CVSep 12, 2024Code
Lagrange Duality and Compound Multi-Attention Transformer for Semi-Supervised Medical Image SegmentationFuchen Zheng, Quanjun Li, Weixuan Li et al.
Medical image segmentation, a critical application of semantic segmentation in healthcare, has seen significant advancements through specialized computer vision techniques. While deep learning-based medical image segmentation is essential for assisting in medical diagnosis, the lack of diverse training data causes the long-tail problem. Moreover, most previous hybrid CNN-ViT architectures have limited ability to combine various attentions in different layers of the Convolutional Neural Network. To address these issues, we propose a Lagrange Duality Consistency (LDC) Loss, integrated with Boundary-Aware Contrastive Loss, as the overall training objective for semi-supervised learning to mitigate the long-tail problem. Additionally, we introduce CMAformer, a novel network that synergizes the strengths of ResUNet and Transformer. The cross-attention block in CMAformer effectively integrates spatial attention and channel attention for multi-scale feature fusion. Overall, our results indicate that CMAformer, combined with the feature fusion framework and the new consistency loss, demonstrates strong complementarity in semi-supervised learning ensembles. We achieve state-of-the-art results on multiple public medical image datasets. Example code are available at: \url{https://github.com/lzeeorno/Lagrange-Duality-and-CMAformer}.
CVSep 12, 2024Code
AFFSegNet: Adaptive Feature Fusion Segmentation Network for Microtumors and Multi-Organ SegmentationFuchen Zheng, Xinyi Chen, Xuhang Chen et al.
Medical image segmentation, a crucial task in computer vision, facilitates the automated delineation of anatomical structures and pathologies, supporting clinicians in diagnosis, treatment planning, and disease monitoring. Notably, transformers employing shifted window-based self-attention have demonstrated exceptional performance. However, their reliance on local window attention limits the fusion of local and global contextual information, crucial for segmenting microtumors and miniature organs. To address this limitation, we propose the Adaptive Semantic Segmentation Network (ASSNet), a transformer architecture that effectively integrates local and global features for precise medical image segmentation. ASSNet comprises a transformer-based U-shaped encoder-decoder network. The encoder utilizes shifted window self-attention across five resolutions to extract multi-scale features, which are then propagated to the decoder through skip connections. We introduce an augmented multi-layer perceptron within the encoder to explicitly model long-range dependencies during feature extraction. Recognizing the constraints of conventional symmetrical encoder-decoder designs, we propose an Adaptive Feature Fusion (AFF) decoder to complement our encoder. This decoder incorporates three key components: the Long Range Dependencies (LRD) block, the Multi-Scale Feature Fusion (MFF) block, and the Adaptive Semantic Center (ASC) block. These components synergistically facilitate the effective fusion of multi-scale features extracted by the decoder while capturing long-range dependencies and refining object boundaries. Comprehensive experiments on diverse medical image segmentation tasks, including multi-organ, liver tumor, and bladder tumor segmentation, demonstrate that ASSNet achieves state-of-the-art results. Code and models are available at: \url{https://github.com/lzeeorno/ASSNet}.
CVDec 3, 2025Code
HBFormer: A Hybrid-Bridge Transformer for Microtumor and Miniature Organ SegmentationFuchen Zheng, Xinyi Chen, Weixuan Li et al.
Medical image segmentation is a cornerstone of modern clinical diagnostics. While Vision Transformers that leverage shifted window-based self-attention have established new benchmarks in this field, they are often hampered by a critical limitation: their localized attention mechanism struggles to effectively fuse local details with global context. This deficiency is particularly detrimental to challenging tasks such as the segmentation of microtumors and miniature organs, where both fine-grained boundary definition and broad contextual understanding are paramount. To address this gap, we propose HBFormer, a novel Hybrid-Bridge Transformer architecture. The 'Hybrid' design of HBFormer synergizes a classic U-shaped encoder-decoder framework with a powerful Swin Transformer backbone for robust hierarchical feature extraction. The core innovation lies in its 'Bridge' mechanism, a sophisticated nexus for multi-scale feature integration. This bridge is architecturally embodied by our novel Multi-Scale Feature Fusion (MFF) decoder. Departing from conventional symmetric designs, the MFF decoder is engineered to fuse multi-scale features from the encoder with global contextual information. It achieves this through a synergistic combination of channel and spatial attention modules, which are constructed from a series of dilated and depth-wise convolutions. These components work in concert to create a powerful feature bridge that explicitly captures long-range dependencies and refines object boundaries with exceptional precision. Comprehensive experiments on challenging medical image segmentation datasets, including multi-organ, liver tumor, and bladder tumor benchmarks, demonstrate that HBFormer achieves state-of-the-art results, showcasing its outstanding capabilities in microtumor and miniature organ segmentation. Code and models are available at: https://github.com/lzeeorno/HBFormer.
CVNov 10, 2025Code
Adaptive Morph-Patch Transformer for Aortic Vessel SegmentationZhenxi Zhang, Fuchen Zheng, Adnan Iltaf et al.
Accurate segmentation of aortic vascular structures is critical for diagnosing and treating cardiovascular diseases.Traditional Transformer-based models have shown promise in this domain by capturing long-range dependencies between vascular features. However, their reliance on fixed-size rectangular patches often influences the integrity of complex vascular structures, leading to suboptimal segmentation accuracy. To address this challenge, we propose the adaptive Morph Patch Transformer (MPT), a novel architecture specifically designed for aortic vascular segmentation. Specifically, MPT introduces an adaptive patch partitioning strategy that dynamically generates morphology-aware patches aligned with complex vascular structures. This strategy can preserve semantic integrity of complex vascular structures within individual patches. Moreover, a Semantic Clustering Attention (SCA) method is proposed to dynamically aggregate features from various patches with similar semantic characteristics. This method enhances the model's capability to segment vessels of varying sizes, preserving the integrity of vascular structures. Extensive experiments on three open-source dataset(AVT, AortaSeg24 and TBAD) demonstrate that MPT achieves state-of-the-art performance, with improvements in segmenting intricate vascular structures.
CVMay 6, 2025Code
ReGraP-LLaVA: Reasoning enabled Graph-based Personalized Large Language and Vision AssistantYifan Xiang, Zhenxi Zhang, Bin Li et al.
Recent advances in personalized MLLMs enable effective capture of user-specific concepts, supporting both recognition of personalized concepts and contextual captioning. However, humans typically explore and reason over relations among objects and individuals, transcending surface-level information to achieve more personalized and contextual understanding. To this end, existing methods may face three main limitations: Their training data lacks multi-object sets in which relations among objects are learnable. Building on the limited training data, their models overlook the relations between different personalized concepts and fail to reason over them. Their experiments mainly focus on a single personalized concept, where evaluations are limited to recognition and captioning tasks. To address the limitations, we present a new dataset named ReGraP, consisting of 120 sets of personalized knowledge. Each set includes images, KGs, and CoT QA pairs derived from the KGs, enabling more structured and sophisticated reasoning pathways. We propose ReGraP-LLaVA, an MLLM trained with the corresponding KGs and CoT QA pairs, where soft and hard graph prompting methods are designed to align KGs within the model's semantic space. We establish the ReGraP Benchmark, which contains diverse task types: multiple-choice, fill-in-the-blank, True/False, and descriptive questions in both open- and closed-ended settings. The proposed benchmark is designed to evaluate the relational reasoning and knowledge-connection capability of personalized MLLMs. We conduct experiments on the proposed ReGraP-LLaVA and other competitive MLLMs. Results show that the proposed model not only learns personalized knowledge but also performs relational reasoning in responses, achieving the SoTA performance compared with the competitive methods. All the codes and datasets are released at: https://github.com/xyfyyds/ReGraP.
CVApr 22, 2025Code
Ask2Loc: Learning to Locate Instructional Visual Answers by Asking QuestionsChang Zong, Bin Li, Shoujun Zhou et al.
Locating specific segments within an instructional video is an efficient way to acquire guiding knowledge. Generally, the task of obtaining video segments for both verbal explanations and visual demonstrations is known as visual answer localization (VAL). However, users often need multiple interactions to obtain answers that align with their expectations when using the system. During these interactions, humans deepen their understanding of the video content by asking themselves questions, thereby accurately identifying the location. Therefore, we propose a new task, named In-VAL, to simulate the multiple interactions between humans and videos in the procedure of obtaining visual answers. The In-VAL task requires interactively addressing several semantic gap issues, including 1) the ambiguity of user intent in the input questions, 2) the incompleteness of language in video subtitles, and 3) the fragmentation of content in video segments. To address these issues, we propose Ask2Loc, a framework for resolving In-VAL by asking questions. It includes three key modules: 1) a chatting module to refine initial questions and uncover clear intentions, 2) a rewriting module to generate fluent language and create complete descriptions, and 3) a searching module to broaden local context and provide integrated content. We conduct extensive experiments on three reconstructed In-VAL datasets. Compared to traditional end-to-end and two-stage methods, our proposed Ask2Loc can improve performance by up to 14.91 (mIoU) on the In-VAL task. Our code and datasets can be accessed at https://github.com/changzong/Ask2Loc.
IVFeb 25, 2025Code
VesselSAM: Leveraging SAM for Aortic Vessel Segmentation with AtrousLoRAAdnan Iltaf, Rayan Merghani Ahmed, Zhenxi Zhang et al.
Medical image segmentation is crucial for clinical diagnosis and treatment planning, especially when dealing with complex anatomical structures such as vessels. However, accurately segmenting vessels remains challenging due to their small size, intricate edge structures, and susceptibility to artifacts and imaging noise. In this work, we propose VesselSAM, an enhanced version of the Segment Anything Model (SAM), specifically tailored for aortic vessel segmentation. VesselSAM incorporates AtrousLoRA, a novel module integrating Atrous Attention and Low-Rank Adaptation (LoRA), to enhance segmentation performance. Atrous Attention enables the model to capture multi-scale contextual information, preserving both fine-grained local details and broader global context. Additionally, LoRA facilitates efficient fine-tuning of the frozen SAM image encoder, reducing the number of trainable parameters and thereby enhancing computational efficiency. We evaluate VesselSAM using two challenging datasets: the Aortic Vessel Tree (AVT) dataset and the Type-B Aortic Dissection (TBAD) dataset. VesselSAM achieves state-of-the-art performance, attaining DSC scores of 93.50\%, 93.25\%, 93.02\%, and 93.26\% across multi-center datasets. Our results demonstrate that VesselSAM delivers high segmentation accuracy while significantly reducing computational overhead compared to existing large-scale models. This development paves the way for enhanced AI-based aortic vessel segmentation in clinical environments. The code and models will be released at https://github.com/Adnan-CAS/AtrousLora.
CVApr 7, 2025Code
MSA-UNet3+: Multi-Scale Attention UNet3+ with New Supervised Prototypical Contrastive Loss for Coronary DSA Image SegmentationRayan Merghani Ahmed, Adnan Iltaf, Mohamed Elmanna et al.
Accurate segmentation of coronary Digital Subtraction Angiography images is essential to diagnose and treat coronary artery diseases. Despite advances in deep learning, challenges such as high intra-class variance and class imbalance limit precise vessel delineation. Most existing approaches for coronary DSA segmentation cannot address these issues. Also, existing segmentation network's encoders do not directly generate semantic embeddings, which could enable the decoder to reconstruct segmentation masks effectively from these well-defined features. We propose a Supervised Prototypical Contrastive Loss that fuses supervised and prototypical contrastive learning to enhance coronary DSA image segmentation. The supervised contrastive loss enforces semantic embeddings in the encoder, improving feature differentiation. The prototypical contrastive loss allows the model to focus on the foreground class while alleviating the high intra-class variance and class imbalance problems by concentrating only on the hard-to-classify background samples. We implement the proposed SPCL loss within an MSA-UNet3+: a Multi-Scale Attention-Enhanced UNet3+ architecture. The architecture integrates key components: a Multi-Scale Attention Encoder and a Multi-Scale Dilated Bottleneck designed to enhance multi-scale feature extraction and a Contextual Attention Fusion Module built to keep fine-grained details while improving contextual understanding. Experiments on a private coronary DSA dataset show that MSA-UNet3+ outperforms state-of-the-art methods, achieving the highest Dice coefficient and F1-score and significantly reducing ASD and ACD. The developed framework provides clinicians with precise vessel segmentation, enabling accurate identification of coronary stenosis and supporting informed diagnostic and therapeutic decisions. The code will be released at https://github.com/rayanmerghani/MSA-UNet3plus.
CLMar 5, 2025Code
Small but Mighty: Enhancing Time Series Forecasting with Lightweight LLMsHaoran Fan, Bin Li, Yixuan Weng et al.
While LLMs have demonstrated remarkable potential in time series forecasting, their practical deployment remains constrained by excessive computational demands and memory footprints. Existing LLM-based approaches typically suffer from three critical limitations: Inefficient parameter utilization in handling numerical time series patterns; Modality misalignment between continuous temporal signals and discrete text embeddings; and Inflexibility for real-time expert knowledge integration. We present SMETimes, the first systematic investigation of sub-3B parameter SLMs for efficient and accurate time series forecasting. Our approach centers on three key innovations: A statistically-enhanced prompting mechanism that bridges numerical time series with textual semantics through descriptive statistical features; A adaptive fusion embedding architecture that aligns temporal patterns with language model token spaces through learnable parameters; And a dynamic mixture-of-experts framework enabled by SLMs' computational efficiency, adaptively combining base predictions with domain-specific models. Extensive evaluations across seven benchmark datasets demonstrate that our 3B-parameter SLM achieves state-of-the-art performance on five primary datasets while maintaining 3.8x faster training and 5.2x lower memory consumption compared to 7B-parameter LLM baselines. Notably, the proposed model exhibits better learning capabilities, achieving 12.3% lower MSE than conventional LLM. Ablation studies validate that our statistical prompting and cross-modal fusion modules respectively contribute 15.7% and 18.2% error reduction in long-horizon forecasting tasks. By redefining the efficiency-accuracy trade-off landscape, this work establishes SLMs as viable alternatives to resource-intensive LLMs for practical time series forecasting. Code and models are available at https://github.com/xiyan1234567/SMETimes.
CVFeb 9, 2025Code
ClinKD: Cross-Modal Clinical Knowledge Distiller For Multi-Task Medical ImagesHongyu Ge, Longkun Hao, Zihui Xu et al.
Medical Visual Question Answering (Med-VQA) represents a critical and challenging subtask within the general VQA domain. Despite significant advancements in general VQA, multimodal large language models (MLLMs) still exhibit substantial limitations when handling multi-task VQA scenarios. These limitations manifest through erroneous spatial localization and misinterpretation of medical images, which primarily arise from two fundamental issues: inadequate image-text alignment and insufficient domain-specified knowledge for medical applications. To address these issues, we introduce the Cross-Modal Clinical Knowledge Distiller (ClinKD), an innovative framework designed to enhance image-text alignment and establish more effective medical knowledge transformation mechanisms, which enables MLLMs to perform better even when lacking prior medical knowledge. Our extensive experimental evaluations demonstrate that the ClinKD achieves state-of-the-art performance on several datasets which are challenging for Med-VQA task. The results indicate that our approach not only significantly improves image-text alignment but also effectively enables MLLMs to adapt to the medical knowledge. The source code for ClinKD is available at: https://github.com/overloadedHenry/ClinKD.
IVAug 28, 2024
SpineMamba: Enhancing 3D Spinal Segmentation in Clinical Imaging through Residual Visual Mamba Layers and Shape PriorsZhiqing Zhang, Tianyong Liu, Guojia Fan et al.
Accurate segmentation of 3D clinical medical images is critical in the diagnosis and treatment of spinal diseases. However, the inherent complexity of spinal anatomy and uncertainty inherent in current imaging technologies, poses significant challenges for semantic segmentation of spinal images. Although convolutional neural networks (CNNs) and Transformer-based models have made some progress in spinal segmentation, their limitations in handling long-range dependencies hinder further improvements in segmentation accuracy.To address these challenges, we introduce a residual visual Mamba layer to effectively capture and model the deep semantic features and long-range spatial dependencies of 3D spinal data. To further enhance the structural semantic understanding of the vertebrae, we also propose a novel spinal shape prior module that captures specific anatomical information of the spine from medical images, significantly enhancing the model's ability to extract structural semantic information of the vertebrae. Comparative and ablation experiments on two datasets demonstrate that SpineMamba outperforms existing state-of-the-art models. On the CT dataset, the average Dice similarity coefficient for segmentation reaches as high as 94.40, while on the MR dataset, it reaches 86.95. Notably, compared to the renowned nnU-Net, SpineMamba achieves superior segmentation performance, exceeding it by up to 2 percentage points. This underscores its accuracy, robustness, and excellent generalization capabilities.
IVSep 12, 2023
Introducing Shape Prior Module in Diffusion Model for Medical Image SegmentationZhiqing Zhang, Guojia Fan, Tianyong Liu et al.
Medical image segmentation is critical for diagnosing and treating spinal disorders. However, the presence of high noise, ambiguity, and uncertainty makes this task highly challenging. Factors such as unclear anatomical boundaries, inter-class similarities, and irrational annotations contribute to this challenge. Achieving both accurate and diverse segmentation templates is essential to support radiologists in clinical practice. In recent years, denoising diffusion probabilistic modeling (DDPM) has emerged as a prominent research topic in computer vision. It has demonstrated effectiveness in various vision tasks, including image deblurring, super-resolution, anomaly detection, and even semantic representation generation at the pixel level. Despite the robustness of existing diffusion models in visual generation tasks, they still struggle with discrete masks and their various effects. To address the need for accurate and diverse spine medical image segmentation templates, we propose an end-to-end framework called VerseDiff-UNet, which leverages the denoising diffusion probabilistic model (DDPM). Our approach integrates the diffusion model into a standard U-shaped architecture. At each step, we combine the noise-added image with the labeled mask to guide the diffusion direction accurately towards the target region. Furthermore, to capture specific anatomical a priori information in medical images, we incorporate a shape a priori module. This module efficiently extracts structural semantic information from the input spine images. We evaluate our method on a single dataset of spine images acquired through X-ray imaging. Our results demonstrate that VerseDiff-UNet significantly outperforms other state-of-the-art methods in terms of accuracy while preserving the natural features and variations of anatomy.
AINov 30, 2025
Med-CRAFT: Automated Construction of Interpretable and Multi-Hop Video Workloads via Knowledge Graph TraversalShenxi Liu, Kan Li, Mingyang Zhao et al.
The scarcity of high-quality, logically annotated video datasets remains a primary bottleneck in advancing Multi-Modal Large Language Models (MLLMs) for the medical domain. Traditional manual annotation is prohibitively expensive and non-scalable, while existing synthetic methods often suffer from stochastic hallucinations and a lack of logical interpretability. To address these challenges, we introduce \textbf{\PipelineName}, a novel neuro-symbolic data engineering framework that formalizes benchmark synthesis as a deterministic graph traversal process. Unlike black-box generative approaches, Med-CRAFT extracts structured visual primitives (e.g., surgical instruments, anatomical boundaries) from raw video streams and instantiates them into a dynamic Spatiotemporal Knowledge Graph. By anchoring query generation to valid paths within this graph, we enforce a rigorous Chain-of-Thought (CoT) provenance for every synthesized benchmark item. We instantiate this pipeline to produce M3-Med-Auto, a large-scale medical video reasoning benchmark exhibiting fine-grained temporal selectivity and multi-hop logical complexity. Comprehensive evaluations demonstrate that our automated pipeline generates query workloads with complexity comparable to expert-curated datasets. Furthermore, a logic alignment analysis reveals a high correlation between the prescribed graph topology and the reasoning steps of state-of-the-art MLLMs, validating the system's capability to encode verifiable logic into visual-linguistic benchmarks. This work paves the way for scalable, low-cost construction of robust evaluation protocols in critical domains.
25.2CVApr 28
TopoMamba: Topology-Aware Scanning and Fusion for Segmenting Heterogeneous Medical Visual MediaFuchen Zheng, Chengpei Xu, Long Ma et al.
Visual state-space models (SSMs) have shown strong potential for medical image segmentation, yet their effectiveness is often limited by two practical issues: axis-biased scan ordering weakens the modeling of oblique and curved structures, and naive multi-branch fusion tends to amplify redundant responses. We present TopoMamba, a topology-aware scan-and-fuse framework for segmenting heterogeneous medical visual media. The method combines a diagonal/anti-diagonal TopoA-Scan branch with the standard Cross-Scan branch to provide complementary structural priors, and introduces ScanCache, a device-aware caching mechanism that amortizes explicit scan-index construction across recurring resolutions. To fuse heterogeneous scan features efficiently, we further propose a lightweight HSIC Gate that regulates branch interaction using a dependence-aware scalar gating rule. We also instantiate a volumetric TopoMamba-3D for practical 3D clinical segmentation. Experiments on Synapse CT, ISIC 2017 dermoscopy, and CVC-ClinicDB endoscopy show that TopoMamba consistently improves segmentation quality over strong CNN, Transformer, and SSM baselines, with particularly clear gains on thin or curved targets such as the pancreas and gallbladder, while maintaining favorable deployment efficiency under dynamic input resolutions. These results suggest that topology-aware scan ordering and lightweight dependence-aware fusion form an effective and practical design for medical multimedia segmentation. The code will be made publicly available.
CVMay 11, 2025
Overview of the NLPCC 2025 Shared Task 4: Multi-modal, Multilingual, and Multi-hop Medical Instructional Video Question Answering ChallengeBin Li, Shenxi Liu, Yixuan Weng et al.
Following the successful hosts of the 1-st (NLPCC 2023 Foshan) CMIVQA and the 2-rd (NLPCC 2024 Hangzhou) MMIVQA challenges, this year, a new task has been introduced to further advance research in multi-modal, multilingual, and multi-hop medical instructional question answering (M4IVQA) systems, with a specific focus on medical instructional videos. The M4IVQA challenge focuses on evaluating models that integrate information from medical instructional videos, understand multiple languages, and answer multi-hop questions requiring reasoning over various modalities. This task consists of three tracks: multi-modal, multilingual, and multi-hop Temporal Answer Grounding in Single Video (M4TAGSV), multi-modal, multilingual, and multi-hop Video Corpus Retrieval (M4VCR) and multi-modal, multilingual, and multi-hop Temporal Answer Grounding in Video Corpus (M4TAGVC). Participants in M4IVQA are expected to develop algorithms capable of processing both video and text data, understanding multilingual queries, and providing relevant answers to multi-hop medical questions. We believe the newly introduced M4IVQA challenge will drive innovations in multimodal reasoning systems for healthcare scenarios, ultimately contributing to smarter emergency response systems and more effective medical education platforms in multilingual communities. Our official website is https://cmivqa.github.io/
CVJul 6, 2025
M$^3$-Med: A Benchmark for Multi-lingual, Multi-modal, and Multi-hop Reasoning in Medical Instructional Video UnderstandingShenxi Liu, Kan Li, Mingyang Zhao et al.
With the rapid progress of artificial intelligence (AI) in multi-modal understanding, there is increasing potential for video comprehension technologies to support professional domains such as medical education. However, existing benchmarks suffer from two primary limitations: (1) Linguistic Singularity: they are largely confined to English, neglecting the need for multilingual resources; and (2) Shallow Reasoning: their questions are often designed for surface-level information retrieval, failing to properly assess deep multi-modal integration. To address these limitations, we present M3-Med, the first benchmark for Multi-lingual, Multi-modal, and Multi-hop reasoning in Medical instructional video understanding. M3-Med consists of medical questions paired with corresponding video segments, annotated by a team of medical experts. A key innovation of M3-Med is its multi-hop reasoning task, which requires a model to first locate a key entity in the text, then find corresponding visual evidence in the video, and finally synthesize information across both modalities to derive the answer. This design moves beyond simple text matching and poses a substantial challenge to a model's deep cross-modal understanding capabilities. We define two tasks: Temporal Answer Grounding in Single Video (TAGSV) and Temporal Answer Grounding in Video Corpus (TAGVC). We evaluated several state-of-the-art models and Large Language Models (LLMs) on M3-Med. The results reveal a significant performance gap between all models and human experts, especially on the complex multi-hop questions where model performance drops sharply. M3-Med effectively highlights the current limitations of AI models in deep cross-modal reasoning within specialized domains and provides a new direction for future research.
CVApr 4, 2025
Hierarchical Modeling for Medical Visual Question Answering with Cross-Attention FusionJunkai Zhang, Bin Li, Shoujun Zhou et al.
Medical Visual Question Answering (Med-VQA) answers clinical questions using medical images, aiding diagnosis. Designing the MedVQA system holds profound importance in assisting clinical diagnosis and enhancing diagnostic accuracy. Building upon this foundation, Hierarchical Medical VQA extends Medical VQA by organizing medical questions into a hierarchical structure and making level-specific predictions to handle fine-grained distinctions. Recently, many studies have proposed hierarchical MedVQA tasks and established datasets, However, several issues still remain: (1) imperfect hierarchical modeling leads to poor differentiation between question levels causing semantic fragmentation across hierarchies. (2) Excessive reliance on implicit learning in Transformer-based cross-modal self-attention fusion methods, which obscures crucial local semantic correlations in medical scenarios. To address these issues, this study proposes a HiCA-VQA method, including two modules: Hierarchical Prompting for fine-grained medical questions and Hierarchical Answer Decoders. The hierarchical prompting module pre-aligns hierarchical text prompts with image features to guide the model in focusing on specific image regions according to question types, while the hierarchical decoder performs separate predictions for questions at different levels to improve accuracy across granularities. The framework also incorporates a cross-attention fusion module where images serve as queries and text as key-value pairs. Experiments on the Rad-Restruct benchmark demonstrate that the HiCA-VQA framework better outperforms existing state-of-the-art methods in answering hierarchical fine-grained questions. This study provides an effective pathway for hierarchical visual question answering systems, advancing medical image understanding.