A Generative Framework for Bidirectional Image-Report Understanding in Chest Radiography

Abstract: The rapid advancements in LLMs have unlocked their potential for multimodal tasks, where text and visual data are processed jointly. However, applying LLMs to medical imaging, particularly for chest X-rays (CXR), poses significant challenges due to the need for precise visual-textual alignment and the preservation of critical diagnostic details. In this paper, we propose Multi-Stage Adaptive Vision-Language Tuning (MAViLT), a novel framework designed to enhance multimodal reasoning and generation for CXR understanding. MAViLT incorporates a clinical gradient-weighted tokenization process and a hierarchical fine-tuning strategy, enabling it to generate accurate radiology reports, synthesize realistic CXRs from text, and answer vision-based clinical questions. We evaluate MAViLT on two benchmark datasets, MIMIC-CXR and Indiana University CXR, achieving state-of-the-art results across all tasks. Human evaluations further validate the clinical relevance and utility of MAViLT, making it a robust tool for real-world medical applications. This work demonstrates the feasibility of leveraging LLMs for multimodal medical imaging while addressing key challenges in vision-language integration.