# Seeing What Matters: Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Report Generation

arXiv: https://arxiv.org/abs/2607.06909 · HTML: https://mlsanity.com/paper/2607.06909/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 40 of its 59 references that are in the map.
- First posted on arXiv 8 Jul 2026.

## Builds on (most cited first, 30 of 40)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [Sigmoid Loss for Language Image Pre-Training](https://mlsanity.com/paper/2303.15343/) (2023)
- [LLaVA-OneVision: Easy Visual Task Transfer](https://mlsanity.com/paper/2408.03326/) (2024)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Phi-3 Technical Report: A Highly Capable Language Model Locally on Your Phone](https://mlsanity.com/paper/2404.14219/) (2024)
- [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)
- [How Far Are We to GPT-4V? Closing the Gap to Commercial Multimodal Models with Open-Source Suites](https://mlsanity.com/paper/2404.16821/) (2024)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [mPLUG-Owl2: Revolutionizing Multi-modal Large Language Model with Modality Collaboration](https://mlsanity.com/paper/2311.04257/) (2023)
- [Generating Radiology Reports via Memory-driven Transformer](https://mlsanity.com/paper/2010.16056/) (2020)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [Cross-modal Memory Networks for Radiology Report Generation](https://mlsanity.com/paper/2204.13258/) (2022)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [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)
- [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)
- [METransformer: Radiology Report Generation by Transformer with Multiple Learnable Expert Tokens](https://mlsanity.com/paper/2304.02211/) (2023)
- [Improving Chest X-Ray Report Generation by Leveraging Warm Starting](https://mlsanity.com/paper/2201.09405/) (2022)
- [PromptMRG: Diagnosis-Driven Prompts for Medical Report Generation](https://mlsanity.com/paper/2308.12604/) (2023)
- [Radiology Report Generation with a Learned Knowledge Base and Multi-modal Alignment](https://mlsanity.com/paper/2112.15011/) (2021)
- [RaTEScore: A Metric for Radiology Report Generation](https://mlsanity.com/paper/2406.16845/) (2024)
- [KiUT: Knowledge-injected U-Transformer for Radiology Report Generation](https://mlsanity.com/paper/2306.11345/) (2023)
- [ORGAN: Observation-Guided Radiology Report Generation via Tree Reasoning](https://mlsanity.com/paper/2306.06466/) (2023)

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

- [Graph-Supervised Hierarchical Clinical Alignment for Radiology Report Generation with Large Language Models](https://mlsanity.com/paper/2608.24121/) (2026)

## Abstract (arXiv)

Despite rapid advances in chest X-ray (CXR) foundation models, most radiology report generation (RRG) systems still rely on heavily downsampled inputs (e.g., 256x256) due to the fixed visual token budgets of pretrained vision encoders, suppressing subtle yet clinically important cues present in native-resolution images. However, enabling high-resolution (high-res) perception remains challenging: naive tiling causes prohibitive token inflation, while global compression suppresses subtle lesions and degrades diagnostic fidelity. Inspired by radiologists' workflow, localizing suspicious regions before detailed high-res assessment. We propose Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Reporting (LePaX), the first RRG framework that enables efficient high-res CXR perception (up to 1920x1920) without increasing the vision-token count. LePaX formulates high-res perception as a constrained spatial resolution allocation problem under a fixed token budget and introduces two key components: Learnable Spatial Resolution Allocation (LSRA), which learns a spatial utility map that adaptively allocates limited high-res capacity to diagnostically relevant regions, enabling targeted extraction of high-res patches from native CXRs; and Global-Regional Fusion (GRF), which performs token-preserving region-to-global refinement by projecting high-resolution regional evidence back onto the global feature grid through spatially aligned resolution write-back, avoiding token inflation. Experiments on multiple CXR benchmarks demonstrate that LePaX consistently improves both clinical and linguistic metrics while enabling native-resolution CXR perception with over 10x fewer visual tokens than naive high-res tiling.