# Clinically Grounded Agent-based Report Evaluation: An Interpretable Metric for Radiology Report Generation

arXiv: https://arxiv.org/abs/2508.02808 · HTML: https://mlsanity.com/paper/2508.02808/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 22 references that are in the map.
- First posted on arXiv 4 Aug 2025.

## Builds on (most cited first, 14 of 14)

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [MedCPT: Contrastive Pre-trained Transformers with Large-scale PubMed Search Logs for Zero-shot Biomedical Information Retrieval](https://mlsanity.com/paper/2307.00589/) (2023)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [MAIRA-1: A specialised large multimodal model for radiology report generation](https://mlsanity.com/paper/2311.13668/) (2023)
- [RaTEScore: A Metric for Radiology Report Generation](https://mlsanity.com/paper/2406.16845/) (2024)
- [Towards a clinically accessible radiology foundation model: open-access and lightweight, with automated evaluation](https://mlsanity.com/paper/2403.08002/) (2024)
- [MedVersa: A Generalist Foundation Model for Medical Image Interpretation](https://mlsanity.com/paper/2405.07988/) (2024)
- [FineRadScore: A Radiology Report Line-by-Line Evaluation Technique Generating Corrections with Severity Scores](https://mlsanity.com/paper/2405.20613/) (2024)
- [Consensus, dissensus and synergy between clinicians and specialist foundation models in radiology report generation](https://mlsanity.com/paper/2311.18260/) (2023)
- [Replace and Report: NLP Assisted Radiology Report Generation](https://mlsanity.com/paper/2306.17180/) (2023)

## Built on by (most cited first, 3 of 3)

- [CRIMSON: A Clinically-Grounded LLM-Based Metric for Generative Radiology Report Evaluation](https://mlsanity.com/paper/2603.06183/) (2026)
- [CLR-voyance: Reinforcing Open-Ended Reasoning for Inpatient Clinical Decision Support with Outcome-Aware Rubrics](https://mlsanity.com/paper/2605.09584/) (2026)
- [Cerebra: A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment](https://mlsanity.com/paper/2603.21597/) (2026)

## Abstract (arXiv)

Radiological imaging is central to diagnosis, treatment planning, and clinical decision-making. Vision-language foundation models have spurred interest in automated radiology report generation (RRG), but safe deployment requires reliable clinical evaluation of generated reports. Existing metrics often rely on surface-level similarity or behave as black boxes, lacking interpretability. We introduce ICARE (Interpretable and Clinically-grounded Agent-based Report Evaluation), an interpretable evaluation framework leveraging large language model agents and dynamic multiple-choice question answering (MCQA). Two agents, each with either the ground-truth or generated report, generate clinically meaningful questions and quiz each other. Agreement on answers captures preservation and consistency of findings, serving as interpretable proxies for clinical precision and recall. By linking scores to question-answer pairs, ICARE enables transparent, and interpretable assessment. Clinician studies show ICARE aligns significantly more with expert judgment than prior metrics. Perturbation analyses confirm sensitivity to clinical content and reproducibility, while model comparisons reveal interpretable error patterns.