# Radiology Report Generation with Layer-Wise Anatomical Attention

arXiv: https://arxiv.org/abs/2512.16841 · HTML: https://mlsanity.com/paper/2512.16841/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 24 of its 44 references that are in the map.
- First posted on arXiv 18 Dec 2025.

## Builds on (most cited first, 24 of 24)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [DINOv3](https://mlsanity.com/paper/2508.10104/) (2025)
- [Train Short, Test Long: Attention with Linear Biases Enables Input Length Extrapolation](https://mlsanity.com/paper/2108.12409/) (2021)
- [PaLI: A Jointly-Scaled Multilingual Language-Image Model](https://mlsanity.com/paper/2209.06794/) (2022)
- [Extending Context Window of Large Language Models via Positional Interpolation](https://mlsanity.com/paper/2306.15595/) (2023)
- [GPT-NeoX-20B: An Open-Source Autoregressive Language Model](https://mlsanity.com/paper/2204.06745/) (2022)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [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)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [Clinically Accurate Chest X-Ray Report Generation](https://mlsanity.com/paper/1904.02633/) (2019)
- [Scaling Laws of RoPE-based Extrapolation](https://mlsanity.com/paper/2310.05209/) (2023)
- [Improving the Factual Correctness of Radiology Report Generation with Semantic Rewards](https://mlsanity.com/paper/2210.12186/) (2022)
- [MAIRA-1: A specialised large multimodal model for radiology report generation](https://mlsanity.com/paper/2311.13668/) (2023)
- [Multimodal Healthcare AI: Identifying and Designing Clinically Relevant Vision-Language Applications for Radiology](https://mlsanity.com/paper/2402.14252/) (2024)
- [CheXmask: a large-scale dataset of anatomical segmentation masks for multi-center chest x-ray images](https://mlsanity.com/paper/2307.03293/) (2023)
- [Structural Attention: Rethinking Transformer for Unpaired Medical Image Synthesis](https://mlsanity.com/paper/2406.18967/) (2024)
- [MAIRA-Seg: Enhancing Radiology Report Generation with Segmentation-Aware Multimodal Large Language Models](https://mlsanity.com/paper/2411.11362/) (2024)
- [Beyond Conventional Transformers: The Medical X-ray Attention (MXA) Block for Improved Multi-Label Diagnosis Using Knowledge Distillation](https://mlsanity.com/paper/2504.02277/) (2025)

## Abstract (arXiv)

Automatic radiology report generation is a promising application of multimodal deep learning, aiming to reduce reporting workload and improve consistency. However, current state-of-the-art (SOTA) systems - such as Multimodal AI for Radiology Applications (MAIRA-2) and Medical Pathways Language Model-Multimodal (MedPaLM-M) - depend on large-scale multimodal training, clinical metadata, and multiple imaging views, making them resource-intensive and inaccessible for most settings. We introduce a compact image-to-text architecture that generates the Findings section of chest X-ray reports from a single frontal image. The model combines a frozen Self-Distillation with No Labels v3 (DINOv3) Vision Transformer (ViT) encoder with a Generative Pre-trained Transformer 2 (GPT-2) decoder enhanced by layer-wise anatomical attention. This mechanism integrates lung and heart segmentation masks through hierarchical Gaussian smoothing, biasing attention toward clinically relevant regions without adding trainable parameters. Evaluated on the official Medical Information Mart for Intensive Care-Chest X-ray (MIMIC-CXR) dataset using Chest Radiograph Expert (CheXpert) and Radiology Graph (RadGraph) metrics, our approach achieved substantial gains: CheXpert Macro-F1 for five key pathologies increased by 168% (0.083 -> 0.238) and Micro-F1 by 146% (0.137 -> 0.337), while broader performance across 14 observations improved by 86% (0.170 -> 0.316). Structural coherence also improved, with RadGraph F1 rising by 9.7%. Despite its small size and purely image-conditioned design, the model demonstrates that decoder-level anatomical guidance improves spatial grounding and enhances coherence in clinically relevant regions. The source code is publicly available at: https://github.com/devMuniz02/UDEM-CXR-Reporting-Thesis-2025.