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.
High-resolution (HR) image perception remains a key challenge in multimodal large language models (MLLMs), as fine-grained details are often lost when the image is processed as a whole. Existing methods either require training to teach models where to look or heuristically divide the image into fixed regions, both of which struggle to generalize in complex HR scenes. In this work, we propose Hierarchical Entity Exploration (HEE), a training-free and model-agnostic framework that transforms static image understanding into dynamic, query-guided entity exploration. HEE first evaluates each region using a dual scoring mechanism to determine whether it already contains sufficient evidence to answer the question. If not, it applies object detection within the most promising region to extract fine-grained entities, clusters them into coherent subregions, and organizes them into a multi-level semantic hierarchy for deeper exploration. When deeper regions still fail to yield confident answers, a confidence-guided backtracking mechanism revisits alternative paths to ensure adaptive perception. Extensive results show that HEE outperforms training-free methods like ZoomEye and RAP in both accuracy and efficiency on two complex HR benchmarks (Visual Probe and HR-Bench), across different MLLMs such as Qwen2.5-VL and LLaVA-OneVision. Moreover, HEE demonstrates generalization on the MME-RealWorld benchmark.