Zhongzhen Huang

Zhongzhen Huang, Xiaofan Zhang, Shaoting Zhang

Radiology report generation aims to automatically generate a clinically accurate and coherent paragraph from the X-ray image, which could relieve radiologists from the heavy burden of report writing. Although various image caption methods have shown remarkable performance in the natural image field, generating accurate reports for medical images requires knowledge of multiple modalities, including vision, language, and medical terminology. We propose a Knowledge-injected U-Transformer (KiUT) to learn multi-level visual representation and adaptively distill the information with contextual and clinical knowledge for word prediction. In detail, a U-connection schema between the encoder and decoder is designed to model interactions between different modalities. And a symptom graph and an injected knowledge distiller are developed to assist the report generation. Experimentally, we outperform state-of-the-art methods on two widely used benchmark datasets: IU-Xray and MIMIC-CXR. Further experimental results prove the advantages of our architecture and the complementary benefits of the injected knowledge.

Linjie Mu, Yannian Gu, Zhongzhen Huang et al.

Large language models with reasoning capabilities have demonstrated impressive performance across a wide range of domains. In clinical applications, a transparent, step-by-step reasoning process provides physicians with strong evidence to support decision-making. While reinforcement learning has effectively enhanced reasoning performance in medical contexts, the clinical reliability of these reasoning processes remains limited because their accuracy and validity are often overlooked during training. To address this gap, we propose MedCEG, a framework that augments medical language models with clinically valid reasoning pathways by explicitly supervising the reasoning process through a Critical Evidence Graph (CEG). We curate a dataset of challenging clinical cases and algorithmically construct a CEG for each sample to represent a high-quality verifiable reasoning pathway. To guide the reasoning process, we introduce a Clinical Reasoning Procedure Reward, which evaluates Node Coverage, Structural Correctness, and Chain Completeness, thereby providing a holistic assessment of reasoning quality. Experimental results show that MedCEG surpasses existing methods in performance while producing clinically valid reasoning chains, representing a solid advancement in reliable medical AI reasoning. The code and models are available at https://github.com/LinjieMu/MedCEG.

Yakun Zhu, Yutong Huang, Shengqian Qin et al.

Medical calculators are fundamental to quantitative, evidence-based clinical practice. However, their real-world use is an adaptive, multi-stage process, requiring proactive EHR data acquisition, scenario-dependent calculator selection, and multi-step computation, whereas current benchmarks focus only on static single-step calculations with explicit instructions. To address these limitations, we introduce MedMCP-Calc, the first benchmark for evaluating LLMs in realistic medical calculator scenarios through Model Context Protocol (MCP) integration. MedMCP-Calc comprises 118 scenario tasks across 4 clinical domains, featuring fuzzy task descriptions mimicking natural queries, structured EHR database interaction, external reference retrieval, and process-level evaluation. Our evaluation of 23 leading models reveals critical limitations: even top performers like Claude Opus 4.5 exhibit substantial gaps, including difficulty selecting appropriate calculators for end-to-end workflows given fuzzy queries, poor performance in iterative SQL-based database interactions, and marked reluctance to leverage external tools for numerical computation. Performance also varies considerably across clinical domains. Building on these findings, we develop CalcMate, a fine-tuned model incorporating scenario planning and tool augmentation, achieving state-of-the-art performance among open-source models. Benchmark and Codes are available in https://github.com/SPIRAL-MED/MedMCP-Calc.

Zhipeng Zhang, Xinglin Hou, Kai Niu et al.

Recently, online shopping has gradually become a common way of shopping for people all over the world. Wonderful merchandise advertisements often attract more people to buy. These advertisements properly integrate multimodal multi-structured information of commodities, such as visual spatial information and fine-grained structure information. However, traditional multimodal text generation focuses on the conventional description of what existed and happened, which does not match the requirement of advertisement copywriting in the real world. Because advertisement copywriting has a vivid language style and higher requirements of faithfulness. Unfortunately, there is a lack of reusable evaluation frameworks and a scarcity of datasets. Therefore, we present a dataset, E-MMAD (e-commercial multimodal multi-structured advertisement copywriting), which requires, and supports much more detailed information in text generation. Noticeably, it is one of the largest video captioning datasets in this field. Accordingly, we propose a baseline method and faithfulness evaluation metric on the strength of structured information reasoning to solve the demand in reality on this dataset. It surpasses the previous methods by a large margin on all metrics. The dataset and method are coming soon on \url{https://e-mmad.github.io/e-mmad.net/index.html}.

Qianhan Feng, Zhongzhen Huang, Yakun Zhu et al.

Vision-Language Models (VLMs) show promise in medical diagnosis, yet suffer from reasoning detachment, where linguistically fluent explanations drift from verifiable image evidence, undermining clinical trust. Recent multi-agent frameworks simulate Multidisciplinary Team (MDT) debates to mitigate single-model bias, but open-ended discussions amplify textual noise and computational cost while failing to anchor reasoning to visual evidence, the cornerstone of medical decision-making. We propose UCAgents, a hierarchical multi-agent framework enforcing unidirectional convergence through structured evidence auditing. Inspired by clinical workflows, UCAgents forbids position changes and limits agent interactions to targeted evidence verification, suppressing rhetorical drift while amplifying visual signal extraction. In UCAgents, a one-round inquiry discussion is introduced to uncover potential risks of visual-textual misalignment. This design jointly constrains visual ambiguity and textual noise, a dual-noise bottleneck that we formalize via information theory. Extensive experiments on four medical VQA benchmarks show UCAgents achieves superior accuracy (71.3% on PathVQA, +6.0% over state-of-the-art) with 87.7% lower token cost, the evaluation results further confirm that UCAgents strikes a balance between uncovering more visual evidence and avoiding confusing textual interference. These results demonstrate that UCAgents exhibits both diagnostic reliability and computational efficiency critical for real-world clinical deployment. Code is available at https://github.com/fqhank/UCAgents.

Yannian Gu, Zhongzhen Huang, Linjie Mu et al.

Multimodal large language models (MLLMs) demonstrate considerable potential in clinical diagnostics, a domain that inherently requires synthesizing complex visual and textual data alongside consulting authoritative medical literature. However, existing benchmarks primarily evaluate MLLMs in end-to-end answering scenarios. This limits the ability to disentangle a model's foundational multimodal reasoning from its proficiency in evidence retrieval and application. We introduce the Clinical Understanding and Retrieval Evaluation (CURE) benchmark. Comprising $500$ multimodal clinical cases mapped to physician-cited reference literature, CURE evaluates reasoning and retrieval under controlled evidence settings to disentangle their respective contributions. We evaluate state-of-the-art MLLMs across distinct evidence-gathering paradigms in both closed-ended and open-ended diagnosis tasks. Evaluations reveal a stark dichotomy: while advanced models demonstrate clinical reasoning proficiency when supplied with physician reference evidence (achieving up to $73.4\%$ accuracy on differential diagnosis), their performance substantially declines (as low as $25.4\%$) when reliant on independent retrieval mechanisms. This disparity highlights the dual challenges of effectively integrating multimodal clinical evidence and retrieving precise supporting literature. CURE is publicly available at https://github.com/yanniangu/CURE.

Zhongzhen Huang, Yan Ling, Hong Chen et al.

We present PULSE, a medical reasoning agent that combines a domain-tuned large language model with scientific literature retrieval to support diagnostic decision-making in complex real-world cases. To evaluate its capabilities, we curated a benchmark of 82 authentic endocrinology case reports encompassing a broad spectrum of disease types and incidence levels. In controlled experiments, we compared PULSE's performance against physicians with varying levels of expertise-from residents to senior specialists-and examined how AI assistance influenced human diagnostic reasoning. PULSE attained expert-competitive accuracy, outperforming residents and junior specialists while matching senior specialist performance at both Top@1 and Top@4 thresholds. Unlike physicians, whose accuracy declined with disease rarity, PULSE maintained stable performance across incidence tiers. The agent also exhibited adaptive reasoning, increasing output length with case difficulty in a manner analogous to the longer deliberation observed among expert clinicians. When used collaboratively, PULSE enabled physicians to correct initial errors and broaden diagnostic hypotheses, but also introduced risks of automation bias. The study explores both serial and concurrent collaboration workflows, revealing that PULSE offers robust support across common and rare presentations. These findings underscore both the promise and the limitations of language model-based agents in clinical diagnosis, and offer a framework for evaluating their role in real-world decision-making.

Qianhan Feng, Zhongzhen Huang, Yakun Zhu et al.

Experienced physicians develop diagnostic expertise through clinical practice, acquiring not only disease knowledge but also the ability to differentiate confusable conditions. Current medical vision-language models (VLMs) lack this capability -- their parameters encode static knowledge that does not evolve across diagnostic encounters. We propose MedExpMem, an experience memory framework enabling VLM-based diagnostic agents to accumulate differential diagnosis expertise. Unlike retrieval-augmented generation, which retrieves encyclopedic disease descriptions, MedExpMem memorizes discriminative experience derived from the agent's own diagnostic failures and organizes them as pairwise differential notes encoding key discriminators, actionable decision rules and reasoning error patterns. The framework adopts a two-phase construction process mirroring physician learning: initial practice exposes knowledge gaps, and reflective re-diagnosis refines understanding. When encountering new cases, the agent retrieves experience memory to guide differential reasoning. We evaluate MedExpMem on a radiology benchmark spanning 11 subspecialties. Results demonstrate consistent accuracy improvements, maximum 7.0%, across diverse models and scales. Analytical experiments validate experience quality and robustness, demonstrating MedExpMem as a competitive method addresses medical adaptation needs beyond the reach of parameteric learning.

Zhipeng Zhang, Zhimin Wei, Zhongzhen Huang et al.

Referring Expression Comprehension (REC) is one of the most important tasks in visual reasoning that requires a model to detect the target object referred by a natural language expression. Among the proposed pipelines, the one-stage Referring Expression Comprehension (OSREC) has become the dominant trend since it merges the region proposal and selection stages. Many state-of-the-art OSREC models adopt a multi-hop reasoning strategy because a sequence of objects is frequently mentioned in a single expression which needs multi-hop reasoning to analyze the semantic relation. However, one unsolved issue of these models is that the number of reasoning steps needs to be pre-defined and fixed before inference, ignoring the varying complexity of expressions. In this paper, we propose a Dynamic Multi-step Reasoning Network, which allows the reasoning steps to be dynamically adjusted based on the reasoning state and expression complexity. Specifically, we adopt a Transformer module to memorize & process the reasoning state and a Reinforcement Learning strategy to dynamically infer the reasoning steps. The work achieves the state-of-the-art performance or significant improvements on several REC datasets, ranging from RefCOCO (+, g) with short expressions, to Ref-Reasoning, a dataset with long and complex compositional expressions.

Yakun Zhu, Zhongzhen Huang, Linjie Mu et al.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3, o1, and DeepSeek-R1, achieve only 51.12%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AI's diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Yongrui Yu, Zhongzhen Huang, Linjie Mu et al.

Radiology reporting is an essential yet time-consuming and error-prone task for radiologists in clinical examinations, especially for volumetric medical images. Rigorous quality control is also critical but tedious, ensuring that the final report meets clinical standards. Existing automated approaches, including radiology report generation methods and medical vision-language models, focus mainly on the report generation phase and neglect the crucial quality control procedure, limiting their capability to provide comprehensive support to radiologists. We propose Radiologist Copilot, an agentic AI assistant equipped with orchestrated tools designed for automated radiology reporting with quality control. Leveraging large language models as the reasoning backbone, the agentic system autonomously selects tools, plans, and executes actions, emulating the behavior of radiologists throughout the holistic radiology reporting process. The orchestrated tools include region localization, think with image paradigm directed region analysis planning, strategic template selection for report generation, quality assessment and feedback-driven adaptive refinement for quality control. Therefore, Radiologist Copilot facilitates accurate, complete, and efficient radiology reporting, assisting radiologists and improving clinical efficiency. Experimental results demonstrate that Radiologist Copilot significantly surpasses other state-of-the-art methods in radiology reporting. The source code will be released upon acceptance.

Linjie Mu, Zhongzhen Huang, Yannian Gu et al.

World models offer a principled framework for simulating future states under interventions, but realizing such models in complex, high-stakes domains like medicine remains challenging. Recent large language models (LLMs) have achieved strong performance on static medical reasoning tasks, raising the question of whether they can function as dynamic medical world models capable of simulating disease progression and treatment outcomes over time. In this work, we show that LLMs only incorporating medical knowledge struggle to maintain consistent patient states under sequential interventions, leading to error accumulation in long-horizon clinical simulation. To address this limitation, we introduce EHRWorld, a patient-centric medical world model trained under a causal sequential paradigm, together with EHRWorld-110K, a large-scale longitudinal clinical dataset derived from real-world electronic health records. Extensive evaluations demonstrate that EHRWorld significantly outperforms naive LLM-based baselines, achieving more stable long-horizon simulation, improved modeling of clinically sensitive events, and favorable reasoning efficiency, highlighting the necessity of training on causally grounded, temporally evolving clinical data for reliable and robust medical world modeling.

Linjie Mu, Zhongzhen Huang, Shengqian Qin et al.

Large vision-language models (LVLMs) have shown great promise in medical applications, particularly in visual question answering (MedVQA) and diagnosis from medical images. However, existing datasets and models often fail to consider critical aspects of medical diagnostics, such as the integration of historical records and the analysis of disease progression over time. In this paper, we introduce MMXU (Multimodal and MultiX-ray Understanding), a novel dataset for MedVQA that focuses on identifying changes in specific regions between two patient visits. Unlike previous datasets that primarily address single-image questions, MMXU enables multi-image questions, incorporating both current and historical patient data. We demonstrate the limitations of current LVLMs in identifying disease progression on MMXU-\textit{test}, even those that perform well on traditional benchmarks. To address this, we propose a MedRecord-Augmented Generation (MAG) approach, incorporating both global and regional historical records. Our experiments show that integrating historical records significantly enhances diagnostic accuracy by at least 20\%, bridging the gap between current LVLMs and human expert performance. Additionally, we fine-tune models with MAG on MMXU-\textit{dev}, which demonstrates notable improvements. We hope this work could illuminate the avenue of advancing the use of LVLMs in medical diagnostics by emphasizing the importance of historical context in interpreting medical images. Our dataset is released at github: https://github.com/linjiemu/MMXU.

Shengyi Hua, Jianfeng Wu, Tianle Shen et al.

Recent pathological foundation models have substantially advanced visual representation learning and multimodal interaction. However, most models still rely on a static inference paradigm in which whole-slide images are processed once to produce predictions, without reassessment or targeted evidence acquisition under ambiguous diagnoses. This contrasts with clinical diagnostic workflows that refine hypotheses through repeated slide observations and further examination requests. We propose PathFound, an agentic multimodal model designed to support evidence-seeking inference in pathological diagnosis. PathFound integrates the power of pathological visual foundation models, vision-language models, and reasoning models trained with reinforcement learning to perform proactive information acquisition and diagnosis refinement by progressing through the initial diagnosis, evidence-seeking, and final decision stages. Across several large multimodal models, adopting this strategy consistently improves diagnostic accuracy, indicating the effectiveness of evidence-seeking workflows in computational pathology. Among these models, PathFound achieves state-of-the-art diagnostic performance across diverse clinical scenarios and demonstrates strong potential to discover subtle details, such as nuclear features and local invasions.

Yakun Zhu, Zhongzhen Huang, Qianhan Feng et al.

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

Zhongzhen Huang, Gui Geng, Shengyi Hua et al.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Yankai Jiang, Zhongzhen Huang, Rongzhao Zhang et al.

The long-tailed distribution problem in medical image analysis reflects a high prevalence of common conditions and a low prevalence of rare ones, which poses a significant challenge in developing a unified model capable of identifying rare or novel tumor categories not encountered during training. In this paper, we propose a new zero-shot pan-tumor segmentation framework (ZePT) based on query-disentangling and self-prompting to segment unseen tumor categories beyond the training set. ZePT disentangles the object queries into two subsets and trains them in two stages. Initially, it learns a set of fundamental queries for organ segmentation through an object-aware feature grouping strategy, which gathers organ-level visual features. Subsequently, it refines the other set of advanced queries that focus on the auto-generated visual prompts for unseen tumor segmentation. Moreover, we introduce query-knowledge alignment at the feature level to enhance each query's discriminative representation and generalizability. Extensive experiments on various tumor segmentation tasks demonstrate the performance superiority of ZePT, which surpasses the previous counterparts and evidence the promising ability for zero-shot tumor segmentation in real-world settings.

Zhongzhen Huang, Kui Xue, Yongqi Fan et al.

Large-scale language models (LLMs) have achieved remarkable success across various language tasks but suffer from hallucinations and temporal misalignment. To mitigate these shortcomings, Retrieval-augmented generation (RAG) has been utilized to provide external knowledge to facilitate the answer generation. However, applying such models to the medical domain faces several challenges due to the lack of domain-specific knowledge and the intricacy of real-world scenarios. In this study, we explore LLMs with RAG framework for knowledge-intensive tasks in the medical field. To evaluate the capabilities of LLMs, we introduce MedicineQA, a multi-round dialogue benchmark that simulates the real-world medication consultation scenario and requires LLMs to answer with retrieved evidence from the medicine database. MedicineQA contains 300 multi-round question-answering pairs, each embedded within a detailed dialogue history, highlighting the challenge posed by this knowledge-intensive task to current LLMs. We further propose a new \textit{Distill-Retrieve-Read} framework instead of the previous \textit{Retrieve-then-Read}. Specifically, the distillation and retrieval process utilizes a tool calling mechanism to formulate search queries that emulate the keyword-based inquiries used by search engines. With experimental results, we show that our framework brings notable performance improvements and surpasses the previous counterparts in the evidence retrieval process in terms of evidence retrieval accuracy. This advancement sheds light on applying RAG to the medical domain.

Zhongzhen Huang, Linjie Mu, Yakun Zhu et al.

Effective clinical decision-making depends on iterative, multimodal reasoning across diverse sources of evidence. The recent emergence of multimodal reasoning models has significantly transformed the landscape of solving complex tasks. Although such models have achieved notable success in mathematics and science, their application to medical domains remains underexplored. In this work, we propose \textit{MedE$^2$}, a two-stage post-training pipeline that elicits and then enhances multimodal reasoning for medical domains. In Stage-I, we fine-tune models using 2,000 text-only data samples containing precisely orchestrated reasoning demonstrations to elicit reasoning behaviors. In Stage-II, we further enhance the model's reasoning capabilities using 1,500 rigorously curated multimodal medical cases, aligning model reasoning outputs with our proposed multimodal medical reasoning preference. Extensive experiments demonstrate the efficacy and reliability of \textit{MedE$^2$} in improving the reasoning performance of medical multimodal models. Notably, models trained with \textit{MedE$^2$} consistently outperform baselines across multiple medical multimodal benchmarks. Additional validation on larger models and under inference-time scaling further confirms the robustness and practical utility of our approach.

Mengya Xu, Zhongzhen Huang, Jie Zhang et al.

In robot-assisted minimally invasive surgery, we introduce the Surgical Action Planning (SAP) task, which generates future action plans from visual inputs to address the absence of intraoperative predictive planning in current intelligent applications. SAP shows great potential for enhancing intraoperative guidance and automating procedures. However, it faces challenges such as understanding instrument-action relationships and tracking surgical progress. Large Language Models (LLMs) show promise in understanding surgical video content but remain underexplored for predictive decision-making in SAP, as they focus mainly on retrospective analysis. Challenges like data privacy, computational demands, and modality-specific constraints further highlight significant research gaps. To tackle these challenges, we introduce LLM-SAP, a Large Language Models-based Surgical Action Planning framework that predicts future actions and generates text responses by interpreting natural language prompts of surgical goals. The text responses potentially support surgical education, intraoperative decision-making, procedure documentation, and skill analysis. LLM-SAP integrates two novel modules: the Near-History Focus Memory Module (NHF-MM) for modeling historical states and the prompts factory for action planning. We evaluate LLM-SAP on our constructed CholecT50-SAP dataset using models like Qwen2.5 and Qwen2-VL, demonstrating its effectiveness in next-action prediction. Pre-trained LLMs are tested in a zero-shot setting, and supervised fine-tuning (SFT) with LoRA is implemented. Our experiments show that Qwen2.5-72B-SFT surpasses Qwen2.5-72B with a 19.3% higher accuracy.

Mengya Xu, Zhongzhen Huang, Dillan Imans et al.

Effective evaluation is critical for driving advancements in MLLM research. The surgical action planning (SAP) task, which aims to generate future action sequences from visual inputs, demands precise and sophisticated analytical capabilities. Unlike mathematical reasoning, surgical decision-making operates in life-critical domains and requires meticulous, verifiable processes to ensure reliability and patient safety. This task demands the ability to distinguish between atomic visual actions and coordinate complex, long-horizon procedures, capabilities that are inadequately evaluated by current benchmarks. To address this gap, we introduce SAP-Bench, a large-scale, high-quality dataset designed to enable multimodal large language models (MLLMs) to perform interpretable surgical action planning. Our SAP-Bench benchmark, derived from the cholecystectomy procedures context with the mean duration of 1137.5s, and introduces temporally-grounded surgical action annotations, comprising the 1,226 clinically validated action clips (mean duration: 68.7s) capturing five fundamental surgical actions across 74 procedures. The dataset provides 1,152 strategically sampled current frames, each paired with the corresponding next action as multimodal analysis anchors. We propose the MLLM-SAP framework that leverages MLLMs to generate next action recommendations from the current surgical scene and natural language instructions, enhanced with injected surgical domain knowledge. To assess our dataset's effectiveness and the broader capabilities of current models, we evaluate seven state-of-the-art MLLMs (e.g., OpenAI-o1, GPT-4o, QwenVL2.5-72B, Claude-3.5-Sonnet, GeminiPro2.5, Step-1o, and GLM-4v) and reveal critical gaps in next action prediction performance.

Zhongzhen Huang, Yankai Jiang, Rongzhao Zhang et al.

Existing promptable segmentation methods in the medical imaging field primarily consider either textual or visual prompts to segment relevant objects, yet they often fall short when addressing anomalies in medical images, like tumors, which may vary greatly in shape, size, and appearance. Recognizing the complexity of medical scenarios and the limitations of textual or visual prompts, we propose a novel dual-prompt schema that leverages the complementary strengths of visual and textual prompts for segmenting various organs and tumors. Specifically, we introduce CAT, an innovative model that Coordinates Anatomical prompts derived from 3D cropped images with Textual prompts enriched by medical domain knowledge. The model architecture adopts a general query-based design, where prompt queries facilitate segmentation queries for mask prediction. To synergize two types of prompts within a unified framework, we implement a ShareRefiner, which refines both segmentation and prompt queries while disentangling the two types of prompts. Trained on a consortium of 10 public CT datasets, CAT demonstrates superior performance in multiple segmentation tasks. Further validation on a specialized in-house dataset reveals the remarkable capacity of segmenting tumors across multiple cancer stages. This approach confirms that coordinating multimodal prompts is a promising avenue for addressing complex scenarios in the medical domain.

Qiao Deng, Zhongzhen Huang, Yunqi Wang et al.

Medical foundation models have the potential to revolutionize healthcare by providing robust and generalized representations of medical data. Medical vision-language pre-training has emerged as a promising approach for learning domain-general representations of medical image and text. Current algorithms that exploit global and local alignment between medical image and text could however be marred by redundant information in medical data. To address this issue, we propose a grounded knowledge-enhanced medical vision-language pre-training (GK-MVLP) framework for chest X-ray. In this framework, medical knowledge was grounded to the appropriate anatomical regions by using a transformer-based grounded knowledge-enhanced module for fine-grained alignment between textural features of medical knowledge and the corresponding anatomical region-level visual features. The performance of GK-MVLP was competitive with or exceeded the state of the art on downstream image understanding tasks (chest X-ray disease classification, disease localization), generative task (report generation), and vision-language understanding task (medical visual question-answering). Our results demonstrate the advantage of incorporating grounding mechanism to remove biases and improve the alignment between chest X-ray image and radiology report.

Zhongzhen Huang, Linda Wei, Shaoting Zhang et al.

Combining images from multi-modalities is beneficial to explore various information in computer vision, especially in the medical domain. As an essential part of clinical diagnosis, multi-modal brain tumor segmentation aims to delineate the malignant entity involving multiple modalities. Although existing methods have shown remarkable performance in the task, the information exchange for cross-scale and high-level representations fusion in spatial and modality are limited in these methods. In this paper, we present a novel Modality Aware and Shift Mixer that integrates intra-modality and inter-modality dependencies of multi-modal images for effective and robust brain tumor segmentation. Specifically, we introduce a Modality-Aware module according to neuroimaging studies for modeling the specific modality pair relationships at low levels, and a Modality-Shift module with specific mosaic patterns is developed to explore the complex relationships across modalities at high levels via the self-attention. Experimentally, we outperform previous state-of-the-art approaches on the public Brain Tumor Segmentation (BraTS 2021 segmentation) dataset. Further qualitative experiments demonstrate the efficacy and robustness of MASM.