Medical VQA

VQA: Visual Question Answering

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10 papers in the last four weeks, up 67% on the four weeks before. 0.1% of all new papers.

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Latest papers 115

Oct 7, 2026cs.CV

HeiCo-FOCUS: A Clinically Grounded Dataset for Long-Context Video Understanding

Recent advances in Vision-Language Models (VLMs) have led to rapid progress in video understanding across a wide range of benchmark tasks. However, existing evaluations largely focus on short-term reasoning, failing to assess a critical capability: maintaining cumulative temporal consistency over extended time horizons. To close this evaluation gap, we introduce HeiCo-FOCUS, a clinically grounded dataset for evaluating long-context video understanding through the task of Foreign Object Contextual Understanding in Surgery. Built on a dataset of Heidelberg Colorectal surgeries, this task requires models to continuously track multiple objects as they are inserted, manipulated, occluded, and removed over procedures lasting up to hours. HeiCo-FOCUS comprises 30,000 visual question answering (VQA) pairs covering five core capabilities: object recognition, temporal grounding, aggregation, event and procedural understanding, and complex reasoning. The dataset was constructed through a rigorous multi-stage annotation pipeline involving large-scale crowd annotation and 39 surgical domain experts to ensure high quality and clinical relevance. To systematically probe model behavior, we introduce a multi-track evaluation framework that progressively increases temporal and contextual demands from single frames to full procedures. Experiments with ten frontier VLMs show that HeiCo-FOCUS tasks are far from solved: only around half of the models clearly outperform a text-only baseline. Across the video tracks, models perform best on event and procedural understanding (mean Accuracy: 56.5% across all models), while temporal grounding remains particularly challenging for all evaluated models (mean Accuracy: 19.7%). We therefore expect HeiCo-FOCUS to serve as a catalyst for the development of models capable of reliable, temporally consistent reasoning over hours-long videos.

Leon Mayer, Lucas Luttner, Patrick Godau +42

Long-Video Understanding Surgical Video Understanding Temporal Video Grounding Medical VQA

Oct 5, 2026cs.CV

A doctrine-grounded visual question answering dataset for Tactical Combat Casualty Care

Tactical Combat Casualty Care (TC3) requires responders to connect visual observations of injuries and interventions with established clinical guidance. Developing vision-language models to support this process requires supervision that links visible evidence to traceable doctrine. We present TC3-VQA, a dataset constructed from public instructional and field TC3 videos and authoritative TC3 documents. It contains 581 items spanning 11 concepts, with 1,860 questions covering intervention recognition, doctrine, clinical reasoning, procedural guidance, and refusal when visual information is insufficient. Doctrine-based answers preserve verbatim source passages and character offsets. Construction combines visual annotation, passage retrieval, entailment checks, and verification across model families. Equipment boxes, anatomical labels, temporal segments, and source metadata accompany the question-answer pairs. Automated audits and ratings by two physicians and two medical students characterize annotation quality, with human ratings available for 88 retained items. The dataset provides a resource for adapting vision-language models to TC3, studying the connection between visual evidence and clinical knowledge, and evaluating recognition, doctrine recall, and abstention.

Junseob Kim, Jade Chng, Ayman Ali +5

Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA · Department of Biomedical Engineering, Duke University, Durham, NC, USA · Department of Surgery, Duke University, Durham, NC, USA +3

Medical VQA Video QA Medical VLMs Knowledge-Based VQA

Oct 5, 2026cs.CL

MedPrune: Topology-Efficient Multimodal Multi-Agent Communication Evolution for Medical VQA Tasks

While medical multimodal large language models (Med-MLLMs) advance medical visual question answering (VQA), existing clinical workflow-inspired multi-agent frameworks suffer from interaction patterns and excessive computational overhead caused by redundant communication topologies. In this paper, we propose MedPrune, an efficient medical multimodal multi-agent collaboration framework that dynamically prunes both nodes and edges from the communication topology to enhance reasoning ability and token efficiency. Specifically, we first formulate the diagnostic process as a heterogeneous communication graph, where nodes represent specialist agents from various departments and edges capture intra- and inter-departmental interactions. Building on this graph, we introduce two sparsification mechanisms to enable adaptive collaborative evolution: (1) Heterogeneous Node Sparsification, which eliminates task-irrelevant specialist agents irrelevant to the current multimodal question via reinforcement learning-driven topological optimization, and (2) Heterogeneous Edge Sparsification, which selectively retains only the most diagnostically salient intra- and inter-departmental connections by jointly optimizing task performance and topological complexity. Extensive medical VQA experiments under full-set and few-shot training settings prove MedPrune surpasses multi-agent baselines and boosts token efficiency with strong adversarial robustness.

Jiuheng Wan, Runze Li, Chen Chen +5

School of Computer Science and Information Engineering, Hefei University of Technology · Nanjing University · Guangdong University of Finance and Economics +2

Medical VQA Multi-Agent Collaboration Multimodal Agents Multi-Agent Communication

Oct 5, 2026cs.CV

BrainTRACE: Tracing Longitudinal, Multimodal, and Volumetric Evidence in Brain MRI Clinical Reasoning

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.

Qizhen Lan, Mengchen Fan, Hang Zhang +5

University of Texas Health Science Center at Houston · University of Alabama at Birmingham · University of Pittsburgh +3

VLM Evaluation 3D Medical Imaging Medical VQA Medical Image Grounding Brain MRI

Oct 1, 2026cs.CV

CineMR: Tool-Integrated Vision-Language Reasoning for Quantitative Cardiac MRI Assessment

Cardiovascular magnetic resonance (CMR), including cine imaging, is a reference standard for the noninvasive assessment of cardiac morphology and ventricular function. Cine CMR interpretation integrates qualitative visual assessment with quantitative measurements of ventricular volumes, ejection fraction, myocardial mass, wall thickness, and regional wall motion. Current medical vision-language models (VLMs) cannot reliably derive quantitative measurements from multidimensional cine images without analysis tools. We present CineMR, a tool-augmented VLM that invokes cardiac image-analysis tools and integrates their outputs into interleaved reasoning for quantitative CMR assessment. We also construct a multi-cohort visual question answering benchmark covering quantitative metric extraction, multiclass diagnosis, and differential diagnosis, together with tools for segmentation, phase selection, volumetry, morphometry, and regional wall motion analysis. CineMR is trained with supervised fine-tuning (SFT) on tool-interaction traces followed by Group Relative Policy Optimization (GRPO) with conditional tool-use rewards. On the multi-cohort cine CMR benchmark, CineMR achieves 35.9% pass@1 and 58.9% pass@4, compared with 1.5% pass@1 for the Qwen3-VL-8B backbone and 0.0% and 7.0% pass@1 for LLaVA-Med v1.5 and MedGemma-4B, respectively. Correct tool invocation reaches 99.8% after GRPO, up from 78.9% after SFT. Live tool outputs improve ventricular measurement accuracy by 20.4--23.7% over direct model predictions, and removing all tools reduces pass@1 from 35.9% to 27.9%. These results highlight the importance of reliable tool use for quantitative cine CMR reasoning and support CineMR as a promising approach for assistive cardiac image assessment. Code, benchmark resources, and model weights are available at https://github.com/AI-MIND-Lab/CineMR.

Kunyang Li, Hai Nguyen, Joshua Lowe +6

Institute for Artificial Intelligence, University of Central Florida · Department of Clinical Sciences, College of Medicine, University of Central Florida · Nemours Cardiac Center, Nemours Children’s Hospital, Florida +1

Tool Use in VLMs Medical VQA VLM Reasoning Medical Image Benchmarks Cardiac MRI

Sep 30, 2026cs.CV

Learning Where to Look: Anatomical Grounding and Guided Attention for Cardiac MRI Vision-Language Models

Cardiac magnetic resonance imaging (CMR) enables assessment of cardiac anatomy, ventricular function, and myocardial tissue characteristics. Clinicians interpret these images by identifying cardiac structures and focusing on the regions relevant to each clinical question, motivating anatomically guided vision-language models (VLMs). Yet CMR-specific supervision for anatomical localisation and clinical question answering remains limited. To address this gap, we investigate fine-grained CMR visual question answering through anatomical grounding and guided attention. We construct 128,915 anatomical-grounding and 42,799 clinical QA pairs across short-axis cine, late gadolinium enhancement, and long-axis cine. These datasets support anatomical recognition, localisation, and clinical assessment without requiring paired reports for individual training images. To help the model learn where to look, we introduce Cardiac Anatomy-Routed Attention (CARA), which selects predicted anatomical priors according to the question and guides decoder attention with learned task-specific strengths. Combining anatomical grounding pretraining with CARA yields our model, CARA-VL. Experiments demonstrate CARA-VL's strengths in clinical assessment and regional localisation across CMR imaging settings, with promising generalization to an external clinical cohort. Together, our data and method provide a practical framework for studying and advancing cardiac visual understanding in VLMs. We will release the QA data derived from public datasets upon publication.

Bangwei Guo, Xiao Chen, Boris Mailhe +8

Rutgers University, NJ, USA · United Imaging Intelligence, Boston, MA, USA · University of Texas Southwestern Medical Center, TX, USA +1

Medical VQA Medical Image Grounding Medical Image Benchmarks Cardiac MRI

Sep 30, 2026cs.CV

CRAFT: Causal Responsibility and Failure Tracing in Medical Vision Language Models

As vision language models are increasingly deployed in clinical diagnosis, understanding how they internally resolve competing visual and textual signals becomes a safety imperative. Existing mechanistic analyses remain confined to unimodal text and offer no explanation for why a single misleading sentence can override a correct image based diagnosis, or why a model commits to a confident answer despite insufficient visual evidence. We find that these two safety risks, arbitration failure where textual context overrides visual grounding and brake failure where the model commits without adequate evidence, are mediated by spatially disjoint attention head populations: arbitration heads form a mid-to-deep wideband reflecting cross-layer evidence competition, while brake heads concentrate in a narrow middle-to-late layer band that regulates evidence sufficiency and abstention behavior. To ground these observations in causal circuitry, we introduce CRAFT, which localizes each failure mode to a minimal causal head set via dual criteria and verifies necessity and sufficiency through temporal probes and Tuned Lens trajectory analysis. Excising arbitration heads sharply reduces conflict following with negligible degradation on clean inputs, while excising brake heads restores appropriate abstention under degraded visual evidence. The two interventions target spatially disjoint head sets and produce distinct corrective effects, underscoring the mechanistic separability of the failure modes. Experiments across multiple medical VQA benchmarks and VLM architectures validate both the localization and interventions, demonstrating that the identified heads causally drive each failure mode and that targeted modulation generalises without retraining. The code is available at GitHub repository.

Chunzheng Zhu, Jiaqi Zeng, Hongbo Zhao +3

Hunan University · University of Hong Kong

Vision-Language Models Medical VQA VLM Interpretability Medical VLMs

Sep 28, 2026cs.CV

See, Measure, and Reason: Learning Visually Grounded Reasoning in Pathology

Pathological assessment relies on recognizing fine-grained visual details in histological images. Vision-language models (VLMs) increasingly support pathology interpretation, yet their ability to perceive these details remains inadequate. This weakness leads to inaccurate cellular observations that can persist even when final answers are correct. In this paper, we propose ASPECT to improve visually grounded reasoning through explicit supervision of cellular appearance and abundance. ASPECT trains intermediate visual tokens through pathology feature reconstruction, cell feature alignment, and count supervision. Three-stage supervised fine-tuning teaches the model to perceive, generate visual tokens, and reason, followed by reinforcement learning that rewards answer correctness and consistency with reported measurements. We also introduce PathoVernier, a benchmark of 759 expert-reviewed questions from five pathology datasets covering four cellular composition tasks. It evaluates both final answers and intermediate measurements to expose errors hidden by answer accuracy. On PathoVernier, ASPECT achieves relative accuracy gains of approximately 19.2% over the strongest baseline, Gemini-3.1-Pro, and 99.3% over its Qwen3-VL-8B backbone, while reducing RAWR, which measures counting errors within correct responses, by 28.1% and 42.7%, respectively. ASPECT also improves over its backbone on three external pathology benchmarks covering classification and question answering beyond cellular composition tasks.

Chengyang Zhang, Wenchuan Zhang, Bo Li +8

College of Computer Science, Sichuan University · Department of Pathology and Institute of Clinical Pathology, West China Hospital, Sichuan University · Department of Computer Science, School of Computing, National University of Singapore +1

Computational Pathology Medical VQA Medical VLMs Visually Grounded Reasoning

Sep 26, 2026cs.CV

EyeVQA: Benchmarking Ophthalmic Vision-Language Models from Recognition to Spatial Grounding

Vision-language models (VLMs) have shown increasing potential for medical image understanding, yet their capabilities in ophthalmic imaging remain insufficiently characterized. Existing ophthalmic datasets are typically designed for individual diseases or specialized tasks, making it difficult to systematically evaluate whether VLMs can move beyond disease recognition toward comparative reasoning and fine-grained spatial grounding. We introduce EyeVQA, a unified visual question answering benchmark for comprehensive evaluation of ophthalmic VLMs. EyeVQA is constructed from 21 available ophthalmic datasets and contains 20,000 question-answer pairs spanning six disease groups and seven question types: Single-Choice, Multi-Select, Variable-Select, True-False, Ranking, Point Location, and Bounding Box. Gold answers are deterministically derived from source-provided diagnoses, severity grades, clinical findings, segmentation masks, bounding boxes, and anatomical landmarks, enabling reproducible evaluation without relying on model-generated annotations. Notably, 44.5% of the questions require reasoning across multiple images, extending evaluation beyond conventional single-image medical VQA. We benchmark fourteen representative general-purpose, scientific, and medically specialized VLMs under a unified zero-shot protocol. The best-performing model only achieves an overall score of 62.8, while substantial gaps remain in spatial grounding and cross-task generalization. These results highlight the limitations of current VLMs in comprehensive ophthalmic visual understanding and establish EyeVQA as a diagnostic benchmark for developing more reliable and spatially grounded ophthalmic multimodal models. The project page is available at https://github.com/PKUTHM/EyeVQA.

Gujie Shao, Zixun Xie, Xuechun Xing +7

VLM Evaluation Medical VQA Vision-Language Grounding Medical Image Benchmarks

Sep 21, 2026cs.AI

Representation-guided in-context learning for medical image interpretation with multimodal large language models

Medical image interpretation is central to diagnosis and care, yet adapting general-purpose multimodal large language models (MLLMs) often requires resource-intensive domain-specific fine-tuning. Here we introduce representation-guided in-context learning (RG-ICL), a training-free inference framework that retrieves query-aligned demonstrations using frozen encoders, without task-specific parameter updates. Across eight datasets spanning histopathology, radiology and retinal fundoscopy, RG-ICL improved classification (mean gain 20 percentage points) and visual question answering (VQA) (mean gain 13 percentage points) over no-context and conventional ICL, approaching or exceeding training-based comparators. Which cases were retrieved mattered more than how many: 6 query-aligned cases outperformed up to 32 randomly selected ones, whereas fixed or random cases often reduced accuracy below baseline. For VQA, aligning reference cases with both image content and question intent produced further gains. These findings indicate that for medical image interpretation, curating which reference cases an MLLM sees is a practical alternative to retraining it.

Minda Zhao, Fangyu Hu, Yan Luo +8

Harvard AI and Robotics Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA · Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA · Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan +6

Medical Image Analysis Multimodal Large Language Models Medical VQA In-Context Learning Retrieval-Augmented ICL

Sep 14, 2026cs.CV

A Unified Vision-Language Model for PSMA PET/CT Report Generation, Visual Question Answering, and Lesion Segmentation

Accurate PSMA PET/CT interpretation is central to prostate cancer management, yet existing PET/CT AI models typically address isolated tasks. We propose a unified PSMA PET/CT vision-language model for report generation, visual question answering, and lesion segmentation. The framework adopts an LLaVA-style architecture, comprising a PET/CT vision encoder, an MLP-Mixer projection module, a LoRA-tuned large language model, and a 3D segmentation branch. Training followed a four-stage strategy: vision encoder pretraining, projection-layer alignment, VLM fine-tuning, and final multitask tuning. Language tasks used 5,747 PSMA PET/CT datasets with paired reports, while segmentation used the PSMA subset of AutoPET. The model outperformed PET2REP and a CT-based baseline across standard report-generation metrics, improved performance across VQA question types, and achieved higher Dice and lesion-level overlap F1 than SegAnyPET and nnUNet. These results support the feasibility of a unified framework for structured, interactive, interpretable PSMA PET/CT analysis with voxel-level grounding within a single multitask model architecture.

Yang Xing, Jiong Wu, Savas Ozdemir +11

1J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA · Department of Radiology, University of Florida, Jacksonville, FL, USA · Department of Applied Mathematics & Statistics, Stony Brook University, Stony Brook, NY, USA +3

Radiology Report Generation Medical VQA PET/CT Imaging Medical VLMs PET/CT Tumor Segmentation

Sep 14, 2026cs.AI

Option-Aware Retrieval and Task-Specific VLM Adaptation for Medical VQA

We describe our submission to the MedReason 2026 challenge, covering multiple-choice (MCQ) and open-ended (OE) medical visual question answering (VQA) under fully offline, containerized inference. Our first finding is that MCQ retrieval must compare answer \emph{semantics} rather than answer labels: labels are independently assigned per question, so copying a retrieved neighbor's label transfers no useful information, whereas scoring each current option's text against correct-answer text from similar training cases raises retrieval-only accuracy from 20.0% to 57.5% on a 200-case retrieval-excluded development holdout. Our second finding attributes the submitted system's accuracy: holding the task-specific MCQ Low-Rank Adaptation (LoRA) adapter fixed and varying the number

k

of in-prompt retrieved examples changes accuracy by at most one case --- 187/200 (93.5%) at both

k=0

and the adapter's training-time

k=1

, 188/200 (94.0%) at the packaged runtime's default

k=3

--- and the submitted confidence-gated override adds no net accuracy on top of

k=3

, selecting the VLM in 198/200 cases. With the final MCQ adapter fixed, retrieval changes accuracy by at most one case, and gating provides no net gain. On 20 OE cases, token-F1 and RaTEScore~\cite{zhao2024ratescore} decrease as

k

grows, but paired sign tests on token-F1 differences are nonsignificant (

p \ge 0.29

); a single-annotator comparison found 6/20 wrong-anchor errors for the final configuration and 14/20 for an earlier configuration that jointly differed in routing, adapter, and prompting. The system reaches 94.0% MCQ accuracy on the development holdout and 93.20% on the organizer's official pre-evaluation, versus 29.43% for the off-the-shelf reference baseline, while both of the organizer's open-ended scores are lower than that baseline's (ground-truth agreement 1.245 versus 1.588, visual accuracy 1.995 versus 2.696, each out of 4).

Tristan Kirscher, Niklas C. Koser, Soren Pirk

ICube, Institut Strauss · ICube Laboratory, CNRS UMR 7357, University of Strasbourg, Strasbourg, France · CLCC Institut Strauss, Strasbourg, France +2

VLM Adaptation Multiple-Choice Question Answering Medical VQA Medical VLMs Retrieval-Augmented ICL

Sep 8, 2026cs.CV

STSG-VQA: Evidence-Grounded Temporal Question Answering from Surgical Spatio-Temporal Scene Graphs

Despite recent advances in surgical vision-language models (VLMs), temporal reasoning remains limited because existing supervision is largely frame-centric. Frame-level scene graphs (SGs) have proven effective in providing structured representations of surgical environments but do not explicitly model the dynamics of surgical workflows. To explicitly model how surgical states evolve across time, we introduce a multi-level structured temporal supervision methodology that augments frame-level surgical SGs with object-level continuity, event-level interaction continuity, and procedure-level connectivity. We then execute temporal queries over the resulting spatio-temporal scene graphs (STSGs) to generate evidence-grounded question-answer pairs, which together form the STSG-VQA benchmark. Each question is linked to the temporal interval and STSG evidence used to derive its reference answer, enabling traceable verification. The benchmark contains 18,458 question-answer pairs across seven temporal categories. Fine-tuning Qwen3-VL-4B and Hulu-Med-4B with STSG-derived supervision improves question-level micro accuracy by 24.39 and 19.56 percentage points over their zero-shot baselines and by 16.50 and 14.25 points over static scene-graph supervision, respectively. These gains span all temporal categories, indicating that STSG-derived supervision helps surgical VLMs reason over temporally grounded interactions rather than isolated frames. The code and dataset will be made publicly available upon acceptance.

Jing Li, Duygu Sarikaya

School of Computer Science, University of Leeds, UK

Medical VQA Question Answering Surgical Video Understanding Temporal QA Temporal Video Understanding

Sep 7, 2026cs.AI

A visual large language foundational model for medical image recognition using clinician-contributed online resources

Large language models (LLMs) have demonstrated strong capabilities across diverse domains, showing considerable potential in medicine. However, their application in medical settings remains limited by the scarcity of visual question answering (VQA) datasets that capture clinical reasoning and explicit image-text alignment. Here, we leverage de-identified medical images and expert commentaries shared through clinician-oriented online resources. By combining an advanced LLM with clinician-in-the-loop verification, we established a rigorous pipeline to construct ThoughtMed-1M, a long-form medical VQA dataset containing over one million VQA pairs and designed to capture structured clinical reasoning and medical image-text alignment. To demonstrate its utility, we developed a FOundational LLM Trained on ThoughtMed-1M (FOLTMed). FOLTMed achieved state-of-the-art performance across 42 medical VQA benchmark datasets, with a macro accuracy of 85.4 percent. It also generated more clinically coherent responses on the ThoughtMed-1M test set, outperforming state-of-the-art models by 3 to 5 percent across factuality and similarity metrics, highlighting a scalable paradigm for advancing research on clinically grounded multimodal LLMs.

Lingxuan Hou, Yuhua Xie, Yue Hu +14

College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan, China · School of Engineering, Computer & Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand · Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China +2

Medical VQA Medical VLMs VLM Reasoning Medical Image Benchmarks

Sep 3, 2026cs.CV

MedQA-MM: Shortcuts Behind Medical Visual Reasoning

A benchmark score credits final answers, but not the route by which an item can be answered. In medical multimodal multiple-choice questions (MCQs), this distinction matters because a correct answer can be supported by the intended image finding or by benchmark-preserved cues in the wording of answers, non-visual clinical text, visible image text, artificial annotations, or device/context artifacts. We call the resulting score-level overinterpretation reasoning inflation. Here, a route is an observable input path that can support answer selection, not a claim about the model's hidden cognition. Across six medical multimodal MCQ datasets, we separate candidate cues from behavioral evidence through prompt- and image-side audits, modality ablations, and matched repairs that preserve the medical target and answer key. In a 13-configuration open-model panel, full-input accuracy is 62.63%, while text-only and options-only settings achieve 53.96% and 29.71%, respectively. Removing length-gap, absolute/conspicuous, and spatial/prepositional cues lowers accuracy by 6.58, 3.50, and 4.77 percentage points. We also construct MedQA-MM, a 1,000-item shortcut-mitigated subset, where text-only and options-only accuracy fall to 5.21% and 12.33%. This does not imply that models never use images; it shows that medical image-reasoning claims require route-level evidence.

Benlu Wang, Yifan Zhang, Jiaqing Yu +7

University of Massachusetts Amherst · 4Yale University · University of Massachusetts Lowell +6

Medical VQA Shortcut Learning Multimodal Model Evaluation Medical Image Benchmarks

Sep 1, 2026cs.CV

Candidate-Expanding Routing with Permutation-Stabilized Experts for Mixed-Format Medical VQA

Mixed-format medical visual question answering (VQA) requires stable option selection and machine-readable free-text output. The two formats fail differently: multiple-choice predictions can change with option symbols or positions, while clinically plausible open answers can fail automated evaluation when serialization is malformed. We address both challenges with an answer-text memory, a permutation-stabilized vision--language expert, and a sparse candidate- expanding router. The cyclic schedule follows prior work; our contribution is to make expert top-2 a routable candidate alongside memory and expert top-1. On a 1,403-case retrospective internal analysis, this expansion improves a matched binary router from 88.95% to 91.73% (+2.78 percentage points; 95% CI 1.57--3.99), with 56 rescued errors and 17 regressions. Oracle coverage rises from 90.31% to 96.15%, and the final submitted configuration reaches 92.23% on the same retrospective split. For open questions, strict generation and deterministic guards produce 475/475 schema- valid participant-facing outputs without repair, retry, or hard-gate failure. Visual ablations reveal substantial textual dependence. Candidate expansion supplies the principal controlled routing gain; open-path evidence establishes output-contract validity rather than clinical correctness in medical use or deployment.

Hai-Dang Nguyen, Huy-Hieu Pham

College of Engineering and Computer Science, VinUniversity, Hanoi, Vietnam · VinUni-Illinois Smart Health Center, VinUniversity, Hanoi, Vietnam · Center for Innovations in Health Sciences, VinUniversity, Hanoi, Vietnam

Memory-Augmented VLMs Visual Question Answering Mixture-of-Experts Inference Medical VQA Structured Output Generation

Aug 31, 2026cs.AI

SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoning

Whole-slide images (WSIs) are challenging for vision-language reasoning because diagnostically relevant morphology is sparse, heterogeneous, and distributed across gigapixel-scale images and multiple spatial resolutions. Existing WSI models and pathology agents can aggregate slide features or actively acquire evidence, but the information retained after exploration is often difficult to access semantically while preserving its connection to the original visual evidence. We introduce SlideBank, a training-free framework that represents each WSI as a persistent, concept-indexed, and spatially grounded evidence bank. SlideBank performs question-independent coarse-to-fine exploration to identify informative regions and multi-scale views, converts them into explicit morphological observations, and grounds pathology signals to their supporting patches and WSI coordinates. At inference time, questions are routed to relevant signals and evidence scales, and the linked global, regional, and patch evidence is integrated through confidence-based cross-level consensus. Experiments on WSI-VQA and SlideBench-BCNB show that with Patho-R1, SlideBank reaches 52.77% on WSI-VQA and with Quilt-LLaVA, it reaches 50.92% average accuracy on SlideBench-BCNB, while structured signal-guided retrieval consistently outperforms random evidence sampling. Reusing the same bank across repeated queries further achieves over 99% rephrasing consistency and substantially reduces amortized inference cost through persistent evidence reuse.

Beidi Zhao, Gexin Huang, Ciro Zhang +6

University of British Columbia · Vector Institute · Harvard University +3

Memory-Augmented VLMs Medical VQA Medical Image Grounding Whole-Slide Image Analysis

Aug 30, 2026cs.CV

Source-Dependent Deference in Medical Imaging Agents Under Falsified Findings: A Pilot Audit

Tool-using agents are being proposed for medical imaging, and their behaviour when a tool returns a false finding is largely unmeasured. We audit whether a ReAct-style tool-calling agent abandons an answer it has already given correctly once a falsified finding arrives, and whether that depends on how the finding is presented. On 20 VQA-RAD closed questions across four vendor-designated model tiers, the agent commits to an answer from the image alone; a negated finding is then delivered either as JSON from an analyze_image tool the agent invokes itself, or as quoted prose attributed to a radiologist. Our outcome is the commission-error rate over cases answered correctly without any tool. Deference is much higher under the prose-attributed claim: at the strongest tier the agent revised its correct answer in 10 of 13 cases against 1 of 13 under the tool (exact McNemar p=0.0039, Holm-adjusted 0.012). We do not claim this isolates the source label. Attribution travels with the delivery channel in our design, and exposure differs because the tool claim reaches the agent only when it calls the tool. The finding is a joint source-and-delivery asymmetry from a small-scale pilot whose pre-specified stopping rule was not met.

Ridam Roy, Md Shahriar Rashid, Md. Rajib Mia

Daffodil International University Savar, Dhaka, Bangladesh · Boise State University Boise, Idaho, USA

Tool-Use Evaluation Medical VQA Tool-Using Agents LLM Agent Reliability

Aug 13, 2026cs.AI

Polish Medical Visual Question Answering: Vision-Language Models Underutilize Visual Evidence

We introduce a Polish-language medical visual question answering (VQA) benchmark, built from Polish Board Certification Examination questions for licensed physicians and dentists pursuing specialist certification. The benchmark comprises image-containing questions spanning diverse medical specialties and visual domains, together with a text-only question answering (QA) control set. We evaluate Polish-oriented, general-purpose open-weight, and commercial vision-language models. The task remains challenging: the best model achieves 79.0% accuracy on the full VQA set, and only GPT-5.6 surpasses the approximate human reference on the subset with available candidate responses; all other evaluated models perform worse than humans. To assess visual grounding, we compare complete inputs with configurations omitting the image, the question, or both, and categorize questions by image importance. Models derive more useful information from the question text than from the image and perform worse on image-dominant questions. Across both QA and VQA, they nevertheless achieve above-chance accuracy from the answer choices alone, showing that non-trivial performance can persist even when key task components are missing.

Jakub Pokrywka, Łukasz Grzybowski, Antoni Lasik +3

Adam Mickiewicz University · ARAAI Poland · NASK National Research Institute +2

Medical VQA Multilingual VLM Evaluation Medical Image Benchmarks

Aug 11, 2026cs.CV

CARE: Confidence-Aware Reasoning for Reliable Medical VQA

Reinforcement Fine-Tuning (RFT) has enabled medical Multimodal Large Language Models (MLLMs) to produce Chain-of-Thought (CoT) reasoning for visual question answering, yet these models suffer from

\textit{confidence miscalibration}

---a systematic gap between expressed certainty and actual diagnostic accuracy that undermines clinical trust. We propose

\textbf{CARE}

, a

\textbf{C}

onfidence-

\textbf{A}

ware medical

\textbf{RE}

asoning framework that jointly optimizes accuracy and calibration through a dual-stage pipeline. First, a scalable Medical-CoT synthesis provides structured cold-start data for Supervised Fine-Tuning. Second, Group Relative Policy Optimization (GRPO) with a novel

\textbf{Confidence-Aware Reward (CAR)}

mechanism ties the model's confidence to diagnostic correctness within the reward signal. Across three Medical VQA benchmarks,

\textbf{CARE}

achieves the highest diagnostic accuracy while obtaining the lowest Expected Calibration Error and Hallucination Rate, establishing a foundation for trustworthy clinical decision support. Our code is available at https://github.com/anotherbricki/CARE.

Yuetian Du, Yucheng Wang, Zhenyuan Chen +9

Zhejiang University · Ant Group · University of Michigan +1

Medical VQA Medical VLMs VLM Reasoning VLM Calibration VLM Hallucination Mitigation RL for VLMs

Aug 9, 2026cs.CV

Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perception

Whole-slide visual reasoning requires identifying sparse diagnostic evidence in gigapixel pathology slides and integrating observations across spatial scales. Existing WSI methods either compress densely sampled patches into global representations or use pretrained vision-language models with heuristic region selection, weakening links between predictions and morphology or lacking pathology-trained observation policies. We present AdaptivePath, an active-perception framework that formulates WSI evidence acquisition as sequential decision making. The Navigator learns question-agnostic abnormality-driven navigation from pathologist-reviewed labels to select observation locations and spatial extents, avoiding costly question-specific trajectory annotations. We train this policy through alternating representation learning and proximal policy optimization, followed by fine-tuning with geometric and appearance consistency objectives to stabilize focus trajectories. During inference, the Navigator hierarchically acquires sparse observations from low to high magnification under a limited ROI budget. A Morphology Interpreter converts observations into question-conditioned evidence, while the Deliberator evaluates evidence and revises intermediate answers across magnifications. The Arbiter integrates deliberation history to produce final answers. AdaptivePath achieves state-of-the-art zero-shot performance on WSI and region pathology VQA benchmarks and reaches 80.14% accuracy for cancer subtype classification across six TCGA cohorts. In a blinded diagnostic-utility study, pathologists using AdaptivePath-selected observation sequences achieve 82.9% accuracy. These results demonstrate that learned active perception enables effective and traceable visual reasoning over gigapixel pathology slides.

Jingyun Chen, Fengchun Liu, Linghan Cai +5

College of Computer Science and Technology, Harbin Institute of Technology, Shenzhen · School of Computing and Data Science, The University of Hong Kong

Active Perception Medical VQA Active View Selection Whole-Slide Image Analysis

Aug 8, 2026cs.CV

Frequency-Domain Dual-Branch Fusion for Medical Visual Question Answering

Medical Visual Question Answering (VQA) requires aligning subtle visual evidence, including lesion texture, boundary sharpness, and diffuse density changes, with clinical language. Existing multimodal fusion approaches operating in the spatial domain may not fully exploit complementary frequency information present in visual and textual representations. We introduce a dual-branch frequency-domain fusion module that conditions spectral filtering on the input question, enabling adaptive selection of global low-frequency structure and fine-grained high-frequency detail before reconstructing the spatial representation for answer generation. To provide a richer spectrum for filtering, we extract complementary features from early texture-sensitive and final semantic layers of a frozen BiomedCLIP encoder and align both with the question representation using a symmetric InfoNCE objective prior to staged joint training with a BioBART decoder. We pretrain the proposed model on PMC-VQA and fine-tune it on the VQA-RAD and SLAKE benchmarks, demonstrating that frequency-aware multimodal fusion improves medical VQA performance while maintaining a lightweight and efficient architecture.

Yusra Tariq, Rakesh Chandra Joshi

Department of Artificial Intelligence, Amity University, Noida, India

Medical VQA Multimodal Fusion

Aug 6, 2026cs.CV

Beyond Relevance: Bayesian Evidence Acquisition for Agentic Whole-Slide Image Reasoning

Whole-slide image (WSI) reasoning requires an agent to sequentially acquire visual evidence before answering a diagnostic question. Existing training-free agentic frameworks formulate this process as iterative patch retrieval based on semantic relevance to the question. However, semantic relevance does not necessarily imply diagnostic informativeness in computational pathology, where competing diagnoses often exhibit similar and overlapping morphological patterns, making many patches semantically relevant yet diagnostically non-discriminative. Consequently, relevance-based retrieval may acquire redundant observations and leave diagnostic uncertainty unresolved. We propose BEACON, a plug-and-play agentic framework that reformulates WSI reasoning as a Bayesian evidence acquisition problem. BEACON maintains a probabilistic belief over competing diagnostic hypotheses and sequentially acquires patches by maximizing expected information gain (EIG) to reduce diagnostic uncertainty. An evidence controller then determines whether to answer, acquire additional evidence, or perform higher-resolution inspection. Built entirely from off-the-shelf foundation models, BEACON requires no additional training or fine-tuning. Extensive zero-shot experiments across five WSI-VQA benchmarks demonstrate that BEACON achieves the strongest overall performance among training-free agentic frameworks while substantially improving evidence acquisition efficiency, establishing Bayesian evidence acquisition as a principled paradigm for uncertainty-aware agentic WSI reasoning. The code is available at https://github.com/bryanwong17/BEACON

Bryan Wong, Xun Xu, Huazhu Fu +2

1Korea Advanced Institute of Science and Technology (KAIST) · Institute of Advanced Intelligence and Computing (IAIC), A*STAR · Centre for Frontier AI Research (CFAR), A*STAR

Visual Question Answering Computational Pathology Medical VQA Whole-Slide Image Analysis

Aug 5, 2026cs.CV

CARVE: Cross-Slice Anisotropic Reallocation of Visual Evidence for Efficient 3D Medical Volume Understanding

Slice-based MLLMs leverage mature 2D encoders by representing 3D volumes as sequences of 2D slices. However, this slice-wise formulation produces thousands of visual tokens that burden the LLM backbone, many of which capture overlapping visual evidence across adjacent slices. To understand how effectively a growing visual token budget improves performance, we perform scaling analyses on two 3D medical VQA benchmarks and find diminishing returns: cost keeps rising while accuracy saturates, and improving in-plane resolution is more effective than adding slices at comparable budgets. The budget should therefore be allocated more selectively rather than simply enlarged, yet most token compression methods are designed for 2D images or videos, where redundancy arises from spatial layout or temporal motion rather than from near-duplicate content along the depth axis. We present CARVE, a training-free framework that compresses visual tokens prior to LLM inference and casts token reduction as budget-constrained 2.5D allocation. CARVE partitions the depth axis into coherent windows and allocates tokens non-uniformly according to normalized cross-slice evidence. Under a shared budget, CARVE builds spatial anchors on representative slices and retrieves locally varying evidence from the full volume, then merges remaining eligible tokens into nearby anchors within each window. Removing roughly 80% of the visual tokens on Hulu-Med-7B, CARVE leads all compression baselines on every AMOS-MM report-generation metric, with 6.2 points higher retention of full-token quality than the strongest baseline, and preserves 98.1% of full-token performance across three VQA benchmarks.

Zhenyu Yi, Qiang Hu, Zhenhao Li +3

School of Biomedical Engineering, Shanghai Jiao Tong University · 2Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology

3D Medical Imaging Medical VQA Multimodal Token Compression Visual Token Compression

Jul 30, 2026cs.CV

SPARC-Rad: A Multimodal Benchmark Dataset and Evaluation Pipeline for Spatial and Anatomical Reasoning in Radiology Vision-Language Models

Vision-language models (VLMs) are increasingly being evaluated for medical imaging, but many available benchmarks emphasize disease classification, report generation, or broad visual question answering rather than the spatial and anatomical reasoning required for radiology. We developed the Spatial Perception and Anatomical Reasoning in Clinical Radiology (SPARC-Rad) Benchmark, a manually curated multimodal benchmark dataset and evaluation pipeline for assessing these capabilities in radiology VLMs. SPARC-Rad includes 300 image-question pairs derived from healthy control imaging studies in The Cancer Imaging Archive (TCIA), spanning CT, MRI, and radiography across the abdomen, chest, breast, neuro, and musculoskeletal categories. Radiology trainees manually designed and annotated questions to evaluate anatomical identification, localization, laterality, regional recognition, device identification, and inter-structure spatial relationships. The evaluation pipeline supports standardized prompting, structured output collection, response normalization, LLM-as-judge grading, human quality review, binary correctness scoring, and subgroup analysis by modality, anatomy, and reasoning type. SPARC-Rad provides a reusable framework for evaluating whether VLMs can provide reasoning for radiologic anatomy as a spatial system, supporting future model development, failure-mode analysis, and pre-deployment assessment.

Satvik Tripathi, Mustafa Ege Seker, Kristian Quevada +8

Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA · Department of Radiology, University of Wisconsin–Madison School of Medicine and Public Health, Madison, Wisconsin, USA · Department of Radiology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA +5

Radiology VLMs Medical Image Analysis Medical VQA Medical Image Localization Medical Image Benchmarks

Jul 30, 2026cs.AI

PathView-Bench: Can Multimodal Large Language Models Achieve Fine-grained Multiscale Understanding of Pathology Images?

Multimodal large language models (MLLMs) are increasingly used to analyze pathology images. However, dominant multimodal benchmarks in pathology mainly score final diagnostic answers, captions, or reports. These evaluations provide limited insight into whether a model understands the multiscale visual content needed for pathology reasoning and decision-making. We introduce PathVU, a vision-anchored benchmark for fine-grained and multiscale visual understanding in computational pathology. Built from 23 public pathology imaging datasets with human-supervised labels and spatial annotations, PathVU evaluates MLLM understanding in two fields of view: Region FOV for high-resolution local regions and Slide FOV for macro whole-slide views. By converting raw annotations into deterministic task targets, PathVU enables programmatic scoring of region localization, visual recognition, quantity estimation, spatial reasoning, and insufficient-context judgment. The benchmark contains 14 VQA-style tasks, 61,673 images, and 308,070 samples across 28 organs and 7,253,526 annotations. Evaluating 18 representative general-purpose, medical-domain, and pathology-oriented MLLMs, we observe substantial limitations even in advanced models on fine-grained visual tasks across multiscale pathology images. PathVU provides a reproducible basis for developing and evaluating pathology MLLMs with explicit multiscale visual understanding.

Zongyi Chen, Yu Liang, Jie Lin +1

National Institute for Data Science in Health and Medicine, Xiamen University · Institute of Artificial Intelligence Xiamen University, Xiamen, China · Department of Computer Science School of Informatics Xiamen University, Xiamen, China

Computational Pathology Medical VQA Multimodal Model Evaluation Medical Image Benchmarks

Jul 30, 2026cs.CV

LoMeVQA: A Comprehensive Benchmark for Longitudinal Medical VQA

In clinical practice, patients often undergo multiple imaging examinations over successive visits, yielding longitudinal data. Modeling such temporal information is crucial for reliable assessment of disease progression and treatment response. However, despite the rapid advancement of multimodal large language models (MLLMs), longitudinal medical visual reasoning remains largely underexplored. To fill this gap, we propose LoMeVQA, a comprehensive benchmark consisting of 206K longitudinal visual question answering (VQA) pairs for temporal medical image analysis. LoMeVQA covers five tasks: progress classification, progress description, progress report generation, differential region grounding, and differential region description. To construct the dataset, we develop an automated pipeline that (1) organizes patient records chronologically, (2) extracts clinically meaningful entities via a medical knowledge graph, and (3) models their temporal evolution to guide large language models in generating high-quality longitudinal VQA pairs. Extensive evaluations demonstrate that both general-purpose and medical-domain MLLMs perform poorly on LoMeVQA, revealing substantial limitations in temporal reasoning. To address these limitations, we introduce MedLong-8B, which achieves state-of-the-art performance across all tasks. Beyond benchmarking, we conduct detailed analyses that uncover key failure modes and shed light on how to improve longitudinal medical visual reasoning. Our data is available at: https://github.com/pepperbubble/LoMeVQA

Zhilin Wu, Zhangkai Ni, Chengmei Yang +4

Tongji University Shanghai, China · East China Normal University Shanghai, China

Longitudinal Medical Image Analysis Medical VQA Medical VLMs Medical Image Grounding Medical Image Benchmarks

Jul 30, 2026cs.CV

Objective-Aligned Direct Answer SFT for Robust Multi-Frame Medical VQA

Multi-frame medical VQA appears to reward increasingly complex adaptation: controller-style inference, localization-aware reranking, static hard-negative mixing, and staged continuation all appear plausible from first principles. We test a simpler competing hypothesis on MedFrameQA: methods that remain tightly aligned with the benchmark's final answer objective should be the strongest \emph{robust} adaptation family once evaluation is controlled across fixed splits, matched budgets, repeated seeds, and calibration. We compare controller-based methods, scaffold evolution, static mixed supervision, continuation-heavy variants, and direct answer-only supervised fine-tuning (SFT). The strongest robust family is direct decoder-only answer SFT on MedGemma-1.5-4B. Empirically, this family yields substantial improvements in held-out report accuracy over frozen baselines while remaining remarkably stable across repeated seeds and matched controls, ensuring our claims reflect true family-level robustness rather than an isolated hyperparameter peak. Furthermore, post-hoc calibration effectively repairs confidence estimation without compromising accuracy, and the core approach transfers consistently to secondary backbones like Qwen2.5-VL-3B. The main result is therefore not that a complex auxiliary mechanism wins, but that objective-aligned direct answer SFT is the strongest robust adaptation family we found for MedFrameQA. By establishing this strong, minimalist baseline, we hope to redirect community focus toward fundamentally robust optimization rather than architectural complexity.

Site Li, Jianyi Hao, Xiaofeng Liu

Yale University

Supervised Fine-Tuning VLM Robustness Medical VQA Medical VLMs

Jul 30, 2026cs.CV

Inference-Time Agentic Decision Rules Beat Longer Evolving Search for Multi-Image Medical Reasoning

Multi-image medical VQA is not merely a prompt-length problem; it is a fundamental challenge of agentic decision-making. Medical vision-language agents must aggregate evidence across ordered images, remain robust to answer-order perturbations, and avoid overfitting to noisy search-time feedback. We study MedFrameQA through a controlled comparison of five inference-time agentic strategies, optimized using the same high-budget ShinkaEvolve configuration and evaluated on a reproducible internal frozen split (1,331 evolution, 665 holdout, 855 final test). Across five independent repeated runs, the strongest method emerges as the simplest robust aggregator: the \textbf{order-vote} policy achieves

57.89 \pm 0.65\%

final-test accuracy, significantly outperforming the fixed baseline (

52.73 \pm 0.42\%

) and the more complex, albeit brittle, order-rerank variant (

55.79 \pm 0.43\%

). Paired bootstrap analysis confirms these significant gains. Extending the evolutionary search budget from 50 to 100 generations yields no generalization benefit: while holdout performance marginally increases, final-test accuracy drops from

57.89\%

to

56.02\%

. Our findings suggest that for multi-image medical reasoning, defining the correct agentic decision rule is substantially more impactful than expanding the optimization search budget.

Site Li, Jianyi Hao, Xiaofeng Liu

Yale University

Medical VQA VLM Reasoning

Jul 29, 2026cs.LG

Position, Not Provenance: Separating Reasoning Mediation from Sycophancy in Medical Vision-Language Models

Medical vision-language models (VLMs) generate chain-of-thought (CoT) reasoning before answering clinical questions, but whether this reasoning causally influences predictions remains unclear. We present CoT-Mediate, a behavioral framework that perturbs a single clinically meaningful attribute within a model's own generated reasoning and measures whether the resulting prediction follows the edited reasoning. Our framework combines a dual-arm protocol comparing re-prompted evidence with prefix-forced continuation, together with a provenance-controlled intervention that varies only the attributed source of identical reasoning to disentangle reasoning mediation from sycophancy. We evaluate LLaVA-Med and MedGemma on 1,000 VQA-RAD samples each. Prefix-forced continuation consistently yields higher mediation faithfulness than re-prompting, while the provenance analysis reveals distinct model-specific deference behaviors. Across both models, removing visual evidence increases reliance on injected reasoning, whereas laterality is the least faithfully tracked clinical attribute. These results show that the mechanism used to inject reasoning substantially affects measured faithfulness and that contextual position, rather than stated provenance, is the primary determinant of whether medical VLMs use their generated reasoning.

Supratik Bhowal, Subhrajyoti Basu, Aritra Gir Mahanta +1

Department of Computer Science (AIML) IEM Kolkata, School of UEMK Kolkata, India · Department of Computer Science and Business System Heritage Institute of Technology Kolkata, India · Department of Computer Science and Engineering Indian Institute of Information Technology, Kalyani Kalyani, India

Medical VQA Medical VLMs VLM Reasoning Faithfulness in VLMs