From Sampled Evidence to Radiology Reports: Objectives, Constraints, and Realization

Kun Zhao, Haoteng Tang, Chenghua Lin, Liang Zhan

Sampling multiple reports creates an inference problem: how should sampled evidence be converted into a final decision, and does a better structured decision yield a better report? We study these questions through a framework that separates the decision signal, scoring objective, and feasible decision set, followed by text realization. On MIMIC-CXR and IU-Xray, controlled comparisons across 13 generator configurations per benchmark under grouped development/test evaluation reveal three findings. First, changing the objective under fixed evidence and rule capacity changes predictions and their held-out metric trade-offs. Second, relaxing candidate constraints has objective-dependent effects under shared signals and frozen scores. Diagnostics connect the IU macro-oriented assertion increase to near-zero label thresholds and show that limited candidate coverage coexists with selection headroom. Third, a controlled realization study with SFT-Qwen3-VL-8B shows that decision-level gains can be attenuated, amplified, or reversed. Change decomposition reveals that realization can remove incorrect assertions while losing correct findings, so target fidelity and reference accuracy need not…