ASTAR: Automated induction of STAndardized radiology Reporting templates from large-scale clinical free-text corpora

Structured reporting converts free-text radiology narratives into queryable data keys, facilitating cohort assembly, longitudinal tracking, and training label generation for medical AI. The prevailing paradigm follows a two-stage pipeline: (1) constructing a reporting template, (2) extracting information to populate it. While the extraction stage has benefited from advances in large language models (LLMs), template construction remains a manual bottleneck relying on labor-intensive expert consensus that is static, difficult to scale, and may fail to capture real-world reporting diversity. We address this limitation with ASTAR, an LLM-based framework for Automated induction of STAndardized radiology Reporting templates from large-scale clinical free-text corpora. Extensive experiments on 4,215 fetal brain MRI reports from multiple centers demonstrate that the ASTAR-induced template surpasses two expert-curated templates across template coverage, information fidelity, diagnostic fidelity, and expert-rated usability, reducing template development from weeks of committee deliberation to hours of automated processing. Code: https://github.com/birthlab/ASTAR