Improving Chest X-Ray Report Generation by Leveraging Warm-Starting

Automatically generating a report from a patient’s Chest X-Rays (CXRs) is a promising solution to reducing clinical workload and improving patient care. However, current CXR report generators—which are predominantly encoder-to-decoder models—lack the diagnostic accuracy to be deployed in a clinical setting. To improve CXR report generation, we investigate warm-starting the encoder and decoder with recent open-source computer vision and natural language processing checkpoints, such as the Vision Transformer (ViT) and PubMedBERT. To this end, each checkpoint is evaluated on the MIMIC-CXR and IU X-Ray datasets using natural language generation and Clinical Efficacy (CE) metrics. Our experimental investigation demonstrates that the Convolutional vision Transformer (CvT) ImageNet-21K and the Distilled Generative Pre-trained Transformer 2 (DistilGPT2) checkpoints are best for warm-starting the encoder and decoder, respectively. Compared to the state-ofthe-art (M Transformer Progressive), CvT2DistilGPT2 attained an improvement of 8.3% for CE F-1, 1.8% for BLEU-4, 1.6% for ROUGE-L, and 1.0% for METEOR. The reports generated by CvT2DistilGPT2 are more diagnostically accurate and have a higher similarity to radiologist reports than previous approaches. By leveraging warm-starting, CvT2DistilGPT2 brings automatic CXR report generation one step closer to the clinical setting. CvT2DistilGPT2 and its MIMIC-CXR checkpoint are available at https://github.com/aehrc/cvt2distilgpt2.