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The paper introduces STRIVE, a novel framework for longitudinal radiology report generation that utilizes specialized agents for diagnosis, attribute estimation, and temporal change detection to enhance clarity and traceability in clinical reasoning. By employing a Progression-Aware GRPO for post-training, STRIVE effectively differentiates between direction-preserving errors and direction reversals, thereby improving the accuracy of temporal comparisons. Evaluated on the Longitudinal-MIMIC dataset, STRIVE significantly outperforms existing methods, achieving the highest clinical efficacy and more than doubling the Longitudinal Change Concordance (LCC) compared to the strongest baseline.
STRIVE transforms longitudinal radiology reporting by integrating structured reasoning and verification, achieving unprecedented accuracy in temporal change detection.
Longitudinal radiology report generation (LRRG) requires identifying both current findings and their changes relative to a prior study. Existing methods jointly model diagnosis, attribute estimation, temporal comparison, and language generation within implicit representations, which can cause task interference, obscure the evidence underlying each decision, and limit error traceability. They also model progression states as independent labels, ignoring their ordered structure and thus treating missed changes and direction reversals equally. We present STRIVE, Multi-Agent Structured Temporal Reasoning with Integrated Verification for LRRG, which decomposes clinical reasoning into specialized Diagnosis, Attribute, and Temporal Change Agents that produce explicit intermediate evidence. In particular, the Temporal Change Agent is further post-trained using Progression-Aware GRPO, a verifiable, shaped reward that assigns partial credit to direction-preserving errors while scoring direction reversals lowest. STRIVE performs verification at two stages: a deterministic Consistency Gate reconciles the agent outputs before report generation, and a Validation Agent checks whether the generated report is supported by the aggregated clinical evidence. On Longitudinal-MIMIC, STRIVE attains the best clinical efficacy among recent methods and more than doubles Longitudinal Change Concordance (LCC), a measure of temporal agreement with the reference report, over the strongest baseline.
