Wenjie Yan

Yihan Xie, Sijing Li, Tianwei Lin et al.

Although electrocardiograms (ECG) play a dominant role in cardiovascular diagnosis and treatment, their intrinsic data forms and representational patterns pose significant challenges for medical multimodal large language models (Med-MLLMs) in achieving cross-modal semantic alignment. To address this gap, we propose Heartcare Suite, a unified ECG suite designed for dual signal-image modeling and understanding: (i) Heartcare-400K. A fine-grained ECG instruction dataset on top of our data pipeline engine--HeartAgent--by integrating high quality clinical ECG reports from top hospitals with open-source data. (ii) Heartcare-Bench. A systematic benchmark assessing performance of models in multi-perspective ECG understanding and cross-modal generalization, providing guidance for optimizing ECG comprehension models. (iii) HeartcareGPT. Built upon a structure-aware discrete tokenizer Beat, we propose Dual Stream Projection Alignment (DSPA) paradigm--a dual encoder projection alignment mechanism enabling joint optimizing and modeling native ECG signal-image within a shared feature space. HeartcareGPT achieves consistent improvements across diverse ECG understanding tasks, validating both the effectiveness of the unified modeling paradigm and the necessity of a high-quality data pipeline, and establishing a methodological foundation for extending Med-MLLMs towards physiological signal domains. Our project is available at https://github.com/ZJU4HealthCare/HeartcareGPT .

Tianwei Lin, Zhongwei Qiu, Jie Cao et al.

Medical vision-language models (VLMs) have rapidly advanced as general-purpose multimodal assistants, yet their deployment in 3D Computed Tomography (CT) analysis remains constrained by a persistent mismatch between optimization objectives and clinical rigor. Current Reinforcement Learning (RL) paradigms still rely on lexical proxy signals that induce ``\textit{Evaluation Hallucinations}'', where models optimize linguistic fluency rather than factual clinical correctness, leading to diagnostically critical errors. To bridge this gap, we introduce the \textbf{Clinical Abnormality Benchmarking Substrate (CABS)}, a structured system that decomposes radiology reports into verifiable clinical semantic units. Using CABS, we identify a ``\textit{Mechanistic Divergence}'' in standard RL, where surface-similarity rewards drive policy gradients to bypass medical facts. We therefore propose \textbf{Trajectory-Integral Feedback GRPO (TIF-GRPO)}, a novel framework integrating control-theoretic principles into policy optimization. By formulating clinical reasoning as a pseudo-temporal trajectory for anomaly discovery, TIF-GRPO regulates anatomy-aware rewards via an integral feedback loop that penalizes persistent omissions as cumulative state errors and suppresses hallucinations as excessive control effort. Experiments on 3D CT benchmarks demonstrate that our approach significantly enhances abnormality detection and clinical faithfulness, establishing a new paradigm for fine-grained regulation in medical VLMs. Our project is available at \href{https://github.com/ZJU4HealthCare/TIF-GRPO}{GitHub}.

Zhuonan Wang, Wenjie Yan, Wenqiao Zhang et al.

Medical image classification is a core task in computer-aided diagnosis (CAD), playing a pivotal role in early disease detection, treatment planning, and patient prognosis assessment. In ophthalmic practice, fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) provide hemodynamic and lesion-structural information that conventional fundus photography cannot capture. However, due to the single-modality nature, subtle lesion patterns, and significant inter-device variability, existing methods still face limitations in generalization and high-confidence prediction. To address these challenges, we propose CLEAR-Mamba, an enhanced framework built upon MedMamba with optimizations in both architecture and training strategy. Architecturally, we introduce HaC, a hypernetwork-based adaptive conditioning layer that dynamically generates parameters according to input feature distributions, thereby improving cross-domain adaptability. From a training perspective, we develop RaP, a reliability-aware prediction scheme built upon evidential uncertainty learning, which encourages the model to emphasize low-confidence samples and improves overall stability and reliability. We further construct a large-scale ophthalmic angiography dataset covering both FFA and ICGA modalities, comprising multiple retinal disease categories for model training and evaluation. Experimental results demonstrate that CLEAR-Mamba consistently outperforms multiple baseline models, including the original MedMamba, across various metrics-showing particular advantages in multi-disease classification and reliability-aware prediction. This study provides an effective solution that balances generalizability and reliability for modality-specific medical image classification tasks.