QureRadEmbed: Structuring Radiological Similarity through Attribute and Reasoning Supervision

Radiological similarity depends on disease relationships and on fine details such as laterality, lobe, severity, size, and certainty. Broad biomedical similarity can overlook these qualifiers, particularly when several attributes vary together. We introduce QureRadEmbed, a 4B radiology-aware encoder trained with two complementary signals: RadSim supplies deterministic, attribute-decomposed ranking targets, while RadThought aligns reports with hierarchical evidence and reasoning descriptions. A three-stage curriculum combines these signals with report triplets, finding perturbations, and single- and cross-attribute contrasts. The final model achieves 0.996 mean ordering accuracy across ten controlled synthetic attributes and raises Spearman correlation with the designed joint-attribute targets from 0.501 to 0.976. On external findings-to-impression retrieval, Recall@1 reaches 10.5% on Open-I, 12.4% on testing XR, and 42.9% on testing CT, compared with 6.6%, 5.7%, and 31.4% for its backbone. Frozen embeddings support finding extraction with only 100 labeled testing-XR reports (macro-F1 0.481 versus 0.412 for the backbone). Whole-report comparison costs 8.8 seconds per 1,000 pairs in our benchmark, versus 2,755.1 seconds for the generative evaluator GREEN. Sentence-level comparison improves sensitivity to local discrepancies, although generative evaluation remains stronger on several expert-rated and subtle-error tasks. The results support reusable radiology-aware representations for search, structured report indexing, and efficient report comparison.