Colon-X: Advancing Intelligent Colonoscopy from Multimodal Understanding to Clinical Reasoning
This work addresses the need for robust and trustworthy clinical reasoning in colonoscopy, though it is incremental as it builds on existing multimodal methods.
The study tackled the problem of advancing multimodal intelligence in colonoscopy by constructing a comprehensive dataset and developing a reasoning-centric model, with ColonR1 achieving 56.61% overall accuracy and outperforming supervised fine-tuning by 25.22% under data-scarce conditions.
In this study, we present Colon-X, an open initiative aimed at advancing multimodal intelligence in colonoscopy. We begin by constructing ColonVQA, the most comprehensive multimodal dataset ever built for colonoscopy, featuring over 1.1M+ visual question answering entries across 76 clinical findings and 18 multimodal tasks. Beyond serving as a community-wide data foundation, we further investigate a critical yet underexplored transition in colonoscopy - evolving from multimodal understanding to clinical reasoning: (a) To capture the current landscape of multimodal understanding behaviors, we systematically assess the generalizability of 22 multimodal large language models and examine their reliability under human-induced perturbations. The results reveal that clinical outputs from leading MLLMs remain far from robust and trustworthy. (b) To narrow this gap, we further explore reasoning-centric intelligence tailored for colonoscopy. Specifically, we curate ColonReason, a clinically grounded reasoning dataset annotated through a multi-expert debating pipeline, and develop ColonR1, the first R1-styled model incorporating task-adaptive rewarding and gradient-stable optimization techniques. Under data-scarce conditions, our ColonR1 achieves 56.61% overall accuracy, outperforming supervised fine-tuning by 25.22%, and sets a new reasoning-enabled baseline for multimodal colonoscopy analysis. All data and model resources are publicly available at https://github.com/ai4colonoscopy/Colon-X.