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arXiv · 2601.03733

RadDiff: Describing Differences in Radiology Image Sets with Natural Language

Xiaoxian Shen·Yuhui Zhang·Sahithi Ankireddy·Xiaohan Wang·Maya Varma·Henry Guo·Curtis Langlotz·Serena Yeung-Levy
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Abstract

Understanding how two radiology image sets differ is critical for generating clinical insights and for interpreting medical AI systems. We introduce RadDiff, a multimodal agentic system that performs radiologist-style comparative reasoning to describe clinically meaningful differences between paired radiology studies. RadDiff builds on a proposer-ranker framework from VisDiff, and incorporates four innovations inspired by real diagnostic workflows: (1) medical knowledge injection through domain-adapted vision-language models; (2) multimodal reasoning that integrates images with their clinical reports; (3) iterative hypothesis refinement across multiple reasoning rounds; and (4) targeted visual search that localizes and zooms in on salient regions to capture subtle findings. To evaluate RadDiff, we construct RadDiffBench, a challenging benchmark comprising 57 expert-validated radiology study pairs with ground-truth difference descriptions. On RadDiffBench, RadDiff achieves 47% accuracy, and 50% accuracy when guided by ground-truth reports, significantly outperforming the general-domain VisDiff baseline. We further demonstrate RadDiff's versatility across diverse clinical tasks, including COVID-19 phenotype comparison, racial subgroup analysis, and discovery of survival-related imaging features. Together, RadDiff and RadDiffBench provide the first method-and-benchmark foundation for systematically uncovering meaningful differences in radiological data.

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Xiaoxian Shen, Yuhui Zhang, Sahithi Ankireddy, Xiaohan Wang, Maya Varma, Henry Guo, Curtis Langlotz, Serena Yeung-Levy. 2026-01-07. RadDiff: Describing Differences in Radiology Image Sets with Natural Language. https://arxiv.org/abs/2601.03733

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