# STRIVE: Multi-Agent Structured Temporal Reasoning with Integrated Verification for Longitudinal Radiology Report Generation

arXiv: https://arxiv.org/abs/2608.24237 · HTML: https://mlsanity.com/paper/2608.24237/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 5 of its 47 references that are in the map.
- First posted on arXiv 25 Aug 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 5 of 5)

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [CogRad: A Cognitively-Inspired Multi-Agent Framework for Radiology Report Generation](https://mlsanity.com/paper/2607.03853/) (2026)

## Abstract (arXiv)

Longitudinal radiology report generation (LRRG) requires identifying both current findings and their changes relative to a prior study. Existing methods jointly model diagnosis, attribute estimation, temporal comparison, and language generation within implicit representations, which can cause task interference, obscure the evidence underlying each decision, and limit error traceability. They also model progression states as independent labels, ignoring their ordered structure and thus treating missed changes and direction reversals equally. We present STRIVE, Multi-Agent Structured Temporal Reasoning with Integrated Verification for LRRG, which decomposes clinical reasoning into specialized Diagnosis, Attribute, and Temporal Change Agents that produce explicit intermediate evidence. In particular, the Temporal Change Agent is further post-trained using Progression-Aware GRPO, a verifiable, shaped reward that assigns partial credit to direction-preserving errors while scoring direction reversals lowest. STRIVE performs verification at two stages: a deterministic Consistency Gate reconciles the agent outputs before report generation, and a Validation Agent checks whether the generated report is supported by the aggregated clinical evidence. On Longitudinal-MIMIC, STRIVE attains the best clinical efficacy among recent methods and more than doubles Longitudinal Change Concordance (LCC), a measure of temporal agreement with the reference report, over the strongest baseline.