Automatically generated radiology reports often receive high scores from existing evaluation metrics but fail to earn clinicians’ trust. This gap reveals fundamental flaws in how current metrics assess the quality of generated reports. We rethink the design and evaluation of these metrics and propose a clinically grounded Meta-Evaluation framework. We define clinically grounded criteria spanning clinical alignment and key metric capabilities, including discrimination, robustness, and monotonicity. Using a fine-grained dataset of ground truth and rewritten report pairs annotated with error types, clinical significance labels, and explanations, we systematically evaluate existing metrics and reveal their limitations in interpreting clinical semantics, such as failing to distinguish clinically significant errors, over-penalizing harmless variations, and lacking consistency across error severity levels. Our framework offers guidance for building more clinically reliable evaluation methods.

Large Language Models (LLMs) have emerged as a pivotal research area, yet the attention module remains a critical bottleneck in LLM inference, even with techniques like KVCache to mitigate redundant computations. While various top-k attention mechanisms have been proposed to accelerate LLM inference by exploiting the inherent sparsity of attention, they often struggled to strike a balance between efficiency and accuracy. In this paper, we introduce HATA (Hash-Aware Top-k Attention), a novel approach that systematically integrates low-overhead learning-to-hash techniques into the Top-k attention process. Different from the existing top-k attention methods which are devoted to seeking an absolute estimation of qk score, typically with a great cost, HATA maps queries and keys into binary hash codes, and acquires the relative qk score order with a quite low cost, which is sufficient for realizing top-k attention. Extensive experiments demonstrate that HATA achieves up to 7.2× speedup compared to vanilla full attention while maintaining model accuracy. In addition, HATA outperforms the state-of-the-art top-k attention methods in both accuracy and efficiency across multiple mainstream LLM models and diverse tasks. HATA is open source at https://github.com/gpzlx1/HATA.