Reliable evaluation of automated coronary computed tomography angiography (CCTA) report generation requires standardized multicentre benchmarks and clinically structured metrics. We established a four-centre benchmark comprising 3,021 CCTA series from 818 patient-report pairs to evaluate seven open-source three-dimensional vision-language models. We developed CSM$_{\text{CCTA}}$, a clinically structured metric for CCTA report evaluation, with patient-, vessel-, and segment-level variables defined according to clinical guidelines. Report pairs are compared at the finest shared anatomical level, and the contributions of different clinical components are weighted based on expert assessments. We estimated these weights using 70 expert-scored cases and evaluated clinical alignment in a non-overlapping set of 30 cases. CSM$_{\text{CCTA}}$ showed a strong correlation with radiologist scores (Pearson's $r=0.97$, $p<0.001$), exceeding the next-best metric, FORTE ($r=0.70$), by 0.27, and agreed with expert preferences in 115 of 160 pairwise comparisons (71.9\%). Under controlled perturbations, CSM$_{\text{CCTA}}$ remained stable to clinically equivalent wording and decreased monotonically with progressive information omission. In the multicenter benchmark, the CCTA-trained C2RG model achieved the highest CSM$_{\text{CCTA}}$ scores across all four hospitals, although its performance remained far from optimal. In contrast, CCTA-irrelevant reports accounted for up to 98.7\% of the outputs from generalist models. Together, the benchmark provides a standardized setting for model comparison, while CSM$_{\text{CCTA}}$ enables clinically structured evaluation of finding agreement and anatomical specificity. These results support a more clinically aligned and anatomically resolved approach to evaluating CCTA report generation. Code is available at https://openi.pcl.ac.cn/OpenMedIA/CSM_CCTA.
Christian Grashei, Fabian Gülhan, Maximilian Legnar +4cs.CV
Prostate cancer is among the most frequently diagnosed malignancies worldwide, and structured reporting of each biopsy core burdens pathologists. Existing tools frame this as classification, leaving pathologists to assemble coherent reports, while many slide-level vision-language models rely on English-centric encoders that transfer poorly to other clinical languages. We present a slide-level framework generating prostate biopsy reports that is language-independent by construction: tokenizer and model are trained from scratch, demonstrated here in German. To address paired-data scarcity, an automated pipeline uses a locally deployed large language model to split composite reports into core-specific image-text pairs, yielding 17,344 pairs from 2,402 historical cases without manual annotation. Evaluated for clinical attributes rather than linguistic similarity, the model achieves 96.2% F1 for malignancy detection and 65.2% for Gleason grading, competitive with an FDA-cleared classifier. Grading is further validated on three external cohorts with latent-space augmentation. Institutions can thus train native-language reporting models on their own archives.
Reliable endoscopic polyp reporting requires integrating quantitative lesion sizing, standardized Paris classification, and clinically meaningful morphological description within a single record. General-purpose vision-language models (VLMs) offer a unified interface for image understanding and report generation. Existing specialization strategies, however, typically rely on task-specific models or model-weight adaptation, leaving unresolved how to introduce reliable specialist knowledge while preserving both this unified interface and the VLM's pretrained capabilities. We introduce a context-fusion framework that specializes a frozen general-purpose VLM through both implicit instruction context and explicit transduction context without modifying its pretrained weights. Specifically, a self-supervised polyp encoder retrieves related image-report pairs as explicit, query-specific evidence, while learned continuous specialist tokens provide implicit instruction context shared across cases. Experiments were conducted on 2,056 expert-annotated public endoscopic images. We compared the framework with general-purpose VLMs, task-specific predictors, and weight-adaptation methods to assess specialist performance, unified reporting, and adaptation efficiency. Across numerical, categorical, and report-generation metrics, the proposed framework substantially improved direct frozen-VLM inference and achieved the strongest overall performance among the evaluated methods. It added trainable parameters equal to only 0.006% of the frozen VLM's parameter count. When the top-1 retrieved case carried the correct target category, our framework corrected 70.5% of the errors made by a weight-adaptation baseline. These findings support the context-fusion framework as a lightweight and effective strategy for specialist adaptation of a frozen VLM.
Despite significant advances in Medical Report Generation (MRG), the reliability remains constrained by the prevalence of factual errors. While Direct Preference Optimization (DPO) has emerged as a promising post-training paradigm to enhance the performance of Supervised Fine-Tuned (SFT) MRG models, existing DPO-based MRG methods typically adopt a naive preference construction that directly pairs model-generated reports with ground truth reports. This strategy inadvertently entangles critical clinical findings with clinically irrelevant linguistic characteristics, and fundamentally lacks explicit vision-language alignment. To address these challenges, we propose DPO-Clin, a novel post-training framework that focuses preference optimization on clinical findings and cross-modal alignment. First, we introduce the Entity-level Clinical Diagnostic (ECD) module to perform a precise entity-level factual diagnosis. ECD guides the generation of linguistically-aligned report preference pairs, isolating clinical discrepancies from linguistic variations. Second, to achieve fine-grained cross-modal alignment, we develop M2DPO, a retrieval-augmented multi-modal DPO variant that enforces textual preference inversion triggered by visual context switches. Third, we locate correct yet highly uncertain predicted entities and apply counterfactual modifications to construct targeted preference data for latent risk mitigation, thereby further enhancing the model reliability. Extensive experiments on two public chest X-ray datasets (MIMIC-CXR and IU X-Ray) and an in-house endoscopy dataset demonstrate that DPO-Clin significantly improves the SFT baselines on clinical-aware metrics. Furthermore, it achieves superior performance over existing DPO-based MRG methods, exhibiting robust generalizability across distinct baseline architectures and diverse medical imaging modalities.
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.
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.
Darya Taratynova, Ahmed Aly, Numan Saeed +1cs.CV cs.LG
Echocardiography is the most widely used non-invasive cardiac imaging modality, providing essential information for cardiovascular diagnosis. Interpreting an echocardiogram requires synthesizing complementary evidence across multiple heart views to identify abnormalities and produce structured clinical reports. While recent efforts focus on improving classification performance, most models lack explicit diagnostic reasoning and spatially grounded anatomical evidence, limiting clinician trust. We present EchoSonar-R, a multi-view reasoning-enabled vision-language model that jointly performs multi-label disease classification and report generation from echocardiography studies. EchoSonar-R combines a spatiotemporal video encoder with a structure-aware cardiac detector that provides spatially grounded anatomical cues to improve interpretability and clinician trust during cross-view reasoning. EchoSonar-R is trained in two stages: supervised fine-tuning (SFT) on reasoning-annotated targets, followed by Group Relative Policy Optimization (GRPO) with task-specific rewards that jointly align classification and report generation within a unified reinforcement-learning framework. Across a private multi-view dataset and two public benchmarks, EchoSonar-R improves macro balanced accuracy by 17.1% on the private set and 6.1% on MIMICEchoQA over the strongest baseline, achieves a GREEN clinical faithfulness score of 0.800, and produces interpretable reasoning traces grounded in multi-view visual evidence.
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.
Sijing Li, Zhongwei Qiu, Zhuoya Wang +6eess.IV cs.AI cs.CV
While Vision-Language Models (VLMs) show great promise in volumetric medical report generation, they frequently suffer from visual hallucinations and a lack of grounding in 3D CT data. Current Supervised Fine-Tuning (SFT) and Reinforcement Learning (RL) strategies typically optimize text fidelity alone, essentially rewarding correct diagnoses derived from language priors rather than genuine visual perception. To address this, we propose cross-view aligned Evidence-driven Multimodal Reinforcement Learning (Evidence-MRL, noted as E-MRL), a reliable RL reasoning framework that formulates the generation process as a Markov Decision Process of "diagnosis-localization-verification". Unlike standard approaches, our model is explicitly trained to identify a "key evidence slice" alongside the global diagnostic report, grounding its findings in verifiable visual evidence. Crucially, we introduce a novel cross-view consistency reward, which validates the semantic alignment between the golden-standard report and a local visual re-query of the selected key slice, providing additional rewards for correctly-localized reasoning. Experiments on large-scale 3D CT tumor datasets demonstrate that E-MRL significantly reduces hallucinations and improves diagnostic accuracy compared to SFT and RL baselines, offering a clinically interpretable solution for visually-grounded and tumor analysis.
Automated medical report generation, MRG, holds substantial value for alleviating radiologist workload and enhancing diagnostic efficiency. However, mainstream approaches typically treat diverse chest abnormalities as isolated classification targets. This paradigm often overlooks inherent disease co-occurrences and struggles to translate medical topological structures into explicit data correlations, constraining the model's reasoning capacity on complex or subtle lesions. To address this, we propose a Graph-Augmented Dual-Stream Medical Report Generation with Topological Internalization, GDMRG. Our framework introduces a Topological Knowledge Internalization module, TKI, which leverages a Graph Convolutional Network, GCN, to generate an explicit parameterized weight matrix based on global disease co-occurrence priors. This facilitates efficient topological knowledge injection without relying on external retrieval mechanisms. Building upon this, we construct a dual-stream classification system: the main branch generates discrete diagnostic prompts under topological constraints, while the auxiliary branch employs an asymmetric optimization strategy to dynamically calibrate decision boundaries for highly imbalanced samples. Concurrently, to establish a logical closed loop between diagnosis and visual grounding, we design a diagnostic-driven Diagnosis-Guided Spatial Attention, DGSA, that utilizes high-dimensional clinical semantics to recalibrate the visual encoder, mitigating feature hallucinations. Comprehensive experiments on the MIMIC-CXR dataset demonstrate that GDMRG achieves competitive clinical efficacy, CE, while maintaining natural language fluency. Furthermore, our model exhibits robust zero-shot generalization on the IU X-Ray dataset. In summary, this work presents an integrated and interpretable paradigm for medical report generation.