# CCS: Clinical Consensus Selection for Radiology Report Generation

arXiv: https://arxiv.org/abs/2605.30131 · HTML: https://mlsanity.com/paper/2605.30131/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 26 of its 41 references that are in the map.
- First posted on arXiv 28 May 2026.

## Builds on (most cited first, 26 of 26)

- [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)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Sigmoid Loss for Language Image Pre-Training](https://mlsanity.com/paper/2303.15343/) (2023)
- [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)
- [Contrastive Decoding: Open-ended Text Generation as Optimization](https://mlsanity.com/paper/2210.15097/) (2022)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Smarter, Better, Faster, Longer: A Modern Bidirectional Encoder for Fast, Memory Efficient, and Long Context Finetuning and Inference](https://mlsanity.com/paper/2412.13663/) (2024)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [Qwen3-VL-Embedding and Qwen3-VL-Reranker: A Unified Framework for State-of-the-Art Multimodal Retrieval and Ranking](https://mlsanity.com/paper/2601.04720/) (2026)
- [Scalable Best-of-N Selection for Large Language Models via Self-Certainty](https://mlsanity.com/paper/2502.18581/) (2025)
- [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)
- [VLM2Vec-V2: Advancing Multimodal Embedding for Videos, Images, and Visual Documents](https://mlsanity.com/paper/2507.04590/) (2025)
- [CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats](https://mlsanity.com/paper/2405.19538/) (2024)
- [Is Best-of-N the Best of Them? Coverage, Scaling, and Optimality in Inference-Time Alignment](https://mlsanity.com/paper/2503.21878/) (2025)
- [MMed-RAG: Versatile Multimodal RAG System for Medical Vision Language Models](https://mlsanity.com/paper/2410.13085/) (2024)
- [Improving the Factual Correctness of Radiology Report Generation with Semantic Rewards](https://mlsanity.com/paper/2210.12186/) (2022)
- [Can Perplexity Reflect Large Language Model's Ability in Long Text Understanding?](https://mlsanity.com/paper/2405.06105/) (2024)
- [Libra: Leveraging Temporal Images for Biomedical Radiology Analysis](https://mlsanity.com/paper/2411.19378/) (2024)
- [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)
- [CCD: Mitigating Hallucinations in Radiology MLLMs via Clinical Contrastive Decoding](https://mlsanity.com/paper/2509.23379/) (2025)

## Abstract (arXiv)

Radiology report generation (RRG) is commonly formulated as a single-path generation task, where a multimodal large language model (MLLM) produces one decoded report as the final output. While recent progress has largely been driven by scaling training data, model capacity, and retrieval mechanisms, improving report quality at inference time remains underexplored. In this work, we observe that fixed radiology MLLMs often generate clinically stronger reports elsewhere in their candidate pool than the one selected by default decoding, suggesting that inference-time decision making remains an overlooked bottleneck. To address this, we propose Clinical Consensus Selection (CCS), a decoder-agnostic inference-time selection framework that samples multiple candidate reports and selects the one with the highest clinical consensus across the rollout pool. CCS unifies text-based utilities with a radiology-adapted utility computed by an image--report-trained multimodal embedder, which measures candidate agreement beyond surface-level textual similarity. Across three datasets and multiple radiology MLLMs, CCS consistently improves inference-time performance over single-path decoding and generic Best-of-N baselines, with particularly clear gains on clinical metrics. Further analysis shows that image-grounded utility forms a selection axis distinct from textual consensus and that substantial headroom remains for improving RRG at inference time.