DiA-gnostic VLVAE: Disentangled Alignment-Constrained Vision Language Variational AutoEncoder for Robust Radiology Reporting with Missing Modalities

Abstract

The integration of medical images with clinical context is essential for generating accurate and clinically interpretable radiology reports. However, current automated methods often rely on resource-heavy Large Language Models (LLMs) or static knowledge graphs and struggle with two fundamental challenges in real-world clinical data: (1) missing modalities, such as incomplete clinical context , and (2) feature entanglement, where mixed modality-specific and shared information leads to suboptimal fusion and clinically unfaithful hallucinated findings. To address these challenges, we propose the DiA-gnostic VLVAE, which achieves robust radiology reporting through Disentangled Alignment. Our framework is designed to be resilient to missing modalities by disentangling shared and modality-specific features using a Mixture-of-Experts (MoE) based Vision-Language Variational Autoencoder (VLVAE). A constrained optimization objective enforces orthogonality and alignment between these latent representations to prevent suboptimal fusion. A compact LLaMA-X decoder then uses these disentangled representations to generate reports efficiently. On the IU X-Ray and MIMIC-CXR datasets, DiA has set new state-of-the-art BLEU@4 scores of 0.266 and 0.134, respectively. Experimental results show that the proposed method significantly outperforms state-of-the-art models.