# INTRODUCTION
@article{buess2025large,
  title={From large language models to multimodal AI: a scoping review on the potential of generative AI in medicine},
  author={Buess, Lukas and Keicher, Matthias and Navab, Nassir and Maier, Andreas and Tayebi Arasteh, Soroosh},
  journal={Biomedical Engineering Letters},
  volume={15},
  number={5},
  pages={845--863},
  year={2025},
  publisher={Springer}
}

@article{buess2025speechct,
  title={SpeechCT-CLIP: Distilling Text-Image Knowledge to Speech for Voice-Native Multimodal CT Analysis},
  author={Buess, Lukas and Geier, Jan and Bani-Harouni, David and Pellegrini, Chantal and Keicher, Matthias and Perez-Toro, Paula Andrea and Navab, Nassir and Maier, Andreas and Arias-Vergara, Tomas},
  journal={arXiv preprint arXiv:2510.02322},
  year={2025}
}

@inproceedings{pellegrini2025radialog,
  title={Radialog: Large vision-language models for x-ray reporting and dialog-driven assistance},
  author={Pellegrini, Chantal and {\"O}zsoy, Ege and Busam, Benjamin and Wiestler, Benedikt and Navab, Nassir and Keicher, Matthias},
  booktitle={Medical Imaging with Deep Learning},
  year={2025}
}

@article{hyland2023maira,
  title={Maira-1: A specialised large multimodal model for radiology report generation},
  author={Hyland, Stephanie L and Bannur, Shruthi and Bouzid, Kenza and Castro, Daniel C and Ranjit, Mercy and Schwaighofer, Anton and P{\'e}rez-Garc{\'\i}a, Fernando and Salvatelli, Valentina and Srivastav, Shaury and Thieme, Anja and others},
  journal={arXiv preprint arXiv:2311.13668},
  year={2023}
}

@article{zhang2024radgenome,
  title={Radgenome-chest ct: A grounded vision-language dataset for chest ct analysis},
  author={Zhang, Xiaoman and Wu, Chaoyi and Zhao, Ziheng and Lei, Jiayu and Zhang, Ya and Wang, Yanfeng and Xie, Weidi},
  journal={arXiv preprint arXiv:2404.16754},
  year={2024}
}

@inproceedings{liu2025t3d,
  title={T3D: Advancing 3D Medical Vision-Language Pre-training by Learning Multi-View Visual Consistency},
  author={Liu, Che and Ouyang, Cheng and Chen, Yinda and Quilodr{\'a}n-Casas, C{\'e}sar and Ma, Lei and Fu, Jie and Guo, Yike and Shah, Anand and Bai, Wenjia and Arcucci, Rossella},
  booktitle={Proceedings of the IEEE/CVF International Conference on Computer Vision},
  pages={6704--6714},
  year={2025}
}

@article{hamamci2025better,
  title={Better Tokens for Better 3D: Advancing Vision-Language Modeling in 3D Medical Imaging},
  author={Hamamci, Ibrahim Ethem and Er, Sezgin and Shit, Suprosanna and Reynaud, Hadrien and Yang, Dong and Guo, Pengfei and Edgar, Marc and Xu, Daguang and Kainz, Bernhard and Menze, Bjoern},
  journal={arXiv preprint arXiv:2510.20639},
  year={2025}
}

@inproceedings{hein2025chexalign,
  title={CheXalign: Preference fine-tuning in chest X-ray interpretation models without human feedback},
  author={Hein, Dennis and Chen, Zhihong and Ostmeier, Sophie and Xu, Justin and Varma, Maya and Reis, Eduardo Pontes and Md, Arne Edward Michalson and Bluethgen, Christian and Shin, Hyun Joo and Langlotz, Curtis and others},
  booktitle={Proceedings of the 63rd Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers)},
  pages={27679--27702},
  year={2025}
}

@article{jiang2025hulu,
  title={Hulu-med: A transparent generalist model towards holistic medical vision-language understanding},
  author={Jiang, Songtao and Wang, Yuan and Song, Sibo and Hu, Tianxiang and Zhou, Chenyi and Pu, Bin and Zhang, Yan and Yang, Zhibo and Feng, Yang and Zhou, Joey Tianyi and others},
  journal={arXiv preprint arXiv:2510.08668},
  year={2025}
}


# RELATED WORK
@inproceedings{delbrouck2025automated,
  title={Automated structured radiology report generation},
  author={Delbrouck, Jean-Benoit and Xu, Justin and Moll, Johannes and Thomas, Alois and Chen, Zhihong and Ostmeier, Sophie and Azhar, Asfandyar and Li, Kelvin Zhenghao and Johnston, Andrew and Bluethgen, Christian and others},
  booktitle={Proceedings of the 63rd Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers)},
  pages={26813--26829},
  year={2025}
}

@inproceedings{keicher2024flexr,
  title={Flexr: Few-shot classification with language embeddings for structured reporting of chest x-rays},
  author={Keicher, Matthias and Zaripova, Kamilia and Czempiel, Tobias and Mach, Kristina and Khakzar, Ashkan and Navab, Nassir},
  booktitle={Medical Imaging with Deep Learning},
  pages={1493--1508},
  year={2024},
  organization={PMLR}
}

@article{mao2025ct,
  title={CT-Agent: A Multimodal-LLM Agent for 3D CT Radiology Question Answering},
  author={Mao, Yuren and Xu, Wenyi and Qin, Yuyang and Gao, Yunjun},
  journal={arXiv preprint arXiv:2505.16229},
  year={2025}
}

@article{zhang2025rexgradient,
  title={ReXGradient-160K: A Large-Scale Publicly Available Dataset of Chest Radiographs with Free-text Reports},
  author={Zhang, Xiaoman and Acosta, Juli{\'a}n N and Miller, Josh and Huang, Ouwen and Rajpurkar, Pranav},
  journal={arXiv preprint arXiv:2505.00228},
  year={2025}
}

@article{johnson2019mimic,
  title={MIMIC-CXR, a de-identified publicly available database of chest radiographs with free-text reports},
  author={Johnson, Alistair EW and Pollard, Tom J and Berkowitz, Seth J and Greenbaum, Nathaniel R and Lungren, Matthew P and Deng, Chih-ying and Mark, Roger G and Horng, Steven},
  journal={Scientific data},
  volume={6},
  number={1},
  pages={317},
  year={2019},
  publisher={Nature Publishing Group UK London}
}

@inproceedings{moll2025structuring,
  title={Structuring Radiology Reports: Challenging LLMs with Lightweight Models},
  author={Moll, Johannes and Fay, Louisa and Azhar, Asfandyar and Ostmeier, Sophie and Gatidis, Sergios and Lueth, Tim C and Langlotz, Curtis and Delbrouck, Jean-Benoit},
  booktitle={Proceedings of the 2025 Conference on Empirical Methods in Natural Language Processing},
  pages={7718--7735},
  year={2025}
}

@article{salmi2024handling,
  title={Handling imbalanced medical datasets: review of a decade of research},
  author={Salmi, Mabrouka and Atif, Dalia and Oliva, Diego and Abraham, Ajith and Ventura, Sebastian},
  journal={Artificial intelligence review},
  volume={57},
  number={10},
  pages={273},
  year={2024},
  publisher={Springer}
}

@inproceedings{liu2025anatomy,
  title={Anatomy-aware Data Augmentation for Multi-organ Segmentation in CT: AnatoMix},
  author={Liu, Chang and Fan, Fuxin and Schwarz, Annette and Maier, Andreas},
  booktitle={BVM Workshop},
  pages={136--141},
  year={2025},
  organization={Springer}
}

@article{yun2011effective,
  title={An effective over-sampling method for imbalanced data sets classification},
  author={Yun, ZHAI and Nan, Ma and Da, Ruan and Bing, AN},
  journal={Chinese Journal of Electronics},
  volume={20},
  number={3},
  pages={489--494},
  year={2011},
  publisher={CIE}
}

@article{chawla2002smote,
  title={SMOTE: synthetic minority over-sampling technique},
  author={Chawla, Nitesh V and Bowyer, Kevin W and Hall, Lawrence O and Kegelmeyer, W Philip},
  journal={Journal of artificial intelligence research},
  volume={16},
  pages={321--357},
  year={2002}
}

@article{agrawal2025pillar,
  title={Pillar-0: A New Frontier for Radiology Foundation Models},
  author={Agrawal, Kumar Krishna and Liu, Longchao and Lian, Long and Nercessian, Michael and Harguindeguy, Natalia and Wu, Yufu and Mikhael, Peter and Lin, Gigin and Sequist, Lecia V and Fintelmann, Florian and others},
  journal={arXiv preprint arXiv:2511.17803},
  year={2025}
}


# METHODS


# EXPERIMENTAL SETUP
@article{draelos2021machine,
  title={Machine-learning-based multiple abnormality prediction with large-scale chest computed tomography volumes},
  author={Draelos, Rachel Lea and Dov, David and Mazurowski, Maciej A and Lo, Joseph Y and Henao, Ricardo and Rubin, Geoffrey D and Carin, Lawrence},
  journal={Medical image analysis},
  volume={67},
  pages={101857},
  year={2021},
  publisher={Elsevier}
}

@article{hu2022lora,
  title={Lora: Low-rank adaptation of large language models.},
  author={Hu, Edward J and Shen, Yelong and Wallis, Phillip and Allen-Zhu, Zeyuan and Li, Yuanzhi and Wang, Shean and Wang, Lu and Chen, Weizhu and others},
  journal={ICLR},
  volume={1},
  number={2},
  pages={3},
  year={2022}
}

@article{ji2022amos,
    title     = {Amos: A large-scale abdominal multi-organ benchmark for versatile 
                 medical image segmentation},
    author    = {Ji, Yuanfeng and Bai, Haotian and Ge, Chongjian and Yang, Jie 
                 and Zhu, Ye and Zhang, Ruimao and Li, Zhen and Zhanng, Lingyan 
                 and Ma, Wanling and Wan, Xiang and others},
    journal   = {Advances in neural information processing systems},
    volume    = {35},
    pages     = {36722--36732},
    year      = {2022}
}

@software{axolotl,
  title = {Axolotl: Open Source LLM Post-Training},
  author = {{Axolotl maintainers and contributors}},
  url = {https://github.com/axolotl-ai-cloud/axolotl},
  license = {Apache-2.0},
  year = {2023}
}


# RESULTS AND DISCUSSION


# CONCLUSION


# APPENDIX
@article{wasserthal2023totalsegmentator,
  title={TotalSegmentator: robust segmentation of 104 anatomic structures in CT images},
  author={Wasserthal, Jakob and Breit, Hanns-Christian and Meyer, Manfred T and Pradella, Maurice and Hinck, Daniel and Sauter, Alexander W and Heye, Tobias and Boll, Daniel T and Cyriac, Joshy and Yang, Shan and others},
  journal={Radiology: Artificial Intelligence},
  volume={5},
  number={5},
  pages={e230024},
  year={2023},
  publisher={Radiological Society of North America}
}

@article{hamamci2026generalist,
  title={Generalist foundation models from a multimodal dataset for 3D computed tomography},
  author={Hamamci, Ibrahim Ethem and Er, Sezgin and Wang, Chenyu and Almas, Furkan and Simsek, Ayse Gulnihan and Esirgun, Sevval Nil and Dogan, Irem and Durugol, Omer Faruk and Hou, Benjamin and Shit, Suprosanna and others},
  journal={Nature Biomedical Engineering},
  pages={1--19},
  year={2026},
  publisher={Nature Publishing Group UK London}
}

@inproceedings{hamamci2025crg,
  title={CRG Score: A Distribution-Aware Clinical Metric for Radiology Report Generation},
  author={Hamamci, Ibrahim Ethem and Er, Sezgin and Shit, Suprosanna and Reynaud, Hadrien and Kainz, Bernhard and Menze, Bjoern},
  booktitle={Medical Imaging with Deep Learning-Short Papers},
  year={2025}
}

@inproceedings{hamamci2024ct2rep,
      title={Ct2rep: Automated radiology report generation for 3d medical imaging},
      author={Hamamci, Ibrahim Ethem and Er, Sezgin and Menze, Bjoern},
      booktitle={International Conference on Medical Image Computing and Computer-Assisted Intervention},
      pages={476--486},
      year={2024},
      organization={Springer}
}

@inproceedings{hamamci2024generatect,
      title={Generatect: Text-conditional generation of 3d chest ct volumes},
      author={Hamamci, Ibrahim Ethem and Er, Sezgin and Sekuboyina, Anjany and Simsar, Enis and Tezcan, Alperen and Simsek, Ayse Gulnihan and Esirgun, Sevval Nil and Almas, Furkan and Do{\u{g}}an, Irem and Dasdelen, Muhammed Furkan and others},
      booktitle={European Conference on Computer Vision},
      pages={126--143},
      year={2024},
      organization={Springer}
}

@article{blankemeier2026merlin,
  title={Merlin: a computed tomography vision--language foundation model and dataset},
  author={Blankemeier, Louis and Kumar, Ashwin and Cohen, Joseph Paul and Liu, Jiaming and Liu, Longchao and Van Veen, Dave and Gardezi, Syed Jamal Safdar and Yu, Hongkun and Paschali, Magdalini and Chen, Zhihong and others},
  journal={Nature},
  pages={1--11},
  year={2026},
  publisher={Nature Publishing Group UK London}
}

@article{ostmeier2024green,
  title={Green: Generative radiology report evaluation and error notation},
  author={Ostmeier, Sophie and Xu, Justin and Chen, Zhihong and Varma, Maya and Blankemeier, Louis and Bluethgen, Christian and Michalson, Arne Edward and Moseley, Michael and Langlotz, Curtis and Chaudhari, Akshay S and others},
  journal={arXiv preprint arXiv:2405.03595},
  year={2024}
}

@article{xu2025radeval,
  title={RadEval: A framework for radiology text evaluation},
  author={Xu, Justin and Zhang, Xi and Abderezaei, Javid and Bauml, Julie and Boodoo, Roger and Haghighi, Fatemeh and Ganjizadeh, Ali and Brattain, Eric and Van Veen, Dave and Meng, Zaiqiao and others},
  journal={arXiv preprint arXiv:2509.18030},
  year={2025}
}

@misc{acosta2024impactaiassistanceradiology,
  title={The Impact of AI Assistance on Radiology Reporting: A Pilot Study Using Simulated AI Draft Reports}, 
  author={Julián N. Acosta and Siddhant Dogra and Subathra Adithan and Kay Wu and Michael Moritz and Stephen Kwak and Pranav Rajpurkar},
  year={2024},
  eprint={2412.12042},
  archivePrefix={arXiv},
  primaryClass={cs.HC},
  url={https://arxiv.org/abs/2412.12042}, 
}