Daily Papers

Medical Visual Question Answering (Med-VQA) answers clinical questions using medical images, aiding diagnosis. Designing the MedVQA system holds profound importance in assisting clinical diagnosis and enhancing diagnostic accuracy. Building upon this foundation, Hierarchical Medical VQA extends Medical VQA by organizing medical questions into a hierarchical structure and making level-specific predictions to handle fine-grained distinctions. Recently, many studies have proposed hierarchical MedVQA tasks and established datasets, However, several issues still remain: (1) imperfect hierarchical modeling leads to poor differentiation between question levels causing semantic fragmentation across hierarchies. (2) Excessive reliance on implicit learning in Transformer-based cross-modal self-attention fusion methods, which obscures crucial local semantic correlations in medical scenarios. To address these issues, this study proposes a HiCA-VQA method, including two modules: Hierarchical Prompting for fine-grained medical questions and Hierarchical Answer Decoders. The hierarchical prompting module pre-aligns hierarchical text prompts with image features to guide the model in focusing on specific image regions according to question types, while the hierarchical decoder performs separate predictions for questions at different levels to improve accuracy across granularities. The framework also incorporates a cross-attention fusion module where images serve as queries and text as key-value pairs. Experiments on the Rad-Restruct benchmark demonstrate that the HiCA-VQA framework better outperforms existing state-of-the-art methods in answering hierarchical fine-grained questions. This study provides an effective pathway for hierarchical visual question answering systems, advancing medical image understanding.

Medical visual question answering (Med-VQA) has tremendous potential in healthcare. However, the development of this technology is hindered by the lacking of publicly-available and high-quality labeled datasets for training and evaluation. In this paper, we present a large bilingual dataset, SLAKE, with comprehensive semantic labels annotated by experienced physicians and a new structural medical knowledge base for Med-VQA. Besides, SLAKE includes richer modalities and covers more human body parts than the currently available dataset. We show that SLAKE can be used to facilitate the development and evaluation of Med-VQA systems. The dataset can be downloaded from http://www.med-vqa.com/slake.

Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs to predict free-form answers as a generative task to solve medical visual question answering (Med-VQA) tasks. In this paper, we propose a parameter efficient framework for fine-tuning MLLM specifically tailored to Med-VQA applications, and empirically validate it on a public benchmark dataset. To accurately measure the performance, we employ human evaluation and the results reveal that our model achieves an overall accuracy of 81.9%, and outperforms the GPT-4v model by a significant margin of 26% absolute accuracy on closed-ended questions. The code will be available here: https://github.com/jinlHe/PeFoMed.

Medical Visual Question Answering (Med-VQA) combines computer vision and natural language processing to automatically answer clinical inquiries about medical images. However, current Med-VQA datasets exhibit two significant limitations: (1) they often lack visual and textual explanations for answers, hindering comprehension for patients and junior doctors; (2) they typically offer a narrow range of question formats, inadequately reflecting the diverse requirements in practical scenarios. These limitations pose significant challenges to the development of a reliable and user-friendly Med-VQA system. To address these challenges, we introduce a large-scale, Groundable, and Explainable Medical VQA benchmark for chest X-ray diagnosis (GEMeX), featuring several innovative components: (1) a multi-modal explainability mechanism that offers detailed visual and textual explanations for each question-answer pair, thereby enhancing answer comprehensibility; (2) four question types, open-ended, closed-ended, single-choice, and multiple-choice, to better reflect practical needs. With 151,025 images and 1,605,575 questions, GEMeX is the currently largest chest X-ray VQA dataset. Evaluation of 12 representative large vision language models (LVLMs) on GEMeX reveals suboptimal performance, underscoring the dataset's complexity. Meanwhile, we propose a strong model by fine-tuning an existing LVLM on the GEMeX training set. The substantial performance improvement showcases the dataset's effectiveness. The benchmark is available at https://www.med-vqa.com/GEMeX.

Medical Visual Question Answering (Med-VQA) holds significant potential for clinical decision support, yet existing efforts primarily focus on 2D imaging with limited task diversity. This paper presents 3D-RAD, a large-scale dataset designed to advance 3D Med-VQA using radiology CT scans. The 3D-RAD dataset encompasses six diverse VQA tasks: anomaly detection, image observation, medical computation, existence detection, static temporal diagnosis, and longitudinal temporal diagnosis. It supports both open- and closed-ended questions while introducing complex reasoning challenges, including computational tasks and multi-stage temporal analysis, to enable comprehensive benchmarking. Extensive evaluations demonstrate that existing vision-language models (VLMs), especially medical VLMs exhibit limited generalization, particularly in multi-temporal tasks, underscoring the challenges of real-world 3D diagnostic reasoning. To drive future advancements, we release a high-quality training set 3D-RAD-T of 136,195 expert-aligned samples, showing that fine-tuning on this dataset could significantly enhance model performance. Our dataset and code, aiming to catalyze multimodal medical AI research and establish a robust foundation for 3D medical visual understanding, are publicly available at https://github.com/Tang-xiaoxiao/3D-RAD.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

In recent advancements, multimodal large language models (MLLMs) have been fine-tuned on specific medical image datasets to address medical visual question answering (Med-VQA) tasks. However, this common approach of task-specific fine-tuning is costly and necessitates separate models for each downstream task, limiting the exploration of zero-shot capabilities. In this paper, we introduce MC-CoT, a modular cross-modal collaboration Chain-of-Thought (CoT) framework designed to enhance the zero-shot performance of MLLMs in Med-VQA by leveraging large language models (LLMs). MC-CoT improves reasoning and information extraction by integrating medical knowledge and task-specific guidance, where LLM provides various complex medical reasoning chains and MLLM provides various observations of medical images based on instructions of the LLM. Our experiments on datasets such as SLAKE, VQA-RAD, and PATH-VQA show that MC-CoT surpasses standalone MLLMs and various multimodality CoT frameworks in recall rate and accuracy. These findings highlight the importance of incorporating background information and detailed guidance in addressing complex zero-shot Med-VQA tasks.

Artificial intelligence has advanced in Medical Visual Question Answering (Med-VQA), but prevalent research tends to focus on the accuracy of the answers, often overlooking the reasoning paths and interpretability, which are crucial in clinical settings. Besides, current Med-VQA algorithms, typically reliant on singular models, lack the robustness needed for real-world medical diagnostics which usually require collaborative expert evaluation. To address these shortcomings, this paper presents MedCoT, a novel hierarchical expert verification reasoning chain method designed to enhance interpretability and accuracy in biomedical imaging inquiries. MedCoT is predicated on two principles: The necessity for explicit reasoning paths in Med-VQA and the requirement for multi-expert review to formulate accurate conclusions. The methodology involves an Initial Specialist proposing diagnostic rationales, followed by a Follow-up Specialist who validates these rationales, and finally, a consensus is reached through a vote among a sparse Mixture of Experts within the locally deployed Diagnostic Specialist, which then provides the definitive diagnosis. Experimental evaluations on four standard Med-VQA datasets demonstrate that MedCoT surpasses existing state-of-the-art approaches, providing significant improvements in performance and interpretability.

Medical visual question answering (VQA) is a challenging multimodal task, where Vision-Language Pre-training (VLP) models can effectively improve the generalization performance. However, most methods in the medical field treat VQA as an answer classification task which is difficult to transfer to practical application scenarios. Additionally, due to the privacy of medical images and the expensive annotation process, large-scale medical image-text pairs datasets for pretraining are severely lacking. In this paper, we propose a large-scale MultI-task Self-Supervised learning based framework (MISS) for medical VQA tasks. Unlike existing methods, we treat medical VQA as a generative task. We unify the text encoder and multimodal encoder and align image-text features through multi-task learning. Furthermore, we propose a Transfer-and-Caption method that extends the feature space of single-modal image datasets using large language models (LLMs), enabling those traditional medical vision field task data to be applied to VLP. Experiments show that our method achieves excellent results with fewer multimodal datasets and demonstrates the advantages of generative VQA models. The code and model weights will be released upon the paper's acceptance.

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

The analysis of 3D medical images is crucial for modern healthcare, yet traditional task-specific models are becoming increasingly inadequate due to limited generalizability across diverse clinical scenarios. Multimodal large language models (MLLMs) offer a promising solution to these challenges. However, existing MLLMs have limitations in fully leveraging the rich, hierarchical information embedded in 3D medical images. Inspired by clinical practice, where radiologists focus on both 3D spatial structure and 2D planar content, we propose Med-2E3, a novel MLLM for 3D medical image analysis that integrates 3D and 2D encoders. To aggregate 2D features more effectively, we design a Text-Guided Inter-Slice (TG-IS) scoring module, which scores the attention of each 2D slice based on slice contents and task instructions. To the best of our knowledge, Med-2E3 is the first MLLM to integrate both 3D and 2D features for 3D medical image analysis. Experiments on a large-scale, open-source 3D medical multimodal benchmark demonstrate that Med-2E3 exhibits task-specific attention distribution and significantly outperforms current state-of-the-art models, with a 14% improvement in report generation and a 5% gain in medical visual question answering (VQA), highlighting the model's potential in addressing complex multimodal clinical tasks. The code will be released upon acceptance.

Medical image grounding aims to align natural language phrases with specific regions in medical images, serving as a foundational task for intelligent diagnosis, visual question answering (VQA), and automated report generation (MRG). However, existing research is constrained by limited modality coverage, coarse-grained annotations, and the absence of a unified, generalizable grounding framework. To address these challenges, we construct a large-scale medical grounding dataset Med-GLIP-5M comprising over 5.3 million region-level annotations across seven imaging modalities, covering diverse anatomical structures and pathological findings. The dataset supports both segmentation and grounding tasks with hierarchical region labels, ranging from organ-level boundaries to fine-grained lesions. Based on this foundation, we propose Med-GLIP, a modality-aware grounding framework trained on Med-GLIP-5M. Rather than relying on explicitly designed expert modules, Med-GLIP implicitly acquires hierarchical semantic understanding from diverse training data -- enabling it to recognize multi-granularity structures, such as distinguishing lungs from pneumonia lesions. Extensive experiments demonstrate that Med-GLIP consistently outperforms state-of-the-art baselines across multiple grounding benchmarks. Furthermore, integrating its spatial outputs into downstream tasks, including medical VQA and report generation, leads to substantial performance gains. Our dataset will be released soon.

Many clinical tasks require an understanding of specialized data, such as medical images and genomics, which is not typically found in general-purpose large multimodal models. Building upon Gemini's multimodal models, we develop several models within the new Med-Gemini family that inherit core capabilities of Gemini and are optimized for medical use via fine-tuning with 2D and 3D radiology, histopathology, ophthalmology, dermatology and genomic data. Med-Gemini-2D sets a new standard for AI-based chest X-ray (CXR) report generation based on expert evaluation, exceeding previous best results across two separate datasets by an absolute margin of 1% and 12%, where 57% and 96% of AI reports on normal cases, and 43% and 65% on abnormal cases, are evaluated as "equivalent or better" than the original radiologists' reports. We demonstrate the first ever large multimodal model-based report generation for 3D computed tomography (CT) volumes using Med-Gemini-3D, with 53% of AI reports considered clinically acceptable, although additional research is needed to meet expert radiologist reporting quality. Beyond report generation, Med-Gemini-2D surpasses the previous best performance in CXR visual question answering (VQA) and performs well in CXR classification and radiology VQA, exceeding SoTA or baselines on 17 of 20 tasks. In histopathology, ophthalmology, and dermatology image classification, Med-Gemini-2D surpasses baselines across 18 out of 20 tasks and approaches task-specific model performance. Beyond imaging, Med-Gemini-Polygenic outperforms the standard linear polygenic risk score-based approach for disease risk prediction and generalizes to genetically correlated diseases for which it has never been trained. Although further development and evaluation are necessary in the safety-critical medical domain, our results highlight the potential of Med-Gemini across a wide range of medical tasks.

Recent advancements in artificial intelligence (AI) have precipitated significant breakthroughs in healthcare, particularly in refining diagnostic procedures. However, previous studies have often been constrained to limited functionalities. This study introduces MiniGPT-Med, a vision-language model derived from large-scale language models and tailored for medical applications. MiniGPT-Med demonstrates remarkable versatility across various imaging modalities, including X-rays, CT scans, and MRIs, enhancing its utility. The model is capable of performing tasks such as medical report generation, visual question answering (VQA), and disease identification within medical imagery. Its integrated processing of both image and textual clinical data markedly improves diagnostic accuracy. Our empirical assessments confirm MiniGPT-Med's superior performance in disease grounding, medical report generation, and VQA benchmarks, representing a significant step towards reducing the gap in assisting radiology practice. Furthermore, it achieves state-of-the-art performance on medical report generation, higher than the previous best model by 19\% accuracy. MiniGPT-Med promises to become a general interface for radiology diagnoses, enhancing diagnostic efficiency across a wide range of medical imaging applications.

Medical Visual Question Answering (MedVQA), which offers language responses to image-based medical inquiries, represents a challenging task and significant advancement in healthcare. It assists medical experts to swiftly interpret medical images, thereby enabling faster and more accurate diagnoses. However, the model interpretability and transparency of existing MedVQA solutions are often limited, posing challenges in understanding their decision-making processes. To address this issue, we devise a semi-automated annotation process to streamline data preparation and build new benchmark MedVQA datasets R-RAD, R-SLAKE and R-Path. These datasets provide intermediate medical decision-making rationales generated by multimodal large language models and human annotations for question-answering pairs in existing MedVQA datasets, i.e., VQA-RAD, SLAKE and PathVQA. Moreover, we design a novel framework, MedThink, which finetunes lightweight pretrained generative models by incorporating medical decision-making rationales. MedThink includes three distinct strategies to generate decision outcomes and corresponding rationales, thereby clearly showcasing the medical decision-making process during reasoning. Our comprehensive experiments show that our method achieves an accuracy of 83.5% on R-RAD, 86.3% on R-SLAKE and 87.2% on R-Path. These results significantly exceed those of existing state-of-the-art models with comparable parameters. Datasets and code will be released.

Contrastive Language--Image Pre-training (CLIP) has shown remarkable success in learning with cross-modal supervision from extensive amounts of image--text pairs collected online. Thus far, the effectiveness of CLIP has been investigated primarily in general-domain multimodal problems. This work evaluates the effectiveness of CLIP for the task of Medical Visual Question Answering (MedVQA). To this end, we present PubMedCLIP, a fine-tuned version of CLIP for the medical domain based on PubMed articles. Our experiments are conducted on two MedVQA benchmark datasets and investigate two MedVQA methods, MEVF (Mixture of Enhanced Visual Features) and QCR (Question answering via Conditional Reasoning). For each of these, we assess the merits of visual representation learning using PubMedCLIP, the original CLIP, and state-of-the-art MAML (Model-Agnostic Meta-Learning) networks pre-trained only on visual data. We open source the code for our MedVQA pipeline and pre-training PubMedCLIP. CLIP and PubMedCLIP achieve improvements in comparison to MAML's visual encoder. PubMedCLIP achieves the best results with gains in the overall accuracy of up to 3%. Individual examples illustrate the strengths of PubMedCLIP in comparison to the previously widely used MAML networks. Visual representation learning with language supervision in PubMedCLIP leads to noticeable improvements for MedVQA. Our experiments reveal distributional differences in the two MedVQA benchmark datasets that have not been imparted in previous work and cause different back-end visual encoders in PubMedCLIP to exhibit different behavior on these datasets. Moreover, we witness fundamental performance differences of VQA in general versus medical domains.

In this paper, we focus on the problem of Medical Visual Question Answering (MedVQA), which is crucial in efficiently interpreting medical images with vital clinic-relevant information. Firstly, we reframe the problem of MedVQA as a generation task that naturally follows the human-machine interaction, we propose a generative-based model for medical visual understanding by aligning visual information from a pre-trained vision encoder with a large language model. Secondly, we establish a scalable pipeline to construct a large-scale medical visual question-answering dataset, named PMC-VQA, which contains 227k VQA pairs of 149k images that cover various modalities or diseases. Thirdly, we pre-train our proposed model on PMC-VQA and then fine-tune it on multiple public benchmarks, e.g., VQA-RAD and SLAKE, outperforming existing work by a large margin. Additionally, we propose a test set that has undergone manual verification, which is significantly more challenging, even the best models struggle to solve.

Medical Visual Question Answering (MedVQA) is a promising field for developing clinical decision support systems, yet progress is often limited by the available datasets, which can lack clinical complexity and visual diversity. To address these gaps, we introduce Kvasir-VQA-x1, a new, large-scale dataset for gastrointestinal (GI) endoscopy. Our work significantly expands upon the original Kvasir-VQA by incorporating 159,549 new question-answer pairs that are designed to test deeper clinical reasoning. We developed a systematic method using large language models to generate these questions, which are stratified by complexity to better assess a model's inference capabilities. To ensure our dataset prepares models for real-world clinical scenarios, we have also introduced a variety of visual augmentations that mimic common imaging artifacts. The dataset is structured to support two main evaluation tracks: one for standard VQA performance and another to test model robustness against these visual perturbations. By providing a more challenging and clinically relevant benchmark, Kvasir-VQA-x1 aims to accelerate the development of more reliable and effective multimodal AI systems for use in clinical settings. The dataset is fully accessible and adheres to FAIR data principles, making it a valuable resource for the wider research community. Code and data: https://github.com/Simula/Kvasir-VQA-x1 and https://huggingface.co/datasets/SimulaMet/Kvasir-VQA-x1

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-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-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 https://github.com/linjiemu/MMXU{https://github.com/linjiemu/MMXU}.

Medical visual question answering (VQA) aims to answer clinically relevant questions regarding input medical images. This technique has the potential to improve the efficiency of medical professionals while relieving the burden on the public health system, particularly in resource-poor countries. Existing medical VQA methods tend to encode medical images and learn the correspondence between visual features and questions without exploiting the spatial, semantic, or medical knowledge behind them. This is partially because of the small size of the current medical VQA dataset, which often includes simple questions. Therefore, we first collected a comprehensive and large-scale medical VQA dataset, focusing on chest X-ray images. The questions involved detailed relationships, such as disease names, locations, levels, and types in our dataset. Based on this dataset, we also propose a novel baseline method by constructing three different relationship graphs: spatial relationship, semantic relationship, and implicit relationship graphs on the image regions, questions, and semantic labels. The answer and graph reasoning paths are learned for different questions.

Medical visual question answering aims to support clinical decision-making by enabling models to answer natural language questions based on medical images. While recent advances in multi-modal learning have significantly improved performance, current methods still suffer from limited answer reliability and poor interpretability, impairing the ability of clinicians and patients to understand and trust model-generated answers. To address this, this work first proposes a Thinking with Visual Grounding (ThinkVG) dataset wherein the answer generation is decomposed into intermediate reasoning steps that explicitly ground relevant visual regions of the medical image, thereby providing fine-grained explainability. Furthermore, we introduce a novel verifiable reward mechanism for reinforcement learning to guide post-training, improving the alignment between the model's reasoning process and its final answer. Remarkably, our method achieves comparable performance using only one-eighth of the training data, demonstrating the efficiency and effectiveness of the proposal. The dataset is available at https://huggingface.co/datasets/BoKelvin/GEMeX-ThinkVG.

Large Vision-Language Models (LVLMs) have demonstrated remarkable capabilities in various multimodal tasks. However, their potential in the medical domain remains largely unexplored. A significant challenge arises from the scarcity of diverse medical images spanning various modalities and anatomical regions, which is essential in real-world medical applications. To solve this problem, in this paper, we introduce OmniMedVQA, a novel comprehensive medical Visual Question Answering (VQA) benchmark. This benchmark is collected from 75 different medical datasets, including 12 different modalities and covering more than 20 distinct anatomical regions. Importantly, all images in this benchmark are sourced from authentic medical scenarios, ensuring alignment with the requirements of the medical field and suitability for evaluating LVLMs. Through our extensive experiments, we have found that existing LVLMs struggle to address these medical VQA problems effectively. Moreover, what surprises us is that medical-specialized LVLMs even exhibit inferior performance to those general-domain models, calling for a more versatile and robust LVLM in the biomedical field. The evaluation results not only reveal the current limitations of LVLM in understanding real medical images but also highlight our dataset's significance. Our dataset will be made publicly available.

Traditional approaches for Visual Question Answering (VQA) require large amount of labeled data for training. Unfortunately, such large scale data is usually not available for medical domain. In this paper, we propose a novel medical VQA framework that overcomes the labeled data limitation. The proposed framework explores the use of the unsupervised Denoising Auto-Encoder (DAE) and the supervised Meta-Learning. The advantage of DAE is to leverage the large amount of unlabeled images while the advantage of Meta-Learning is to learn meta-weights that quickly adapt to VQA problem with limited labeled data. By leveraging the advantages of these techniques, it allows the proposed framework to be efficiently trained using a small labeled training set. The experimental results show that our proposed method significantly outperforms the state-of-the-art medical VQA.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Bridging clinical diagnostic reasoning with AI remains a central challenge in medical imaging. We introduce MedCLM, an automated pipeline that converts detection datasets into large-scale medical visual question answering (VQA) data with Chain-of-Thought (CoT) reasoning by linking lesion boxes to organ segmentation and structured rationales. These contextual signals enable medical vision-language models to generate question-answer pairs with step-by-step reasoning. To utilize this data effectively, we propose an Integrated CoT-Curriculum Strategy composed of an Easy stage with explicit lesion boxes for visual grounding, a Medium stage that encourages implicit localization, and a Hard stage for weakly supervised reasoning. Experimental results demonstrate that MedCLM attains state-of-the-art performance on several medical VQA benchmarks, providing a scalable framework for developing clinically aligned medical vision-language models.

In this paper, we critically evaluate the capabilities of the state-of-the-art multimodal large language model, i.e., GPT-4 with Vision (GPT-4V), on Visual Question Answering (VQA) task. Our experiments thoroughly assess GPT-4V's proficiency in answering questions paired with images using both pathology and radiology datasets from 11 modalities (e.g. Microscopy, Dermoscopy, X-ray, CT, etc.) and fifteen objects of interests (brain, liver, lung, etc.). Our datasets encompass a comprehensive range of medical inquiries, including sixteen distinct question types. Throughout our evaluations, we devised textual prompts for GPT-4V, directing it to synergize visual and textual information. The experiments with accuracy score conclude that the current version of GPT-4V is not recommended for real-world diagnostics due to its unreliable and suboptimal accuracy in responding to diagnostic medical questions. In addition, we delineate seven unique facets of GPT-4V's behavior in medical VQA, highlighting its constraints within this complex arena. The complete details of our evaluation cases are accessible at https://github.com/ZhilingYan/GPT4V-Medical-Report.

Existing medical VQA benchmarks mostly focus on single-image analysis, yet clinicians almost always compare a series of images before reaching a diagnosis. To better approximate this workflow, we introduce MedFrameQA -- the first benchmark that explicitly evaluates multi-image reasoning in medical VQA. To build MedFrameQA both at scale and in high-quality, we develop 1) an automated pipeline that extracts temporally coherent frames from medical videos and constructs VQA items whose content evolves logically across images, and 2) a multiple-stage filtering strategy, including model-based and manual review, to preserve data clarity, difficulty, and medical relevance. The resulting dataset comprises 2,851 VQA pairs (gathered from 9,237 high-quality frames in 3,420 videos), covering nine human body systems and 43 organs; every question is accompanied by two to five images. We comprehensively benchmark ten advanced Multimodal LLMs -- both proprietary and open source, with and without explicit reasoning modules -- on MedFrameQA. The evaluation challengingly reveals that all models perform poorly, with most accuracies below 50%, and accuracy fluctuates as the number of images per question increases. Error analysis further shows that models frequently ignore salient findings, mis-aggregate evidence across images, and propagate early mistakes through their reasoning chains; results also vary substantially across body systems, organs, and modalities. We hope this work can catalyze research on clinically grounded, multi-image reasoning and accelerate progress toward more capable diagnostic AI systems.

Biomedical visual question answering (VQA) has been widely studied and has demonstrated significant application value and potential in fields such as assistive medical diagnosis. Despite their success, current biomedical VQA models perform multimodal information interaction only at the model level within large language models (LLMs), leading to suboptimal multimodal semantic alignment when dealing with complex tasks. To address this issue, we propose BioD2C: a novel Dual-level Semantic Consistency Constraint Framework for Biomedical VQA, which achieves dual-level semantic interaction alignment at both the model and feature levels, enabling the model to adaptively learn visual features based on the question. Specifically, we firstly integrate textual features into visual features via an image-text fusion mechanism as feature-level semantic interaction, obtaining visual features conditioned on the given text; and then introduce a text-queue-based cross-modal soft semantic loss function to further align the image semantics with the question semantics. Specifically, in this work, we establish a new dataset, BioVGQ, to address inherent biases in prior datasets by filtering manually-altered images and aligning question-answer pairs with multimodal context, and train our model on this dataset. Extensive experimental results demonstrate that BioD2C achieves state-of-the-art (SOTA) performance across multiple downstream datasets, showcasing its robustness, generalizability, and potential to advance biomedical VQA research.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

We propose the task of free-form and open-ended Visual Question Answering (VQA). Given an image and a natural language question about the image, the task is to provide an accurate natural language answer. Mirroring real-world scenarios, such as helping the visually impaired, both the questions and answers are open-ended. Visual questions selectively target different areas of an image, including background details and underlying context. As a result, a system that succeeds at VQA typically needs a more detailed understanding of the image and complex reasoning than a system producing generic image captions. Moreover, VQA is amenable to automatic evaluation, since many open-ended answers contain only a few words or a closed set of answers that can be provided in a multiple-choice format. We provide a dataset containing ~0.25M images, ~0.76M questions, and ~10M answers (www.visualqa.org), and discuss the information it provides. Numerous baselines and methods for VQA are provided and compared with human performance. Our VQA demo is available on CloudCV (http://cloudcv.org/vqa).

Vision-Language Models (VLMs) have shown promise in various 2D visual tasks, yet their readiness for 3D clinical diagnosis remains unclear due to stringent demands for recognition precision, reasoning ability, and domain knowledge. To systematically evaluate these dimensions, we present DeepTumorVQA, a diagnostic visual question answering (VQA) benchmark targeting abdominal tumors in CT scans. It comprises 9,262 CT volumes (3.7M slices) from 17 public datasets, with 395K expert-level questions spanning four categories: Recognition, Measurement, Visual Reasoning, and Medical Reasoning. DeepTumorVQA introduces unique challenges, including small tumor detection and clinical reasoning across 3D anatomy. Benchmarking four advanced VLMs (RadFM, M3D, Merlin, CT-CHAT), we find current models perform adequately on measurement tasks but struggle with lesion recognition and reasoning, and are still not meeting clinical needs. Two key insights emerge: (1) large-scale multimodal pretraining plays a crucial role in DeepTumorVQA testing performance, making RadFM stand out among all VLMs. (2) Our dataset exposes critical differences in VLM components, where proper image preprocessing and design of vision modules significantly affect 3D perception. To facilitate medical multimodal research, we have released DeepTumorVQA as a rigorous benchmark: https://github.com/Schuture/DeepTumorVQA.

In recent years, visual question answering (VQA) has attracted attention from the research community because of its highly potential applications (such as virtual assistance on intelligent cars, assistant devices for blind people, or information retrieval from document images using natural language as queries) and challenge. The VQA task requires methods that have the ability to fuse the information from questions and images to produce appropriate answers. Neural visual question answering models have achieved tremendous growth on large-scale datasets which are mostly for resource-rich languages such as English. However, available datasets narrow the VQA task as the answers selection task or answer classification task. We argue that this form of VQA is far from human ability and eliminates the challenge of the answering aspect in the VQA task by just selecting answers rather than generating them. In this paper, we introduce the OpenViVQA (Open-domain Vietnamese Visual Question Answering) dataset, the first large-scale dataset for VQA with open-ended answers in Vietnamese, consists of 11,000+ images associated with 37,000+ question-answer pairs (QAs). Moreover, we proposed FST, QuMLAG, and MLPAG which fuse information from images and answers, then use these fused features to construct answers as humans iteratively. Our proposed methods achieve results that are competitive with SOTA models such as SAAA, MCAN, LORA, and M4C. The dataset is available to encourage the research community to develop more generalized algorithms including transformers for low-resource languages such as Vietnamese.

Recent advancements in vision-language systems have improved the accuracy of Radiological Visual Question Answering (VQA) Models. However, some challenges remain across each stage of model development: limited expert-labeled images hinders data procurement at scale; the intricate and nuanced patterns of radiological images make modeling inherently difficult; and the lack of evaluation evaluation efforts makes it difficult to identify cases where the model might be ill-conditioned. In this study, we fine-tune a lightweight 3B parameter vision-language model for Radiological VQA, demonstrating that small models, when appropriately tuned with curated data, can achieve robust performance across both open- and closed-ended questions. We propose a cost-effective training pipeline from synthetic question-answer pair generation to multi-stage fine-tuning on specialised radiological domain-targeted datasets (e.g., ROCO v2.0, MedPix v2.0). Our results show that despite operating at a fraction of the scale of state-of-the-art models such as LLaVA-Med, our model achieves promising performance given its small parameter size and the limited scale of training data. We introduce a lightweight saliency-based diagnostic tool that enables domain experts to inspect VQA model performance and identify ill-conditioned failure modes through saliency analysis.

Computed Tomography (CT) scan, which produces 3D volumetric medical data that can be viewed as hundreds of cross-sectional images (a.k.a. slices), provides detailed anatomical information for diagnosis. For radiologists, creating CT radiology reports is time-consuming and error-prone. A visual question answering (VQA) system that can answer radiologists' questions about some anatomical regions on the CT scan and even automatically generate a radiology report is urgently needed. However, existing VQA systems cannot adequately handle the CT radiology question answering (CTQA) task for: (1) anatomic complexity makes CT images difficult to understand; (2) spatial relationship across hundreds slices is difficult to capture. To address these issues, this paper proposes CT-Agent, a multimodal agentic framework for CTQA. CT-Agent adopts anatomically independent tools to break down the anatomic complexity; furthermore, it efficiently captures the across-slice spatial relationship with a global-local token compression strategy. Experimental results on two 3D chest CT datasets, CT-RATE and RadGenome-ChestCT, verify the superior performance of CT-Agent.

Modern operating room is becoming increasingly complex, requiring innovative intra-operative support systems. While the focus of surgical data science has largely been on video analysis, integrating surgical computer vision with language capabilities is emerging as a necessity. Our work aims to advance Visual Question Answering (VQA) in the surgical context with scene graph knowledge, addressing two main challenges in the current surgical VQA systems: removing question-condition bias in the surgical VQA dataset and incorporating scene-aware reasoning in the surgical VQA model design. First, we propose a Surgical Scene Graph-based dataset, SSG-QA, generated by employing segmentation and detection models on publicly available datasets. We build surgical scene graphs using spatial and action information of instruments and anatomies. These graphs are fed into a question engine, generating diverse QA pairs. Our SSG-QA dataset provides a more complex, diverse, geometrically grounded, unbiased, and surgical action-oriented dataset compared to existing surgical VQA datasets. We then propose SSG-QA-Net, a novel surgical VQA model incorporating a lightweight Scene-embedded Interaction Module (SIM), which integrates geometric scene knowledge in the VQA model design by employing cross-attention between the textual and the scene features. Our comprehensive analysis of the SSG-QA dataset shows that SSG-QA-Net outperforms existing methods across different question types and complexities. We highlight that the primary limitation in the current surgical VQA systems is the lack of scene knowledge to answer complex queries. We present a novel surgical VQA dataset and model and show that results can be significantly improved by incorporating geometric scene features in the VQA model design. The source code and the dataset will be made publicly available at: https://github.com/CAMMA-public/SSG-QA

Large Multimodal Models (LMMs) are increasingly capable of answering medical questions that require joint reasoning over images and text, yet training general medical VQA systems is impeded by the lack of large, openly usable, high-quality corpora. We present MedVLSynther, a rubric-guided generator-verifier framework that synthesizes high-quality multiple-choice VQA items directly from open biomedical literature by conditioning on figures, captions, and in-text references. The generator produces self-contained stems and parallel, mutually exclusive options under a machine-checkable JSON schema; a multi-stage verifier enforces essential gates (self-containment, single correct answer, clinical validity, image-text consistency), awards fine-grained positive points, and penalizes common failure modes before acceptance. Applying this pipeline to PubMed Central yields MedSynVQA: 13,087 audited questions over 14,803 images spanning 13 imaging modalities and 28 anatomical regions. Training open-weight LMMs with reinforcement learning using verifiable rewards improves accuracy across six medical VQA benchmarks, achieving averages of 55.85 (3B) and 58.15 (7B), with up to 77.57 on VQA-RAD and 67.76 on PathVQA, outperforming strong medical LMMs. A Ablations verify that both generation and verification are necessary and that more verified data consistently helps, and a targeted contamination analysis detects no leakage from evaluation suites. By operating entirely on open literature and open-weight models, MedVLSynther offers an auditable, reproducible, and privacy-preserving path to scalable medical VQA training data.

Visual Question Answering (VQA) is a challenging task of natural language processing (NLP) and computer vision (CV), attracting significant attention from researchers. English is a resource-rich language that has witnessed various developments in datasets and models for visual question answering. Visual question answering in other languages also would be developed for resources and models. In addition, there is no multilingual dataset targeting the visual content of a particular country with its own objects and cultural characteristics. To address the weakness, we provide the research community with a benchmark dataset named EVJVQA, including 33,000+ pairs of question-answer over three languages: Vietnamese, English, and Japanese, on approximately 5,000 images taken from Vietnam for evaluating multilingual VQA systems or models. EVJVQA is used as a benchmark dataset for the challenge of multilingual visual question answering at the 9th Workshop on Vietnamese Language and Speech Processing (VLSP 2022). This task attracted 62 participant teams from various universities and organizations. In this article, we present details of the organization of the challenge, an overview of the methods employed by shared-task participants, and the results. The highest performances are 0.4392 in F1-score and 0.4009 in BLUE on the private test set. The multilingual QA systems proposed by the top 2 teams use ViT for the pre-trained vision model and mT5 for the pre-trained language model, a powerful pre-trained language model based on the transformer architecture. EVJVQA is a challenging dataset that motivates NLP and CV researchers to further explore the multilingual models or systems for visual question answering systems. We released the challenge on the Codalab evaluation system for further research.

Visual Question-Answering (VQA) has become a key use-case in several applications to aid user experience, particularly after Vision-Language Models (VLMs) achieving good results in zero-shot inference. But evaluating different VLMs for an application requirement using a standardized framework in practical settings is still challenging. This paper introduces a comprehensive framework for evaluating VLMs tailored to VQA tasks in practical settings. We present a novel dataset derived from established VQA benchmarks, annotated with task types, application domains, and knowledge types, three key practical aspects on which tasks can vary. We also introduce GoEval, a multimodal evaluation metric developed using GPT-4o, achieving a correlation factor of 56.71% with human judgments. Our experiments with ten state-of-the-art VLMs reveals that no single model excelling universally, making appropriate selection a key design decision. Proprietary models such as Gemini-1.5-Pro and GPT-4o-mini generally outperform others, though open-source models like InternVL-2-8B and CogVLM-2-Llama-3-19B demonstrate competitive strengths in specific contexts, while providing additional advantages. This study guides the selection of VLMs based on specific task requirements and resource constraints, and can also be extended to other vision-language tasks.

Existing medical reasoning benchmarks for vision-language models primarily focus on analyzing a patient's condition based on an image from a single visit. However, this setting deviates significantly from real-world clinical practice, where doctors typically refer to a patient's historical conditions to provide a comprehensive assessment by tracking their changes over time. In this paper, we introduce TemMed-Bench, the first benchmark designed for analyzing changes in patients' conditions between different clinical visits, which challenges large vision-language models (LVLMs) to reason over temporal medical images. TemMed-Bench consists of a test set comprising three tasks - visual question-answering (VQA), report generation, and image-pair selection - and a supplementary knowledge corpus of over 17,000 instances. With TemMed-Bench, we conduct an evaluation of six proprietary and six open-source LVLMs. Our results show that most LVLMs lack the ability to analyze patients' condition changes over temporal medical images, and a large proportion perform only at a random-guessing level in the closed-book setting. In contrast, GPT o3, o4-mini and Claude 3.5 Sonnet demonstrate comparatively decent performance, though they have yet to reach the desired level. Furthermore, we explore augmenting the input with both retrieved visual and textual modalities in the medical domain. We also show that multi-modal retrieval augmentation yields notably higher performance gains than no retrieval and textual retrieval alone across most models on our benchmark, with the VQA task showing an average improvement of 2.59%. Overall, we compose a benchmark grounded on real-world clinical practice, and it reveals LVLMs' limitations in temporal medical image reasoning, as well as highlighting the use of multi-modal retrieval augmentation as a potentially promising direction worth exploring to address this challenge.

Visual question answering (VQA) is known as an AI-complete task as it requires understanding, reasoning, and inferring about the vision and the language content. Over the past few years, numerous neural architectures have been suggested for the VQA problem. However, achieving success in zero-shot VQA remains a challenge due to its requirement for advanced generalization and reasoning skills. This study explores the impact of incorporating image captioning as an intermediary process within the VQA pipeline. Specifically, we explore the efficacy of utilizing image captions instead of images and leveraging large language models (LLMs) to establish a zero-shot setting. Since image captioning is the most crucial step in this process, we compare the impact of state-of-the-art image captioning models on VQA performance across various question types in terms of structure and semantics. We propose a straightforward and efficient question-driven image captioning approach within this pipeline to transfer contextual information into the question-answering (QA) model. This method involves extracting keywords from the question, generating a caption for each image-question pair using the keywords, and incorporating the question-driven caption into the LLM prompt. We evaluate the efficacy of using general-purpose and question-driven image captions in the VQA pipeline. Our study highlights the potential of employing image captions and harnessing the capabilities of LLMs to achieve competitive performance on GQA under the zero-shot setting. Our code is available at https://github.com/ovguyo/captions-in-VQA.

Visual Question Answering (VQA) has emerged as a pivotal task in the intersection of computer vision and natural language processing, requiring models to understand and reason about visual content in response to natural language questions. Analyzing VQA datasets is essential for developing robust models that can handle the complexities of multimodal reasoning. Several approaches have been developed to examine these datasets, each offering distinct perspectives on question diversity, answer distribution, and visual-textual correlations. Despite significant progress, existing VQA models face challenges related to dataset bias, limited model complexity, commonsense reasoning gaps, rigid evaluation methods, and generalization to real world scenarios. This paper offers a detailed study of the original VQA dataset, baseline models and methods along with a comparative study of five advanced VQA models, ABC-CNN, KICNLE, Masked Vision and Language Modeling, BLIP-2, and OFA, each employing distinct methods to address these ongoing challenges.

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI. Project Page: https://uni-medical.github.io/GMAI-MMBench.github.io/

Medical vision-and-language pre-training (Med-VLP) has shown promising improvements on many downstream medical tasks owing to its applicability to extracting generic representations from medical images and texts. Practically, there exist two typical types, i.e., the fusion-encoder type and the dual-encoder type, depending on whether a heavy fusion module is used. The former is superior at multi-modal tasks owing to the sufficient interaction between modalities; the latter is good at uni-modal and cross-modal tasks due to the single-modality encoding ability. To take advantage of these two types, we propose an effective yet straightforward scheme named PTUnifier to unify the two types. We first unify the input format by introducing visual and textual prompts, which serve as a feature bank that stores the most representative images/texts. By doing so, a single model could serve as a foundation model that processes various tasks adopting different input formats (i.e., image-only, text-only, and image-text-pair). Furthermore, we construct a prompt pool (instead of static ones) to improve diversity and scalability. Experimental results show that our approach achieves state-of-the-art results on a broad range of tasks, spanning uni-modal tasks (i.e., image/text classification and text summarization), cross-modal tasks (i.e., image-to-text generation and image-text/text-image retrieval), and multi-modal tasks (i.e., visual question answering), demonstrating the effectiveness of our approach. Note that the adoption of prompts is orthogonal to most existing Med-VLP approaches and could be a beneficial and complementary extension to these approaches.

This paper presents a comprehensive evaluation of GPT-4V's capabilities across diverse medical imaging tasks, including Radiology Report Generation, Medical Visual Question Answering (VQA), and Visual Grounding. While prior efforts have explored GPT-4V's performance in medical image analysis, to the best of our knowledge, our study represents the first quantitative evaluation on publicly available benchmarks. Our findings highlight GPT-4V's potential in generating descriptive reports for chest X-ray images, particularly when guided by well-structured prompts. Meanwhile, its performance on the MIMIC-CXR dataset benchmark reveals areas for improvement in certain evaluation metrics, such as CIDEr. In the domain of Medical VQA, GPT-4V demonstrates proficiency in distinguishing between question types but falls short of the VQA-RAD benchmark in terms of accuracy. Furthermore, our analysis finds the limitations of conventional evaluation metrics like the BLEU scores, advocating for the development of more semantically robust assessment methods. In the field of Visual Grounding, GPT-4V exhibits preliminary promise in recognizing bounding boxes, but its precision is lacking, especially in identifying specific medical organs and signs. Our evaluation underscores the significant potential of GPT-4V in the medical imaging domain, while also emphasizing the need for targeted refinements to fully unlock its capabilities.

We present ReXVQA, the largest and most comprehensive benchmark for visual question answering (VQA) in chest radiology, comprising approximately 696,000 questions paired with 160,000 chest X-rays studies across training, validation, and test sets. Unlike prior efforts that rely heavily on template based queries, ReXVQA introduces a diverse and clinically authentic task suite reflecting five core radiological reasoning skills: presence assessment, location analysis, negation detection, differential diagnosis, and geometric reasoning. We evaluate eight state-of-the-art multimodal large language models, including MedGemma-4B-it, Qwen2.5-VL, Janus-Pro-7B, and Eagle2-9B. The best-performing model (MedGemma) achieves 83.24% overall accuracy. To bridge the gap between AI performance and clinical expertise, we conducted a comprehensive human reader study involving 3 radiology residents on 200 randomly sampled cases. Our evaluation demonstrates that MedGemma achieved superior performance (83.84% accuracy) compared to human readers (best radiology resident: 77.27%), representing a significant milestone where AI performance exceeds expert human evaluation on chest X-ray interpretation. The reader study reveals distinct performance patterns between AI models and human experts, with strong inter-reader agreement among radiologists while showing more variable agreement patterns between human readers and AI models. ReXVQA establishes a new standard for evaluating generalist radiological AI systems, offering public leaderboards, fine-grained evaluation splits, structured explanations, and category-level breakdowns. This benchmark lays the foundation for next-generation AI systems capable of mimicking expert-level clinical reasoning beyond narrow pathology classification. Our dataset will be open-sourced at https://huggingface.co/datasets/rajpurkarlab/ReXVQA

Reasoning is a critical frontier for advancing medical image analysis, where transparency and trustworthiness play a central role in both clinician trust and regulatory approval. Although Medical Visual Language Models (VLMs) show promise for radiological tasks, most existing VLMs merely produce final answers without revealing the underlying reasoning. To address this gap, we introduce MedVLM-R1, a medical VLM that explicitly generates natural language reasoning to enhance transparency and trustworthiness. Instead of relying on supervised fine-tuning (SFT), which often suffers from overfitting to training distributions and fails to foster genuine reasoning, MedVLM-R1 employs a reinforcement learning framework that incentivizes the model to discover human-interpretable reasoning paths without using any reasoning references. Despite limited training data (600 visual question answering samples) and model parameters (2B), MedVLM-R1 boosts accuracy from 55.11% to 78.22% across MRI, CT, and X-ray benchmarks, outperforming larger models trained on over a million samples. It also demonstrates robust domain generalization under out-of-distribution tasks. By unifying medical image analysis with explicit reasoning, MedVLM-R1 marks a pivotal step toward trustworthy and interpretable AI in clinical practice.

Visual Question Answering (VQA) is a multimodal task requiring reasoning across textual and visual inputs, which becomes particularly challenging in low-resource languages like Vietnamese due to linguistic variability and the lack of high-quality datasets. Traditional methods often rely heavily on extensive annotated datasets, computationally expensive pipelines, and large pre-trained models, specifically in the domain of Vietnamese VQA, limiting their applicability in such scenarios. To address these limitations, we propose a training framework that combines a paraphrase-based feature augmentation module with a dynamic curriculum learning strategy. Explicitly, augmented samples are considered "easy" while raw samples are regarded as "hard". The framework then utilizes a mechanism that dynamically adjusts the ratio of easy to hard samples during training, progressively modifying the same dataset to increase its difficulty level. By enabling gradual adaptation to task complexity, this approach helps the Vietnamese VQA model generalize well, thus improving overall performance. Experimental results show consistent improvements on the OpenViVQA dataset and mixed outcomes on the ViVQA dataset, highlighting both the potential and challenges of our approach in advancing VQA for Vietnamese language.

Visual Question Answering (VQA) in its ideal form lets us study reasoning in the joint space of vision and language and serves as a proxy for the AI task of scene understanding. However, most VQA benchmarks to date are focused on questions such as simple counting, visual attributes, and object detection that do not require reasoning or knowledge beyond what is in the image. In this paper, we address the task of knowledge-based visual question answering and provide a benchmark, called OK-VQA, where the image content is not sufficient to answer the questions, encouraging methods that rely on external knowledge resources. Our new dataset includes more than 14,000 questions that require external knowledge to answer. We show that the performance of the state-of-the-art VQA models degrades drastically in this new setting. Our analysis shows that our knowledge-based VQA task is diverse, difficult, and large compared to previous knowledge-based VQA datasets. We hope that this dataset enables researchers to open up new avenues for research in this domain. See http://okvqa.allenai.org to download and browse the dataset.

Medical vision-language models (VLMs) have shown promise as clinical assistants across various medical fields. However, specialized dermatology VLM capable of delivering professional and detailed diagnostic analysis remains underdeveloped, primarily due to less specialized text descriptions in current dermatology multimodal datasets. To address this issue, we propose MM-Skin, the first large-scale multimodal dermatology dataset that encompasses 3 imaging modalities, including clinical, dermoscopic, and pathological and nearly 10k high-quality image-text pairs collected from professional textbooks. In addition, we generate over 27k diverse, instruction-following vision question answering (VQA) samples (9 times the size of current largest dermatology VQA dataset). Leveraging public datasets and MM-Skin, we developed SkinVL, a dermatology-specific VLM designed for precise and nuanced skin disease interpretation. Comprehensive benchmark evaluations of SkinVL on VQA, supervised fine-tuning (SFT) and zero-shot classification tasks across 8 datasets, reveal its exceptional performance for skin diseases in comparison to both general and medical VLM models. The introduction of MM-Skin and SkinVL offers a meaningful contribution to advancing the development of clinical dermatology VLM assistants. MM-Skin is available at https://github.com/ZwQ803/MM-Skin

In the healthcare domain, summarizing medical questions posed by patients is critical for improving doctor-patient interactions and medical decision-making. Although medical data has grown in complexity and quantity, the current body of research in this domain has primarily concentrated on text-based methods, overlooking the integration of visual cues. Also prior works in the area of medical question summarisation have been limited to the English language. This work introduces the task of multimodal medical question summarization for codemixed input in a low-resource setting. To address this gap, we introduce the Multimodal Medical Codemixed Question Summarization MMCQS dataset, which combines Hindi-English codemixed medical queries with visual aids. This integration enriches the representation of a patient's medical condition, providing a more comprehensive perspective. We also propose a framework named MedSumm that leverages the power of LLMs and VLMs for this task. By utilizing our MMCQS dataset, we demonstrate the value of integrating visual information from images to improve the creation of medically detailed summaries. This multimodal strategy not only improves healthcare decision-making but also promotes a deeper comprehension of patient queries, paving the way for future exploration in personalized and responsive medical care. Our dataset, code, and pre-trained models will be made publicly available.

Visual Question Answering (VQA) is a complicated task that requires the capability of simultaneously processing natural language and images. Initially, this task was researched, focusing on methods to help machines understand objects and scene contexts in images. However, some text appearing in the image that carries explicit information about the full content of the image is not mentioned. Along with the continuous development of the AI era, there have been many studies on the reading comprehension ability of VQA models in the world. As a developing country, conditions are still limited, and this task is still open in Vietnam. Therefore, we introduce the first large-scale dataset in Vietnamese specializing in the ability to understand text appearing in images, we call it ViTextVQA (Vietnamese Text-based Visual Question Answering dataset) which contains over 16,000 images and over 50,000 questions with answers. Through meticulous experiments with various state-of-the-art models, we uncover the significance of the order in which tokens in OCR text are processed and selected to formulate answers. This finding helped us significantly improve the performance of the baseline models on the ViTextVQA dataset. Our dataset is available at this https://github.com/minhquan6203/ViTextVQA-Dataset{link} for research purposes.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Visual Question Answering (VQA) is an important task in multimodal AI, and it is often used to test the ability of vision-language models to understand and reason on knowledge present in both visual and textual data. However, most of the current VQA models use datasets that are primarily focused on English and a few major world languages, with images that are typically Western-centric. While recent efforts have tried to increase the number of languages covered on VQA datasets, they still lack diversity in low-resource languages. More importantly, although these datasets often extend their linguistic range via translation or some other approaches, they usually keep images the same, resulting in narrow cultural representation. To address these limitations, we construct CVQA, a new Culturally-diverse multilingual Visual Question Answering benchmark, designed to cover a rich set of languages and cultures, where we engage native speakers and cultural experts in the data collection process. As a result, CVQA includes culturally-driven images and questions from across 28 countries on four continents, covering 26 languages with 11 scripts, providing a total of 9k questions. We then benchmark several Multimodal Large Language Models (MLLMs) on CVQA, and show that the dataset is challenging for the current state-of-the-art models. This benchmark can serve as a probing evaluation suite for assessing the cultural capability and bias of multimodal models and hopefully encourage more research efforts toward increasing cultural awareness and linguistic diversity in this field.

Vision and language understanding has emerged as a subject undergoing intense study in Artificial Intelligence. Among many tasks in this line of research, visual question answering (VQA) has been one of the most successful ones, where the goal is to learn a model that understands visual content at region-level details and finds their associations with pairs of questions and answers in the natural language form. Despite the rapid progress in the past few years, most existing work in VQA have focused primarily on images. In this paper, we focus on extending VQA to the video domain and contribute to the literature in three important ways. First, we propose three new tasks designed specifically for video VQA, which require spatio-temporal reasoning from videos to answer questions correctly. Next, we introduce a new large-scale dataset for video VQA named TGIF-QA that extends existing VQA work with our new tasks. Finally, we propose a dual-LSTM based approach with both spatial and temporal attention, and show its effectiveness over conventional VQA techniques through empirical evaluations.

Is it possible to develop an "AI Pathologist" to pass the board-certified examination of the American Board of Pathology? To achieve this goal, the first step is to create a visual question answering (VQA) dataset where the AI agent is presented with a pathology image together with a question and is asked to give the correct answer. Our work makes the first attempt to build such a dataset. Different from creating general-domain VQA datasets where the images are widely accessible and there are many crowdsourcing workers available and capable of generating question-answer pairs, developing a medical VQA dataset is much more challenging. First, due to privacy concerns, pathology images are usually not publicly available. Second, only well-trained pathologists can understand pathology images, but they barely have time to help create datasets for AI research. To address these challenges, we resort to pathology textbooks and online digital libraries. We develop a semi-automated pipeline to extract pathology images and captions from textbooks and generate question-answer pairs from captions using natural language processing. We collect 32,799 open-ended questions from 4,998 pathology images where each question is manually checked to ensure correctness. To our best knowledge, this is the first dataset for pathology VQA. Our dataset will be released publicly to promote research in medical VQA.

We propose Visual-only Question Answering (VoQA), a novel multimodal task in which questions are visually embedded within images, without any accompanying textual input. This requires models to locate, recognize, and reason over visually embedded textual questions, posing challenges for existing large vision-language models (LVLMs), which show notable performance drops even with carefully designed prompts. To bridge this gap, we introduce Guided Response Triggering Supervised Fine-tuning (GRT-SFT), a structured fine-tuning strategy that guides the model to perform step-by-step reasoning purely based on visual input, significantly improving model performance. Our work enhances models' capacity for human-like visual understanding in complex multimodal scenarios, where information, including language, is perceived visually.

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

In recent years, Multimodal Large Language Models (MLLM) have achieved notable advancements, demonstrating the feasibility of developing an intelligent biomedical assistant. However, current biomedical MLLMs predominantly focus on image-level understanding and restrict interactions to textual commands, thus limiting their capability boundaries and the flexibility of usage. In this paper, we introduce a novel end-to-end multimodal large language model for the biomedical domain, named MedPLIB, which possesses pixel-level understanding. Excitingly, it supports visual question answering (VQA), arbitrary pixel-level prompts (points, bounding boxes, and free-form shapes), and pixel-level grounding. We propose a novel Mixture-of-Experts (MoE) multi-stage training strategy, which divides MoE into separate training phases for a visual-language expert model and a pixel-grounding expert model, followed by fine-tuning using MoE. This strategy effectively coordinates multitask learning while maintaining the computational cost at inference equivalent to that of a single expert model. To advance the research of biomedical MLLMs, we introduce the Medical Complex Vision Question Answering Dataset (MeCoVQA), which comprises an array of 8 modalities for complex medical imaging question answering and image region understanding. Experimental results indicate that MedPLIB has achieved state-of-the-art outcomes across multiple medical visual language tasks. More importantly, in zero-shot evaluations for the pixel grounding task, MedPLIB leads the best small and large models by margins of 19.7 and 15.6 respectively on the mDice metric. The codes, data, and model checkpoints will be made publicly available at https://github.com/ShawnHuang497/MedPLIB.

The Visual Question Answering (VQA) task aspires to provide a meaningful testbed for the development of AI models that can jointly reason over visual and natural language inputs. Despite a proliferation of VQA datasets, this goal is hindered by a set of common limitations. These include a reliance on relatively simplistic questions that are repetitive in both concepts and linguistic structure, little world knowledge needed outside of the paired image, and limited reasoning required to arrive at the correct answer. We introduce A-OKVQA, a crowdsourced dataset composed of a diverse set of about 25K questions requiring a broad base of commonsense and world knowledge to answer. In contrast to the existing knowledge-based VQA datasets, the questions generally cannot be answered by simply querying a knowledge base, and instead require some form of commonsense reasoning about the scene depicted in the image. We demonstrate the potential of this new dataset through a detailed analysis of its contents and baseline performance measurements over a variety of state-of-the-art vision-language models. Project page: http://a-okvqa.allenai.org/

Medical Visual Language Models have shown great potential in various healthcare applications, including medical image captioning and diagnostic assistance. However, most existing models rely on text-based instructions, limiting their usability in real-world clinical environments especially in scenarios such as surgery, text-based interaction is often impractical for physicians. In addition, current medical image analysis models typically lack comprehensive reasoning behind their predictions, which reduces their reliability for clinical decision-making. Given that medical diagnosis errors can have life-changing consequences, there is a critical need for interpretable and rational medical assistance. To address these challenges, we introduce an end-to-end speech-driven medical VLM, SilVar-Med, a multimodal medical image assistant that integrates speech interaction with VLMs, pioneering the task of voice-based communication for medical image analysis. In addition, we focus on the interpretation of the reasoning behind each prediction of medical abnormalities with a proposed reasoning dataset. Through extensive experiments, we demonstrate a proof-of-concept study for reasoning-driven medical image interpretation with end-to-end speech interaction. We believe this work will advance the field of medical AI by fostering more transparent, interactive, and clinically viable diagnostic support systems. Our code and dataset are publicly available at SiVar-Med.

Vision-Language (VL) models have gained significant research focus, enabling remarkable advances in multimodal reasoning. These architectures typically comprise a vision encoder, a Large Language Model (LLM), and a projection module that aligns visual features with the LLM's representation space. Despite their success, a critical limitation persists: the vision encoding process remains decoupled from user queries, often in the form of image-related questions. Consequently, the resulting visual features may not be optimally attuned to the query-specific elements of the image. To address this, we introduce QA-ViT, a Question Aware Vision Transformer approach for multimodal reasoning, which embeds question awareness directly within the vision encoder. This integration results in dynamic visual features focusing on relevant image aspects to the posed question. QA-ViT is model-agnostic and can be incorporated efficiently into any VL architecture. Extensive experiments demonstrate the effectiveness of applying our method to various multimodal architectures, leading to consistent improvement across diverse tasks and showcasing its potential for enhancing visual and scene-text understanding.

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Medical vision-and-language pre-training (Med-VLP) has received considerable attention owing to its applicability to extracting generic vision-and-language representations from medical images and texts. Most existing methods mainly contain three elements: uni-modal encoders (i.e., a vision encoder and a language encoder), a multi-modal fusion module, and pretext tasks, with few studies considering the importance of medical domain expert knowledge and explicitly exploiting such knowledge to facilitate Med-VLP. Although there exist knowledge-enhanced vision-and-language pre-training (VLP) methods in the general domain, most require off-the-shelf toolkits (e.g., object detectors and scene graph parsers), which are unavailable in the medical domain. In this paper, we propose a systematic and effective approach to enhance Med-VLP by structured medical knowledge from three perspectives. First, considering knowledge can be regarded as the intermediate medium between vision and language, we align the representations of the vision encoder and the language encoder through knowledge. Second, we inject knowledge into the multi-modal fusion model to enable the model to perform reasoning using knowledge as the supplementation of the input image and text. Third, we guide the model to put emphasis on the most critical information in images and texts by designing knowledge-induced pretext tasks. To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results illustrate the effectiveness of our approach, where state-of-the-art performance is achieved on all downstream tasks. Further analyses explore the effects of different components of our approach and various settings of pre-training.

Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s). LLaVA-Med exhibits excellent multimodal conversational capability and can follow open-ended instruction to assist with inquiries about a biomedical image. On three standard biomedical visual question answering datasets, LLaVA-Med outperforms previous supervised state-of-the-art on certain metrics. To facilitate biomedical multimodal research, we will release our instruction-following data and the LLaVA-Med model.

Visual Question Answering (VQA) entails answering questions about images. We introduce the first VQA dataset in which all contents originate from an authentic use case. Sourced from online question answering community forums, we call it VQAonline. We then characterize our dataset and how it relates to eight other VQA datasets. Observing that answers in our dataset tend to be much longer (e.g., with a mean of 173 words) and thus incompatible with standard VQA evaluation metrics, we next analyze which of the six popular metrics for longer text evaluation align best with human judgments. We then use the best-suited metrics to evaluate six state-of-the-art vision and language foundation models on VQAonline and reveal where they struggle most. We will release the dataset soon to facilitate future extensions.

The accelerating development of general medical artificial intelligence (GMAI), powered by multimodal large language models (MLLMs), offers transformative potential for addressing persistent healthcare challenges, including workforce deficits and escalating costs. The parallel development of systematic evaluation benchmarks emerges as a critical imperative to enable performance assessment and provide technological guidance. Meanwhile, as an invaluable knowledge source, the potential of medical textbooks for benchmark development remains underexploited. Here, we present MedBookVQA, a systematic and comprehensive multimodal benchmark derived from open-access medical textbooks. To curate this benchmark, we propose a standardized pipeline for automated extraction of medical figures while contextually aligning them with corresponding medical narratives. Based on this curated data, we generate 5,000 clinically relevant questions spanning modality recognition, disease classification, anatomical identification, symptom diagnosis, and surgical procedures. A multi-tier annotation system categorizes queries through hierarchical taxonomies encompassing medical imaging modalities (42 categories), body anatomies (125 structures), and clinical specialties (31 departments), enabling nuanced analysis across medical subdomains. We evaluate a wide array of MLLMs, including proprietary, open-sourced, medical, and reasoning models, revealing significant performance disparities across task types and model categories. Our findings highlight critical capability gaps in current GMAI systems while establishing textbook-derived multimodal benchmarks as essential evaluation tools. MedBookVQA establishes textbook-derived benchmarking as a critical paradigm for advancing clinical AI, exposing limitations in GMAI systems while providing anatomically structured performance metrics across specialties.

In the era of modern healthcare, swiftly generating medical question summaries is crucial for informed and timely patient care. Despite the increasing complexity and volume of medical data, existing studies have focused solely on text-based summarization, neglecting the integration of visual information. Recognizing the untapped potential of combining textual queries with visual representations of medical conditions, we introduce the Multimodal Medical Question Summarization (MMQS) Dataset. This dataset, a major contribution to our work, pairs medical queries with visual aids, facilitating a richer and more nuanced understanding of patient needs. We also propose a framework, utilizing the power of Contrastive Language Image Pretraining(CLIP) and Large Language Models(LLMs), consisting of four modules that identify medical disorders, generate relevant context, filter medical concepts, and craft visually aware summaries. Our comprehensive framework harnesses the power of CLIP, a multimodal foundation model, and various general-purpose LLMs, comprising four main modules: the medical disorder identification module, the relevant context generation module, the context filtration module for distilling relevant medical concepts and knowledge, and finally, a general-purpose LLM to generate visually aware medical question summaries. Leveraging our MMQS dataset, we showcase how visual cues from images enhance the generation of medically nuanced summaries. This multimodal approach not only enhances the decision-making process in healthcare but also fosters a more nuanced understanding of patient queries, laying the groundwork for future research in personalized and responsive medical care

Visual question answering requires a system to provide an accurate natural language answer given an image and a natural language question. However, it is widely recognized that previous generic VQA methods often exhibit a tendency to memorize biases present in the training data rather than learning proper behaviors, such as grounding images before predicting answers. Therefore, these methods usually achieve high in-distribution but poor out-of-distribution performance. In recent years, various datasets and debiasing methods have been proposed to evaluate and enhance the VQA robustness, respectively. This paper provides the first comprehensive survey focused on this emerging fashion. Specifically, we first provide an overview of the development process of datasets from in-distribution and out-of-distribution perspectives. Then, we examine the evaluation metrics employed by these datasets. Thirdly, we propose a typology that presents the development process, similarities and differences, robustness comparison, and technical features of existing debiasing methods. Furthermore, we analyze and discuss the robustness of representative vision-and-language pre-training models on VQA. Finally, through a thorough review of the available literature and experimental analysis, we discuss the key areas for future research from various viewpoints.

Contrastive pretraining on parallel image-text data has attained great success in vision-language processing (VLP), as exemplified by CLIP and related methods. However, prior explorations tend to focus on general domains in the web. Biomedical images and text are rather different, but publicly available datasets are small and skew toward chest X-ray, thus severely limiting progress. In this paper, we conducted by far the largest study on biomedical VLP, using 15 million figure-caption pairs extracted from biomedical research articles in PubMed Central. Our dataset (PMC-15M) is two orders of magnitude larger than existing biomedical image-text datasets such as MIMIC-CXR, and spans a diverse range of biomedical images. The standard CLIP method is suboptimal for the biomedical domain. We propose BiomedCLIP with domain-specific adaptations tailored to biomedical VLP. We conducted extensive experiments and ablation studies on standard biomedical imaging tasks from retrieval to classification to visual question-answering (VQA). BiomedCLIP established new state of the art in a wide range of standard datasets, substantially outperformed prior VLP approaches. Surprisingly, BiomedCLIP even outperformed radiology-specific state-of-the-art models such as BioViL on radiology-specific tasks such as RSNA pneumonia detection, thus highlighting the utility in large-scale pretraining across all biomedical image types. We will release our models at https://aka.ms/biomedclip to facilitate future research in biomedical VLP.

Video text-based visual question answering (Video TextVQA) is a practical task that aims to answer questions by jointly reasoning textual and visual information in a given video. Inspired by the development of TextVQA in image domain, existing Video TextVQA approaches leverage a language model (e.g. T5) to process text-rich multiple frames and generate answers auto-regressively. Nevertheless, the spatio-temporal relationships among visual entities (including scene text and objects) will be disrupted and models are susceptible to interference from unrelated information, resulting in irrational reasoning and inaccurate answering. To tackle these challenges, we propose the TEA (stands for ``Track thE Answer'') method that better extends the generative TextVQA framework from image to video. TEA recovers the spatio-temporal relationships in a complementary way and incorporates OCR-aware clues to enhance the quality of reasoning questions. Extensive experiments on several public Video TextVQA datasets validate the effectiveness and generalization of our framework. TEA outperforms existing TextVQA methods, video-language pretraining methods and video large language models by great margins.

Despite recent advances in Vision-Language Models (VLMs), many still over-rely on visual language priors present in their training data rather than true visual reasoning. To examine the situation, we introduce ViLP, a visual question answering (VQA) benchmark that pairs each question with three potential answers and three corresponding images: one image whose answer can be inferred from text alone, and two images that demand visual reasoning. By leveraging image generative models, we ensure significant variation in texture, shape, conceptual combinations, hallucinated elements, and proverb-based contexts, making our benchmark images distinctly out-of-distribution. While humans achieve near-perfect accuracy, modern VLMs falter; for instance, GPT-4 achieves only 66.17% on ViLP. To alleviate this, we propose a self-improving framework in which models generate new VQA pairs and images, then apply pixel-level and semantic corruptions to form "good-bad" image pairs for self-training. Our training objectives compel VLMs to focus more on actual visual inputs and have demonstrated their effectiveness in enhancing the performance of open-source VLMs, including LLaVA-v1.5 and Cambrian.

Recent advances in Large Vision-Language Models (LVLMs) have significantly improve performance in image comprehension tasks, such as formatted charts and rich-content images. Yet, Graphical User Interface (GUI) pose a greater challenge due to their structured format and detailed textual information. Existing LVLMs often overly depend on internal knowledge and neglect image content, resulting in hallucinations and incorrect responses in GUI comprehension. To address these issues, we introduce VGA, a fine-tuned model designed for comprehensive GUI understanding. Our model aims to enhance the interpretation of visual data of GUI and reduce hallucinations. We first construct a Vision Question Answering (VQA) dataset of 63.8k high-quality examples with our propose Referent Method, which ensures the model's responses are highly depend on visual content within the image. We then design a two-stage fine-tuning method called Foundation and Advanced Comprehension (FAC) to enhance both the model's ability to extract information from image content and alignment with human intent. Experiments show that our approach enhances the model's ability to extract information from images and achieves state-of-the-art results in GUI understanding tasks. Our dataset and fine-tuning script will be released soon.

Visual question answering (VQA) is a challenging task that requires the ability to comprehend and reason with visual information. While recent vision-language models have made strides, they continue to struggle with zero-shot VQA, particularly in handling complex compositional questions and adapting to new domains i.e. knowledge-based reasoning. This paper explores the use of various prompting strategies, focusing on the BLIP2 model, to enhance zero-shot VQA performance. We conduct a comprehensive investigation across several VQA datasets, examining the effectiveness of different question templates, the role of few-shot exemplars, the impact of chain-of-thought (CoT) reasoning, and the benefits of incorporating image captions as additional visual cues. Despite the varied outcomes, our findings demonstrate that carefully designed question templates and the integration of additional visual cues, like image captions, can contribute to improved VQA performance, especially when used in conjunction with few-shot examples. However, we also identify a limitation in the use of chain-of-thought rationalization, which negatively affects VQA accuracy. Our study thus provides critical insights into the potential of prompting for improving zero-shot VQA performance.

Current Visual Question Answering (VQA) systems can answer intelligent questions about `Known' visual content. However, their performance drops significantly when questions about visually and linguistically `Unknown' concepts are presented during inference (`Open-world' scenario). A practical VQA system should be able to deal with novel concepts in real world settings. To address this problem, we propose an exemplar-based approach that transfers learning (i.e., knowledge) from previously `Known' concepts to answer questions about the `Unknown'. We learn a highly discriminative joint embedding space, where visual and semantic features are fused to give a unified representation. Once novel concepts are presented to the model, it looks for the closest match from an exemplar set in the joint embedding space. This auxiliary information is used alongside the given Image-Question pair to refine visual attention in a hierarchical fashion. Since handling the high dimensional exemplars on large datasets can be a significant challenge, we introduce an efficient matching scheme that uses a compact feature description for search and retrieval. To evaluate our model, we propose a new split for VQA, separating Unknown visual and semantic concepts from the training set. Our approach shows significant improvements over state-of-the-art VQA models on the proposed Open-World VQA dataset and standard VQA datasets.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

Artificial intelligence (AI) has significant potential in healthcare applications, but its training and deployment faces challenges due to healthcare's diverse data, complex tasks, and the need to preserve privacy. Foundation models that perform well on medical tasks and require less task-specific tuning data are critical to accelerate the development of healthcare AI applications. We introduce MedGemma, a collection of medical vision-language foundation models based on Gemma 3 4B and 27B. MedGemma demonstrates advanced medical understanding and reasoning on images and text, significantly exceeding the performance of similar-sized generative models and approaching the performance of task-specific models, while maintaining the general capabilities of the Gemma 3 base models. For out-of-distribution tasks, MedGemma achieves 2.6-10% improvement on medical multimodal question answering, 15.5-18.1% improvement on chest X-ray finding classification, and 10.8% improvement on agentic evaluations compared to the base models. Fine-tuning MedGemma further improves performance in subdomains, reducing errors in electronic health record information retrieval by 50% and reaching comparable performance to existing specialized state-of-the-art methods for pneumothorax classification and histopathology patch classification. We additionally introduce MedSigLIP, a medically-tuned vision encoder derived from SigLIP. MedSigLIP powers the visual understanding capabilities of MedGemma and as an encoder achieves comparable or better performance than specialized medical image encoders. Taken together, the MedGemma collection provides a strong foundation of medical image and text capabilities, with potential to significantly accelerate medical research and development of downstream applications. The MedGemma collection, including tutorials and model weights, can be found at https://goo.gle/medgemma.

Visual question answering (VQA) is the task of providing accurate answers to natural language questions based on visual input. Programmatic VQA (PVQA) models have been gaining attention recently. These use large language models (LLMs) to formulate executable programs that address questions requiring complex visual reasoning. However, there are challenges in enabling LLMs to comprehend the usage of image processing modules and generate relevant code. To overcome these challenges, this paper introduces PyramidCoder, a novel prompting framework for PVQA models. PyramidCoder consists of three hierarchical levels, each serving a distinct purpose: query rephrasing, code generation, and answer aggregation. Notably, PyramidCoder utilizes a single frozen LLM and pre-defined prompts at each level, eliminating the need for additional training and ensuring flexibility across various LLM architectures. Compared to the state-of-the-art PVQA model, our approach improves accuracy by at least 0.5% on the GQA dataset, 1.4% on the VQAv2 dataset, and 2.9% on the NLVR2 dataset.

Faithful reasoning in medical vision-language models (VLMs) requires not only accurate predictions but also transparent alignment between textual rationales and visual evidence. While Chain-of-Thought (CoT) prompting has shown promise in medical visual question answering (VQA), no large-scale expert-level dataset has captured stepwise reasoning with precise visual grounding. We introduce S-Chain, the first large-scale dataset of 12,000 expert-annotated medical images with bounding boxes and structured visual CoT (SV-CoT), explicitly linking visual regions to reasoning steps. The dataset further supports 16 languages, totaling over 700k VQA pairs for broad multilingual applicability. Using S-Chain, we benchmark state-of-the-art medical VLMs (ExGra-Med, LLaVA-Med) and general-purpose VLMs (Qwen2.5-VL, InternVL2.5), showing that SV-CoT supervision significantly improves interpretability, grounding fidelity, and robustness. Beyond benchmarking, we study its synergy with retrieval-augmented generation, revealing how domain knowledge and visual grounding interact during autoregressive reasoning. Finally, we propose a new mechanism that strengthens the alignment between visual evidence and reasoning, improving both reliability and efficiency. S-Chain establishes a new benchmark for grounded medical reasoning and paves the way toward more trustworthy and explainable medical VLMs.

We study visual question answering in a setting where the answer has to be mined from a pool of relevant and irrelevant images given as a context. For such a setting, a model must first retrieve relevant images from the pool and answer the question from these retrieved images. We refer to this problem as retrieval-based visual question answering (or RETVQA in short). The RETVQA is distinctively different and more challenging than the traditionally-studied Visual Question Answering (VQA), where a given question has to be answered with a single relevant image in context. Towards solving the RETVQA task, we propose a unified Multi Image BART (MI-BART) that takes a question and retrieved images using our relevance encoder for free-form fluent answer generation. Further, we introduce the largest dataset in this space, namely RETVQA, which has the following salient features: multi-image and retrieval requirement for VQA, metadata-independent questions over a pool of heterogeneous images, expecting a mix of classification-oriented and open-ended generative answers. Our proposed framework achieves an accuracy of 76.5% and a fluency of 79.3% on the proposed dataset, namely RETVQA and also outperforms state-of-the-art methods by 4.9% and 11.8% on the image segment of the publicly available WebQA dataset on the accuracy and fluency metrics, respectively.

Medical question-answering (QA) is a critical task for evaluating how effectively large language models (LLMs) encode clinical knowledge and assessing their potential applications in medicine. Despite showing promise on multiple-choice tests, LLMs frequently struggle with open-ended medical questions, producing responses with dangerous hallucinations or lacking comprehensive coverage of critical aspects. Existing approaches attempt to address these challenges through domain-specific fine-tuning, but this proves resource-intensive and difficult to scale across models. To improve the comprehensiveness and factuality of medical responses, we propose a novel approach utilizing structured medical reasoning. Our method guides LLMs through an seven-step cognitive process inspired by clinical diagnosis, enabling more accurate and complete answers without additional training. Experiments on the MedLFQA benchmark demonstrate that our approach achieves the highest Factuality Score of 85.8, surpassing fine-tuned models. Notably, this improvement transfers to smaller models, highlighting the method's efficiency and scalability. Our code and datasets are available.

Artificial Intelligence (AI) has demonstrated significant potential in healthcare, particularly in disease diagnosis and treatment planning. Recent progress in Medical Large Vision-Language Models (Med-LVLMs) has opened up new possibilities for interactive diagnostic tools. However, these models often suffer from factual hallucination, which can lead to incorrect diagnoses. Fine-tuning and retrieval-augmented generation (RAG) have emerged as methods to address these issues. However, the amount of high-quality data and distribution shifts between training data and deployment data limit the application of fine-tuning methods. Although RAG is lightweight and effective, existing RAG-based approaches are not sufficiently general to different medical domains and can potentially cause misalignment issues, both between modalities and between the model and the ground truth. In this paper, we propose a versatile multimodal RAG system, MMed-RAG, designed to enhance the factuality of Med-LVLMs. Our approach introduces a domain-aware retrieval mechanism, an adaptive retrieved contexts selection method, and a provable RAG-based preference fine-tuning strategy. These innovations make the RAG process sufficiently general and reliable, significantly improving alignment when introducing retrieved contexts. Experimental results across five medical datasets (involving radiology, ophthalmology, pathology) on medical VQA and report generation demonstrate that MMed-RAG can achieve an average improvement of 43.8% in the factual accuracy of Med-LVLMs. Our data and code are available in https://github.com/richard-peng-xia/MMed-RAG.

Recent advancements in Large Multimodal Models (LMMs) have made significant progress in the field of single-image visual question answering. However, these models face substantial challenges when tasked with queries that span extensive collections of images, similar to real-world scenarios like searching through large photo albums, finding specific information across the internet, or monitoring environmental changes through satellite imagery. This paper explores the task of Multi-Image Visual Question Answering (MIQA): given a large set of images and a natural language query, the task is to generate a relevant and grounded response. We propose a new public benchmark, dubbed "Visual Haystacks (VHs)," specifically designed to evaluate LMMs' capabilities in visual retrieval and reasoning over sets of unrelated images, where we perform comprehensive evaluations demonstrating that even robust closed-source models struggle significantly. Towards addressing these shortcomings, we introduce MIRAGE (Multi-Image Retrieval Augmented Generation), a novel retrieval/QA framework tailored for LMMs that confronts the challenges of MIQA with marked efficiency and accuracy improvements over baseline methods. Our evaluation shows that MIRAGE surpasses closed-source GPT-4o models by up to 11% on the VHs benchmark and offers up to 3.4x improvements in efficiency over text-focused multi-stage approaches.

Following the impressive development of LLMs, vision-language alignment in LLMs is actively being researched to enable multimodal reasoning and visual IO. This direction of research is particularly relevant to medical imaging because medical image analysis and generation consist of reasoning based on a combination of visual features and prior knowledge. Many recent works have focused on training adapter networks that serve as an information bridge between image processing networks and LLMs; but presumably, in order to achieve maximum reasoning potential of LLMs on visual information as well, visual and language features should be allowed to interact more freely. This is especially important in the medical domain because understanding and generating medical images such as chest X-rays (CXR) require not only accurate visual and language-based reasoning but also a more intimate mapping between the two modalities. Thus, taking inspiration from previous work on the transformer and VQ-GAN combination for bidirectional image and text generation, we build upon this approach and develop a method for instruction-tuning an LLM pre-trained only on text to gain vision-language capabilities for medical images. Specifically, we leverage a pretrained LLM's existing question-answering and instruction-following abilities to teach it to understand visual inputs by instructing it to answer questions about image inputs and, symmetrically, output both text and image responses appropriate to a given query by tuning the LLM with diverse tasks that encompass image-based text-generation and text-based image-generation. We show that our model, LLM-CXR, trained in this approach shows better image-text alignment in both CXR understanding and generation tasks while being smaller in size compared to previously developed models that perform a narrower range of tasks. The code is at https://github.com/hyn2028/llm-cxr.

Visual question answering is a task of predicting the answer to a question about an image. Given that different people can provide different answers to a visual question, we aim to better understand why with answer groundings. We introduce the first dataset that visually grounds each unique answer to each visual question, which we call VQAAnswerTherapy. We then propose two novel problems of predicting whether a visual question has a single answer grounding and localizing all answer groundings. We benchmark modern algorithms for these novel problems to show where they succeed and struggle. The dataset and evaluation server can be found publicly at https://vizwiz.org/tasks-and-datasets/vqa-answer-therapy/.

Visual Question Answering (VQA) research seeks to create AI systems to answer natural language questions in images, yet VQA methods often yield overly simplistic and short answers. This paper aims to advance the field by introducing Visual Question Explanation (VQE), which enhances the ability of VQA to provide detailed explanations rather than brief responses and address the need for more complex interaction with visual content. We first created an MLVQE dataset from a 14-week streamed video machine learning course, including 885 slide images, 110,407 words of transcripts, and 9,416 designed question-answer (QA) pairs. Next, we proposed a novel SparrowVQE, a small 3 billion parameters multimodal model. We trained our model with a three-stage training mechanism consisting of multimodal pre-training (slide images and transcripts feature alignment), instruction tuning (tuning the pre-trained model with transcripts and QA pairs), and domain fine-tuning (fine-tuning slide image and QA pairs). Eventually, our SparrowVQE can understand and connect visual information using the SigLIP model with transcripts using the Phi-2 language model with an MLP adapter. Experimental results demonstrate that our SparrowVQE achieves better performance in our developed MLVQE dataset and outperforms state-of-the-art methods in the other five benchmark VQA datasets. The source code is available at https://github.com/YoushanZhang/SparrowVQE.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Medical Vision-Language Pretraining (MedVLP) shows promise in learning generalizable and transferable visual representations from paired and unpaired medical images and reports. MedVLP can provide useful features to downstream tasks and facilitate adapting task-specific models to new setups using fewer examples. However, existing MedVLP methods often differ in terms of datasets, preprocessing, and finetuning implementations. This pose great challenges in evaluating how well a MedVLP method generalizes to various clinically-relevant tasks due to the lack of unified, standardized, and comprehensive benchmark. To fill this gap, we propose BenchX, a unified benchmark framework that enables head-to-head comparison and systematical analysis between MedVLP methods using public chest X-ray datasets. Specifically, BenchX is composed of three components: 1) Comprehensive datasets covering nine datasets and four medical tasks; 2) Benchmark suites to standardize data preprocessing, train-test splits, and parameter selection; 3) Unified finetuning protocols that accommodate heterogeneous MedVLP methods for consistent task adaptation in classification, segmentation, and report generation, respectively. Utilizing BenchX, we establish baselines for nine state-of-the-art MedVLP methods and found that the performance of some early MedVLP methods can be enhanced to surpass more recent ones, prompting a revisiting of the developments and conclusions from prior works in MedVLP. Our code are available at https://github.com/yangzhou12/BenchX.

In question-answering scenarios, humans can assess whether the available information is sufficient and seek additional information if necessary, rather than providing a forced answer. In contrast, Vision Language Models (VLMs) typically generate direct, one-shot responses without evaluating the sufficiency of the information. To investigate this gap, we identify a critical and challenging task in the Visual Question Answering (VQA) scenario: can VLMs indicate how to adjust an image when the visual information is insufficient to answer a question? This capability is especially valuable for assisting visually impaired individuals who often need guidance to capture images correctly. To evaluate this capability of current VLMs, we introduce a human-labeled dataset as a benchmark for this task. Additionally, we present an automated framework that generates synthetic training data by simulating ``where to know'' scenarios. Our empirical results show significant performance improvements in mainstream VLMs when fine-tuned with this synthetic data. This study demonstrates the potential to narrow the gap between information assessment and acquisition in VLMs, bringing their performance closer to humans.

The Visual Question Answering (VQA) task requires the simultaneous understanding of image content and question semantics. However, existing methods often have difficulty handling complex reasoning scenarios due to insufficient cross-modal interaction and capturing the entity spatial relationships in the image.huang2023adaptiveliu2021comparingguibas2021adaptivezhang2022vsaWe studied a brand-new approach to replace the attention mechanism in order to enhance the reasoning ability of the model and its understanding of spatial relationships.Specifically, we propose a dynamic bidirectional spatial tower, which is divided into four layers to observe the image according to the principle of human gestalt vision. This naturally provides a powerful structural prior for the spatial organization between entities, enabling the model to no longer blindly search for relationships between pixels but make judgments based on more meaningful perceptual units. Change from "seeing images" to "perceiving and organizing image content".A large number of experiments have shown that our module can be used in any other multimodal model and achieve advanced results, demonstrating its potential in spatial relationship processing.Meanwhile, the multimodal visual question-answering model July trained by our method has achieved state-of-the-art results with only 3B parameters, especially on the question-answering dataset of spatial relations.

We introduce MedXpertQA, a highly challenging and comprehensive benchmark to evaluate expert-level medical knowledge and advanced reasoning. MedXpertQA includes 4,460 questions spanning 17 specialties and 11 body systems. It includes two subsets, Text for text evaluation and MM for multimodal evaluation. Notably, MM introduces expert-level exam questions with diverse images and rich clinical information, including patient records and examination results, setting it apart from traditional medical multimodal benchmarks with simple QA pairs generated from image captions. MedXpertQA applies rigorous filtering and augmentation to address the insufficient difficulty of existing benchmarks like MedQA, and incorporates specialty board questions to improve clinical relevance and comprehensiveness. We perform data synthesis to mitigate data leakage risk and conduct multiple rounds of expert reviews to ensure accuracy and reliability. We evaluate 16 leading models on MedXpertQA. Moreover, medicine is deeply connected to real-world decision-making, providing a rich and representative setting for assessing reasoning abilities beyond mathematics and code. To this end, we develop a reasoning-oriented subset to facilitate the assessment of o1-like models.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Multimodal Large Language Models (MLLMs) have shown significant potential in medical image analysis. However, their capabilities in interpreting fundus images, a critical skill for ophthalmology, remain under-evaluated. Existing benchmarks lack fine-grained task divisions and fail to provide modular analysis of its two key modules, i.e., large language model (LLM) and vision encoder (VE). This paper introduces FunBench, a novel visual question answering (VQA) benchmark designed to comprehensively evaluate MLLMs' fundus reading skills. FunBench features a hierarchical task organization across four levels (modality perception, anatomy perception, lesion analysis, and disease diagnosis). It also offers three targeted evaluation modes: linear-probe based VE evaluation, knowledge-prompted LLM evaluation, and holistic evaluation. Experiments on nine open-source MLLMs plus GPT-4o reveal significant deficiencies in fundus reading skills, particularly in basic tasks such as laterality recognition. The results highlight the limitations of current MLLMs and emphasize the need for domain-specific training and improved LLMs and VEs.

Infographics are documents designed to effectively communicate information using a combination of textual, graphical and visual elements. In this work, we explore the automatic understanding of infographic images by using Visual Question Answering technique.To this end, we present InfographicVQA, a new dataset that comprises a diverse collection of infographics along with natural language questions and answers annotations. The collected questions require methods to jointly reason over the document layout, textual content, graphical elements, and data visualizations. We curate the dataset with emphasis on questions that require elementary reasoning and basic arithmetic skills. Finally, we evaluate two strong baselines based on state of the art multi-modal VQA models, and establish baseline performance for the new task. The dataset, code and leaderboard will be made available at http://docvqa.org

The advent and proliferation of large multi-modal models (LMMs) have introduced new paradigms to computer vision, transforming various tasks into a unified visual question answering framework. Video Quality Assessment (VQA), a classic field in low-level visual perception, focused initially on quantitative video quality scoring. However, driven by advances in LMMs, it is now progressing toward more holistic visual quality understanding tasks. Recent studies in the image domain have demonstrated that Visual Question Answering (VQA) can markedly enhance low-level visual quality evaluation. Nevertheless, related work has not been explored in the video domain, leaving substantial room for improvement. To address this gap, we introduce the VQA2 Instruction Dataset - the first visual question answering instruction dataset that focuses on video quality assessment. This dataset consists of 3 subsets and covers various video types, containing 157,755 instruction question-answer pairs. Then, leveraging this foundation, we present the VQA2 series models. The VQA2 series models interleave visual and motion tokens to enhance the perception of spatial-temporal quality details in videos. We conduct extensive experiments on video quality scoring and understanding tasks, and results demonstrate that the VQA2series models achieve excellent performance in both tasks. Notably, our final model, the VQA2-Assistant, exceeds the renowned GPT-4o in visual quality understanding tasks while maintaining strong competitiveness in quality scoring tasks. Our work provides a foundation and feasible approach for integrating low-level video quality assessment and understanding with LMMs.

We present a new dataset for Visual Question Answering (VQA) on document images called DocVQA. The dataset consists of 50,000 questions defined on 12,000+ document images. Detailed analysis of the dataset in comparison with similar datasets for VQA and reading comprehension is presented. We report several baseline results by adopting existing VQA and reading comprehension models. Although the existing models perform reasonably well on certain types of questions, there is large performance gap compared to human performance (94.36% accuracy). The models need to improve specifically on questions where understanding structure of the document is crucial. The dataset, code and leaderboard are available at docvqa.org

In this study, we introduce Vision-Caption aware Supervised FineTuning (VCASFT), a novel learning paradigm designed to enhance the performance of smaller Vision Language Models(VLMs) on scientific visual question answering(VQA) tasks. VCASFT leverages image captions as zero-shot prompts alongside question-answer pairs and instruction-tunes models to yield significant performance improvements. To comprehensively evaluate VCASFT, we benchmark it on ScienceQA, which consists of questions across diverse languages, subjects, and fields, demonstrating its adaptability and effectiveness in a variety of educational contexts. Additionally, to further demonstrate the effectiveness of this technique on lowresource languages, we developed HiSciVQA, a dataset comprising 2,245 high-quality, hand-annotated Hindi multimodal Q&A pairs. This dataset addresses the critical need for low-resource language Q&A datasets and serves as a foundation for testing VCASFT. Additionally, we introduce a novel LLM-based evaluation scheme to evaluate VLMs on HiSciVQA which offers deeper insights into model effectiveness surpassing traditional n-gram matching accuracy metrics. We are committed to advancing the field by open-sourcing all code files and the HiSciVQA dataset for the research community.

Electronic Health Records (EHRs), which contain patients' medical histories in various multi-modal formats, often overlook the potential for joint reasoning across imaging and table modalities underexplored in current EHR Question Answering (QA) systems. In this paper, we introduce EHRXQA, a novel multi-modal question answering dataset combining structured EHRs and chest X-ray images. To develop our dataset, we first construct two uni-modal resources: 1) The MIMIC- CXR-VQA dataset, our newly created medical visual question answering (VQA) benchmark, specifically designed to augment the imaging modality in EHR QA, and 2) EHRSQL (MIMIC-IV), a refashioned version of a previously established table-based EHR QA dataset. By integrating these two uni-modal resources, we successfully construct a multi-modal EHR QA dataset that necessitates both uni-modal and cross-modal reasoning. To address the unique challenges of multi-modal questions within EHRs, we propose a NeuralSQL-based strategy equipped with an external VQA API. This pioneering endeavor enhances engagement with multi-modal EHR sources and we believe that our dataset can catalyze advances in real-world medical scenarios such as clinical decision-making and research. EHRXQA is available at https://github.com/baeseongsu/ehrxqa.

Large Language Models (LLMs) have introduced a new era of proficiency in comprehending complex healthcare and biomedical topics. However, there is a noticeable lack of models in languages other than English and models that can interpret multi-modal input, which is crucial for global healthcare accessibility. In response, this study introduces Qilin-Med-VL, the first Chinese large vision-language model designed to integrate the analysis of textual and visual data. Qilin-Med-VL combines a pre-trained Vision Transformer (ViT) with a foundational LLM. It undergoes a thorough two-stage curriculum training process that includes feature alignment and instruction tuning. This method enhances the model's ability to generate medical captions and answer complex medical queries. We also release ChiMed-VL, a dataset consisting of more than 1M image-text pairs. This dataset has been carefully curated to enable detailed and comprehensive interpretation of medical data using various types of images.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

We propose Encyclopedic-VQA, a large scale visual question answering (VQA) dataset featuring visual questions about detailed properties of fine-grained categories and instances. It contains 221k unique question+answer pairs each matched with (up to) 5 images, resulting in a total of 1M VQA samples. Moreover, our dataset comes with a controlled knowledge base derived from Wikipedia, marking the evidence to support each answer. Empirically, we show that our dataset poses a hard challenge for large vision+language models as they perform poorly on our dataset: PaLI [14] is state-of-the-art on OK-VQA [37], yet it only achieves 13.0% accuracy on our dataset. Moreover, we experimentally show that progress on answering our encyclopedic questions can be achieved by augmenting large models with a mechanism that retrieves relevant information from the knowledge base. An oracle experiment with perfect retrieval achieves 87.0% accuracy on the single-hop portion of our dataset, and an automatic retrieval-augmented prototype yields 48.8%. We believe that our dataset enables future research on retrieval-augmented vision+language models. It is available at https://github.com/google-research/google-research/tree/master/encyclopedic_vqa .

Vision-language models (VLMs) often produce chain-of-thought (CoT) explanations that sound plausible yet fail to reflect the underlying decision process, undermining trust in high-stakes clinical use. Existing evaluations rarely catch this misalignment, prioritizing answer accuracy or adherence to formats. We present a clinically grounded framework for chest X-ray visual question answering (VQA) that probes CoT faithfulness via controlled text and image modifications across three axes: clinical fidelity, causal attribution, and confidence calibration. In a reader study (n=4), evaluator-radiologist correlations fall within the observed inter-radiologist range for all axes, with strong alignment for attribution (Kendall's tau_b=0.670), moderate alignment for fidelity (tau_b=0.387), and weak alignment for confidence tone (tau_b=0.091), which we report with caution. Benchmarking six VLMs shows that answer accuracy and explanation quality are decoupled, acknowledging injected cues does not ensure grounding, and text cues shift explanations more than visual cues. While some open-source models match final answer accuracy, proprietary models score higher on attribution (25.0% vs. 1.4%) and often on fidelity (36.1% vs. 31.7%), highlighting deployment risks and the need to evaluate beyond final answer accuracy.

Document Visual Question Answering (VQA) aims to understand visually-rich documents to answer questions in natural language, which is an emerging research topic for both Natural Language Processing and Computer Vision. In this work, we introduce a new Document VQA dataset, named TAT-DQA, which consists of 3,067 document pages comprising semi-structured table(s) and unstructured text as well as 16,558 question-answer pairs by extending the TAT-QA dataset. These documents are sampled from real-world financial reports and contain lots of numbers, which means discrete reasoning capability is demanded to answer questions on this dataset. Based on TAT-DQA, we further develop a novel model named MHST that takes into account the information in multi-modalities, including text, layout and visual image, to intelligently address different types of questions with corresponding strategies, i.e., extraction or reasoning. Extensive experiments show that the MHST model significantly outperforms the baseline methods, demonstrating its effectiveness. However, the performance still lags far behind that of expert humans. We expect that our new TAT-DQA dataset would facilitate the research on deep understanding of visually-rich documents combining vision and language, especially for scenarios that require discrete reasoning. Also, we hope the proposed model would inspire researchers to design more advanced Document VQA models in future. Our dataset will be publicly available for non-commercial use at https://nextplusplus.github.io/TAT-DQA/.

Medical image analysis is a fundamental component. As deep learning progresses, the focus has shifted from single-task applications, such as classification and segmentation, to more complex multimodal tasks, including medical visual question answering and report generation. Traditional shallow and task-specific models are increasingly limited in addressing the complexity and scalability required in clinical practice. The emergence of large language models (LLMs) has driven the development of medical Large Vision-Language Models (LVLMs), offering a unified solution for diverse vision-language tasks. In this study, we investigate various architectural designs for medical LVLMs based on the widely adopted LLaVA framework, which follows an encoder-connector-LLM paradigm. We construct two distinct models targeting 2D and 3D modalities, respectively. These models are designed to support both general-purpose medical tasks and domain-specific fine-tuning, thereby serving as effective foundation models. To facilitate reproducibility and further research, we develop a modular and extensible codebase, MedM-VL, and release two LVLM variants: MedM-VL-2D for 2D medical image analysis and MedM-VL-CT-Chest for 3D CT-based applications. The code and models are available at: https://github.com/MSIIP/MedM-VL

Vision-and-language models (VLMs) have been increasingly explored in the medical domain, particularly following the success of CLIP in general domain. However, unlike the relatively straightforward pairing of 2D images and text, curating large-scale paired data in the medical field for volumetric modalities such as CT scans remains a challenging and time-intensive process. This difficulty often limits the performance on downstream tasks. To address these challenges, we propose a novel vision-language pre-training (VLP) framework, termed as VELVET-Med, specifically designed for limited volumetric data such as 3D CT and associated radiology reports. Instead of relying on large-scale data collection, our method focuses on the development of effective pre-training objectives and model architectures. The key contributions are: 1) We incorporate uni-modal self-supervised learning into VLP framework, which are often underexplored in the existing literature. 2) We propose a novel language encoder, termed as TriBERT, for learning multi-level textual semantics. 3) We devise the hierarchical contrastive learning to capture multi-level vision-language correspondence. Using only 38,875 scan-report pairs, our approach seeks to uncover rich spatial and semantic relationships embedded in volumetric medical images and corresponding clinical narratives, thereby enhancing the generalization ability of the learned encoders. The resulting encoders exhibit strong transferability, achieving state-of-the-art performance across a wide range of downstream tasks, including 3D segmentation, cross-modal retrieval, visual question answering, and report generation.

The advancement of Large Vision-Language Models (LVLMs) has propelled their application in the medical field. However, Medical LVLMs (Med-LVLMs) encounter factuality challenges due to modality misalignment, where the models prioritize textual knowledge over visual input, leading to hallucinations that contradict information in medical images. Previous attempts to enhance modality alignment in Med-LVLMs through preference optimization have inadequately mitigated clinical relevance in preference data, making these samples easily distinguishable and reducing alignment effectiveness. To address this challenge, we propose MMedPO, a novel multimodal medical preference optimization approach that considers the clinical relevance of preference samples to enhance Med-LVLM alignment. MMedPO curates multimodal preference data by introducing two types of dispreference: (1) plausible hallucinations injected through target Med-LVLMs or GPT-4o to produce medically inaccurate responses, and (2) lesion region neglect achieved through local lesion-noising, disrupting visual understanding of critical areas. We then calculate clinical relevance for each sample based on scores from multiple Med-LLMs and visual tools, and integrate these scores into the preference optimization process as weights, enabling effective alignment. Our experiments demonstrate that MMedPO significantly enhances factual accuracy in Med-LVLMs, achieving substantial improvements over existing preference optimization methods by averaging 14.2% and 51.7% across the Med-VQA and report generation tasks. Our code are available in https://github.com/aiming-lab/MMedPO.

The evaluation of text-generative vision-language models is a challenging yet crucial endeavor. By addressing the limitations of existing Visual Question Answering (VQA) benchmarks and proposing innovative evaluation methodologies, our research seeks to advance our understanding of these models' capabilities. We propose a novel VQA benchmark based on well-known visual classification datasets which allows a granular evaluation of text-generative vision-language models and their comparison with discriminative vision-language models. To improve the assessment of coarse answers on fine-grained classification tasks, we suggest using the semantic hierarchy of the label space to ask automatically generated follow-up questions about the ground-truth category. Finally, we compare traditional NLP and LLM-based metrics for the problem of evaluating model predictions given ground-truth answers. We perform a human evaluation study upon which we base our decision on the final metric. We apply our benchmark to a suite of vision-language models and show a detailed comparison of their abilities on object, action, and attribute classification. Our contributions aim to lay the foundation for more precise and meaningful assessments, facilitating targeted progress in the exciting field of vision-language modeling.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. In traditional computer vision tasks, creative or approximate answers may be acceptable, but in healthcare, precision is paramount.Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data-features that are often too intricate for a VLM to capture effectively especially in radiology. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...

Document Visual Question Answering (DocVQA) faces dual challenges in processing lengthy multimodal documents (text, images, tables) and performing cross-modal reasoning. Current document retrieval-augmented generation (DocRAG) methods remain limited by their text-centric approaches, frequently missing critical visual information. The field also lacks robust benchmarks for assessing multimodal evidence selection and integration. We introduce MMDocRAG, a comprehensive benchmark featuring 4,055 expert-annotated QA pairs with multi-page, cross-modal evidence chains. Our framework introduces innovative metrics for evaluating multimodal quote selection and enables answers that interleave text with relevant visual elements. Through large-scale experiments with 60 VLM/LLM models and 14 retrieval systems, we identify persistent challenges in multimodal evidence retrieval, selection, and integration.Key findings reveal advanced proprietary LVMs show superior performance than open-sourced alternatives. Also, they show moderate advantages using multimodal inputs over text-only inputs, while open-source alternatives show significant performance degradation. Notably, fine-tuned LLMs achieve substantial improvements when using detailed image descriptions. MMDocRAG establishes a rigorous testing ground and provides actionable insights for developing more robust multimodal DocVQA systems. Our benchmark and code are available at https://mmdocrag.github.io/MMDocRAG/.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, example ordering exhibits a recency bias, i.e., placing the most relevant example last can lead to substantial performance improvements by up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context.

Vision Language Models (VLMs), which extend Large Language Models (LLM) by incorporating visual understanding capability, have demonstrated significant advancements in addressing open-ended visual question-answering (VQA) tasks. However, these models cannot accurately interpret images infused with text, a common occurrence in real-world scenarios. Standard procedures for extracting information from images often involve learning a fixed set of query embeddings. These embeddings are designed to encapsulate image contexts and are later used as soft prompt inputs in LLMs. Yet, this process is limited to the token count, potentially curtailing the recognition of scenes with text-rich context. To improve upon them, the present study introduces BLIVA: an augmented version of InstructBLIP with Visual Assistant. BLIVA incorporates the query embeddings from InstructBLIP and also directly projects encoded patch embeddings into the LLM, a technique inspired by LLaVA. This approach assists the model to capture intricate details potentially missed during the query decoding process. Empirical evidence demonstrates that our model, BLIVA, significantly enhances performance in processing text-rich VQA benchmarks (up to 17.76\% in OCR-VQA benchmark) and in undertaking typical VQA benchmarks (up to 7.9\% in Visual Spatial Reasoning benchmark), comparing to our baseline InstructBLIP. BLIVA demonstrates significant capability in decoding real-world images, irrespective of text presence. To demonstrate the broad industry applications enabled by BLIVA, we evaluate the model using a new dataset comprising YouTube thumbnails paired with question-answer sets across 13 diverse categories. For researchers interested in further exploration, our code and models are freely accessible at https://github.com/mlpc-ucsd/BLIVA.git

Vision-Language Models (VLMs) have demonstrated remarkable progress in multimodal understanding, yet their capabilities for scientific reasoning remains inadequately assessed. Current multimodal benchmarks predominantly evaluate generic image comprehension or text-driven reasoning, lacking authentic scientific contexts that require domain-specific knowledge integration with visual evidence analysis. To fill this gap, we present CSVQA, a diagnostic multimodal benchmark specifically designed for evaluating scientific reasoning through domain-grounded visual question answering.Our benchmark features 1,378 carefully constructed question-answer pairs spanning diverse STEM disciplines, each demanding domain knowledge, integration of visual evidence, and higher-order reasoning. Compared to prior multimodal benchmarks, CSVQA places greater emphasis on real-world scientific content and complex reasoning.We additionally propose a rigorous evaluation protocol to systematically assess whether model predictions are substantiated by valid intermediate reasoning steps based on curated explanations. Our comprehensive evaluation of 15 VLMs on this benchmark reveals notable performance disparities, as even the top-ranked proprietary model attains only 49.6\% accuracy.This empirical evidence underscores the pressing need for advancing scientific reasoning capabilities in VLMs. Our CSVQA is released at https://huggingface.co/datasets/Skywork/CSVQA.

We present MedConceptsQA, a dedicated open source benchmark for medical concepts question answering. The benchmark comprises of questions of various medical concepts across different vocabularies: diagnoses, procedures, and drugs. The questions are categorized into three levels of difficulty: easy, medium, and hard. We conducted evaluations of the benchmark using various Large Language Models. Our findings show that pre-trained clinical Large Language Models achieved accuracy levels close to random guessing on this benchmark, despite being pre-trained on medical data. However, GPT-4 achieves an absolute average improvement of nearly 27%-37% (27% for zero-shot learning and 37% for few-shot learning) when compared to clinical Large Language Models. Our benchmark serves as a valuable resource for evaluating the understanding and reasoning of medical concepts by Large Language Models. Our benchmark is available at https://huggingface.co/datasets/ofir408/MedConceptsQA

Scientific research demands sophisticated reasoning over multimodal data, a challenge especially prevalent in biology. Despite recent advances in multimodal large language models (MLLMs) for AI-assisted research, existing multimodal reasoning benchmarks only target up to college-level difficulty, while research-level benchmarks emphasize lower-level perception, falling short of the complex multimodal reasoning needed for scientific discovery. To bridge this gap, we introduce MicroVQA, a visual-question answering (VQA) benchmark designed to assess three reasoning capabilities vital in research workflows: expert image understanding, hypothesis generation, and experiment proposal. MicroVQA consists of 1,042 multiple-choice questions (MCQs) curated by biology experts across diverse microscopy modalities, ensuring VQA samples represent real scientific practice. In constructing the benchmark, we find that standard MCQ generation methods induce language shortcuts, motivating a new two-stage pipeline: an optimized LLM prompt structures question-answer pairs into MCQs; then, an agent-based `RefineBot' updates them to remove shortcuts. Benchmarking on state-of-the-art MLLMs reveal a peak performance of 53\%; models with smaller LLMs only slightly underperform top models, suggesting that language-based reasoning is less challenging than multimodal reasoning; and tuning with scientific articles enhances performance. Expert analysis of chain-of-thought responses shows that perception errors are the most frequent, followed by knowledge errors and then overgeneralization errors. These insights highlight the challenges in multimodal scientific reasoning, showing MicroVQA is a valuable resource advancing AI-driven biomedical research. MicroVQA is available at https://huggingface.co/datasets/jmhb/microvqa, and project page at https://jmhb0.github.io/microvqa.

Recently a number of studies demonstrated impressive performance on diverse vision-language multi-modal tasks such as image captioning and visual question answering by extending the BERT architecture with multi-modal pre-training objectives. In this work we explore a broad set of multi-modal representation learning tasks in the medical domain, specifically using radiology images and the unstructured report. We propose Medical Vision Language Learner (MedViLL), which adopts a BERT-based architecture combined with a novel multi-modal attention masking scheme to maximize generalization performance for both vision-language understanding tasks (diagnosis classification, medical image-report retrieval, medical visual question answering) and vision-language generation task (radiology report generation). By statistically and rigorously evaluating the proposed model on four downstream tasks with three radiographic image-report datasets (MIMIC-CXR, Open-I, and VQA-RAD), we empirically demonstrate the superior downstream task performance of MedViLL against various baselines, including task-specific architectures. The source code is publicly available at: https://github.com/SuperSupermoon/MedViLL

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Visual Question Answering (VQA) methods have made incredible progress, but suffer from a failure to generalize. This is visible in the fact that they are vulnerable to learning coincidental correlations in the data rather than deeper relations between image content and ideas expressed in language. We present a dataset that takes a step towards addressing this problem in that it contains questions expressed in two languages, and an evaluation process that co-opts a well understood image-based metric to reflect the method's ability to reason. Measuring reasoning directly encourages generalization by penalizing answers that are coincidentally correct. The dataset reflects the scene-text version of the VQA problem, and the reasoning evaluation can be seen as a text-based version of a referring expression challenge. Experiments and analysis are provided that show the value of the dataset.

This paper introduces MedTrinity-25M, a comprehensive, large-scale multimodal dataset for medicine, covering over 25 million images across 10 modalities, with multigranular annotations for more than 65 diseases. These enriched annotations encompass both global textual information, such as disease/lesion type, modality, region-specific descriptions, and inter-regional relationships, as well as detailed local annotations for regions of interest (ROIs), including bounding boxes, segmentation masks. Unlike existing approach which is limited by the availability of image-text pairs, we have developed the first automated pipeline that scales up multimodal data by generating multigranular visual and texual annotations (in the form of image-ROI-description triplets) without the need for any paired text descriptions. Specifically, data from over 90 different sources have been collected, preprocessed, and grounded using domain-specific expert models to identify ROIs related to abnormal regions. We then build a comprehensive knowledge base and prompt multimodal large language models to perform retrieval-augmented generation with the identified ROIs as guidance, resulting in multigranular texual descriptions. Compared to existing datasets, MedTrinity-25M provides the most enriched annotations, supporting a comprehensive range of multimodal tasks such as captioning and report generation, as well as vision-centric tasks like classification and segmentation. Pretraining on MedTrinity-25M, our model achieves state-of-the-art performance on VQA-RAD and PathVQA, surpassing both multimodal large language models and other representative SoTA approaches. This dataset can also be utilized to support large-scale pre-training of multimodal medical AI models, contributing to the development of future foundation models in the medical domain.

Recent Vision-Language Models (VLMs) have demonstrated remarkable capabilities in visual understanding and reasoning, and in particular on multiple-choice Visual Question Answering (VQA). Still, these models can make distinctly unnatural errors, for example, providing (wrong) answers to unanswerable VQA questions, such as questions asking about objects that do not appear in the image. To address this issue, we propose CLIP-UP: CLIP-based Unanswerable Problem detection, a novel lightweight method for equipping VLMs with the ability to withhold answers to unanswerable questions. By leveraging CLIP to extract question-image alignment information, CLIP-UP requires only efficient training of a few additional layers, while keeping the original VLMs' weights unchanged. Tested across LLaVA models, CLIP-UP achieves state-of-the-art results on the MM-UPD benchmark for assessing unanswerability in multiple-choice VQA, while preserving the original performance on other tasks.

Optical Character Recognition - Visual Question Answering (OCR-VQA) is the task of answering text information contained in images that have just been significantly developed in the English language in recent years. However, there are limited studies of this task in low-resource languages such as Vietnamese. To this end, we introduce a novel dataset, ViOCRVQA (Vietnamese Optical Character Recognition - Visual Question Answering dataset), consisting of 28,000+ images and 120,000+ question-answer pairs. In this dataset, all the images contain text and questions about the information relevant to the text in the images. We deploy ideas from state-of-the-art methods proposed for English to conduct experiments on our dataset, revealing the challenges and difficulties inherent in a Vietnamese dataset. Furthermore, we introduce a novel approach, called VisionReader, which achieved 0.4116 in EM and 0.6990 in the F1-score on the test set. Through the results, we found that the OCR system plays a very important role in VQA models on the ViOCRVQA dataset. In addition, the objects in the image also play a role in improving model performance. We open access to our dataset at link (https://github.com/qhnhynmm/ViOCRVQA.git) for further research in OCR-VQA task in Vietnamese.

Document Visual Question Answering (DocVQA) refers to the task of answering questions from document images. Existing work on DocVQA only considers single-page documents. However, in real scenarios documents are mostly composed of multiple pages that should be processed altogether. In this work we extend DocVQA to the multi-page scenario. For that, we first create a new dataset, MP-DocVQA, where questions are posed over multi-page documents instead of single pages. Second, we propose a new hierarchical method, Hi-VT5, based on the T5 architecture, that overcomes the limitations of current methods to process long multi-page documents. The proposed method is based on a hierarchical transformer architecture where the encoder summarizes the most relevant information of every page and then, the decoder takes this summarized information to generate the final answer. Through extensive experimentation, we demonstrate that our method is able, in a single stage, to answer the questions and provide the page that contains the relevant information to find the answer, which can be used as a kind of explainability measure.

This paper introduces MedMCQA, a new large-scale, Multiple-Choice Question Answering (MCQA) dataset designed to address real-world medical entrance exam questions. More than 194k high-quality AIIMS \& NEET PG entrance exam MCQs covering 2.4k healthcare topics and 21 medical subjects are collected with an average token length of 12.77 and high topical diversity. Each sample contains a question, correct answer(s), and other options which requires a deeper language understanding as it tests the 10+ reasoning abilities of a model across a wide range of medical subjects \& topics. A detailed explanation of the solution, along with the above information, is provided in this study.