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arXiv · 2604.09450

ECHO: Efficient Chest X-ray Report Generation with One-step Block Diffusion

Lifeng Chen·Tianqi You·Hao Liu·Zhimin Bao·Jile Jiao·Xiao Han·Zhicai Ou·Tao Sun·Xiaofeng Mou·Xiaojie Jin·Yi Xu
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Abstract

Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose \textbf{ECHO}, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by \textbf{64.33\%} and \textbf{60.58\%} respectively, while achieving up to \textbf{$8\times$} inference speedup with negligible degradation in clinical accuracy.

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Lifeng Chen, Tianqi You, Hao Liu, Zhimin Bao, Jile Jiao, Xiao Han, Zhicai Ou, Tao Sun, Xiaofeng Mou, Xiaojie Jin, Yi Xu. 2026-05-17. ECHO: Efficient Chest X-ray Report Generation with One-step Block Diffusion. https://arxiv.org/abs/2604.09450

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