# Libra: Leveraging Temporal Images for Biomedical Radiology Analysis

arXiv: https://arxiv.org/abs/2411.19378 · HTML: https://mlsanity.com/paper/2411.19378/

## Key facts

- Cited by 29 papers in the map (data through 14 Oct 2026).
- Builds on 47 of its 70 references that are in the map.
- First posted on arXiv 28 Nov 2024.

## Builds on (most cited first, 30 of 47)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Non-local Neural Networks](https://mlsanity.com/paper/1711.07971/) (2017)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [ZeRO: Memory Optimizations Toward Training Trillion Parameter Models](https://mlsanity.com/paper/1910.02054/) (2019)
- [Vision-Language Models for Vision Tasks: A Survey](https://mlsanity.com/paper/2304.00685/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Generating Radiology Reports via Memory-driven Transformer](https://mlsanity.com/paper/2010.16056/) (2020)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Learning to Exploit Temporal Structure for Biomedical Vision-Language Processing](https://mlsanity.com/paper/2301.04558/) (2023)
- [Cross-modal Memory Networks for Radiology Report Generation](https://mlsanity.com/paper/2204.13258/) (2022)
- [VLP: A Survey on Vision-Language Pre-training](https://mlsanity.com/paper/2202.09061/) (2022)
- [When Radiology Report Generation Meets Knowledge Graph](https://mlsanity.com/paper/2002.08277/) (2020)
- [Improving Factual Completeness and Consistency of Image-to-Text Radiology Report Generation](https://mlsanity.com/paper/2010.10042/) (2020)
- [Interactive and Explainable Region-guided Radiology Report Generation](https://mlsanity.com/paper/2304.08295/) (2023)
- [TieNet: Text-Image Embedding Network for Common Thorax Disease Classification and Reporting in Chest X-rays](https://mlsanity.com/paper/1801.04334/) (2018)
- [Clinically Accurate Chest X-Ray Report Generation](https://mlsanity.com/paper/1904.02633/) (2019)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [Dynamic Graph Enhanced Contrastive Learning for Chest X-ray Report Generation](https://mlsanity.com/paper/2303.10323/) (2023)
- [METransformer: Radiology Report Generation by Transformer with Multiple Learnable Expert Tokens](https://mlsanity.com/paper/2304.02211/) (2023)

## Built on by (most cited first, 29 of 29)

- [RadEval: A framework for radiology text evaluation](https://mlsanity.com/paper/2509.18030/) (2025)
- [RADAR: Enhancing Radiology Report Generation with Supplementary Knowledge Injection](https://mlsanity.com/paper/2505.14318/) (2025)
- [MedSG-Bench: A Benchmark for Medical Image Sequences Grounding](https://mlsanity.com/paper/2505.11852/) (2025)
- [Lunguage: A Benchmark for Structured and Sequential Chest X-ray Interpretation](https://mlsanity.com/paper/2505.21190/) (2025)
- [CXRAgent: Director-Orchestrated Multi-Stage Reasoning for Chest X-Ray Interpretation](https://mlsanity.com/paper/2510.21324/) (2025)
- [CCD: Mitigating Hallucinations in Radiology MLLMs via Clinical Contrastive Decoding](https://mlsanity.com/paper/2509.23379/) (2025)
- [CX-Mind: A Pioneering Multimodal Large Language Model for Interleaved Reasoning in Chest X-ray via Curriculum-Guided Reinforcement Learning](https://mlsanity.com/paper/2508.03733/) (2025)
- [A Review of Longitudinal Radiology Report Generation: Dataset Composition, Methods, and Performance Evaluation](https://mlsanity.com/paper/2510.12444/) (2025)
- [Enhancing Reinforcement Learning for Radiology Report Generation with Evidence-aware Rewards and Self-correcting Preference Learning](https://mlsanity.com/paper/2604.13598/) (2026)
- [A data- and compute-efficient chest X-ray foundation model beyond aggressive scaling](https://mlsanity.com/paper/2602.22843/) (2026)
- [Multi-Modal Multi-Agent Reinforcement Learning for Radiology Report Generation](https://mlsanity.com/paper/2603.16876/) (2026)
- [Seeing Like Radiologists: Context- and Gaze-Guided Vision-Language Pretraining for Chest X-rays](https://mlsanity.com/paper/2603.26049/) (2026)
- [MI-CXR: A Benchmark for Longitudinal Reasoning over Multi-Interval Chest X-rays](https://mlsanity.com/paper/2605.15574/) (2026)
- [Time to Revist Exact Match](https://mlsanity.com/paper/2509.16720/) (2025)
- [Closing the Performance Gap Between AI and Radiologists in Chest X-Ray Reporting](https://mlsanity.com/paper/2511.21735/) (2025)
- [Standardizing Longitudinal Radiology Report Evaluation via Large Language Model Annotation](https://mlsanity.com/paper/2601.16753/) (2026)
- [MedGPT-oss: Training a General-Purpose Vision-Language Model for Biomedicine](https://mlsanity.com/paper/2603.00842/) (2026)
- [Ran Score: a LLM-based Evaluation Score for Radiology Report Generation](https://mlsanity.com/paper/2603.22935/) (2026)
- [Radiology Report Generation for Low-Quality X-Ray Images](https://mlsanity.com/paper/2604.10188/) (2026)
- [CXRMate-2: Structured Multimodal Temporal Embeddings and Tractable Reinforcement Learning for Clinically Acceptable Chest X-ray Radiology Report Generation](https://mlsanity.com/paper/2604.18967/) (2026)
- [CCS: Clinical Consensus Selection for Radiology Report Generation](https://mlsanity.com/paper/2605.30131/) (2026)
- [Learning Directional Semantic Transitions for Longitudinal Chest X-ray Analysis](https://mlsanity.com/paper/2606.15938/) (2026)
- [SHOVIR: A Benchmark for Evaluating Vision Shortcut Learning in Radiology Report Generation](https://mlsanity.com/paper/2606.30201/) (2026)
- [GRCD: Grounded Region Change Detection for Multi-Finding Chest X-Ray Pairs](https://mlsanity.com/paper/2607.02719/) (2026)
- [PanDent: Toward Comprehensive Tooth-Level Structure-Language Consistency in Dental Radiology](https://mlsanity.com/paper/2607.27378/) (2026)
- [LoMeVQA: A Comprehensive Benchmark for Longitudinal Medical VQA](https://mlsanity.com/paper/2607.27806/) (2026)
- [RadFusion: Towards Threshold-Controllable Radiology Report Generation](https://mlsanity.com/paper/2608.10505/) (2026)
- [CheXGround: Anatomical Region Tokens for Grounded Longitudinal Chest X-ray Interpretation](https://mlsanity.com/paper/2608.30758/) (2026)
- [Reporting Practice Matters: The Impact of Reference Choice on Chest X-ray Report Evaluation](https://mlsanity.com/paper/2609.19093/) (2026)

## Abstract (arXiv)

Radiology report generation (RRG) requires advanced medical image analysis, effective temporal reasoning, and accurate text generation. While multimodal large language models (MLLMs) align with pre-trained vision encoders to enhance visual-language understanding, most existing methods rely on single-image analysis or rule-based heuristics to process multiple images, failing to fully leverage temporal information in multi-modal medical datasets. In this paper, we introduce Libra, a temporal-aware MLLM tailored for chest X-ray report generation. Libra combines a radiology-specific image encoder with a novel Temporal Alignment Connector (TAC), designed to accurately capture and integrate temporal differences between paired current and prior images. Extensive experiments on the MIMIC-CXR dataset demonstrate that Libra establishes a new state-of-the-art benchmark among similarly scaled MLLMs, setting new standards in both clinical relevance and lexical accuracy.