# Transition-Aware best-of-N sampling for Longitudinal Chest X-ray Reports

arXiv: https://arxiv.org/abs/2606.28393 · HTML: https://mlsanity.com/paper/2606.28393/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 13 of its 23 references that are in the map.
- First posted on arXiv 23 Jun 2026.

## Builds on (most cited first, 13 of 13)

- [Training Verifiers to Solve Math Word Problems](https://mlsanity.com/paper/2110.14168/) (2021)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [Learning to Exploit Temporal Structure for Biomedical Vision-Language Processing](https://mlsanity.com/paper/2301.04558/) (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)
- [R2GenGPT: Radiology Report Generation with Frozen LLMs](https://mlsanity.com/paper/2309.09812/) (2023)
- [Improving the Factual Correctness of Radiology Report Generation with Semantic Rewards](https://mlsanity.com/paper/2210.12186/) (2022)
- [ReXGradient-160K: A Large-Scale Publicly Available Dataset of Chest Radiographs with Free-text Reports](https://mlsanity.com/paper/2505.00228/) (2025)
- [Longitudinal Data and a Semantic Similarity Reward for Chest X-Ray Report Generation](https://mlsanity.com/paper/2307.09758/) (2023)
- [SDR: Set-Distance Rewards for Radiology Report Generation](https://mlsanity.com/paper/2606.00440/) (2026)

## Abstract (arXiv)

In longitudinal clinical practice, every chest X-ray is read in the context of the patients prior exam, and much of what the radiologist communicates is the change from one visit to the next. To the best of our knowledge, we present the first training-free best-of-N sampling scheme for pre-trained chest X-ray report generators that is explicitly aware of this longitudinal prior to current transition. We call it transition-aware best-of-N sampling, each report is split into sentences and embedded into an unordered set in Rd; each (prior, current) pair is reduced to a fixed-dim directional vector via a set-to-set distance designed to encode the change between the two sets; and candidates are scored by cosine distance from their candidate transition vector to a cached bank of ground-truth training transition vectors, aggregated as min or kNN. We instantiate the framework with four directional set distances (mean-shift, novelty residual, directed-Hausdorff anchor, and cost-weighted optimal transport) and evaluate on a multi-visit AP-PA cohort, running inference under three prompts on three vision-language generators. Transition-aware best-of-N outperforms random selection across the board, with the largest relative gains on the Impression section.