Electrocardiogram (ECG) is the primary non-invasive diagnostic tool for monitoring cardiac conditions and is crucial in assisting clinicians. Recent studies have concentrated on classifying cardiac conditions using ECG data but have overlooked ECG report generation, which is time-consuming and requires clinical expertise. To automate ECG report generation and ensure its versatility, we propose the Multimodal ECG Instruction Tuning (MEIT) framework, the first attempt to tackle ECG report generation with LLMs and multimodal instructions. To facilitate future research, we establish a benchmark to evaluate MEIT with various LLMs backbones across two large-scale ECG datasets. Our approach uniquely aligns the representations of the ECG signal and the report, and we conduct extensive experiments to benchmark MEIT with nine open-source LLMs using more than 800,000 ECG reports. MEIT’s results underscore the superior performance of instruction-tuned LLMs, showcasing their proficiency in quality report generation, zero-shot capabilities, resilience to signal perturbation, and alignment with human expert evaluation. These findings emphasize the efficacy of our MEIT framework and its potential for real-world clinical application.

Medical Vision-Language Pre-training (MedVLP) has made significant progress in enabling zero-shot tasks for medical image understanding. However, training MedVLP models typically requires large-scale datasets with paired, high-quality image-text data, which are scarce in the medical domain. Recent advancements in Large Language Models (LLMs) and diffusion models have made it possible to generate large-scale synthetic image-text pairs. This raises the question: Can MedVLP succeed using purely synthetic data? To address this, we use off-the-shelf generative models to create synthetic radiology reports and paired Chest X-ray (CXR) images, and propose an automated pipeline to build a diverse, high-quality synthetic dataset, enabling a rigorous study that isolates model and training settings, focusing entirely from the data perspective.Our results show that MedVLP models trained exclusively on synthetic data outperform those trained on real data by 3.8% in averaged AUC on zero-shot classification. Moreover, using a combination of synthetic and real data leads to a further improvement of 9.07%. Additionally, MedVLP models trained on synthetic or mixed data consistently outperform those trained on real data in zero-shot grounding, as well as in fine-tuned classification and segmentation tasks.Our analysis suggests MedVLP trained on well-designed synthetic data can outperform models trained on real datasets, which may be limited by low-quality samples and long-tailed distributions[^1].[^1]: All data and code will be released upon acceptance.

Automatic radiology report generation holds significant potential to streamline the labor-intensive process of report writing by radiologists, particularly for 3D radiographs such as CT scans. While CT scans are critical for clinical diagnostics, they remain less explored compared to 2D radiographs. To date, there has been no comprehensive benchmark for 3D radiograph report generation (3DRRG), nor sufficient investigation into the optimal training strategies for Vision Language Models (VLMs) in this context, particularly with respect to vision encoder choices, visual token compression, and model scaling.In this work, we make two three contributions. We curate CT-3DRRG, the largest publicly available 3D CT-report dataset, establishing a robust and diverse benchmark for evaluating VLM performance on 3DRRG. Furthermore, we propose a comprehensive training recipe for building high-performing VLMs for 3DRRG, exploring key factors such as vision encoder pretraining strategies, visual token compression, and the impact of data & model scale. Guided by these findings, we introduce Argus, a state-of-the-art family of VLMs that achieve superior performance across different model sizes and input 3D medical image resolutions, efficiently processing high-resolution 3D images up to 512 × 512 × 256.