Towards Multimodal Retrieval-Augmented Generation for Medical Visual Question Answering

Beyond Surface Features: Advancing Medical Vision-Language Alignment via Dynamic Evidence-Guided Preference Optimization

Medical large Vision-Language Models (Med-LVLMs) have shown strong potential in multimodal clinical applications such as medical visual question answering and report generation. However, Med-LVLMs remain challenged by hallucinations caused by modality misalignment, where models prioritize textual knowledge over visual evidence and generate outputs that conflict with medical images. To mitigate this issue, recent studies have explored preference optimization to improve image–text alignment, achieving promising results. Despite these advances, existing preference-based meth-ods still face two limitations in medical settings: (1) overfitting to superficial cues, and (2) pseudo convergence of the preference signal. In this paper, we propose Dynamic Evidence-Guided Preference Optimization (DEPO), a new framework that enables evidence-aware and adaptive preference learning for Med-LVLMs. DEPO introduces Multi-Modal Evidence Perturbation (MEP) to suppress non-causal textual and visual shortcuts, and Dispre-ferred Evidence Resampling (DER) to continuously update dispreferred responses as hallucination patterns evolve. Experiments on multiple medical VQA and report generation benchmarks demonstrate consistent improvements over existing methods, with strong robustness across datasets and architectures.

Multimodal AI in healthcare: Review of vision-language foundation models for real-world medical applications.

A definitive taxonomy of the medical VLM landscape is provided, tracing the evolution from early Contrastive Alignment and Generative MLLMs to the cutting-edge frontiers of Dense Pixel-Grounding, Sparse Mixture-of-Experts (MoE), and Reasoning-Incentivized (RL) architectures.

Retrieval-augmented generation for medical question answering: a multi-metric performance evaluation

The proposed framework offers a practical and scalable approach to mitigating hallucinations without requiring task-specific fine-tuning, highlighting the potential of retrieval-augmented approaches for trustworthy artificial intelligence (AI)-assisted healthcare applications.

MedVCoT: Bridging the Modality Gap in Medical VQA Through Latent Visual Reasoning

LocAnyMed: Vision-Language Grounding for Multimodal Medical Images

Medical visual grounding connects free-form clinical queries to spatial evidence in medical images and is an important component of interpretable medical artificial intelligence. However, general-purpose grounding models are predominantly trained on natural images, while existing medical localization resources remain fragmented across imaging modalities, datasets, and task formulations. To address this gap, we construct LocAnyMed-200K, a multimodal medical visual grounding dataset containing approximately 200K image-query-answer examples across computed tomography, optical medical imaging, ultrasound, and X-ray. We harmonize heterogeneous detection and localization resources into a unified free-form instruction format that supports one or multiple bounding boxes, point coordinates, and no-target outputs for negative queries. Full-parameter fine-tuning of LocateAnything-3B on LocAnyMed-200K improves F1@IoU 0.50 from 10.64 to 85.59 on a held-out evaluation split, demonstrating that large-scale domain-specific supervision can equip a general grounding model with effective medical localization capabilities. Beyond spatial coordinates, a clinically interpretable grounding system should also communicate the evidence supporting its prediction. We therefore derive LocAnyMed-CoT-20K, a rationale-augmented subset that connects anatomical context, visual observations, and spatial conclusions through structured reasoning and further improves cross-source generalization through fine-tuning. Together, these resources provide a unified foundation for studying both localization accuracy and rationale quality across heterogeneous medical imaging modalities. The code is publicly available at https://github.com/MiliLab/LocAnyMed.

Towards Clinically Faithful Medical Image Captioning via Enhanced Vision-Language Alignment

Medical image captioning is a technique that accelerates early-stage diagnostic workflows and enhances the interpretability of medical diagnostic AI systems. However, unlike general image captioning, clinically reliable captioning remains challenging due to grayscale-based modalities, subtle anatomical cues, specialized medical phrasing, and variations in data quality. Despite recent advances in large vision-language models, fluent outputs do not necessarily guarantee sufficient alignment with clinical concept spaces or evaluation criteria. To address this issue, we propose a framework that strengthens clinical alignment by separating and enhancing training-time alignment and inference-time alignment. We build a medical image captioning pipeline that integrates single/dual vision encoders based on BioMedCLIP and SigLIP2, a Q-Former, and a LLaMA-based decoder, and examine the contribution of auxiliary learning for UMLS concept/type prediction. At inference, we apply single-embedding-based reranking to select the best caption among candidates, while at training we introduce MedPAIR-SCST, which combines clinically relevant rewards to shift the generative distribution toward improved clinical alignment. Our experiments show that complementary visual representations with a multi-encoder design and concept-level auxiliary learning help preserve clinically meaningful information. Furthermore, inference-time reranking provides a practical way to improve semantic and clinical alignment without additional training, whereas MedPAIR-SCST goes beyond selection by directly improving the model's distribution to generate more consistent and clinically grounded captions. These findings suggest that jointly leveraging selection-based alignment and reinforcement-learning-based alignment can promote more trustworthy medical image captioning even in data-constrained settings.