KG-CMI: Knowledge graph enhanced cross-Mamba interaction for medical visual question answering

Medical visual question answering (Med-VQA) aims to answer clinically relevant questions grounded in medical images. However, existing multimodal large language models (MLLMs) often exhibit shortcut answering, producing plausible responses by exploiting language priors or dataset biases while insufficiently attending to visual evidence. This behavior undermines clinical reliability, especially when subtle imaging findings are decisive. We propose a lightweight plug-in framework, termed Intent-aware Visual Cues (InViC), to explicitly enhance image-based answer generation in medical VQA. InViC introduces a Cue Tokens Extraction (CTE) module that distills dense visual tokens into a compact set of K question-conditioned cue tokens, which serve as structured visual intermediaries injected into the LLM decoder to promote intent-aligned visual evidence. To discourage bypassing of visual information, we further design a two-stage fine-tuning strategy with a cue-bottleneck attention mask. In Stage I, we employ an attention mask to block the LLM's direct view of raw visual features, thereby funneling all visual evidence through the cue pathway. In Stage II, standard causal attention is restored to train the LLM to jointly exploit the visual and cue tokens. We evaluate InViC on three public Med-VQA benchmarks (VQA-RAD, SLAKE, and ImageCLEF VQA-Med 2019) across multiple representative MLLMs. InViC consistently improves over zero-shot inference and standard LoRA fine-tuning, demonstrating that intent-aware visual cues with bottlenecked training is a practical and effective strategy for improving trustworthy Med-VQA.

Medical Visual Question Answering (Med-VQA) holds significant promise for clinical decision support, yet faces challenges due to limited annotated data and the high computational demands of existing large vision-language models. We propose MedFG-VQA, a lightweight framework that leverages a memory bank to augment DCT-based low-frequency features and employs graph-enhanced cross-attention for effective visual-textual alignment. Specifically, our approach features two key components: Frequency-Memory Fusion (FMF), which enhances low-frequency features by retrieving from a learnable memory bank built on DCT decomposition, and Graph-Aware Cross-Attention (GACA), which aligns visual-textual features via cross-attention and refines them through graph-convolutional aggregation. To address data scarcity, we construct SynMed-VQA, a large-scale synthetic dataset comprising over 2 million question-answer pairs across 9 imaging modalities and 10 major organs, generated with GPT-4o. Extensive experiments on SynMed-VQA and three other standard biomedical VQA benchmarks demonstrate that MedFG-VQA achieves competitive or superior performance compared to much larger models while maintaining significantly lower computational costs, highlighting its efficiency and potential for clinical deployment.

Medical vision--language models (VLMs) have shown strong potential for medical visual question answering (VQA), yet their reasoning remains largely text-centric: images are encoded once as static context, and subsequent inference is dominated by language. This paradigm is fundamentally limited in clinical scenarios, where accurate answers often depend on subtle, localized visual evidence that cannot be reliably preserved in static embeddings. We propose MedLVR, a latent visual reasoning framework that introduces an explicit visual evidence state into autoregressive decoding. Instead of relying solely on text-based intermediate reasoning, MedLVR interleaves a short latent reasoning segment within the decoder by reusing hidden states as continuous latent steps, enabling iterative preservation and refinement of query-relevant visual evidence before answer generation. To support effective visual supervision, we adopt a two-stage training strategy: region of interest (ROI)-supervised fine-tuning aligns latent states with clinically relevant image evidence, and Visual-Latent Policy Optimization (VLPO) further optimizes latent reasoning and answer generation under outcome-level rewards. Experiments on OmniMedVQA and five external medical VQA benchmarks show that MedLVR consistently outperforms recent reasoning baselines and improves the average score over the Qwen2.5-VL-7B backbone from 48.3% to 53.4%. These results show that latent visual reasoning provides an effective mechanism for preserving diagnostically relevant visual evidence and improving the reliability of medical VQA.