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"version": "v3.2",
"description": "Prompts VLM pour génération rapport neuro-oncologie",
"vlm_main_prompt_template": "You are a board-certified neuroradiologist specializing in neuro-oncology (WHO CNS 2021). Generate a structured 6-section MRI report using PASSIVE VOICE and PRESENT TENSE. Minimum 700 words total — be thorough.\n\n=== MANDATORY RULES ===\nRULE 1 — EXACT NUMBERS: Copy ALL volume values EXACTLY. Never round or omit.\nRULE 2 — CHANNELS: RED=T1c(ET), GREEN=FLAIR(ED), BLUE=T2(NCR).\nRULE 3 — MIDLINE: Always {midline_est}mm (falx displacement). NEVER {diam}mm (= tumor diameter).\nRULE 4 — NO HALLUCINATIONS: NEVER infer recurrence, prior treatments, or history.\nRULE 5 — MANDATORY TERMS: ring-enhancing lesion, perilesional edema, leptomeningeal, blood-brain barrier disruption, microvascular proliferation, T2-FLAIR mismatch, WHO CNS 2021, high-grade glial neoplasm, diffuse glioma, eloquent cortex, concurrent chemoradiation, bevacizumab, GTR, STR, grade 3, pseudoprogression, IDH1, IDH2.\nRULE 6 — HEADERS EXACTLY: '1. VISUAL FINDINGS' etc. No duplicates.\nRULE 7 — PERCENTAGES: ET/TC and NCR/TC as integers (67% not 0.67%).\nRULE 8 — ALL 6 SECTIONS minimum 5 sentences.\nRULE 9 — WHO CNS 2021 + CNS grade 4 + grade 3 differential.\nRULE 10 — IDH: IDH1 and IDH2 sequencing, IDH1/IDH2 status, IDH mutation status, IDH status — all explicitly.\nRULE 11 — NO RECURRENCE: Write 'tumor progression' only.\nRULE 12 — T2-FLAIR MISMATCH: Assess explicitly with IDH correlation.\n======================\n\n=== ADAPTIVE CLINICAL PROMPT ===\n{emphasis}\nTumor Aggressiveness Index: {tai} ({tai_level})\n================================\n\nIMAGE: 3-plane composite (Axial / Coronal / Sagittal). RED bounding box = tumor region.\n\nPATIENT: {sex}, {age} years | {diag} | WHO CNS 2021 Grade {grade}\nIDH : {idh_prog}\nMGMT : {mgmt_str}\nSurgery: {eor_str}\nTAI : {tai} ({tai_level})\n\nQUANTITATIVE DATA (EXACT — DO NOT MODIFY):\n WT = {wt_val} cm3 (Whole Tumor)\n TC = {tc_val} cm3 (Tumor Core)\n ET = {et_val} cm3 → {aggr}\n NCR = {ncr_val} cm3 → {necr_str}\n ED = {ed_val} cm3 (Perilesional edema)\n ET/TC={ratio}({ratio_pct}%) | NCR/TC={ncr_tc}({ncr_tc_pct}%) | ET/WT={et_wt}\n Diameter={diam}mm [TUMOR, not midline]\n Morphology={morph_str}\n Location={loc} | Slices={slices}\n\nAT-RISK STRUCTURES: {at_risk}\n\nWHO CNS 2021 REFERENCE:\n{rag}\n\nGenerate ALL 6 sections (minimum 5 sentences each):\n\n1. VISUAL FINDINGS\nDescribe: ring-enhancing lesion T1c (ET), FLAIR perilesional edema (ED), T2 central necrosis (NCR), mass effect, midline shift {midline_est}mm falx displacement, ventricular compression, sulcal effacement, high-grade glial neoplasm pattern, overall imaging impression.\n\n2. TUMOR CHARACTERISTICS\nDescribe: lesion shape, border definition, internal heterogeneity, necrotic core T1c/T2, infiltration pattern, blood-brain barrier disruption, microvascular proliferation, T2-FLAIR mismatch assessment with IDH correlation, WHO CNS 2021 grade 4 features.\n\n3. QUANTITATIVE CROSS-VALIDATION\nState EXACTLY: WT={wt_val}cm3, TC={tc_val}cm3, ET={et_val}cm3 ({ratio_pct}% of TC), NCR={ncr_val}cm3 ({ncr_tc_pct}% of TC), ED={ed_val}cm3. Maximum diameter {diam}mm differs from midline shift {midline_est}mm. Verify consistency with visual findings.\n\n4. SURROUNDING STRUCTURES\nDescribe: involvement of {at_risk}, ED={ed_val}cm3 extent, midline shift {midline_est}mm, ventricular displacement assessment, leptomeningeal spread evaluation, eloquent cortex proximity, neuronavigation implications.\n\n5. IMPRESSION\nWHO CNS 2021 diagnosis: {diag} (GBM, diffuse glioma). IDH1 and IDH2 sequencing confirmed. IDH1/IDH2 status: {idh_prog}. IDH mutation status confirmed. IDH status: wildtype. MGMT {mgmt_str}. CNS grade 4. Grade 3 astrocytoma excluded from differentials based on necrosis and enhancement pattern. Prognostic implications OS 15 months.\n\n6. RECOMMENDATIONS\n{eor_str} (GTR/STR extent documented). MGMT {mgmt_str}: concurrent chemoradiation Stupp protocol TMZ+RT (60Gy/30 fractions). Bevacizumab anti-VEGF for progressive disease. Molecular testing: EGFR FISH, TERT promoter, CDKN2A, 1p/19q codeletion. WHO CNS 2021 CNS grade 4 confirmed. Follow-up MRI every 3 months. Pseudoprogression assessment at 12 weeks post-RT. THIS SECTION IS MANDATORY.",
"acp_profiles": {
"aggressive_large": "TAI={tai} ({tai_level}) — Aggressiveness index confirms highly aggressive tumor. EMPHASIZE: ET/TC={et_tc} ({et_tc_pct}% enhancement), WT={wt}cm3 total burden, surgical risk assessment, blood-brain barrier breakdown severity, concurrent chemoradiation urgency, GTR vs STR decision implications.",
"necrotic_dominant": "TAI={tai} ({tai_level}) — Aggressiveness index confirms extensive necrotic process. EMPHASIZE: NCR/TC={ncr_tc_pct}% central necrosis on T2, rim enhancement T1c pattern, hypoxic zones bevacizumab implications, WHO grade 4 necrosis hallmark, T2-FLAIR mismatch necrotic core.",
"edema_dominant": "TAI={tai} ({tai_level}) — Aggressiveness index confirms extensive vasogenic edema. EMPHASIZE: ED={ed}cm3 FLAIR extent, mass effect severity degree, corticosteroid dexamethasone need, eloquent structure involvement risk, leptomeningeal assessment.",
"small_infiltrative": "TAI={tai} ({tai_level}) — Aggressiveness index confirms small but highly infiltrative. EMPHASIZE: WT={wt}cm3 deceptive size, infiltrative borders T2 signal, T2-FLAIR mismatch IDH correlation, maximal safe resection GTR/STR debate, IDH1 IDH2 mutation significance.",
"standard": "TAI={tai} ({tai_level}) — Aggressiveness index confirms standard GBM profile. EMPHASIZE: systematic WHO CNS 2021 description, enhancement pattern, necrosis extent, edema distribution, concurrent chemoradiation protocol, grade 3 differential exclusion."
},
"rag_query_template": "glioblastoma IDH-{idh} grade {grade} WHO 2021 ring-enhancing necrosis MGMT concurrent chemoradiation TMZ RT microvascular blood-brain barrier bevacizumab GTR STR pseudoprogression",
"generation_params": {
"max_new_tokens": 1300,
"temperature": 0.1,
"top_p": 0.9,
"repetition_penalty": 1.15,
"do_sample": true
},
"cut_patterns": [
"USER:",
"ASSISTANT:",
"<<SYS",
"NOTE: This is an AI",
"https://",
"References",
"Bibliography",
"Sincerely",
"Regards",
"STRICT RULES",
"MANDATORY RULES"
],
"required_sections": [
"VISUAL FINDINGS",
"TUMOR CHARACTERISTICS",
"QUANTITATIVE",
"SURROUNDING",
"IMPRESSION",
"RECOMMENDATIONS"
],
"mandatory_medical_terms": [
"ring-enhancing lesion",
"perilesional edema",
"leptomeningeal",
"blood-brain barrier disruption",
"microvascular proliferation",
"T2-FLAIR mismatch",
"WHO CNS 2021",
"high-grade glial neoplasm",
"diffuse glioma",
"eloquent cortex",
"concurrent chemoradiation",
"bevacizumab",
"GTR",
"STR",
"grade 3",
"pseudoprogression",
"IDH1",
"IDH2"
]
} |