S N Li

Sijing Li, Zhongwei Qiu, Jiang Liu et al.

Accurate tumor analysis is central to clinical radiology and precision oncology, where early detection, reliable lesion characterization, and pathology-level risk assessment guide diagnosis and treatment planning. Chain-of-Thought (CoT) reasoning is particularly important in this setting because it enables step-by-step interpretation from imaging findings to clinical impressions and pathology conclusions, improving traceability and reducing diagnostic errors. Here, we target the clinical tumor analysis task and build a large-scale benchmark that operationalizes a multimodal reasoning pipeline, spanning findings, impressions, and pathology predictions. We curate TumorCoT, a large-scale dataset of 1.5M CoT-labeled VQA instructions paired with 3D CT scans, with step-aligned rationales and cross-modal alignments along the trajectory from findings to impression to pathology, enabling evaluation of both answer accuracy and reasoning consistency. We further propose TumorChain, a multimodal interleaved reasoning framework that tightly couples 3D imaging encoders, clinical text understanding, and organ-level vision-language alignment. Through cross-modal alignment and iterative interleaved causal reasoning, TumorChain grounds visual evidence, aggregates conclusions, and issues pathology predictions after multiple rounds of self-refinement, improving traceability and reducing hallucination risk. Experiments show consistent improvements over strong baselines in lesion detection, impression generation, and pathology classification, and demonstrate strong generalization on the DeepTumorVQA benchmark. These results highlight the potential of multimodal reasoning for reliable and interpretable tumor analysis in clinical practice. Detailed information about our project can be found on our project homepage at https://github.com/ZJU4HealthCare/TumorChain.

Tianwei Lin, Zhongwei Qiu, Wenqiao Zhang et al.

Computed Tomography (CT) is one of the most widely used and diagnostically information-dense imaging modalities, covering critical organs such as the heart, lungs, liver, and colon. Clinical interpretation relies on both slice-driven local features (e.g., sub-centimeter nodules, lesion boundaries) and volume-driven spatial representations (e.g., tumor infiltration, inter-organ anatomical relations). However, existing Large Vision-Language Models (LVLMs) remain fragmented in CT slice versus volumetric understanding: slice-driven LVLMs show strong generalization but lack cross-slice spatial consistency, while volume-driven LVLMs explicitly capture volumetric semantics but suffer from coarse granularity and poor compatibility with slice inputs. The absence of a unified modeling paradigm constitutes a major bottleneck for the clinical translation of medical LVLMs. We present OmniCT, a powerful unified slice-volume LVLM for CT scenarios, which makes three contributions: (i) Spatial Consistency Enhancement (SCE): volumetric slice composition combined with tri-axial positional embedding that introduces volumetric consistency, and an MoE hybrid projection enables efficient slice-volume adaptation; (ii) Organ-level Semantic Enhancement (OSE): segmentation and ROI localization explicitly align anatomical regions, emphasizing lesion- and organ-level semantics; (iii) MedEval-CT: the largest slice-volume CT dataset and hybrid benchmark integrates comprehensive metrics for unified evaluation. OmniCT consistently outperforms existing methods with a substantial margin across diverse clinical tasks and satisfies both micro-level detail sensitivity and macro-level spatial reasoning. More importantly, it establishes a new paradigm for cross-modal medical imaging understanding.

Xiaoda Yang, JunYu Lu, Hongshun Qiu et al.

Vision-Language Models (VLMs) based on Mixture-of-Experts (MoE) architectures have emerged as a pivotal paradigm in multimodal understanding, offering a powerful framework for integrating visual and linguistic information. However, the increasing complexity and diversity of tasks present significant challenges in coordinating load balancing across heterogeneous visual experts, where optimizing one specialist's performance often compromises others' capabilities. To address task heterogeneity and expert load imbalance, we propose Astrea, a novel multi-expert collaborative VLM architecture based on progressive pre-alignment. Astrea introduces three key innovations: 1) A heterogeneous expert coordination mechanism that integrates four specialized models (detection, segmentation, classification, captioning) into a comprehensive expert matrix covering essential visual comprehension elements; 2) A dynamic knowledge fusion strategy featuring progressive pre-alignment to harmonize experts within the VLM latent space through contrastive learning, complemented by probabilistically activated stochastic residual connections to preserve knowledge continuity; 3) An enhanced optimization framework utilizing momentum contrastive learning for long-range dependency modeling and adaptive weight allocators for real-time expert contribution calibration. Extensive evaluations across 12 benchmark tasks spanning VQA, image captioning, and cross-modal retrieval demonstrate Astrea's superiority over state-of-the-art models, achieving an average performance gain of +4.7\%. This study provides the first empirical demonstration that progressive pre-alignment strategies enable VLMs to overcome task heterogeneity limitations, establishing new methodological foundations for developing general-purpose multimodal agents.