Radiology reports are essential for diagnostic reasoning and patient care, yet their manual preparation is time-consuming and cognitively demanding. Automatic radiology report generation (RRG) offers a scalable alternative, but existing models often produce lengthy, unstructured narratives that overlook diagnostic cues and multi-view information.

We present Clinical-Knowledge Guided Disease-aware Visual-Textual Alignment for QA-Style Radiology Report Generation (CliQ-RRG), a unified two-stage framework for interpretable and clinically grounded reporting. In Stage 1, CliQ-RRG employs a Disease-aware Visual-Textual Alignment module that aligns image and text representations using predicted disease embeddings, reinforced by a Prior-Guided Attention Module (PrAM) to capture multi-view dependencies across current and prior scans.

In Stage 2, GraphRAG-guided retrieval augments intermediate textual representations with graph-grounded clinical evidence, and a large language model restructures them into concise, interpretable question-answer (QA) pairs with diagnostic summaries. Experiments on two public chest X-ray benchmarks demonstrate that CliQ-RRG consistently outperforms prior methods across both lexical and clinical metrics, generating accurate and clinically coherent QA-style radiology reports.

Code is available at: https://github.com/chandravardhan-singh-raghaw/CliQ-RRG.