Learning Self-Critiquing Mechanisms for Region-Guided Chest X-Ray Report Generation

Automatic radiology reporting assists radiologists in diagnosing abnormalities in radiology images, where grounding the automatic diagnosis with abnormality locations is important for the report interpretability. However, existing supervised-learning methods could lead to learning the superficial statistical correlations between images and reports, lacking multi-faceted reasoning to critique the relevant regions on which radiologists would focus. Recently, self-critical reasoning has been investigated in test-time scaling approaches to alleviate hallucinations of LLMs with increased time complexity. In this work, we focus on chest X-ray report generation with particular focus on clinical accuracy, where self-critical reasoning is alternatively introduced into the model architecture and their training objective, preferred by the real-time automatic reporting system. In particular, three types of self-critical reasoning are proposed to critique the hypotheses of grounded abnormalities compared to i) alternative abnormalities, ii) alternative patient's X-ray image, and iii) potential false negative abnormalities. To realize this, we propose a novel Radiology Self-Critiquing Reporting (RadSCR) framework, which constructs the abnormality proposals for each localized abnormality region and verify them by the proposed self-critiquing mechanisms accordingly. The critiqued results of the abnormality proposals are then integrated to generate the completed report with interpretable diagnostic process. Our experiments show the state-of-the-art performance achieved by RadSCR in the grounded report generation and diagnosis critiquing, demonstrating its effectiveness in generating the clinically accurate report.