X-Edit: Exact, Explicit, and Explainable Null-Space Editing for Medical Vision Transformers
Authors: Yuanye Liu, Siyuan Zhou, Ke Zhang, Lei Li, Wei Chen, Xiahai Zhuang
Organizations: Fudan University, Shanghai, China · Johns Hopkins University, Baltimore, USA · National University of Singapore, Singapore · University of Sydney, Sydney, Australia
Abstract
Pre-trained Vision Transformers (ViTs) are increasingly deployed for medical image classification. However, correcting their inevitable failure cases in dynamic clinical scenarios poses a critical challenge. Conventional fine-tuning approaches inherently suffer from catastrophic forgetting, severely degrading previously acquired diagnostic capabilities. Such instability fundamentally compromises clinical safety. Addressing this vulnerability requires an active, controllable, and reliable intervention mechanism that is both theoretically grounded and inherently interpretable. To this end, we propose X-Edit (eXact, eXplicit, and eXplainable Editing), an efficient null-space model editing framework. X-Edit transitions the editing process from iterative gradient-based optimization to a theoretically grounded, closed-form solution. Specifically, we first explicitly localize the influential layers via causal tracing governing the erroneous prediction. Subsequently, we construct an orthogonal null-space projection matrix from a curated anchor set. By geometrically constraining the exact parameter update strictly within this null space, we provide mathematical guarantees that the intervention rectifies targeted errors without perturbing established diagnostic representations. Extensive evaluations on six medical imaging benchmarks demonstrate that X-Edit comprehensively suppresses catastrophic forgetting while achieving superior edit success rates. Our code is available at https://github.com/HenryLau7/X-Edit.
Model editing promises a fast, targeted way to correct post-deployment mistakes in medical vision-language models (VLMs) without costly retraining. However, existing multimodal model editing benchmarks focus on general-purpose tasks and do not reflect realistic clinical domain requirements and variability. To address this, we introduce M3Bench, a clinically grounded benchmark for multimodal model editing that evaluates whether an edit remains reliable, precise, and generalizable under the challenges of image and text variation, modality and protocol shifts, clinical knowledge composition, and temporal progression. M3Bench contains 16,276 questions spanning diverse anatomy, modalities, and specialties, and supports both single and sequential edits. By evaluating 4 representative editors across 6 medical and general VLMs, we find that no method excels across all criteria. Gradient-based editors achieve strong transfer but suffer from catastrophic locality violations, whereas memory-based methods preserve locality but lack compositional generality and exhibit high backbone-dependent hyperparameter sensitivity. We further attribute these failures to the latent space geometry of VLMs and how different editing methods shift its landscape. Overall, M3Bench establishes a rigorous clinical stress test for multimodal model editing and offers actionable guidance for safer post-deployment adaptation. The benchmark is publicly available at https://github.com/BioMed-AI-Lab-U-Michgan/M3Bench .
Modern image editors combine vision-language models (VLMs) with diffusion transformer backbones to modify a single reference image according to instructions without fine-tuning. This capability also enables unauthorized manipulation of publicly released images. Existing inference-time defenses either invalidate edits through conspicuous corruption, thereby exposing the protection, or allow them to proceed with identity or reference content drift, thereby failing to prevent the editing behavior itself. We instead target a stealthy and harmless no-op in which the requested edit is suppressed, the output remains natural and source-preserving without conspicuous artifacts or identity replacement, and harmful semantics requested by malicious instructions are absent. We propose NullEdit, which targets the VLM representation jointly formed from the reference image and instruction before it conditions the downstream DiT backbone. Using normal-edit and no-edit anchors, NullEdit redirects this representation, while cross-prompt gradient averaging transfers protection to held out instructions. Across Step1X-Edit and Qwen-Image-Edit on CelebA-HQ and VGGFace2, NullEdit reduces the EditReward IF score by 0.813 on average relative to the SOTA baseline while preserving subject identity and source content.
Large Vision-Language Models (LVLMs) have achieved strong performance across medical imaging tasks, yet they remain prone to factual inconsistencies, poor visual grounding, and misalignment with clinically meaningful feedback. Existing post-training alignment approaches, including Direct Preference Optimization (DPO) and its variants, face three critical limitations in the medical domain: (1) sequence-level reward signals treat clinically critical tokens identically to generic filler text; (2) reliance on static supervised fine-tuning references as preferred responses introduces an off-policy distribution shift, steering optimization toward stylistic artifacts over clinical correctness; and (3) alignment objectives lack explicit visual grounding constraints, leaving models insensitive to subtle yet diagnostically decisive pathological features. Our method leverages a bidirectional token-wise KL regularizer alongside a visual-contrastive grounding objective that pairs clean and lesion-corrupted images to penalize responses generated without adequate visual evidence. Together, these components form a fine-grained, on-policy alignment framework that constructs preference pairs by minimally editing model-generated outputs, correcting only clinically erroneous spans while preserving the original linguistic style. Extensive experiments across medical imaging tasks and clinical text generation benchmarks validate the effectiveness of our approach.
Shayan Mohammadizadehsamakosh, Pritam Sarkar, Leonid Sigal +2