Shuchang Ye

Shuchang Ye, Mingyuan Meng, Mingjian Li et al.

Segmentation of infected areas in chest X-rays is pivotal for facilitating the accurate delineation of pulmonary structures and pathological anomalies. Recently, multi-modal language-guided image segmentation methods have emerged as a promising solution for chest X-rays where the clinical text reports, depicting the assessment of the images, are used as guidance. Nevertheless, existing language-guided methods require clinical reports alongside the images, and hence, they are not applicable for use in image segmentation in a decision support context, but rather limited to retrospective image analysis after clinical reporting has been completed. In this study, we propose a self-guided segmentation framework (SGSeg) that leverages language guidance for training (multi-modal) while enabling text-free inference (uni-modal), which is the first that enables text-free inference in language-guided segmentation. We exploit the critical location information of both pulmonary and pathological structures depicted in the text reports and introduce a novel localization-enhanced report generation (LERG) module to generate clinical reports for self-guidance. Our LERG integrates an object detector and a location-based attention aggregator, weakly-supervised by a location-aware pseudo-label extraction module. Extensive experiments on a well-benchmarked QaTa-COV19 dataset demonstrate that our SGSeg achieved superior performance than existing uni-modal segmentation methods and closely matched the state-of-the-art performance of multi-modal language-guided segmentation methods.

Pengyu Wang, Shuchang Ye, Usman Naseem et al.

Medical report generation (MRG) aims to automatically derive radiology-style reports from medical images to aid in clinical decision-making. However, existing methods often generate text that mimics the linguistic style of radiologists but fails to guarantee clinical correctness, because they are trained on token-level objectives which focus on word-choice and sentence structure rather than actual medical accuracy. We propose a semantic-driven reinforcement learning (SRL) method for medical report generation, adopted on a large vision-language model (LVLM). SRL adopts Group Relative Policy Optimization (GRPO) to encourage clinical-correctness-guided learning beyond imitation of language style. Specifically, we optimise a report-level reward: a margin-based cosine similarity (MCCS) computed between key radiological findings extracted from generated and reference reports, thereby directly aligning clinical-label agreement and improving semantic correctness. A lightweight reasoning format constraint further guides the model to generate structured "thinking report" outputs. We evaluate Medical Report Generation with Sematic-driven Reinforment Learning (MRG-R1), on two datasets: IU X-Ray and MIMIC-CXR using clinical efficacy (CE) metrics. MRG-R1 achieves state-of-the-art performance with CE-F1 51.88 on IU X-Ray and 40.39 on MIMIC-CXR. We found that the label-semantic reinforcement is better than conventional token-level supervision. These results indicate that optimizing a clinically grounded, report-level reward rather than token overlap,meaningfully improves clinical correctness. This work is a prior to explore semantic-reinforcement in supervising medical correctness in medical Large vision-language model(Med-LVLM) training.

Shuchang Ye, Usman Naseem, Mingyuan Meng et al.

Medical Visual Question Answering (MedVQA) is crucial for enhancing the efficiency of clinical diagnosis by providing accurate and timely responses to clinicians' inquiries regarding medical images. Existing MedVQA models suffered from modality preference bias, where predictions are heavily dominated by one modality while overlooking the other (in MedVQA, usually questions dominate the answer but images are overlooked), thereby failing to learn multimodal knowledge. To overcome the modality preference bias, we proposed a Medical CounterFactual VQA (MedCFVQA) model, which trains with bias and leverages causal graphs to eliminate the modality preference bias during inference. Existing MedVQA datasets exhibit substantial prior dependencies between questions and answers, which results in acceptable performance even if the model significantly suffers from the modality preference bias. To address this issue, we reconstructed new datasets by leveraging existing MedVQA datasets and Changed their P3rior dependencies (CP) between questions and their answers in the training and test set. Extensive experiments demonstrate that MedCFVQA significantly outperforms its non-causal counterpart on both SLAKE, RadVQA and SLAKE-CP, RadVQA-CP datasets.

Pengyu Wang, Shuchang Ye, Usman Naseem et al.

Medical Large Vision-Language Models (Med-LVLMs) have been widely adopted for medical report generation. Despite Med-LVLMs producing state-of-the-art performance, they exhibit a bias toward predicting all findings as normal, leading to reports that overlook critical abnormalities. Furthermore, these models often fail to provide comprehensive descriptions of radiologically relevant regions necessary for accurate diagnosis. To address these challenges, we proposeMedical Report Generation Agents (MRGAgents), a novel multi-agent framework that fine-tunes specialized agents for different disease categories. By curating subsets of the IU X-ray and MIMIC-CXR datasets to train disease-specific agents, MRGAgents generates reports that more effectively balance normal and abnormal findings while ensuring a comprehensive description of clinically relevant regions. Our experiments demonstrate that MRGAgents outperformed the state-of-the-art, improving both report comprehensiveness and diagnostic utility.

Shuchang Ye, Usman Naseem, Mingyuan Meng et al.

Medical language-guided segmentation, integrating textual clinical reports as auxiliary guidance to enhance image segmentation, has demonstrated significant improvements over unimodal approaches. However, its inherent reliance on paired image-text input, which we refer to as ``textual reliance", presents two fundamental limitations: 1) many medical segmentation datasets lack paired reports, leaving a substantial portion of image-only data underutilized for training; and 2) inference is limited to retrospective analysis of cases with paired reports, limiting its applicability in most clinical scenarios where segmentation typically precedes reporting. To address these limitations, we propose ProLearn, the first Prototype-driven Learning framework for language-guided segmentation that fundamentally alleviates textual reliance. At its core, we introduce a novel Prototype-driven Semantic Approximation (PSA) module to enable approximation of semantic guidance from textual input. PSA initializes a discrete and compact prototype space by distilling segmentation-relevant semantics from textual reports. Once initialized, it supports a query-and-respond mechanism which approximates semantic guidance for images without textual input, thereby alleviating textual reliance. Extensive experiments on QaTa-COV19, MosMedData+ and Kvasir-SEG demonstrate that ProLearn outperforms state-of-the-art language-guided methods when limited text is available.

Hao Wang, Shuchang Ye, Jinghao Lin et al.

Large vision-language models (LVMs) hold a great promise for automating medical report generation, potentially reducing the burden of manual reporting. State-of-the-art (SOTA) research fine-tunes general LVMs with medical data to align radiology images to corresponding medical reports. However, there are two key factors that limit these LVM's performance. Firstly, LVMs lack complex reasoning capability that leads to logical inconsistencies and potential diagnostic errors in generated reports. Secondly, LVMs lack reflection mechanism that leads to an inability to discover errors in the thinking process. To address these gaps, we propose LVMed-R2, a new fine-tuning strategy that introduces complex reasoning and reflection mechanisms for LVMs to enhance medical report generation. To the best of our knowledge, this is the first work to introduce complex reasoning to the medical report generation (MRG) task. Our proposed complex reasoning contains medical knowledge injection and perception-enhancing modules which improve the accuracy of LVMs diagnosis, coupled with a perception tree to provide guidance to limit the perception range. Further, the reflection mechanism forces self-verification for outputs to correct for potential errors. We experimented by fine-tuning LVMs with our proposed LVMed-R2 strategy, using IU-Xray and MIMIC-CXR datasets. Our results, measured on natural language generation (NLG) metrics and clinical efficacy (CE) metrics, demonstrate that LVMs fine-tuned with the proposed reflection mechanism possess the ability to correct outputs and complex reasoning effectively and improve LVMs performance for MRG.