CREPE: Rapid Chest X-ray Report Evaluation by Predicting Multi-category Error Counts

We introduce CREPE (Rapid Chest Xray Report Evaluation by Predicting Multicategory Error Counts), a rapid, interpretable, and clinically grounded metric for automated chest X-ray report generation. CREPE uses a domain-specific BERT model fine-tuned with a multi-head regression architecture to predict error counts across six clinically meaningful categories. Trained on a large-scale synthetic dataset of 32,000 annotated report pairs, CREPE demonstrates strong generalization and interpretability. On the expert-annotated ReX-Val dataset, CREPE achieves a Kendall's τ correlation of 0.786 with radiologist error counts, outperforming traditional and recent metrics. CREPE achieves these results with an inference speed approximately 280 times faster than large language model (LLM)-based approaches, enabling rapid and fine-grained evaluation for scalable development of chest X-ray report generation models.