Vision-Language Alignment

Radiology Report Generation aims to produce accurate and coherent diagnostics from medical images. Although large vision-language models improve report fluency and accuracy, they still suffer from hallucinations by generating plausible pathological descriptions that are not supported by the input images. Existing methods primarily rely on external knowledge guidance to facilitate the alignment between generated text and visual information. However, these approaches often ignore the inherent decoding priors and vision-language alignment biases in pretrained models and lack robustness due to reliance on constructed guidance. In this paper, we propose Layer-wise Expert-aligned Decoding, a method that directly intervenes in the internal decoding process of large vision-language models. A pathology-specific expert module is designed to extract discriminative pathological features, which are then injected into each decoder layer through a gated mechanism. This architecture enables the large language model to progressively incorporate expert features during generation through a learned layer-wise gating function, thereby mitigating decoding biases and steering generation toward factual consistency. Experiments on multiple public datasets demonstrate that the proposed method improves clinical accuracy and factual consistency while maintaining competitive report generation quality.

As large language models are increasingly used in high-stakes domains, it is essential that their outputs reflect not average} human preference, rather range of varying perspectives. Achieving such pluralism, however, remains challenging. Existing approaches consider limited values or rely on prompt-level interventions, lacking value control and representation. To address this, we introduce VISPA, a training-free pluralistic alignment framework, that enables direct control over value expression by dynamic selection and internal model activation steering. Across extensive empirical studies spanning multiple models and evaluation settings, we show VISPA is performant across all pluralistic alignment modes in healthcare and beyond. Further analysis reveals VISPA is adaptable with different steering initiations, model, and/or values. These results suggest that pluralistic alignment can be achieved through internal activation mechanisms, offering a scalable path toward language models that serves all.

While Vision-Language Models (VLMs) have achieved notable progress in computational pathology (CPath), the gigapixel scale and spatial heterogeneity of Whole Slide Images (WSIs) continue to pose challenges for multimodal understanding. Existing alignment methods struggle to capture fine-grained correspondences between textual descriptions and visual cues across thousands of patches from a slide, compromising their performance on downstream tasks. In this paper, we propose PathFLIP (Pathology Fine-grained Language-Image Pretraining), a novel framework for holistic WSI interpretation. PathFLIP decomposes slide-level captions into region-level subcaptions and generates text-conditioned region embeddings to facilitate precise visual-language grounding. By harnessing Large Language Models (LLMs), PathFLIP can seamlessly follow diverse clinical instructions and adapt to varied diagnostic contexts. Furthermore, it exhibits versatile capabilities across multiple paradigms, efficiently handling slide-level classification and retrieval, fine-grained lesion localization, and instruction following. Extensive experiments demonstrate that PathFLIP outperforms existing large-scale pathological VLMs on four representative benchmarks while requiring significantly less training data, paving the way for fine-grained, instruction-aware WSI interpretation in clinical practice.

The rapid digitization of histopathology slides has opened new opportunities for computational tools in clinical and research workflows. Content-based slide retrieval can help pathologists identify morphologically and semantically related precedent cases, supporting expert diagnosis and example-based education. Effective retrieval of whole-slide images (WSIs), however, remains challenging because gigapixel slides contain abundant irrelevant content, focal diagnostic patterns and slide-level semantic information that must be represented at a practicable search cost. Here we present PathSearch, a retrieval framework that combines fine-grained attentive mosaics with slide-level embeddings aligned through vision-language contrastive learning. Trained on 6,926 slide-report pairs, PathSearch captures both fine-grained morphological cues and high-level semantic patterns to enable accurate and flexible retrieval. The framework supports two key functionalities: (1) mosaic-based image-to-image (I2I) retrieval, ensuring accurate and efficient slide search; and (2) multimodal retrieval, where text queries can directly retrieve relevant slides. PathSearch was evaluated on eight tasks comprising 5,021 evaluation slides, spanning malignancy assessment on frozen and hematoxylin and eosin (H&E)-stained slides, lymph-node metastasis detection, tumor subtyping, mixed-gallery rare-cancer retrieval, and hepatocellular carcinoma (HCC) risk stratification. Internal and external experimental results demonstrate that PathSearch consistently outperforms the strongest existing methods without compromising multimodal accuracy. A multi-center reader study further demonstrated increases in task-level mean diagnostic accuracy, confidence, and inter-observer agreement with PathSearch's support. Together, these results support the effectiveness of PathSearch across diverse retrieval tasks and evaluation settings.

Currently, a prevalent approach for enhancing Vision-Language Models (VLMs) performance is to encode both the high-resolution version and the thumbnail of an image simultaneously. While effective, this method generates a large number of image tokens. When combined with the widely used Rotary Position Embedding (RoPE), its long-term decay property hinders the interaction between high-resolution tokens and thumbnail tokens, as well as between text and image. To address these issues, we propose ID-Align, which alleviates these problems by reordering position IDs. In this method, high-resolution tokens inherit IDs from their corresponding thumbnail token while constraining the overexpansion of positional indices. Our experiments conducted within the LLaVA-Next framework demonstrate that ID-Align achieves significant improvements, including a 6.09% enhancement on MMBench's relation reasoning tasks and notable gains across multiple benchmarks. Our code is available at the following link: https://github.com/zooblastlbz/ID-Align.