ArticleJMIR medical informatics2026
Cross-Domain Chest Radiograph Report Generation Under Dataset Shift: Bidirectional Audit Study.
Article in JMIR medical informatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
Background: Cross-domain chest radiograph report generation may produce formally valid reports that are nevertheless repetitive, weakly case-specific, or missing clinically relevant findings. These failures can be missed when evaluation relies on a single language-overlap or clinical-label score. Objective: This study aimed to evaluate cross-domain report generation with a bidirectional layered audit, characterize direction-specific and end point-specific failure profiles under a composite training-side control and 3 decoding policies, and explore whether selected audit dimensions remained informative for a contemporary medical vision language model. Methods: A fixed R2Gen-style system was evaluated bidirectionally on 575 IU X-ray and 401 MIMIC-CXR (Medical Information Mart for Intensive Care Chest X-Ray) target records. The audit included surface validity, complete-report recurrence and concentration, a predefined prefix end point, lexical diversity, official Stanford CheXpert/NegBio labels, paired cluster-bootstrap inference, and blinded review by 2 medical trainees. The primary human audit included 210 reports from 70 randomly sampled cases, with blinded adjudication of unresolved primary end point disagreements. A 60-report targeted panel was used for failure-mode analysis. Separately, a fixed MedGemma 1.5 4B configuration generated reports for all 976 records. Results: In MIMIC-CXR-to-IU X-ray transfer, out of 575 reports, ON (protocol-defined training-side control enabled)+B4 (beam search with a beam size of 4) reduced the predefined recurrent prefix from 575 (100%) to 8 (1.4%; Holm-adjusted Conclusions: No configuration performed consistently well across end points, and no single metric captured all forms of cross-domain degradation. The MedGemma stress test suggested that recurrence and label-traceability checks remain useful across architectures, although it was not a matched performance comparison. Cross-domain report generators should undergo bidirectional evaluation, final-text verification, and image-grounded human review before external validation or clinical deployment.
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