MedQ-UNI: Toward Unified Medical Image Quality Assessment and Restoration via Vision-Language Modeling

Image restoration aims to recover high quality images from inputs degraded by various factors, such as adverse weather, blur, or low light. While recent studies have shown remarkable progress across individual or unified restoration tasks, they still suffer from limited generalization and inefficiency when handling unknown or composite degradations. To address these limitations, we propose RAR, a Restore, Assess and Repeat process, that integrates Image Quality Assessment (IQA) and Image Restoration (IR) into a unified framework to iteratively and efficiently achieve high quality image restoration. Specifically, we introduce a restoration process that operates entirely in the latent domain to jointly perform degradation identification, image restoration, and quality verification. The resulting model is fully trainable end to end and allows for an all-in-one assess and restore approach that dynamically adapts the restoration process. Also, the tight integration of IQA and IR into a unified model minimizes the latency and information loss that typically arises from keeping the two modules disjoint, (e.g. during image and/or text decoding). Extensive experiments show that our approach consistent improvements under single, unknown and composite degradations, thereby establishing a new state-of-the-art.

All-in-One medical image restoration (MedIR) aims to address diverse tasks across modalities and degradation types using a single universal model. Existing methods typically prioritize modeling inter-task heterogeneity (e.g., distinct data distributions and degradation types). However, they largely neglect the inherent homogeneity present in medical images, such as widely shared anatomical structures within and across modalities, which can be leveraged to ease model training and improve generalization. To this end, we propose UniH3, a novel framework that Unifies Hierarchical Homogeneity and Heterogeneity for all-in-one medical image restoration. Specifically, to comprehensively exploit homogeneity, we introduce a Hierarchical Homogeneity Memory (H2M) module that progressively distills intra- and inter-task homogeneity priors from high-quality images during training, and adaptively retrieves the most relevant priors tailored to the input for guided restoration. These retrieved priors are then injected into the restoration pipeline via an efficient Homogeneity-Guided Attention (HGA) mechanism. Furthermore, to comprehensively address heterogeneity, we design a Hierarchical Heterogeneity Balancer (H2B) that mitigates both inter- and intra-task conflicts during optimization, facilitating balanced and effective multi-task learning. Extensive experiments on two large-scale benchmarks, MedIR-2D-500K and MedIR-3D-3K, demonstrate that UniH3 achieves state-of-the-art performance on both all-in-one and single-task medical image restoration. We hope this work establishes a strong benchmark and advances the development of general-purpose medical image restoration models. Code is available at https://github.com/Yaziwel/UniH3.

Universal image restoration (UIR) aims to recover clean images from diverse and unknown degradations using a unified model. Existing UIR methods primarily focus on pixel reconstruction and often lack explicit diagnostic reasoning over degradation composition, severity, and scene semantics prior to restoration. We propose Reason and Restore (R&R), a novel framework that integrates structured Chain-of-Thought (CoT) reasoning into the image restoration pipeline. R&R introduces an explicit reasoner, implemented by fine-tuning Qwen3-VL, to diagnose degradation types, quantify degradation severity, infer key degradation-related factors, and describe relevant scene and object semantics. The resulting structured reasoning provides interpretable and fine-grained diagnostic priors for the restorer. To further improve restoration quality, the quantified degradation severity produced by the reasoner is leveraged as reinforcement learning (RL) signals to guide and strengthen the restorer. Unlike existing multimodal LLM-based agentic systems that decouple reasoning from low-level vision tasks, R&R tightly couples semantic diagnostic reasoning with pixel-level restoration in a unified framework. Extensive experiments across diverse UIR benchmarks demonstrate that R&R achieves state-of-the-art performance while offering unique interpretability into the restoration process.