LLM-Bootstrapped Targeted Finding Guidance for Factual MLLM-based Medical Report Generation

The automatic generation of medical reports utilizing Multimodal Large Language Models (MLLMs) frequently encounters challenges related to factual instability, which may manifest as the omission of findings or the incorporation of inaccurate information, thereby constraining their applicability in clinical settings. Current methodologies typically produce reports based directly on image features, which inherently lack a definitive factual basis. In response to this limitation, we introduce Fact-Flow, an innovative framework that separates the process of visual fact identification from the generation of reports. This is achieved by initially predicting clinical findings from the image, which subsequently directs the MLLM to produce a report that is factually precise. A pivotal advancement of our approach is a pipeline that leverages a Large Language Model (LLM) to autonomously create a dataset of labeled medical findings, effectively eliminating the need for expensive manual annotation. Extensive experimental evaluations conducted on two disease-focused medical datasets validate the efficacy of our method, demonstrating a significant enhancement in factual accuracy compared to state-of-the-art models, while concurrently preserving high standards of text quality.

Directed Ordinal Diffusion Regularization for Progression-Aware Diabetic Retinopathy Grading

Diabetic Retinopathy (DR) progresses as a continuous and irreversible deterioration of the retina, following a well-defined clinical trajectory from mild to severe stages. However, most existing ordinal regression approaches model DR severity as a set of static, symmetric ranks, capturing relative order while ignoring the inherent unidirectional nature of disease progression. As a result, the learned feature representations may violate biological plausibility, allowing implausible proximity between non-consecutive stages or even reverse transitions. To bridge this gap, we propose Directed Ordinal Diffusion Regularization (D-ODR), which explicitly models the feature space as a directed flow by constructing a progression-constrained directed graph that strictly enforces forward disease evolution. By performing multi-scale diffusion on this directed structure, D-ODR imposes penalties on score inversions along valid progression paths, thereby effectively preventing the model from learning biologically inconsistent reverse transitions. This mechanism aligns the feature representation with the natural trajectory of DR worsening. Extensive experiments demonstrate that D-ODR yields superior grading performance compared to state-of-the-art ordinal regression and DR-specific grading methods, offering a more clinically reliable assessment of disease severity. Our code is available on https://github.com/HovChen/D-ODR.