Medical VLMs

High-stakes clinical use of large vision-language models (LVLMs) requires reasoning that is grounded in visual evidence and clinical knowledge, not just correct final answers. We introduce OpenMedReason, a large-scale, open multimodal medical reasoning corpus comprising approximately 450K image-question-answer instances whose reasoning traces are primarily derived from curated biomedical, human-authored scientific articles. OpenMedReason provides high-fidelity supervision beyond synthetic chains of thought, covering diverse medical domain vision modalities such as radiological scans, microscopic images, visible light photographs, charts, and others. We complement it with OpenMedReason-Bench, a held-out benchmark that allows fine-grained evaluation of LVLMs along three complementary axes of capability, including perception, medical knowledge, and rationale, enabling diagnostic evaluation beyond final-answer accuracy. OpenMedReason is a rich training resource that exhibits its effectiveness in both supervised fine-tuning (SFT) and reinforcement-based alignment. Training with OpenMedReason yields a 20% average improvement in VQA accuracy over the base model and achieves performance within 4.2% of the strongest comparable-scale medical LVLMs. Fine-grained performance analysis confirms that the gains are not concentrated in any single axis: OpenMedReason improves perception, medical knowledge, and rationale jointly, and its reasoning traces are preferred over those of the base model in 86.1% of pairwise comparisons. We release the code and dataset at huggingface.co/datasets/neginb/OpenMedReason.

A global shortage of trained sonographers limits prenatal ultrasound screening in low- and middle-income countries, where over half of pregnant women receive no skilled sonography. Current deep learning approaches address detection, segmentation, or classification in isolation, each demanding a separate model and expert-specified labels at inference. We present FADA, a unified vision-language model built on Qwen3.5-VL that performs clinical interpretation, classification, detection, and segmentation through a single interpretation-first pipeline without external labels. FADA distills knowledge from four domain-specific foundation models (FetalCLIP, UltraSAM, USF-MAE, UltraFedFM) via offline pre-computed feature caching. Selective distillation, which applies feature alignment only to annotation tasks while interpretation relies on standard fine-tuning, consistently outperforms full distillation across most evaluation axes. The recommended variant, FADA-SKD, achieves 0.8820 mean Dice for segmentation, 0.7671 [email protected] for detection, and 100% structured interpretation compliance. Expert sonographer validation across 237 images confirms clinically acceptable outputs in both autonomous and human-in-the-loop modes, with 73.5% of interpretations scoring perfectly under clinician guidance. The system is trainable on a single consumer GPU and deployable without cloud connectivity. We validate edge deployment by running the compressed 0.8B model on a commodity smartphone (Qualcomm Snapdragon 7 Gen 1, 12 GB RAM) using llama.cpp with GGUF quantization, completing the full 5-phase pipeline in approximately 60 seconds entirely offline. This establishes a practical pathway for integrating AI-assisted fetal assessment with portable ultrasound devices, directly addressing diagnostic access gaps in resource-constrained settings. Code, models, and data are available at https://github.com/mahmoodphd/FADA.

Strabismus is a common ocular disorder that requires fine-grained subtype diagnosis for individualized treatment planning. However, existing deep learning methods mainly provide diagnostic predictions without transparent reasoning, while recent large vision-language models (LVLMs), although promising for joint image understanding and report generation, remain highly prone to hallucination in this evidence-sensitive and rule-driven medical task. To address these challenges, we propose MAGIS, an evidence-based Multi-AGent reasoning for Interpretable Strabismus diagnosis framework. MAGIS transforms black-box end-to-end generation into a structured diagnostic process consisting of candidate hypothesis generation, dual-evidence constrained context, evidence-based corrective verification, and report generation. Specifically, we introduce a Dual-Evidence Constrained Context (DECC) mechanism that jointly organizes visual evidence from the photograph of the nine cardinal positions of gaze and evidence-based clinical diagnostic rules into a constrained context for reliable diagnostic reasoning. We further develop an Evidence-Based Corrective Verification (EBCV) mechanism that verifies whether the current diagnostic hypothesis is supported by visual evidence, heatmap-based visual cues, and evidence-based clinical diagnostic rules. Hypothesis refinement is triggered when inconsistency is detected. Experiments on a fine-grained strabismus benchmark demonstrate that MAGIS not only significantly outperforms other state-of-the-art diagnostic systems, improving the weighted F1 score from 72.0% to 91.3%, but also substantially improves the clinical reliability (consistency, alignment, and completeness) of generated diagnostic reports. These results demonstrate that MAGIS provides an effective solution for building accurate, evidence-based, and clinically interpretable strabismus diagnosis systems.

The processing of gigapixel whole slide images within vision language models faces a major difficulty due to an excessive number of visual tokens. Existing solutions typically rely on spatial downsampling or heuristic pruning strategies that operate without training, and these methods often discard subtle but clinically meaningful patterns because pathological evidence is scattered irregularly across the tissue. To overcome this limitation, we reformulate token reduction in whole slide images as a trainable sparsification problem, allowing the model to learn an optimal selection strategy instead of following fixed heuristics. We propose a decoupled routing architecture. To enable gradient propagation through the nondifferentiable pruning operation during training, we introduce a component called SparseLearn. This component uses a variance-preserving noise gate that regulates the information flow of each patch via a differentiable Soft Top-K operator, together with a diagonal attention denoiser that recovers perturbed representations without leaking spatial information. At inference time, the SparseLearn module is entirely discarded, and the trained scorer applies a deterministic Hard Top-K operator to keep only the highest scoring 32 tokens, incurring no extra computation. By compressing the visual sequence down to a sparse set of just 32 tokens, which represents as little as 0.78% of the original length, our framework achieves 73.32% overall accuracy on SlideBench (TCGA), consistently surpassing sampling-based baselines and general-purpose vision language models. It also demonstrates strong zero shot generalization on SlideBench (BCNB) and WSI VQA*. By resolving the visual context bottleneck and preventing the dilution of sparse diagnostic evidence, this work provides a highly efficient paradigm for end to end gigapixel whole slide image reasoning.

Medical large vision-language models (Med-LVLMs) have recently achieved remarkable progress in vision-language comprehension and medical image segmentation. However, existing models still struggle to unify these two capabilities, which is essential for achieving clinically reasoning that connects visual findings with semantic interpretation. We present MedSIGHT, a unified framework that equips Med-LVLMs with structured, pixel-level understanding for grounded visual comprehension. MedSIGHT introduces a novel Region Perceiver module that produces region-centric tokens, encoding spatial information directly into representation space of the language model. We further propose a medical region codebook into the LLM vocabulary, allowing the model to generate discrete region codes as symbolic representations of anatomical and pathological regions. These codes are decoded through the Region Perceiver to reconstruct segmentation mask, achieving end-to-end spatial grounding. Lastly, MedSIGHT combines Region Perceiver, Codebook and LLM using our proposed progressive training strategy to gradually aligns these modules stably. Trained on only 72K multimodal instruction pairs, MedSIGHT achieves state-of-the-art performance across diverse imaging modalities on both medical comprehension and segmentation tasks.

Vision and language models (VLMs) hold immense promise to transform biomedical imaging workflows, from detecting lesions in chest X-rays to profiling cellular features in microscopy. Realizing this potential, however, requires robust and fine-grained visual perception. Models need to correctly interpret subtle features in images, and they must do so across diverse biomedical modalities, scales, and contexts. Nevertheless, current benchmarks remain limited. To address these gaps, we introduce the Massive Multimodal Biomedical Understanding (MMBU) benchmark. It is the largest biomedical vision and language benchmark to date, covering 35 submodalities with rich structured metadata. It includes both open and closed versions of ungrounded classification, grounded classification, and object detection, enabling systematic evaluation of model performance across biological scales, clinical settings, and imaging modalities. Evaluating 15 open-weight and 2 frontier VLMs, we find that while medical adaptation provides measurable gains for some models, the high accuracy often reported on established benchmarks can mask deficiencies in visual perception and domain generalization.

Medical vision-language models (VLMs) have shown increasing potential for clinical image interpretation, including lesion detection and report generation. However, their practical utility remains limited by insufficient sensitivity to subtle lesions, whose visual evidence is often sparse, low-contrast, and embedded within complex anatomical context. As local visual tokens are aggregated, these weak lesion cues can become underrepresented in global image representations, making them difficult for medical VLMs to recognize. Existing efforts to improve lesion sensitivity mainly rely on medical-domain vision-encoder pre-training, clinical-term-guided alignment, or trainable pathological representation enhancement. Although effective, these approaches usually require additional training or model-specific adaptation and may overfit to particular disease morphologies, limiting their applicability to frozen medical VLMs. To address these limitations, we propose EasyLens, a training-free plug-and-play subtle-lesion representation amplifier for medical VLMs. EasyLens first constructs EasyBank, a pathology-anatomy prototype space that provides lesion-related prototypes and anatomy-aware normal references for comparing suspicious patches against both pathological and normal anatomical patterns. To avoid blindly amplifying normal tissues, EasyTag selects lesion-relevant patches through counterfactual prototype reasoning. To counteract the dilution of subtle lesion cues in global image representations, EasyAmplifier strengthens the selected lesion-relevant patch representations through morphology-guided residual enhancement, thereby increasing their contribution to the global image embedding. Experiments on multiple medical image datasets and frozen medical VLM backbones show that EasyLens improves subtle-lesion detection and outperforms existing encoder-enhancement baselines.

Medical visual question answering (Med-VQA) has strong potential for clinical decision support by enabling AI models to interpret medical images and answer clinically relevant queries. Recent approaches typically connect off-the-shelf vision encoders with large language models (LLMs) through lightweight mapping networks to reduce computational cost. However, these methods often overlook the importance of handling noise and small irrelevant changes in visual representations. To address these challenges, we propose a noise-aware Med-VQA framework that incorporates a denoising autoencoder before visual embeddings are mapped into the input space of an LLM. The denoising autoencoder is pretrained to reconstruct clean visual embeddings from corrupted inputs, encouraging the model to learn robust visual representations that are less sensitive to noise. The resulting embeddings are then projected into the language model embedding space using a multi-layer perceptron (MLP), forming visual prefix tokens that provide image information to the LLM. To enable efficient adaptation without full retraining, we employ parameter-efficient fine-tuning using low-rank adaptation (LoRA). The proposed method is evaluated on the SLAKE and PathVQA benchmarks. Experimental results show improved robustness to noisy input embeddings while maintaining competitive clean performance across multiple evaluation criteria. These findings suggest that learning more robust visual representations can enhance Med-VQA performance and robustness.

Current prompt-based and adapter-based tuning of vision-language models (VLMs) is attractive for medical imaging, where clinical data sensitivity favors frozen backbones and annotations are limited. However, these methods typically optimize only the ground-truth class, treating all other classes as equally incorrect, ignoring clinically meaningful class relations and yielding unstable decision boundaries in limited-supervision settings. We propose Omni-Geometry Knowledge Distillation (OGKD), a new framework that injects class-relation structure into the teacher to produce directional targets that preserve the ground truth while respecting inter-class geometry. Using these targets, we develop two distillation losses: Global Geometry-Aware Distillation (GAD) operates on the global image token, and Label-Guided Geometry Distillation (LGD) applies the same geometry to attentive patch tokens to improve fine-grained alignment. Across comprehensive experiments and analyses on 11 widely-used medical datasets for base-to-novel and few-shot evaluations, our OGKD achieves substantially better performance, consistently improving accuracy by an average absolute gain of 1.7%-2.8% over all prior state-of-the-art VLM adaptation counterparts. It also robustly generalizes to unseen classes and yields more reliable predictions than other approaches. Our code is available at https://github.com/tientrandinh/OGKD.

Breast cancer remains a leading cause of cancer-related mortality among women. Its clinical management requires multimodal reasoning across a clinical workflow that spans \textit{screening}, \textit{diagnosis} and \textit{treatment planning}, where each stage involves distinct imaging modalities, task objectives, and reasoning patterns. However, constrained by data scarcity and model versatility, existing medical MLLMs are typically evaluated on isolated modalities or narrow task families, limiting their ability to support workflow-level clinical reasoning. In this work, we first introduce \textbf{BreastStage}, a workflow-aligned breast imaging instruction corpus comprising 1.86M instruction-following pairs curated from 17 sub-datasets across 5 imaging modalities and 136 task templates. Its held-out split, \textbf{BreastStage-Bench}, provides a comprehensive benchmark for evaluating multimodal reasoning across the breast cancer care continuum. Building on this corpus, we propose \textbf{BreastGPT}, a unified MLLM equipped with a dual-branch visual encoder and concept-preserving token compression to bridge the scale gap between standard radiology and gigapixel pathology. On BreastStage-Bench, BreastGPT achieves 75.66% closed-ended accuracy and 89.92% open-ended score, outperforming both general-purpose and medical-specific MLLMs across clinical stages and task formats. These results suggest that workflow-aligned data and cross-scale visual modeling are critical for clinically grounded medical MLLMs. All data, code, and model checkpoints are released at https://yangyy-liu.github.io/BreastGPT.io.

Vision-Language Models (VLMs) struggle when applied to medical image-text data, yet the tools available to diagnose this failure remain limited. Existing representation alignment metrics are symmetric, collapsing both modalities into a single score and hiding which modality drives cross-modal degradation. We introduce the Spectral Alignment Score (SAS), an asymmetric metric that projects both modalities onto the principal eigenbasis of an anchor modality and computes eigenvalue-weighted per-eigenmode correlations, resulting in directional scores whose difference quantifies modality information imbalance. We embed SAS within a benchmarking framework evaluating 15 VLMs across natural and medical image-text datasets alongside 6 alignment metrics and bidirectional retrieval. Our experiments show that medical images retain richer structural information than their paired clinical reports, a directional asymmetry invisible to all competing metrics, and that SAS achieves the strongest zero-label correlation with retrieval performance in the medical domain, positioning it as a practical diagnostic tool for clinical deployment. Code is available at this URL: https://github.com/iamalegambetti/medical-vlms-assessment.

Background: Oral diseases affect nearly 3.5 billion people worldwide, yet the comparative clinical potential of large-scale AI models in dentistry remains poorly understood. Three distinct model categories have emerged: language-generative models, discriminative vision foundation models, and dental-specific foundation models, with no unified review examining their relationships and collective limitations. Methods: Following PRISMA-ScR guidelines, we systematically searched four databases (PubMed, Google Scholar, Scopus, arXiv), screened independently by two reviewers. After applying inclusion/exclusion criteria, 97 studies (2020-2026) were included. We propose a two-dimensional classification framework organizing models by architectural paradigm and dental specialization degree. Results: Language-generative models excel at text-based tasks (clinical reasoning, licensing exams, patient communication) but show inconsistent performance on image-dependent diagnostics. Adapted SAM and CLIP variants achieve strong tooth segmentation and lesion detection results. Dental-specific models (DentVFM, DentVLM, OralGPT) demonstrate strongest performance on complex multimodal tasks. Integrated pipelines consistently outperform single-model approaches. A data asymmetry is observed: dental-specific pretraining concentrates almost entirely in the vision domain, reflecting scarce large-scale dental text corpora. Conclusions: General-purpose and dental-specific models play complementary roles; the most effective systems combine both within structured pipelines. Safe autonomous deployment requires resolving three persistent barriers: hallucination in generative models, limited annotated dental datasets, and absent standardized clinical evaluation benchmarks.

Vision-language models (VLMs) trained on paired chest radiographs and radiology reports learn a shared embedding space that can preserve instance-level image-report correspondence. This poses a privacy risk in settings where radiographs and reports are deliberately kept separate after acquisition, such as image-only data sharing or access-controlled reports, because a de-identified image may be re-linked to its original narrative report through cosine similarity alone. We formalized this as image-to-report retrieval and used public paired cohorts, in which the true pairing is known by design, as ground-truth benchmarks to audit the risk rather than as the privacy scenario. Evaluating VLMs of increasing clinical specialization on 406,241 paired examples from 126,804 patients across MIMIC-CXR (43,793 held-out pairs) and external CheXpert Plus (29,296 pairs), we found that re-linkage rose systematically with specialization: the strongest VLM retrieved the correct report at 15 times chance at a candidate pool of N = 100, 50 times chance at N = 10,000, and well above chance at full-database scale. The signal persisted under pathology-matched hard negatives that removed disease-label shortcuts, indicating correspondence beyond broad diagnostic categories. To reduce it without retraining, we froze both encoders and applied differentially private optimization only to the projection heads defining the alignment layer (epsilon = 0.34, delta = 6x10-6). This reduced Recall@1 by 61.8% at N = 10,000 on MIMIC-CXR and transferred to CheXpert Plus without retraining, while image-side utility was largely preserved: macro AUROC for linear-probe classification across 14 labels shifted only from 79.63% to 79.43%. Targeted DP finetuning of the shared alignment layer can substantially reduce cross-modal re-linkage without materially degrading the image representations that make these models clinically useful.

Biomedical figures are explained not by captions alone but by body-text passages that discuss them. Yet current multimodal corpora typically reduce figures to isolated image-caption pairs, discarding this crucial context. Existing pipelines either omit this context or append it without enforcing the figure references that support each attachment, which can create unsupported image-text attachments and incoherent discourse. We introduce context-grounded reconstruction, a source-grounded framework that converts PubMed Central Open Access (PMC-OA) records into referentially coherent interleaved sequences. It recovers captions and source text, attaches context only through article-native figure references, repairs non-contiguous context, and prunes unsupported images. Starting from these reconstructed sequences, PMC-InterCPT first filters records for text quality and medical relevance, then applies evidence-aware allocation to form a 9.63B-token corpus for continued pretraining (CPT) of generative medical MLLMs. With fixed supervised fine-tuning (SFT), PMC-InterCPT improves Qwen3.5-4B-Base by 1.46 medical-average points and 3.11 general/scientific-average points over a token-matched raw source control, and surpasses a 42% larger raw-data run. Gains transfer to Qwen3.5-2B-Base and LLaVA-OneVision-1.5-4B-Base. Controlled ablations show that context-grounded reconstruction, rather than simply appending article context, is central to useful biomedical multimodal CPT.

General-purpose VLMs remain unreliable for biomedical research because valid answers in scientific papers depend on evidence split across figures, tables, charts, captions, and referring text. Existing post-training pipelines are bottlenecked by costly expert annotation and by synthetic data that drops this evidence structure. We present Ryze, a fully automated system that converts raw biomedical papers into an evidence-enriched training set and a domain-specialized VLM. Ryze synthesizes QA pairs with complete supporting evidence (visual element, caption, extracted structure, and referring paragraphs), reduces layout and OCR errors via chart/table-aware extraction and LLM-based cleansing, and applies a progress-gated post-training strategy combining supervised fine-tuning with reinforcement learning. Starting from Qwen3-VL-8B, Ryze produces BioVLM-8B at under USD 200, achieving 48.0% weighted accuracy on LAB-Bench, outperforming the base model by +12.6 percentage points (pp) and surpassing GPT-5.2 by +3.8 pp. We release Ryze as open source together with the trained BioVLM-8B model.

Learning transferable and interpretable representations from medical volumetric scans remains challenging due to complex anatomical structures and weak, heterogeneous supervision provided by radiology reports. In this paper, we propose Anatomy-aware Semantically-Adaptive Pre-training (ASAP), a principled vision-language pre-training framework for fine-grained medical volumetric representation learning from large-scale chest CT scans and their corresponding radiology reports. ASAP integrates three key components: (1) an anatomy-aware knowledge injection module that incorporates organ-level structural priors via off-the-shelf segmentation tool to encourage anatomically coherent representations; (2) a semantically-adaptive selective alignment mechanism that dynamically associates sentence-level findings with localized volumetric regions; and (3) a semantically-adaptive fusion module for effective interaction between anatomically informed visual features and grounded textual cues under dual-modal masked modeling paradigm. Beyond methodological contributions, we establish a comprehensive benchmark for medical volumetric vision-language pre-training on chest CT, covering 15 datasets and 22 downstream tasks spanning abnormality classification, segmentation, disease prognosis prediction, report generation, vocabulary classification, cross-modal retrieval and visual question answering. This benchmark provides standardized evaluation protocols to systematically assess representation quality under diverse clinical settings and data regimes. Extensive experiments demonstrate that ASAP consistently achieves state-of-the-art performance across tasks and datasets, with particularly pronounced gains under limited supervision and distribution shift, validating its effectiveness in learning transferable and clinically meaningful volumetric representations.

Generating clinically useful pathology reports for pathology cases from whole-slide images (WSIs) is challenging due to gigapixel resolution, long visual-token sequences, and the complexity of case-level reasoning, where a single case may contain multiple WSIs with heterogeneous tissues and ambiguous findings. We present a simple token-efficient vision--language model for case-level synoptic report generation that remains practical under constrained GPU memory. Our architecture follows a minimal three-component design: a frozen pathology patch encoder, a lightweight two-layer MLP vision-language aligner, and a large language model decoder, with an explicit WSI marker token to separate slides within a case. Training proceeds in two supervised stages: (1) aligner-only WSI captioning using heterogeneous WSI-text pairs, and (2) case-level supervised fine-tuning on case-report pairs for structured report generation. To reduce sequence length, we represent each slide using $512 \times 512$ patches at $5\times$ magnification, which reduces the average sequence length by up to $64\times$ times compared to the commonly used $20\times$ patches. Combined with efficient training techniques, we enable practical training with only half a NVIDIA H100 GPU. Across both training stages, our approach achieves high ROUGE-L/METEOR/BLEU-4 scores while being substantially more efficient in memory and runtime. In AI-based evaluations, our model is consistently preferred over strong baselines. Extensive ablations characterize performance-efficiency trade-offs and identify simple choices that improve robustness in multi-WSI settings. Overall, this work provides a strong, reproducible baseline for efficient pathology report generation, lowering the barrier to multi-WSI VLM research under limited compute.

Multimodal Large Language Models (MLLMs) have shown strong performance on public medical benchmarks, yet existing evaluations often remain weak proxies for clinical use, relying on isolated inputs and simplified recognition-style tasks. We introduce CardioLens, a leakage-resistant evaluation testbed for multi-sequence Cardiovascular Magnetic Resonance (CMR), constructed from private hospital archives through a rigorous report-to-QA construction and verification pipeline. CardioLens contains 473,896 slices and 13,494 verified QA pairs across 4D Cine, LGE, perfusion, and T2-weighted imaging, and evaluates three stages of CMR interpretation: image understanding, report generation, and disease diagnosis. Across 24 state-of-the-art MLLMs, CardioLens reveals a substantial clinical reality gap: models perform poorly overall, with performance degrading along the real CMR workflow. Confusion analysis further shows a category-collapse failure mode, where models default to frequent abnormal categories rather than distinguishing clinically distinct findings. To rule out MLLM-compatible input construction as the primary cause, we compare random, clinically motivated, and data-driven slice selection protocols under different slice budgets; performance changes only marginally, typically by about 1%. Explicit reasoning prompts also fail to rescue performance, often making models more conservative rather than improving visual evidence use. These results show that current MLLMs remain far from reliable CMR interpretation, where clinical decisions require integrating distributed evidence across sequences, views, and temporal phases. CardioLens provides a clinically grounded testbed for developing next-generation MLLMs toward real-world clinical deployment.

Evaluations of dental vision-language models remain fragmented across datasets, task definitions and metrics, and often ignore their computational cost. This limits their widespread deployment for dental screening outside specialist centres, where timely inference, limited hardware, and local handling of patient images are vital for practical, privacy-preserving clinical prescreening. Here we present Pocket-Dentist, an efficiency-aware benchmark for dental multimodal question answering that brings together three datasets spanning approximately 1,159 patients from BRAR and MetaDent, five task types and seven metrics. Across 14 typical VLMs, our results reveal an interesting observation: compact VLMs, such as 2B-parameter models, become competitive with much larger VLMs on most metrics after lightweight adaptation while requiring substantially lower computational costs in dental image understanding. Deployed locally on an iPhone 17 Pro, our finetuned compact VLM Pocket-Dentist-2B processed each sample in 4.31 s, reducing latency by 4.9x and memory use by 2.3x compared with a 7B baseline. Our project page is available at https://2026-icml.github.io/pocket-dentist-icml.

Latent reasoning enables reasoning over continuous hidden states rather than explicit tokens, avoiding the language bottleneck and inference overhead of chain-of-thought for medical VQA. However, existing methods suffer from modality collapse, insufficient visual supervision, and train-inference mismatch. Moreover, their opaque latent states offer no interpretability, which is critical in clinical applications. We propose VITAL, a latent-space reasoning framework for medical MLLMs with visual-semantic dual supervision: an auxiliary text decoder reconstructs reasoning chains from latent states, while a visual projector regresses ROI features from a frozen, independent medical vision encoder. Both modules are discarded at inference with zero overhead, yet can be re-attached post-hoc for dual interpretability, providing textual and visual explanations of the reasoning process without sacrificing efficiency. We construct a 61K dataset spanning 9 imaging modalities, exceeding prior medical visual latent reasoning datasets by an order of magnitude. Experiments on 7 benchmarks show that VITAL consistently and substantially outperforms the backbone, all latent reasoning baselines, and medical MLLMs trained on far larger data, achieving state-of-the-art results competitive with trillion-parameter proprietary models.

The advancement of general medical Multimodal Large Language Models (MLLMs) has shown great potential for building conversational assistants to support clinical diagnosis. However, their adaptation to highly specialized domains such as ophthalmology remains underexplored, primarily due to the scarcity of large-scale, domain-specific instruction-tuning data. Existing ophthalmic datasets for conversational agents are often limited in scale and largely rely on images from established public benchmarks, limiting the scalability of ophthalmic MLLMs and their ability to capture real-world clinical complexity. To address this gap, we propose $\textbf{OphIn-Engine}$, an ophthalmology-specific instruction data curation pipeline that constructs high-quality instruction data from open-access ophthalmology web-scale videos. The pipeline integrates multimodal transcription for extracting image-transcript pairs, visual cue separation and scoring for identifying clinically relevant visual descriptions, and instruction synthesis with quality control for generating accurate and diverse clinical dialogues. Using this engine, we introduce $\textbf{OphIn-500K}$, a large-scale multimodal ophthalmology instruction-tuning dataset containing over 500,000 instruction instances and more than 151,000 unique images from over 29,000 video clips, formatted as visual question answering (VQA), multi-turn conversational interactions, and chain-of-thought (CoT) reasoning. Built upon this dataset, we further develop $\textbf{OphIn-VL}$, an ophthalmology-specific MLLM with advanced visual understanding and conversational capabilities. Comprehensive experiments and case studies demonstrate that OphIn-VL achieves superior performance compared with state-of-the-art general medical and domain-specific MLLMs.

Distilling demonstration effects into hidden-space interventions offers a lightweight alternative to full finetuning. However, existing multimodal variants are mostly evaluated on short-form tasks, where outputs end after a few tokens. Extending these methods to long-form generation exposes a fundamental yet underexamined limitation: token-level distillation implicitly treats all output tokens as equally informative, but long-form outputs are dominated by high-frequency template and grammatical tokens, while the tokens that actually determine output quality are sparsely distributed. In medical report generation (MRG), two such decisive tokens stand out: pathology-related tokens that determine diagnostic content, and the end-of-sequence (EOS) event that determines termination. Both receive insufficient supervision under uniform cross-entropy, and autoregressive decoding further compounds the problem by drifting away from teacher-forced trajectories. We propose DIVE, a frozen-backbone distillation framework that addresses long-form report generation through two complementary mechanisms matched to these failures. Decisive-token supervision restores supervision balance by upweighting the cross-entropy contribution of pathology-related tokens and the EOS event, ensuring that content fidelity and termination are learned during training rather than imposed at decoding time. State-conditioned dynamic steering replaces fixed open-loop residuals with hidden-state-dependent adapters, allowing the injected signal to adapt as decoding drifts. Experiments on MIMIC-CXR and CheXpert Plus with two medical VLM backbones show that DIVE consistently ranks among the strongest methods across lexical and clinical-proxy metrics. Our method achieves the best BLEU-4, ROUGE-L, and RadGraph F1 in all dataset--backbone settings, while remaining competitive on coarse label-level CheXbert F1.

Volumetric Reasoning Segmentation (VRS) aims to segment a target region in a 3D medical scan from a free-form clinical query, where the referent is often implicit and requires both medical knowledge and volume-grounded reasoning. Existing methods typically rely on specialized segmentation tokens to connect language with mask decoding, but this coupling collapses the decision process into opaque latent representations, limiting interpretability and generalization to diverse narrative expressions. In this paper, we present MedVol-R1, a reinforcement learning-based framework for VRS that explicitly decouples evidence grounding from volumetric delineation: the LVLM grounds clinical reasoning to a verifiable 2D evidence anchor (key axial slice and 2D bounding boxes), which is then propagated into a coherent 3D mask by a frozen MedSAM2 module. We train MedVol-R1 with cold-start supervised fine-tuning followed by GRPO, guided by a multi-component reward that encourages informative evidence selection, accurate 2D spatial grounding, and cross-slice volumetric coherence, without requiring costly chain-of-thought annotations. Experiments on CT-ORG, AbdomenCT-1K, and KiTS23 from the M3D-Seg benchmark demonstrate that MedVol-R1 consistently outperforms strong baselines and achieves state-of-the-art performance, with reinforcement learning providing clear gains over pure supervised fine-tuning.

Hepatocellular carcinoma (HCC) is biologically heterogeneous, shaped by the interplay between hepatic functional reserve and tumor-related oncologic factors; thus, similar survival outcomes may reflect fundamentally different underlying biological processes. Prognostic modeling in HCC is informed by rich multimodal information from multiparametric MRI and radiology reports from routine clinical practice. Existing prognostic vision-language models (VLMs) learn a single entangled latent representation that blends hepatic and tumor-related factors, limiting both accuracy and biological interpretability. We present BioFact-MoE, a biologically factorized Mixture of Experts (MoE) framework that explicitly decomposes liver and tumor factors via biologically supervised experts within a residual MoE survival architecture. On a HCC cohort of N=588 patients (pretrained on 4,582 3D MRI image-report pairs), BioFact-MoE consistently improves survival prediction over all baselines across time horizons, achieving 12-, 18-, and 24-month AUCs of 75.33%, 75.85%, and 73.96%. Beyond scalar risk prediction, gated expert weights enable phenotype-aware risk stratification. Pathway-informed gating uncovers clinically meaningful treatment-associated survival heterogeneity. In held-out validation, hepatic and tumor embeddings show selective associations with liver function and tumor burden markers, respectively (p<0.05), without supervision. The code is available at https://github.com/jy-639/BioFact-MoE.

Skin cancer is a common and fast rising malignancy worldwide. Early detection is critical for improving outcomes. Deep learning models trained on dermoscopic and clinical images can support automated and fast triage. However, many studies evaluate only a limited set of architectures. Experimental setups also vary across studies. In this paper, we present a unified evaluation of twelve deep learning models for binary skin cancer detection on the PAD-UFES-20 dataset. The models span four families: convolutional neural networks (CNN), vision transformers (ViT), hybrid convolution transformer backbones, and vision language models (VLM). Performance is assessed using AUC, the maximum F1 score with its precision and recall, and sensitivity at 80% specificity, reflecting screening oriented requirements. Our results show that well tuned CNNs already provide strong baselines, but transformer based families consistently improve discrimination. Hybrid models (MaxViT Tiny, CoAtNet0) and a SigLIP based VLM achieve the best overall trade off between ranking performance and clinically relevant operating points, while CLIP based model offers high precision. The full codebase for all experiments is publicly released. Together, these findings offer practical guidance on which model families are most suitable for real world deployment in skin cancer screening and establish a reproducible reference point for future work on PAD-UFES-20.

Modern deep learning offers powerful tools for automated retinal screening, but it remains unclear how different visual model families compare in realistic multi-disease settings and under domain shift. In this work, we benchmark twelve architectures across four model families: convolutional neural networks, vision transformers, hybrid CNN-transformer backbones, and vision-language models, using the Retinal Fundus Multi-disease Image Dataset (RFMiD). We evaluate two tasks: binary screening for any retinal disease and multi-label classification across 28 disease classes. Using standardized training, calibration, and evaluation protocols, we report AUC, F1, precision, recall, and sensitivity at a clinically relevant operating point with specificity near 80%. On RFMiD, all architectures perform well on binary screening, with AUC above 84%, but attention-based models perform best. SwinTiny and the hybrid CoAtNet0 and MaxViTTiny models achieve the strongest binary screening results and improve macro and micro F1 in the multi-label setting. Vision-language models, including CLIP ViT-B/16 and SigLIP-Base384, are competitive with CNN baselines but do not surpass the best transformer and hybrid backbones. In external validation on Messidor-2 for referable diabetic retinopathy, AUC ranges from 66.8% to 84.7%, with hybrid and transformer models again showing strong performance. These results provide a reproducible reference for model selection in multi-disease retinal screening and guide future automated screening tools for clinical deployment.

Urgent suspected colorectal cancer (CRC) referrals create operational bottlenecks because semi-structured clinical documents often require manual review and transcription. The original RAPTOR system used Large Language Models for structured extraction but relied on a separate OCR stage, making it vulnerable to handwriting, layout variation, and loss of visual evidence linkage. We present RAPTOR+, a multimodal extension that uses Vision-Language Models (VLMs) for end-to-end referral understanding. We evaluate fine-tuned VLMs, commercial and open-source zero-shot VLMs, and the original OCR-based pipeline on 223 clinically curated CRC urgent referral forms. We also introduce a grounding-aware evaluation framework that measures both extraction accuracy and evidence localisation. Results show a clear grounding gap in zero-shot models. Gemini 2.5 Flash achieved 92.6% Reading Accuracy but only 1.2% Strict Safety. In contrast, fine-tuned Qwen3-VL-8B achieved 96.1% Reading Accuracy and 60.6% Strict Safety, substantially improving verifiable evidence grounding. These findings show that task-specific fine-tuning is essential for reliable, auditable clinical document understanding. RAPTOR+ enables extracted referral decisions to be linked to visual evidence, supporting safer and more efficient cancer referral triage.

Medical vision-language models (VLMs) often hallucinate findings when generating chest X-ray reports: they fabricate findings that are not present in the image, miss important ones, or locate them incorrectly. We mitigate this without weight updates by decoding-time residual steering on a per-token sparse autoencoder (SAE) basis: Top-$K$ SAEs on late layers, causal steering against clinical errors, then combined suppress/boost intervention at inference time. On the MIMIC-CXR test split, our inference-only method improves the quality of generated reports for three radiology VLMs (RadVLM, LLaVA-Rad, and CheXOne), with relative improvements of +5.4%, +7.2%, and +17.0% in the clinical composite metric, and statistically significant GREEN gains on all backbones. A cross-model feature alignment shows that the quality-promoting (boost) directions overlap strongly across architectures, whereas hallucination-linked (suppress) directions are model-specific. Therefore, transferable steering must treat suppression per-backbone, rather than sharing a universal suppress list. The same recipe transfers zero-shot to IU-Xray (Green $+7.7\%$ rel.) without retraining, confirming that the identified features are properties of the model, not of the training corpus. We release causal feature sets and an interactive feature dashboard: https://cxr-sparse-feature-dashboard.netlify.app/.

The major limitations of gastrointestinal (GI) endoscopy AI systems arise from a shortage of annotated data, strict privacy policies, and significant bottlenecks in conventional model fine-tuning. Such limitations impede the successful application of sophisticated AI models in clinical practice, particularly affecting the reliability and scalability of diagnosis. In this paper, we present a dual-pipeline PEFT model that addresses two fundamental problems: medical Visual Question Answering (VQA) and the generation of privacy-preserving synthetic data. For clinical VQA, we adopt the Florence-2 vision-language model. Leveraging PEFT enhances model interpretability while substantially reducing the computational cost of training. Simultaneously, we employ Low-Rank Adaptation (LoRA) with Stable Diffusion 2.1 to generate high-quality GI images that enhance training databases without violating patient privacy. This research utilized the Kvasir-VQA dataset. Our Florence-2 VQA model achieved ROUGE-1 of 0.92, ROUGE-L of 0.91, and BLEU score improvements from 0.08 to 0.24. Fine-tuning on private datasets consistently showed better results than fine-tuning on public datasets. The rank-4 LoRA synthesis achieved optimal performance with a fidelity score of 0.290, an agreement score of 0.730, and a Frechet BiomedCLIP Distance (FBD) of 1450, reducing computational costs by almost 90 percent. This framework improves the clinical potential of AI in GI endoscopy. Compared to FLUX, MSDM, and Kandinsky 2.2, our model demonstrates superior FBD and strong semantic alignment. While other models lead in Fidelity or Agreement, our lower FBD indicates better image-text coherence. These results establish our approach as a robust solution for enhancing VQA and synthetic data generation in clinical AI.

Classical noisy-label theory predicts that downstream performance under weak supervision is bounded above by the labeler's accuracy, implying a sharp crossover: once a gold-trained classifier matches the labeler, weak labels stop helping and start hurting. The prediction is theoretical; what is missing is a benchmark calibration that turns it into an instance-level statement for modern foundation-model labelers. We provide such a calibration for BiomedCLIP-generated weak labels on three medical-imaging benchmarks (PCAM, ISIC, NIH-CXR) and six downstream architectures spanning an 11x parameter range. The crossover predicted by theory appears at ng~100 on PCAM, 20-50 on ISIC, and 250-500 on NIH-CXR; weak labels above the crossover degrade AUC by up to -0.10. The location is architecture-invariant for four of five pretrained architectures, and a within-family DenseNet sweep (2.5x parameters, identical pretraining) supports the view that the labeler, not the student, is the dominant constraint. The calibration in turn produces a decision rule operable from 10-20 gold labels: compare gold-only AUC to VLM accuracy on the user's gold set. A structured-vs-random noise sign flip on NIH-CXR shows that the rate-only formulation of the bound is incomplete and identifies a concrete refinement (label-space projection) that future benchmarks can be designed to test.