# A Chain of Diagnosis Framework for Accurate and Explainable Radiology Report Generation

arXiv: https://arxiv.org/abs/2508.09566 · HTML: https://mlsanity.com/paper/2508.09566/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 50 of its 67 references that are in the map.
- First posted on arXiv 13 Aug 2025.

## Builds on (most cited first, 30 of 50)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Qwen Technical Report](https://mlsanity.com/paper/2309.16609/) (2023)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (2023)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [FixMatch: Simplifying Semi-Supervised Learning with Consistency and Confidence](https://mlsanity.com/paper/2001.07685/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Graph of Thoughts: Solving Elaborate Problems with Large Language Models](https://mlsanity.com/paper/2308.09687/) (2023)
- [Multimodal Chain-of-Thought Reasoning in Language Models](https://mlsanity.com/paper/2302.00923/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (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)
- [TransVG: End-to-End Visual Grounding with Transformers](https://mlsanity.com/paper/2104.08541/) (2021)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [On the Automatic Generation of Medical Imaging Reports](https://mlsanity.com/paper/1711.08195/) (2017)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [Exploring and Distilling Posterior and Prior Knowledge for Radiology Report Generation](https://mlsanity.com/paper/2106.06963/) (2021)
- [When Radiology Report Generation Meets Knowledge Graph](https://mlsanity.com/paper/2002.08277/) (2020)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [Interactive and Explainable Region-guided Radiology Report Generation](https://mlsanity.com/paper/2304.08295/) (2023)
- [Clinically Accurate Chest X-Ray Report Generation](https://mlsanity.com/paper/1904.02633/) (2019)
- [Dynamic Graph Enhanced Contrastive Learning for Chest X-ray Report Generation](https://mlsanity.com/paper/2303.10323/) (2023)

## Built on by (most cited first, 7 of 7)

- [Vision-Language Models for Automated 3D PET/CT Report Generation](https://mlsanity.com/paper/2511.20145/) (2025)
- [LEAD: Layer-wise Expert-aligned Decoding for Faithful Radiology Report Generation](https://mlsanity.com/paper/2602.04617/) (2026)
- [Rethinking the Efficiency and Effectiveness of Reinforcement Learning for Radiology Report Generation](https://mlsanity.com/paper/2603.04022/) (2026)
- [DECIS: Dual-Evidence Corrective Verification for Interpretable Strabismus Diagnostic Decision-Making](https://mlsanity.com/paper/2606.09249/) (2026)
- [Super-Generalist: Towards Comprehensive and Accurate Medical Image Understanding via Generalist-Specialist Synergy](https://mlsanity.com/paper/2607.09135/) (2026)
- [REVA-PO: Stabilizing Reinforcement Learning for Chest X-ray Report Generation](https://mlsanity.com/paper/2607.10147/) (2026)
- [Pre-training, Reasoning, Benchmarking: X-ray Report Generation on CheXpert Plus Dataset](https://mlsanity.com/paper/2610.08813/) (2026)

## Abstract (arXiv)

Despite the progress of radiology report generation (RRG), existing works face two challenges: 1) The performances in clinical efficacy are unsatisfactory, especially for lesion attributes description; 2) the generated text lacks explainability, making it difficult for radiologists to trust the results. To address the challenges, we focus on a trustworthy RRG model, which not only generates accurate descriptions of abnormalities, but also provides basis of its predictions. To this end, we propose a framework named chain of diagnosis (CoD), which maintains a chain of diagnostic process for clinically accurate and explainable RRG. It first generates question-answer (QA) pairs via diagnostic conversation to extract key findings, then prompts a large language model with QA diagnoses for accurate generation. To enhance explainability, a diagnosis grounding module is designed to match QA diagnoses and generated sentences, where the diagnoses act as a reference. Moreover, a lesion grounding module is designed to locate abnormalities in the image, further improving the working efficiency of radiologists. To facilitate label-efficient training, we propose an omni-supervised learning strategy with clinical consistency to leverage various types of annotations from different datasets. Our efforts lead to 1) an omni-labeled RRG dataset with QA pairs and lesion boxes; 2) a evaluation tool for assessing the accuracy of reports in describing lesion location and severity; 3) extensive experiments to demonstrate the effectiveness of CoD, where it outperforms both specialist and generalist models consistently on two RRG benchmarks and shows promising explainability by accurately grounding generated sentences to QA diagnoses and images.