Medical VQA

VQA: Visual Question Answering

Follow this topic Ask about this topic

Medical visual question answering (MedVQA) asks models to interpret images such as X-rays, scans, pathology slides, and surgical videos in response to clinical questions, supporting tasks from finding specific abnormalities to integrating evidence across views or time. Common approaches adapt vision-language models with medical image-question datasets, while newer methods add region grounding, clinical knowledge, stepwise reasoning, or tools for measurements and image navigation. Benchmarks increasingly test spatial, temporal, multilingual, and multi-image reasoning, as well as whether answers actually depend on the visual evidence. A central challenge remains that high answer accuracy can coexist with shortcut use, hallucinations, poor calibration, or weak generalization across modalities and clinical settings.

Latest papers

175 papers19 papers in the last four weeks, up 46% on the four weeks before. 0.1% of all new papers.

May 5, 2026

DALPHIN: Benchmarking Digital Pathology AI Copilots Against Pathologists on an Open Multicentric Dataset

Foundation models with visual question answering capabilities for digital pathology are emerging. Such unprecedented technology requires independent benchmarking to assess its potential in assisting pathologists in routine diagnostics. We created DALPHIN, the first multicentric open benchmark for pathology AI copilots, comprising 1236 images from 300 cases, spanning 130 rare to common diagnoses, 6 countries, and 14 subspecialties. The DALPHIN design and dataset are introduced alongside a human performance benchmark of 31 pathologists from 10 countries with varying expertise. We report results for two general-purpose (GPT-5, Gemini 2.5 Pro) and one pathology-specific copilot (PathChat+) for sequential and independent answer generation. We observed no statistically significant difference from expert-level performance in four of six tasks for PathChat, 2/6 tasks for Gemini, and 1/6 tasks for GPT. DALPHIN is publicly released with sequestered, indirectly accessible ground truth to foster robust and enduring benchmarking. Data, methods, and the evaluation platform are accessible through dalphin.grand-challenge.org.

Carlijn Lems, Sander Moonemans, Natálie Klubíčková +53

Computational Pathology Healthcare Medical VQA Pathology Foundation Models Pathology VQA Medical Image Benchmarks

May 3, 2026

SurgCheck: Do Vision-Language Models Really Look at Images in Surgical VQA?

Purpose: Vision-language models (VLMs) have shown promising performance in surgical visual question answering (VQA). However, existing surgical VQA datasets often contain linguistic shortcuts, where question phrasing implicitly constrains the answer space. It remains unclear whether reported performance reflects visual understanding or reliance on such linguistic shortcuts. Methods: We introduce SurgCheck, a diagnostic benchmark for quantifying linguistic shortcut reliance in surgical VQA. SurgCheck employs a paired-question design in which each surgical frame is associated with an original question containing entity names and a less-biased counterpart that removes these names while preserving identical visual content and ground-truth answers. The resulting performance gap provides a diagnostic signal of shortcut reliance. To ensure that the less-biased question remains well-defined even without entity names, four grounding cues are incorporated: bounding box, arrow, spatial position, and periphrasis. We evaluate both general-purpose and surgical-specific VLMs under zero-shot and fine-tuned settings on SurgCheck. To evaluate open-ended zero-shot responses, we introduce an LLM-as-a-judge evaluation protocol. Results: Using SurgCheck, we observe consistent performance degradation on less-biased questions across five VLMs, despite identical visual inputs. Text-only ablation reveals minimal performance drops for action and target prediction, indicating that action and target prediction is largely driven by linguistic shortcuts rather than visual reasoning. Conclusion: SurgCheck provides a controlled diagnostic framework that exposes failure modes masked by linguistic bias in existing surgical VQA benchmarks. Our findings demonstrate that strong benchmark performance does not necessarily imply faithful visual understanding, underscoring the need for bias-aware evaluation in surgical VQA.

Jongmin Shin, Ka Young Kim, Eunki Cho +2

Department of Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea · Kyung Hee University, Yongin 17104, Republic of Korea

VLM Evaluation Medical VQA Shortcut Learning

Apr 30, 2026

Auditing Frontier Vision-Language Models for Trustworthy Medical VQA: Grounding Failures, Format Collapse, and Domain Adaptation

Deploying vision-language models (VLMs) in clinical settings demands auditable behavior under realistic failure conditions, yet the failure landscape of frontier VLMs on specialized medical inputs is poorly characterized. We audit five recent frontier and grounding-aware VLMs (Gemini~~2.5~~Pro, GPT-5, o3, GLM-4.5V, Qwen~~2.5~~VL) on Medical VQA along two trust-relevant axes. Perception: all models localize anatomical and pathological targets poorly -- the best model reaches only 0.23 mean IoU and 19.1% [email protected] -- and exhibit clinically dangerous laterality confusion. Pipeline integration: a self-grounding pipeline, where the same model localizes then answers, degrades VQA accuracy for every model -- driven by both inaccurate localization and format-compliance failures under the two-step prompt (parse failure rises to 70%--99% for Gemini and GPT-5 on VQA-RAD). Replacing predicted boxes with ground-truth annotations recovers and improves VQA accuracy, consistent with the failure residing in the perception module rather than in the decomposition itself. These observational findings identify grounding quality as a primary trustworthiness bottleneck in our SLAKE bounding-box setting. As a complementary fine-tuning follow-up, supervised fine-tuning of Qwen~~2.5~~VL on combined Med-VQA training data attains the highest reported SLAKE open-ended recall (85.5%) among comparable methods, suggesting that the VQA-level gap is tractable with domain adaptation; whether this also closes the perception/trustworthiness bottleneck is left to future work.

Xupeng Chen, Binbin Shi, Chenqian Le +5

New York University, New York, USA · Tsinghua University, Beijing, China · Columbia University, New York, USA +1

VLM Evaluation Healthcare Medical VQA Medical VLMs Medical Image Grounding

Apr 28, 2026

Toward Multimodal Conversational AI for Age-Related Macular Degeneration

Despite strong performance of deep learning models in retinal disease detection, most systems produce static predictions without clinical reasoning or interactive explanation. Recent advances in multimodal large language models (MLLMs) integrate diagnostic predictions with clinically meaningful dialogue to support clinical decision-making and patient counseling. In this study, OcularChat, an MLLM, was fine-tuned from Qwen2.5-VL using simulated patient-physician dialogues to diagnose age-related macular degeneration (AMD) through visual question answering on color fundus photographs (CFPs). A total of 705,850 simulated dialogues paired with 46,167 CFPs were generated to train OcularChat to identify key AMD features and produce reasoned predictions. OcularChat demonstrated strong classification performance in AREDS, achieving accuracies of 0.954, 0.849, and 0.678 for the three diagnostic tasks: advanced AMD, pigmentary abnormalities, and drusen size, significantly outperforming existing MLLMs. On AREDS2, OcularChat remained the top-performing method on all tasks. Across three independent ophthalmologist graders, OcularChat achieved higher mean scores than a strong baseline model for advanced AMD (3.503 vs. 2.833), pigmentary abnormalities (3.272 vs. 2.828), drusen size (3.064 vs. 2.433), and overall impression (2.978 vs. 2.464) on a 5-point clinical grading rubric. Beyond strong objective performance in AMD severity classification, OcularChat demonstrated the ability to provide diagnostic reasoning, clinically relevant explanations, and interactive dialogue, with high performance in subjective ophthalmologist evaluation. These findings suggest that MLLMs may enable accurate, interpretable, and clinically useful image-based diagnosis and classification of AMD.

Ran Gu, Benjamin Hou, Mélanie Hébert +5

Division of Intramural Research, NaMonal Library of Medicine, NaMonal InsMtutes of Health, Bethesda, Maryland, USA · 2. Division of Epidemiology and Clinical ApplicaMons, NaMonal Eye InsMtute, NaMonal InsMtutes of Health, Bethesda, Maryland, USA · 1. Division of Intramural Research, NaMonal Library of Medicine, NaMonal InsMtutes of Health, Bethesda, Maryland, USA

Medical Diagnosis Medical VQA Ophthalmology Medical VLMs Retinal Disease Classification

Apr 22, 2026

X-PCR: A Benchmark for Cross-modality Progressive Clinical Reasoning in Ophthalmic Diagnosis

Despite significant progress in Multi-modal Large Language Models (MLLMs), their clinical reasoning capacity for multi-modal diagnosis remains largely unexamined. Current benchmarks, mostly single-modality data, can't evaluate progressive reasoning and cross-modal integration essential for clinical practice. We introduce the Cross-Modality Progressive Clinical Reasoning (X-PCR) benchmark, the first comprehensive evaluation of MLLMs through a complete ophthalmology diagnostic workflow, with two reasoning tasks: 1) a six-stage progressive reasoning chain spanning image quality assessment to clinical decision-making, and 2) a cross-modality reasoning task integrating six imaging modalities. The benchmark comprises 26,415 images and 177,868 expert-verified VQA pairs curated from 51 public datasets, covering 52 ophthalmic diseases. Evaluation of 21 MLLMs reveals critical gaps in progressive reasoning and cross-modal integration. Dataset and code: https://github.com/CVI-SZU/X-PCR.

Gui Wang, Zehao Zhong, YongSong Zhou +6

School of Computer Science and Software Engineering, Shenzhen University · 2Tsinghua University · 5Wenzhou Medical University +3

Healthcare Medical Diagnosis Medical VQA Ophthalmology Clinical Reasoning Multimodal Model Evaluation+1

Apr 22, 2026

Dual Causal Inference: Integrating Backdoor Adjustment and Instrumental Variable Learning for Medical VQA

Medical Visual Question Answering (MedVQA) aims to generate clinically reliable answers conditioned on complex medical images and questions. However, existing methods often overfit to superficial cross-modal correlations, neglecting the intrinsic biases embedded in multimodal medical data. Consequently, models become vulnerable to cross-modal confounding effects, severely hindering their ability to provide trustworthy diagnostic reasoning. To address this limitation, we propose a novel Dual Causal Inference (DCI) framework for MedVQA. To the best of our knowledge, DCI is the first unified architecture that integrates Backdoor Adjustment (BDA) and Instrumental Variable (IV) learning to jointly tackle both observable and unobserved confounders. Specifically, we formulate a Structural Causal Model (SCM) where observable cross-modal biases (e.g., frequent visual and textual co-occurrences) are mitigated via BDA, while unobserved confounders are compensated using an IV learned from a shared latent space. To guarantee the validity of the IV, we design mutual information constraints that maximize its dependence on the fused multimodal representations while minimizing its associations with the unobserved confounders and target answers. Through this dual mechanism, DCI extracts deconfounded representations that capture genuine causal relationships. Extensive experiments on four benchmark datasets, SLAKE, SLAKE-CP, VQA-RAD, and PathVQA, demonstrate that our method consistently outperforms existing approaches, particularly in out-of-distribution (OOD) generalization. Furthermore, qualitative analyses confirm that DCI significantly enhances the interpretability and robustness of cross-modal reasoning by explicitly disentangling true causal effects from spurious cross-modal shortcuts.

Zibo Xu, Qiang Li, Ke Lu +3

School of Microelectronics, Tianjin University, Tianjin 300072, China · Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu 215300, China · Department of Clinical Laboratory, The Third Central Hospital of Tianjin, Tianjin 300170, China +1

Multimodal Robustness Medical VQA Causal Inference

Apr 19, 2026

PBSBench: A Multi-Level Vision-Language Framework and Benchmark for Hematopathology Whole Slide Image Interpretation

Peripheral Blood Smear (PBS) is a critical microscopic examination in hematopathology that yields whole-slide imaging (WSI). Unlike solid tissue pathology, PBS interpretation focuses on individual cell morphologies rather than tissue architecture, making it distinct in both visual characteristics and diagnostic reasoning. However, current multimodal large language models (MLLMs) for pathology are primarily developed on solid-tissue WSIs and struggle to generalize to PBS. To bridge this gap, we construct PBSInstr, the first vision-language dataset for PBS interpretation, comprising 353 PBS WSIs paired with microscopic impression paragraphs and 29k cell-level image crops annotated with cell type labels and morphological descriptions. To facilitate instruction tuning, PBSInstr further includes 27k question-answer (QA) pairs for cell crops and 1,286 QA pairs for PBS slides. Building upon PBSInstr, we develop PBS-VL, a hematopathology-tailored vision-language model for multi-level PBS interpretation at both cell and slide levels. To comprehensively evaluate PBS understanding, we construct PBSBench, a visual question answering (VQA) benchmark featuring four question categories and six PBS interpretation tasks. Experiments show that PBS-VL outperforms existing general-purpose and pathology MLLMs, underscoring the value of PBS-specific data. We release our code, datasets, and model weights to facilitate future research. Our proposed framework lays the foundation for developing practical AI assistants supporting decision-making in hematopathology.

Yuanlong Wang, Weichi Chen, Adrian Rajab +4

The Ohio State University · The Ohio State University Wexner Medical Center

Computational Pathology Medical VQA Medical VLMs Medical Image Benchmarks Whole-Slide Image Analysis

Apr 17, 2026

Beyond a Single Frame: Multi-Frame Spatially Grounded Reasoning Across Volumetric MRI

Spatial reasoning and visual grounding are core capabilities for vision-language models (VLMs), yet most medical VLMs produce predictions without transparent reasoning or spatial evidence. Existing benchmarks also evaluate VLMs on isolated 2D images, overlooking the volumetric nature of clinical imaging, where findings can span multiple frames or appear on only a few slices. We introduce Spatially Grounded MRI Visual Question Answering (SGMRI-VQA), a 41,307-pair benchmark for multi-frame, spatially grounded reasoning on volumetric MRI. Built from expert radiologist annotations in the fastMRI+ dataset across brain and knee studies, each QA pair includes a clinician-aligned chain-of-thought trace with frame-indexed bounding box coordinates. Tasks are organized hierarchically across detection, localization, counting/classification, and captioning, requiring models to jointly reason about what is present, where it is, and across which frames it extends. We benchmark 10 VLMs and show that supervised fine-tuning of Qwen3-VL-8B with bounding box supervision consistently improves grounding performance over strong zero-shot baselines, indicating that targeted spatial supervision is an effective path toward grounded clinical reasoning.

Lama Moukheiber, Caleb M. Yeung, Haotian Xue +3

Georgia Institute of Technology · Harvard University · Georgetown University

3D Spatial Reasoning 3D Medical Imaging Medical VQA Visually Grounded Reasoning Medical Image Grounding Medical Image Benchmarks

Apr 16, 2026

MetaDent: Labeling Clinical Images for Vision-Language Models in Dentistry

Vision-Language Models (VLMs) have demonstrated significant potential in medical image analysis, yet their application in intraoral photography remains largely underexplored due to the lack of fine-grained, annotated datasets and comprehensive benchmarks. To address this, we present MetaDent, a comprehensive resource that includes (1) a novel and large-scale dentistry image dataset collected from clinical, public, and web sources; (2) a semi-structured annotation framework designed to capture the hierarchical and clinically nuanced nature of dental photography; and (3) comprehensive benchmark suites for evaluating state-of-the-art VLMs on clinical image understanding. Our labeling approach combines a high-level image summary with point-by-point, free-text descriptions of abnormalities. This method enables rich, scalable, and task-agnostic representations. We curated 60,669 dental images from diverse sources and annotated a representative subset of 2,588 images using this meta-labeling scheme. Leveraging Large Language Models (LLMs), we derive standardized benchmarks: approximately 15K Visual Question Answering (VQA) pairs and an 18-class multi-label classification dataset, which we validated with human review and error analysis to justify that the LLM-driven transition reliably preserves fidelity and semantic accuracy. We then evaluate state-of-the-art VLMs across VQA, classification, and image captioning tasks. Quantitative results reveal that even the most advanced models struggle with a fine-grained understanding of intraoral scenes, achieving moderate accuracy and producing inconsistent or incomplete descriptions in image captioning. We publicly release our dataset, annotations, and tools to foster reproducible research and accelerate the development of vision-language systems for dental applications.

Meng-Xun Li, Wen-Hui Deng, Zhi-Xing Wu +6

Department of Prosthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine, Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China · School of Artificial Intelligence, Wuhan University, Wuhan, Hubei, China · School of Computer Science, Wuhan University, Wuhan, Hubei, China +2

VLM Evaluation Medical Image Analysis LLM-Assisted Annotation Medical VQA Medical Image Benchmarks Dental Imaging

Apr 15, 2026

Seeing Through Experts Eyes A Foundational Vision Language Model Trained on Radiologists Gaze and Reasoning

Large scale vision language models have shown promise in automating chest Xray interpretation, yet their clinical utility remains limited by a gap between model outputs and radiologist reasoning. Most systems optimize for semantic information without emulating how experts visually examine medical images, often overlooking critical findings or diverging from established diagnostic workflows. Radiologists follow structured protocols (e.g., the ABCDEF approach) that ensure all clinically relevant regions are systematically examined, reducing missed findings and supporting reliable diagnostic reasoning. We introduce GazeX, a vision language model that leverages radiologists' eye tracking data as a behavioral prior to model expert diagnostic reasoning. By incorporating gaze trajectories and fixation patterns into pretraining, GazeX learns to follow the spatial and temporal structure of radiologist attention and integrates observations in a clinically meaningful sequence. Using a curated dataset of over 30,000 gaze key frames from five radiologists, we demonstrate that GazeX produces more accurate, interpretable, and expert consistent outputs across radiology report generation, disease grounding, and visual question answering, utilizing 231,835 radiographic studies, 780,014 question answer pairs, and 1,162 image sentence pairs with bounding boxes. Unlike autonomous reporting systems, GazeX produces verifiable evidence artifacts, including inspection trajectories and finding linked localized regions, enabling efficient human verification and safe human AI collaboration. Learning through expert eyes provides a practical route toward more trustworthy, explainable, and diagnostically robust AI systems for radiology and beyond.

Kinhei Lee, Peiyuan Jing, Zhenxuan Zhang +5

Bioengineering Department and Imperial-X, Imperial College London, London W12 7SL, UK · College of physics and information engineering, Fuzhou University, Fuzhou, 350108, China · Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK +3

Radiology VLMs Explainable Medical Image Analysis Radiology Report Generation Medical VQA

Apr 14, 2026

Medical thinking with multiple images

Large language models perform well on many medical QA benchmarks, but real clinical reasoning often requires integrating evidence across multiple images rather than interpreting a single view. We introduce MedThinkVQA, an expert-annotated benchmark for thinking with multiple images, where models must interpret each image, combine cross-view evidence, and answer diagnostic questions with intermediate supervision and step-level evaluation. The dataset contains 8,067 cases, including 720 test cases, with an average of 6.62 images per case, substantially denser than prior work, whose expert-level benchmarks use at most 1.43 images per case. On the test set, the best closed-source models, Claude-4.6-Opus, Gemini-3-Pro, and GPT-5.2-xhigh, reach only 57.2%, 55.3%, and 54.9% accuracy, while GPT-5-mini and GPT-5-nano reach 39.7% and 30.8%. Strong open-source models lag behind, led by Qwen3.5-397B-A17B at 52.2% and Qwen3.5-27B at 50.6%. Further analysis identifies grounded multi-image reasoning as the main bottleneck: models often fail to extract, align, and compose evidence across views before higher-level inference can help. Providing expert single-image cues and cross-image summaries improves performance, whereas replacing them with self-generated intermediates reduces accuracy. Step-level analysis shows that over 70% of errors arise from image reading and cross-view integration. Scaling results further show that additional inference-time computation helps only when visual grounding is already reliable; when early evidence extraction is weak, longer reasoning yields limited or unstable gains and can amplify misread cues. These results suggest that the key challenge is not reasoning length alone, but reliable mechanisms for grounding, aligning, and composing distributed evidence across real-world multimodal clinical inputs.

Zonghai Yao, Benlu Wang, Yifan Zhang +8

Manning College of Information and Computer Sciences, UMass Amherst · Center for Healthcare Organization and Implementation Research, VA Bedford Health Care · Department of Computer Science, Yale University +2

Medical VQA Multimodal Reasoning Multi-Image Reasoning Medical Image Benchmarks Medical Image Grounding

Apr 13, 2026

Dialectic-Med: Mitigating Diagnostic Hallucinations via Counterfactual Adversarial Multi-Agent Debate

Multimodal Large Language Models (MLLMs) in healthcare suffer from severe confirmation bias, often hallucinating visual details to support initial, potentially erroneous diagnostic hypotheses. Existing Chain-of-Thought (CoT) approaches lack intrinsic correction mechanisms, rendering them vulnerable to error propagation. To bridge this gap, we propose Dialectic-Med, a multi-agent framework that enforces diagnostic rigor through adversarial dialectics. Unlike static consensus models, Dialectic-Med orchestrates a dynamic interplay between three role-specialized agents: a proponent that formulates diagnostic hypotheses; an opponent equipped with a novel visual falsification module that actively retrieves contradictory visual evidence to challenge the Proponent; and a mediator that resolves conflicts via a weighted consensus graph. By explicitly modeling the cognitive process of falsification, our framework guarantees that diagnostic reasoning is tightly grounded in verified visual regions. Empirical evaluations on MIMIC-CXR-VQA, VQA-RAD, and PathVQA demonstrate that Dialectic-Med not only achieves state-of-the-art performance but also fundamentally enhances the trustworthiness of the reasoning process. Beyond accuracy, our approach significantly enhances explanation faithfulness and decisively mitigates hallucinations, establishing a new standard over single-agent baselines.

Zhixiang Lu, Jionglong Su

Xi’an Jiaotong-Liverpool University

VLM Hallucination Mitigation Medical VLMs Medical VQA Multi-Agent Debate Counterfactual Reasoning in Language Models

Apr 13, 2026

ReXSonoVQA: A Video QA Benchmark for Procedure-Centric Ultrasound Understanding

Ultrasound acquisition requires skilled probe manipulation and real-time adjustments. Vision-language models (VLMs) could enable autonomous ultrasound systems, but existing benchmarks evaluate only static images, not dynamic procedural understanding. We introduce ReXSonoVQA, a video QA benchmark with 514 video clips and 514 questions (249 MCQ, 265 free-response) targeting three competencies: Action-Goal Reasoning, Artifact Resolution & Optimization, and Procedure Context & Planning. Zero-shot evaluation of Gemini 3 Pro, Qwen3.5-397B, LLaVA-Video-72B, and Seed 2.0 Pro shows VLMs can extract some procedural information, but troubleshooting questions remain challenging with minimal gains over text-only baselines, exposing limitations in causal reasoning. ReXSonoVQA enables developing perception systems for ultrasound training, guidance, and robotic automation.

Xucheng Wang, Xiaoman Zhang, Sung Eun Kim +2

Department of Biomedical Informatics, Harvard Medical School, Boston, MA

Medical VQA Video QA Medical VLMs Ultrasound Imaging

Apr 11, 2026

Adapting 2D Multi-Modal Large Language Model for 3D CT Image Analysis

3D medical image analysis is of great importance in disease diagnosis and treatment. Recently, multimodal large language models (MLLMs) have exhibited robust perceptual capacity, strong cross-modal alignment, and promising generalizability. Therefore, they have great potential to improve the performance of medical report generation (MRG) and medical visual question answering (MVQA), which serve as two important tasks in clinical scenarios. However, due to the scarcity of 3D medical images, existing 3D medical MLLMs suffer from insufficiently pretrained vision encoder and inability to extract customized image features for different kinds of tasks. In this paper, we propose to first transfer a 2D MLLM, which is well trained with 2D natural images, to support 3D medical volumetric inputs while reusing all of its pre-trained parameters. To enable the vision encoder to extract tailored image features for various tasks, we then design a Text-Guided Hierarchical MoE (TGH-MoE) framework, which can distinguish tasks under the guidance of the text prompt. Furthermore, we propose a two-stage training strategy to learn both task-shared and task-specific image features. As demonstrated empirically, our method outperforms existing 3D medical MLLMs in both MRG and MVQA tasks. Our code will be released once this paper is accepted.

Yang Yu, Dunyuan Xu, Yaoqian Li +3

Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong, China. · Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China. · Center for Artificial Intelligence and Robotics, Hong Kong Institute of Science and Innovation, Chinese Academy of Sciences, Hong Kong, China. +1

Multimodal Large Language Models 3D VLMs Medical Report Generation Medical VQA Mixture of Experts

Apr 10, 2026

Improving Medical VQA through Trajectory-Aware Process Supervision

Reasoning capabilities are crucial for reliable medical visual question answering (VQA); however, existing datasets rarely include reasoning explanations. We address this by generating reasoning trajectories for six medical VQA benchmarks using the COMCTS algorithm with open-source vision-language models, with an LLM serving as the verification judge. Building on these generated datasets, we propose a two-stage training framework: supervised fine-tuning followed by Group Relative Policy Optimization (GRPO) with a novel process-based reward. While standard approaches rely solely on exact-match rewards for final answers, we introduce a trajectory-aware reward that measures the similarity between generated and ground-truth reasoning processes. Specifically, we embed reasoning steps using sentence transformers and compute the Dynamic Time Warping (DTW) distance between the resulting vector sequences. Experiments across six benchmarks demonstrate that combining the DTW-based process reward with exact-match reward consistently outperforms SFT-only training, raising mean accuracy from 0.598 to 0.689, mean BERTScore from 0.845 to 0.881, and mean ROUGE-L from 0.665 to 0.748. Our results highlight the importance of process supervision in training reasoning-capable medical VLMs. We make our code and generated reasoning datasets publicly available at https://anonymous.4open.science/r/MICCAI-R1-MED-VQA-code-B14B/

Halil Ibrahim Gulluk, Olivier Gevaert

Electrical Engineering, Stanford University · Stanford Center For Biomedical Informatics Research

Medical VQA Medical VLMs VLM Reasoning Process Supervision RL for VLMs

Apr 10, 2026

MedLVR: Latent Visual Reasoning for Reliable Medical Visual Question Answering

Medical vision--language models (VLMs) have shown strong potential for medical visual question answering (VQA), yet their reasoning remains largely text-centric: images are encoded once as static context, and subsequent inference is dominated by language. This paradigm is fundamentally limited in clinical scenarios, where accurate answers often depend on subtle, localized visual evidence that cannot be reliably preserved in static embeddings. We propose MedLVR, a latent visual reasoning framework that introduces an explicit visual evidence state into autoregressive decoding. Instead of relying solely on text-based intermediate reasoning, MedLVR interleaves a short latent reasoning segment within the decoder by reusing hidden states as continuous latent steps, enabling iterative preservation and refinement of query-relevant visual evidence before answer generation. To support effective visual supervision, we adopt a two-stage training strategy: region of interest (ROI)-supervised fine-tuning aligns latent states with clinically relevant image evidence, and Visual-Latent Policy Optimization (VLPO) further optimizes latent reasoning and answer generation under outcome-level rewards. Experiments on OmniMedVQA and five external medical VQA benchmarks show that MedLVR consistently outperforms recent reasoning baselines and improves the average score over the Qwen2.5-VL-7B backbone from 48.3% to 53.4%. These results show that latent visual reasoning provides an effective mechanism for preserving diagnostically relevant visual evidence and improving the reliability of medical VQA.

Suyang Xi, Songtao Hu, Yuxiang Lai +4

Department of Radiation Oncology and Winship Cancer Institute, Emory University School of Medicine, Atlanta, 30322, GA, USA · Department of Biostatistics and Bioinformatics, Emory University, Atlanta, 30322, GA, USA

Medical VQA Medical VLMs Latent Visual Reasoning RL for VLMs

Apr 9, 2026

MedVR: Annotation-Free Medical Visual Reasoning via Agentic Reinforcement Learning

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.

Zheng Jiang, Heng Guo, Chengyu Fang +4

Tsinghua University · DAMO Academy, Alibaba Group · Hupan Lab, 310023, Hangzhou, China +2

VLM Reasoning Visual Reasoning Medical VLMs RL for VLMs Medical VQA

Apr 2, 2026

Overconfidence and Calibration in Medical VQA: Empirical Findings and Hallucination-Aware Mitigation

As vision-language models (VLMs) are increasingly deployed in clinical decision support, more than accuracy is required: knowing when to trust their predictions is equally critical. Yet, a comprehensive and systematic investigation into the overconfidence of these models remains notably scarce in the medical domain. We address this gap through a comprehensive empirical study of confidence calibration in VLMs, spanning three model families (Qwen3-VL, InternVL3, LLaVA-NeXT), three model scales (2B--38B), and multiple confidence estimation prompting strategies, across three medical visual question answering (VQA) benchmarks. Our study yields three key findings: First, overconfidence persists across model families and is not resolved by scaling or prompting, such as chain-of-thought and verbalized confidence variants. Second, simple post-hoc calibration approaches, such as Platt scaling, reduce calibration error and consistently outperform the prompt-based strategy. Third, due to their (strict) monotonicity, these post-hoc calibration methods are inherently limited in improving the discriminative quality of predictions, leaving AUROC at the same level. Motivated by these findings, we investigate hallucination-aware calibration (HAC), which incorporates vision-grounded hallucination detection signals as complementary inputs to refine confidence estimates. We find that leveraging these hallucination signals improves both calibration and AUROC, with the largest gains on open-ended questions. On closed-ended questions, format-specific signals such as the logit margin show more informative. Overall, our findings suggest post-hoc calibration as standard practice for medical VLM deployment over raw confidence estimates, and highlight the practical usefulness of hallucination signals to enable more reliable use of VLMs in medical VQA.

Ji Young Byun, Young-Jin Park, Jean-Philippe Corbeil +1

Johns Hopkins University, School of Medicine · Massachusetts Institute of Technology · Microsoft Healthcare & Life Sciences

Vision-Language Models VLM Hallucination Medical VQA Language Model Calibration VLM Calibration

Apr 1, 2026

An Approach to Enriching Surgical Video Datasets for Fine-Grained Spatial-Temporal Understanding of Vision-Language Models

Surgical video understanding is a crucial prerequisite for advancing Computer-Assisted Surgery. While vision-language models (VLMs) have recently been applied to the surgical domain, existing surgical vision-language datasets lack in capturing and evaluating complex, interleaved spatial-temporal dynamics. Creating large scale datasets that accurately represent fine-grained spatial-temporal relationships in surgical videos is challenging due to costly manual annotations or error-prone generation using large language models. To address this gap, we introduce the SurgSTU-Pipeline, a deterministic generation pipeline featuring temporal and spatial continuity filtering to reliably create surgical datasets for fine-grained spatial-temporal multimodal understanding. Applying this pipeline to publicly available surgical datasets, we create the SurgSTU dataset, comprising 6711 video clips densely extended with 150k fine-grained spatial-temporal question-answer samples. Our comprehensive evaluation shows that while state-of-the-art generalist VLMs struggle in zero-shot settings, their spatial-temporal capabilities can be improved through in-context learning. A fine-tuned VLM on the SurgSTU training dataset achieves highest performance among all spatial-temporal tasks, validating the dataset's efficacy to improve spatial-temporal understanding of VLMs in surgical videos. The project is available here: https://lennart-maack.github.io/SurgSTU-project

Lennart Maack, Alexander Schlaefer

Hamburg University of Technology, Germany

Medical VQA Surgical Video Understanding Medical VLMs Temporal Video Understanding

Apr 1, 2026

KG-CMI: Knowledge graph enhanced cross-Mamba interaction for medical visual question answering

Medical visual question answering (Med-VQA) is a crucial multimodal task in clinical decision support and telemedicine. Recent methods fail to fully leverage domain-specific medical knowledge, making it difficult to accurately associate lesion features in medical images with key diagnostic criteria. Additionally, classification-based approaches typically rely on predefined answer sets. Treating Med-VQA as a simple classification problem limits its ability to adapt to the diversity of free-form answers and may overlook detailed semantic information in those answers. To address these challenges, we propose a knowledge graph enhanced cross-Mamba interaction (KG-CMI) framework, which consists of a fine-grained cross-modal feature alignment (FCFA) module, a knowledge graph embedding (KGE) module, a cross-modal interaction representation (CMIR) module, and a free-form answer enhanced multi-task learning (FAMT) module. The KG-CMI learns cross-modal feature representations for images and texts by effectively integrating professional medical knowledge through a graph, establishing associations between lesion features and disease knowledge. Moreover, FAMT leverages auxiliary knowledge from open-ended questions, improving the model's capability for open-ended Med-VQA. Experimental results demonstrate that KG-CMI outperforms existing state-of-the-art methods on three Med-VQA datasets, i.e., VQA-RAD, SLAKE, and OVQA. Additionally, we conduct interpretability experiments to further validate the framework's effectiveness.

Xianyao Zheng, Hong Yu, Hui Cui +7

School of Software, Northwestern Polytechnical University, Shaanxi, China · Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China · Department of Computer Science and Information Technology, La Trobe University, Melbourne, Australia +6

Medical VQA Medical VLMs Knowledge-Based VQA

Mar 31, 2026

SurgTEMP: Temporal-Aware Surgical Video Question Answering with Text-guided Visual Memory for Laparoscopic Cholecystectomy

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, they enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA. The project page is available at: https://camma-public.github.io/SurgTEMP/

Shi Li, Vinkle Srivastav, Shih-Min Yin +7

University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France · IHU Strasbourg, Strasbourg, France · Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan +1

Medical VQA Surgical Video Understanding Medical VLMs Temporal Video Understanding

Mar 27, 2026

Learning to Trim: End-to-End Causal Graph Pruning with Dynamic Anatomical Feature Banks for Medical VQA

Medical Visual Question Answering (MedVQA) models often exhibit limited generalization due to reliance on dataset-specific correlations, such as recurring anatomical patterns or question-type regularities, rather than genuine diagnostic evidence. Existing causal approaches are typically implemented as static adjustments or post-hoc corrections. To address this issue, we propose a Learnable Causal Trimming (LCT) framework that integrates causal pruning into end-to-end optimization. We introduce a Dynamic Anatomical Feature Bank (DAFB), updated via a momentum mechanism, to capture global prototypes of frequent anatomical and linguistic patterns, serving as an approximation of dataset-level regularities. We further design a differentiable trimming module that estimates the dependency between instance-level representations and the global feature bank. Features highly correlated with global prototypes are softly suppressed, while instance-specific evidence is emphasized. This learnable mechanism encourages the model to prioritize causal signals over spurious correlations adaptively. Experiments on VQA-RAD, SLAKE, SLAKE-CP and PathVQA demonstrate that LCT consistently improves robustness and generalization over existing debiasing strategies.

Zibo Xu, Qiang Li, Weizhi Nie +1

School of Microelectronics, Tianjin University, Tianjin 300072, China · School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China

Medical VQA Spurious Correlation Robustness VLM Robustness Causal Representation Learning

Mar 26, 2026

Photon: Speedup Volume Understanding with Efficient Multimodal Large Language Models

Multimodal large language models are promising for clinical visual question answering tasks, but scaling to 3D imaging is hindered by high computational costs. Prior methods often rely on 2D slices or fixed-length token compression, disrupting volumetric continuity and obscuring subtle findings. We present Photon, a framework that represents 3D medical volumes with token sequences of variable length. Photon introduces instruction-conditioned token scheduling and surrogate gradient propagation to adaptively reduce tokens during both training and inference, which lowers computational cost while mitigating the attention dilution caused by redundant tokens. It incorporates a custom backpropagation rule with gradient restoration to enable differentiable optimization despite discrete token drop. To stabilize token compression and ensure reliable use of visual evidence, Photon further applies regularization objectives that mitigate language-only bias and improve reliability. Experiments on diverse medical visual question answering tasks show that Photon achieves state-of-the-art accuracy while reducing resource usage and accelerating both training and inference.

Chengyu Fang, Heng Guo, Zheng Jiang +3

Tsinghua University · DAMO Academy, Alibaba Group · Hupan Lab +1

Medical VLMs 3D VLMs Efficient Multimodal Inference Medical VQA Visual Token Compression

Mar 23, 2026

Deterministic Hallucination Detection in Medical VQA via Confidence-Evidence Bayesian Gain

Multimodal large language models (MLLMs) have shown strong potential for medical Visual Question Answering (VQA), yet they remain prone to hallucinations, defined as generating responses that contradict the input image, posing serious risks in clinical settings. Current hallucination detection methods, such as Semantic Entropy (SE) and Vision-Amplified Semantic Entropy (VASE), require 10 to 20 stochastic generations per sample together with an external natural language inference model for semantic clustering, making them computationally expensive and difficult to deploy in practice. We observe that hallucinated responses exhibit a distinctive signature directly in the model's own log-probabilities: inconsistent token-level confidence and weak sensitivity to visual evidence. Based on this observation, we propose Confidence-Evidence Bayesian Gain (CEBaG), a deterministic hallucination detection method that requires no stochastic sampling, no external models, and no task-specific hyperparameters. CEBaG combines two complementary signals: token-level predictive variance, which captures inconsistent confidence across response tokens, and evidence magnitude, which measures how much the image shifts per-token predictions relative to text-only inference. Evaluated across four medical MLLMs and three VQA benchmarks (16 experimental settings), CEBaG achieves the highest AUC in 13 of 16 settings and improves over VASE by 8 AUC points on average, while being fully deterministic and self-contained. https://github.com/masadi-99/CEBaG

Mohammad Asadi, Tahoura Nedaee, Jack W. O'Sullivan +2

Department of Electrical Engineering, Stanford University, CA, USA · Department of Biology, Stanford University, CA, USA · Division of Cardiology, Department of Medicine, Stanford University, CA, USA +3

Hallucination Detection in VLMs Hallucination Detection Medical VQA Medical VLMs

Mar 19, 2026

ReXInTheWild: A Unified Benchmark for Medical Photograph Understanding

Everyday photographs taken with ordinary cameras are already widely used in telemedicine and other online health conversations, yet no comprehensive benchmark evaluates whether vision-language models can interpret their medical content. Analyzing these images requires both fine-grained natural image understanding and domain-specific medical reasoning, a combination that challenges both general-purpose and specialized models. We introduce ReXInTheWild, a benchmark of 955 clinician-verified multiple-choice questions spanning seven clinical topics across 484 photographs sourced from the biomedical literature. When evaluated on ReXInTheWild, leading multimodal large language models show substantial performance variation: Gemini-3 achieves 78% accuracy, followed by Claude Opus 4.5 (72%) and GPT-5 (68%), while the medical specialist model MedGemma reaches only 37%. A systematic error analysis also reveals four categories of common errors, ranging from low-level geometric errors to high-level reasoning failures and requiring different mitigation strategies. ReXInTheWild provides a challenging, clinically grounded benchmark at the intersection of natural image understanding and medical reasoning. The dataset is available on HuggingFace.

Oishi Banerjee, Sung Eun Kim, Alexandra N. Willauer +9

Department of Biomedical Informatics, Harvard Medical School, Boston, MA · National Strategic Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea · Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA +3

Medical VLMs Medical Image Benchmarks Medical VQA Medical Image Analysis Multimodal Model Evaluation

Mar 19, 2026

Gastric-X: A Multimodal Multi-Phase Benchmark Dataset for Advancing Vision-Language Models in Gastric Cancer Analysis

Recent vision-language models (VLMs) have shown strong generalization and multimodal reasoning abilities in natural domains. However, their application to medical diagnosis remains limited by the lack of comprehensive and structured datasets that capture real clinical workflows. To advance the development of VLMs for clinical applications, particularly in gastric cancer, we introduce Gastric-X, a large-scale multimodal benchmark for gastric cancer analysis providing 1.7K cases. Each case in Gastric-X includes paired resting and dynamic CT scans, endoscopic image, a set of structured biochemical indicators, expert-authored diagnostic notes, and bounding box annotations of tumor regions, reflecting realistic clinical conditions. We systematically examine the capability of recent VLMs on five core tasks: Visual Question Answering (VQA), report generation, cross-modal retrieval, disease classification, and lesion localization. These tasks simulate critical stages of clinical workflow, from visual understanding and reasoning to multimodal decision support. Through this evaluation, we aim not only to assess model performance but also to probe the nature of VLM understanding: Can current VLMs meaningfully correlate biochemical signals with spatial tumor features and textual reports? We envision Gastric-X as a step toward aligning machine intelligence with the cognitive and evidential reasoning processes of physicians, and as a resource to inspire the development of next-generation medical VLMs.

Sheng Lu, Hao Chen, Rui Yin +3

Ruijin Hospital · University of Cambridge · Nanjing First Hospital +2

Medical VLMs Medical Image Benchmarks Medical Diagnosis Medical VQA Multimodal Model Evaluation

Mar 19, 2026

Instruction-Free Tuning of Large Vision Language Models for Medical Instruction Following

Large vision language models (LVLMs) have demonstrated impressive performance across a wide range of tasks. These capabilities largely stem from visual instruction tuning, which fine-tunes models on datasets consisting of curated image-instruction-output triplets. However, in the medical domain, constructing large-scale, high-quality instruction datasets is particularly challenging due to the need for specialized expert knowledge. To address this issue, we propose an instruction-free tuning approach that reduces reliance on handcrafted instructions, leveraging only image-description pairs for fine-tuning. Specifically, we introduce a momentum proxy instruction as a replacement for curated text instructions, which preserves the instruction-following capability of the pre-trained LVLM while promoting updates to parameters that remain valid during inference. Consequently, the fine-tuned LVLM can flexibly respond to domain-specific instructions, even though explicit instructions are absent during fine-tuning. Additionally, we incorporate a response shuffling strategy to mitigate the model's over-reliance on previous words, facilitating more effective fine-tuning. Our approach achieves state-of-the-art accuracy on multiple-choice visual question answering tasks across SKINCON, WBCAtt, CBIS, and MIMIC-CXR datasets, significantly enhancing the fine-tuning efficiency of LVLMs in medical domains.

Myeongkyun Kang, Soopil Kim, Xiaoxiao Li +1

Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada · Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea · Division of Intelligent Robot, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea +2

Medical VLMs Large Vision-Language Models Instruction Following Supervised Fine-Tuning Medical VQA

Mar 19, 2026

VGS-Decoding: Visual Grounding Score Guided Decoding for Hallucination Mitigation in Medical VLMs

Medical Vision-Language Models (VLMs) often hallucinate by generating responses based on language priors rather than visual evidence, posing risks in clinical applications. We propose Visual Grounding Score Guided Decoding (VGS-Decoding), a training-free method to mitigate hallucinations during inference. Our key insight is that hallucinated tokens maintain or increase their probability when visual information is degraded, while visually grounded tokens decrease in probability. We introduce the Visual Grounding Score (VGS), which measures each token's visual dependency by comparing distributions from original and distorted images. During decoding, we reweight probabilities by amplifying visually grounded tokens while suppressing hallucinations. Unlike fixed-weight contrastive methods, VGS-Decoding provides per-token adaptive control. Experiments on MIMIC-Diff-VQA and VQA-RAD across LLaVA-Med, CheXagent, and MedGemma demonstrate consistent improvements, with up to +9.12% overall gain and

+8.98\%

in open-ended recall, while introducing only

2\times

inference overhead and no additional training, making it practical for clinical deployment. Upon acceptance, code will be released publicly to facilitate reproducibility.

Govinda Kolli, Adinath Madhavrao Dukre, Behzad Bozorgtabar +2

MBZUAI, Abu Dhabi, UAE · Rajiv Gandhi University of Knowledge Technologies, India · Aarhus University, Aarhus, Denmark +1

VLM Hallucination Mitigation Medical VLMs Medical VQA

Mar 17, 2026

IOSVLM: A 3D Vision-Language Model for Unified Dental Diagnosis from Intraoral Scans

3D intraoral scans (IOS) are increasingly adopted in routine dentistry due to abundant geometric evidence, and unified multi-disease diagnosis is desirable for clinical documentation and communication. While recent works introduce dental vision-language models (VLMs) to enable unified diagnosis and report generation on 2D images or multi-view images rendered from IOS, they do not fully leverage native 3D geometry. Such work is necessary and also challenging, due to: (i) heterogeneous scan forms and the complex IOS topology, (ii) multi-disease co-occurrence with class imbalance and fine-grained morphological ambiguity, (iii) limited paired 3D IOS-text data. Thus, we present IOSVLM, an end-to-end 3D VLM that represents scans as point clouds and follows a 3D encoder-projector-LLM design for unified diagnosis and generative visual question-answering (VQA), together with IOSVQA, a large-scale multi-source IOS diagnosis VQA dataset comprising 19,002 cases and 249,055 VQA pairs over 23 oral diseases and heterogeneous scan types. To address the distribution gap between color-free IOS data and color-dependent 3D pre-training, we propose a geometry-to-chromatic proxy that stabilizes fine-grained geometric perception and cross-modal alignment. A two-stage curriculum training strategy further enhances robustness. IOSVLM consistently outperforms strong baselines, achieving gains of at least +9.58% macro accuracy and +1.46% macro F1, indicating the effectiveness of direct 3D geometry modeling for IOS-based diagnosis.

Huimin Xiong, Zijie Meng, Tianxiang Hu +3

ZJU-UIUC Institute, Zhejiang University, Haining, 314400, China · Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310058, China · Angelalign Research Institute, Angel Align Inc., Shanghai, 200011, China

3D VLMs Medical VLMs Medical Diagnosis Medical VQA Dental Imaging 3D VQA

Mar 17, 2026

InViC: Intent-aware Visual Cues for Medical Visual Question Answering

Medical visual question answering (Med-VQA) aims to answer clinically relevant questions grounded in medical images. However, existing multimodal large language models (MLLMs) often exhibit shortcut answering, producing plausible responses by exploiting language priors or dataset biases while insufficiently attending to visual evidence. This behavior undermines clinical reliability, especially when subtle imaging findings are decisive. We propose a lightweight plug-in framework, termed Intent-aware Visual Cues (InViC), to explicitly enhance image-based answer generation in medical VQA. InViC introduces a Cue Tokens Extraction (CTE) module that distills dense visual tokens into a compact set of K question-conditioned cue tokens, which serve as structured visual intermediaries injected into the LLM decoder to promote intent-aligned visual evidence. To discourage bypassing of visual information, we further design a two-stage fine-tuning strategy with a cue-bottleneck attention mask. In Stage I, we employ an attention mask to block the LLM's direct view of raw visual features, thereby funneling all visual evidence through the cue pathway. In Stage II, standard causal attention is restored to train the LLM to jointly exploit the visual and cue tokens. We evaluate InViC on three public Med-VQA benchmarks (VQA-RAD, SLAKE, and ImageCLEF VQA-Med 2019) across multiple representative MLLMs. InViC consistently improves over zero-shot inference and standard LoRA fine-tuning, demonstrating that intent-aware visual cues with bottlenecked training is a practical and effective strategy for improving trustworthy Med-VQA.

Zhisong Wang, Ziyang Chen, Zanting Ye +3

National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi’an 710072, China · Southern Medical University · Westlake University

Medical VQA Medical VLMs Visual Token Compression