Jake Lever

Xi Zhang, Yingshu Li, Zaiqiao Meng et al.

Radiology report generation (RRG) is commonly formulated as a single-path generation task, where a multimodal large language model (MLLM) produces one decoded report as the final output. While recent progress has largely been driven by scaling training data, model capacity, and retrieval mechanisms, improving report quality at inference time remains underexplored. In this work, we observe that fixed radiology MLLMs often generate clinically stronger reports elsewhere in their candidate pool than the one selected by default decoding, suggesting that inference-time decision making remains an overlooked bottleneck. To address this, we propose Clinical Consensus Selection (CCS), a decoder-agnostic inference-time selection framework that samples multiple candidate reports and selects the one with the highest clinical consensus across the rollout pool. CCS unifies text-based utilities with a radiology-adapted utility computed by an image--report-trained multimodal embedder, which measures candidate agreement beyond surface-level textual similarity. Across three datasets and multiple radiology MLLMs, CCS consistently improves inference-time performance over single-path decoding and generic Best-of-N baselines, with particularly clear gains on clinical metrics. Further analysis shows that image-grounded utility forms a selection axis distinct from textual consensus and that substantial headroom remains for improving RRG at inference time.

Xi Zhang, Zaiqiao Meng, Jake Lever et al.

Radiology report generation (RRG) requires advanced medical image analysis, effective temporal reasoning, and accurate text generation. While multimodal large language models (MLLMs) align with pre-trained vision encoders to enhance visual-language understanding, most existing methods rely on single-image analysis or rule-based heuristics to process multiple images, failing to fully leverage temporal information in multi-modal medical datasets. In this paper, we introduce Libra, a temporal-aware MLLM tailored for chest X-ray report generation. Libra combines a radiology-specific image encoder with a novel Temporal Alignment Connector (TAC), designed to accurately capture and integrate temporal differences between paired current and prior images. Extensive experiments on the MIMIC-CXR dataset demonstrate that Libra establishes a new state-of-the-art benchmark among similarly scaled MLLMs, setting new standards in both clinical relevance and lexical accuracy.

Erlend Frayling, Jake Lever, Graham McDonald

The challenge of accessing historical patient data for clinical research, while adhering to privacy regulations, is a significant obstacle in medical science. An innovative approach to circumvent this issue involves utilising synthetic medical records that mirror real patient data without compromising individual privacy. The creation of these synthetic datasets, particularly without using actual patient data to train Large Language Models (LLMs), presents a novel solution as gaining access to sensitive patient information to train models is also a challenge. This study assesses the capability of the Llama 2 LLM to create synthetic medical records that accurately reflect real patient information, employing zero-shot and few-shot prompting strategies for comparison against fine-tuned methodologies that do require sensitive patient data during training. We focus on generating synthetic narratives for the History of Present Illness section, utilising data from the MIMIC-IV dataset for comparison. In this work introduce a novel prompting technique that leverages a chain-of-thought approach, enhancing the model's ability to generate more accurate and contextually relevant medical narratives without prior fine-tuning. Our findings suggest that this chain-of-thought prompted approach allows the zero-shot model to achieve results on par with those of fine-tuned models, based on Rouge metrics evaluation.

Xi Zhang, Zaiqiao Meng, Jake Lever et al.

We introduce a radiology-focused visual language model designed to generate radiology reports from chest X-rays. Building on previous findings that large language models (LLMs) can acquire multimodal capabilities when aligned with pretrained vision encoders, we demonstrate similar potential with chest X-ray images. This integration enhances the ability of model to understand and describe chest X-ray images. Our model combines an image encoder with a fine-tuned LLM based on the Vicuna-7B architecture, enabling it to generate different sections of a radiology report with notable accuracy. The training process involves a two-stage approach: (i) initial alignment of chest X-ray features with the LLM (ii) followed by fine-tuning for radiology report generation.

Xinhao Yi, Jake Lever, Kevin Bryson et al.

Knowledge editing has emerged as an effective approach for updating large language models (LLMs) by modifying their internal knowledge. However, their application to the biomedical domain faces unique challenges due to the long-tailed distribution of biomedical knowledge, where rare and infrequent information is prevalent. In this paper, we conduct the first comprehensive study to investigate the effectiveness of knowledge editing methods for editing long-tail biomedical knowledge. Our results indicate that, while existing editing methods can enhance LLMs' performance on long-tail biomedical knowledge, their performance on long-tail knowledge remains inferior to that on high-frequency popular knowledge, even after editing. Our further analysis reveals that long-tail biomedical knowledge contains a significant amount of one-to-many knowledge, where one subject and relation link to multiple objects. This high prevalence of one-to-many knowledge limits the effectiveness of knowledge editing in improving LLMs' understanding of long-tail biomedical knowledge, highlighting the need for tailored strategies to bridge this performance gap.

Xi Zhang, Zaiqiao Meng, Jake Lever et al.

Multimodal large language models (MLLMs) have recently achieved remarkable progress in radiology by integrating visual perception with natural language understanding. However, they often generate clinically unsupported descriptions, known as medical hallucinations, which pose serious risks in medical applications that demand accuracy and image-grounded outputs. Through empirical analysis, we find that prompt-induced hallucinations remain prevalent in radiology MLLMs, largely due to over-sensitivity to clinical sections. To address this, we introduce Clinical Contrastive Decoding (CCD), a training-free and retrieval-free inference framework that integrates structured clinical signals from task-specific radiology expert models. CCD introduces a dual-stage contrastive mechanism to refine token-level logits during generation, thereby enhancing clinical fidelity without modifying the base MLLM. Experiments on three datasets and multiple models demonstrate that CCD consistently improves overall performance on radiology report generation (RRG). On the MIMIC-CXR dataset, it yields up to a 17% improvement in RadGraph-F1 when applied to state-of-the-art RRG models. Our approach provides a lightweight and generalisable solution for mitigating medical hallucinations, effectively bridging expert models and MLLMs in radiology.