Iterative Multimodal Retrieval-Augmented Generation for Medical Question Answering

Retrieval-Augmented Generation (RAG) streamlines long-document understanding by leveraging retrieval mechanisms to restrict input images to a highly curated subset. However, existing multimodal RAG pipelines primarily face two critical challenges: first, standard semantic similarity retrievers frequently fetch topically overlapping yet answer-void distractor pages that mislead downstream generation; second, rigid single-pass pipelines heavily depend on initial retrieval success, where any omission of core evidence inevitably causes cascading errors. To address these challenges, we introduce HIEVI-RAG, a hierarchical, evidence-driven multimodal RAG framework for closed-domain document understanding. HIEVI-RAG systematically factorizes complex queries into a cooperative four-stage pipeline: (1) hierarchical question decomposition to break multi-hop root queries into atomic child questions; (2) coarse visual page retrieval leveraging a multimodal retriever to fetch candidate pages based on semantic similarity; (3) fine-grained page verification via EVIAGENT, a specialized multi-page verifier trained with GRPO to execute cross-page reasoning over multi-image blocks; and (4) memory-guided iterative generation that leverages accumulated sub-question context to execute multi-round, dynamic reasoning over the prioritized sequence. Extensive evaluations across four benchmarks demonstrate the robust efficacy and synergy of our framework, which significantly outperforms existing open-source baselines and exceeds the strongest reported baseline by an average of 8.05% in accuracy.

Real-world knowledge resides in multimodal documents, necessitating retrieval-augmented generation (RAG) for accurate question answering. However, existing multimodal RAG models are primarily designed for single-image or closed-document settings and exhibit limited accuracy in realistic multi-image scenarios. Moreover, processing numerous retrieved images incurs substantial computational overhead from irrelevant visual tokens. To address these challenges, we introduce DocLongRAG, a large-scale dataset of 343K question--answer pairs, each associated with an average of 37.4 retrieved images to reflect authentic RAG workflows. Building on this dataset, we propose Doc-REFRAG, a question-guided framework that compresses visual tokens into coarse chunks and selectively expands question-relevant ones via a lightweight RL-based selector. Experiments on six benchmarks show that Doc-REFRAG outperforms eleven strong baselines, achieving state-of-the-art accuracy with significantly lower inference latency. Our resources are available at https://github.com/Collab-Gen/Doc-REFRAG.

Retrieval-Augmented Generation (RAG) is widely employed to mitigate risks such as hallucinations and knowledge obsolescence in medical question answering, yet its predominantly single-round, static retrieval paradigm misaligns with the multi-stage process of clinical reasoning. This compressed workflow induces two structural deficiencies: question-to-query translation often lacks clinically grounded semantic interpretation, and retrieval lacks iterative sufficiency feedback, making it difficult to form reliable evidence chains. We argue that both issues stem from a deeper cause: overloading a single reasoning chain with heterogeneous tasks of interpretation, exploration, and adjudication. The remedy is to reconstruct the workflow via task decoupling and dynamic multi-round exploration. To this end, we propose SEMA-RAG, a Self-Evolving Multi-Agent RAG framework for medical question answering, which assigns these roles to three specialist agents: the Interpreter Agent for clinical schema interpretation, the Explorer Agent for sufficiency-driven self-evolving retrieval, and the Arbiter Agent for evidence adjudication and answer selection. Across five benchmarks and five LLM backbones, SEMA-RAG improves the strongest baseline by +6.46 accuracy points on average, measured per backbone.