DS@GT ARC at ImageCLEFmedical 2026: Architectural Diversity for Concept Detection and Foundation-Model Scaling for Caption Prediction in Medical Image Analysis

This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.

Generative vision-language models can produce fluent medical image captions but remain prone to hallucination, over-specific diagnostic claims, and factual inconsistency-serious issues in pathology. We investigate retrieval-guided generation (RGG) as a safer alternative, where captions are formed by summarizing expert text from visually similar cases rather than generated de novo. On the ARCH histopathology dataset, RGG improves semantic alignment with ground truth, achieving cosine similarity of $\approx$0.60 versus $\approx$0.47 from MedGemma, with non-overlapping confidence intervals indicating a robust gain. A pathologist-led qualitative review shows better preservation of morphology-relevant terminology and fewer unsupported diagnoses, while revealing failure modes such as concept mixing and inherited over-specific labeling. Overall, retrieval-guided captioning offers a more transparent and reliable approach with clearer opportunities for auditing than fully generative methods.

Promptable segmentation foundation models (FMs) such as SAM3 and Medical SAM3 promise few-shot, interactively-specified segmentation for medical imaging through a natural language interface, yet their performance on clinical tasks falls well short of this promise. We posit that this shortfall is not an artefact of insufficient medical pretraining or imperfect prompt phrasing, but a structural limitation that will persist in any domain where paired image-text supervision is scarce, as it is across most clinical modalities. We further hypothesize that the limitation is specific to natural language as a control signal: a visually grounded prompt, learned directly from the target distribution, should recover the lost performance without additional image-text data or backbone retraining. We propose Few-Shot Concept Prompt Learning (FS-CPL), which learns a continuous concept prompt embedding $\mathbf{p}^* \in \mathbb{R}^{T \times d}$ from a small support set of $K$ image--mask pairs via mask supervision, with the encoder-decoder backbone frozen. Across four public benchmarks spanning ultrasound and endoscopy (BUSI, HC18, TN3K, CVC-Clinic), FS-CPL delivers absolute Dice improvements of up to $+0.62$ over canonical text prompts and is \emph{backbone-agnostic}: it lifts both vanilla SAM3 and the domain-specifically pretrained Medical SAM3, showing that visual concept prompting is complementary to in-domain pretraining.