FAMDR: Feature-Aligned Multimodal Denoising for Reliable Diagnostic Reconciliation in Medical Imaging

This paper presents FAMDR, a Feature-Aligned Multimodal Denoising framework for Reliable Diagnostic Reconciliation. Existing approaches suffer from two major limitations: (1) an overemphasis on simplifying observational descriptions and (2) a failure to denoise the misleading content in radiological findings against clinical histories. Current methods often dismiss such cross-modal inconsistencies as noise rather than clinically significant signals. To bridge this gap, the framework integrates four synergistic components: (1) noise-aware multimodal alignment that preserves discriminative discrepancy features while ensuring semantic coherence, (2) cross-modal retrieval augmentation leveraging external medical knowledge to resolve ambiguous cases, (3) granular localization of noises at pixel and phrase levels using adaptive thresholding, and (4) medical noise uncertainty quantification to provide reliable confidence estimates. Evaluated on an extended MIMIC-CXR dataset enriched with expert-annotated noise and longitudinal records, FAMDR achieves superior accuracy in denoising and inconsistency localization while preserving clinical interpretability. Its capability to generate actionable, uncertainty-aware reports advances safer and more reliable integration into diagnostic workflows.