Visually Irrelevant Hallucinations in Medical Vision-Language Models

Vision-Language models (VLMs) reliability in medical diagnosis is challenged by trust-undermining hallucinations. Existing hallucination detection approaches mainly focus on identifying factual inconsistencies between generated text and reference data. While some studies analyze where models attend in images, they seldom verify whether such attention truly reflects the visual evidence supporting the generated text. To address this gap, we propose Co}unter-Evidence Verification (CoEV), a training-free plug-and-play framework that detects and corrects hallucinations through evidence-based factual consistency verification. CoEV performs bidirectional verification between textual assertions and visual evidence, testing whether each statement is supported by its corresponding evidence region, and assigns each statement into a four-quadrant diagnostic map capturing combinations of text factuality and visual grounding. CoEV detects hallucinated content and serves as a post hoc refinement tool, correcting hallucinations without retraining. Extensive experiments on four medical datasets show that CoEV combats hallucinations in VLMs.For hallucination detection, CoEV consistently outperforms existing methods, improving average PR-AUC and ROC-AUC by 3.0% and 3.9% absolute points respectively, with notable gains of up to 18.5% in specific VQA scenarios. For hallucination correction, it improves Micro-F1 by up to 12.5%, reduces hallucination rates by over 11.9% on medical report generation, and also boosts medical VQA accuracy. These results show that CoEV enables reliable detection and correction of hallucinations, providing clinicians with dependable, evidence-based cues for diagnosis. Code will be released upon acceptance.

Vision-language models (VLMs) are increasingly used for medical image interpretation, yet they frequently hallucinate, generating clinically plausible but factually incorrect findings that pose direct patient safety risks. We introduce HalluCXR, a benchmark evaluating six architecturally diverse VLMs across 856 stratified MIMIC-CXR chest radiographs and three query types, yielding 15,408 model evaluations. An eight-category hallucination taxonomy with clinical severity ratings and a two-layer detection pipeline are validated against 250 human annotations (auto-detection F1=0.959; LLM judge F1=0.907). We find that 61.9--82.3% of outputs contain hallucinations, with clinically dangerous errors in up to 80.2%. Three key patterns emerge: normal radiographs paradoxically attract the most severe hallucinations, common findings are systematically over-fabricated while rare findings go under-detected, and response length alone predicts hallucination risk (AUC up to 0.908). A six-model ensemble reduces fabrication by up to 84.8% at the cost of increased omission; a three-model subset retains comparable performance at half the cost. These results establish that hallucination auditing, verbosity-based risk monitoring, and ensemble-based safety layers are prerequisites for clinical deployment.

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