# Beyond Report Imitation: Clinically Aware Multi-Image Ultrasound Report Generation from Visible Evidence

arXiv: https://arxiv.org/abs/2610.11610 · HTML: https://mlsanity.com/paper/2610.11610/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 5 of its 23 references that are in the map.
- First posted on arXiv 8 Oct 2026.

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

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [LLaVA-OneVision: Easy Visual Task Transfer](https://mlsanity.com/paper/2408.03326/) (2024)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)

## Abstract (arXiv)

Generating ultrasound reports from multiple images requires aggregating clinical evidence across views, yet archived key frames capture only part of the dynamic examination. Raw-report imitation is therefore misaligned with visual supervision: content that is clinically valid for the full examination may be unverifiable from the images available to a model. This gap creates a clinical behavior alignment problem. A model must preserve visible findings, avoid diagnostic reversals and unsupported completion, and not collapse into conservative templates. We propose CAMEO, a Clinically Aware Multi-image Evidence-grounded Orchestration framework for ultrasound report generation. Stage I learns ultrasound visual-language primitives; Stage II performs Cross-View Evidence Grounding by distilling trusted visible report points into multi-image QA and report-style supervision; and Stage III performs Clinically Aware Preference Alignment using clinical-error-oriented preference pairs. From USReport, we construct USReport-Distilled with 17,670 evidence-grounded paired-image training instances and USReport-Pref with 21,869 preference pairs; we additionally use 25,631 PubMedVision-US ultrasound instruction samples for domain adaptation and multi-image instruction tuning. On the primary USReport-Distilled benchmark, CAMEO improves over EchoVLM from 0.25 to 0.40 BLEU-1, 0.28 to 0.45 ROUGE-1, and 0.27 to 0.43 METEOR, while raising ClinicalScore from 55.02 to 74.20. These results underscore the value of evidence-grounded supervision, clinically aware alignment, and clinically structured evaluation for reliable ultrasound report generation.