Ask4VG: Risk-Aware Question Selection for Reducing Prior-Driven Answers in Medical VQA

While medical Multimodal Large Language Models (MLLMs) have shown promise in assisting diagnosis, they still frequently generate hallucinated responses that appear linguistically plausible but lack visual evidence. Such hallucinations pose risks to clinical decision-making and necessitate effective detection. Existing introspective detection methods primarily perform uncertainty estimation or logical verification by analyzing model responses conditioned on original or perturbed inputs. However, such external perturbations are often heuristic and context-agnostic, which overlooks the internal cross-modal dependency between generated tokens and related visual tokens during decoding. To address this issue, we propose VIHD, a Visual Intervention-based Hallucination Detection method that leverages targeted visual token masking to calibrate semantic entropy for more effective hallucination detection. VIHD locates visually dominant decoder layers via Visual Dependency Probing (VDP), executes Visual Intervention Decoding (VID) via token masking to calibrate the semantic distribution, and quantifies the resulting Calibrated Semantic Entropy (CSE) as a reliable hallucination signal. Extensive experiments on three medical VQA benchmarks with two medical MLLMs demonstrate that VIHD consistently outperforms state-of-the-art methods, underscoring the importance of fine-grained visual dependency for hallucination detection. The code will be available at https://github.com/Jiayi-Chen-AU/VIHD

We describe our submission to the MedReason 2026 challenge, covering multiple-choice (MCQ) and open-ended (OE) medical visual question answering (VQA) under fully offline, containerized inference. Our first finding is that MCQ retrieval must compare answer \emph{semantics} rather than answer labels: labels are independently assigned per question, so copying a retrieved neighbor's label transfers no useful information, whereas scoring each current option's text against correct-answer text from similar training cases raises retrieval-only accuracy from 20.0% to 57.5% on a 200-case retrieval-excluded development holdout. Our second finding attributes the submitted system's accuracy: holding the task-specific MCQ Low-Rank Adaptation (LoRA) adapter fixed and varying the number $k$ of in-prompt retrieved examples changes accuracy by at most one case --- 187/200 (93.5%) at both $k=0$ and the adapter's training-time $k=1$, 188/200 (94.0%) at the packaged runtime's default $k=3$ --- and the submitted confidence-gated override adds no net accuracy on top of $k=3$, selecting the VLM in 198/200 cases. With the final MCQ adapter fixed, retrieval changes accuracy by at most one case, and gating provides no net gain. On 20 OE cases, token-F1 and RaTEScore~\cite{zhao2024ratescore} decrease as $k$ grows, but paired sign tests on token-F1 differences are nonsignificant ($p \ge 0.29$); a single-annotator comparison found 6/20 wrong-anchor errors for the final configuration and 14/20 for an earlier configuration that jointly differed in routing, adapter, and prompting. The system reaches 94.0% MCQ accuracy on the development holdout and 93.20% on the organizer's official pre-evaluation, versus 29.43% for the off-the-shelf reference baseline, while both of the organizer's open-ended scores are lower than that baseline's (ground-truth agreement 1.245 versus 1.588, visual accuracy 1.995 versus 2.696, each out of 4).

Large vision language models (VLMs) report strong accuracy on medical question-answering, yet it remains unclear whether they reason from visual evidence or exploit textual shortcuts. We introduce a counterfactual evaluation framework that decouples visual and textual contributions by substituting input images with controlled surrogates blank, pixel-shuffled, image-absent, and CLIP-retrieved hard negatives and derive a suite of grounding metrics including the Visual Reliance Score (VRS) and Visual Hallucination Rate (VHR). We further introduce CORAL (COntrastive Retrieval-Augmented Learning), a 7B-parameter LoRA fine-tune of Qwen2.5-VL-7B trained with a Contrastive Grounding Objective (CGO) that penalises answer invariance under hard-negative image swaps. On a paired controlled evaluation across four closed-form medical VQA benchmarks (PathVQA, PMC-VQA, SLAKE, VQA-RAD; n=400 total), CORAL improves macro accuracy by +6.7 pp (P(Delta>0)=0.988) and reduces VHR by 8.0 pp (P<0.001) over the matched Qwen2.5-VL-7B base; neither MedVLThinker RL variant achieves a significant gain on either metric. Cross-domain diagnostics further reveal that image substitution costs only <=6.5 pp on medical benchmarks versus 48-61 pp on general-domain tasks, situating the grounding gap that CGO targets. We discuss evaluation limitations openly including train/eval benchmark overlap and underpowered secondary metrics and release our framework, training code, and model weights to support reproducible grounding audits of medical VLMs.