Pre-training, Reasoning, Benchmarking: X-ray Report Generation on CheXpert Plus Dataset

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. The performance of current RRG approaches remains unsatisfactory against clinical standards. This paper introduces a novel RRG method, MLLM-RRG, that integrates multimodal large language models (MLLMs) with various types of clinical knowledge to generate accurate and comprehensive chest X-ray reports. Our method first designs a referring anatomical feature extractor that leverages anatomical knowledge to analyze different regions of the chest X-ray image and extract visual features without explicitly detecting regions. Next, based on the MLLM's decoder, we develop a multimodal report generator that leverages multimodal prompts constructed from dedicated visual features and textual instructions to produce the radiology report in an auto-regressive way. Finally, we introduce a disease-oriented clinical classification and alignment scheme in a multi-task learning manner to leverage disease knowledge to better preserve the clinical relevance among the generated reports. Once the model is trained, we also introduce a novel clinical quality reinforcement learning strategy to enhance the MLLM with report knowledge, further refining the tones of the generated reports towards radiologists. Extensive experiments on the MIMIC-CXR and IU X-Ray datasets demonstrate the superiority of our method over the state of the art. Our codes will be available at https://github.com/viscom-tongji/MLLM-RRG.

Despite the remarkable progress of LLM-based and knowledge graph-augmented Radiology Report Generation (RRG) methods, existing techniques still suffer from inherent defects. Conventional LLM-only models lack structured medical prior knowledge, resulting in frequent medical hallucinations and low diagnostic interpretability. Current knowledge graph-enhanced schemes adopt static one-round knowledge fusion with single-source knowledge, incapable of dynamic knowledge updating according to generation feedback. This paper proposes a novel Multi-Agent Collaborative iterative framework for X-ray Radiology Report Generation, termed MAC-RRG. Inspired by multi-agent technology, our framework constructs a closed-loop optimization paradigm based on task decoupling and collaborative reasoning. Specifically, the framework first generates a preliminary radiology report from input X-ray images via a vision encoder and a basic LLM. Subsequently, a multimodal knowledge graph (MM-KG) agent mines structured disease correlation and anatomical knowledge from medical knowledge graphs, while an auxiliary knowledge agent extracts unstructured domain knowledge from public medical databases. The multi-source knowledge acquired by dual agents is fused and embedded to guide the LLM in iteratively refining the initial report. Extensive quantitative and qualitative experiments on mainstream X-ray RRG datasets, including IU X-ray, MIMIC, and CheXpert Plus, fully verify the superiority of our proposed method. The source code and pre-trained models have been released on https://github.com/Event-AHU/Medical_Image_Analysis

Chest X-ray (CXR) radiology report generation (RRG) models have shown rapid progress on automated metrics, yet their clinical utility remains uncertain due to limited qualitative evaluation by radiologists. We present CXRMate-2, a state-of-the-art CXR RRG model that enables tractable reinforcement learning (RL) through structured multimodal temporal embeddings and high-resolution visual feature compression, for efficient, unified conditioning of an LLM decoder on visual, textual, and temporal context from a study and its prior. This enables group relative policy optimisation (GRPO), where a proposed reward function is used to improve semantic alignment with radiologist reports. Across the MIMIC-CXR, CheXpert Plus, and ReXgradient datasets, CXRMate-2 achieves statistically significant improvements over strong benchmarks, including gains of 11.2% and 24.4% in GREEN and RadGraph-XL, respectively, on MIMIC-CXR relative to MedGemma 1.5 (4B). To directly compare CXRMate-2 against radiologist reporting, we conduct a blinded, randomised qualitative retrospective evaluation. Three consultant radiologists compare generated and radiologist reports across 120 studies from the MIMIC-CXR test set. Generated reports were deemed acceptable (defined as preferred or rated equally to radiologist reports) in 45% of ratings, with no statistically significant difference in preference rates for seven of the eight analysed findings. Preferences for radiologist reports were driven primarily by higher recall, while generated reports were consistently preferred for readability. Together, these results define a clear pathway to clinically acceptable CXR RRG. Improving recall and the detection of subtle findings represents the primary remaining barrier to non-inferiority with radiologist reporting, positioning CXR RRG for prospective evaluation in assistive, radiologist-led workflows.