MedVTok: A General-Purpose Medical Visual Tokenizer

Modern multimodal large language models (MLLMs) typically keep the language model fixed and train a visual projector that maps the pixels into a sequence of tokens in its embedding space, so that images can be presented in essentially the same form as text. However, the language model has been optimized to operate on discrete, semantically meaningful tokens, while prevailing visual projectors transform an image into a long stream of continuous and highly correlated embeddings. This causes the visual tokens to behave differently from the word-like units that LLMs are originally trained to understand. We propose a novel Disentangled Visual Tokenization (DiVT) that clusters patch embeddings into coherent semantic units, so each token corresponds to a distinct visual concept instead of a rigid grid cell. DiVT further adapts its token budget to image complexity, providing an explicit accuracy-compute trade-off modifying neither the vision encoder nor the language model. Across diverse multimodal benchmarks, DiVT matches or surpasses baselines with significantly fewer visual tokens, demonstrating robustness under limited token budgets, significantly reducing memory cost and latency while making visual inputs more compatible with LLMs. Our code is available at https://github.com/snuviplab/DiVT.

Vision-language models (VLMs) combining reinforcement learning (RL) ignite remarkable progress in multimodal reasoning, yet still struggle with medical images, which typically exhibit extremely sparse visual evidence to inform clinical decision-making. We recognize that pruning visual tokens outside the grounding region greatly enhances medical reasoning. However, a united RL framework for active visual token pruning (VTP) and medical multimodal reasoning remains unestablished. Here, we propose a dual-stream RL framework, ViToS, to fulfill token pruning and question answering. ViToS trains one policy model with two task branches, where one focuses on grounding while the other conducts token-sparse reasoning after VTP. Furthermore, we solve the coupled policy learning problem by introducing the cross-feedback sequential optimization, avoiding gradient conflict and facilitating convergence of the shared policy model. Evaluated on seven medical benchmarks, our method reduces visual tokens to 77% of the original sequence length while achieving a 108.27% relative performance on Lingshu-7B and 104.16% relative performance on HuatuoGPT-Vision-7B. Overall, ViToS delivers superior performance and inference speedup, establishing an efficient paradigm for medical multimodal reasoning.

Latent diffusion models now dominate medical image generation, and every such pipeline rests on a tokenizer that compresses images into the latent codes for image generation to operate on. Thereby, the tokenizer choice bounds every downstream task from reconstruction fidelity and generation quality to the representations available for downstream analysis. Yet, medical imaging pipelines routinely utilize tokenizers from natural imaging on the hypothesis that their behavior carries over. However, this is an assumption never tested in the medical imaging regime, where datasets are orders of magnitude smaller and images exhibit far lower inter-sample variance. We present a systematic evaluation of medical image tokenizers evaluating thirty configurations across ten model families on twelve datasets at three compression factors, spanning reconstruction, generation, latent geometry, downstream classification, and memorization. We find that (1) performance on image reconstruction and generation strongly correlate, unlike prior reports on natural images; (2) modern tokenizers use nearly all of their codebook entries, but still leave most of the latent space unused; (3) training-set memorization is mild and is further suppressed by stronger latent space compression; and (4) discrete quantization can largely preserve downstream classification, with lookup-free schemes being the main exception.