Daily Papers

The performance of text summarization has been greatly boosted by pre-trained language models. A main concern of existing methods is that most generated summaries are not factually inconsistent with their source documents. To alleviate the problem, many efforts have focused on developing effective factuality evaluation metrics based on natural language inference, question answering, and syntactic dependency et al. However, these approaches are limited by either their high computational complexity or the uncertainty introduced by multi-component pipelines, resulting in only partial agreement with human judgement. Most recently, large language models(LLMs) have shown excellent performance in not only text generation but also language comprehension. In this paper, we particularly explore ChatGPT's ability to evaluate factual inconsistency under a zero-shot setting by examining it on both coarse-grained and fine-grained evaluation tasks including binary entailment inference, summary ranking, and consistency rating. Experimental results indicate that ChatGPT generally outperforms previous evaluation metrics across the three tasks, indicating its great potential for factual inconsistency evaluation. However, a closer inspection of ChatGPT's output reveals certain limitations including its preference for more lexically similar candidates, false reasoning, and inadequate understanding of instructions.

Single document news summarization has seen substantial progress on faithfulness in recent years, driven by research on the evaluation of factual consistency, or hallucinations. We ask whether these advances carry over to other text summarization domains. We propose a new evaluation benchmark on topic-focused dialogue summarization, generated by LLMs of varying sizes. We provide binary sentence-level human annotations of the factual consistency of these summaries along with detailed explanations of factually inconsistent sentences. Our analysis shows that existing LLMs hallucinate significant amounts of factual errors in the dialogue domain, regardless of the model's size. On the other hand, when LLMs, including GPT-4, serve as binary factual evaluators, they perform poorly and can be outperformed by prevailing state-of-the-art specialized factuality evaluation metrics. Finally, we conducted an analysis of hallucination types with a curated error taxonomy. We find that there are diverse errors and error distributions in model-generated summaries and that non-LLM based metrics can capture all error types better than LLM-based evaluators.

Multimodal large language models (MLLMs) excel at generating highly detailed captions but often produce hallucinations. Our analysis reveals that existing hallucination detection methods struggle with detailed captions. We attribute this to the increasing reliance of MLLMs on their generated text, rather than the input image, as the sequence length grows. To address this issue, we propose a multiagent approach that leverages LLM-MLLM collaboration to correct given captions. Additionally, we introduce an evaluation framework and a benchmark dataset to facilitate the systematic analysis of detailed captions. Our experiments demonstrate that our proposed evaluation method better aligns with human judgments of factuality than existing metrics and that existing approaches to improve the MLLM factuality may fall short in hyper-detailed image captioning tasks. In contrast, our proposed method significantly enhances the factual accuracy of captions, even improving those generated by GPT-4V. Finally, we highlight a limitation of VQA-centric benchmarking by demonstrating that an MLLM's performance on VQA benchmarks may not correlate with its ability to generate detailed image captions.

Recent advancements in text summarization, particularly with the advent of Large Language Models (LLMs), have shown remarkable performance. However, a notable challenge persists as a substantial number of automatically-generated summaries exhibit factual inconsistencies, such as hallucinations. In response to this issue, various approaches for the evaluation of consistency for summarization have emerged. Yet, these newly-introduced metrics face several limitations, including lack of interpretability, focus on short document summaries (e.g., news articles), and computational impracticality, especially for LLM-based metrics. To address these shortcomings, we propose Factuality Evaluation of summarization based on Natural language Inference and Claim Extraction (FENICE), a more interpretable and efficient factuality-oriented metric. FENICE leverages an NLI-based alignment between information in the source document and a set of atomic facts, referred to as claims, extracted from the summary. Our metric sets a new state of the art on AGGREFACT, the de-facto benchmark for factuality evaluation. Moreover, we extend our evaluation to a more challenging setting by conducting a human annotation process of long-form summarization.

Hallucinated outputs from language models pose risks in the medical domain, especially for lay audiences making health-related decisions. Existing factuality evaluation methods, such as entailment- and question-answering-based (QA), struggle with plain language summary (PLS) generation due to elaborative explanation phenomenon, which introduces external content (e.g., definitions, background, examples) absent from the source document to enhance comprehension. To address this, we introduce PlainQAFact, a framework trained on a fine-grained, human-annotated dataset PlainFact, to evaluate the factuality of both source-simplified and elaboratively explained sentences. PlainQAFact first classifies factuality type and then assesses factuality using a retrieval-augmented QA-based scoring method. Our approach is lightweight and computationally efficient. Empirical results show that existing factuality metrics fail to effectively evaluate factuality in PLS, especially for elaborative explanations, whereas PlainQAFact achieves state-of-the-art performance. We further analyze its effectiveness across external knowledge sources, answer extraction strategies, overlap measures, and document granularity levels, refining its overall factuality assessment.

Metrics like FactScore and VeriScore that evaluate long-form factuality operate by decomposing an input response into atomic claims and then individually verifying each claim. While effective and interpretable, these methods incur numerous LLM calls and can take upwards of 100 seconds to evaluate a single response, limiting their practicality in large-scale evaluation and training scenarios. To address this, we propose VeriFastScore, which leverages synthetic data to fine-tune Llama3.1 8B for simultaneously extracting and verifying all verifiable claims within a given text based on evidence from Google Search. We show that this task cannot be solved via few-shot prompting with closed LLMs due to its complexity: the model receives ~4K tokens of evidence on average and needs to concurrently decompose claims, judge their verifiability, and verify them against noisy evidence. However, our fine-tuned VeriFastScore model demonstrates strong correlation with the original VeriScore pipeline at both the example level (r=0.80) and system level (r=0.94) while achieving an overall speedup of 6.6x (9.9x excluding evidence retrieval) over VeriScore. To facilitate future factuality research, we publicly release our VeriFastScore model and synthetic datasets.

Plain language summarization with LLMs can be useful for improving textual accessibility of technical content. But how factual are these summaries in a high-stakes domain like medicine? This paper presents FactPICO, a factuality benchmark for plain language summarization of medical texts describing randomized controlled trials (RCTs), which are the basis of evidence-based medicine and can directly inform patient treatment. FactPICO consists of 345 plain language summaries of RCT abstracts generated from three LLMs (i.e., GPT-4, Llama-2, and Alpaca), with fine-grained evaluation and natural language rationales from experts. We assess the factuality of critical elements of RCTs in those summaries: Populations, Interventions, Comparators, Outcomes (PICO), as well as the reported findings concerning these. We also evaluate the correctness of the extra information (e.g., explanations) added by LLMs. Using FactPICO, we benchmark a range of existing factuality metrics, including the newly devised ones based on LLMs. We find that plain language summarization of medical evidence is still challenging, especially when balancing between simplicity and factuality, and that existing metrics correlate poorly with expert judgments on the instance level.

The rapid evolution of large language models (LLMs) and the real world has outpaced the static nature of widely used evaluation benchmarks, raising concerns about their reliability for evaluating LLM factuality. While substantial works continue to rely on the popular but old benchmarks, their temporal misalignment with real-world facts and modern LLMs, and their effects on LLM factuality evaluation remain underexplored. Therefore, in this work, we present a systematic investigation of this issue by examining five popular factuality benchmarks and eight LLMs released across different years. An up-to-date fact retrieval pipeline and three metrics are tailored to quantify benchmark aging and its impact on LLM factuality evaluation. Experimental results and analysis illustrate that a considerable portion of samples in the widely used factuality benchmarks are outdated, leading to unreliable assessments of LLM factuality. We hope our work can provide a testbed to assess the reliability of a benchmark for LLM factuality evaluation and inspire more research on the benchmark aging issue. Codes are available in https://github.com/JiangXunyi/BenchAge.

Before deploying a language model (LM) within a given domain, it is important to measure its tendency to generate factually incorrect information in that domain. Existing factual generation evaluation methods focus on facts sampled from the LM itself, and thus do not control the set of evaluated facts and might under-represent rare and unlikely facts. We propose FACTOR: Factual Assessment via Corpus TransfORmation, a scalable approach for evaluating LM factuality. FACTOR automatically transforms a factual corpus of interest into a benchmark evaluating an LM's propensity to generate true facts from the corpus vs. similar but incorrect statements. We use our framework to create two benchmarks: Wiki-FACTOR and News-FACTOR. We show that: (i) our benchmark scores increase with model size and improve when the LM is augmented with retrieval; (ii) benchmark score correlates with perplexity, but the two metrics do not always agree on model ranking; and (iii) when perplexity and benchmark score disagree, the latter better reflects factuality in open-ended generation, as measured by human annotators. We make our data and code publicly available in https://github.com/AI21Labs/factor.

In the medical domain, numerous scenarios necessitate the long-form generation ability of large language models (LLMs). Specifically, when addressing patients' questions, it is essential that the model's response conveys factual claims, highlighting the need for an automated method to evaluate those claims. Thus, we introduce MedLFQA, a benchmark dataset reconstructed using long-form question-answering datasets related to the biomedical domain. We use MedLFQA to facilitate the automatic evaluations of factuality. We also propose OLAPH, a simple and novel framework that enables the improvement of factuality through automatic evaluations. The OLAPH framework iteratively trains LLMs to mitigate hallucinations using sampling predictions and preference optimization. In other words, we iteratively set the highest-scoring response as a preferred response derived from sampling predictions and train LLMs to align with the preferred response that improves factuality. We highlight that, even on evaluation metrics not used during training, LLMs trained with our OLAPH framework demonstrate significant performance improvement in factuality. Our findings reveal that a 7B LLM trained with our OLAPH framework can provide long answers comparable to the medical experts' answers in terms of factuality. We believe that our work could shed light on gauging the long-text generation ability of LLMs in the medical domain. Our code and datasets are available at https://github.com/dmis-lab/OLAPH}{https://github.com/dmis-lab/OLAPH.

The propensity of abstractive summarization models to make factual errors has been studied extensively, including design of metrics to detect factual errors and annotation of errors in current systems' outputs. However, the ever-evolving nature of summarization systems, metrics, and annotated benchmarks makes factuality evaluation a moving target, and drawing clear comparisons among metrics has become increasingly difficult. In this work, we aggregate factuality error annotations from nine existing datasets and stratify them according to the underlying summarization model. We compare performance of state-of-the-art factuality metrics, including recent ChatGPT-based metrics, on this stratified benchmark and show that their performance varies significantly across different types of summarization models. Critically, our analysis shows that much of the recent improvement in the factuality detection space has been on summaries from older (pre-Transformer) models instead of more relevant recent summarization models. We further perform a finer-grained analysis per error-type and find similar performance variance across error types for different factuality metrics. Our results show that no one metric is superior in all settings or for all error types, and we provide recommendations for best practices given these insights.

Multimodal hallucination in multimodal large language models (MLLMs) restricts the correctness of MLLMs. However, multimodal hallucinations are multi-sourced and arise from diverse causes. Existing benchmarks fail to adequately distinguish between perception-induced hallucinations and reasoning-induced hallucinations. This failure constitutes a significant issue and hinders the diagnosis of multimodal reasoning failures within MLLMs. To address this, we propose the {\dataset} benchmark, which isolates reasoning hallucinations by constructing questions where input images are correctly perceived by MLLMs yet reasoning errors persist. {\dataset} introduces multi-granular evaluation metrics: accuracy, factuality, and LLMs hallucination score for hallucination quantification. Our analysis reveals that (1) the model scale, data scale, and training stages significantly affect the degree of logical, fabrication, and factual hallucinations; (2) current MLLMs show no effective improvement on spatial hallucinations caused by misinterpreted spatial relationships, indicating their limited visual reasoning capabilities; and (3) question types correlate with distinct hallucination patterns, highlighting targeted challenges and potential mitigation strategies. To address these challenges, we propose {\method}, a method that combines curriculum reinforcement fine-tuning to encourage models to generate logic-consistent reasoning chains by stepwise reducing learning difficulty, and collaborative hint inference to reduce reasoning complexity. {\method} establishes a baseline on {\dataset}, and reduces the logical hallucinations in original base models.

In this research, we introduce BEATS, a novel framework for evaluating Bias, Ethics, Fairness, and Factuality in Large Language Models (LLMs). Building upon the BEATS framework, we present a bias benchmark for LLMs that measure performance across 29 distinct metrics. These metrics span a broad range of characteristics, including demographic, cognitive, and social biases, as well as measures of ethical reasoning, group fairness, and factuality related misinformation risk. These metrics enable a quantitative assessment of the extent to which LLM generated responses may perpetuate societal prejudices that reinforce or expand systemic inequities. To achieve a high score on this benchmark a LLM must show very equitable behavior in their responses, making it a rigorous standard for responsible AI evaluation. Empirical results based on data from our experiment show that, 37.65\% of outputs generated by industry leading models contained some form of bias, highlighting a substantial risk of using these models in critical decision making systems. BEATS framework and benchmark offer a scalable and statistically rigorous methodology to benchmark LLMs, diagnose factors driving biases, and develop mitigation strategies. With the BEATS framework, our goal is to help the development of more socially responsible and ethically aligned AI models.

Large language models show improved downstream task performance when prompted to generate step-by-step reasoning to justify their final answers. These reasoning steps greatly improve model interpretability and verification, but objectively studying their correctness (independent of the final answer) is difficult without reliable methods for automatic evaluation. We simply do not know how often the stated reasoning steps actually support the final end task predictions. In this work, we present ROSCOE, a suite of interpretable, unsupervised automatic scores that improve and extend previous text generation evaluation metrics. To evaluate ROSCOE against baseline metrics, we design a typology of reasoning errors and collect synthetic and human evaluation scores on commonly used reasoning datasets. In contrast with existing metrics, ROSCOE can measure semantic consistency, logicality, informativeness, fluency, and factuality - among other traits - by leveraging properties of step-by-step rationales. We empirically verify the strength of our metrics on five human annotated and six programmatically perturbed diagnostics datasets - covering a diverse set of tasks that require reasoning skills and show that ROSCOE can consistently outperform baseline metrics.

As requirements drift with rapid iterations, agile development becomes the dominant paradigm. Goal-driven Requirements Elicitation (RE) is a pivotal yet challenging task in agile project development due to its heavy tangling with adaptive planning and efficient collaboration. Recently, AI agents have shown promising ability in supporting requirements analysis by saving significant time and effort for stakeholders. However, current research mainly focuses on functional RE, and research works have not been reported bridging the long journey from goal to user stories. Moreover, considering the cost of LLM facilities and the need for data and idea protection, privately hosted small-sized LLM should be further utilized in RE. To address these challenges, we propose Goal2Story, a multi-agent fleet that adopts the Impact Mapping (IM) framework while merely using cost-effective sLLMs for goal-driven RE. Moreover, we introduce a StorySeek dataset that contains over 1,000 user stories (USs) with corresponding goals and project context information, as well as the semi-automatic dataset construction method. For evaluation, we proposed two metrics: Factuality Hit Rate (FHR) to measure consistency between the generated USs with the dataset and Quality And Consistency Evaluation (QuACE) to evaluate the quality of the generated USs. Experimental results demonstrate that Goal2Story outperforms the baseline performance of the Super-Agent adopting powerful LLMs, while also showcasing the performance improvements in key metrics brought by CoT and Agent Profile to Goal2Story, as well as its exploration in identifying latent needs.

A wide variety of NLP applications, such as machine translation, summarization, and dialog, involve text generation. One major challenge for these applications is how to evaluate whether such generated texts are actually fluent, accurate, or effective. In this work, we conceptualize the evaluation of generated text as a text generation problem, modeled using pre-trained sequence-to-sequence models. The general idea is that models trained to convert the generated text to/from a reference output or the source text will achieve higher scores when the generated text is better. We operationalize this idea using BART, an encoder-decoder based pre-trained model, and propose a metric BARTScore with a number of variants that can be flexibly applied in an unsupervised fashion to evaluation of text from different perspectives (e.g. informativeness, fluency, or factuality). BARTScore is conceptually simple and empirically effective. It can outperform existing top-scoring metrics in 16 of 22 test settings, covering evaluation of 16 datasets (e.g., machine translation, text summarization) and 7 different perspectives (e.g., informativeness, factuality). Code to calculate BARTScore is available at https://github.com/neulab/BARTScore, and we have released an interactive leaderboard for meta-evaluation at http://explainaboard.nlpedia.ai/leaderboard/task-meval/ on the ExplainaBoard platform, which allows us to interactively understand the strengths, weaknesses, and complementarity of each metric.

We present Gyan AI Paramanu ("atom"), a family of novel language models for Indian languages. It is a collection of auto-regressive monolingual, bilingual, and multilingual Indic language models pretrained from scratch on a single GPU for 10 Indian languages (Assamese, Bangla, Hindi, Konkani, Maithili, Marathi, Odia, Sanskrit, Tamil, Telugu) across 5 scripts (Bangla, Devanagari, Odia, Tamil, Telugu) of varying sizes ranging from 13.29M to 367.5M.The models are pretrained with a context size of 1024 on a single GPU. The models are very efficient, small, fast, and powerful. We have also developed an efficient most advanced Indic tokenizer that can even tokenize unseen languages. In order to avoid the "curse of multi-linguality" in our multilingual mParamanu model, we pretrained on comparable corpora by typological grouping using the same script. We performed human evaluation of our pretrained models for open end text generation on grammar, coherence, creativity, and factuality metrics for Bangla, Hindi, and Sanskrit. Our Bangla, Hindi, and Sanskrit models outperformed GPT-3.5-Turbo (ChatGPT), Bloom 7B, LLaMa-2 7B, OPT 6.7B, GPT-J 6B, GPTNeo 1.3B, GPT2-XL large language models (LLMs) by a large margin despite being smaller in size by 66 to 20 times compared to standard 7B LLMs. To run inference on our pretrained models, CPU is enough, and GPU is not needed. We also instruction-tuned our pretrained Bangla, Hindi, Marathi, Tamil, and Telugu models on 23k instructions in respective languages. Our pretrained and instruction-tuned models which are first of its kind, most powerful efficient small generative language models ever developed for Indic languages, and the various results lead to the conclusion that high quality generative language models are possible without high amount of compute power and humongous number of parameters. We plan to release our models at https://www.bharatgpts.com.

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world clinics. Frontier general-domain models such as GPT-4V still have significant performance gaps in multimodal biomedical applications. More importantly, less-acknowledged pragmatic issues, including accessibility, model cost, and tedious manual evaluation make it hard for clinicians to use state-of-the-art large models directly on private patient data. Here, we explore training open-source small multimodal models (SMMs) to bridge competency gaps for unmet clinical needs in radiology. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space, as exemplified by LLaVA-Med. For training, we assemble a large dataset of over 697 thousand radiology image-text pairs. For evaluation, we propose CheXprompt, a GPT-4-based metric for factuality evaluation, and demonstrate its parity with expert evaluation. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LlaVA-Rad (7B) model attains state-of-the-art results on standard radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). The inference of LlaVA-Rad is fast and can be performed on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

While modern visual generation models excel at creating aesthetically pleasing natural images, they struggle with producing or editing structured visuals like charts, diagrams, and mathematical figures, which demand composition planning, text rendering, and multimodal reasoning for factual fidelity. To address this, we present the first comprehensive, systematic investigation of this domain, encompassing data construction, model training, and an evaluation benchmark. First, we construct a large-scale dataset of 1.3 million high-quality structured image pairs derived from executable drawing programs and augmented with chain-of-thought reasoning annotations. Building on it, we train a unified model that integrates a VLM with FLUX.1 Kontext via a lightweight connector for enhanced multimodal understanding. A three-stage training curriculum enables progressive feature alignment, knowledge infusion, and reasoning-augmented generation, further boosted by an external reasoner at inference time. Finally, we introduce StructBench, a novel benchmark for generation and editing with over 1,700 challenging instances, and an accompanying evaluation metric, StructScore, which employs a multi-round Q\&A protocol to assess fine-grained factual accuracy. Evaluations of 15 models reveal that even leading closed-source systems remain far from satisfactory. Our model attains strong editing performance, and inference-time reasoning yields consistent gains across diverse architectures. By releasing the dataset, model, and benchmark, we aim to advance unified multimodal foundations for structured visuals.

Legal claims refer to the plaintiff's demands in a case and are essential to guiding judicial reasoning and case resolution. While many works have focused on improving the efficiency of legal professionals, the research on helping non-professionals (e.g., plaintiffs) remains unexplored. This paper explores the problem of legal claim generation based on the given case's facts. First, we construct ClaimGen-CN, the first dataset for Chinese legal claim generation task, from various real-world legal disputes. Additionally, we design an evaluation metric tailored for assessing the generated claims, which encompasses two essential dimensions: factuality and clarity. Building on this, we conduct a comprehensive zero-shot evaluation of state-of-the-art general and legal-domain large language models. Our findings highlight the limitations of the current models in factual precision and expressive clarity, pointing to the need for more targeted development in this domain. To encourage further exploration of this important task, we will make the dataset publicly available.

Human feedback has become the de facto standard for evaluating the performance of Large Language Models, and is increasingly being used as a training objective. However, it is not clear which properties of a generated output this single `preference' score captures. We hypothesise that preference scores are subjective and open to undesirable biases. We critically analyse the use of human feedback for both training and evaluation, to verify whether it fully captures a range of crucial error criteria. We find that while preference scores have fairly good coverage, they under-represent important aspects like factuality. We further hypothesise that both preference scores and error annotation may be affected by confounders, and leverage instruction-tuned models to generate outputs that vary along two possible confounding dimensions: assertiveness and complexity. We find that the assertiveness of an output skews the perceived rate of factuality errors, indicating that human annotations are not a fully reliable evaluation metric or training objective. Finally, we offer preliminary evidence that using human feedback as a training objective disproportionately increases the assertiveness of model outputs. We encourage future work to carefully consider whether preference scores are well aligned with the desired objective.

Large language models (LLMs) typically generate identical or similar responses for all users given the same prompt, posing serious safety risks in high-stakes applications where user vulnerabilities differ widely. Existing safety evaluations primarily rely on context-independent metrics - such as factuality, bias, or toxicity - overlooking the fact that the same response may carry divergent risks depending on the user's background or condition. We introduce personalized safety to fill this gap and present PENGUIN - a benchmark comprising 14,000 scenarios across seven sensitive domains with both context-rich and context-free variants. Evaluating six leading LLMs, we demonstrate that personalized user information significantly improves safety scores by 43.2%, confirming the effectiveness of personalization in safety alignment. However, not all context attributes contribute equally to safety enhancement. To address this, we develop RAISE - a training-free, two-stage agent framework that strategically acquires user-specific background. RAISE improves safety scores by up to 31.6% over six vanilla LLMs, while maintaining a low interaction cost of just 2.7 user queries on average. Our findings highlight the importance of selective information gathering in safety-critical domains and offer a practical solution for personalizing LLM responses without model retraining. This work establishes a foundation for safety research that adapts to individual user contexts rather than assuming a universal harm standard.

This survey addresses the crucial issue of factuality in Large Language Models (LLMs). As LLMs find applications across diverse domains, the reliability and accuracy of their outputs become vital. We define the Factuality Issue as the probability of LLMs to produce content inconsistent with established facts. We first delve into the implications of these inaccuracies, highlighting the potential consequences and challenges posed by factual errors in LLM outputs. Subsequently, we analyze the mechanisms through which LLMs store and process facts, seeking the primary causes of factual errors. Our discussion then transitions to methodologies for evaluating LLM factuality, emphasizing key metrics, benchmarks, and studies. We further explore strategies for enhancing LLM factuality, including approaches tailored for specific domains. We focus two primary LLM configurations standalone LLMs and Retrieval-Augmented LLMs that utilizes external data, we detail their unique challenges and potential enhancements. Our survey offers a structured guide for researchers aiming to fortify the factual reliability of LLMs.

Modern abstractive summarization models often generate summaries that contain hallucinated or contradictory information. In this paper, we propose a simple but effective contrastive learning framework that incorporates recent developments in reward learning and factuality metrics. Empirical studies demonstrate that the proposed framework enables summarization models to learn from feedback of factuality metrics using contrastive reward learning, leading to more factual summaries by human evaluations. This suggests that further advances in learning and evaluation algorithms can feed directly into providing more factual summaries.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Recent advances in reasoning-enhanced large language models (LLMs) and multimodal LLMs (MLLMs) have significantly improved performance in complex tasks, yet medical AI models often overlook the structured reasoning processes inherent in clinical practice. In this work, we present ChestX-Reasoner, a radiology diagnosis MLLM designed to leverage process supervision mined directly from clinical reports, reflecting the step-by-step reasoning followed by radiologists. We construct a large dataset by extracting and refining reasoning chains from routine radiology reports. Our two-stage training framework combines supervised fine-tuning and reinforcement learning guided by process rewards to better align model reasoning with clinical standards. We introduce RadRBench-CXR, a comprehensive benchmark featuring 59K visual question answering samples with 301K clinically validated reasoning steps, and propose RadRScore, a metric evaluating reasoning factuality, completeness, and effectiveness. ChestX-Reasoner outperforms existing medical and general-domain MLLMs in both diagnostic accuracy and reasoning ability, achieving 16%, 5.9%, and 18% improvements in reasoning ability compared to the best medical MLLM, the best general MLLM, and its base model, respectively, as well as 3.3%, 24%, and 27% improvements in outcome accuracy. All resources are open-sourced to facilitate further research in medical reasoning MLLMs.