Error Detection in Emergency Radiology Reports Using a Large Language Model: Multistage Evaluation Study

Background: Emergency radiology requires highly accurate reporting under time constraints; yet, increasing workloads raise the risk of errors. While large language models (LLMs) show potential for proofreading in general radiology, their performance in emergency settings and non-English contexts remains unclear. Objective: We aim to evaluate the performance of a domain-optimized LLM, DeepSeek-R1, for identifying errors in Chinese emergency radiology reports, with comparison against assessments by board-certified radiologists. Methods: We compiled 7435 emergency reports (dataset 1; radiography, computed tomography, and magnetic resonance imaging) collected from November 2024 to April 2025. In stage 1, a total of 5 LLMs were evaluated using 200 reports. The best model, DeepSeek-R1, proceeded to stages 2 and 3, where 0-shot and few-shot learning were tested on a separate set (n=100). Model performance was compared against 12 radiologists. Stage 4 validated real-world utility on 800 verified reports. Results: In subdataset 1, under stress-testing conditions, DeepSeek-R1 achieved a higher error detection rate in the few-shot setting than in the 0-shot setting (84.4% vs 60.9%, P=.003). Its performance exceeded that of radiology residents (84.4% vs 51.6% and 53.1%, respectively; both P