VLM Hallucination

Large Vision-Language Models (LVLMs) have shown remarkable performance on a wide range of vision-language tasks. Despite this progress, they are still prone to hallucination, generating responses that are inconsistent with visual content. In this work, we find that LVLMs tend to hallucinate when they pay insufficient attention to the correct visual evidence and gradually forget it during the generation process. We empirically find that although LVLMs overall attend insufficiently to visual evidence, they exhibit sensitivity to the correct visual evidence in specific layers, with notable inter-layer discrepancy. Motivated by this observation, we propose a novel hallucination mitigation method that enhances visual evidence based on Inter-Layer Visual Attention Discrepancy (ILVAD). Specifically, we obtain the attention weights from early generated tokens to visual tokens across layers and identify the tokens that are repeatedly activated as visual evidence, forming a saliency map. We then enhance attention to visual evidence during generation through the saliency map to reduce visual forgetting. In addition, we leverage the saliency map to obtain attention scores of generated text to visual evidence, in order to select and emphasize text tokens that are strongly grounded in visual evidence. Our method is training-free and plug-and-play. Multiple benchmark evaluations conducted on five recently released models show that our method can consistently mitigate hallucinations in different LVLMs over various architectures. Code is available at https://github.com/ytx-ML/ILVAD.

While medical Multimodal Large Language Models (MLLMs) have shown promise in assisting diagnosis, they still frequently generate hallucinated responses that appear linguistically plausible but lack visual evidence. Such hallucinations pose risks to clinical decision-making and necessitate effective detection. Existing introspective detection methods primarily perform uncertainty estimation or logical verification by analyzing model responses conditioned on original or perturbed inputs. However, such external perturbations are often heuristic and context-agnostic, which overlooks the internal cross-modal dependency between generated tokens and related visual tokens during decoding. To address this issue, we propose VIHD, a Visual Intervention-based Hallucination Detection method that leverages targeted visual token masking to calibrate semantic entropy for more effective hallucination detection. VIHD locates visually dominant decoder layers via Visual Dependency Probing (VDP), executes Visual Intervention Decoding (VID) via token masking to calibrate the semantic distribution, and quantifies the resulting Calibrated Semantic Entropy (CSE) as a reliable hallucination signal. Extensive experiments on three medical VQA benchmarks with two medical MLLMs demonstrate that VIHD consistently outperforms state-of-the-art methods, underscoring the importance of fine-grained visual dependency for hallucination detection. The code will be available at https://github.com/Jiayi-Chen-AU/VIHD

Vision-language models (VLMs) are increasingly used for medical image interpretation, yet they frequently hallucinate, generating clinically plausible but factually incorrect findings that pose direct patient safety risks. We introduce HalluCXR, a benchmark evaluating six architecturally diverse VLMs across 856 stratified MIMIC-CXR chest radiographs and three query types, yielding 15,408 model evaluations. An eight-category hallucination taxonomy with clinical severity ratings and a two-layer detection pipeline are validated against 250 human annotations (auto-detection F1=0.959; LLM judge F1=0.907). We find that 61.9--82.3% of outputs contain hallucinations, with clinically dangerous errors in up to 80.2%. Three key patterns emerge: normal radiographs paradoxically attract the most severe hallucinations, common findings are systematically over-fabricated while rare findings go under-detected, and response length alone predicts hallucination risk (AUC up to 0.908). A six-model ensemble reduces fabrication by up to 84.8% at the cost of increased omission; a three-model subset retains comparable performance at half the cost. These results establish that hallucination auditing, verbosity-based risk monitoring, and ensemble-based safety layers are prerequisites for clinical deployment.

Large vision-language models (LVLMs) have achieved remarkable performance across diverse multimodal tasks, yet they continue to suffer from hallucinations, generating content that is inconsistent with the visual input. Prior work DHCP (Detecting Hallucinations by Cross-modal Attention Pattern) has explored hallucination detection from the perspective of cross-modal attention, but does not address hallucination mitigation. In this paper, we propose MHSA (Mitigating Hallucinations via Steered Attention), a lightweight framework that mitigates hallucinations by learning to correct cross-modal attention patterns in LVLMs. MHSA trains a simple three-layer MLP generator to produce corrected attention, guided by supervisory signals from the DHCP discriminator and the LVLM itself. During inference, MHSA mitigates both discriminative and generative hallucinations across various datasets and LVLMs by simply replacing the original cross-modal attention with the corrected one, without modifying any LVLM parameters. By extending cross-modal attention mechanisms from hallucination detection to hallucination mitigation, MHSA offers a novel perspective on hallucination research in LVLMs and helps enhance their reliability.

Large vision-language models (LVLMs) often hallucinate when language priors dominate weak or ambiguous visual evidence. Existing contrastive decoding methods mitigate this problem by comparing predictions from the original image with those from externally perturbed visual inputs, but such references can introduce off-manifold artifacts and require costly extra forward passes. We propose SIRA, a training-free internal contrastive decoding framework that constructs a counterfactual reference inside the same LVLM by exploiting the staged information flow of multimodal transformers. Instead of removing visual information from the input, SIRA first lets image and text tokens interact through a shared prefix, forming an aligned multimodal state that preserves prompt interpretation, decoding history, positional structure, and early visual grounding. It then forks a counterfactual branch in later transformer layers, where attention to image-token positions is masked. This branch retains the shared multimodal context but lacks continued access to fine-grained visual evidence, yielding a language-prior-dominated internal reference for token-level contrast. During decoding, SIRA suppresses tokens that remain strong without late visual access and favors predictions whose advantage depends on the full visual pathway. Experiments on POPE, CHAIR, and AMBER with Qwen2.5-VL and LLaVA-v1.5 show that SIRA consistently reduces hallucinations while preserving descriptive coverage and incurring lower overhead than two-pass contrastive decoding. SIRA requires no training, external verifier, or perturbed input, and applies to open-weight LVLMs with white-box inference access.

Hallucination remains a fundamental challenge in vision-language models (VLMs), where autoregressive generation may produce linguistically plausible yet physically inconsistent or visually ungrounded responses due to likelihood maximization under joint probabilistic modeling. We propose a stage-wise preference optimization framework for hallucination reduction through targeted multimodal data construction. Rather than directly optimizing on generic instruction-following data, our approach progressively constructs hallucination-focused preference pairs near known failure boundaries. The framework emphasizes ambiguous spatial orientation, object relationships, OCR uncertainty, and adversarial false-premise training. Hallucinated negatives are generated through minimally perturbed yet visually inconsistent alternatives, enabling Direct Preference Optimization (DPO) to better separate grounded reasoning from plausible hallucination. Experiments on open-source benchmarks and real-world multimodal evaluation scenarios demonstrate improved grounding consistency, reduced hallucination, and more informative grounded responses. Cross-model qualitative evaluation further shows that the proposed multimodal LLM DPO framework produces more visually grounded responses than several frontier proprietary VLMs, such as in ambiguous spatial reasoning and adversarial false-premise settings. The results suggest that hallucination may arise not only from limited model capacity, but also from inherent tendencies of autoregressive probabilistic generation to favor linguistically plausible continuations under weak visual grounding. Future work may explore physical consistency modeling, uncertainty-aware multimodal reasoning, and architectural alternatives beyond standard autoregressive decoding.

Large Vision-Language Models (LVLMs) have achieved remarkable performance on diverse vision-language tasks. However, LVLMs still suffer from hallucinations, generating text that contradicts the visual input. Existing research has primarily focused on mitigating object hallucinations, but often overlooks more complex relation hallucinations, particularly action relations involving interactions between objects. In this study, we empirically observe that the primary cause of action-relation hallucinations in LVLMs is the insufficient attention allocated to visual information. Thus, we propose a framework to locate action-relevant image regions and enhance the LVLM's attention to those regions. Specifically, we define the Action-Relation Sensitivity (ARS) score to identify attention heads that are most sensitive to action-relation changes, thereby localizing action-relevant image regions that contain key visual cues. Then, we propose the Relation-aware Visual Enhancement (RVE) method to enhance the LVLM's attention to these action-relevant image regions. Extensive experiments demonstrate that, compared to existing baselines, our method achieves superior performance in mitigating action-relation hallucinations with negligible additional inference cost. Furthermore, it effectively generalizes to spatial-relation hallucinations and object hallucinations.

Multimodal large language models (MLLMs) have become a key interface for visual reasoning and grounded question answering, yet they remain vulnerable to visual hallucinations, where generated responses contradict image content or mention nonexistent objects. A central challenge is that hallucination is not always caused by a simple lack of visual attention: the model may still assign substantial attention mass to image tokens while internally drifting toward an incorrect answer. In this paper, we show that the high-frequency structure of visual attention, measured by layer-wise Laplacian energy, reveals both the layer where hallucinated preferences emerge and the layer where the ground-truth answer transiently recovers. Building on this finding, we propose LaSCD (Laplacian-Spectral Contrastive Decoding), a training-free decoding strategy that selects informative layers via Laplacian energy and remaps next-token logits in closed form. Experiments on hallucination and general multimodal benchmarks show that LaSCD consistently reduces hallucination while preserving general capabilities, highlighting its potential as a faithful decoding paradigm. The code is available at https://github.com/macovaseas/LaSCD.

During MLLM decoding, attention often abnormally concentrates on irrelevant image tokens. While existing research dismisses this as invalid noise and forcibly redirects attention to compel focusing on key image information, we argue these tokens are critical carriers of visual and narrative logic, and such coercive corrections exacerbate visual-language imbalance. Adopting a "decoding-as-game" perspective, we reveal that hallucinations stem from an equilibrium imbalance between linguistic priors and visual information. We propose Adversarial Counter-Commonsense Equilibrium (ACE), a training-free framework that perturbs visual context via counter-commonsense patches. Leveraging the fact that authentic visual features remain stable under perturbation while hallucinations fluctuate, ACE implements a dynamic game decoding strategy. This approach precisely suppresses perturbation-sensitive priors while compensating for stable visual signals to restore balance. Extensive experiments demonstrate that ACE, as a plug-and-play strategy, enhances model trustworthiness with negligible inference overhead.

Large Vision-Language Models (LVLMs) have achieved remarkable progress in multimodal tasks, yet their reliability is persistently undermined by hallucinations-generating text that contradicts visual input. Recent studies often attribute these errors to inadequate visual attention. In this work, we analyze the attention mechanisms via the logit lens, uncovering a distinct anomaly we term Vocabulary Hijacking. We discover that specific visual tokens, defined as Inert Tokens, disproportionately attract attention. Crucially, when their intermediate hidden states are projected into the vocabulary space, they consistently decode to a fixed set of unrelated words (termed Hijacking Anchors) across layers, revealing a rigid semantic collapse. Leveraging this semantic rigidity, we propose Hijacking Anchor-Based Identification (HABI), a robust strategy to accurately localize these Inert Tokens. To quantify the impact of this phenomenon, we introduce the Non-Hijacked Visual Attention Ratio (NHAR), a novel metric designed to identify attention heads that remain resilient to hijacking and are critical for factual accuracy. Building on these insights, we propose Hijacking-Aware Visual Attention Enhancement (HAVAE), a training-free intervention that selectively strengthens the focus of these identified heads on salient visual content. Extensive experiments across multiple benchmarks demonstrate that HAVAE significantly mitigates hallucinations with no additional computational overhead, while preserving the model's general capabilities. Our code is publicly available at https://github.com/lab-klc/HAVAE.

Vision-language models (VLMs) achieve strong multimodal performance but remain prone to relation hallucination, which requires accurate reasoning over inter-object interactions. We study the impact of visual perturbations, specifically rotation and noise, and show that even mild distortions significantly degrade relational reasoning across models and datasets. We further evaluate prompt-based augmentation and preprocessing strategies (orientation correction and denoising), finding that while they offer partial improvements, they do not fully resolve hallucinations. Our results reveal a gap between perceptual robustness and relational understanding, highlighting the need for more robust, geometry-aware VLMs.

Vision-language models (VLMs) have shown potential for automated radiology report generation, yet existing approaches rely on global embedding compression of volumetric data, often leading to hallucinated findings and limited anatomical grounding in 3D CT imaging. We introduce MedScribe, a hypothesis-driven framework that reformulates report generation as an iterative evidence acquisition process rather than a single-pass encoding task. MedScribe models reporting as a sequential decision process in which a large language model dynamically invokes pathology-specific diagnostic tools to extract localized volumetric features. These structured features are used to query a multidimensional retrieval space aligned with pathology-specific textual evidence. By explicitly accumulating quantitative evidence prior to synthesis, the framework enforces fine-grained grounding and reduces unsupported claims. Without task-specific fine-tuning, MedScribe improves clinical accuracy, factual consistency, and interpretability on CT-RATE and RadChestCT compared to state-of-the-art 2D and 3D VLMs, demonstrating the value of hypothesis-driven reasoning for reliable medical image reporting.

Vision-Language Models (VLMs) hallucinate objects that are not present, and a growing line of work tries to curb this by feeding the model its own generated caption as auxiliary evidence -- assuming that a caption, once available, is something to consume. We show this fails: naively appending a caption can lower accuracy rather than raise it, dropping Qwen2.5-VL-3B† on HallusionBench by nearly ten points. To understand why, we build GD-Probe, a diagnostic set that pairs a global and a detail question on the same image, so that any difference in caption effect is attributable to the question alone. Caption utility proves to be a per-query property: the same caption helps global questions and harms detail ones, through a single mechanism -- an embedded caption competes with the image for attention and pulls the model's evidence onto its own text -- whose sign is set by whether the caption covers the queried content. Crucially, this regime is readable from quantities the decoder already emits, with no attention access or grounding. We turn this into GEASS (Gated Evidence-Adaptive Selective Caption Trust), a training-free, logit-level module that decides per query how much of the caption to trust, gating it by the clean path's confidence, weighting it by the entropy reduction it induces, and raising the evidence bar when the two pathways disagree. Across four VLMs and two benchmarks (POPE and HallusionBench), GEASS improves over both vanilla inference and contrastive decoding under a single fixed setting, adding only two forward passes and no parameters.

Large Vision-Language Models (VLMs) have achieved remarkable multimodal performance yet remain prone to factual hallucinations, particularly in long-tail or specialized domains. Moreover, current models exhibit a weak capacity to refuse queries that exceed their parametric knowledge. In this paper, we propose a systematic framework to enhance the refusal capability of VLMs when facing such unknown questions. We first curate a model-specific "Visual-Idk" (Visual-I don't know) dataset, leveraging multi-sample consistency probing to distinguish between known and unknown facts. We then align the model using supervised fine-tuning followed by preference-aware optimization (e.g., DPO, ORPO) to effectively delineate its knowledge boundaries. Results on the Visual-Idk dataset show our method improves the Truthful Rate from 57.9% to 67.3%. Additionally, internal probing also demonstrates that the model genuinely recognizes its boundaries instead of just memorizing refusal patterns. Our framework further generalizes to out-of-distribution medical and perceptual domains, providing a robust path toward more trustworthy and prudent visual assistants.

Large Vision-Language Models (LVLMs) have achieved remarkable progress in visual-textual understanding, yet their reliability is critically undermined by hallucinations, i.e., the generation of factually incorrect or inconsistent responses. While recent studies using steering vectors demonstrated promise in reducing hallucinations, a notable challenge remains: they inadvertently amplify the severity of residual hallucinations. We attribute this to their exclusive focus on the decoding stage, where errors accumulate autoregressively and progressively worsen subsequent hallucinatory outputs. To address this, we propose Prefill-Time Intervention (PTI), a novel steering paradigm that intervenes only once during the prefill stage, enhancing the initial Key-Value (KV) cache before error accumulation occurs. Specifically, PTI is modality-aware, deriving distinct directions for visual and textual representations. This intervention is decoupled to steer keys toward visually-grounded objects and values to filter background noise, correcting hallucination-prone representations at their source. Extensive experiments demonstrate PTI's significant performance in mitigating hallucinations and its generalizability across diverse decoding strategies, LVLMs, and benchmarks. Moreover, PTI is orthogonal to existing decoding-stage methods, enabling plug-and-play integration and further boosting performance. Code is available at: https://github.com/huaiyi66/PTI.

Generative vision-language models can produce fluent medical image captions but remain prone to hallucination, over-specific diagnostic claims, and factual inconsistency-serious issues in pathology. We investigate retrieval-guided generation (RGG) as a safer alternative, where captions are formed by summarizing expert text from visually similar cases rather than generated de novo. On the ARCH histopathology dataset, RGG improves semantic alignment with ground truth, achieving cosine similarity of $\approx$0.60 versus $\approx$0.47 from MedGemma, with non-overlapping confidence intervals indicating a robust gain. A pathologist-led qualitative review shows better preservation of morphology-relevant terminology and fewer unsupported diagnoses, while revealing failure modes such as concept mixing and inherited over-specific labeling. Overall, retrieval-guided captioning offers a more transparent and reliable approach with clearer opportunities for auditing than fully generative methods.

Large Vision-Language Models (LVLMs) frequently suffer from hallucinations. Existing preference learning-based approaches largely rely on proprietary models to construct preference datasets. We identify that this reliance introduces a distributional mismatch between the proprietary and target models that hinders efficient alignment. To address this, we propose Alignment via VErified Self-correction DPO (AVES-DPO), a framework that aligns LVLMs using in-distribution data derived from the model's intrinsic knowledge. Our approach employs a consensus-based verification mechanism to diagnose diverse hallucinations and guides the model to self-correct, thereby generating preference pairs strictly compatible with its internal distribution. Extensive experiments demonstrate that AVES-DPO surpasses existing baselines in hallucination mitigation while requiring only 5.2k samples.

Despite impressive progress in capabilities of large vision-language models (LVLMs), these systems remain vulnerable to hallucinations, i.e., outputs that are not grounded in the visual input. Prior work has attributed hallucinations in LVLMs to factors such as limitations of the vision backbone or the dominance of the language component, yet the relative importance of these factors remains unclear. To resolve this ambiguity, We propose HalluScope, a benchmark to better understand the extent to which different factors induce hallucinations. Our analysis indicates that hallucinations largely stem from excessive reliance on textual priors and background knowledge, especially information introduced through textual instructions. To mitigate hallucinations induced by textual instruction priors, we propose HalluVL-DPO, a framework for fine-tuning off-the-shelf LVLMs towards more visually grounded responses. HalluVL-DPO leverages preference optimization using a curated training dataset that we construct, guiding the model to prefer grounded responses over hallucinated ones. We demonstrate that our optimized model effectively mitigates the targeted hallucination failure mode, while preserving or improving performance on other hallucination benchmarks and visual capability evaluations. To support reproducibility and further research, we will publicly release our evaluation benchmark, preference training dataset, and code at https://pegah-kh.github.io/projects/prompts-override-vision/ .

Point-Vision-Language Models promise to empower embodied agents with executable spatial reasoning, yet they frequently succumb to geometric hallucination where predicted 3D structures contradict the observed 2D reality. We identify a key cause of this failure not as a representation bottleneck but as a structural misalignment in reinforcement learning, where sparse geometric tokens are drowned out by noisy and broadcasted sequence-level rewards. To resolve this causal dilution, we propose Geometric Reward Credit Assignment, a framework that disentangles holistic supervision into field-specific signals and routes them exclusively to their responsible token spans. This mechanism transforms vague feedback into precise gradient updates and effectively turns generic policy optimization into targeted structural alignment. Furthermore, we internalize physical constraints via a Reprojection-Consistency term which serves as a cross-modal verifier to penalize physically impossible geometries. Validated on a calibrated benchmark derived from ShapeNetCore, our approach bridges the reliability gap by boosting 3D KPA from 0.64 to 0.93, increasing 3D bounding box intersection over union to 0.686, and raising reprojection consistency scores to 0.852. Crucially, these gains are achieved while maintaining robust 2D localization performance, marking a meaningful step from plausible textual outputs toward physically verifiable spatial predictions.

Large Vision-Language Models (LVLMs) exhibit powerful generative capabilities but frequently produce hallucinations that compromise output reliability. Fine-tuning on annotated data devoid of hallucinations offers the most direct solution, while its high computational cost motivates recent representation-based methods, which focus on mitigating hallucinatory components within hidden representations. Though efficient, we empirically observe that these methods degrade general generation capacity due to incomplete extraction of hallucination components and non-selective parameter updates. To address these limitations, we propose MPD, a dual-stage framework for mitigating hallucinations without performance degradation. Specifically, our MPD relies on two essential factors: (1) semantic-aware component disentanglement to extract pure hallucination components, and (2) interpretable parameter updates that selectively modify parameters most relevant to hallucination. Extensive experiments demonstrate that MPD achieves state-of-the-art performance, reducing hallucinations by 23.4% while maintaining 97.4% of general generative capability as evaluated on LLaVA-Bench and MME, with no additional computational cost.

Vision-Language Models (VLMs) are increasingly deployed in settings where reliable visual grounding carries operational consequences, yet their behavior under progressively coercive prompt phrasing remains undercharacterized. Existing hallucination benchmarks predominantly rely on neutral prompts and binary detection, leaving open how both the incidence and the intensity of fabrication respond to graded linguistic pressure across structurally distinct task types. We present Ghost-100, a procedurally constructed benchmark of 800 synthetically generated images spanning eight categories across three task families: text-illegibility, time-reading, and object-absence, each designed under a negative-ground-truth principle that guarantees the queried target is absent, illegible, or indeterminate by construction. Every image is paired with five prompts drawn from a structured 5-Level Prompt Intensity Framework, holding the image and task identity fixed while varying only directive force, so that tone is isolated as the sole independent variable. We adopt a dual-track evaluation protocol: a rule-based H-Rate measuring the proportion of responses in which a model crosses from grounded refusal into unsupported positive commitment, and a GPT-4o-mini-judged H-Score on a 1-5 scale characterizing the confidence and specificity of fabrication once it occurs. We additionally release a three-stage automated validation workflow, which retrospectively confirms 717 of 800 images as strictly compliant. Evaluating nine open-weight VLMs, we find that H-Rate and H-Score dissociate substantially across model families, reading-style and presence-detection subsets respond to prompt pressure in qualitatively different ways, and several models exhibit non-monotonic sensitivity peaking at intermediate tone levels: patterns that aggregate metrics obscure.

Large Vision-Language Models (LVLMs) still struggle with vision hallucination, where generated responses are inconsistent with the visual input. Existing methods either rely on large-scale annotated data for fine-tuning, which incurs massive computational overhead, or employ static post-hoc strategies that overlook the dynamic nature of hallucination emergence. To address these, we introduce a new self-rewarding framework, enabling dynamic hallucination mitigation at inference time without external supervision. On the empirical side, we reveal that visual hallucination exhibits phase-wise dynamic patterns, peaking at the onset of each semantic phase. Drawing on these insights, we propose \textbf{PSRD} (\textbf{Phase-wise \textbf{S}elf-\textbf{R}eward \textbf{D}ecoding) for online hallucination correction guided by phase-wise self-reward signals. To reduce the cost of repeated self-evaluation during decoding, we distill the hallucination guidance signal from LVLMs into a lightweight reward model. The reward model subsequently provides on-the-fly guidance for targeted intervention during the decoding process, enabling precise hallucination suppression. The proposed PSRD significantly reduces the hallucination rate of LLaVA-1.5-7B by 50.0% and consistently outperforms existing post-hoc methods across five hallucination evaluation benchmarks for four LVLMs. Further analysis confirms that PSRD effectively mitigates hallucination propagation and achieves a highly controllable trade-off between strong performance and inference efficiency.

Recent advances in Vision-Language Models (VLMs) have substantially enhanced their ability across multimodal video understanding benchmarks spanning temporal, action, object, and spatial understanding. However, we identify a critical yet overlooked issue: when embedded on-screen text contradicts the visual scene, existing VLMs systematically hallucinate, prioritizing overlay textual semantics over the actual visual content. We define this phenomenon as Text Overlay-Induced Hallucination (TOIH). In this work, we propose VisualTextTrap, the first comprehensive benchmark, including large-scale human-validated samples with specifically designed evaluation metrics. In particular, we construct VisualTextTrap from widely-used public datasets using a scalable hybrid pipeline of VLMs assisted text generation and rigorous manual verification. The benchmark features 6,057 samples annotated across 88 fine-grained attributes within four dimensions, with hallucination intensity quantified on a five-level scale (L1--L5) that reflects the semantic contradiction between overlay text and visual reality. Moreover, we propose Visual Text Hallucination Mitigation Mixture-of-Experts (VTHM-MoE), a novel Vision-Text Disentanglement framework that employs a dual-encoder architecture. Concretely, four dimension-specialized expert modules spanning Temporal, Action, Object, and Spatial reasoning are first pre-trained to identify and leverage cross-modal discrepancies between textual semantics and actual video content. We develop an Adaptive Token Routing Strategy to enable dynamic expert allocation, conferring robust resistance to TOIH while preserving performance on uncontaminated videos. Extensive experiments conducted on our VisualTextTrap benchmark verify the effectiveness of VTHM-MoE, outperforming state-of-the-art counterparts with diverse video question answering tasks.

Vision-Language Models (VLMs) have made significant strides in static image understanding but continue to face critical hurdles in spatiotemporal reasoning. A major bottleneck is "multi-image reasoning hallucination", where a large performance drop between forward and reverse temporal queries reveals a dependence on superficial shortcuts instead of state-based understanding. To mitigate this, we first develop a new Chain-of-Thought (CoT) dataset that decomposes intricate reasoning into detailed spatiotemporal steps and definitive judgments. Building on this, we present a progressive training framework: it initiates with supervised pre-training on our CoT dataset to instill logical structures, followed by fine-tuning with scalable weakly-labeled data for broader generalization. Our experiments demonstrate that this approach not only improves backbone accuracy but also reduces the forward-backward performance gap from over 70% to only 6.53%. This shows that the method strengthens dynamic reasoning and reduces the inherent temporal biases of current VLMs.

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.

Large vision-language models (LVLMs) are increasingly being applied to multi-view image inputs captured from diverse viewpoints. Despite this growing use, current LVLMs often generate incorrect responses due to visual interference from non-target instances or viewpoints, a phenomenon we term multi-view hallucination (MVH). To systematically analyze this problem, we construct MVH-Bench, a benchmark comprising 4.8k question-answer pairs targeting two types of hallucination: cross-instance and cross-view. Empirical results show that MVH is prevalent across recent LVLMs. To address this issue, we propose Reference Shift Contrastive Decoding (RSCD), a training-free decoding technique that suppresses visual interference by generating negative logits through attention masking. Experiments on MVH-Bench with LLaVA-OneVision and Qwen2.5-VL demonstrate that RSCD improves performance by up to 25.7 and 94.8 points over existing hallucination mitigation methods, highlighting the effectiveness of RSCD.

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.

Large Vision-Language Models (LVLMs) recently achieve significant breakthroughs in understanding complex visual-textual contexts. However, hallucination issues still limit their real-world applicability. Although previous mitigation methods effectively reduce hallucinations in photographic images, they largely overlook the potential risks posed by stylized images, which play crucial roles in critical scenarios such as game scene understanding, art education, and medical analysis. In this work, we first construct a dataset comprising photographic images and their corresponding stylized versions with carefully annotated caption labels. We then conduct head-to-head comparisons on both discriminative and generative tasks by benchmarking 13 advanced LVLMs on the collected datasets. Our findings reveal that stylized images tend to induce significantly more hallucinations than their photographic counterparts. To address this issue, we propose Style-Aware Visual Early Revision SAVER, a novel mechanism that dynamically adjusts LVLMs' final outputs based on the token-level visual attention patterns, leveraging early-layer feedback to mitigate hallucinations caused by stylized images. Extensive experiments demonstrate that SAVER achieves state-of-the-art performance in hallucination mitigation across various models, datasets, and tasks.