Enhancing Visual Reasoning in Chest X-Ray Report Generation Using Reinforcement Learning

Denis Musinguzi, Andrew Katumba, Prasenjit Mitra

Medical report generation has made significant progress with the rise of modern vision-language models and the growing availability of large-scale medical datasets. However, hallucinations remain a major challenge, largely due to the limitations of supervised fine-tuning (SFT), which prioritizes lexical similarity to reference reports rather than clinical correctness. While reinforcement learning has shown strong performance in domains with verifiable rewards such as mathematics and code generation, its application to open-ended medical tasks remains limited. Existing work focuses on evaluating final answers, overlooking the model's reasoning, despite evidence that flawed reasoning can degrade overall performance. In this study, we propose a framework that verifies the model's reasoning process by integrating anatomical regions, bounding boxes, and region-level textual descriptions. We design spatial and factual reward mechanisms to ensure that the model's reasoning is both visually grounded and factually accurate. Starting from Qwen3-VL-8B-Instruct as our base model, we adapt it to the medical domain using supervised fine-tuning, introduce reasoning capability through a…