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arXiv

AbSteering steers general-purpose VideoLMs with abnormality-centric chain-of-thought and DPO to generate HRCT reports, surpassing large-scale CT-specific foundation models on fine-grained clinical metrics while improving detection sensitivity and reducing hallucinations.

The work presents AbSteering, a two-stage framework combining abnormality-centric chain-of-thought training with a Direct Preference Optimization objective for fine-grained abnormality discrimination, to adapt general-purpose VideoLMs to high-resolution CT report generation, and curates the CT-RATE-AB dataset; results show that general-purpose VideoLMs transfer effectively to 3D medical imaging under limited data, achieving state-of-the-art performance on fine-grained clinical efficacy metrics, with superior detection sensitivity over domain-specific CT foundation models pretrained on large-scale CTs while mitigating hallucinations.