence and Excellence), demonstrated excellent internal consistency (Cronbach’s α = 0.95). It encompasses seven dimensions: relevance, completeness, applicability, falsification, satisfaction, structure, and correctness of language and terminology. Confirmatory factor analysis supported a two-factor structure (content and form), with strong fit indices (RMSEA = 0.079, CFI = 0.989, TLI = 0.982, SRMR = 0.029). Criterion validity was confirmed by significant between-group differences (p < 0.001). Conclusions: ELEGANCE is the first validated tool for expert evaluation of LLM-generated medical record summaries for radiologists, providing a standardized framework to ensure quality and clinical utility.