Multimodal Instruction Tuning

Latest papers 80

7 papers in the last four weeks, down 36% on the four weeks before. 0.0% of all new papers.

Apr 17, 2026

neuralCAD-Edit: An Expert Benchmark for Multimodal-Instructed 3D CAD Model Editing

We introduce neuralCAD-Edit, the first benchmark for editing 3D CAD models collected from expert CAD engineers. Instead of text conditioning as in prior works, we collect realistic CAD editing requests by capturing videos of professional designers, interacting directly with CAD models in CAD software, while talking, pointing and drawing. We recruited ten consenting designers to contribute to this contained study. We benchmark leading foundation models against human CAD experts carrying out edits, and find a large performance gap in both automatic metrics and human evaluations. Even the best foundation model (GPT 5.2) scores 53% lower (absolute) than CAD experts in human acceptance trials, demonstrating the challenge of neuralCAD-Edit. We hope neuralCAD-Edit will provide a solid foundation against which 3D CAD editing approaches and foundation models can be developed. Code/data: https://autodeskailab.github.io/neuralCAD-Edit
Apr 15, 2026

MAny: Merge Anything for Multimodal Continual Instruction Tuning

Multimodal Continual Instruction Tuning (MCIT) is essential for sequential task adaptation of Multimodal Large Language Models (MLLMs) but is severely restricted by catastrophic forgetting. While existing literature focuses on the reasoning language backbone, in this work, we expose a critical yet neglected dual-forgetting phenomenon across both perception drift in Cross-modal Projection Space and reasoning collapse in Low-rank Parameter Space. To resolve this, we present MAny (Merge Anything), a framework that merges task-specific knowledge through Cross-modal Projection Merging (CPM) and Low-rank Parameter Merging (LPM). Specifically, CPM recovers perceptual alignment by adaptively merging cross-modal visual representations via visual-prototype guidance, ensuring accurate feature recovery during inference. Simultaneously, LPM eliminates mutual interference among task-specific low-rank modules by recursively merging low-rank weight matrices. By leveraging recursive least squares, LPM provides a closed-form solution that mathematically guarantees an optimal fusion trajectory for reasoning stability. Notably, MAny operates as a training-free paradigm that achieves knowledge merging via efficient CPU-based algebraic operations, eliminating additional gradient-based optimization beyond initial tuning. Our extensive evaluations confirm the superior performance and robustness of MAny across multiple MLLMs and benchmarks. Specifically, on the UCIT benchmark, MAny achieves significant leads of up to 8.57% and 2.85% in final average accuracy over state-of-the-art methods across two different MLLMs, respectively.
Apr 14, 2026

Boosting Visual Instruction Tuning with Self-Supervised Guidance

Multimodal large language models (MLLMs) perform well on many vision-language tasks but often struggle with vision-centric problems that require fine-grained visual reasoning. Recent evidence suggests that this limitation arises not from weak visual representations, but from under-utilization of visual information during instruction tuning, where many tasks can be partially solved using language priors alone. We propose a simple and lightweight approach that augments visual instruction tuning with a small number of visually grounded self-supervised tasks expressed as natural language instructions. By reformulating classical self-supervised pretext tasks, such as rotation prediction, color matching, and cross-view correspondence, as image-instruction-response triplets, we introduce supervision that cannot be solved without relying on visual evidence. Our approach requires no human annotations, no architectural modifications, and no additional training stages. Across multiple models, training regimes, and benchmarks, injecting only a small fraction (3-10%) of such visually grounded instructions consistently improves performance on vision-centric evaluations. Our findings highlight instruction tuning with visually grounded SSL tasks as a powerful lever for improving visual reasoning in MLLMs through simple adjustments to the training data distribution. Code available at: https://github.com/sirkosophia/V-GIFT
Apr 9, 2026

Vision-Language Foundation Models for Comprehensive Automated Pavement Condition Assessment

General-purpose vision-language models demonstrate strong performance in everyday domains but struggle with specialized technical fields requiring precise terminology, structured reasoning, and adherence to engineering standards. This work addresses whether domain-specific instruction tuning can enable comprehensive pavement condition assessment through vision-language models. PaveInstruct, a dataset containing 278,889 image-instruction-response pairs spanning 32 task types, was created by unifying annotations from nine heterogeneous pavement datasets. PaveGPT, a pavement foundation model trained on this dataset, was evaluated against state-of-the-art vision-language models across perception, understanding, and reasoning tasks. Instruction tuning transformed model capabilities, achieving improvements exceeding 20% in spatial grounding, reasoning, and generation tasks while producing ASTM D6433-compliant outputs. These results enable transportation agencies to deploy unified conversational assessment tools that replace multiple specialized systems, simplifying workflows and reducing technical expertise requirements. The approach establishes a pathway for developing instruction-driven AI systems across infrastructure domains including bridge inspection, railway maintenance, and building condition assessment.
Apr 3, 2026

InstructTable: Improving Table Structure Recognition Through Instructions

Table structure recognition (TSR) holds widespread practical importance by parsing tabular images into structured representations, yet encounters significant challenges when processing complex layouts involving merged or empty cells. Traditional visual-centric models rely exclusively on visual information while lacking crucial semantic support, thereby impeding accurate structural recognition in complex scenarios. Vision-language models leverage contextual semantics to enhance comprehension; however, these approaches underemphasize the modeling of visual structural information. To address these limitations, this paper introduces InstructTable, an instruction-guided multi-stage training TSR framework. Meticulously designed table instruction pre-training directs attention toward fine-grained structural patterns, enhancing comprehension of complex tables. Complementary TSR fine-tuning preserves robust visual information modeling, maintaining high-precision table parsing across diverse scenarios. Furthermore, we introduce Table Mix Expand (TME), an innovative template-free method for synthesizing large-scale authentic tabular data. Leveraging TME, we construct the Balanced Complex Dense Synthetic Tables (BCDSTab) benchmark, comprising 900 complex table images synthesized through our method to serve as a rigorous benchmark. Extensive experiments on multiple public datasets (FinTabNet, PubTabNet, MUSTARD) and BCDSTab demonstrate that InstructTable achieves state-of-the-art performance in TSR tasks. Ablation studies further confirm the positive impact of the proposed tabular-data-specific instructions and synthetic data.
Apr 3, 2026

Visual Instruction-Finetuned Language Model for Versatile Brain MR Image Tasks

LLMs have demonstrated remarkable capabilities in linguistic reasoning and are increasingly adept at vision-language tasks. The integration of image tokens into transformers has enabled direct visual input and output, advancing research from image-to-text descriptions to text-to-image generation. However, simple text-to-image generation holds limited clinical utility. In medical imaging, tasks such as image segmentation for localizing pathologies or image translation for reconstructing missing sequences have much greater clinical importance. Despite this, integrating these diverse, clinically relevant tasks within a single, versatile language model remains unexplored. Our method, LLaBIT (Large Language Model for Brain Image Translation), extends the visual reasoning of LLMs to these clinically meaningful tasks in the brain MRI domain. To mitigate the spatial information loss inherent in image tokenization, we incorporate a mechanism to reuse feature maps from the image encoder, minimizing data degradation. We also generate text data using LLMs with strict predefined instructions to augment limited image-text paired data in brain MRI. We comprehensively evaluated our method on five brain MRI datasets across four distinct tasks: report generation, visual question answering, image segmentation, and image translation. Our model not only demonstrated superior performance across all tasks but also outperformed specialized, task-specific models in direct comparisons, highlighting its efficacy and versatility
Apr 2, 2026

Jagle: Building a Large-Scale Japanese Multimodal Post-Training Dataset for Vision-Language Models

Developing vision-language models (VLMs) that generalize across diverse tasks requires large-scale training datasets with diverse content. In English, such datasets are typically constructed by aggregating and curating numerous existing visual question answering (VQA) resources. However, this strategy does not readily extend to other languages, where VQA datasets remain limited in both scale and domain coverage. In this work, we introduce Jagle, the largest Japanese multimodal post-training dataset to date, comprising approximately 9.2 million instances across diverse tasks. Rather than relying on existing VQA datasets, we collect heterogeneous source data, including images, image-text pairs, and PDF documents, and generate VQA pairs through multiple strategies such as VLM-based QA generation, translation, and text rendering. Experiments demonstrate that a 2.2B model trained with Jagle surpasses InternVL3.5-2B in average score across ten Japanese evaluation tasks and comes within five points of Qwen3-VL-2B-Instruct. Moreover, combining Jagle with FineVision improves English performance over training with FineVision alone. These benefits generalize across model backbones and scales: LLM-jp-4-VL 9B beta, a 9B-scale model built on the Japanese-centric LLM-jp-4-8B-instruct, achieves Japanese performance comparable to Qwen3-VL-8B-Instruct. To facilitate reproducibility and future research, we release the dataset, models, and code.
Mar 31, 2026

A Comprehensive Information-Decomposition Analysis of Large Vision-Language Models

Large vision-language models (LVLMs) achieve impressive performance, yet their internal decision-making processes remain opaque, making it difficult to determine if the success stems from true multimodal fusion or from reliance on unimodal priors. To address this attribution gap, we introduce a novel framework using partial information decomposition (PID) to quantitatively measure the "information spectrum" of LVLMs -- decomposing a model's decision-relevant information into redundant, unique, and synergistic components. By adapting a scalable estimator to modern LVLM outputs, our model-agnostic pipeline profiles 26 LVLMs on four datasets across three dimensions -- breadth (cross-model & cross-task), depth (layer-wise information dynamics), and time (learning dynamics across training). Our analysis reveals two key results: (i) two task regimes (synergy-driven vs. knowledge-driven) and (ii) two stable, contrasting family-level strategies (fusion-centric vs. language-centric). We also uncover a consistent three-phase pattern in layer-wise processing and identify visual instruction tuning as the key stage where fusion is learned. Together, these contributions provide a quantitative lens beyond accuracy-only evaluation and offer insights for analyzing and designing the next generation of LVLMs. Code and data are available at https://github.com/RiiShin/pid-lvlm-analysis .
Mar 29, 2026

Data Organization Matters in Multimodal Instruction Tuning: A Controlled Study of Capability Trade-offs

Recent multimodal large language models (MLLMs) perform strongly on general visual understanding, diagram and chart reasoning, and document-centric perception. However, these abilities are learned from heterogeneous supervision sources with very different task structures and learning demands, and the effect of their temporal organization during training remains underexplored. We study whether data organization affects the trade-off among general understanding, structured reasoning, and fine-grained OCR/document understanding in multimodal instruction tuning. To isolate this factor, we use a controlled three-stage training framework in which the backbone, trainable modules, and optimization pipeline are fixed across all runs, and only the temporal arrangement of post-alignment supervision is changed. We compare four strategies: direct mixture, curriculum training, balanced sampling, and reverse curriculum. Experiments on general visual instruction following, diagram reasoning, chart reasoning, scene-text question answering, and document question answering show that data organization is a first-order design variable in multimodal adaptation. Curriculum training gives the best overall trade-off and the strongest structured reasoning performance. Balanced sampling is better for OCR-oriented capability but weakens the broader capability balance. Reverse curriculum performs worst in both final performance and optimization stability. Training-dynamics analysis further suggests that building general understanding and reasoning before introducing OCR-intensive supervision leads to smoother optimization and faster convergence. These findings highlight data scheduling as an explicit design dimension for multimodal model adaptation.
Mar 23, 2026

Domain Adapted Large Language Models for Additive Manufacturing

This work presents a collection of multi-modal domain adapted large language models built upon the instruction tuned variants of open weight models (Gemma 3, Qwen 3, Gemma 4) using a relatively small dataset of around 50 million tokens. The dataset consists of open-access additive manufacturing journal articles with data extracted for the domain adaptive pretraining and visual instruction tuning processes. Various stages of the developed model are evaluated with the Additive-Manufacturing-Benchmark which consists of additive manufacturing domain specific tasks compiled published resources. Domain adapted and instruction tuned models exhibit proficiency in both language and vision based tasks, achieving accuracies upwards of 90% in general additive manufacturing knowledge. This domain adaptive pretraining and instruction tuning strategy outline an accessible specialization method for large language models to a domain such as additive manufacturing.
Mar 12, 2026

Less Data, Faster Convergence: Goal-Driven Data Optimization for Multimodal Instruction Tuning

Multimodal instruction tuning is often compute-inefficient because training budgets are spread across large mixed image-video pools whose utility is highly uneven. We present Goal-Driven Data Optimization (GDO), a framework that computes six sample descriptors for each candidate and constructs optimized 1×\times training subsets for different goals. Under a fixed one-epoch Qwen3-VL-8B-Instruct training and evaluation recipe on 8 H20 GPUs, GDO uses far fewer training samples than the Uni-10x baseline while converging faster and achieving higher accuracy. Relative to the fixed 512k-sample Uni-10x baseline, GDO reaches the Uni-10x reference after 35.4k samples on MVBench, 26.6k on VideoMME, 27.3k on MLVU, and 34.7k on LVBench, while improving Accuracy by +1.38, +1.67, +3.08, and +0.84 percentage points, respectively. The gains are largest on MVBench and MLVU, while LVBench improves more modestly, consistent with its ultra-long-video setting and the mismatch between that benchmark and the short-video/image-dominant training pool. Across MinLoss, Diverse, Temp, and Temp+, stronger temporal emphasis yields steadily better long-video understanding behavior. Overall, GDO provides a goal-driven data optimization framework that enables faster convergence with fewer training samples under a fixed training protocol. Code is available at https://github.com/rujiewu/GDO.
Mar 10, 2026

Does the Question Really Matter? Training-Free Data Selection for Vision-Language SFT

Visual instruction tuning is crucial for improving vision-language large models (VLLMs). However, many samples can be solved via linguistic patterns or common-sense shortcuts, without genuine cross-modal reasoning, limiting the effectiveness of multimodal learning. Prior data selection methods often rely on costly proxy model training and focus on difficulty or diversity, failing to capture a sample's true contribution to vision-language joint reasoning. In this paper, we propose CVS, a training-free data selection method based on the insight that, for high-quality multimodal samples, introducing the question should substantially alter the model's assessment of answer validity given an image. CVS leverages a frozen VLLM as an evaluator and measures the discrepancy in answer validity with and without conditioning on the question, enabling the identification of samples that require vision-language joint reasoning while filtering semantic-conflict noise. Experiments on Vision-Flan and The Cauldron show that CVS achieves solid performance across datasets. On Vision-Flan, CVS outperforms full-data training by 3.5% and 4.8% using only 10% and 15% of the data, respectively, and remains robust on the highly heterogeneous Cauldron dataset. Moreover, CVS reduces computational cost by 17.3% and 44.4% compared to COINCIDE and XMAS.
Mar 4, 2026

Crab+^{+}: A Scalable and Unified Audio-Visual Scene Understanding Model with Explicit Cooperation

Developing Audio-Visual Large Language Models (AV-LLMs) for unified scene understanding is pivotal in multimodal intelligence. While instruction tuning enables pre-trained models with multi-task abilities, we observe that conventional multi-task unification methods often suffer from severe negative transfer, where nearly 55% of tasks degrade compared to single-task training. We attribute this phenomenon to audio-visual task heterogeneity, characterized by disparate task granularity and divergent capability demands, which lead to negative interference under joint training. To tackle this, we present Crab+^{+}, a scalable and unified audio-visual scene understanding model that addresses task heterogeneity through explicit cooperation from both data and model perspectives. On the data side, we introduce AV-UIE v2, a comprehensive Audio-Visual Unified Instruction-tuning dataset with Explicit reasoning processes. It contains approximately 222K samples spanning 17 datasets and 7 tasks, enabling the model to capture cross-task relationships at different levels of granularity. On the model side, we design a unified interface to align heterogeneous task formulations, and propose Interaction-aware LoRA (I-LoRA), which explicitly models inter-task relationships via dynamic routing to coordinate distinct audio-visual interaction patterns, mitigating parameter interference. Extensive experiments show Crab+^{+} covers broader tasks than existing unified models while outperforming specialized models on various benchmarks. We successfully reverse the negative transfer trend, achieving positive transfer where multi-task learning surpasses single-task baselines in nearly 88% of tasks. These results hold across diverse AV-LLM paradigms and are validated through in-depth visualization, positioning Crab+^{+} as a robust step towards holistic audio-visual scene understanding.
Mar 4, 2026

From Narrow to Panoramic Vision: Attention-Guided Cold-Start Reshapes Multimodal Reasoning

The cold-start initialization stage plays a pivotal role in training Multimodal Large Reasoning Models (MLRMs), yet its mechanisms remain insufficiently understood. To analyze this stage, we introduce the Visual Attention Score (VAS), an attention-based metric that quantifies how much a model attends to visual tokens. We find that reasoning performance is strongly correlated with VAS (r=0.9616): models with higher VAS achieve substantially stronger multimodal reasoning. Surprisingly, multimodal cold-start fails to elevate VAS, resulting in attention distributions close to the base model, whereas text-only cold-start leads to a clear increase. We term this counter-intuitive phenomenon Lazy Attention Localization. To validate its causal role, we design training-free interventions that directly modulate attention allocation during inference, performance gains of 1−-2% without any retraining. Building on these insights, we further propose Attention-Guided Visual Anchoring and Reflection (AVAR), a comprehensive cold-start framework that integrates visual-anchored data synthesis, attention-guided objectives, and visual-anchored reward shaping. Applied to Qwen2.5-VL-7B, AVAR achieves an average gain of 7.0% across 7 multimodal reasoning benchmarks. Ablation studies further confirm that each component of AVAR contributes step-wise to the overall gains. The code, data, and models are available at https://github.com/lrlbbzl/Qwen-AVAR.
Mar 1, 2026

VisNec: Measuring and Leveraging Visual Necessity for Multimodal Instruction Tuning

The effectiveness of multimodal instruction tuning depends not only on dataset scale, but critically on whether training samples genuinely require visual reasoning. However, existing instruction datasets often contain a substantial portion of visually redundant samples (solvable from text alone), as well as multimodally misaligned supervision that can degrade learning. To address this, we propose VisNec (Visual Necessity Score), a principled data selection framework that measures the marginal contribution of visual input during instruction tuning. By comparing predictive loss with and without visual context, VisNec identifies whether a training instance is vision-critical, redundant, or misaligned. To preserve task diversity, we combine VisNec with semantic clustering and select high-necessity samples within each cluster. Across 10 downstream benchmarks, training on only 15% of the LLaVA-665K dataset selected by VisNec achieves 100.2% of full-data performance. On the smaller Vision-Flan-186K dataset, our selection not only further reduces data size but also surpasses full-data training by 15.8%. These results demonstrate that measuring and leveraging visual necessity provides an effective solution for both efficient and robust multimodal instruction tuning. Codes and selected subsets will be released upon acceptance.
Feb 28, 2026

CMI-RewardBench: Evaluating Music Reward Models with Compositional Multimodal Instruction

While music generation models have evolved to handle complex multimodal inputs mixing text, lyrics, and reference audio, evaluation mechanisms have lagged behind. In this paper, we bridge this critical gap by establishing a comprehensive ecosystem for music reward modeling under Compositional Multimodal Instruction (CMI), where the generated music may be conditioned on text descriptions, lyrics, and audio prompts. We first introduce CMI-Pref-Pseudo, a large-scale preference dataset comprising 110k pseudo-labeled samples, and CMI-Pref, a high-quality, human-annotated corpus tailored for fine-grained alignment tasks. To unify the evaluation landscape, we propose CMI-RewardBench, a unified benchmark that evaluates music reward models on heterogeneous samples across musicality, text-music alignment, and compositional instruction alignment. Leveraging these resources, we develop CMI reward models (CMI-RMs), a parameter-efficient reward model family capable of processing heterogeneous inputs. We evaluate their correlation with human judgment scores on musicality and alignment on CMI-Pref along with previous datasets. Further experiments demonstrate that CMI-RM not only correlates strongly with human judgments, but also enables effective inference-time scaling via top-k filtering. Code is available at GitHub (https://github.com/Haiwen-Xia/CMI-RewardBench). Model weights: CMI-RM (https://huggingface.co/HaiwenXia/CMI-RM). Datasets: CMI-Pref-Pseudo (https://huggingface.co/datasets/HaiwenXia/cmi-pref-pseudo) and CMI-Pref (https://huggingface.co/datasets/HaiwenXia/cmi-pref)
Feb 26, 2026

MM-NeuroOnco: A Multimodal Benchmark and Instruction Dataset for MRI-Based Brain Tumor Diagnosis

Accurate brain tumor diagnosis requires models to not only detect lesions but also generate clinically interpretable reasoning grounded in imaging manifestations, yet existing public datasets remain limited in annotation richness and diagnostic semantics. To bridge this gap, we introduce MM-NeuroOnco, a large-scale multimodal benchmark and instruction-tuning dataset for brain tumor MRI understanding, consisting of 24,726 MRI slices from 20 data sources paired with approximately 200,000 semantically enriched multimodal instructions spanning diverse tumor subtypes and imaging modalities. To mitigate the scarcity and high cost of diagnostic semantic annotations, we develop a multi-model collaborative pipeline for automated medical information completion and quality control, enabling the generation of diagnosis-related semantics beyond mask-only annotations. Building upon this dataset, we further construct MM-NeuroOnco-Bench, a manually annotated evaluation benchmark with a rejection-aware setting to reduce biases inherent in closed-ended question formats. Evaluation across ten representative models shows that even the strongest baseline, Gemini 3 Flash, achieves only 41.88% accuracy on diagnosis-related questions, highlighting the substantial challenges of multimodal brain tumor diagnostic understanding. Leveraging MM-NeuroOnco, we further propose NeuroOnco-GPT, which achieves a 27% absolute accuracy improvement on diagnostic questions following fine-tuning. This result demonstrates the effectiveness of our dataset and benchmark in advancing clinically grounded multimodal diagnostic reasoning. Code and dataset are publicly available at: https://github.com/gfnnnb/MM-NeuroOnco
Feb 24, 2026

LUMEN: Longitudinal Multi-Modal Radiology Model for Prognosis and Diagnosis

Large vision-language models (VLMs) have evolved from general-purpose applications to specialized use cases such as in the clinical domain, demonstrating potential for decision support in radiology. One promising application is assisting radiologists in decision-making by the analysis of radiology imaging data such as chest X-rays (CXR) via a visual and natural language question-answering (VQA) interface. When longitudinal imaging is available, radiologists analyze temporal changes, which are essential for accurate diagnosis and prognosis. The manual longitudinal analysis is a time-consuming process, motivating the development of a training framework that can provide prognostic capabilities. We introduce a novel training framework LUMEN, that is optimized for longitudinal CXR interpretation, leveraging multi-image and multi-task instruction fine-tuning to enhance prognostic and diagnostic performance. We conduct experiments on the publicly available MIMIC-CXR and its associated Medical-Diff-VQA datasets. We further formulate and construct a novel instruction-following dataset incorporating longitudinal studies, enabling the development of a prognostic VQA task. Our method demonstrates significant improvements over baseline models in diagnostic VQA tasks, and more importantly, shows promising potential for prognostic capabilities. These results underscore the value of well-designed, instruction-tuned VLMs in enabling more accurate and clinically meaningful radiological interpretation of longitudinal radiological imaging data.
Feb 19, 2026

QuPAINT: Physics-Aware Instruction Tuning Approach to Quantum Material Discovery

Characterizing two-dimensional quantum materials from optical microscopy images is challenging due to the subtle layer-dependent contrast, limited labeled data, and significant variation across laboratories and imaging setups. Existing vision models struggle in this domain since they lack physical priors and cannot generalize to new materials or hardware conditions. This work presents a new physics-aware multimodal framework that addresses these limitations from both the data and model perspectives. We first present Synthia, a physics-based synthetic data generator that simulates realistic optical responses of quantum material flakes under thin-film interference. Synthia produces diverse and high-quality samples, helping reduce the dependence on expert manual annotation. We introduce QMat-Instruct, the first large-scale instruction dataset for quantum materials, comprising multimodal, physics-informed question-answer pairs designed to teach Multimodal Large Language Models (MLLMs) to understand the appearance and thickness of flakes. Then, we propose Physics-Aware Instruction Tuning (QuPAINT), a multimodal architecture that incorporates a Physics-Informed Attention module to fuse visual embeddings with optical priors, enabling more robust and discriminative flake representations. Finally, we establish QF-Bench, a comprehensive benchmark spanning multiple materials, substrates, and imaging settings, offering standardized protocols for fair and reproducible evaluation.
Oct 19, 2024

MultiViewDx: Evidence-Linked Multi-View Clinical Diagnosis

Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. MultiViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence -> findings -> differential discussion -> diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond MedVQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.