arXiv:2603.22935v1 Announce Type: new Abstract: Chest X-ray report generation and automated evaluation are limited by poor recognition of low-prevalence abnormalities and inadequate handling of clinically important language, including negation and ambiguity. We develop a clinician-guided framework combining human expertise and large language models for multi-label finding extraction from free-text chest X-ray reports and use it to define Ran Score, a finding-level metric for report evaluation. Using three non-overlapping MIMIC-CXR-EN cohorts from a public chest X-ray dataset and an independent ChestX-CN validation cohort, we optimize prompts, establish radiologist-derived reference labels and evaluate report generation models. The optimized framework improves the macro-averaged score from 0.753 to 0.956 on the MIMIC-CXR-EN development cohort, exceeds the CheXbert benchmark by 15.7 percentage points on directly comparable labels, and shows robust generalization on the ChestX-CN validation cohort. Here we show that clinician-guided prompt optimization improves agreement with a radiologist-derived reference standard and that Ran Score enables finding-level evaluation of report fidelity, particularly for low-prevalence abnormalities.

arXiv:2602.17686v2 Announce Type: replace-cross Abstract: Distilling Chain-of-Thought (CoT) reasoning from large language models into compact student models presents a fundamental challenge: teacher rationales are often too verbose for smaller models to faithfully reproduce. Existing approaches either compress reasoning into single-step, losing the interpretability that makes CoT valuable. We present a three-stage curriculum learning framework that addresses this capacity mismatch through progressive skill acquisition. First, we establish structural understanding via masked shuffled reconstruction. Second, we apply Group Relative Policy Optimization (GRPO) on masked completion tasks, enabling the model to discover its own balance between accuracy and brevity. Third, we identify persistent failure cases and guide the student to internalize teacher knowledge through targeted rewriting, again optimized with GRPO. Experiments on GSM8K demonstrate that our approach enables Qwen2.5-3B-Base to achieve an 11.29 percent accuracy improvement while reducing output length by 27.4 percent, surpassing both instruction-tuned variants and prior distillation methods.