# Process Reward Models for Sentence-Level Verification of LVLM Radiology Reports

arXiv: https://arxiv.org/abs/2510.23217 · HTML: https://mlsanity.com/paper/2510.23217/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Hallucination detection and mitigation, one of 17 directions in LLM reasoning.
- Builds on 22 of its 34 references that are in the map.
- First posted on arXiv 27 Oct 2025.

## Placed in

- LLM reasoning / [Hallucination detection and mitigation](https://mlsanity.com/lr/hallucination-detection-and-mitigation/)
- Multimodal LLMs / vision-language models / [Hallucination mitigation in LVLMs](https://mlsanity.com/mllm/hallucination-mitigation-in-lvlms/)
- LLM alignment / RLHF / preference optimisation / [Diffusion and multimodal model alignment](https://mlsanity.com/alignment/diffusion-and-multimodal-model-alignment/)

## Builds on (most cited first, 22 of 22)

- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [SGDR: Stochastic Gradient Descent with Warm Restarts](https://mlsanity.com/paper/1608.03983/) (2016)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [HuggingFace's Transformers: State-of-the-art Natural Language Processing](https://mlsanity.com/paper/1910.03771/) (2019)
- [Solving math word problems with process- and outcome-based feedback](https://mlsanity.com/paper/2211.14275/) (2022)
- [SelfCheckGPT: Zero-Resource Black-Box Hallucination Detection for Generative Large Language Models](https://mlsanity.com/paper/2303.08896/) (2023)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [INSIDE: LLMs' Internal States Retain the Power of Hallucination Detection](https://mlsanity.com/paper/2402.03744/) (2024)
- [Rewarding Progress: Scaling Automated Process Verifiers for LLM Reasoning](https://mlsanity.com/paper/2410.08146/) (2024)
- [Factuality Enhanced Language Models for Open-Ended Text Generation](https://mlsanity.com/paper/2206.04624/) (2022)
- [Turning Up the Heat: Min-p Sampling for Creative and Coherent LLM Outputs](https://mlsanity.com/paper/2407.01082/) (2024)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [The Dawn After the Dark: An Empirical Study on Factuality Hallucination in Large Language Models](https://mlsanity.com/paper/2401.03205/) (2024)
- [LLM Internal States Reveal Hallucination Risk Faced With a Query](https://mlsanity.com/paper/2407.03282/) (2024)
- [A Vision-Language Foundation Model to Enhance Efficiency of Chest X-ray Interpretation](https://mlsanity.com/paper/2401.12208/) (2024)
- [Foundation Models in Radiology: What, How, When, Why and Why Not](https://mlsanity.com/paper/2411.18730/) (2024)
- [RadFlag: A Black-Box Hallucination Detection Method for Medical Vision Language Models](https://mlsanity.com/paper/2411.00299/) (2024)
- [Enhancing Hallucination Detection through Noise Injection](https://mlsanity.com/paper/2502.03799/) (2025)
- [ReXTrust: A Model for Fine-Grained Hallucination Detection in AI-Generated Radiology Reports](https://mlsanity.com/paper/2412.15264/) (2024)
- [Process-Supervised Reward Models for Verifying Clinical Note Generation: A Scalable Approach Guided by Domain Expertise](https://mlsanity.com/paper/2412.12583/) (2024)

## Built on by (most cited first, 1 of 1)

- [Unmentioned Checklist Findings Change How Reinforcement Learning Appears to Improve Chest Radiograph Report Checking](https://mlsanity.com/paper/2610.05425/) (2026)

## Abstract (arXiv)

Automating radiology report generation with Large Vision-Language Models (LVLMs) holds great potential, yet these models often produce clinically critical hallucinations, posing serious risks. Existing hallucination detection methods frequently lack the necessary sentence-level granularity or robust generalization across different LVLM generators. We introduce a novel approach: a sentence-level Process Reward Model (PRM) adapted for this vision-language task. Our PRM predicts the factual correctness of each generated sentence, conditioned on clinical context and preceding text. When fine-tuned on MIMIC-CXR with weakly-supervised labels, a lightweight 0.5B-parameter PRM outperforms existing verification techniques, demonstrating, for instance, relative improvements of 7.5% in Matthews Correlation Coefficient and 1.8% in AUROC over strong white-box baselines on outputs from one LVLM. Unlike methods reliant on internal model states, our PRM demonstrates strong generalization to an unseen LVLM. We further show its practical utility: PRM scores effectively filter low-quality reports, improving F1-CheXbert scores by 4.5% (when discarding the worst 10% of reports). Moreover, when guiding a novel weighted best-of-N selection process on the MIMIC-CXR test set, our PRM show relative improvements in clinical metrics of 7.4% for F1-CheXbert and 0.6% for BERTScore. These results demonstrate that a lightweight, context-aware PRM provides a model-agnostic safety layer for clinical LVLMs without access to internal activations