# REVA-PO: Stabilizing Reinforcement Learning for Chest X-ray Report Generation

arXiv: https://arxiv.org/abs/2607.10147 · HTML: https://mlsanity.com/paper/2607.10147/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in RL for clinical treatment and surgery, one of 15 directions in Deep reinforcement learning methods.
- Builds on 59 of its 81 references that are in the map.
- First posted on arXiv 11 Jul 2026.

## Placed in

- Deep reinforcement learning methods / [RL for clinical treatment and surgery](https://mlsanity.com/deeprl/rl-for-clinical-treatment-and-surgery/)

## Builds on (most cited first, 30 of 59)

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- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
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- [Training a Helpful and Harmless Assistant with Reinforcement Learning from Human Feedback](https://mlsanity.com/paper/2204.05862/) (2022)
- [DAPO: An Open-Source LLM Reinforcement Learning System at Scale](https://mlsanity.com/paper/2503.14476/) (2025)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Fine-Tuning Language Models from Human Preferences](https://mlsanity.com/paper/1909.08593/) (2019)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [TinyLlama: An Open-Source Small Language Model](https://mlsanity.com/paper/2401.02385/) (2024)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Self-critical Sequence Training for Image Captioning](https://mlsanity.com/paper/1612.00563/) (2016)
- [VLM-R1: A Stable and Generalizable R1-style Large Vision-Language Model](https://mlsanity.com/paper/2504.07615/) (2025)
- [Process Reinforcement through Implicit Rewards](https://mlsanity.com/paper/2502.01456/) (2025)
- [Open-Reasoner-Zero: An Open Source Approach to Scaling Up Reinforcement Learning on the Base Model](https://mlsanity.com/paper/2503.24290/) (2025)
- [LLaVA-CoT: Let Vision Language Models Reason Step-by-Step](https://mlsanity.com/paper/2411.10440/) (2024)
- [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)
- [Learning to Reason under Off-Policy Guidance](https://mlsanity.com/paper/2504.14945/) (2025)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [Exploring and Distilling Posterior and Prior Knowledge for Radiology Report Generation](https://mlsanity.com/paper/2106.06963/) (2021)
- [When Radiology Report Generation Meets Knowledge Graph](https://mlsanity.com/paper/2002.08277/) (2020)

## Abstract (arXiv)

Automated chest X-ray report generation has recently benefited from reinforcement learning (RL) and large language models. However, RL training often suffers from instability or limited exploration due to fixed Kullback-Leibler (KL) regularization and a static reference policy that accumulates KL pressure over time. We propose Response-Weighted and Validation-Anchored Policy Optimization (REVA-PO), a RL framework that stabilizes long-term training via Response-Weighted Regularization (RER) and Validation-Anchored Policy Reset (VAPR). RER dynamically adjusts per-response KL weights based on advantage and reference-policy entropy, relaxing constraints for high-quality responses while tightening them for low-quality ones. Complementarily, VAPR periodically synchronizes the reference and current policies to the best validation checkpoint, resetting accumulated regularization pressure to expand the viable exploration space. To ensure a robust starting point, we employ a three-stage pipeline consisting of warm-up training, classifier-guided supervised fine-tuning, and RL. Extensive evaluations on MIMIC-CXR and IU-Xray demonstrate that REVA-PO sets new state-of-the-art benchmarks in both linguistic quality and clinical accuracy. Notably, BLEU-4 improves by 5.1% on MIMIC-CXR and 3.6% on IU-Xray, while CheXpert F1 and RadGraph F1 scores increase by 4.5% and 12.8%, respectively, over prior leading methods. The code is publicly available at https://github.com/LiGuo12/REVA_PO/.