# MIRROR: Multimodal Intelligent Radiology Reasoning and Observation Reporter

arXiv: https://arxiv.org/abs/2608.16709 · HTML: https://mlsanity.com/paper/2608.16709/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 18 of its 25 references that are in the map.
- First posted on arXiv 17 Aug 2026.

## Builds on (most cited first, 18 of 18)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Towards A Rigorous Science of Interpretable Machine Learning](https://mlsanity.com/paper/1702.08608/) (2017)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [Generating Radiology Reports via Memory-driven Transformer](https://mlsanity.com/paper/2010.16056/) (2020)
- [Top-down Neural Attention by Excitation Backprop](https://mlsanity.com/paper/1608.00507/) (2016)
- [Clinically Accurate Chest X-Ray Report Generation](https://mlsanity.com/paper/1904.02633/) (2019)

## Abstract (arXiv)

A radiologist reading a model's output faces two problems. The model returns a number and no reason, and any system that turns that number into readable prose can quietly add claims the model never made. MIRROR is a research prototype built to separate those failures. It chains a multi-label classifier, a Grad-CAM localizer that turns each positive finding into a named anatomical region, and a report writer that receives the labels, probabilities, and regions but never the image. Because the language layer cannot see pixels, it cannot assert a finding the classifier did not make. We are precise about what that buys: a MIRROR report's findings are auditable against the probability vector, while the sentences framing them are ordinary generated text, and we show one stating a cardiothoracic ratio the system never measured. One registry holds the taxonomy, anatomy, and phrasing for chest X-ray, brain MRI, and head CT, so adding a modality is a data change; all three are routed and tested, one is trained. On ChestMNIST that classifier reaches macro AUROC 0.729 and ranks better than chance on all 14 labels, at 1.6 to 6.8 times the precision a random ranker would get. Yet at the default 0.5 threshold it emits no positive prediction at all for 11 of them, and its excellent-looking Brier score of 0.045 sits beside the 0.047 earned by a predictor that ignores the image. The discrimination is real; the decisions are not. Under the class imbalance normal in radiology, aggregate metrics flatter models that do nothing, and should be reported against that floor.