提升放射科报告准确性,让AI生成更符合临床逻辑。
CLARIFID: Improving Radiology Report Generation by Reinforcing Clinically Accurate Impressions and Enforcing Detailed Findings
- 模仿医生先写发现再下结论的流程,分步生成报告。
- 在MIMIC-CXR数据集上,报告诊断准确率显著优于现有方法。
- 适合需要高可靠性的医疗AI系统开发者使用。
自动生成放射科报告有望减轻放射科医生的工作负担,但现有方法难以保证报告的临床可靠性。多数先前方法仅关注文本流畅性,缺乏对报告事实正确性的有效保障,且通常依赖单视角图像,影响诊断全面性。本文提出CLARIFID框架,通过模拟专家的两步工作流程,直接优化诊断正确性。具体包括:(1) 通过章节感知预训练学习从‘发现’到‘印象’的逻辑流程;(2) 使用近端策略优化(Proximal Policy Optimization)进行微调,以CheXbert F1分数作为‘印象’部分的奖励信号;(3) 采用控制解码策略,确保先完成‘发现’部分再生成‘印象’;(4) 通过基于视觉变换器的多视角编码器融合多张胸部X光片。推理时,采用逐词强制策略结合报告级重排序,确保模型先生成完整‘发现’部分再推导‘印象’,保持连贯的临床推理。在MIMIC-CXR数据集上的实验表明,该方法在临床有效性评分上优于现有基线。
原文摘要 · Abstract (English)
Automatic generation of radiology reports has the potential to alleviate radiologists' significant workload, yet current methods struggle to deliver clinically reliable conclusions. In particular, most prior approaches focus on producing fluent text without effectively ensuring the factual correctness of the reports and often rely on single-view images, limiting diagnostic comprehensiveness. We propose CLARIFID, a novel framework that directly optimizes diagnostic correctness by mirroring the two-step workflow of experts. Specifically, CLARIFID (1) learns the logical flow from Findings to Impression through section-aware pretraining, (2) is fine-tuned with Proximal Policy Optimization in which the CheXbert F1 score of the Impression section serves as the reward, (3) employs controlled decoding that completes "Findings" before synthesizing the "Impression", and (4) fuses multiple chest X-ray views via a vision-transformer-based multi-view encoder. During inference, we apply a next-token forcing strategy followed by report-level re-ranking, ensuring that the model first produces a comprehensive "Findings" section before synthesizing the "Impression" and thereby preserving coherent clinical reasoning. Experimental results on the MIMIC-CXR dataset demonstrate that our method achieves superior clinical efficacy and outperforms existing baselines on clinical efficacy scores.
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