NeuroSymb-MRG: Differentiable Abductive Reasoning with Active Uncertainty Minimization for Radiology Report Generation

Radiologists generate diagnostic reports through iterative and selective revisiting of suspicious regions to refine their interpretations. Recent multimodal large language models (MLLMs) for radiology report generation (RRG) have shifted from text-only reasoning toward a ``Thinking-with-Images'' paradigm, incorporating visual evidence into the reasoning process. However, existing methods provide static visual evidence without a dynamic revisit mechanism during reasoning, neglecting how radiologists re-examine uncertain observations. To this end, we propose an Uncertainty-aware Revisit Reasoning MLLM (UR$^{2}$-MLLM) framework that dynamically revisits uncertain regions during reasoning for RRG. UR$^{2}$-MLLM is first equipped with uncertainty perception by training on an uncertainty-aware dataset. We then construct a multimodal reasoning trajectory dataset together with a detect-and-copy mechanism, which guides when and where to revisit. Finally, a visual grounding reward refines this behavior through reinforcement learning, aligning the revisited regions with corresponding anatomical structures. Experiments on MIMIC-CXR and IU-Xray show that UR$^{2}$-MLLM achieves state-of-the-art performance, highlighting the value of uncertainty-aware visual revisit reasoning for reliable and clinically aligned report generation.

Radiology reports are essential for diagnostic reasoning and patient care, yet their manual preparation is time-consuming and cognitively demanding. Automatic radiology report generation (RRG) offers a scalable alternative, but existing models often produce lengthy, unstructured narratives that overlook diagnostic cues and multi-view information. We present Clinical-Knowledge Guided Disease-aware Visual-Textual Alignment for QA-Style Radiology Report Generation (CliQ-RRG), a unified two-stage framework for interpretable and clinically grounded reporting. In Stage 1, CliQ-RRG employs a Disease-aware Visual-Textual Alignment module that aligns image and text representations using predicted disease embeddings, reinforced by a Prior-Guided Attention Module (PrAM) to capture multi-view dependencies across current and prior scans. In Stage 2, GraphRAG-guided retrieval augments intermediate textual representations with graph-grounded clinical evidence, and a large language model restructures them into concise, interpretable question-answer (QA) pairs with diagnostic summaries. Experiments on two public chest X-ray benchmarks demonstrate that CliQ-RRG consistently outperforms prior methods across both lexical and clinical metrics, generating accurate and clinically coherent QA-style radiology reports. Code is available at: https://github.com/chandravardhan-singh-raghaw/CliQ-RRG.

Vision-language models (VLMs) have shown potential for automated radiology report generation, yet existing approaches rely on global embedding compression of volumetric data, often leading to hallucinated findings and limited anatomical grounding in 3D CT imaging. We introduce MedScribe, a hypothesis-driven framework that reformulates report generation as an iterative evidence acquisition process rather than a single-pass encoding task. MedScribe models reporting as a sequential decision process in which a large language model dynamically invokes pathology-specific diagnostic tools to extract localized volumetric features. These structured features are used to query a multidimensional retrieval space aligned with pathology-specific textual evidence. By explicitly accumulating quantitative evidence prior to synthesis, the framework enforces fine-grained grounding and reduces unsupported claims. Without task-specific fine-tuning, MedScribe improves clinical accuracy, factual consistency, and interpretability on CT-RATE and RadChestCT compared to state-of-the-art 2D and 3D VLMs, demonstrating the value of hypothesis-driven reasoning for reliable medical image reporting.