Radiology Report Generation

Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose ECHO, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by 64.33% and 60.58% respectively, while achieving up to \textbf{$8\times$} inference speedup with negligible degradation in clinical accuracy.

Cardiac magnetic resonance (CMR) is a cornerstone for diagnosing cardiovascular disease. However, it remains underutilized due to complex, time-consuming interpretation across multi-sequences, phases, quantitative measures that heavily reliant on specialized expertise. Here, we present BAAI Cardiac Agent, a multimodal intelligent system designed for end-to-end CMR interpretation. The agent integrates specialized cardiac expert models to perform automated segmentation of cardiac structures, functional quantification, tissue characterization and disease diagnosis, and generates structured clinical reports within a unified workflow. Evaluated on CMR datasets from two hospitals (2413 patients) spanning 7-types of major cardiovascular diseases, the agent achieved an area under the receiver-operating-characteristic curve exceeding 0.93 internally and 0.81 externally. In the task of estimating left ventricular function indices, the results generated by this system for core parameters such as ejection fraction, stroke volume, and left ventricular mass are highly consistent with clinical reports, with Pearson correlation coefficients all exceeding 0.90. The agent outperformed state-of-the-art models in segmentation and diagnostic tasks, and generated clinical reports showing high concordance with expert radiologists (six readers across three experience levels). By dynamically orchestrating expert models for coordinated multimodal analysis, this agent framework enables accurate, efficient CMR interpretation and highlights its potentials for complex clinical imaging workflows. Code is available at https://github.com/plantain-herb/Cardiac-Agent.

LLMs have demonstrated remarkable capabilities in linguistic reasoning and are increasingly adept at vision-language tasks. The integration of image tokens into transformers has enabled direct visual input and output, advancing research from image-to-text descriptions to text-to-image generation. However, simple text-to-image generation holds limited clinical utility. In medical imaging, tasks such as image segmentation for localizing pathologies or image translation for reconstructing missing sequences have much greater clinical importance. Despite this, integrating these diverse, clinically relevant tasks within a single, versatile language model remains unexplored. Our method, LLaBIT (Large Language Model for Brain Image Translation), extends the visual reasoning of LLMs to these clinically meaningful tasks in the brain MRI domain. To mitigate the spatial information loss inherent in image tokenization, we incorporate a mechanism to reuse feature maps from the image encoder, minimizing data degradation. We also generate text data using LLMs with strict predefined instructions to augment limited image-text paired data in brain MRI. We comprehensively evaluated our method on five brain MRI datasets across four distinct tasks: report generation, visual question answering, image segmentation, and image translation. Our model not only demonstrated superior performance across all tasks but also outperformed specialized, task-specific models in direct comparisons, highlighting its efficacy and versatility

Lumbar Spinal Stenosis (LSS) diagnosis remains a critical clinical challenge, with diagnosis heavily dependent on labor-intensive manual interpretation of multi-view Magnetic Resonance Imaging (MRI), leading to substantial inter-observer variability and diagnostic delays. Existing vision-language models simultaneously fail to address the extreme class imbalance prevalent in clinical segmentation datasets while preserving spatial accuracy, primarily due to global pooling mechanisms that discard crucial anatomical hierarchies. We present an end-to-end Explainable Vision-Language Model framework designed to overcome these limitations, achieved through two principal objectives. We propose a Spatial Patch Cross-Attention module that enables precise, text-directed localization of spinal anomalies with spatial precision. A novel Adaptive PID-Tversky Loss function by integrating control theory principles dynamically further modifies training penalties to specifically address difficult, under-segmented minority instances. By incorporating foundational VLMs alongside an Automated Radiology Report Generation module, our framework demonstrates considerable performance: a diagnostic classification accuracy of 90.69%, a macro-averaged Dice score of 0.9512 for segmentation, and a CIDEr score of 92.80%. Furthermore, the framework shows explainability by converting complex segmentation predictions into radiologist-style clinical reports, thereby establishing a new benchmark for transparent, interpretable AI in clinical medical imaging that keeps essential human supervision while enhancing diagnostic capabilities.

Chest X-rays (CXRs) are among the most frequently performed imaging examinations worldwide, yet rising imaging volumes increase radiologist workload and the risk of diagnostic errors. Although artificial intelligence (AI) systems have shown promise for CXR interpretation, most generate only final predictions, without making explicit how visual evidence is translated into radiographic findings and diagnostic predictions. We present CheXOne, a reasoning-enabled vision-language model for CXR interpretation. CheXOne jointly generates diagnostic predictions and explicit, clinically grounded reasoning traces that connect visual evidence, radiographic findings, and these predictions. The model is trained on 14.7 million instruction and reasoning samples curated from 30 public datasets spanning 36 CXR interpretation tasks, using a two-stage framework that combines instruction tuning with reinforcement learning to improve reasoning quality. We evaluate CheXOne in zero-shot settings across visual question answering, report generation, visual grounding and reasoning assessment, covering 17 evaluation settings. CheXOne outperforms existing medical and general-domain foundation models and achieves strong performance on independent public benchmarks. A clinical reader study demonstrates that CheXOne-drafted reports are comparable to or better than resident-written reports in 55% of cases, while effectively addressing clinical indications and enhancing both report writing and CXR interpretation efficiency. Further analyses involving radiologists reveal that the generated reasoning traces show high clinical factuality and provide causal support for the final predictions, offering a plausible explanation for the performance gains. These results suggest that explicit reasoning can improve model performance, interpretability and clinical utility in AI-assisted CXR interpretation.

Automated radiology report summarization aims to distill verbose findings into concise clinical impressions, but existing multimodal models often struggle with visual noise and fail to meaningfully improve over strong text-only baselines in the FINDINGS $\to$ IMPRESSION transformation. We challenge two prevailing assumptions: (1) that more visual input is always better, and (2) that multimodal models add limited value when findings already contain rich image-derived detail. Through controlled ablations on MIMIC-CXR benchmark, we show that selectively focusing on pathology-relevant visual patches rather than full images yields substantially better performance. We introduce ViTAS, Visual-Text Attention Summarizer, a multi-stage pipeline that combines ensemble-guided MedSAM2 lung segmentation, bidirectional cross-attention for multi-view fusion, Shapley-guided adaptive patch clustering, and hierarchical visual tokenization feeding a ViT. ViTAS achieves SOTA results with 29.25% BLEU-4 and 69.83% ROUGE-L, improved factual alignment in qualitative analysis, and the highest expert-rated human evaluation scores. Our findings demonstrate that less but more relevant visual input is not only sufficient but superior for multimodal radiology summarization.

Safe deployment of Large Vision-Language Models (LVLMs) in radiology report generation requires not only accurate predictions but also clinically interpretable indicators of when outputs should be thoroughly reviewed, enabling selective radiologist verification and reducing the risk of hallucinated findings influencing clinical decisions. One intuitive approach to this is verbalized confidence, where the model explicitly states its certainty. However, current state-of-the-art language models are often overconfident, and research on calibration in multimodal settings such as radiology report generation is limited. To address this gap, we introduce ConRad (Confidence Calibration for Radiology Reports), a reinforcement learning framework for fine-tuning medical LVLMs to produce calibrated verbalized confidence estimates alongside radiology reports. We study two settings: a single report-level confidence score and a sentence-level variant assigning a confidence to each claim. Both are trained using the GRPO algorithm with reward functions based on the logarithmic scoring rule, which incentivizes truthful self-assessment by penalizing miscalibration and guarantees optimal calibration under reward maximization. Experimentally, ConRad substantially improves calibration and outperforms competing methods. In a clinical evaluation we show that ConRad's report level scores are well aligned with clinicians' judgment. By highlighting full reports or low-confidence statements for targeted review, ConRad can support safer clinical integration of AI-assistance for report generation.

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

Automated radiology report generation from 3D computed tomography (CT) volumes is challenging due to extreme sequence lengths, severe class imbalance, and the tendency of large language models (LLMs) to ignore visual tokens in favor of linguistic priors. We present Ker-VLJEPA-3B, a four-phase curriculum learning framework for free-text report generation from thoracic CT volumes. A phased training curriculum progressively adapts a Llama 3.2 3B decoder to ground its output in visual features from a frozen, self-supervised encoder. Our visual backbone (LeJEPA ViT-Large) is trained via self-supervised joint-embedding prediction on unlabeled CTs, without text supervision. Unlike contrastive models (CLIP, BiomedCLIP), this language-free backbone yields modality-pure representations. Vision-language alignment is deferred to the curriculum's bridge and generation phases. This modality-agnostic design can integrate any self-supervised encoder into an LLM without paired text during foundation training. Methodological innovations include: (1) zone-constrained cross-attention compressing slice embeddings into 32 spatially-grounded visual tokens; (2) PCA whitening of anisotropic LLM embeddings; (3) a positive-findings-only strategy eliminating posterior collapse; (4) warm bridge initialization transferring projection weights; and (5) selective cross-attention freezing with elastic weight consolidation to prevent catastrophic forgetting. Evaluated on the CT-RATE benchmark (2,984 validation volumes, 18 classes), Ker-VLJEPA-3B achieves a macro F1 of 0.429, surpassing the state-of-the-art (U-VLM, macro F1 = 0.414) by 3.6%, and reaching 0.448 (+8.2%) with threshold optimization. Ablation studies confirm 56.6% of generation quality derives from patient-specific visual content. Code and weights are available.

Chest X-ray report generation and automated evaluation are limited by poor recognition of low-prevalence abnormalities and inadequate handling of clinically important language, including negation and ambiguity. We develop a clinician-guided framework combining human expertise and large language models for multi-label finding extraction from free-text chest X-ray reports and use it to define Ran Score, a finding-level metric for report evaluation. Using three non-overlapping MIMIC-CXR-EN cohorts from a public chest X-ray dataset and an independent ChestX-CN validation cohort, we optimize prompts, establish radiologist-derived reference labels and evaluate report generation models. The optimized framework improves the macro-averaged score from 0.753 to 0.956 on the MIMIC-CXR-EN development cohort, exceeds the CheXbert benchmark by 15.7 percentage points on directly comparable labels, and shows robust generalization on the ChestX-CN validation cohort. Here we show that clinician-guided prompt optimization improves agreement with a radiologist-derived reference standard and that Ran Score enables finding-level evaluation of report fidelity, particularly for low-prevalence abnormalities.

Automated radiology report generation has gained increasing attention with the rise of deep learning and large language models. However, fully generative approaches often suffer from hallucinations and lack clinical grounding, limiting their reliability in real-world workflows. In this study, we propose a multimodal retrieval-augmented generation (RAG) system for grounded drafting of chest radiograph impressions. The system combines contrastive image-text embeddings, case-based similarity retrieval, and citation-constrained draft generation to ensure factual alignment with historical radiology reports. A curated subset of the MIMIC-CXR dataset was used to construct a multimodal retrieval database. Image embeddings were generated using CLIP encoders, while textual embeddings were derived from structured impression sections. A fusion similarity framework was implemented using FAISS indexing for scalable nearest-neighbor retrieval. Retrieved cases were used to construct grounded prompts for draft impression generation, with safety mechanisms enforcing citation coverage and confidence-based refusal. Experimental results demonstrate that multimodal fusion significantly improves retrieval performance compared to image-only retrieval, achieving Recall@5 above 0.95 on clinically relevant findings. The grounded drafting pipeline produces interpretable outputs with explicit citation traceability, enabling improved trustworthiness compared to conventional generative approaches. This work highlights the potential of retrieval-augmented multimodal systems for reliable clinical decision support and radiology workflow augmentation

While large language models (LLMs) have advanced CT report generation, existing methods typically encode 3D volumes holistically, failing to distinguish informative cues from redundant anatomical background. Inspired by radiological cognitive subtraction, we propose Differential Visual Prompting (DiffVP), which conditions report generation on explicit, high-level semantic scan-to-reference differences rather than solely on absolute visual features. DiffVP employs a hierarchical difference extractor to capture complementary global and local semantic discrepancies into a shared latent space, along with a difference-to-prompt generator that transforms these signals into learnable visual prefix tokens for LLM conditioning. These difference prompts serve as structured conditioning signals that implicitly suppress invariant anatomy while amplifying diagnostically relevant visual evidence, thereby facilitating accurate report generation without explicit lesion localization. On two large-scale benchmarks, DiffVP consistently outperforms prior methods, improving the average BLEU-1-4 by +10.98 and +4.36, respectively, and further boosts clinical efficacy on RadGenome-ChestCT (F1 score 0.421). All codes will be released at https://github.com/ArielTYH/DiffVP/.

Automated radiology report generation from 3D CT volumes often suffers from incomplete pathology coverage. We provide empirical evidence that this limitation stems from a representational bottleneck: contrastive 3D CT embeddings encode discriminative pathology signals, yet exhibit severe dimensional concentration, with as few as 2 effective dimensions out of 512. Corroborating this, scaling the language model yields no measurable improvement, suggesting that the bottleneck lies in the visual representation rather than the generator. This bottleneck limits both generation and retrieval; naive static retrieval fails to improve clinical efficacy and can even degrade performance. We propose AdaRAG-CT, an adaptive augmentation framework that compensates for this visual bottleneck by introducing supplementary textual information through controlled retrieval and selectively integrating it during generation. On the CT-RATE benchmark, AdaRAG-CT achieves state-of-the-art clinical efficacy, improving Clinical F1 from 0.420 (CT-Agent) to 0.480 (+6 points); ablation studies confirm that both the retrieval and generation components contribute to the improvement. Code is available at https://github.com/renjie-liang/Adaptive-RAG-for-3DCT-Report-Generation.

Vietnamese medical research has become an increasingly vital domain, particularly with the rise of intelligent technologies aimed at reducing time and resource burdens in clinical diagnosis. Recent advances in vision-language models (VLMs), such as Gemini and GPT-4V, have sparked a growing interest in applying AI to healthcare. However, most existing VLMs lack exposure to Vietnamese medical data, limiting their ability to generate accurate and contextually appropriate diagnostic outputs for Vietnamese patients. To address this challenge, we introduce ViX-Ray, a novel dataset comprising 5,400 Vietnamese chest X-ray images annotated with expert-written findings and impressions from physicians at a major Vietnamese hospital. We analyze linguistic patterns within the dataset, including the frequency of mentioned body parts and diagnoses, to identify domain-specific linguistic characteristics of Vietnamese radiology reports. Furthermore, we fine-tune five state-of-the-art open-source VLMs on ViX-Ray and compare their performance to leading proprietary models, GPT-4V and Gemini. Our results show that while several models generate outputs partially aligned with clinical ground truths, they often suffer from low precision and excessive hallucination, especially in impression generation. These findings not only demonstrate the complexity and challenge of our dataset but also establish ViX-Ray as a valuable benchmark for evaluating and advancing vision-language models in the Vietnamese clinical domain.

Automated radiology report generation holds immense potential to alleviate the heavy workload of radiologists. Despite the formidable vision-language capabilities of recent Multimodal Large Language Models (MLLMs), their clinical deployment is severely constrained by inherent limitations: their "black-box" decision-making renders the generated reports untraceable due to the lack of explicit visual evidence to support the diagnosis, and they struggle to access external domain knowledge. To address these challenges, we propose the Evidence-driven Radiology Report Generation Agent (EviAgent). Unlike opaque end-to-end paradigms, EviAgent coordinates a transparent reasoning trajectory by breaking down the complex generation process into granular operational units. We integrate multi-dimensional visual experts and retrieval mechanisms as external support modules, endowing the system with explicit visual evidence and high-quality clinical priors. Extensive experiments on MIMIC-CXR, CheXpert Plus, and IU-Xray datasets demonstrate that EviAgent outperforms both large-scale generalist models and specialized medical models, providing a robust and trustworthy solution for automated radiology report generation.

Generating precise diagnostic reports from High-Resolution Computed Tomography (HRCT) is critical for clinical workflow, yet it remains a formidable challenge due to the high pathological diversity and spatial sparsity within 3D volumes. While Video Language Models (VideoLMs) have demonstrated remarkable spatio-temporal reasoning in general domains, their adaptability to domain-specific, high-volume medical interpretation remains underexplored. In this work, we present AbSteering, an abnormality-centric framework that steers VideoLMs toward precise HRCT report generation. Specifically, AbSteering introduces: (i) an abnormality-centric Chain-of-Thought scheme that enforces abnormality reasoning, and (ii) a Direct Preference Optimization objective that utilizes clinically confusable abnormalities as hard negatives to enhance fine-grained discrimination. Our results demonstrate that general-purpose VideoLMs possess strong transferability to high-volume medical imaging when guided by this paradigm. Notably, AbSteering outperforms state-of-the-art domain-specific CT foundation models, which are pretrained with large-scale CTs, achieving superior detection sensitivity while simultaneously mitigating hallucinations.

Structured radiology reporting promises faster, more consistent communication than free text, but automation remains difficult as models must make many fine-grained, discrete decisions about rare findings and attributes from limited structured supervision. In contrast, free-text reports are produced at scale in routine care and implicitly encode fine-grained, image-linked information through detailed descriptions. To leverage this unstructured knowledge, we propose ProtoSR, an approach for injecting free-text information into structured report population. First, we introduce an automatic extraction pipeline that uses an instruction-tuned LLM to mine 80k+ MIMIC-CXR studies and build a multimodal knowledge base aligned with a structured reporting template, representing each answer option with a visual prototype. Using this knowledge base, ProtoSR is trained to retrieve prototypes relevant for the current image-question pair and augment the model predictions through a prototype-conditioned residual, providing a data-driven second opinion that selectively corrects predictions. On the Rad-ReStruct benchmark, ProtoSR achieves state-of-the-art results, with the largest improvements on detailed attribute questions, demonstrating the value of integrating free-text derived signal for fine-grained image understanding.

Generative AI has advanced rapidly in medical report generation; however, its application to oral and maxillofacial CBCT reporting remains limited, largely because of the scarcity of high-quality paired CBCT-report data and the intrinsic complexity of volumetric CBCT interpretation. To address this, we introduce CBCTRepD, a bilingual oral and maxillofacial CBCT report-generation system designed for integration into routine radiologist-AI co-authoring workflows. We curated a large-scale, high-quality paired CBCT-report dataset comprising approximately 7,408 studies, covering 55 oral disease entities across diverse acquisition settings, and used it to develop the system. We further established a clinically grounded, multi-level evaluation framework that assesses both direct AI-generated drafts and radiologist-edited collaboration reports using automatic metrics together with radiologist- and clinician-centered evaluation. Using this framework, we show that CBCTRepD achieves superior report-generation performance and produces drafts with writing quality and standardization comparable to those of intermediate radiologists. More importantly, in radiologist-AI collaboration, CBCTRepD provides consistent and clinically meaningful benefits across experience levels: it helps novice radiologists improve toward intermediate-level reporting, enables intermediate radiologists to approach senior-level performance, and even assists senior radiologists by reducing omission-related errors, including clinically important missed lesions. By improving report structure, reducing omissions, and promoting attention to co-existing lesions across anatomical regions, CBCTRepD shows strong and reliable potential as a practical assistant for real-world CBCT reporting across multi-level care settings.

PET/CT imaging is pivotal in oncology and nuclear medicine, yet summarizing complex findings into precise diagnostic impressions is labor-intensive. While LLMs have shown promise in medical text generation, their capability in the highly specialized domain of PET/CT remains underexplored. We introduce PET-F2I-41K (PET Findings-to-Impression Benchmark), a large-scale benchmark for PET/CT impression generation using LLMs, constructed from over 41k real-world reports. Using PET-F2I-41K, we conduct a comprehensive evaluation of 27 models across proprietary frontier LLMs, open-source generalist models, and medical-domain LLMs, and we develop a domain-adapted 7B model (PET-F2I-7B) fine-tuned from Qwen2.5-7B-Instruct via LoRA. Beyond standard NLG metrics (e.g., BLEU-4, ROUGE-L, BERTScore), we propose three clinically grounded metrics - Entity Coverage Rate (ECR), Uncovered Entity Rate (UER), and Factual Consistency Rate (FCR) - to assess diagnostic completeness and factual reliability. Experiments reveal that neither frontier nor medical-domain LLMs perform adequately in zero-shot settings. In contrast, PET-F2I-7B achieves substantial gains (e.g., 0.708 BLEU-4) and a 3.0x improvement in entity coverage over the strongest baseline, while offering advantages in cost, latency, and privacy. Beyond this modeling contribution, PET-F2I-41K establishes a standardized evaluation framework to accelerate the development of reliable and clinically deployable reporting systems for PET/CT.

We introduce CRIMSON, a clinically grounded evaluation framework for chest X-ray report generation that assesses reports based on diagnostic correctness, contextual relevance, and patient safety. Unlike prior metrics, CRIMSON incorporates full clinical context, including patient age, indication, and guideline-based decision rules, and prevents normal or clinically insignificant findings from exerting disproportionate influence on the overall score. The framework categorizes errors into a comprehensive taxonomy covering false findings, missing findings, and eight attribute-level errors (e.g., location, severity, measurement, and diagnostic overinterpretation). Each finding is assigned a clinical significance level (urgent, actionable non-urgent, non-actionable, or expected/benign), based on a guideline developed in collaboration with attending cardiothoracic radiologists, enabling severity-aware weighting that prioritizes clinically consequential mistakes over benign discrepancies. CRIMSON is validated through strong alignment with clinically significant error counts annotated by six board-certified radiologists in ReXVal (Kendalls tau = 0.61-0.71; Pearsons r = 0.71-0.84), and through two additional benchmarks that we introduce. In RadJudge, a targeted suite of clinically challenging pass-fail scenarios, CRIMSON shows consistent agreement with expert judgment. In RadPref, a larger radiologist preference benchmark of over 100 pairwise cases with structured error categorization, severity modeling, and 1-5 overall quality ratings from three cardiothoracic radiologists, CRIMSON achieves the strongest alignment with radiologist preferences. We release the metric, the evaluation benchmarks, RadJudge and RadPref, and a fine-tuned MedGemma model to enable reproducible evaluation of report generation, all available at https://github.com/rajpurkarlab/CRIMSON.

Computed Tomography Report Generation (CTRG) aims to automate the clinical radiology reporting process, thereby reducing the workload of report writing and facilitating patient care. While deep learning approaches have achieved remarkable advances in X-ray report generation, their effectiveness may be limited in CTRG due to larger data volumes of CT images and more intricate details required to describe them. This work introduces a novel two-stage (structure- and report-learning) framework tailored for CTRG featuring effective structure-wise image-text contrasting. In the first stage, a set of learnable structure-specific visual queries observe corresponding structures in a CT image. The resulting observation tokens are contrasted with structure-specific textual features extracted from the accompanying radiology report with a structure-wise image-text contrastive loss. In addition, text-text similarity-based soft pseudo targets are proposed to mitigate the impact of false negatives, i.e., semantically identical image structures and texts from non-paired images and reports. Thus, the model learns structure-level semantic correspondences between CT images and reports. Further, a dynamic, diversity-enhanced negative queue is proposed to guide the network in learning to discriminate various abnormalities. In the second stage, the visual structure queries are frozen and used to select the critical image patch embeddings depicting each anatomical structure, minimizing distractions from irrelevant areas while reducing memory consumption. Also, a text decoder is added and trained for report generation.Our extensive experiments on two public datasets demonstrate that our framework establishes new state-of-the-art performance for CTRG in clinical efficiency, and its components are effective.

Radiologists highly desire fully automated AI for radiology report generation (R2G), yet existing approaches fall short in clinical utility. Reinforcement learning (RL) holds potential to address these shortcomings, but its adoption in this task remains underexplored. In this paper, we revisit RL in terms of data efficiency and optimization effectiveness for R2G tasks. First, we explore the impact of data quantity and quality on the performance of RL in medical contexts, revealing that data quality plays a more critical role than quantity. To this end, we propose a diagnostic diversity-based data sampling strategy that enables comparable performance with fewer samples. Second, we observe that the majority of tokens in radiology reports are template-like and diagnostically uninformative, whereas the low frequency of clinically critical tokens heightens the risk of being overlooked during optimization. To tackle this, we introduce Diagnostic Token-weighted Policy Optimization (DiTPO), which directly optimizes for clinical accuracy by using a diagnostic F1 score as the reward signal. Unlike standard RL approaches that treat all tokens equally, DiTPO explicitly models the varying importance of different tokens through rule- or gradient-based mechanisms to prioritize clinically relevant content. Extensive experiments on the MIMIC-CXR, IU-Xray, and CheXpert Plus datasets demonstrate that our framework achieves state-of-the-art (SOTA) performance while requiring substantially fewer training samples in RL. Notably, on MIMIC-CXR, our framework attains an F1 score of 0.516 using only 20% of the RL training samples.

Automatic generation of radiology reports seeks to reduce clinician workload while improving documentation consistency. Existing methods that adopt encoder-decoder or retrieval-augmented pipelines achieve progress in fluency but remain vulnerable to visual-linguistic biases, factual inconsistency, and lack of explicit multi-hop clinical reasoning. We present NeuroSymb-MRG, a unified framework that integrates NeuroSymbolic abductive reasoning with active uncertainty minimization to produce structured, clinically grounded reports. The system maps image features to probabilistic clinical concepts, composes differentiable logic-based reasoning chains, decodes those chains into templated clauses, and refines the textual output via retrieval and constrained language-model editing. An active sampling loop driven by rule-level uncertainty and diversity guides clinician-in-the-loop adjudication and promptbook refinement. Experiments on standard benchmarks demonstrate consistent improvements in factual consistency and standard language metrics compared to representative baselines.

Reliable deployment of Vision-Language Models (VLMs) in radiology requires validation metrics that go beyond surface-level text similarity to ensure clinical fidelity and demographic fairness. This paper investigates a critical blind spot in current model evaluation: the use of decoding strategies that lead to high aggregate token-overlap scores despite succumbing to template collapse, in which models generate only repetitive, safe generic text and omit clinical terminology. Unaddressed, this blind spot can lead to metric gaming, where models that perform well on benchmarks prove clinically uninformative. Instead, we advocate for lexical diversity measures to check model generations for clinical specificity. We introduce Clinical Association Displacement (CAD), a vocabulary-level framework that quantifies shifts in demographic-based word associations in generated reports. Weighted Association Erasure (WAE) aggregates these shifts to measure the clinical signal loss across demographic groups. We show that deterministic decoding produces high levels of semantic erasure, while stochastic sampling generates diverse outputs but risks introducing new bias, motivating a fundamental rethink of how "optimal" reporting is defined.

Automated radiology report generation is key for reducing radiologist workload and improving diagnostic consistency, yet generating accurate reports for 3D medical imaging remains challenging. Existing vision-language models face two limitations: they do not leverage segmentation-pretrained encoders, and they inject visual features only at the input layer of language models, losing multi-scale information. We propose U-VLM, which enables hierarchical vision-language modeling in both training and architecture: (1) progressive training from segmentation to classification to report generation, and (2) multi-layer visual injection that routes U-Net encoder features to corresponding language model layers. Each training stage can leverage different datasets without unified annotations. U-VLM achieves state-of-the-art performance on CT-RATE (F1: 0.414 vs 0.258, BLEU-mean: 0.349 vs 0.305) and AbdomenAtlas 3.0 (F1: 0.624 vs 0.518 for segmentation-based detection) using only a 0.1B decoder trained from scratch, demonstrating that well-designed vision encoder pretraining outweighs the benefits of 7B+ pre-trained language models. Ablation studies show that progressive pretraining significantly improves F1, while multi-layer injection improves BLEU-mean. Code is available at https://github.com/yinghemedical/U-VLM.

The automatic generation of medical reports utilizing Multimodal Large Language Models (MLLMs) frequently encounters challenges related to factual instability, which may manifest as the omission of findings or the incorporation of inaccurate information, thereby constraining their applicability in clinical settings. Current methodologies typically produce reports based directly on image features, which inherently lack a definitive factual basis. In response to this limitation, we introduce Fact-Flow, an innovative framework that separates the process of visual fact identification from the generation of reports. This is achieved by initially predicting clinical findings from the image, which subsequently directs the MLLM to produce a report that is factually precise. A pivotal advancement of our approach is a pipeline that leverages a Large Language Model (LLM) to autonomously create a dataset of labeled medical findings, effectively eliminating the need for expensive manual annotation. Extensive experimental evaluations conducted on two disease-focused medical datasets validate the efficacy of our method, demonstrating a significant enhancement in factual accuracy compared to state-of-the-art models, while concurrently preserving high standards of text quality.

Automated radiology report generation using vision-language models (VLMs) is limited by the risk of prior-comparison hallucination, where the model generates historical findings unsupported by the current study. We address this challenge with a training-free, inference-time control framework termed Semantically Decoupled Latent Steering (SDLS). Unlike generic activation steering, which often suffers from semantic entanglement, our approach constructs a semantic-free intervention vector via large language model (LLM)-driven semantic decomposition followed by $QR$-based orthogonalization. This orthogonalization step is critical. It leverages geometric constraints to filter out the clinical semantics often entangled in standard principal component analysis (PCA) directions, ensuring that the steering vector targets only the ``historical comparison" axis. We validate our method on the BiomedGPT foundation model, demonstrating that it overcomes the trade-off between hallucination suppression and clinical accuracy. Extensive experiments on MIMIC-CXR, and zero-shot transfer evaluation on CheXpert Plus and IU-Xray, demonstrate the robustness of our approach. Quantitative evaluations on MIMIC-CXR show that our approach significantly reduces the probability of historical hallucinations (FilBERT score decreases from 0.2373 to 0.1889) and improves clinical label fidelity (CheXpert macro-F1 increases from 0.2242 to 0.3208). Supplementary evaluations confirm that the structural integrity of the clinical narrative is maintained.

Screening mammography is high volume, time sensitive, and documentation heavy. Radiologists must translate subtle visual findings into consistent BI-RADS assessments, breast density categories, and structured narrative reports. While recent Vision Language Models (VLMs) enable image-to-text reporting, many rely on closed cloud systems or tightly coupled architectures that limit privacy, reproducibility, and adaptability. We present MammoWise, a local multi-model pipeline that transforms open source VLMs into mammogram report generators and multi-task classifiers. MammoWise supports any Ollama-hosted VLM and mammography dataset, and enables zero-shot, few-shot, and Chain-of-Thought prompting, with optional multimodal Retrieval Augmented Generation (RAG) using a vector database for case-specific context. We evaluate MedGemma, LLaVA-Med, and Qwen2.5-VL on VinDr-Mammo and DMID datasets, assessing report quality (BERTScore, ROUGE-L), BI-RADS classification, breast density, and key findings. Report generation is consistently strong and improves with few-shot prompting and RAG. Classification is feasible but sensitive to model and dataset choice. Parameter-efficient fine-tuning (QLoRA) of MedGemma improves reliability, achieving BI-RADS accuracy of 0.7545, density accuracy of 0.8840, and calcification accuracy of 0.9341 while preserving report quality. MammoWise provides a practical and extensible framework for deploying local VLMs for mammography reporting within a unified and reproducible workflow.

Current medical vision-language models (VLMs) process volumetric brain MRI using 2D slice-based approximations, fragmenting the spatial context required for accurate neuroradiological interpretation. We developed Brain3D, a staged vision-language framework for automated radiology report generation from 3D brain tumor MRI. Our approach inflates a pretrained 2D medical encoder into a native 3D architecture and progressively aligns it with a causal language model through three stages: contrastive grounding, supervised projector warmup, and LoRA-based linguistic specialization. Unlike generalist 3D medical VLMs, Brain3D is tailored to neuroradiology, where hemispheric laterality, tumor infiltration patterns, and anatomical localization are critical. Evaluated on 468 subjects (BraTS pathological cases plus healthy controls), our model achieves a Clinical Pathology F1 of 0.951 versus 0.413 for a strong 2D baseline while maintaining perfect specificity on healthy scans. The staged alignment proves essential: contrastive grounding establishes visual-textual correspondence, projector warmup stabilizes conditioning, and LoRA adaptation shifts output from verbose captions to structured clinical reports\footnote{Our code is publicly available for transparency and reproducibility

Recent advances in radiology report generation (RRG) have been driven by large paired image-text datasets; however, progress in neuro-oncology has been limited due to a lack of open paired image-report datasets. Here, we introduce BTReport, an open-source framework for brain tumor RRG that constructs natural language radiology reports using deterministically extracted imaging features. Unlike existing approaches that rely on large general-purpose or fine-tuned vision-language models for both image interpretation and report composition, BTReport performs deterministic feature extraction for image analysis and uses large language models only for syntactic structuring and narrative formatting. By separating RRG into a deterministic feature extraction step and a report generation step, the generated reports are completely interpretable and less prone to hallucinations. We show that the features used for report generation are predictive of key clinical outcomes, including survival and IDH mutation status, and reports generated by BTReport are more closely aligned with reference clinical reports than existing baselines for RRG. Finally, we introduce BTReport-BraTS, a companion dataset that augments BraTS imaging with synthetically generated radiology reports produced with BTReport. Code for this project can be found at https://github.com/KurtLabUW/BTReport.