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原文摘要

Radiology report generators often produce fluent text yet miss crucial details, leading to local semantic conflicts or flipped findings that require stronger penalties. **Cross-entropy (CE) merely increases the probability of the ground-truth token y^* without directly suppressing the model's current wrong choice \hat y **, and treats all positions uniformly, so corrections are not prioritized. We introduce a **self-adaptive optimization framework** that dynamically adjusts token-level gradients based on semantic discrepancy cues derived from a frozen LLM referee. The LLM itself is not the contribution--it merely provides weak supervision to trigger the adaptive learning process. Within this framework, (i) semantic conflicts between the predicted and reference reports are **automatically localized** and tagged with "..." (used only during training), and (ii) **adaptive, stronger penalties** are applied within these sparse but critical spans. Updates follow a *push-pull* scheme: error spans are pushed down, while non-error tokens are reinforced. The update strength is governed by two complementary signals--*normalized entropy* (for uncertainty calibration) and *focal-style confidence* (for handling over- and under-confident predictions). On MIMIC-CXR and IU-Xray, our framework consistently improves both language metrics (BLEU-4, ROUGE-L, CIDEr) and clinical metrics (RadGraph F1, CheXbert), and remains robust to noisy or imperfect error tags.