Discrete Diffusion Language Models for Interactive Radiology Report Drafting

Radiology report generation (RRG) aims to automatically produce clinically accurate textual reports from medical images. Existing methods predominantly rely on autoregressive (AR) language models, whose causal dependency structure restricts generation to a unidirectional left-to-right process. This paradigm can induce sequence bias, where models tend to follow stereotypical token orders and high-frequency report templates rather than fully grounding generation in image-specific evidence. In this paper, we propose AnchorDiff, the first masked-diffusion framework for RRG that integrates knowledge-graph-derived clinical anchors into diffusion language modeling. By leveraging bidirectional context and iterative refinement, AnchorDiff mitigates the limitations of fixed-order autoregressive decoding. Specifically, we introduce a topology-aware training strategy that uses RadGraph-derived entity hierarchies to assign clinically important tokens differentiated masking protection and loss weights. We further design an inference-time rewriting strategy that detects unstable committed tokens through perturbation-based testing and selectively revises them during denoising. Extensive experiments on the MIMIC-CXR and MIMIC-RG4 benchmarks demonstrate that AnchorDiff achieves state-of-the-art (SOTA) performance, showing the effectiveness of clinically anchored masked diffusion for radiology report generation.

Imaging demand is growing faster than the radiology workforce can expand, and reporting backlogs cannot be resolved through training and recruitment alone. The most direct opportunity is reducing the time and effort radiologists spend producing reports, a task that requires interpreting images, integrating clinical history and prior studies, and drafting structured findings. We present Harrison.Rad 1.5 (HR1.5), a radiology-specific multimodal large language model that accepts interleaved text and visual inputs and generates structured and unstructured text across plain-film radiology, spanning computed radiography, chest, musculoskeletal, abdominal, spine, and pelvic x-rays, and mammography. HR1.5 is trained through a three-stage pipeline: domain adaptation of a base language model on radiology reports, contrastive vision-encoder training with curriculum-based hard negatives on ~6 million image-report instances, and visual-question-answering fine-tuning on multi-turn conversations. We evaluate it with a Findings-Diagnosis scoring framework that extends RadGraph-XL entity extraction with ontology-based synonym matching and polarity-contradiction detection, benchmarked on RadBench, a simulated FRCR 2B Short Case examination scored against Angoff-method thresholds, ReXGradient, and internal multi-modality datasets. HR1.5 is the only system evaluated to meet the simulated FRCR passing standard and achieves the highest accuracy on closed-format clinical questions, across anatomical regions, on internal multi-body-part and mammography reporting, and on the primary clinically-aligned score for public chest reporting. We further examine explainability and model behaviour, including question-sensitive Grad-CAM heatmaps, attention analysis, and confidence estimation, to support responsible future evaluation toward clinical use, and a framework for clinically grounded assessment of report quality.

We introduce DiffusionGemma, an experimental open-weight language model that uses discrete diffusion to generate text at exceptionally high speed. Rather than decoding one token at a time, DiffusionGemma iteratively refines blocks of 256 tokens in parallel, avoiding the sequential decoding bottleneck of conventional autoregressive (AR) large language models. Instead of training from scratch, we obtain DiffusionGemma by fine-tuning the mixture-of-experts Gemma 4 model with 3.8B activated and 25.2B total parameters. Our compute-efficient two-stage training pipeline uses fewer than 10% of the starting AR model's total training token budget. The first stage uses supervised fine-tuning to teach bidirectional denoising, while the second stage combines reinforcement learning with sampler distillation to jointly improve generation quality and inference efficiency. DiffusionGemma establishes a new Pareto frontier for the trade-off between generation speed and model capability. Averaged across our full evaluation suite, it generates around 20 tokens per forward pass and achieves roughly 1,500 output tokens per second on a single NVIDIA H100 GPU, which is substantially faster than AR models even with state-of-the-art speculative decoding. DiffusionGemma also retains the starting model's support for thinking mode, multimodal inputs, and long contexts. Despite diffusion fine-tuning, it remains capable of AR generation with only minor performance degradation, suggesting a path toward hybrid diffusion-AR decoding.