ECHO: Efficient Chest X-ray Report Generation with One-step Block Diffusion
This work addresses the workload of radiologists by improving efficiency in medical report generation, though it is incremental as it builds on existing diffusion methods.
The paper tackled the problem of high inference latency in chest X-ray report generation by proposing ECHO, a diffusion-based model that enables one-step-per-block inference, resulting in a 64.33% improvement in RaTE, a 60.58% improvement in SemScore, and an 8× inference speedup.
Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose \textbf{ECHO}, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by \textbf{64.33\%} and \textbf{60.58\%} respectively, while achieving an \textbf{$8\times$} inference speedup without compromising clinical accuracy.