ARISE: Adaptive Agentic Reasoning with Image-grounded Self-Evaluation for Interpretable IBD Assessment

Medical AI systems face two fundamental limitations. First, conventional vision-language models (VLMs) perform single-pass inference, yielding black-box predictions that cannot be audited or explained in clinical terms. Second, iterative reasoning systems that expose intermediate steps rely on fixed iteration budgets wasting compute on simple cases while providing insufficient depth for complex ones. We address both limitations with a unified framework. RVLM replaces single-pass inference with an iterative generate-execute loop: at each step, the model writes Python code, invokes vision sub-agents, manipulates images, and accumulates evidence. Every diagnostic claim is grounded in executable code, satisfying auditability requirements of clinical AI governance frameworks. RRouter makes iteration depth adaptive: a lightweight controller predicts the optimal budget from task-complexity features, then monitors progress and terminates early when reasoning stalls. We evaluate on BraTS 2023 Meningioma (brain MRI) and MIMIC-CXR (chest X-ray) using Gemini 2.5 Flash without fine-tuning. Across repeated runs, RVLM shows high consistency on salient findings (e.g., mass presence and enhancement) and can detect cross-modal discrepancies between Fluid-Attenuated Inversion Recovery (FLAIR) signal characteristics and segmentation boundaries. On MIMIC-CXR, it generates structured reports and correctly recognises view-specific artefacts. Code: https://github.com/nican2018/rvlm.

Lesion detection, symptom tracking, and visual explainability are central to real-world medical image analysis, yet current medical Vision-Language Models (VLMs) still lack mechanisms that translate their broad knowledge into clinically actionable outputs. To bridge this gap, we present MEDIC-AD, a clinically oriented VLM that strengthens these three capabilities through a stage-wise framework. First, learnable anomaly-aware tokens (<Ano>) encourage the model to focus on abnormal regions and build more discriminative lesion centered representations. Second, inter image difference tokens (<Diff>) explicitly encode temporal changes between studies, allowing the model to distinguish worsening, improvement, and stability in disease burden. Finally, a dedicated explainability stage trains the model to generate heatmaps that highlight lesion-related regions, offering clear visual evidence that is consistent with the model's reasoning. Through our staged design, MEDIC-AD steadily boosts performance across anomaly detection, symptom tracking, and anomaly segmentation, achieving state-of-the-art results compared with both closed source and medical-specialized baselines. Evaluations on real longitudinal clinical data collected from real hospital workflows further show that MEDIC-AD delivers stable predictions and clinically faithful explanations in practical patient-monitoring and decision-support workflows

Large visual language models (VLMs) have shown strong multi-modal medical reasoning ability, but most operate as end-to-end black boxes, diverging from clinicians' evidence-based, staged workflows and hindering clinical accountability. Complementarily, expert visual grounding models can accurately localize regions of interest (ROIs), providing explicit, reliable evidence that improves both reasoning accuracy and trust. In this paper, we introduce CARE, advancing Clinical Accountability in multi-modal medical Reasoning with an Evidence-grounded agentic framework. Unlike existing approaches that couple grounding and reasoning within a single generalist model, CARE decomposes the task into coordinated sub-modules to reduce shortcut learning and hallucination: a compact VLM proposes relevant medical entities; an expert entity-referring segmentation model produces pixel-level ROI evidence; and a grounded VLM reasons over the full image augmented by ROI hints. The VLMs are optimized with reinforcement learning with verifiable rewards to align answers with supporting evidence. Furthermore, a VLM coordinator plans tool invocation and reviews evidence-answer consistency, providing agentic control and final verification. Evaluated on standard medical VQA benchmarks, our CARE-Flow (coordinator-free) improves average accuracy by 10.9% over the same size (10B) state-of-the-art (SOTA). With dynamic planning and answer review, our CARE-Coord yields a further gain, outperforming the heavily pre-trained SOTA by 5.2%. Our experiments demonstrate that an agentic framework that emulates clinical workflows, incorporating decoupled specialized models and explicit evidence, yields more accurate and accountable medical AI. Project page: https://xypb.github.io/CARE-Project-Page/