Radiology Report Generation

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Overview

Radiology report generation studies how to turn images such as chest X-rays, CT scans, and MRI into clinical findings and impressions. Common approaches use vision-language models with image-text alignment, anatomical or disease-specific features, retrieval of similar cases, and structured clinical concepts; newer systems also use agents, reinforcement learning, and prior studies to guide or refine reports. The field has improved on language and clinical-label benchmarks, but fluent text can still omit findings, invent details, or miss their location and change over time. A central challenge is evaluating factual accuracy and usefulness across hospitals and modalities, since text similarity alone does not reliably measure clinical correctness.

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159 papers20 papers in the last four weeks, up 5% on the four weeks before. 0.1% of all new papers.

Jul 24, 2026

TextSLIP: Text Self-Supervised CLIP for Medical Report Generation

Automating radiology report generation is important for improving reporting consistency and clinical workflows . While Contrastive Language--Image Pretraining (CLIP) has advanced medical vision language modeling, existing CLIP-style approaches may still provide insufficient fine-grained semantic supervision for complex report generation. Standard CLIP primarily optimizes cross-modal alignment, without explicitly structuring the textual embedding space that guides visual representation learning. To address this limitation, we propose TextSLIP, a general medical vision-language pretraining framework that augments CLIP with intra-modal text contrastive learning. By improving textual embedding discriminability through self-supervised augmented text pairs, TextSLIP is designed to provide finer-grained linguistic supervision to the visual encoder. As an initial validation, we pretrain TextSLIP on a curated dataset of 7 million brain MRI image-text pairs and fine-tune the pretrained visual encoder within a report generation architecture. In controlled comparisons with CLIP-style baselines, TextSLIP shows consistent improvements on report generation metrics. Ablation studies further suggest that text-side self-supervision contributes to the observed gains. These results indicate that text-level contrastive learning is a promising direction for improving medical visual-textual alignment, while broader validation across additional medical domains remains an important next step.

Haoyu Jiang, Ziping Cong

Centre for Artificial Intelligence and Robotics (CAIR) · Hong Kong Institute of Science & Innovation · Chinese Academy of Sciences

Radiology Report GenerationSelf-Supervised LearningMedical VLMsVision-Language AlignmentMultimodal Contrastive Learning
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Jul 23, 2026

Sparse Concept Channels in Frozen 3D CT Vision Encoders

Large vision-language models are becoming increasingly dominant in 3D medical image interpretation, but we rarely know <i>which</i> internal units encode clinical findings or <i>where</i> that information lives in the representation. We first study this on a 3D chest vision-language model (Pillar-0) by probing its frozen vision embeddings. We show that (i) each radiological finding is encoded by a <i>sparse</i> set of ~10 vision-encoder channels that match full-feature classification performance and far exceed a zero-shot text prompting; (ii) turning off the channels tied to one finding, that finding's score collapses while unrelated labels stay stable; and (iii) the same sparse probe <i>replicates</i> on an architecturally unrelated 3D abdominal VLM (Merlin) suggesting a general property of frozen medical encoders. Our training-free concept channel probe (CCP) method, paired with a corpus-derived report template, outperforms published CT-CHAT on clinical efficacy and NLG metrics (F1 0.549 vs. 0.184; BLEU 0.483 vs. 0.373) at 22x lower latency. Our results provide a clear, reproducible characterization of how frozen medical encoders represent findings, demonstrating direct applicability across models.

Farhad Nooralahzadeh, Lea Bogensperger, Christian Bluethgen +1

Department of Quantitative Biomedicine, University of Zurich, Switzerland · Center for Artificial Intelligence in Medicine and Imaging, Stanford University, USA

Radiology Report Generation3D Medical ImagingVLM InterpretabilityMedical VLMsRepresentation Probing
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Jul 21, 2026

DobicVLM: Aligning Chest X-Ray Report Generation with Clinically-Grounded Programmatic Rewards via Group Relative Policy Optimization

Medical imaging is a cornerstone of diagnostics, yet automated chest X-ray report generation struggles with structural adherence, anatomical completeness, and semantic faithfulness. We introduce DobicVLM, a vision-language model combining supervised fine-tuning on MedGemma-4B with Group Relative Policy Optimization (GRPO) and clinically-grounded programmatic rewards. Our approach uses interpretable, rule-based reward components; structural verification, anatomical checklist, semantic similarity, and length constraints to enforce clinical standards without neural reward models. Trained on 1,000 de-identified image-report pairs from a private clinical dataset (with ethics approval and compliance to local regulations), DobicVLM is evaluated via blinded expert review on 69 held-out cases. DobicVLM outperforms Gemini 2.5 Flash across the majority of criteria, achieving the highest impression accuracy (27.2%) and medical terminology (86.5%) compared to both Gemini 2.5 Flash and MedGemma 4B baselines, with minor trade-offs in completeness and referrals. This demonstrates GRPO's value for transparent alignment in resource-limited settings. Keywords: Vision-Language Models, Radiology Report Generation, Reinforcement Learning, Medical AI, GRPO

Thanni Adewuyi, Angelica Obayi, Andem Aniekan +10

Dobic Health · HelpMum Africa · University of Ibadan

Radiology Report GenerationRadiology VLMsRL for VLMs
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Jul 16, 2026

Multi-LLM Collaborative MRI Report Generation for Visual Instruction Tuning in Brain Oncology

Recent advances in large language models (LLMs) and their extension to vision-language models (VLMs) have made it easier to combine text and images for tasks such as report generation. Existing VLMs in medicine typically focus on 2D images (chest X-rays), and their extension to 3D imaging has been difficult because of the lack of paired 3D imaging-text data. Thus, we introduce a new method for creating a 3D image-text dataset for brain oncology using 3D MRI scans of glioma and meningioma cases. We use a cooperative system in which several LLMs work together to generate and check reports, ensuring that they are accurate and clear. By leveraging the new 3D MRI-text dataset, we further build a VLM that converts MRI scans into tokens and aligns them with text instructions. Our VLM performed better in report generation and visual question answering tasks than other 2D and 3D methods. Our method not only improves the quality of reports but also helps with better diagnosis and treatment in brain oncology.

Sinyoung Ra, Jonghun Kim, Hyunjin Park

Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Republic of Korea · Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, Republic of Korea

Radiology Report Generation3D Medical ImagingVisual Instruction TuningMultimodal Instruction Tuning3D VLMs
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Jul 15, 2026

MonteRET: AI Agent Enhancing Multimodal LLMs with Multi-granularity Knowledge Retrieval for Chest CT Report Generation

Automated chest CT report generation remains challenging because clinically faithful reporting requires both whole-volume understanding and accurate description of localized anatomical findings. Here we developed and retrospectively evaluated MonteRET, a region-aware retrieval-enhanced framework for generating chest CT findings sections. MonteRET integrates global CT features with region-level anatomical representations, retrieves clinically relevant knowledge using predicted medical conditions and region-level vision-language alignment, and refines initial reports through a knowledge-guided report rewriting agent. We trained our model on a public cohort with 24,128 CT scans from RadGenome-ChestCT. We evaluated MonteRET on the public RadGenome-ChestCT test set of 1,564 CT scans and an external cohort of 82 CT scans from NewYork-Presbyterian/Weill Cornell Medical Center. MonteRET improved report quality, semantic similarity, and clinical efficacy compared with a matched baseline and several state-of-the-art methods. Gains were most pronounced for recall, suggesting fewer omitted findings. Human expert evaluation by radiology residents also favored MonteRET.

Yi Lin, Yihao Ding, Elana Benishay +8

Department of Population Health Sciences, Weill Cornell Medicine, New York, USA · School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Australia · Department of Radiology, Weill Cornell Medicine, New York, USA +4

Radiology Report GenerationMultimodal RAGAgentic RAGComputed TomographyCT Report Generation
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Jul 11, 2026

REVA-PO: Stabilizing Reinforcement Learning for Chest X-ray Report Generation

Automated chest X-ray report generation has recently benefited from reinforcement learning (RL) and large language models. However, RL training often suffers from instability or limited exploration due to fixed Kullback-Leibler (KL) regularization and a static reference policy that accumulates KL pressure over time. We propose Response-Weighted and Validation-Anchored Policy Optimization (REVA-PO), a RL framework that stabilizes long-term training via Response-Weighted Regularization (RER) and Validation-Anchored Policy Reset (VAPR). RER dynamically adjusts per-response KL weights based on advantage and reference-policy entropy, relaxing constraints for high-quality responses while tightening them for low-quality ones. Complementarily, VAPR periodically synchronizes the reference and current policies to the best validation checkpoint, resetting accumulated regularization pressure to expand the viable exploration space. To ensure a robust starting point, we employ a three-stage pipeline consisting of warm-up training, classifier-guided supervised fine-tuning, and RL. Extensive evaluations on MIMIC-CXR and IU-Xray demonstrate that REVA-PO sets new state-of-the-art benchmarks in both linguistic quality and clinical accuracy. Notably, BLEU-4 improves by 5.1% on MIMIC-CXR and 3.6% on IU-Xray, while CheXpert F1 and RadGraph F1 scores increase by 4.5% and 12.8%, respectively, over prior leading methods. The code is publicly available at https://github.com/LiGuo12/REVA_PO/.

Li Guo, Anas M. Tahir, Z. Jane Wang

University of British Columbia, Vancouver, BC, Canada

Radiology Report GenerationRadiology VLMsKL-Regularized RLRL Post-TrainingRL for VLMs
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Jul 8, 2026

Seeing What Matters: Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Report Generation

Despite rapid advances in chest X-ray (CXR) foundation models, most radiology report generation (RRG) systems still rely on heavily downsampled inputs (e.g., 256x256) due to the fixed visual token budgets of pretrained vision encoders, suppressing subtle yet clinically important cues present in native-resolution images. However, enabling high-resolution (high-res) perception remains challenging: naive tiling causes prohibitive token inflation, while global compression suppresses subtle lesions and degrades diagnostic fidelity. Inspired by radiologists' workflow, localizing suspicious regions before detailed high-res assessment. We propose Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Reporting (LePaX), the first RRG framework that enables efficient high-res CXR perception (up to 1920x1920) without increasing the vision-token count. LePaX formulates high-res perception as a constrained spatial resolution allocation problem under a fixed token budget and introduces two key components: Learnable Spatial Resolution Allocation (LSRA), which learns a spatial utility map that adaptively allocates limited high-res capacity to diagnostically relevant regions, enabling targeted extraction of high-res patches from native CXRs; and Global-Regional Fusion (GRF), which performs token-preserving region-to-global refinement by projecting high-resolution regional evidence back onto the global feature grid through spatially aligned resolution write-back, avoiding token inflation. Experiments on multiple CXR benchmarks demonstrate that LePaX consistently improves both clinical and linguistic metrics while enabling native-resolution CXR perception with over 10x fewer visual tokens than naive high-res tiling.

Yingshu Li, Yunyi Liu, Zhenghao Chen +5

The University of Sydney, Sydney, NSW 2006, Australia · The University of Newcastle, Newcastle, NSW 2308, Australia · University of Wollongong, Wollongong, NSW 2522, Australia +1

Radiology Report GenerationMedical Image AnalysisMedical VLMs
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Jul 7, 2026

MAC-XA: Multi-view Anatomy-Correspondence Fusion for Coronary Stenosis Reporting from X-ray Angiography

Multi-view reasoning in coronary X-ray angiography is inherently a cross-projection geometric problem, yet automated report generation in this setting remains largely unexplored. The 3D vascular topology leads to projection-dependent branch overlap and foreshortening, rendering single-view modeling fundamentally incomplete and unstable for lesion localization and stenosis grading. Although multi-view fusion appears promising, learning anatomically consistent fusion from real angiograms is impeded by a critical limitation: cross-view alignment is unobservable and cannot be explicitly supervised. Consequently, conventional fusion relies on implicit correlations rather than verified anatomical correspondence. We address this by reformulating multi-view stenosis reporting as an alignment-constrained aggregation problem. A controllable synthetic angiography generation strategy is introduced to expose geometry-derived patch-level correspondence supervision unavailable in real data. An anatomy-correspondence module learns cross-view correspondence matrices that explicitly align auxiliary features within the main-view coordinate space prior to fusion, thereby constraining evidence aggregation to anatomically consistent regions. Experiments on synthetic data and zero-shot transfer to real angiograms show that this alignment-constrained design improves correspondence consistency and structured stenosis reporting compared to single-view modeling and conventional multi-view fusion methods. The code will be publicly available upon publication.

Chen Jia, Baochang Zhang, Fatia Kusuma Dewi +4

Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany · relAI – Konrad Zuse School of Excellence in Reliable AI, Munich, Germany · German Heart Center Munich, Munich, Germany +3

Radiology Report GenerationMulti-View ConsistencyMedical ImagingCoronary AngiographyMedical Image AnalysisMulti-View Learning
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Jul 7, 2026

Harrison.Rad 1.5 Technical Report: A radiology foundation model that can draft reports from images, priors and clinical context

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.

Suneeta Mall, Vladimir Nekrasov, Ashnil Kumar +5

Radiology Report GenerationRadiology VLMsMultimodal Large Language ModelsRadiology Report Evaluation
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Jul 4, 2026

CogRad: A Cognitively-Inspired Multi-Agent Framework for Radiology Report Generation

Automated radiology report generation (RRG) can ease radiologist workload, yet most existing systems produce a report in a single forward pass, with no mechanism to check a claim against the image or revisit a finding once stated. We present CogRad, a cognitively inspired multi-agent framework that structures generation around four stages of a radiologist's reading process. A Scout agent discovers anatomical regions directly from image patches via slot attention and assigns region and disease-level triage scores; an Investigator agent concentrates representational capacity on the regions Scout flags as suspicious; a Writer agent compiles these signals into a disease gated visual prefix for a large language model; and a Verifier agent supervises training with a visual entailment loss and, at inference, re-examines its own draft sentence by sentence, regenerating any report it judges insufficiently grounded. On CheXpert Plus, CogRad attains a BLEU-4 of 0.316 and a CIDEr of 0.322, the best scores among the methods we compare against. On IU X-Ray, it attains a BLEU-4 of 0.201 and a CIDEr of 0.724, leading every baseline on every standard NLG metric. We further evaluate CogRad with RadGraph F1, CheXbert F1, and a hallucination analysis to assess clinical accuracy beyond standard text-overlap metrics, complemented by ablation studies and Grad-CAM-based visualizations that characterize each agent's contribution and the model's visual grounding.

Saif Ur Rehman Khan, Hasaan Maqsood, Sebastian Vollmer +2

Department of Computer Science, Rhineland-Palatinate Technical University of Kaiserslautern-Landau, Kaiserslautern, 67663, Germany. · 2German Research Center for Artificial Intelligence, Kaiserslautern, 67663, Germany. · 3Intelligentx GmbH (intelligentx.com), Kaiserslautern, Germany. +1

Radiology Report GenerationMedical VLMsMultimodal Agents
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Jul 2, 2026

GRCD: Grounded Region Change Detection for Multi-Finding Chest X-Ray Pairs

Radiologists routinely compare current and prior chest X-rays to track disease progression, producing follow-up reports that describe multiple findings, each localised to an anatomical region and annotated with a temporal change status. Existing automated methods either generate reports from a single image without modelling temporal context, or incorporate temporal information but do not ground their outputs spatially. The few approaches that combine temporal reasoning with spatial grounding are restricted to single-finding descriptions, leaving multi-finding reports with mixed change directions unaddressed. We present GRCD, a framework for grounded report generation from chest X-ray pairs in the multi-finding setting. We first construct a rigorously cleaned dataset of temporal chest X-ray pairs by identifying and correcting two systematic labelling errors in the source annotations. We then introduce a Region-Guided Change Token module that encodes per-region temporal change across anatomical structures and injects this signal into a language model through a dual-pathway strategy combining prepended spatial tokens with gated cross-attention. On a multi-finding test set, GRCD outperforms existing baselines on text generation and clinical accuracy metrics, with gains in change detection. Ablation studies confirm that the dual-pathway design outperforms either integration strategy in isolation on text and clinical metrics, and that region-level change encoding is necessary for multi-finding generation. Code is available at https://github.com/UTSA-VIRLab/GRCD

OFM Riaz Rahman Aranya, Peyman Najafirad, Kevin Desai

Department of Computer Science · The University of Texas at San Antonio · San Antonio, Texas, USA

Radiology Report GenerationMedical Image AnalysisLongitudinal Medical Image AnalysisMedical Image Grounding
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Jul 2, 2026

Spatio-Temporal and Clinical Conditioning for Fine-Grained Radiology Report Retrieval

Radiology is vital to modern healthcare, but rising imaging demand and persistent workforce shortages strain reporting capacity and clinical workflows. Automated radiology report generation has the potential to support radiologists and help alleviate this burden; however, existing retrieval-based methods remain rigid, lack explicit anatomical grounding, and do not account for longitudinal disease progression or available clinical context. In this work, we introduce STAR3, a multimodal, spatio-temporal, attentive retrieval framework for radiology report generation that aligns region-level anatomical information with clinical indications and longitudinal changes across chest X-ray studies. Our framework employs an object detector to identify anatomically meaningful regions and retrieves semantically relevant report sentences conditioned on both current clinical context and changes observed between prior and current examinations. This design enables anatomically and temporally grounded report generation that better reflects clinical reporting practice. Experiments on the MIMIC-CXR dataset demonstrate that STAR3 outperforms current retrieval-based approaches on retrieval, NLP and clinical metrics, highlighting the value of conditioning retrieval anatomically, temporally and clinically for advancing automated radiology report generation.

P. Sloan, E. Simpson, M. Mirmehdi

Department of Computer Science University of Bristol Bristol, UK

Radiology Report GenerationMedical Image Grounding
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Jul 1, 2026

Discrete Diffusion Language Models for Interactive Radiology Report Drafting

Diffusion language models, which generate text by denoising a token canvas bidirectionally instead of emitting tokens left to right, have become competitive with autoregressive (AR) generation. Medical foundation models, however, remain almost entirely autoregressive. We adapt a mixture-of-experts diffusion language model, DiffusionGemma-26B, and benchmark it against its same-size AR sibling Gemma-4-26B under an identical LoRA recipe on medical visual question answering datasets, scored by a verbosity-robust LLM judge. Diffusion matches or exceeds AR on all of them, and the finetuned model (3.8B active) is competitive with frontier vision-language models; its decoding is also 3.5-4.4x faster. Beyond this parity, the diffusion model offers a drafting capability AR lacks: any-order infill. Because the canvas is denoised bidirectionally, a radiologist can fix report fragments and have the model fill the text between them, an operation inherent to diffusion but not to autoregression, which is subpar at it. This suits real reports, which are often terse or inconsistent across clinicians and institutions.

Max Van Puyvelde, Halil Ibrahim Gulluk, Wim Van Criekinge +1

Department of Biomedical Data Science, Stanford University School of Medicine · Department of Mathematical Modelling, Statistics & Bioinformatics, Ghent University · Department of Electrical Engineering, Stanford University

Radiology Report GenerationDiffusion Language ModelsText Generation
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Jun 30, 2026

Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence

Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations still undermine trustworthy use: models can produce fluent conclusions that conflict with imaging evidence. Existing mitigation strategies typically rely on additional training, external retrieval/knowledge bases, or multi-stage post-hoc verification, which increases cost and pipeline complexity and often generalizes poorly across models and tasks.To address this, we propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection. By leveraging ROI priors acquired using MedSAM in our implementation, we recalibrate the visual perception trajectory via ROI-guided activation modulation while anchoring the textual reasoning trajectory by mapping anatomical coordinates into discrete semantic tokens as verifiable external memory. Then we introduce a task-aware dynamic router to select modality-specific interventions based on task semantics, balancing perceptual grounding and linguistic fluency. We conduct systematic evaluations on 2 tasks and 5 datasets using LLaVA-1.5-7B, LLaVA-Med-1.5-7B, Qwen3-VL-8B/32B, and InternVL-3.5-8B/38B. Controlled ablations and visualizations further validate the framework, which consistently outperforms baselines across medical benchmarks, improving close-ended accuracy by up to ∼6%↑\sim\mathbf{6}\%\uparrow and reducing open-ended hallucinations by ∼35%↓\sim\mathbf{35}\%\downarrow. The code has been made available on GitHub: blue{https://github.com/Henry991115/SPRG}.

Rui Hao, Qiankun Li, Junyuan Mao +4

Huazhong University of Science and Technology, Wuhan, China · Imperial Global Singapore, Imperial College London, London, United Kingdom · Nanyang Technological University, Singapore, Singapore +2

Radiology Report GenerationMedical VQAMedical VLMsVisually Grounded ReasoningMedical Image GroundingVLM Hallucination Mitigation
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Jun 30, 2026

Seeing Through Multiple Views: Parameter-Efficient Fine-Tuning via Selective Neurons for Consistent Radiology Report Generation

Recent years have seen substantial advances in radiology report generation (RRG), yet existing approaches predominantly adopt direct feature fusion when handling multi-view X-ray images. Such approaches overlook the potential clinical inconsistencies and inaccuracies arising when a single model processes different views, adversely impacting performance and clinical reliability. To this end, we introduce View-PNDF (View-specific Pattern Neuron Detection and Fine-tuning), a parameter-efficient framework that fosters view-consistent report generation from a neuronal perspective. Specifically, View-PNDF comprises: (i) a view-specific neuron detection module identifying neurons responsive to particular views, (ii) a verification module quantifying the existence of these neurons, and (iii) a selective fine-tuning strategy strengthening detected neurons while preserving view-agnostic representations. By updating only view-specific neurons, View-PNDF achieves consistent diagnoses across different views with reduced computational costs. Subsequently, we employ Large Language Models (LLMs) to consolidate the view-specific reports into a complete radiology report. Furthermore, we use traditional Natural Language Generation (NLG) metrics-based assessment on integrated reports for baseline comparison and employ LLM-based assessment (e.g., GPT-4o) on view-specific reports to capture clinical significance. Extensive experiments on two medical RRG benchmarks demonstrate that View-PNDF substantially improves view-specific chest X-ray report generation quality while maintaining robust general-view performance.

Yucheng Chen, Jinjing Zhu, Yang Yu +7

MedVisAI Lab · Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore · Centre of AI in Medicine, Singapore +3

Radiology Report GenerationMulti-View ConsistencyParameter-Efficient Fine-Tuning
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Jun 29, 2026

SHOVIR: A Benchmark for Evaluating Vision Shortcut Learning in Radiology Report Generation

Current evaluation protocols for Vision-Language Models (VLMs) in Radiology Report Generation (RRG) rely on report-level metrics that measure lexical overlap or aggregate clinical correctness. However, such metrics do not test whether individual diagnostic statements stem from the actual pathological evidence visible in the image. This allows models to achieve competitive scores by exploiting learned priors or spurious correlations, a failure mode we refer to as vision shortcut. We introduce SHOVIR, a benchmark for evaluating vision shortcut behavior in RRG. SHOVIR extends two spatially annotated chest X-ray datasets, MIMIC-CXR and PadChest-GR, with per-box CheXpert labels, and defines image-level and disease-level occlusion experiments that contrast baseline performance on clean images against localized, region-specific perturbations. Comparing predictions across these conditions isolates two failure modes at the disease-class level: direct shortcuts, where a finding persists after its visual evidence is removed, and contextual shortcuts, where detection degrades once co-occurring pathologies are occluded despite the target region remaining intact. Benchmarking eight state-of-the-art VLMs, we find that shortcut behavior varies substantially across architectures and datasets. Models achieving the highest baseline report quality do not necessarily rank highest in spatial grounding, revealing that clinically fluent generation can coexist with shallow reliance on visual evidence. These findings expose a blind spot in current RRG evaluation and motivate region-aware assessment protocols.

Filippo Ruffini, Marco Salmé, Rosa Sicilia +2

Unit of Artificial Intelligence and Computer Systems, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy · Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden · UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy

VLM EvaluationRadiology Report GenerationVision-Language ModelsMedical Image BenchmarksRadiology Report Evaluation
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Jun 25, 2026

CORTEX: A Structured Reasoning Benchmark for Trustworthy 3D Chest CT MLLMs

Reasoning in multimodal large language models (MLLMs) has shown strong promise in medical imaging. However, this reasoning is usually free-form text judged only by its final answer, making it hard to interpret and verify, especially in 3D radiology, where a diagnosis should be traceable to evidence in the scan. Existing chest CT question-answering datasets compound this by reducing expert radiology reports to answer-only pairs, dropping the reasoning that links findings to conclusions and omitting the patient history clinicians rely on. As a result, reasoning-capable 3D chest CT MLLMs remain out of reach, as neither the structured supervision needed to train them nor the protocol needed to verify their reasoning yet exists. We introduce CORTEX (Clinically Organized Reasoning and sTructured EXplanation), a structured reasoning benchmark for 3D chest CT. For each question, CORTEX restores the missing reasoning as a four-stage diagnostic trace mirroring a radiologist's workflow: task understanding, visual observation, diagnostic reasoning, and answer synthesis. We generate these traces using frontier large language models with broad medical and general-domain knowledge, then filter and verify them with a stage-level evaluation protocol combining automated rubric scoring with expert radiologist review. Crucially, both the reasoning structure and evaluation rubrics are designed in close collaboration with clinicians. Built on CT-RATE, a large, publicly available chest CT dataset without reasoning annotations, CORTEX comprises 76,177 validated reasoning traces across open-ended VQA, closed-ended VQA, and report generation, providing both the structured supervision and the stage-level evaluation protocol needed to build and evaluate trustworthy reasoning models for 3D chest CT. Our dataset and evaluation code is available at https://huggingface.co/datasets/aneesurhashmi/cortex

Hashmat Shadab Malik, Anees Ur Rehman Hashmi, Numan Saeed +3

MBZUAI, Abu Dhabi, UAE · Hasso Plattner Institute, Potsdam, Germany · Khalifa University, Abu Dhabi, UAE

Radiology Report Generation3D Medical ImagingMultimodal QAMedical VLMsMultimodal CoT ReasoningMedical Image Benchmarks
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Jun 25, 2026

TAVR-VLM: Risk-Conditioned Causal Grounding for Hallucination-Resistant Report Generation

Transcatheter Aortic Valve Replacement (TAVR) planning requires meticulous multimodal reasoning. However, adapting Multimodal Large Language Models (MLLMs) to this high-stakes domain is severely impeded by diagnostic hallucinations, where generated text lacks anatomical grounding. To address this, TAVR-VLM is introduced: a novel framework featuring Risk-Conditioned Causal Grounding Attention (R-CGA) that instantiates a model-internal ``Risk →\rightarrow Region →\rightarrow Word'' structural grounding pathway. R-CGA compresses multimodal inputs into a causal risk bottleneck, purifying dense visual features into a global risk mask. During autoregressive generation, a support-projected causal consistency objective constrains token-level grounding within the risk-defined support mask. Evaluated on M3TAVR\text{M}^3\text{TAVR}, a comprehensive 1,482-patient cohort, TAVR-VLM establishes a new state-of-the-art. It achieves an AUROC of 0.896, boosts CIDEr to 0.936, and drastically reduces the hallucination rate to 8.1%, thereby improving interpretability for evidence-based surgical AI.

Zhixiang Lu, Xiwei Liu, Sifan Song +5

Xi’an Jiaotong-Liverpool University · University of Liverpool · Mohamed bin Zayed University of Artificial Intelligence +2

Radiology Report GenerationMedical VLMsVLM Hallucination Mitigation
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Jun 24, 2026

MRI2Rep: Autoregressive Structured Report Generation for 3D Liver MRI

Manual reporting of 3D MRI studies is time-consuming, yet end-to-end structured report generation for 3D liver MRI remains underexplored due to volumetric complexity and scarce paired data. We propose MRI2Rep, an autoregressive framework for liver MRI report generation. From 3,929 real-world MRI-report pairs acquired over a 10-year single-institution cohort, a Report-to-Label Canonicalization (RLC) module converts free-text reports into structured, closed-vocabulary diagnostic sequences without lesion-level annotations. On a held-out test set, MRI2Rep achieves 76.0% case-level sensitivity, 29.4% lesion-level F1, compared with no more than 8.3% for adapted medical vision-language baselines, and 82.4% liver-level accuracy. In a blinded reader study, two radiologists rated 75% and 70% of AI-generated reports as clinically acceptable, compared with 95% and 100% for original reports. Our automated LLM-based judge, LLM-Eval, rated 61.8% of AI-generated reports as acceptable, applying a stricter standard and supporting its use as a conservative proxy. To our knowledge, this is the first end-to-end LI-RADS-structured reporting system for 3D liver MRI.

Xinran Li, Junlin Yang, Annabella Shewarega +4

Yale University, New Haven, CT 06520, USA · Department of Biomedical Engineering · Department of Radiology & Biomedical Imaging +3

Radiology Report Generation3D Medical ImagingMagnetic Resonance Imaging
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Jun 23, 2026

Transition-Aware best-of-N sampling for Longitudinal Chest X-ray Reports

In longitudinal clinical practice, every chest X-ray is read in the context of the patients prior exam, and much of what the radiologist communicates is the change from one visit to the next. To the best of our knowledge, we present the first training-free best-of-N sampling scheme for pre-trained chest X-ray report generators that is explicitly aware of this longitudinal prior to current transition. We call it transition-aware best-of-N sampling, each report is split into sentences and embedded into an unordered set in Rd; each (prior, current) pair is reduced to a fixed-dim directional vector via a set-to-set distance designed to encode the change between the two sets; and candidates are scored by cosine distance from their candidate transition vector to a cached bank of ground-truth training transition vectors, aggregated as min or kNN. We instantiate the framework with four directional set distances (mean-shift, novelty residual, directed-Hausdorff anchor, and cost-weighted optimal transport) and evaluate on a multi-visit AP-PA cohort, running inference under three prompts on three vision-language generators. Transition-aware best-of-N outperforms random selection across the board, with the largest relative gains on the Impression section.

Halil Ibrahim Gulluk, Max Van Puyvelde, Wim Van Criekinge +1

Department of Electrical Engineering, Stanford University, Stanford, CA, USA · Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA · Department of Mathematical Modelling, Statistics & Bioinformatics, Ghent University, Ghent, Belgium

Radiology Report GenerationRadiology VLMsLongitudinal Medical Image AnalysisBest-of-N Sampling
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Jun 23, 2026

Female-RHINO: A Real-Time Scanner-Integrated Framework for Automated Quantitative Uterine MRI Analysis and Structured Reporting

Standardized assessment of uterine MRI remains challenging due to anatomical variability, observer dependence, and the lack of workflow-integrated automated analysis tools. This work presents Female-RHINO: (R)eproductive (H)ealth (I)maging A(N)alysis T(O)ol, a real-time AI-assisted framework for automated quantitative uterine MRI analysis and structured reporting during image acquisition. We present an end-to-end system that integrates inline communication with the MRI scanner and deep learning-based analysis to derive quantitative uterine biomarkers from sagittal T2-weighted pelvic MRI. The framework combines segmentation and anatomical landmark detection models trained and evaluated on more than 500 multi-center datasets spanning diverse protocols, vendors, and patient populations. It performs volumetry, detects and quantifies common incidental findings such as fibroids and Nabothian cysts, and extracts six anatomical landmarks for biometric assessment. Results are compiled into a structured clinician-oriented report with integrated visualizations, without manual interaction. Evaluation on independent retrospective and prospective cohorts demonstrated robust performance across varying acquisition settings. Mean Dice similarity coefficients were 0.82 for the uterus and 0.80 for fibroids, with lower but consistent agreement for Nabothian cysts. Landmark detection achieved a mean radial error of 3.7 mm. End-to-end processing was completed in under 70 seconds, enabling availability of results during the ongoing scan. Prospective deployment yielded immediate, standardized, and reproducible analyses supported by inter-observer agreement. The proposed system enables real-time scanner-integrated AI for automated uterine MRI analysis and reporting, with potential to improve standardization, efficiency, and clinical workflow in pelvic imaging.

Deepak Bhatia, Saad Ahmad, Smiti Tripathy +7

Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany · School of Biomedical Engineering and Imaging, KCL, London, UK · Institute for Information Processing, Leibniz University Hannover, Germany and CAIMed, L3S research institute, Hannover, Germany +1

Radiology Report GenerationMagnetic Resonance ImagingMedical Image SegmentationMedical Image Localization
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Jun 20, 2026

GTA-Net: Cooperative Game Theory for Vision-Language Alignment in Chest X-Ray Report Generation

Automated chest X-ray report generation requires precise cross-modal grounding to ensure clinically reliable descriptions. However, existing vision-language models rely on implicit attention mechanisms that fail to enforce explicit region-word correspondence and disease-level consistency. We propose Game-Theoretic Alignment Network (GTA-Net), a vision-language framework that formulates report generation as a cooperative game-theoretic alignment problem. The model introduces a BinaryGameAligner that models interactions between image regions and text tokens using similarity-based payoff matrices with Shapley-inspired importance weighting. To enforce clinical semantics, we further develop a Disease-Aware Ternary Aligner, which captures joint interactions among images, reports, and structured disease concepts. GTA-Net combines a Swin-based visual encoder with a LoRA-adapted large language model and is trained with a unified objective for generation and alignment. Experiments on CheXpertPlus and IU-XRay demonstrate state-of-the-art performance across standard generation metrics and improved clinical consistency, highlighting the effectiveness of explicit game-theoretic alignment for medical vision-language generation.

Saif ur Rehman Khan, Imad Ahmed Waqar, Sebastian Vollmer +2

Department of Computer Science, Rhineland-Palatinate Technical University of Kaiserslautern-Landau, Kaiserslautern 67663, Germany · German Research Center for Artificial Intelligence (DFKI), Kaiserslautern 67663, Germany · IntelligentX GmbH (intelligentx.com), Kaiserslautern, Germany +1

Radiology Report GenerationMedical VLMsVision-Language Alignment
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Jun 19, 2026

Precision Recall Controllable Radiology Report Generation via Hybrid Natural Language and Clinical Reward Learning

Automated radiology report generation (RRG) has gained increasing attention because it can reduce the heavy workload of clinical report writing. However, most existing methods mainly optimize for natural language generation (NLG) metrics that focus on language fluency, while providing little control over clinically important factors such as precision and recall. As consequence, generated reports may be fluent but not well aligned with different clinical needs. To address this challenge, we propose a reinforcement learning framework for precision recall controllable RRG, where a control parameter explicitly adjusts the trade-off between clinical precision and recall during inference. This design allows the model to flexibly generate reports according to different clinical requirements. To ensure clinical correctness, we introduce a clinical reward into the training objective, which helps improve clinical efficacy (CE) beyond standard language-based optimization. In addition, we apply a group-relative training strategy that normalizes rewards within each training group, reducing reward variance and improving training stability. Extensive experiments on the MIMIC-CXR dataset show that our method consistently outperforms state-of-the-art approaches in both NLG and CE evaluation metrics, while providing reliable control over the CE precision recall trade-off.

Ling Chen, Ruinan Jin, Jun Luo +6

The Ohio State University, Columbus, OH 43221, USA · University Medical Center Regensburg, Regensburg, Germany

Radiology Report GenerationControllable Text GenerationRL for Generative Models
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Jun 18, 2026

Scalable Training of Spatially Grounded 2D Vision-Language Models for Radiology

We study how to train visually grounded vision-language models (VLMs) for radiology without manual spatial annotations. We introduce RefRad2D, a large-scale bilingual (German/English) dataset of 1.2M CT and MR image-text pairs derived from clinical practice, with task-specific VQA and spatial grounding subsets generated automatically via LLM-based curation and automated segmentation. Trained on this data, our model RadGrounder jointly performs report generation, visual question answering, and spatial grounding via bounding-box detection or segmentation. On external VQA benchmarks (Slake, VQA-RAD), RadGrounder achieves competitive results with specialized medical VLMs. Adding our clinical data to the training mixture improves open-ended VQA over fine-tuning on the downstream datasets alone, showing the transferability of our dataset. Crucially, adding grounding supervision does not degrade language quality, enabling spatially verifiable outputs at no cost to VQA performance.

Yusuf Salcan, Simon Ging, Robin Tibor Schirrmeister +4

Computer Vision Group, University of Freiburg, Germany · CRIION-AI Lab, Freiburg, Germany · Adaptive & Agentic AI +3

Radiology Report GenerationRadiology VLMsMedical VQAMedical Image Grounding
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Jun 15, 2026

A Multi-Center Benchmark for Abdominal Disease Diagnosis and Report Generation from Non-Contrast CT

Multiphasic contrast-enhanced CT (CECT) is widely used for abdominal lesion characterization, yet it carries inherent risks of contrast-induced nephropathy, escalates acquisition burden, and heavily contributes to radiologist workload. To address these challenges, we introduce a novel multi-center benchmark for multi-organ abdominal disease diagnosis and automated radiology report generation, which learns to synthesize contrast-enhanced findings from single-phase non-contrast CT (NCCT). To support this, we curated a large-scale dataset of paired NCCT-CECT studies and their corresponding contrast-enhanced radiology reports from two centers, partitioned into internal sets and an external validation cohort. Under a unified evaluation protocol, we benchmarked five contemporary deep learning architectures encompassing chest-specific, abdomen-specific, and general-purpose multimodal domains. Extensive experiments demonstrate that NCCT retains diagnostic signals, achieving an average multi-organ AUC of 69.1% on the internal cohort and 63.1% on the external cohort, respectively. By releasing this dataset and standardized benchmark publicly, this study aims to catalyze future research into safer, resource-efficient, and globally accessible contrast-free abdominal imaging workflows. Code is available at: https://github.com/xmed-lab/TriALS-Report.

Mariam Elbakry, Aliaa Sayed Sheha, Salma Hassan Tantawy +5

Ain Shams University, Cairo, Egypt · University of Catania, Catania, Italy · Universitat de Barcelona, Barcelona, Spain +1

Radiology Report GenerationMedical Image ClassificationComputed TomographyMedical Image Benchmarks
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Jun 13, 2026

ReportQA: QA-Based Radiology Report Evaluation

Radiology report evaluation is essential for advancing automated report generation. Natural language generation metrics have limited clinical relevance. Clinical efficacy (CE) metrics evaluate important medical findings, but focus mainly on presence and cover only a limited set of entities. Due to heavy reliance on manual annotations, it is difficult for CE metrics to extend clinical entities or attributes. In clinical practice, radiology reports serve as a medium for information transfer. Clinicians use them to perform downstream diagnostic tasks without directly inspecting images. Based on this insight, we propose ReportQA, a clinical-related and flexible radiology report evaluation framework, supporting detailed quantitative analysis of radiology report generation systems. We first collect datasets covering multiple imaging modalities and anatomical regions. We then construct knowledge trees of clinical entities and attributes with radiologist guidance, and use large language models (LLMs) to extract structured information from raw reports. Next, we generate QA pairs from predefined templates and apply quality control through self-filtering and report-based filtering. During evaluation, the report is treated as context, and an LLM acts as a judge model to answer the QA pairs. Based on the resulting QA accuracy, we introduce QAScore metric. Compared with existing metrics, QAScore shows better alignment with radiologist judgments. Experiments on multiple state-of-the-art vision-language models reveal that current report-based inference paradigms struggle to learn fine-grained clinical representations and exhibit strong negative prior biases. In contrast, question-driven inference provides a more effective alternative. For reproducibility and extensibility, we release the knowledge trees, structured reports, and QA pairs, along with the pipeline code for QA construction and evaluation.

Yiming Shi, Shaoshuai Yang, Xi Chen +10

Department of Electronic Engineering, Tsinghua University · Beijing Electronic Digital & Intelligence · College of AI, Tsinghua University +1

Radiology Report GenerationMedical VLMsAutomated EvaluationRadiology Report Evaluation
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Jun 8, 2026

XMedFusion: A Knowledge-Guided Multimodal Perception and Reasoning Framework for Autonomous Medical Systems

Autonomous medical and robotic systems increasingly rely on intelligent perception and reasoning capabilities to interpret visual data and support clinical decision making. Radiology report generation represents a critical component of such automated diagnostic workflows, yet existing end-to-end multimodal models often suffer from weak visual grounding, resulting in unreliable interpretations and omission of subtle clinical findings. This paper presents XMedFusion, a modular AI framework designed as an intelligent perception and reasoning module for autonomous medical systems. The proposed framework decomposes visual information into coordinated functional components that emulate expert-driven analysis, including a visual perception agent that extracts image-grounded evidence, a knowledge graph construction agent that structures clinically relevant findings, and a retrieval-guided drafting process that ensures a consistent reporting structure. A synthesis agent iteratively integrates visual and structured evidence through reasoning-driven verification to produce reliable and interpretable diagnostic outputs. Experimental evaluation on a public chest radiograph dataset demonstrates significant improvements over baseline vision-language models, achieving gains from 0.0493 to 0.3359 in BLEU-1, 0.0863 to 0.2440 in ROUGE-L, and 0.0829 to 0.1708 in METEOR, along with substantial improvements in semantic evaluation metrics such as Consistency (2.38 to 7.80) and Accuracy (2.34 to 6.93). The results highlight the effectiveness of structured multi-agent perception and reasoning for enhancing robustness, transparency, and automation in intelligent medical imaging systems, enabling integration into autonomous healthcare and robotic diagnostic workflows.

Hamza Riaz, Arham Haroon, Maha Baig +3

National University of Sciences and Technology (NUST), Islamabad, Pakistan · University of Staffordshire, Stoke-on-Trent, ST4 2DE, United Kingdom

Radiology Report GenerationRadiology VLMsMulti-Agent SystemsMultimodal Fusion
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Jun 8, 2026

A multi-agent system for spine MRI report generation from multi-sequence imaging

Spinal pathology is a leading cause of pain and disability worldwide. Spine MRI is central to clinical evaluation, yet its interpretation remains complex and time-consuming, requiring integration of information across multiple imaging sequences and anatomical regions. Despite recent advances in automated MRI analysis, effectively combining multi-sequence data while preserving sequence-specific diagnostic information remains an open challenge. Here we present SpineAgent, a multi-agent framework for spine MRI report generation built upon a multi-sequence foundation model trained on routine clinical data from 32,047 patients and 453,683 MRI series, comprising a total of 13,441,191 MRI slices. To accommodate diverse modalities of sequences, we first pre-train two DINOv3-based encoders separately on T1- and T2-weighted sequences. We then introduce a continual training strategy that learns a synthesizer to embed images of other sequences using the T1 and T2 encoders, producing patient-level embedding that integrates various signals across MRI sequences. Using these embeddings, SpineAgent achieves state-of-the-art performance, and demonstrates strong generalizability under cross-manufacturer and cross-cohort evaluation. Beyond classification, SpineAgent enables pathology localization by identifying findings-relevant slices and segmenting pathological regions. It also supports multimodal image-report retrieval, providing a solid foundation for scalable and explainable MRI report generation. We further integrate these validated capabilities of SpineAgent into 37 specialized agents. Finally, we incorporate their outputs as structured tokens within a Medical Report Agent trained end-to-end for report generation. Through both automated metrics and expert evaluation by five radiologists, SpineAgent achieves leading performance in spine MRI report generation.

Zhiping Xiao, Junwei Yang, Gongbo Sun +12

1Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA · School of Computer Science, Peking University, Beijing, China · Department of Computer Sciences, University of Wisconsin–Madison, Madison, WI, USA +3

Radiology Report GenerationMedical Imaging Foundation ModelsMagnetic Resonance ImagingMulti-Agent Systems
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Jun 7, 2026

RadOT-Eval: Auditable Structured-Evidence Transport for Radiology Report Evaluation

Automatic evaluation is critical for high-stakes text generation, where errors often involve omitted findings, hallucinated content, polarity reversals, location changes, uncertainty mismatches, and temporal-comparison errors rather than low surface similarity alone. Radiology report generation provides a challenging test case because generated reports must preserve structured clinical evidence across sources. We present RadOT-Eval, an interpretable structured-evidence optimal transport framework for offline auditing of radiology report generation. RadOT-Eval decomposes reference and candidate reports into attribute-structured clinical evidence units, aligns corresponding evidence using entropy-regularized optimal transport, and uses clinically meaningful side-channel discrepancies in a monotone risk model to predict error burden. All transport, feature, and readout choices are selected using the ReXVal dataset, and the frozen system is evaluated on the independent RadEvalX dataset. RadOT-Eval achieves Spearman correlations of 0.715, 0.548, and 0.399 with total, clinically significant, and clinically insignificant annotated error burden, respectively, yielding higher point estimates than standard evaluation metrics and the open-source large language model (LLM)-based evaluator GREEN-radllama2-7B. In a frozen auxiliary corruption-sensitivity stress test on ReXErr-v1, RadOT-Eval achieves 0.768 AUROC and a 0.990 corrupted-greater-than-clean paired win rate. These results show that structured evidence transport provides an auditable, rank-oriented evaluation tool for high-stakes generated clinical text under ReXVal-only model selection and frozen RadEvalX testing.

Weixin Liu, Juming Xiong, Yang Li +5

Vanderbilt University, Nashville, TN, USA · Vanderbilt University Medical Center, Nashville, TN, USA · Virginia Tech, Blacksburg, VA, USA

Radiology Report GenerationAutomated EvaluationOptimal TransportRadiology Report Evaluation
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Jun 2, 2026

A unified multi-task framework enables interpretable chest radiograph analysis

While multimodal deep learning has advanced medical imaging analysis, existing black-box systems \textcolor{black}{may remain confined to isolated tasks, often overlooking} the trust-sensitive nature of clinical diagnosis as a multi-task process. We propose IMT-CXR (Interpretable Multi-task Transformer for Chest X-ray Analysis), a framework that emulates radiologists' diagnostic workflow through three evidence-driven stages: 1) Disease recognition; 2) Attribute characterization (e.g., size, location, severity quantification); 3) Evidence-integrated report generation with traceable decision pathways. The framework employs a unified transformer architecture optimized via medical-domain instruction tuning, sequentially executing four clinical tasks: multi-label disease classification, lesion localization, anatomical segmentation, and radiology report generation. Experimental validation demonstrates competitive performance on ten CXR benchmarks under direct inference and fine-tuning settings. In a blinded evaluation of 160 historical reports from four medical centers, three radiologists rated 66% of AI-generated reports as comparable to or surpassing original clinical reports in diagnostic clarity, highlighting the framework's translational potential. By establishing traceable diagnostic pathways from anatomical findings to conclusions, this work bridges the gap between AI technical metrics and clinical utility, advancing trustworthy AI systems in medical imaging.

Lijian Xu, Ziyu Ni, Xinglong Liu +3

Shenzhen University of Advanced Technology · the Chinese University of Hong Kong, Hong Kong · Lead contact +4

Radiology Report GenerationChest X-Ray ClassificationMulti-Task LearningExplainable Medical Image AnalysisMedical Image Localization
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