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Shuang Chen

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Preprint Aug 2026

PixVL: Self-Supervised Training of Pixel-Level MLLMs via a Unified Mask--Text Consistency Cycle

Recent studies develop pixel-level multimodal large language models (MLLMs) that support both Region Segmentation and Region Understanding, extending multimodal interaction from whole images to specific objects and regions. However, these methods face two fundamental challenges. First, the scarcity of high-quality mask--text pairs leaves abundant mask annotations without corresponding language supervision. Second, discrepancies in supervision formats and learning-signal densities induce optimization interference between Region Segmentation and Region Understanding. To address these challenges, we propose PixVL, a self-supervised post-training framework that introduces a unified Mask--Text Consistency Cycle, enabling pixel-level MLLMs to generate and self-verify regional descriptions and learn from unlabeled data. We found that direct cycle based solely on geometric reconstruction is unreliable because re-segmentation IoU does not faithfully reflect the semantic quality and referring sufficiency. PixVL therefore introduces confuser-aware semantic verification, which uses the model's confidence when it correctly chooses the target among highly similar candidate regions, and assigns zero reward to an incorrect choice. Meanwhile, PixVL performs cross-view verification using temporally separated video frames or geometrically transformed image views, preventing cyclic learning from collapsing to positional and shape shortcuts. Finally, a quality-coupled bidirectional learning strategy uses the highest-reward description to guide Text-to-Mask learning. This strategy transforms Region Understanding and Region Segmentation from competing tasks into mutual generators and verifiers. Experiments demonstrate that PixVL improves both region understanding task and segmentation task.

Yicheng Xiao, Haoxuan Ma, Caorui Li et al. · 0 citations
Preprint Aug 2026

Sparse Multi-Stage Expert-Agent Routing for Complex Clinical Reasoning

Complex clinical reasoning requires models to update diagnostic hypotheses as new evidence emerges and to coordinate different medical specialities under limited consultation resources. Existing LLM-based clinical reasoning systems typically perform single-pass prediction or rely on fixed multi-agent workflows, making expert participation either static or unnecessarily exhaustive. We propose Sparse Multi-Stage Expert-Agent Routing, a language-based clinical reasoning framework that models diagnosis as a stage-wise routing process. Given progressively available clinical evidence derived from multiple modalities, the framework maintains an evolving case state and adaptively activates a sparse set of medical expert agents, supported by expert-specific memory across stages. To evaluate free-text diagnostic conclusions beyond surface similarity, we further introduce ClinFEScore, a fact-aware semantic evaluation protocol for clinical reasoning outputs. On reconstructed multi-stage cases from MAC and AgentClinic-NEJM, our framework reduces the average number of activated experts from 17.0 to 3.0 whilst maintaining strong fact-level diagnostic quality. On 200 real-world hospital MDT cases, ClinFEScore correlates strongly with clinician judgements (Spearman's $\rho=0.81$; Pearson's $r=0.87$), whilst our method achieves 91.5\% clinician-verified diagnostic accuracy with approximately five expert-agent/LLM calls per case. These results support sparse stage-wise coordination as an efficient and clinically relevant approach to LLM-based clinical reasoning.

Sike Xiang, Shuang Chen, Qianpeng Sun et al. · 0 citations

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