Daily Papers

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.

Multimodal Large Language Models (MLLMs) inherit the superior text understanding capabilities of LLMs and extend these capabilities to multimodal scenarios. These models achieve excellent results in the general domain of multimodal tasks. However, in the medical domain, the substantial training costs and the requirement for extensive medical data pose challenges to the development of medical MLLMs. Furthermore, due to the free-text form of answers, tasks such as visual grounding that need to produce output in a prescribed form become difficult for MLLMs. So far, there have been no medical MLLMs works in medical visual grounding area. For the medical vision grounding task, which involves identifying locations in medical images based on short text descriptions, we propose Parameter-efficient Fine-tuning medical multimodal large language models for Medcial Visual Grounding (PFMVG). To validate the performance of the model, we evaluate it on a public benchmark dataset for medical visual grounding, where it achieves competitive results, and significantly outperforming GPT-4v. Our code will be open sourced after peer review.

Visual grounding is essential for precise perception and reasoning in multimodal large language models (MLLMs), especially in medical imaging domains. While existing medical visual grounding benchmarks primarily focus on single-image scenarios, real-world clinical applications often involve sequential images, where accurate lesion localization across different modalities and temporal tracking of disease progression (e.g., pre- vs. post-treatment comparison) require fine-grained cross-image semantic alignment and context-aware reasoning. To remedy the underrepresentation of image sequences in existing medical visual grounding benchmarks, we propose MedSG-Bench, the first benchmark tailored for Medical Image Sequences Grounding. It comprises eight VQA-style tasks, formulated into two paradigms of the grounding tasks, including 1) Image Difference Grounding, which focuses on detecting change regions across images, and 2) Image Consistency Grounding, which emphasizes detection of consistent or shared semantics across sequential images. MedSG-Bench covers 76 public datasets, 10 medical imaging modalities, and a wide spectrum of anatomical structures and diseases, totaling 9,630 question-answer pairs. We benchmark both general-purpose MLLMs (e.g., Qwen2.5-VL) and medical-domain specialized MLLMs (e.g., HuatuoGPT-vision), observing that even the advanced models exhibit substantial limitations in medical sequential grounding tasks. To advance this field, we construct MedSG-188K, a large-scale instruction-tuning dataset tailored for sequential visual grounding, and further develop MedSeq-Grounder, an MLLM designed to facilitate future research on fine-grained understanding across medical sequential images. The benchmark, dataset, and model are available at https://huggingface.co/MedSG-Bench

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.

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.

Medical phrase grounding (MPG) aims to locate the most relevant region in a medical image, given a phrase query describing certain medical findings, which is an important task for medical image analysis and radiological diagnosis. However, existing visual grounding methods rely on general visual features for identifying objects in natural images and are not capable of capturing the subtle and specialized features of medical findings, leading to sub-optimal performance in MPG. In this paper, we propose MedRPG, an end-to-end approach for MPG. MedRPG is built on a lightweight vision-language transformer encoder and directly predicts the box coordinates of mentioned medical findings, which can be trained with limited medical data, making it a valuable tool in medical image analysis. To enable MedRPG to locate nuanced medical findings with better region-phrase correspondences, we further propose Tri-attention Context contrastive alignment (TaCo). TaCo seeks context alignment to pull both the features and attention outputs of relevant region-phrase pairs close together while pushing those of irrelevant regions far away. This ensures that the final box prediction depends more on its finding-specific regions and phrases. Experimental results on three MPG datasets demonstrate that our MedRPG outperforms state-of-the-art visual grounding approaches by a large margin. Additionally, the proposed TaCo strategy is effective in enhancing finding localization ability and reducing spurious region-phrase correlations.

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.

Medical phrase grounding is crucial for identifying relevant regions in medical images based on phrase queries, facilitating accurate image analysis and diagnosis. However, current methods rely on manual extraction of key phrases from medical reports, reducing efficiency and increasing the workload for clinicians. Additionally, the lack of model confidence estimation limits clinical trust and usability. In this paper, we introduce a novel task called Medical Report Grounding (MRG), which aims to directly identify diagnostic phrases and their corresponding grounding boxes from medical reports in an end-to-end manner. To address this challenge, we propose uMedGround, a robust and reliable framework that leverages a multimodal large language model to predict diagnostic phrases by embedding a unique token, <BOX>, into the vocabulary to enhance detection capabilities. A vision encoder-decoder processes the embedded token and input image to generate grounding boxes. Critically, uMedGround incorporates an uncertainty-aware prediction model, significantly improving the robustness and reliability of grounding predictions. Experimental results demonstrate that uMedGround outperforms state-of-the-art medical phrase grounding methods and fine-tuned large visual-language models, validating its effectiveness and reliability. This study represents a pioneering exploration of the MRG task, marking the first-ever endeavor in this domain. Additionally, we demonstrate the applicability of uMedGround in medical visual question answering and class-based localization tasks, where it highlights visual evidence aligned with key diagnostic phrases, supporting clinicians in interpreting various types of textual inputs, including free-text reports, visual question answering queries, and class labels.

Vision-language models have revolutionized human-computer interaction and shown significant progress in multi-modal tasks. However, applying these models to complex visual tasks like medical image analysis remains challenging. In this study, we propose ViLaM, a unified Vision-Language transformer model that integrates instruction tuning predicated on a large language model. This approach enables us to optimally utilize the knowledge and reasoning capacities of large pre-trained language models for an array of tasks encompassing both language and vision. We employ frozen pre-trained encoders to encode and align both image and text features, enabling ViLaM to handle a variety of visual tasks following textual instructions. Besides, we've designed cycle training for referring expressions to address the need for high-quality, paired referring expression datasets for training large models in terms of both quantity and quality. We evaluated ViLaM's exceptional performance on public general datasets and further confirmed its generalizability on medical datasets. Importantly, we've observed the model's impressive zero-shot learning ability, indicating the potential future application of ViLaM in the medical field.

Chain-of-thought (CoT) reasoning has advanced medical visual question answering (VQA), yet most existing CoT rationales are free-form and fail to capture the structured reasoning process clinicians actually follow. This work asks: Can traceable, multi-step reasoning supervision improve reasoning accuracy and the interpretability of Medical VQA? To this end, we introduce Step-CoT, a large-scale medical reasoning dataset with expert-curated, structured multi-step CoT aligned to clinical diagnostic workflows, implicitly grounding the model's reasoning in radiographic evidence. Step-CoT comprises more than 10K real clinical cases and 70K VQA pairs organized around diagnostic workflows, providing supervised intermediate steps that guide models to follow valid reasoning trajectories. To effectively learn from Step-CoT, we further introduce a teacher-student framework with a dynamic graph-structured focusing mechanism that prioritizes diagnostically informative steps while filtering out less relevant contexts. Our experiments show that using Step-CoT can improve reasoning accuracy and interpretability. Benchmark: github.com/hahaha111111/Step-CoT. Dataset Card: huggingface.co/datasets/fl-15o/Step-CoT

Medical imaging provides critical evidence for clinical diagnosis, treatment planning, and surgical decisions, yet most existing imaging models are narrowly focused and require multiple specialized networks, limiting their generalization. Although large-scale language and multimodal models exhibit strong reasoning and multi-task capabilities, real-world clinical applications demand precise visual grounding, multimodal integration, and chain-of-thought reasoning. We introduce Citrus-V, a multimodal medical foundation model that combines image analysis with textual reasoning. The model integrates detection, segmentation, and multimodal chain-of-thought reasoning, enabling pixel-level lesion localization, structured report generation, and physician-like diagnostic inference in a single framework. We propose a novel multimodal training approach and release a curated open-source data suite covering reasoning, detection, segmentation, and document understanding tasks. Evaluations demonstrate that Citrus-V outperforms existing open-source medical models and expert-level imaging systems across multiple benchmarks, delivering a unified pipeline from visual grounding to clinical reasoning and supporting precise lesion quantification, automated reporting, and reliable second opinions.

In this paper, we consider enhancing medical visual-language pre-training (VLP) with domain-specific knowledge, by exploiting the paired image-text reports from the radiological daily practice. In particular, we make the following contributions: First, unlike existing works that directly process the raw reports, we adopt a novel triplet extraction module to extract the medical-related information, avoiding unnecessary complexity from language grammar and enhancing the supervision signals; Second, we propose a novel triplet encoding module with entity translation by querying a knowledge base, to exploit the rich domain knowledge in medical field, and implicitly build relationships between medical entities in the language embedding space; Third, we propose to use a Transformer-based fusion model for spatially aligning the entity description with visual signals at the image patch level, enabling the ability for medical diagnosis; Fourth, we conduct thorough experiments to validate the effectiveness of our architecture, and benchmark on numerous public benchmarks, e.g., ChestX-ray14, RSNA Pneumonia, SIIM-ACR Pneumothorax, COVIDx CXR-2, COVID Rural, and EdemaSeverity. In both zero-shot and fine-tuning settings, our model has demonstrated strong performance compared with the former methods on disease classification and grounding.

Recent progress in medical vision-language models (VLMs) has achieved strong performance on image-level text-centric tasks such as report generation and visual question answering (VQA). However, achieving fine-grained visual grounding and volumetric spatial reasoning in 3D medical VLMs remains challenging, particularly when aiming to unify these capabilities within a single, generalizable framework. To address this challenge, we proposed MedVL-SAM2, a unified 3D medical multimodal model that concurrently supports report generation, VQA, and multi-paradigm segmentation, including semantic, referring, and interactive segmentation. MedVL-SAM2 integrates image-level reasoning and pixel-level perception through a cohesive architecture tailored for 3D medical imaging, and incorporates a SAM2-based volumetric segmentation module to enable precise multi-granular spatial reasoning. The model is trained in a multi-stage pipeline: it is first pre-trained on a large-scale corpus of 3D CT image-text pairs to align volumetric visual features with radiology-language embeddings. It is then jointly optimized with both language-understanding and segmentation objectives using a comprehensive 3D CT segmentation dataset. This joint training enables flexible interaction via language, point, or box prompts, thereby unifying high-level visual reasoning with spatially precise localization. Our unified architecture delivers state-of-the-art performance across report generation, VQA, and multiple 3D segmentation tasks. Extensive analyses further show that the model provides reliable 3D visual grounding, controllable interactive segmentation, and robust cross-modal reasoning, demonstrating that high-level semantic reasoning and precise 3D localization can be jointly achieved within a unified 3D medical VLM.

We present VinDr-CXR-VQA, a large-scale chest X-ray dataset for explainable Medical Visual Question Answering (Med-VQA) with spatial grounding. The dataset contains 17,597 question-answer pairs across 4,394 images, each annotated with radiologist-verified bounding boxes and clinical reasoning explanations. Our question taxonomy spans six diagnostic types-Where, What, Is there, How many, Which, and Yes/No-capturing diverse clinical intents. To improve reliability, we construct a balanced distribution of 41.7% positive and 58.3% negative samples, mitigating hallucinations in normal cases. Benchmarking with MedGemma-4B-it demonstrates improved performance (F1 = 0.624, +11.8% over baseline) while enabling lesion localization. VinDr-CXR-VQA aims to advance reproducible and clinically grounded Med-VQA research. The dataset and evaluation tools are publicly available at huggingface.co/datasets/Dangindev/VinDR-CXR-VQA.

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 study, we aim to build up a model that can Segment Anything in radiology scans, driven by medical terminologies as Text prompts, termed as SAT. Our main contributions are three folds: (i) for dataset construction, we construct the first multi-modal knowledge tree on human anatomy, including 6502 anatomical terminologies; Then, we build up the largest and most comprehensive segmentation dataset for training, by collecting over 22K 3D medical image scans from72 segmentation datasets, across 497 classes, with careful standardization on both image scans and label space; (ii) for architecture design, we propose to inject medical knowledge into a text encoder via contrastive learning, and then formulate a universal segmentation model, that can be prompted by feeding in medical terminologies in text form; (iii) As a result, we have trained SAT-Nano (110M parameters) and SAT-Pro (447M parameters), demonstrating superior or comparable performance to 72 specialist models, i.e., nnU-Nets, U-Mamba or SwinUNETR, trained on each dataset/subsets. We validate SAT as a foundational segmentation model, with better generalization on external (cross-center) datasets, and can be further improved on specific tasks after fine-tuning adaptation. Comparing with state-of-the-art interactive segmentation model MedSAM, SAT demonstrate superior performance, scalability and robustness. We further compare SAT with BiomedParse, and observe SAT is significantly superior in both internal and external evaluation. Through extensive ablation study, we validate the benefit of domain knowledge on universal segmentation, especially on tail categories. As a use case, we demonstrate that SAT can act as a powerful out-of-the-box agent for large language models, enabling visual grounding in versatile application scenarios. All the data, codes, and models in this work have been released.

While Multi-Agent Systems (MAS) show potential for complex clinical decision support, the field remains hindered by architectural fragmentation and the lack of standardized multimodal integration. Current medical MAS research suffers from non-uniform data ingestion pipelines, inconsistent visual-reasoning evaluation, and a lack of cross-specialty benchmarking. To address these challenges, we present MedMASLab, a unified framework and benchmarking platform for multimodal medical multi-agent systems. MedMASLab introduces: (1) A standardized multimodal agent communication protocol that enables seamless integration of 11 heterogeneous MAS architectures across 24 medical modalities. (2) An automated clinical reasoning evaluator, a zero-shot semantic evaluation paradigm that overcomes the limitations of lexical string-matching by leveraging large vision-language models to verify diagnostic logic and visual grounding. (3) The most extensive benchmark to date, spanning 11 organ systems and 473 diseases, standardizing data from 11 clinical benchmarks. Our systematic evaluation reveals a critical domain-specific performance gap: while MAS improves reasoning depth, current architectures exhibit significant fragility when transitioning between specialized medical sub-domains. We provide a rigorous ablation of interaction mechanisms and cost-performance trade-offs, establishing a new technical baseline for future autonomous clinical systems. The source code and data is publicly available at: https://github.com/NUS-Project/MedMASLab/

Vision-grounded medical report generation aims to produce clinically accurate descriptions of medical images, anchored in explicit visual evidence to improve interpretability and facilitate integration into clinical workflows. However, existing methods often rely on separately trained detection modules that require extensive expert annotations, introducing high labeling costs and limiting generalizability due to pathology distribution bias across datasets. To address these challenges, we propose Self-Supervised Anatomical Consistency Learning (SS-ACL) -- a novel and annotation-free framework that aligns generated reports with corresponding anatomical regions using simple textual prompts. SS-ACL constructs a hierarchical anatomical graph inspired by the invariant top-down inclusion structure of human anatomy, organizing entities by spatial location. It recursively reconstructs fine-grained anatomical regions to enforce intra-sample spatial alignment, inherently guiding attention maps toward visually relevant areas prompted by text. To further enhance inter-sample semantic alignment for abnormality recognition, SS-ACL introduces a region-level contrastive learning based on anatomical consistency. These aligned embeddings serve as priors for report generation, enabling attention maps to provide interpretable visual evidence. Extensive experiments demonstrate that SS-ACL, without relying on expert annotations, (i) generates accurate and visually grounded reports -- outperforming state-of-the-art methods by 10\% in lexical accuracy and 25\% in clinical efficacy, and (ii) achieves competitive performance on various downstream visual tasks, surpassing current leading visual foundation models by 8\% in zero-shot visual grounding.

In clinical radiology reports, doctors capture important information about the patient's health status. They convey their observations from raw medical imaging data about the inner structures of a patient. As such, formulating reports requires medical experts to possess wide-ranging knowledge about anatomical regions with their normal, healthy appearance as well as the ability to recognize abnormalities. This explicit grasp on both the patient's anatomy and their appearance is missing in current medical image-processing systems as annotations are especially difficult to gather. This renders the models to be narrow experts e.g. for identifying specific diseases. In this work, we recover this missing link by adding human anatomy into the mix and enable the association of content in medical reports to their occurrence in associated imagery (medical phrase grounding). To exploit anatomical structures in this scenario, we present a sophisticated automatic pipeline to gather and integrate human bodily structures from computed tomography datasets, which we incorporate in our PAXRay: A Projected dataset for the segmentation of Anatomical structures in X-Ray data. Our evaluation shows that methods that take advantage of anatomical information benefit heavily in visually grounding radiologists' findings, as our anatomical segmentations allow for up to absolute 50% better grounding results on the OpenI dataset as compared to commonly used region proposals. The PAXRay dataset is available at https://constantinseibold.github.io/paxray/.

Image-text multimodal representation learning aligns data across modalities and enables important medical applications, e.g., image classification, visual grounding, and cross-modal retrieval. In this work, we establish a connection between multimodal representation learning and multiple instance learning. Based on this connection, we propose a generic framework for constructing permutation-invariant score functions with many existing multimodal representation learning approaches as special cases. Furthermore, we use the framework to derive a novel contrastive learning approach and demonstrate that our method achieves state-of-the-art results in several downstream tasks.

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.

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose Knowledge to Sight (K2Sight), a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in mAP_{50}. Code and models: https://lijunrio.github.io/K2Sight/{SOTAPink{https://lijunrio.github.io/K2Sight/}}.

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.

Multimodal large language models (MLLMs) have rapidly advanced, yet their adoption in medicine remains limited by gaps in domain coverage, modality alignment, and grounded reasoning. In this work, we introduce MedMO, a medical foundation model built upon a generalized MLLM architecture and trained exclusively on large-scale, domain-specific data. MedMO follows a multi-stage training recipe: (i) cross-modal pretraining to align heterogeneous visual encoders with a medical language backbone; (ii) instruction tuning on multi-task supervision that spans captioning, VQA, report generation, retrieval, and grounded disease localization with bounding boxes; and (iii) reinforcement learning with verifiable rewards that combine factuality checks with a box-level GIoU reward to strengthen spatial grounding and step-by-step reasoning in complex clinical scenarios. MedMO consistently outperforms strong open-source medical MLLMs across multiple modalities and tasks. On VQA benchmarks, MedMO achieves an average accuracy improvement of +13.7% over the baseline and performs within 1.9% of the SOTA Fleming-VL. For text-based QA, it attains +6.9% over the baseline and +14.5% over Fleming-VL. In medical report generation, MedMO delivers significant gains in both semantic and clinical accuracy. Moreover, it exhibits strong grounding capability, achieving an IoU improvement of +40.4 over the baseline and +37.0% over Fleming-VL, underscoring its robust spatial reasoning and localization performance. Evaluations across radiology, ophthalmology, and pathology-microscopy confirm MedMO's broad cross-modality generalization. We release two versions of MedMO: 4B and 8B. Project is available at https://genmilab.github.io/MedMO-Page

Localizing the exact pathological regions in a given medical scan is an important imaging problem that traditionally requires a large amount of bounding box ground truth annotations to be accurately solved. However, there exist alternative, potentially weaker, forms of supervision, such as accompanying free-text reports, which are readily available. The task of performing localization with textual guidance is commonly referred to as phrase grounding. In this work, we use a publicly available Foundation Model, namely the Latent Diffusion Model, to perform this challenging task. This choice is supported by the fact that the Latent Diffusion Model, despite being generative in nature, contains cross-attention mechanisms that implicitly align visual and textual features, thus leading to intermediate representations that are suitable for the task at hand. In addition, we aim to perform this task in a zero-shot manner, i.e., without any training on the target task, meaning that the model's weights remain frozen. To this end, we devise strategies to select features and also refine them via post-processing without extra learnable parameters. We compare our proposed method with state-of-the-art approaches which explicitly enforce image-text alignment in a joint embedding space via contrastive learning. Results on a popular chest X-ray benchmark indicate that our method is competitive with SOTA on different types of pathology, and even outperforms them on average in terms of two metrics (mean IoU and AUC-ROC). Source code will be released upon acceptance at https://github.com/vios-s.

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.

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.

Accurately grounding regions of interest (ROIs) is critical for diagnosis and treatment planning in medical imaging. While multimodal large language models (MLLMs) combine visual perception with natural language, current medical-grounding pipelines still rely on supervised fine-tuning with explicit spatial hints, making them ill-equipped to handle the implicit queries common in clinical practice. This work makes three core contributions. We first define Unified Medical Reasoning Grounding (UMRG), a novel vision-language task that demands clinical reasoning and pixel-level grounding. Second, we release U-MRG-14K, a dataset of 14K samples featuring pixel-level masks alongside implicit clinical queries and reasoning traces, spanning 10 modalities, 15 super-categories, and 108 specific categories. Finally, we introduce MedReasoner, a modular framework that distinctly separates reasoning from segmentation: an MLLM reasoner is optimized with reinforcement learning, while a frozen segmentation expert converts spatial prompts into masks, with alignment achieved through format and accuracy rewards. MedReasoner achieves state-of-the-art performance on U-MRG-14K and demonstrates strong generalization to unseen clinical queries, underscoring the significant promise of reinforcement learning for interpretable medical grounding.

Vision-language pre-training (VLP) models have shown significant advancements in the medical domain. Yet, most VLP models align raw reports to images at a very coarse level, without modeling fine-grained relationships between anatomical and pathological concepts outlined in reports and the corresponding semantic counterparts in images. To address this problem, we propose a Medical Dual-Stream Language-Image Pre-training (MeDSLIP) framework. Specifically, MeDSLIP establishes vision-language fine-grained alignments via disentangling visual and textual representations into anatomy-relevant and pathology-relevant streams. Moreover, a novel vision-language Prototypical Contr-astive Learning (ProtoCL) method is adopted in MeDSLIP to enhance the alignment within the anatomical and pathological streams. MeDSLIP further employs cross-stream Intra-image Contrastive Learning (ICL) to ensure the consistent coexistence of paired anatomical and pathological concepts within the same image. Such a cross-stream regularization encourages the model to exploit the synchrony between two streams for a more comprehensive representation learning. MeDSLIP is evaluated under zero-shot and supervised fine-tuning settings on three public datasets: NIH CXR14, RSNA Pneumonia, and SIIM-ACR Pneumothorax. Under these settings, MeDSLIP outperforms six leading CNN-based models on classification, grounding, and segmentation tasks.

Recent reasoning based medical MLLMs have made progress in generating step by step textual reasoning chains. However, they still struggle with complex tasks that necessitate dynamic and iterative focusing on fine-grained visual regions to achieve precise grounding and diagnosis. We introduce Ophiuchus, a versatile, tool-augmented framework that equips an MLLM to (i) decide when additional visual evidence is needed, (ii) determine where to probe and ground within the medical image, and (iii) seamlessly weave the relevant sub-image content back into an interleaved, multimodal chain of thought. In contrast to prior approaches limited by the performance ceiling of specialized tools, Ophiuchus integrates the model's inherent grounding and perception capabilities with external tools, thereby fostering higher-level reasoning. The core of our method is a three-stage training strategy: cold-start training with tool-integrated reasoning data to achieve basic tool selection and adaptation for inspecting key regions; self-reflection fine-tuning to strengthen reflective reasoning and encourage revisiting tool outputs; and Agentic Tool Reinforcement Learning to directly optimize task-specific rewards and emulate expert-like diagnostic behavior. Extensive experiments show that Ophiuchus consistently outperforms both closed-source and open-source SOTA methods across diverse medical benchmarks, including VQA, detection, and reasoning-based segmentation. Our approach illuminates a path toward medical AI agents that can genuinely "think with images" through tool-integrated reasoning. Datasets, codes, and trained models will be released publicly.

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.

Text-guided image editing has seen rapid progress in natural image domains, but its adaptation to medical imaging remains limited and lacks standardized evaluation. Clinically, such editing holds promise for simulating surgical outcomes, creating personalized teaching materials, and enhancing patient communication. To bridge this gap, we introduce MedEBench, a comprehensive benchmark for evaluating text-guided medical image editing. It consists of 1,182 clinically sourced image-prompt triplets spanning 70 tasks across 13 anatomical regions. MedEBench offers three key contributions: (1) a clinically relevant evaluation framework covering Editing Accuracy, Contextual Preservation, and Visual Quality, supported by detailed descriptions of expected change and ROI (Region of Interest) masks; (2) a systematic comparison of seven state-of-the-art models, revealing common failure patterns; and (3) a failure analysis protocol based on attention grounding, using IoU between attention maps and ROIs to identify mislocalization. MedEBench provides a solid foundation for developing and evaluating reliable, clinically meaningful medical image editing systems.

Visual grounding refers to the ability of a model to identify a region within some visual input that matches a textual description. Consequently, a model equipped with visual grounding capabilities can target a wide range of applications in various domains, including referring expression comprehension, answering questions pertinent to fine-grained details in images or videos, caption visual context by explicitly referring to entities, as well as low and high-level control in simulated and real environments. In this survey paper, we review representative works across the key areas of research on modern general-purpose vision language models (VLMs). We first outline the importance of grounding in VLMs, then delineate the core components of the contemporary paradigm for developing grounded models, and examine their practical applications, including benchmarks and evaluation metrics for grounded multimodal generation. We also discuss the multifaceted interrelations among visual grounding, multimodal chain-of-thought, and reasoning in VLMs. Finally, we analyse the challenges inherent to visual grounding and suggest promising directions for future research.

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.

Despite the rapid progress of Multimodal Large Language Models (MLLMs), their ability to perform reliable visual grounding in high-stakes clinical software environments remains underexplored. Existing GUI benchmarks largely focus on isolated, single-step grounding queries, overlooking the sequential, workflow-driven reasoning required in real-world medical interfaces, where tasks evolve across independent steps and dynamic interface states. We introduce MedSPOT, a workflow-aware sequential grounding benchmark for clinical GUI environments. Unlike prior benchmarks that treat grounding as a standalone prediction task, MedSPOT models procedural interaction as a sequence of structured spatial decisions. The benchmark comprises 216 task-driven videos with 597 annotated keyframes, in which each task consists of 2 to 3 interdependent grounding steps within realistic medical workflows. This design captures interface hierarchies, contextual dependencies, and fine-grained spatial precision under evolving conditions. To evaluate procedural robustness, we propose a strict sequential evaluation protocol that terminates task assessment upon the first incorrect grounding prediction, explicitly measuring error propagation in multi-step workflows. We further introduce a comprehensive failure taxonomy, including edge bias, small-target errors, no prediction, near miss, far miss, and toolbar confusion, to enable systematic diagnosis of model behavior in clinical GUI settings. By shifting evaluation from isolated grounding to workflow-aware sequential reasoning, MedSPOT establishes a realistic and safety-critical benchmark for assessing multimodal models in medical software environments. Code and data are available at: https://github.com/Tajamul21/MedSPOT.

Visual Grounding (VG) methods in Visual Question Answering (VQA) attempt to improve VQA performance by strengthening a model's reliance on question-relevant visual information. The presence of such relevant information in the visual input is typically assumed in training and testing. This assumption, however, is inherently flawed when dealing with imperfect image representations common in large-scale VQA, where the information carried by visual features frequently deviates from expected ground-truth contents. As a result, training and testing of VG-methods is performed with largely inaccurate data, which obstructs proper assessment of their potential benefits. In this study, we demonstrate that current evaluation schemes for VG-methods are problematic due to the flawed assumption of availability of relevant visual information. Our experiments show that these methods can be much more effective when evaluation conditions are corrected. Code is provided on GitHub.

Visual grounding is the task of locating objects specified by natural language expressions. Existing methods extend generic object detection frameworks to tackle this task. They typically extract visual and textual features separately using independent visual and textual encoders, then fuse these features in a multi-modal decoder for final prediction. However, visual grounding presents unique challenges. It often involves locating objects with different text descriptions within the same image. Existing methods struggle with this task because the independent visual encoder produces identical visual features for the same image, limiting detection performance. Some recently approaches propose various language-guided visual encoders to address this issue, but they mostly rely solely on textual information and require sophisticated designs. In this paper, we introduce Multi-modal Conditional Adaptation (MMCA), which enables the visual encoder to adaptively update weights, directing its focus towards text-relevant regions. Specifically, we first integrate information from different modalities to obtain multi-modal embeddings. Then we utilize a set of weighting coefficients, which generated from the multimodal embeddings, to reorganize the weight update matrices and apply them to the visual encoder of the visual grounding model. Extensive experiments on four widely used datasets demonstrate that MMCA achieves significant improvements and state-of-the-art results. Ablation experiments further demonstrate the lightweight and efficiency of our method. Our source code is available at: https://github.com/Mr-Bigworth/MMCA.

Visual grounding, which aims to ground a visual region via natural language, is a task that heavily relies on cross-modal alignment. Existing works utilized uni-modal pre-trained models to transfer visual/linguistic knowledge separately while ignoring the multimodal corresponding information. Motivated by recent advancements in contrastive language-image pre-training and low-rank adaptation (LoRA) methods, we aim to solve the grounding task based on multimodal pre-training. However, there exists significant task gaps between pre-training and grounding. Therefore, to address these gaps, we propose a concise and efficient hierarchical multimodal fine-grained modulation framework, namely HiVG. Specifically, HiVG consists of a multi-layer adaptive cross-modal bridge and a hierarchical multimodal low-rank adaptation (Hi LoRA) paradigm. The cross-modal bridge can address the inconsistency between visual features and those required for grounding, and establish a connection between multi-level visual and text features. Hi LoRA prevents the accumulation of perceptual errors by adapting the cross-modal features from shallow to deep layers in a hierarchical manner. Experimental results on five datasets demonstrate the effectiveness of our approach and showcase the significant grounding capabilities as well as promising energy efficiency advantages. The project page: https://github.com/linhuixiao/HiVG.

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Radiology reporting is a complex task that requires detailed image understanding, integration of multiple inputs, including comparison with prior imaging, and precise language generation. This makes it ideal for the development and use of generative multimodal models. Here, we extend report generation to include the localisation of individual findings on the image - a task we call grounded report generation. Prior work indicates that grounding is important for clarifying image understanding and interpreting AI-generated text. Therefore, grounded reporting stands to improve the utility and transparency of automated report drafting. To enable evaluation of grounded reporting, we propose a novel evaluation framework - RadFact - leveraging the reasoning capabilities of large language models (LLMs). RadFact assesses the factuality of individual generated sentences, as well as correctness of generated spatial localisations when present. We introduce MAIRA-2, a large multimodal model combining a radiology-specific image encoder with a LLM, and trained for the new task of grounded report generation on chest X-rays. MAIRA-2 uses more comprehensive inputs than explored previously: the current frontal image, the current lateral image, the prior frontal image and prior report, as well as the Indication, Technique and Comparison sections of the current report. We demonstrate that these additions significantly improve report quality and reduce hallucinations, establishing a new state of the art on findings generation (without grounding) on MIMIC-CXR while demonstrating the feasibility of grounded reporting as a novel and richer task.

Visual grounding is a common vision task that involves grounding descriptive sentences to the corresponding regions of an image. Most existing methods use independent image-text encoding and apply complex hand-crafted modules or encoder-decoder architectures for modal interaction and query reasoning. However, their performance significantly drops when dealing with complex textual expressions. This is because the former paradigm only utilizes limited downstream data to fit the multi-modal feature fusion. Therefore, it is only effective when the textual expressions are relatively simple. In contrast, given the wide diversity of textual expressions and the uniqueness of downstream training data, the existing fusion module, which extracts multimodal content from a visual-linguistic context, has not been fully investigated. In this paper, we present a simple yet robust transformer-based framework, SimVG, for visual grounding. Specifically, we decouple visual-linguistic feature fusion from downstream tasks by leveraging existing multimodal pre-trained models and incorporating additional object tokens to facilitate deep integration of downstream and pre-training tasks. Furthermore, we design a dynamic weight-balance distillation method in the multi-branch synchronous learning process to enhance the representation capability of the simpler branch. This branch only consists of a lightweight MLP, which simplifies the structure and improves reasoning speed. Experiments on six widely used VG datasets, i.e., RefCOCO/+/g, ReferIt, Flickr30K, and GRefCOCO, demonstrate the superiority of SimVG. Finally, the proposed method not only achieves improvements in efficiency and convergence speed but also attains new state-of-the-art performance on these benchmarks. Codes and models will be available at https://github.com/Dmmm1997/SimVG.

Answer grounding is the task of locating relevant visual evidence for the Visual Question Answering task. While a wide variety of attention methods have been introduced for this task, they suffer from the following three problems: designs that do not allow the usage of pre-trained networks and do not benefit from large data pre-training, custom designs that are not based on well-grounded previous designs, therefore limiting the learning power of the network, or complicated designs that make it challenging to re-implement or improve them. In this paper, we propose a novel architectural block, which we term Sentence Attention Block, to solve these problems. The proposed block re-calibrates channel-wise image feature-maps by explicitly modeling inter-dependencies between the image feature-maps and sentence embedding. We visually demonstrate how this block filters out irrelevant feature-maps channels based on sentence embedding. We start our design with a well-known attention method, and by making minor modifications, we improve the results to achieve state-of-the-art accuracy. The flexibility of our method makes it easy to use different pre-trained backbone networks, and its simplicity makes it easy to understand and be re-implemented. We demonstrate the effectiveness of our method on the TextVQA-X, VQS, VQA-X, and VizWiz-VQA-Grounding datasets. We perform multiple ablation studies to show the effectiveness of our design choices.

Current Vision-Language Models (VLMs) struggle to ground anatomical regions in 3D medical images and reason about them in a step-by-step manner, a key requirement of real-world diagnostic assessment. This ability is essential for aligning model outputs with the diagnostic workflows clinicians use in practice, enabling trustworthy clinician-AI collaboration. Existing 3D datasets provide localization labels, but none support this "grounded reasoning" ability. To address this gap, we introduce 3DReasonKnee, the first 3D grounded reasoning dataset for medical images, which provides 494k high-quality quintuples derived from 7,970 3D knee MRI volumes. Each quintuple includes: (1) the 3D MRI volume, (2) a diagnostic question targeting a specific anatomical region (3) a 3D bounding box localizing the relevant anatomical structures, (4) clinician-generated diagnostic reasoning steps that explicitly detail the 3D reasoning process, and (5) structured severity assessments for the relevant anatomical region. The creation and validation of 3DReasonKnee, involving over 450 hours of expert clinician time for manually segmenting MRIs and generating reasoning chains, ensures its superior quality and clinical relevance. We establish ReasonKnee-Bench to evaluate localization and diagnostic accuracy, providing insight into VLM ability to perform grounding and severity assessment across anatomical regions and diagnostic inquiries. We benchmark five state-of-the-art VLMs, providing baseline performance for ReasonKnee-Bench. By providing this unique resource of expert-annotated 3D reasoning pathways, 3DReasonKnee serves as a repository of orthopedic surgeons' diagnostic expertise and offers a vital testbed for advancing multimodal medical AI systems towards 3D, clinically aligned, localized decision-making capabilities. The dataset can be found in: https://huggingface.co/datasets/rajpurkarlab/3DReasonKnee

Visual Grounding is also known as Referring Expression Comprehension and Phrase Grounding. It involves localizing a natural number of specific regions within an image based on a given textual description. The objective of this task is to emulate the prevalent referential relationships in social conversations, equipping machines with human-like multimodal comprehension capabilities. Consequently, it has extensive applications in various domains. However, since 2021, visual grounding has witnessed significant advancements, with emerging new concepts such as grounded pre-training, grounding multimodal LLMs, generalized visual grounding, and giga-pixel grounding, which have brought numerous new challenges. In this survey, we initially examine the developmental history of visual grounding and provide an overview of essential background knowledge. We systematically track and summarize the advancements and meticulously organize the various settings in visual grounding, thereby establishing precise definitions of these settings to standardize future research and ensure a fair comparison. Additionally, we delve into several advanced topics and highlight numerous applications of visual grounding. Finally, we outline the challenges confronting visual grounding and propose valuable directions for future research, which may serve as inspiration for subsequent researchers. By extracting common technical details, this survey encompasses the representative works in each subtopic over the past decade. To the best, this paper presents the most comprehensive overview currently available in the field of grounding. This survey is designed to be suitable for both beginners and experienced researchers, serving as an invaluable resource for understanding key concepts and tracking the latest research developments. We keep tracing related works at https://github.com/linhuixiao/Awesome-Visual-Grounding.

Visual grounding, a crucial vision-language task involving the understanding of the visual context based on the query expression, necessitates the model to capture the interactions between objects, as well as various spatial and attribute information. However, the annotation data of visual grounding task is limited due to its time-consuming and labor-intensive annotation process, resulting in the trained models being constrained from generalizing its capability to a broader domain. To address this challenge, we propose GroundVLP, a simple yet effective zero-shot method that harnesses visual grounding ability from the existing models trained from image-text pairs and pure object detection data, both of which are more conveniently obtainable and offer a broader domain compared to visual grounding annotation data. GroundVLP proposes a fusion mechanism that combines the heatmap from GradCAM and the object proposals of open-vocabulary detectors. We demonstrate that the proposed method significantly outperforms other zero-shot methods on RefCOCO/+/g datasets, surpassing prior zero-shot state-of-the-art by approximately 28\% on the test split of RefCOCO and RefCOCO+. Furthermore, GroundVLP performs comparably to or even better than some non-VLP-based supervised models on the Flickr30k entities dataset. Our code is available at https://github.com/om-ai-lab/GroundVLP.

Visual Grounding (VG) is a crucial topic in the field of vision and language, which involves locating a specific region described by expressions within an image. To reduce the reliance on manually labeled data, unsupervised visual grounding have been developed to locate regions using pseudo-labels. However, the performance of existing unsupervised methods is highly dependent on the quality of pseudo-labels and these methods always encounter issues with limited diversity. In order to utilize vision and language pre-trained models to address the grounding problem, and reasonably take advantage of pseudo-labels, we propose CLIP-VG, a novel method that can conduct self-paced curriculum adapting of CLIP with pseudo-language labels. We propose a simple yet efficient end-to-end network architecture to realize the transfer of CLIP to the visual grounding. Based on the CLIP-based architecture, we further propose single-source and multi-source curriculum adapting algorithms, which can progressively find more reliable pseudo-labels to learn an optimal model, thereby achieving a balance between reliability and diversity for the pseudo-language labels. Our method outperforms the current state-of-the-art unsupervised method by a significant margin on RefCOCO/+/g datasets in both single-source and multi-source scenarios, with improvements ranging from 6.78% to 10.67% and 11.39% to 14.87%, respectively. The results even outperform existing weakly supervised visual grounding methods. Furthermore, our method is also competitive in fully supervised setting. The code and models are available at https://github.com/linhuixiao/CLIP-VG.

3D Visual Grounding (3DVG) seeks to locate target objects in 3D scenes using natural language descriptions, enabling downstream applications such as augmented reality and robotics. Existing approaches typically rely on labeled 3D data and predefined categories, limiting scalability to open-world settings. We present SeeGround, a zero-shot 3DVG framework that leverages 2D Vision-Language Models (VLMs) to bypass the need for 3D-specific training. To bridge the modality gap, we introduce a hybrid input format that pairs query-aligned rendered views with spatially enriched textual descriptions. Our framework incorporates two core components: a Perspective Adaptation Module that dynamically selects optimal viewpoints based on the query, and a Fusion Alignment Module that integrates visual and spatial signals to enhance localization precision. Extensive evaluations on ScanRefer and Nr3D confirm that SeeGround achieves substantial improvements over existing zero-shot baselines -- outperforming them by 7.7% and 7.1%, respectively -- and even rivals fully supervised alternatives, demonstrating strong generalization under challenging conditions.

Vision-language models can connect the text description of an object to its specific location in an image through visual grounding. This has potential applications in enhanced radiology reporting. However, these models require large annotated image-text datasets, which are lacking for PET/CT. We developed an automated pipeline to generate weak labels linking PET/CT report descriptions to their image locations and used it to train a 3D vision-language visual grounding model. Our pipeline finds positive findings in PET/CT reports by identifying mentions of SUVmax and axial slice numbers. From 25,578 PET/CT exams, we extracted 11,356 sentence-label pairs. Using this data, we trained ConTEXTual Net 3D, which integrates text embeddings from a large language model with a 3D nnU-Net via token-level cross-attention. The model's performance was compared against LLMSeg, a 2.5D version of ConTEXTual Net, and two nuclear medicine physicians. The weak-labeling pipeline accurately identified lesion locations in 98% of cases (246/251), with 7.5% requiring boundary adjustments. ConTEXTual Net 3D achieved an F1 score of 0.80, outperforming LLMSeg (F1=0.22) and the 2.5D model (F1=0.53), though it underperformed both physicians (F1=0.94 and 0.91). The model achieved better performance on FDG (F1=0.78) and DCFPyL (F1=0.75) exams, while performance dropped on DOTATE (F1=0.58) and Fluciclovine (F1=0.66). The model performed consistently across lesion sizes but showed reduced accuracy on lesions with low uptake. Our novel weak labeling pipeline accurately produced an annotated dataset of PET/CT image-text pairs, facilitating the development of 3D visual grounding models. ConTEXTual Net 3D significantly outperformed other models but fell short of the performance of nuclear medicine physicians. Our study suggests that even larger datasets may be needed to close this performance gap.

Agentic systems offer a potential path to solve complex clinical tasks through collaboration among specialized agents, augmented by tool use and external knowledge bases. Nevertheless, for chest X-ray (CXR) interpretation, prevailing methods remain limited: (i) reasoning is frequently neither clinically interpretable nor aligned with guidelines, reflecting mere aggregation of tool outputs; (ii) multimodal evidence is insufficiently fused, yielding text-only rationales that are not visually grounded; and (iii) systems rarely detect or resolve cross-tool inconsistencies and provide no principled verification mechanisms. To bridge the above gaps, we present RadAgents, a multi-agent framework for CXR interpretation that couples clinical priors with task-aware multimodal reasoning. In addition, we integrate grounding and multimodal retrieval-augmentation to verify and resolve context conflicts, resulting in outputs that are more reliable, transparent, and consistent with clinical practice.

Zero-shot medical detection can further improve detection performance without relying on annotated medical images even upon the fine-tuned model, showing great clinical value. Recent studies leverage grounded vision-language models (GLIP) to achieve this by using detailed disease descriptions as prompts for the target disease name during the inference phase. However, these methods typically treat prompts as equivalent context to the target name, making it difficult to assign specific disease knowledge based on visual information, leading to a coarse alignment between images and target descriptions. In this paper, we propose StructuralGLIP, which introduces an auxiliary branch to encode prompts into a latent knowledge bank layer-by-layer, enabling more context-aware and fine-grained alignment. Specifically, in each layer, we select highly similar features from both the image representation and the knowledge bank, forming structural representations that capture nuanced relationships between image patches and target descriptions. These features are then fused across modalities to further enhance detection performance. Extensive experiments demonstrate that StructuralGLIP achieves a +4.1\% AP improvement over prior state-of-the-art methods across seven zero-shot medical detection benchmarks, and consistently improves fine-tuned models by +3.2\% AP on endoscopy image datasets.

Visual grounding aims to ground an image region through natural language, which heavily relies on cross-modal alignment. Most existing methods transfer visual/linguistic knowledge separately by fully fine-tuning uni-modal pre-trained models, followed by a simple stack of visual-language transformers for multimodal fusion. However, these approaches not only limit adequate interaction between visual and linguistic contexts, but also incur significant computational costs. Therefore, to address these issues, we explore a step-wise multimodal fusion and adaption framework, namely SwimVG. Specifically, SwimVG proposes step-wise multimodal prompts (Swip) and cross-modal interactive adapters (CIA) for visual grounding, replacing the cumbersome transformer stacks for multimodal fusion. Swip can improve {the} alignment between the vision and language representations step by step, in a token-level fusion manner. In addition, weight-level CIA further promotes multimodal fusion by cross-modal interaction. Swip and CIA are both parameter-efficient paradigms, and they fuse the cross-modal features from shallow to deep layers gradually. Experimental results on four widely-used benchmarks demonstrate that SwimVG achieves remarkable abilities and considerable benefits in terms of efficiency. Our code is available at https://github.com/liuting20/SwimVG.

3D visual grounding is the ability to localize objects in 3D scenes conditioned by utterances. Most existing methods devote the referring head to localize the referred object directly, causing failure in complex scenarios. In addition, it does not illustrate how and why the network reaches the final decision. In this paper, we address this question Can we design an interpretable 3D visual grounding framework that has the potential to mimic the human perception system?. To this end, we formulate the 3D visual grounding problem as a sequence-to-sequence task by first predicting a chain of anchors and then the final target. Interpretability not only improves the overall performance but also helps us identify failure cases. Following the chain of thoughts approach enables us to decompose the referring task into interpretable intermediate steps, boosting the performance and making our framework extremely data-efficient. Moreover, our proposed framework can be easily integrated into any existing architecture. We validate our approach through comprehensive experiments on the Nr3D, Sr3D, and Scanrefer benchmarks and show consistent performance gains compared to existing methods without requiring manually annotated data. Furthermore, our proposed framework, dubbed CoT3DRef, is significantly data-efficient, whereas on the Sr3D dataset, when trained only on 10% of the data, we match the SOTA performance that trained on the entire data.

3D visual grounding allows an embodied agent to understand visual information in real-world 3D environments based on human instructions, which is crucial for embodied intelligence. Existing 3D visual grounding methods typically rely on separate encoders for different modalities (e.g., RGB images, text, and 3D point clouds), resulting in large and complex models that are inefficient to train. While some approaches use pre-trained 2D multi-modal models like CLIP for 3D tasks, they still struggle with aligning point cloud data to 2D encoders. As a result, these methods continue to depend on 3D encoders for feature extraction, further increasing model complexity and training inefficiency. In this paper, we propose a unified 2D pre-trained multi-modal network to process all three modalities (RGB images, text, and point clouds), significantly simplifying the architecture. By leveraging a 2D CLIP bi-modal model with adapter-based fine-tuning, this framework effectively adapts to the tri-modal setting, improving both adaptability and performance across modalities. Our Geometric-Aware 2D-3D Feature Recovery and Fusion (GARF) module is designed to fuse geometric multi-scale features from point clouds and images. We then integrate textual features for final modality fusion and introduce a multi-modal decoder to facilitate deep cross-modal understanding. Together, our method achieves unified feature extraction and fusion across the three modalities, enabling an end-to-end 3D visual grounding model. Compared to the baseline, our method reduces the number of trainable parameters by approximately 58\%, while achieving a 6.52\% improvement in the 3D detection task and a 6.25\% improvement in the 3D visual grounding task.

Large Vision Language Models (LVLMs) have recently achieved superior performance in various tasks on natural image and text data, which inspires a large amount of studies for LVLMs fine-tuning and training. Despite their advancements, there has been scant research on the robustness of these models against hallucination when fine-tuned on smaller datasets. In this study, we introduce a new benchmark dataset, the Medical Visual Hallucination Test (MedVH), to evaluate the hallucination of domain-specific LVLMs. MedVH comprises five tasks to evaluate hallucinations in LVLMs within the medical context, which includes tasks for comprehensive understanding of textual and visual input, as well as long textual response generation. Our extensive experiments with both general and medical LVLMs reveal that, although medical LVLMs demonstrate promising performance on standard medical tasks, they are particularly susceptible to hallucinations, often more so than the general models, raising significant concerns about the reliability of these domain-specific models. For medical LVLMs to be truly valuable in real-world applications, they must not only accurately integrate medical knowledge but also maintain robust reasoning abilities to prevent hallucination. Our work paves the way for future evaluations of these studies.

Despite great progress, existing multimodal large language models (MLLMs) are prone to visual hallucination, greatly impeding their trustworthy applications. In this paper, we study this problem from the perspective of visual-spatial reasoning, and propose a new learning task for MLLMs, termed Grounded Chain-of-Thought (GCoT). Different from recent visual CoT studies, which focus more on visual knowledge reasoning, GCoT is keen to helping MLLMs to recognize and ground the relevant visual cues step by step, thereby predicting the correct answer with grounding coordinates as the intuitive basis. To facilitate this task, we also carefully design and construct a dataset called multimodal grounded chain-of-thought (MM-GCoT) consisting of 24,022 GCoT examples for 5,033 images. Besides, a comprehensive consistency evaluation system is also introduced, including the metrics of answer accuracy, grounding accuracy and answer-grounding consistency. We further design and conduct a bunch of experiments on 12 advanced MLLMs, and reveal some notable findings: i. most MLLMs performs poorly on the consistency evaluation, indicating obvious visual hallucination; ii. visual hallucination is not directly related to the parameter size and general multimodal performance, i.e., a larger and stronger MLLM is not less affected by this issue. Lastly, we also demonstrate that the proposed dataset can help existing MLLMs to well cultivate their GCoT capability and reduce the inconsistent answering significantly. Moreover, their GCoT can be also generalized to exiting multimodal tasks, such as open-world QA and REC.

3D Visual Grounding (3DVG) aims to locate objects in 3D scenes based on textual descriptions, which is essential for applications like augmented reality and robotics. Traditional 3DVG approaches rely on annotated 3D datasets and predefined object categories, limiting scalability and adaptability. To overcome these limitations, we introduce SeeGround, a zero-shot 3DVG framework leveraging 2D Vision-Language Models (VLMs) trained on large-scale 2D data. We propose to represent 3D scenes as a hybrid of query-aligned rendered images and spatially enriched text descriptions, bridging the gap between 3D data and 2D-VLMs input formats. We propose two modules: the Perspective Adaptation Module, which dynamically selects viewpoints for query-relevant image rendering, and the Fusion Alignment Module, which integrates 2D images with 3D spatial descriptions to enhance object localization. Extensive experiments on ScanRefer and Nr3D demonstrate that our approach outperforms existing zero-shot methods by large margins. Notably, we exceed weakly supervised methods and rival some fully supervised ones, outperforming previous SOTA by 7.7% on ScanRefer and 7.1% on Nr3D, showcasing its effectiveness.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

The rapid development of Large Multimodal Models (LMMs) has significantly advanced multimodal understanding by harnessing the language abilities of Large Language Models (LLMs) and integrating modality-specific encoders. However, LMMs are plagued by hallucinations that limit their reliability and adoption. While traditional methods to detect and mitigate these hallucinations often involve costly training or rely heavily on external models, recent approaches utilizing internal model features present a promising alternative. In this paper, we critically assess the limitations of the state-of-the-art training-free technique, the logit lens, in handling generalized visual hallucinations. We introduce a refined method that leverages contextual token embeddings from middle layers of LMMs. This approach significantly improves hallucination detection and grounding across diverse categories, including actions and OCR, while also excelling in tasks requiring contextual understanding, such as spatial relations and attribute comparison. Our novel grounding technique yields highly precise bounding boxes, facilitating a transition from Zero-Shot Object Segmentation to Grounded Visual Question Answering. Our contributions pave the way for more reliable and interpretable multimodal models.

Language grounding to vision is an active field of research aiming to enrich text-based representations of word meanings by leveraging perceptual knowledge from vision. Despite many attempts at language grounding, it is still unclear how to effectively inject visual knowledge into the word embeddings of a language in such a way that a proper balance of textual and visual knowledge is maintained. Some common concerns are the following. Is visual grounding beneficial for abstract words or is its contribution only limited to concrete words? What is the optimal way of bridging the gap between text and vision? How much do we gain by visually grounding textual embeddings? The present study addresses these questions by proposing a simple yet very effective grounding approach for pre-trained word embeddings. Our model aligns textual embeddings with vision while largely preserving the distributional statistics that characterize word use in text corpora. By applying a learned alignment, we are able to generate visually grounded embeddings for unseen words, including abstract words. A series of evaluations on word similarity benchmarks shows that visual grounding is beneficial not only for concrete words, but also for abstract words. We also show that our method for visual grounding offers advantages for contextualized embeddings, but only when these are trained on corpora of relatively modest size. Code and grounded embeddings for English are available at https://github.com/Hazel1994/Visually_Grounded_Word_Embeddings_2.

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.

3D visual grounding is the task of localizing the object in a 3D scene which is referred by a description in natural language. With a wide range of applications ranging from autonomous indoor robotics to AR/VR, the task has recently risen in popularity. A common formulation to tackle 3D visual grounding is grounding-by-detection, where localization is done via bounding boxes. However, for real-life applications that require physical interactions, a bounding box insufficiently describes the geometry of an object. We therefore tackle the problem of dense 3D visual grounding, i.e. referral-based 3D instance segmentation. We propose a dense 3D grounding network ConcreteNet, featuring three novel stand-alone modules which aim to improve grounding performance for challenging repetitive instances, i.e. instances with distractors of the same semantic class. First, we introduce a bottom-up attentive fusion module that aims to disambiguate inter-instance relational cues, next we construct a contrastive training scheme to induce separation in the latent space, and finally we resolve view-dependent utterances via a learned global camera token. ConcreteNet ranks 1st on the challenging ScanRefer online benchmark by a considerable +9.43% accuracy at 50% IoU and has won the ICCV 3rd Workshop on Language for 3D Scenes "3D Object Localization" challenge.

Multimodal large language models (MLLMs) have recently achieved remarkable progress in radiology by integrating visual perception with natural language understanding. However, they often generate clinically unsupported descriptions, known as medical hallucinations, which pose serious risks in medical applications that demand accuracy and image-grounded outputs. Through empirical analysis, we find that prompt-induced hallucinations remain prevalent in radiology MLLMs, largely due to over-sensitivity to clinical sections. To address this, we introduce Clinical Contrastive Cecoding (CCD), a training-free and retrieval-free inference framework that integrates structured clinical signals from task-specific radiology expert models. CCD introduces a dual-stage contrastive mechanism to refine token-level logits during generation, thereby enhancing clinical fidelity without modifying the base MLLM. Experiments on three datasets and multiple models demonstrate that CCD consistently improves overall performance on radiology report generation (RRG). On the MIMIC-CXR dataset, it yields up to a 17% improvement in RadGraph-F1 when applied to state-of-the-art RRG models. Our approach provides a lightweight and generalisable solution for mitigating medical hallucinations, effectively bridging expert models and MLLMs in radiology.

In this work, we identify an inherent bias in prevailing LVLM architectures toward the language modality, largely resulting from the common practice of simply appending visual embeddings to the input text sequence. To address this, we propose a simple yet effective method that refines textual embeddings by integrating average-pooled visual features. Our approach demonstrably improves visual grounding and significantly reduces hallucinations on established benchmarks. While average pooling offers a straightforward, robust, and efficient means of incorporating visual information, we believe that more sophisticated fusion methods could further enhance visual grounding and cross-modal alignment. Given that the primary focus of this work is to highlight the modality imbalance and its impact on hallucinations -- and to show that refining textual embeddings with visual information mitigates this issue -- we leave exploration of advanced fusion strategies for future work.

Recent interest in Large Vision-Language Models (LVLMs) for practical applications is moderated by the significant challenge of hallucination or the inconsistency between the factual information and the generated text. In this paper, we first perform an in-depth analysis of hallucinations and discover several novel insights about how and when LVLMs hallucinate. From our analysis, we show that: (1) The community's efforts have been primarily targeted towards reducing hallucinations related to visual recognition (VR) prompts (e.g., prompts that only require describing the image), thereby ignoring hallucinations for cognitive prompts (e.g., prompts that require additional skills like reasoning on contents of the image). (2) LVLMs lack visual perception, i.e., they can see but not necessarily understand or perceive the input image. We analyze responses to cognitive prompts and show that LVLMs hallucinate due to a perception gap: although LVLMs accurately recognize visual elements in the input image and possess sufficient cognitive skills, they struggle to respond accurately and hallucinate. To overcome this shortcoming, we propose Visual Description Grounded Decoding (VDGD), a simple, robust, and training-free method for alleviating hallucinations. Specifically, we first describe the image and add it as a prefix to the instruction. Next, during auto-regressive decoding, we sample from the plausible candidates according to their KL-Divergence (KLD) to the description, where lower KLD is given higher preference. Experimental results on several benchmarks and LVLMs show that VDGD improves significantly over other baselines in reducing hallucinations. We also propose VaLLu, a benchmark for the comprehensive evaluation of the cognitive capabilities of LVLMs.

Automatic radiology report generation is a promising application of multimodal deep learning, aiming to reduce reporting workload and improve consistency. However, current state-of-the-art (SOTA) systems - such as Multimodal AI for Radiology Applications (MAIRA-2) and Medical Pathways Language Model-Multimodal (MedPaLM-M) - depend on large-scale multimodal training, clinical metadata, and multiple imaging views, making them resource-intensive and inaccessible for most settings. We introduce a compact image-to-text architecture that generates the Findings section of chest X-ray reports from a single frontal image. The model combines a frozen Self-Distillation with No Labels v3 (DINOv3) Vision Transformer (ViT) encoder with a Generative Pre-trained Transformer 2 (GPT-2) decoder enhanced by layer-wise anatomical attention. This mechanism integrates lung and heart segmentation masks through hierarchical Gaussian smoothing, biasing attention toward clinically relevant regions without adding trainable parameters. Evaluated on the official Medical Information Mart for Intensive Care-Chest X-ray (MIMIC-CXR) dataset using Chest Radiograph Expert (CheXpert) and Radiology Graph (RadGraph) metrics, our approach achieved substantial gains: CheXpert Macro-F1 for five key pathologies increased by 168% (0.083 -> 0.238) and Micro-F1 by 146% (0.137 -> 0.337), while broader performance across 14 observations improved by 86% (0.170 -> 0.316). Structural coherence also improved, with RadGraph F1 rising by 9.7%. Despite its small size and purely image-conditioned design, the model demonstrates that decoder-level anatomical guidance improves spatial grounding and enhances coherence in clinically relevant regions. The source code is publicly available at: https://github.com/devMuniz02/UDEM-CXR-Reporting-Thesis-2025.

Visual grounding is an essential tool that links user-provided text queries with query-specific regions within an image. Despite advancements in visual grounding models, their ability to comprehend complex queries remains limited. To overcome this limitation, we introduce LLM-Optic, an innovative method that utilizes Large Language Models (LLMs) as an optical lens to enhance existing visual grounding models in comprehending complex text queries involving intricate text structures, multiple objects, or object spatial relationships, situations that current models struggle with. LLM-Optic first employs an LLM as a Text Grounder to interpret complex text queries and accurately identify objects the user intends to locate. Then a pre-trained visual grounding model is used to generate candidate bounding boxes given the refined query by the Text Grounder. After that, LLM-Optic annotates the candidate bounding boxes with numerical marks to establish a connection between text and specific image regions, thereby linking two distinct modalities. Finally, it employs a Large Multimodal Model (LMM) as a Visual Grounder to select the marked candidate objects that best correspond to the original text query. Through LLM-Optic, we have achieved universal visual grounding, which allows for the detection of arbitrary objects specified by arbitrary human language input. Importantly, our method achieves this enhancement without requiring additional training or fine-tuning. Extensive experiments across various challenging benchmarks demonstrate that LLM-Optic achieves state-of-the-art zero-shot visual grounding capabilities. Project Page: https://haoyu-zhao.github.io/LLM-Optic.github.io/.

Traditional visual grounding methods primarily focus on single-image scenarios with simple textual references. However, extending these methods to real-world scenarios that involve implicit and complex instructions, particularly in conjunction with multiple images, poses significant challenges, which is mainly due to the lack of advanced reasoning ability across diverse multi-modal contexts. In this work, we aim to address the more practical universal grounding task, and propose UniVG-R1, a reasoning guided multimodal large language model (MLLM) for universal visual grounding, which enhances reasoning capabilities through reinforcement learning (RL) combined with cold-start data. Specifically, we first construct a high-quality Chain-of-Thought (CoT) grounding dataset, annotated with detailed reasoning chains, to guide the model towards correct reasoning paths via supervised fine-tuning. Subsequently, we perform rule-based reinforcement learning to encourage the model to identify correct reasoning chains, thereby incentivizing its reasoning capabilities. In addition, we identify a difficulty bias arising from the prevalence of easy samples as RL training progresses, and we propose a difficulty-aware weight adjustment strategy to further strengthen the performance. Experimental results demonstrate the effectiveness of UniVG-R1, which achieves state-of-the-art performance on MIG-Bench with a 9.1% improvement over the previous method. Furthermore, our model exhibits strong generalizability, achieving an average improvement of 23.4% in zero-shot performance across four image and video reasoning grounding benchmarks. The project page can be accessed at https://amap-ml.github.io/UniVG-R1-page/.

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

Clinical decision-making relies heavily on understanding relative positions of anatomical structures and anomalies. Therefore, for Vision-Language Models (VLMs) to be applicable in clinical practice, the ability to accurately determine relative positions on medical images is a fundamental prerequisite. Despite its importance, this capability remains highly underexplored. To address this gap, we evaluate the ability of state-of-the-art VLMs, GPT-4o, Llama3.2, Pixtral, and JanusPro, and find that all models fail at this fundamental task. Inspired by successful approaches in computer vision, we investigate whether visual prompts, such as alphanumeric or colored markers placed on anatomical structures, can enhance performance. While these markers provide moderate improvements, results remain significantly lower on medical images compared to observations made on natural images. Our evaluations suggest that, in medical imaging, VLMs rely more on prior anatomical knowledge than on actual image content for answering relative position questions, often leading to incorrect conclusions. To facilitate further research in this area, we introduce the MIRP , Medical Imaging Relative Positioning, benchmark dataset, designed to systematically evaluate the capability to identify relative positions in medical images.

3D Visual Grounding (3D-VG) aims to localize objects in 3D scenes via natural language descriptions. While recent advancements leveraging Vision-Language Models (VLMs) have explored zero-shot possibilities, they typically suffer from a static workflow relying on preprocessed 3D point clouds, essentially degrading grounding into proposal matching. To bypass this reliance, our core motivation is to decouple the task: leveraging 2D VLMs to resolve complex spatial semantics, while relying on deterministic multi-view geometry to instantiate the 3D structure. Driven by this insight, we propose "Think, Act, Build (TAB)", a dynamic agentic framework that reformulates 3D-VG tasks as a generative 2D-to-3D reconstruction paradigm operating directly on raw RGB-D streams. Specifically, guided by a specialized 3D-VG skill, our VLM agent dynamically invokes visual tools to track and reconstruct the target across 2D frames. Crucially, to overcome the multi-view coverage deficit caused by strict VLM semantic tracking, we introduce the Semantic-Anchored Geometric Expansion, a mechanism that first anchors the target in a reference video clip and then leverages multi-view geometry to propagate its spatial location across unobserved frames. This enables the agent to "Build" the target's 3D representation by aggregating these multi-view features via camera parameters, directly mapping 2D visual cues to 3D coordinates. Furthermore, to ensure rigorous assessment, we identify flaws such as reference ambiguity and category errors in existing benchmarks and manually refine the incorrect queries. Extensive experiments on ScanRefer and Nr3D demonstrate that our framework, relying entirely on open-source models, significantly outperforms previous zero-shot methods and even surpasses fully supervised baselines.

Recently, Vision Language Models (VLMs) have increasingly emphasized document visual grounding to achieve better human-computer interaction, accessibility, and detailed understanding. However, its application to visualizations such as charts remains under-explored due to the inherent complexity of interleaved visual-numerical relationships in chart images. Existing chart understanding methods primarily focus on answering questions without explicitly identifying the visual elements that support their predictions. To bridge this gap, we introduce RefChartQA, a novel benchmark that integrates Chart Question Answering (ChartQA) with visual grounding, enabling models to refer elements at multiple granularities within chart images. Furthermore, we conduct a comprehensive evaluation by instruction-tuning 5 state-of-the-art VLMs across different categories. Our experiments demonstrate that incorporating spatial awareness via grounding improves response accuracy by over 15%, reducing hallucinations, and improving model reliability. Additionally, we identify key factors influencing text-spatial alignment, such as architectural improvements in TinyChart, which leverages a token-merging module for enhanced feature fusion. Our dataset is open-sourced for community development and further advancements. All models and code will be publicly available at https://github.com/moured/RefChartQA.

Chest X-ray plays a central role in thoracic diagnosis, and its interpretation inherently requires multi-step, evidence-grounded reasoning. However, large vision-language models (LVLMs) often generate plausible responses that are not faithfully grounded in diagnostic evidence and provide limited visual evidence for verification, while also requiring costly retraining to support new diagnostic tasks, limiting their reliability and adaptability in clinical settings. To address these limitations, we present CXReasonAgent, a diagnostic agent that integrates a large language model (LLM) with clinically grounded diagnostic tools to perform evidence-grounded diagnostic reasoning using image-derived diagnostic and visual evidence. To evaluate these capabilities, we introduce CXReasonDial, a multi-turn dialogue benchmark with 1,946 dialogues across 12 diagnostic tasks, and show that CXReasonAgent produces faithfully grounded responses, enabling more reliable and verifiable diagnostic reasoning than LVLMs. These findings highlight the importance of integrating clinically grounded diagnostic tools, particularly in safety-critical clinical settings.

Visual Grounding (VG) tasks, such as referring expression detection and segmentation tasks are important for linking visual entities to context, especially in complex reasoning tasks that require detailed query interpretation. This paper explores VG beyond basic perception, highlighting challenges for methods that require reasoning like human cognition. Recent advances in large language methods (LLMs) and Vision-Language methods (VLMs) have improved abilities for visual comprehension, contextual understanding, and reasoning. These methods are mainly split into end-to-end and compositional methods, with the latter offering more flexibility. Compositional approaches that integrate LLMs and foundation models show promising performance but still struggle with complex reasoning with language-based logical representations. To address these limitations, we propose NAVER, a compositional visual grounding method that integrates explicit probabilistic logic reasoning within a finite-state automaton, equipped with a self-correcting mechanism. This design improves robustness and interpretability in inference through explicit logic reasoning. Our results show that NAVER achieves SoTA performance comparing to recent end-to-end and compositional baselines. The code is available at https://github.com/ControlNet/NAVER .

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.

Large Vision Language Models (LVLMs) are increasingly integral to healthcare applications, including medical visual question answering and imaging report generation. While these models inherit the robust capabilities of foundational Large Language Models (LLMs), they also inherit susceptibility to hallucinations-a significant concern in high-stakes medical contexts where the margin for error is minimal. However, currently, there are no dedicated methods or benchmarks for hallucination detection and evaluation in the medical field. To bridge this gap, we introduce Med-HallMark, the first benchmark specifically designed for hallucination detection and evaluation within the medical multimodal domain. This benchmark provides multi-tasking hallucination support, multifaceted hallucination data, and hierarchical hallucination categorization. Furthermore, we propose the MediHall Score, a new medical evaluative metric designed to assess LVLMs' hallucinations through a hierarchical scoring system that considers the severity and type of hallucination, thereby enabling a granular assessment of potential clinical impacts. We also present MediHallDetector, a novel Medical LVLM engineered for precise hallucination detection, which employs multitask training for hallucination detection. Through extensive experimental evaluations, we establish baselines for popular LVLMs using our benchmark. The findings indicate that MediHall Score provides a more nuanced understanding of hallucination impacts compared to traditional metrics and demonstrate the enhanced performance of MediHallDetector. We hope this work can significantly improve the reliability of LVLMs in medical applications. All resources of this work will be released soon.

Semi-Supervised Visual Grounding (SSVG) is a new challenge for its sparse labeled data with the need for multimodel understanding. A previous study, RefTeacher, makes the first attempt to tackle this task by adopting the teacher-student framework to provide pseudo confidence supervision and attention-based supervision. However, this approach is incompatible with current state-of-the-art visual grounding models, which follow the Transformer-based pipeline. These pipelines directly regress results without region proposals or foreground binary classification, rendering them unsuitable for fitting in RefTeacher due to the absence of confidence scores. Furthermore, the geometric difference in teacher and student inputs, stemming from different data augmentations, induces natural misalignment in attention-based constraints. To establish a compatible SSVG framework, our paper proposes the ACTive REtraining approach for Semi-Supervised Visual Grounding, abbreviated as ACTRESS. Initially, the model is enhanced by incorporating an additional quantized detection head to expose its detection confidence. Building upon this, ACTRESS consists of an active sampling strategy and a selective retraining strategy. The active sampling strategy iteratively selects high-quality pseudo labels by evaluating three crucial aspects: Faithfulness, Robustness, and Confidence, optimizing the utilization of unlabeled data. The selective retraining strategy retrains the model with periodic re-initialization of specific parameters, facilitating the model's escape from local minima. Extensive experiments demonstrates our superior performance on widely-used benchmark datasets.

3D Visual Grounding (3DVG) aims at localizing 3D object based on textual descriptions. Conventional supervised methods for 3DVG often necessitate extensive annotations and a predefined vocabulary, which can be restrictive. To address this issue, we propose a novel visual programming approach for zero-shot open-vocabulary 3DVG, leveraging the capabilities of large language models (LLMs). Our approach begins with a unique dialog-based method, engaging with LLMs to establish a foundational understanding of zero-shot 3DVG. Building on this, we design a visual program that consists of three types of modules, i.e., view-independent, view-dependent, and functional modules. These modules, specifically tailored for 3D scenarios, work collaboratively to perform complex reasoning and inference. Furthermore, we develop an innovative language-object correlation module to extend the scope of existing 3D object detectors into open-vocabulary scenarios. Extensive experiments demonstrate that our zero-shot approach can outperform some supervised baselines, marking a significant stride towards effective 3DVG.

Visual grounding, localizing objects from natural language descriptions, represents a critical bridge between language and vision understanding. While multimodal large language models (MLLMs) achieve impressive scores on existing benchmarks, a fundamental question remains: can MLLMs truly ground language in vision with human-like sophistication, or are they merely pattern-matching on simplified datasets? Current benchmarks fail to capture real-world complexity where humans effortlessly navigate ambiguous references and recognize when grounding is impossible. To rigorously assess MLLMs' true capabilities, we introduce GroundingME, a benchmark that systematically challenges models across four critical dimensions: (1) Discriminative, distinguishing highly similar objects, (2) Spatial, understanding complex relational descriptions, (3) Limited, handling occlusions or tiny objects, and (4) Rejection, recognizing ungroundable queries. Through careful curation combining automated generation with human verification, we create 1,005 challenging examples mirroring real-world complexity. Evaluating 25 state-of-the-art MLLMs reveals a profound capability gap: the best model achieves only 45.1% accuracy, while most score 0% on rejection tasks, reflexively hallucinating objects rather than acknowledging their absence, raising critical safety concerns for deployment. We explore two strategies for improvements: (1) test-time scaling selects optimal response by thinking trajectory to improve complex grounding by up to 2.9%, and (2) data-mixture training teaches models to recognize ungroundable queries, boosting rejection accuracy from 0% to 27.9%. GroundingME thus serves as both a diagnostic tool revealing current limitations in MLLMs and a roadmap toward human-level visual grounding.

Vision language models (VLMs) achieve strong performance on general image understanding but struggle to think with medical images, especially when performing multi-step reasoning through iterative visual interaction. Medical VLMs often rely on static visual embeddings and single-pass inference, preventing models from re-examining, verifying, or refining visual evidence during reasoning. While tool-integrated reasoning offers a promising path forward, open-source VLMs lack the training infrastructure to learn effective tool selection, invocation, and coordination in multi-modal medical reasoning. We introduce MedVistaGym, a scalable and interactive training environment that incentivizes tool-integrated visual reasoning for medical image analysis. MedVistaGym equips VLMs to determine when and which tools to invoke, localize task-relevant image regions, and integrate single or multiple sub-image evidence into interleaved multimodal reasoning within a unified, executable interface for agentic training. Using MedVistaGym, we train MedVistaGym-R1 to interleave tool use with agentic reasoning through trajectory sampling and end-to-end reinforcement learning. Across six medical VQA benchmarks, MedVistaGym-R1-8B exceeds comparably sized tool-augmented baselines by 19.10% to 24.21%, demonstrating that structured agentic training--not tool access alone--unlocks effective tool-integrated reasoning for medical image analysis.

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.

Phrase grounding, i.e., mapping natural language phrases to specific image regions, holds significant potential for disease localization in medical imaging through clinical reports. While current state-of-the-art methods rely on discriminative, self-supervised contrastive models, we demonstrate that generative text-to-image diffusion models, leveraging cross-attention maps, can achieve superior zero-shot phrase grounding performance. Contrary to prior assumptions, we show that fine-tuning diffusion models with a frozen, domain-specific language model, such as CXR-BERT, substantially outperforms domain-agnostic counterparts. This setup achieves remarkable improvements, with mIoU scores doubling those of current discriminative methods. These findings highlight the underexplored potential of generative models for phrase grounding tasks. To further enhance performance, we introduce Bimodal Bias Merging (BBM), a novel post-processing technique that aligns text and image biases to identify regions of high certainty. BBM refines cross-attention maps, achieving even greater localization accuracy. Our results establish generative approaches as a more effective paradigm for phrase grounding in the medical imaging domain, paving the way for more robust and interpretable applications in clinical practice. The source code and model weights are available at https://github.com/Felix-012/generate_to_ground.

Long-form clinical videos are central to visual evidence-based decision-making, with growing importance for applications such as surgical robotics and related settings. However, current multimodal large language models typically process videos with passive sampling or weakly grounded inspection, which limits their ability to iteratively locate, verify, and justify predictions with temporally targeted evidence. To close this gap, we propose MedScope, a tool-using clinical video reasoning model that performs coarse-to-fine evidence seeking over long-form procedures. By interleaving intermediate reasoning with targeted tool calls and verification on retrieved observations, MedScope produces more accurate and trustworthy predictions that are explicitly grounded in temporally localized visual evidence. To address the lack of high-fidelity supervision, we build ClinVideoSuite, an evidence-centric, fine-grained clinical video suite. We then optimize MedScope with Grounding-Aware Group Relative Policy Optimization (GA-GRPO), which directly reinforces tool use with grounding-aligned rewards and evidence-weighted advantages. On full and fine-grained video understanding benchmarks, MedScope achieves state-of-the-art performance in both in-domain and out-of-domain evaluations. Our approach illuminates a path toward medical AI agents that can genuinely "think with videos" through tool-integrated reasoning. We will release our code, models, and data.

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.

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.

Human experts excel at fine-grained visual discrimination by leveraging domain knowledge to refine perceptual features, a capability that remains underdeveloped in current Multimodal Large Language Models (MLLMs). Despite possessing vast expert-level knowledge, MLLMs struggle to integrate reasoning into visual perception, often generating direct responses without deeper analysis. To bridge this gap, we introduce knowledge-intensive visual grounding (KVG), a novel visual grounding task that requires both fine-grained perception and domain-specific knowledge integration. To address the challenges of KVG, we propose DeepPerception, an MLLM enhanced with cognitive visual perception capabilities. Our approach consists of (1) an automated data synthesis pipeline that generates high-quality, knowledge-aligned training samples, and (2) a two-stage training framework combining supervised fine-tuning for cognitive reasoning scaffolding and reinforcement learning to optimize perception-cognition synergy. To benchmark performance, we introduce KVG-Bench a comprehensive dataset spanning 10 domains with 1.3K manually curated test cases. Experimental results demonstrate that DeepPerception significantly outperforms direct fine-tuning, achieving +8.08\% accuracy improvements on KVG-Bench and exhibiting +4.60\% superior cross-domain generalization over baseline approaches. Our findings highlight the importance of integrating cognitive processes into MLLMs for human-like visual perception and open new directions for multimodal reasoning research. The data, codes, and models are released at https://github.com/thunlp/DeepPerception.

We introduce Cambrian-1, a family of multimodal LLMs (MLLMs) designed with a vision-centric approach. While stronger language models can enhance multimodal capabilities, the design choices for vision components are often insufficiently explored and disconnected from visual representation learning research. This gap hinders accurate sensory grounding in real-world scenarios. Our study uses LLMs and visual instruction tuning as an interface to evaluate various visual representations, offering new insights into different models and architectures -- self-supervised, strongly supervised, or combinations thereof -- based on experiments with over 20 vision encoders. We critically examine existing MLLM benchmarks, addressing the difficulties involved in consolidating and interpreting results from various tasks, and introduce a new vision-centric benchmark, CV-Bench. To further improve visual grounding, we propose the Spatial Vision Aggregator (SVA), a dynamic and spatially-aware connector that integrates high-resolution vision features with LLMs while reducing the number of tokens. Additionally, we discuss the curation of high-quality visual instruction-tuning data from publicly available sources, emphasizing the importance of data source balancing and distribution ratio. Collectively, Cambrian-1 not only achieves state-of-the-art performance but also serves as a comprehensive, open cookbook for instruction-tuned MLLMs. We provide model weights, code, supporting tools, datasets, and detailed instruction-tuning and evaluation recipes. We hope our release will inspire and accelerate advancements in multimodal systems and visual representation learning.

Unified visual grounding pursues a simple and generic technical route to leverage multi-task data with less task-specific design. The most advanced methods typically present boxes and masks as vertex sequences to model referring detection and segmentation as an autoregressive sequential vertex generation paradigm. However, generating high-dimensional vertex sequences sequentially is error-prone because the upstream of the sequence remains static and cannot be refined based on downstream vertex information, even if there is a significant location gap. Besides, with limited vertexes, the inferior fitting of objects with complex contours restricts the performance upper bound. To deal with this dilemma, we propose a parallel vertex generation paradigm for superior high-dimension scalability with a diffusion model by simply modifying the noise dimension. An intuitive materialization of our paradigm is Parallel Vertex Diffusion (PVD) to directly set vertex coordinates as the generation target and use a diffusion model to train and infer. We claim that it has two flaws: (1) unnormalized coordinate caused a high variance of loss value; (2) the original training objective of PVD only considers point consistency but ignores geometry consistency. To solve the first flaw, Center Anchor Mechanism (CAM) is designed to convert coordinates as normalized offset values to stabilize the training loss value. For the second flaw, Angle summation loss (ASL) is designed to constrain the geometry difference of prediction and ground truth vertexes for geometry-level consistency. Empirical results show that our PVD achieves state-of-the-art in both referring detection and segmentation, and our paradigm is more scalable and efficient than sequential vertex generation with high-dimension data.

In this paper, we present a neat yet effective transformer-based framework for visual grounding, namely TransVG, to address the task of grounding a language query to the corresponding region onto an image. The state-of-the-art methods, including two-stage or one-stage ones, rely on a complex module with manually-designed mechanisms to perform the query reasoning and multi-modal fusion. However, the involvement of certain mechanisms in fusion module design, such as query decomposition and image scene graph, makes the models easily overfit to datasets with specific scenarios, and limits the plenitudinous interaction between the visual-linguistic context. To avoid this caveat, we propose to establish the multi-modal correspondence by leveraging transformers, and empirically show that the complex fusion modules e.g., modular attention network, dynamic graph, and multi-modal tree) can be replaced by a simple stack of transformer encoder layers with higher performance. Moreover, we re-formulate the visual grounding as a direct coordinates regression problem and avoid making predictions out of a set of candidates i.e., region proposals or anchor boxes). Extensive experiments are conducted on five widely used datasets, and a series of state-of-the-art records are set by our TransVG. We build the benchmark of transformer-based visual grounding framework and make the code available at https://github.com/djiajunustc/TransVG.

3D visual grounding (3DVG) is challenging because of the requirement of understanding on visual information, language and spatial relationships. While supervised approaches have achieved superior performance, they are constrained by the scarcity and high cost of 3D vision-language datasets. On the other hand, LLM/VLM based agents are proposed for 3DVG, eliminating the need for training data. However, these methods incur prohibitive time and token costs during inference. To address the challenges, we introduce a novel training-free symbolic framework for 3D visual grounding, namely Evolvable Symbolic Visual Grounder, that offers significantly reduced inference costs compared to previous agent-based methods while maintaining comparable performance. EaSe uses LLM generated codes to compute on spatial relationships. EaSe also implements an automatic pipeline to evaluate and optimize the quality of these codes and integrate VLMs to assist in the grounding process. Experimental results demonstrate that EaSe achieves 52.9% accuracy on Nr3D dataset and 49.2% Acc@0.25 on ScanRefer, which is top-tier among training-free methods. Moreover, it substantially reduces the inference time and cost, offering a balanced trade-off between performance and efficiency. Codes are available at https://github.com/OpenRobotLab/EaSe.

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

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.

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.

GUI grounding, the task of identifying a precise location on an interface image from a natural language query, plays a crucial role in enhancing the capabilities of Vision-Language Model (VLM) agents. While general VLMs, such as GPT-4V, demonstrate strong performance across various tasks, their proficiency in GUI grounding remains suboptimal. Recent studies have focused on fine-tuning these models specifically for one-shot GUI grounding, yielding significant improvements over baseline performance. We introduce a visual prompting framework called Iterative Narrowing (IN) to further enhance the performance of both general and fine-tuned models in GUI grounding. For evaluation, we tested our method on a comprehensive benchmark comprising different UI platforms.

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.

Visual grounding aims to identify objects or regions in a scene based on natural language descriptions, essential for spatially aware perception in autonomous driving. However, existing visual grounding tasks typically depend on bounding boxes that often fail to capture fine-grained details. Not all voxels within a bounding box are occupied, resulting in inaccurate object representations. To address this, we introduce a benchmark for 3D occupancy grounding in challenging outdoor scenes. Built on the nuScenes dataset, it integrates natural language with voxel-level occupancy annotations, offering more precise object perception compared to the traditional grounding task. Moreover, we propose GroundingOcc, an end-to-end model designed for 3D occupancy grounding through multi-modal learning. It combines visual, textual, and point cloud features to predict object location and occupancy information from coarse to fine. Specifically, GroundingOcc comprises a multimodal encoder for feature extraction, an occupancy head for voxel-wise predictions, and a grounding head to refine localization. Additionally, a 2D grounding module and a depth estimation module enhance geometric understanding, thereby boosting model performance. Extensive experiments on the benchmark demonstrate that our method outperforms existing baselines on 3D occupancy grounding. The dataset is available at https://github.com/RONINGOD/GroundingOcc.

3D visual grounding (3DVG) is a critical task in scene understanding that aims to identify objects in 3D scenes based on text descriptions. However, existing methods rely on separately pre-trained vision and text encoders, resulting in a significant gap between the two modalities in terms of spatial geometry and semantic categories. This discrepancy often causes errors in object positioning and classification. The paper proposes UniSpace-3D, which innovatively introduces a unified representation space for 3DVG, effectively bridging the gap between visual and textual features. Specifically, UniSpace-3D incorporates three innovative designs: i) a unified representation encoder that leverages the pre-trained CLIP model to map visual and textual features into a unified representation space, effectively bridging the gap between the two modalities; ii) a multi-modal contrastive learning module that further reduces the modality gap; iii) a language-guided query selection module that utilizes the positional and semantic information to identify object candidate points aligned with textual descriptions. Extensive experiments demonstrate that UniSpace-3D outperforms baseline models by at least 2.24% on the ScanRefer and Nr3D/Sr3D datasets. The code will be made available upon acceptance of the paper.

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.

Effectively representing medical images, especially retinal images, presents a considerable challenge due to variations in appearance, size, and contextual information of pathological signs called lesions. Precise discrimination of these lesions is crucial for diagnosing vision-threatening issues such as diabetic retinopathy. While visual attention-based neural networks have been introduced to learn spatial context and channel correlations from retinal images, they often fall short in capturing localized lesion context. Addressing this limitation, we propose a novel attention mechanism called Guided Context Gating, an unique approach that integrates Context Formulation, Channel Correlation, and Guided Gating to learn global context, spatial correlations, and localized lesion context. Our qualitative evaluation against existing attention mechanisms emphasize the superiority of Guided Context Gating in terms of explainability. Notably, experiments on the Zenodo-DR-7 dataset reveal a substantial 2.63% accuracy boost over advanced attention mechanisms & an impressive 6.53% improvement over the state-of-the-art Vision Transformer for assessing the severity grade of retinopathy, even with imbalanced and limited training samples for each class.

Automatic radiology report generation is booming due to its huge application potential for the healthcare industry. However, existing computer vision and natural language processing approaches to tackle this problem are limited in two aspects. First, when extracting image features, most of them neglect multi-view reasoning in vision and model single-view structure of medical images, such as space-view or channel-view. However, clinicians rely on multi-view imaging information for comprehensive judgment in daily clinical diagnosis. Second, when generating reports, they overlook context reasoning with multi-modal information and focus on pure textual optimization utilizing retrieval-based methods. We aim to address these two issues by proposing a model that better simulates clinicians' perspectives and generates more accurate reports. Given the above limitation in feature extraction, we propose a Globally-intensive Attention (GIA) module in the medical image encoder to simulate and integrate multi-view vision perception. GIA aims to learn three types of vision perception: depth view, space view, and pixel view. On the other hand, to address the above problem in report generation, we explore how to involve multi-modal signals to generate precisely matched reports, i.e., how to integrate previously predicted words with region-aware visual content in next word prediction. Specifically, we design a Visual Knowledge-guided Decoder (VKGD), which can adaptively consider how much the model needs to rely on visual information and previously predicted text to assist next word prediction. Hence, our final Intensive Vision-guided Network (IVGN) framework includes a GIA-guided Visual Encoder and the VKGD. Experiments on two commonly-used datasets IU X-Ray and MIMIC-CXR demonstrate the superior ability of our method compared with other state-of-the-art approaches.

Medical diagnostic applications require models that can process multimodal medical inputs (images, patient histories, lab results) and generate diverse outputs including both textual reports and visual content (annotations, segmentation masks, and images). Despite this need, existing medical AI systems disrupt this unified process: medical image understanding models interpret images but cannot generate visual outputs, while medical image generation models synthesize images but cannot provide textual explanations. This leads to gaps in data representation, feature integration, and task-level multimodal capabilities. To this end, we propose a multi-level framework that draws inspiration from diagnostic workflows through the Observation-Knowledge-Analysis (OKA) paradigm. Specifically, at the observation level, we construct UniMed-5M, a dataset comprising over 5.6M samples that reformat diverse unimodal data into multimodal pairs for foundational observation. At the knowledge level, we propose Progressive Curriculum Learning that systematically introduces medical multimodal knowledge. At the analysis level, we introduce UniMedVL, the first medical unified multimodal model for the simultaneous analysis of image understanding and generation tasks within a single architecture. UniMedVL achieves superior performance on five medical image understanding benchmarks, while matching specialized models in generation quality across eight medical imaging modalities. Crucially, our unified architecture enables bidirectional knowledge sharing: generation tasks enhance visual understanding features, demonstrating that integrating traditionally separate capabilities within a single medical framework unlocks improvements across diverse medical vision-language tasks. Code is available at https://github.com/uni-medical/UniMedVL.

Learning visual representations of medical images (e.g., X-rays) is core to medical image understanding but its progress has been held back by the scarcity of human annotations. Existing work commonly relies on fine-tuning weights transferred from ImageNet pretraining, which is suboptimal due to drastically different image characteristics, or rule-based label extraction from the textual report data paired with medical images, which is inaccurate and hard to generalize. Meanwhile, several recent studies show exciting results from unsupervised contrastive learning from natural images, but we find these methods help little on medical images because of their high inter-class similarity. We propose ConVIRT, an alternative unsupervised strategy to learn medical visual representations by exploiting naturally occurring paired descriptive text. Our new method of pretraining medical image encoders with the paired text data via a bidirectional contrastive objective between the two modalities is domain-agnostic, and requires no additional expert input. We test ConVIRT by transferring our pretrained weights to 4 medical image classification tasks and 2 zero-shot retrieval tasks, and show that it leads to image representations that considerably outperform strong baselines in most settings. Notably, in all 4 classification tasks, our method requires only 10\% as much labeled training data as an ImageNet initialized counterpart to achieve better or comparable performance, demonstrating superior data efficiency.

Affordance grounding refers to the task of finding the area of an object with which one can interact. It is a fundamental but challenging task, as a successful solution requires the comprehensive understanding of a scene in multiple aspects including detection, localization, and recognition of objects with their parts, of geo-spatial configuration/layout of the scene, of 3D shapes and physics, as well as of the functionality and potential interaction of the objects and humans. Much of the knowledge is hidden and beyond the image content with the supervised labels from a limited training set. In this paper, we make an attempt to improve the generalization capability of the current affordance grounding by taking the advantage of the rich world, abstract, and human-object-interaction knowledge from pretrained large-scale vision language models. Under the AGD20K benchmark, our proposed model demonstrates a significant performance gain over the competing methods for in-the-wild object affordance grounding. We further demonstrate it can ground affordance for objects from random Internet images, even if both objects and actions are unseen during training. Project site: https://jasonqsy.github.io/AffordanceLLM/

Understanding and localizing objects in complex 3D environments from natural language descriptions, known as 3D Visual Grounding (3DVG), is a foundational challenge in embodied AI, with broad implications for robotics, augmented reality, and human-machine interaction. Large-scale pre-trained foundation models have driven significant progress on this front, enabling open-vocabulary 3DVG that allows systems to locate arbitrary objects in a given scene. However, their reliance on pre-trained models constrains 3D perception and reasoning within the inherited knowledge boundaries, resulting in limited generalization to unseen spatial relationships and poor robustness to out-of-distribution scenes. In this paper, we replace this constrained perception with training-free visual and geometric reasoning, thereby unlocking open-world 3DVG that enables the localization of any object in any scene beyond the training data. Specifically, the proposed UniGround operates in two stages: a Global Candidate Filtering stage that constructs scene candidates through training-free 3D topology and multi-view semantic encoding, and a Local Precision Grounding stage that leverages multi-scale visual prompting and structured reasoning to precisely identify the target object. Experiments on ScanRefer and EmbodiedScan show that UniGround achieves 46.1\%/34.1\% Acc@0.25/0.5 on ScanRefer and 28.7\% Acc@0.25 on EmbodiedScan, establishing a new state-of-the-art among zero-shot methods on EmbodiedScan without any 3D supervision. We further evaluate UniGround in real-world environments under uncontrolled reconstruction conditions and substantial domain shift, showing training-free reasoning generalizes robustly beyond curated benchmarks.

Developing generalist foundation model has recently attracted tremendous attention among researchers in the field of AI for Medicine (AI4Medicine). A pivotal insight in developing these models is their reliance on dataset scaling, which emphasizes the requirements on developing open-source medical image datasets that incorporate diverse supervision signals across various imaging modalities. In this paper, we introduce RadGenome-Chest CT, a comprehensive, large-scale, region-guided 3D chest CT interpretation dataset based on CT-RATE. Specifically, we leverage the latest powerful universal segmentation and large language models, to extend the original datasets (over 25,692 non-contrast 3D chest CT volume and reports from 20,000 patients) from the following aspects: (i) organ-level segmentation masks covering 197 categories, which provide intermediate reasoning visual clues for interpretation; (ii) 665 K multi-granularity grounded reports, where each sentence of the report is linked to the corresponding anatomical region of CT volume in the form of a segmentation mask; (iii) 1.3 M grounded VQA pairs, where questions and answers are all linked with reference segmentation masks, enabling models to associate visual evidence with textual explanations. All grounded reports and VQA pairs in the validation set have gone through manual verification to ensure dataset quality. We believe that RadGenome-Chest CT can significantly advance the development of multimodal medical foundation models, by training to generate texts based on given segmentation regions, which is unattainable with previous relevant datasets. We will release all segmentation masks, grounded reports, and VQA pairs to facilitate further research and development in this field.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

The recent advancement of Multimodal Large Language Models (MLLMs) has significantly improved their fine-grained perception of single images and general comprehension across multiple images. However, existing MLLMs still face challenges in achieving precise grounding in complex multi-image scenarios. To address this, we first explore a Chain-of-Thought (CoT) framework that integrates single-image grounding with multi-image comprehension. While partially effective, it remains unstable and struggles to capture abstract visual information due to its non-end-to-end nature. Therefore, we introduce Migician, the first multi-image grounding model capable of performing free-form and accurate grounding across multiple images. To support this, we present the MGrounding-630k dataset, which comprises data for several multi-image grounding tasks derived from existing datasets, along with newly generated free-form grounding instruction-following data. Furthermore, we propose MIG-Bench, a comprehensive benchmark specifically designed for evaluating multi-image grounding capabilities. Experimental results demonstrate that our model achieves significantly superior multi-image grounding capabilities, outperforming the best existing MLLMs by 21.61% and even surpassing much larger 70B models. Our code, model, dataset, and benchmark are fully open-sourced.

Current large multimodal models (LMMs) face challenges in grounding, which requires the model to relate language components to visual entities. Contrary to the common practice that fine-tunes LMMs with additional grounding supervision, we find that the grounding ability can in fact emerge in LMMs trained without explicit grounding supervision. To reveal this emerging grounding, we introduce an "attend-and-segment" method which leverages attention maps from standard LMMs to perform pixel-level segmentation. Furthermore, to enhance the grounding ability, we propose DIFFLMM, an LMM utilizing a diffusion-based visual encoder, as opposed to the standard CLIP visual encoder, and trained with the same weak supervision. Without being constrained by the biases and limited scale of grounding-specific supervision data, our approach is more generalizable and scalable. We achieve competitive performance on both grounding-specific and general visual question answering benchmarks, compared with grounding LMMs and generalist LMMs, respectively. Notably, we achieve a 44.2 grounding mask recall on grounded conversation generation without any grounding supervision, outperforming the extensively supervised model GLaMM. Project page: https://GroundLMM-ICCV.github.io.

Visual grounding, the task of linking textual queries to specific regions within images, plays a pivotal role in vision-language integration. Existing methods typically rely on extensive task-specific annotations and fine-tuning, limiting their ability to generalize effectively to novel or out-of-distribution scenarios. To address these limitations, we introduce GroundingAgent, a novel agentic visual grounding framework that operates without any task-specific fine-tuning. GroundingAgent employs a structured, iterative reasoning mechanism that integrates pretrained open-vocabulary object detectors, multimodal large language models (MLLMs), and large language models (LLMs) to progressively refine candidate regions through joint semantic and spatial analyses. Remarkably, GroundingAgent achieves an average zero-shot grounding accuracy of 65.1 % on widely-used benchmarks (RefCOCO, RefCOCO+, RefCOCOg), entirely without fine-tuning. Furthermore, by substituting MLLM-generated captions with the original query texts, the accuracy at the selection stage alone reaches approximately 90 %, closely matching supervised performance and underscoring the critical role of LLM reasoning capabilities. GroundingAgent also offers strong interpretability, transparently illustrating each reasoning step and providing clear insights into its decision-making process.

Multi-view visual reasoning is essential for intelligent systems that must understand complex environments from sparse and discrete viewpoints, yet existing research has largely focused on single-image or temporally dense video settings. In real-world scenarios, reasoning across views requires integrating partial observations without explicit guidance, while collecting large-scale multi-view data with accurate geometric and semantic annotations remains challenging. To address this gap, we leverage physically grounded simulation to construct diverse, high-fidelity 3D scenes with precise per-view metadata, enabling scalable data generation that remains transferable to real-world settings. Based on this engine, we introduce VIEW2SPACE, a multi-dimensional benchmark for sparse multi-view reasoning, together with a scalable, disjoint training split supporting millions of grounded question-answer pairs. Using this benchmark, a comprehensive evaluation of state-of-the-art vision-language and spatial models reveals that multi-view reasoning remains largely unsolved, with most models performing only marginally above random guessing. We further investigate whether training can bridge this gap. Our proposed Grounded Chain-of-Thought with Visual Evidence substantially improves performance under moderate difficulty, and generalizes to real-world data, outperforming existing approaches in cross-dataset evaluation. We further conduct difficulty-aware scaling analyses across model size, data scale, reasoning depth, and visibility constraints, indicating that while geometric perception can benefit from scaling under sufficient visibility, deep compositional reasoning across sparse views remains a fundamental challenge.

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.

Large reasoning models have recently made significant strides in mathematical and code reasoning, yet their success has not transferred smoothly to the medical domain. While multiple factors contribute to this disparity, a critical issue is the inadequate focus on the quality of intermediate reflection steps, which is particularly crucial in high-stakes medical scenarios. To address this challenge, we propose Med-REFL, a \textbf{Med}ical \textbf{R}easoning \textbf{E}nhancement via self-corrected \textbf{F}ine-grained ref\textbf{L}ection. Our method leverages a tree-of-thought approach to decompose medical questions into fine-grained reasoning paths, quantitatively evaluating each step and its subsequent reflections. These assessments enable automatic construction of direct preference optimization data, reducing reliance on expensive expert annotations while guiding models to identify and correct reasoning errors. Experimental results on the MedQA-USMLE benchmark demonstrate Med-REFL achieves consistent improvements, with average gains up to 4.11\%. Notably, it further boosts the state-of-the-art performance of 7B/8B models by an additional 4.13\%. Furthermore, Med-REFL exhibits strong generalization capabilities and robustness across several challenging medical question-answering datasets. Our work illustrates that prioritizing reflection quality leads to more accurate and trustworthy reasoning in medical AI applications. Checkpoints, code, and data can be found https://github.com/TianYin123/Med-REFL{here}.

With the emergence of large-scale vision language models (VLM), it is now possible to produce realistic-looking radiology reports for chest X-ray images. However, their clinical translation has been hampered by the factual errors and hallucinations in the produced descriptions during inference. In this paper, we present a novel phrase-grounded fact-checking model (FC model) that detects errors in findings and their indicated locations in automatically generated chest radiology reports. Specifically, we simulate the errors in reports through a large synthetic dataset derived by perturbing findings and their locations in ground truth reports to form real and fake findings-location pairs with images. A new multi-label cross-modal contrastive regression network is then trained on this dataset. We present results demonstrating the robustness of our method in terms of accuracy of finding veracity prediction and localization on multiple X-ray datasets. We also show its effectiveness for error detection in reports of SOTA report generators on multiple datasets achieving a concordance correlation coefficient of 0.997 with ground truth-based verification, thus pointing to its utility during clinical inference in radiology workflows.

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.

3D visual grounding (3DVG) aims to localize objects in a 3D scene based on natural language queries. In this work, we explore zero-shot 3DVG from multi-view images alone, without requiring any geometric supervision or object priors. We introduce Z3D, a universal grounding pipeline that flexibly operates on multi-view images while optionally incorporating camera poses and depth maps. We identify key bottlenecks in prior zero-shot methods causing significant performance degradation and address them with (i) a state-of-the-art zero-shot 3D instance segmentation method to generate high-quality 3D bounding box proposals and (ii) advanced reasoning via prompt-based segmentation, which utilizes full capabilities of modern VLMs. Extensive experiments on the ScanRefer and Nr3D benchmarks demonstrate that our approach achieves state-of-the-art performance among zero-shot methods. Code is available at https://github.com/col14m/z3d .

We present MedXIAOHE, a medical vision-language foundation model designed to advance general-purpose medical understanding and reasoning in real-world clinical applications. MedXIAOHE achieves state-of-the-art performance across diverse medical benchmarks and surpasses leading closed-source multimodal systems on multiple capabilities. To achieve this, we propose an entity-aware continual pretraining framework that organizes heterogeneous medical corpora to broaden knowledge coverage and reduce long-tail gaps (e.g., rare diseases). For medical expert-level reasoning and interaction, MedXIAOHE incorporates diverse medical reasoning patterns via reinforcement learning and tool-augmented agentic training, enabling multi-step diagnostic reasoning with verifiable decision traces. To improve reliability in real-world use, MedXIAOHE integrates user-preference rubrics, evidence-grounded reasoning, and low-hallucination long-form report generation, with improved adherence to medical instructions. We release this report to document our practical design choices, scaling insights, and evaluation framework, hoping to inspire further research.

Visual grounding aims to predict the locations of target objects specified by textual descriptions. For this task with linguistic and visual modalities, there is a latest research line that focuses on only selecting the linguistic-relevant visual regions for object localization to reduce the computational overhead. Albeit achieving impressive performance, it is iteratively performed on different image scales, and at every iteration, linguistic features and visual features need to be stored in a cache, incurring extra overhead. To facilitate the implementation, in this paper, we propose a feature selection-based simple yet effective baseline for visual grounding, called FSVG. Specifically, we directly encapsulate the linguistic and visual modalities into an overall network architecture without complicated iterative procedures, and utilize the language in parallel as guidance to facilitate the interaction between linguistic modal and visual modal for extracting effective visual features. Furthermore, to reduce the computational cost, during the visual feature learning, we introduce a similarity-based feature selection mechanism to only exploit language-related visual features for faster prediction. Extensive experiments conducted on several benchmark datasets comprehensively substantiate that the proposed FSVG achieves a better balance between accuracy and efficiency beyond the current state-of-the-art methods. Code is available at https://github.com/jcwang0602/FSVG.

Visual grounding, i.e., localizing objects in images according to natural language queries, is an important topic in visual language understanding. The most effective approaches for this task are based on deep learning, which generally require expensive manually labeled image-query or patch-query pairs. To eliminate the heavy dependence on human annotations, we present a novel method, named Pseudo-Q, to automatically generate pseudo language queries for supervised training. Our method leverages an off-the-shelf object detector to identify visual objects from unlabeled images, and then language queries for these objects are obtained in an unsupervised fashion with a pseudo-query generation module. Then, we design a task-related query prompt module to specifically tailor generated pseudo language queries for visual grounding tasks. Further, in order to fully capture the contextual relationships between images and language queries, we develop a visual-language model equipped with multi-level cross-modality attention mechanism. Extensive experimental results demonstrate that our method has two notable benefits: (1) it can reduce human annotation costs significantly, e.g., 31% on RefCOCO without degrading original model's performance under the fully supervised setting, and (2) without bells and whistles, it achieves superior or comparable performance compared to state-of-the-art weakly-supervised visual grounding methods on all the five datasets we have experimented. Code is available at https://github.com/LeapLabTHU/Pseudo-Q.

3D visual grounding aims to locate objects based on natural language descriptions in 3D scenes. Existing methods rely on a pre-defined Object Lookup Table (OLT) to query Visual Language Models (VLMs) for reasoning about object locations, which limits the applications in scenarios with undefined or unforeseen targets. To address this problem, we present OpenGround, a novel zero-shot framework for open-world 3D visual grounding. Central to OpenGround is the Active Cognition-based Reasoning (ACR) module, which is designed to overcome the fundamental limitation of pre-defined OLTs by progressively augmenting the cognitive scope of VLMs. The ACR module performs human-like perception of the target via a cognitive task chain and actively reasons about contextually relevant objects, thereby extending VLM cognition through a dynamically updated OLT. This allows OpenGround to function with both pre-defined and open-world categories. We also propose a new dataset named OpenTarget, which contains over 7000 object-description pairs to evaluate our method in open-world scenarios. Extensive experiments demonstrate that OpenGround achieves competitive performance on Nr3D, state-of-the-art on ScanRefer, and delivers a substantial 17.6% improvement on OpenTarget. Project Page at https://why-102.github.io/openground.io/.

Visual grounding is a ubiquitous building block in many vision-language tasks and yet remains challenging due to large variations in visual and linguistic features of grounding entities, strong context effect and the resulting semantic ambiguities. Prior works typically focus on learning representations of individual phrases with limited context information. To address their limitations, this paper proposes a language-guided graph representation to capture the global context of grounding entities and their relations, and develop a cross-modal graph matching strategy for the multiple-phrase visual grounding task. In particular, we introduce a modular graph neural network to compute context-aware representations of phrases and object proposals respectively via message propagation, followed by a graph-based matching module to generate globally consistent localization of grounding phrases. We train the entire graph neural network jointly in a two-stage strategy and evaluate it on the Flickr30K Entities benchmark. Extensive experiments show that our method outperforms the prior state of the arts by a sizable margin, evidencing the efficacy of our grounding framework. Code is available at "https://github.com/youngfly11/LCMCG-PyTorch".

Large Vision-Language Models (LVLMs) have demonstrated impressive general capabilities across a wide range of multi-modal tasks. However, the reasoning processes of LVLMs often suffer from unreliable outputs and limited interpretability. To address this, grounded visual reasoning has emerged as a promising paradigm that enforces responses anchored on salient visual evidence regions. However, existing approaches typically rely on costly supervision such as bounding box annotations, chain-of-thought rationale or external tool calls, limiting their scalability. In this work, we propose Ground-R1, a reinforcement learning framework that enables grounded visual reasoning without requiring explicit evidence or rationale annotations. Ground-R1 consists of a grounding phase that generates evidence region rollouts based on format constraints, and an answering phase that produces responses guided by both answer correctness and format adherence rewards. Extensive experiments across multiple visual reasoning benchmarks manifest that Ground-R1 achieves superior performance and exhibits emergent cognitive behaviors such as uncertainty awareness, spatial perception, and iterative refinement, offering a scalable and interpretable alternative to existing approaches.