Daily Papers

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, they enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA. The project page is available at: https://camma-public.github.io/SurgTEMP/

Owing to recent advances in machine learning and the ability to harvest large amounts of data during robotic-assisted surgeries, surgical data science is ripe for foundational work. We present a large dataset of surgical videos and their accompanying labels for this purpose. We describe how the data was collected and some of its unique attributes. Multiple example problems are outlined. Although the dataset was curated for a particular set of scientific challenges (in an accompanying paper), it is general enough to be used for a broad range machine learning questions. Our hope is that this dataset exposes the larger machine learning community to the challenging problems within surgical data science, and becomes a touch-stone for future research. The videos are available at https://storage.googleapis.com/isi-surgvu/surgvu24_videos_only.zip, the labels at https://storage.googleapis.com/isi-surgvu/surgvu24_labels_updated_v2.zip, a validation set for tool detection problem at https://storage.googleapis.com/isi-surgvu/cat1_test_set_public.zip, and a sample set of question & answer pairs dataset for surgical visual question answering at https://storage.googleapis.com/isi-surgvu/SURGVU25_cat_2_sample_set_public.zip.

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

Visual Question Answering (VQA) within the surgical domain, utilizing Large Language Models (LLMs), offers a distinct opportunity to improve intra-operative decision-making and facilitate intuitive surgeon-AI interaction. However, the development of LLMs for surgical VQA is hindered by the scarcity of diverse and extensive datasets with complex reasoning tasks. Moreover, contextual fusion of the image and text modalities remains an open research challenge due to the inherent differences between these two types of information and the complexity involved in aligning them. This paper introduces PitVQA, a novel dataset specifically designed for VQA in endonasal pituitary surgery and PitVQA-Net, an adaptation of the GPT2 with a novel image-grounded text embedding for surgical VQA. PitVQA comprises 25 procedural videos and a rich collection of question-answer pairs spanning crucial surgical aspects such as phase and step recognition, context understanding, tool detection and localization, and tool-tissue interactions. PitVQA-Net consists of a novel image-grounded text embedding that projects image and text features into a shared embedding space and GPT2 Backbone with an excitation block classification head to generate contextually relevant answers within the complex domain of endonasal pituitary surgery. Our image-grounded text embedding leverages joint embedding, cross-attention and contextual representation to understand the contextual relationship between questions and surgical images. We demonstrate the effectiveness of PitVQA-Net on both the PitVQA and the publicly available EndoVis18-VQA dataset, achieving improvements in balanced accuracy of 8% and 9% over the most recent baselines, respectively. Our code and dataset is available at https://github.com/mobarakol/PitVQA.

Visual Question Answering (VQA) in robotic surgery, referred to as surgical VQA, requires high-level understanding of complex surgical scenes and the integration of visual perception with language reasoning, with the potential to support surgical training and intraoperative decision-making. Recent Vision-Language Models (VLMs) have shown promising performance through parameter-efficient fine-tuning; however, most existing approaches rely on coarse visual grounding, typically limited to bounding boxes, which fails to capture the fine-grained spatial structure of surgical objects. In this work, we propose a unified framework that jointly performs pixel-level segmentation and visual question answering within a single framework. Our approach integrates a VLM with a Segment Anything Model (SAM)-based decoder and represents scene elements as object tokens generated by the VLM. These object tokens guide answer prediction and are further projected to the SAM-based decoder to produce segmentation masks. By optimizing the object token embeddings through both segmentation and question answering objectives, the model learns spatially grounded representations that enhance visual reasoning while providing explicit pixel-level grounding. We evaluate the proposed method on the private RAMIE (Robot-Assisted Minimally Invasive Esophagectomy) dataset and the public EndoVis18 dataset, where it consistently outperforms baseline methods for surgical VQA. These results demonstrate that incorporating context-aware object tokens into vision-language models improves fine-grained surgical scene understanding.

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

Recent advances in multimodal large language models (LLMs) have highlighted their potential for medical and surgical applications. However, existing surgical datasets predominantly adopt a Visual Question Answering (VQA) format with heterogeneous taxonomies and lack support for pixel-level segmentation, limiting consistent evaluation and applicability. We present SurgMLLMBench, a unified multimodal benchmark explicitly designed for developing and evaluating interactive multimodal LLMs for surgical scene understanding, including the newly collected Micro-surgical Artificial Vascular anastomosIS (MAVIS) dataset. It integrates pixel-level instrument segmentation masks and structured VQA annotations across laparoscopic, robot-assisted, and micro-surgical domains under a unified taxonomy, enabling comprehensive evaluation beyond traditional VQA tasks and richer visual-conversational interactions. Extensive baseline experiments show that a single model trained on SurgMLLMBench achieves consistent performance across domains and generalizes effectively to unseen datasets. SurgMLLMBench will be publicly released as a robust resource to advance multimodal surgical AI research, supporting reproducible evaluation and development of interactive surgical reasoning models.

Surgical site infection (SSI) is one of the most common and costly healthcare-associated infections and and surgical wound care remains a significant clinical challenge in preventing SSIs and improving patient outcomes. While recent studies have explored the use of deep learning for preliminary surgical wound screening, progress has been hindered by concerns over data privacy and the high costs associated with expert annotation. Currently, no publicly available dataset or benchmark encompasses various types of surgical wounds, resulting in the absence of an open-source Surgical-Wound screening tool. To address this gap: (1) we present SurgWound, the first open-source dataset featuring a diverse array of surgical wound types. It contains 697 surgical wound images annotated by 3 professional surgeons with eight fine-grained clinical attributes. (2) Based on SurgWound, we introduce the first benchmark for surgical wound diagnosis, which includes visual question answering (VQA) and report generation tasks to comprehensively evaluate model performance. (3) Furthermore, we propose a three-stage learning framework, WoundQwen, for surgical wound diagnosis. In the first stage, we employ five independent MLLMs to accurately predict specific surgical wound characteristics. In the second stage, these predictions serve as additional knowledge inputs to two MLLMs responsible for diagnosing outcomes, which assess infection risk and guide subsequent interventions. In the third stage, we train a MLLM that integrates the diagnostic results from the previous two stages to produce a comprehensive report. This three-stage framework can analyze detailed surgical wound characteristics and provide subsequent instructions to patients based on surgical images, paving the way for personalized wound care, timely intervention, and improved patient outcomes.

Video Question Answering (VideoQA) in the surgical domain aims to enhance intraoperative understanding by enabling AI models to reason over temporally coherent events rather than isolated frames. Current approaches are limited to static image features, and available datasets often lack temporal annotations, ignoring the dynamics critical for accurate procedural interpretation. We propose SurgViVQA, a surgical VideoQA model that extends visual reasoning from static images to dynamic surgical scenes. It uses a Masked Video--Text Encoder to fuse video and question features, capturing temporal cues such as motion and tool--tissue interactions, which a fine-tuned large language model (LLM) then decodes into coherent answers. To evaluate its performance, we curated REAL-Colon-VQA, a colonoscopic video dataset that includes motion-related questions and diagnostic attributes, as well as out-of-template questions with rephrased or semantically altered formulations to assess model robustness. Experimental validation on REAL-Colon-VQA and the public EndoVis18-VQA dataset shows that SurgViVQA outperforms existing image-based VQA benchmark models, particularly in keyword accuracy, improving over PitVQA by +11\% on REAL-Colon-VQA and +9\% on EndoVis18-VQA. A perturbation study on the questions further confirms improved generalizability and robustness to variations in question phrasing. SurgViVQA and the REAL-Colon-VQA dataset provide a framework for temporally-aware understanding in surgical VideoQA, enabling AI models to interpret dynamic procedural contexts more effectively. Code and dataset available at https://github.com/madratak/SurgViVQA.

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

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.

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

Medical vision--language models (VLMs) have shown strong potential for medical visual question answering (VQA), yet their reasoning remains largely text-centric: images are encoded once as static context, and subsequent inference is dominated by language. This paradigm is fundamentally limited in clinical scenarios, where accurate answers often depend on subtle, localized visual evidence that cannot be reliably preserved in static embeddings. We propose MedLVR, a latent visual reasoning framework that introduces an explicit visual evidence state into autoregressive decoding. Instead of relying solely on text-based intermediate reasoning, MedLVR interleaves a short latent reasoning segment within the decoder by reusing hidden states as continuous latent steps, enabling iterative preservation and refinement of query-relevant visual evidence before answer generation. To support effective visual supervision, we adopt a two-stage training strategy: region of interest (ROI)-supervised fine-tuning aligns latent states with clinically relevant image evidence, and Visual-Latent Policy Optimization (VLPO) further optimizes latent reasoning and answer generation under outcome-level rewards. Experiments on OmniMedVQA and five external medical VQA benchmarks show that MedLVR consistently outperforms recent reasoning baselines and improves the average score over the Qwen2.5-VL-7B backbone from 48.3\% to 53.4\%. These results show that latent visual reasoning provides an effective mechanism for preserving diagnostically relevant visual evidence and improving the reliability of medical VQA.

Medical visual question answering (Med-VQA) aims to answer clinically relevant questions grounded in medical images. However, existing multimodal large language models (MLLMs) often exhibit shortcut answering, producing plausible responses by exploiting language priors or dataset biases while insufficiently attending to visual evidence. This behavior undermines clinical reliability, especially when subtle imaging findings are decisive. We propose a lightweight plug-in framework, termed Intent-aware Visual Cues (InViC), to explicitly enhance image-based answer generation in medical VQA. InViC introduces a Cue Tokens Extraction (CTE) module that distills dense visual tokens into a compact set of K question-conditioned cue tokens, which serve as structured visual intermediaries injected into the LLM decoder to promote intent-aligned visual evidence. To discourage bypassing of visual information, we further design a two-stage fine-tuning strategy with a cue-bottleneck attention mask. In Stage I, we employ an attention mask to block the LLM's direct view of raw visual features, thereby funneling all visual evidence through the cue pathway. In Stage II, standard causal attention is restored to train the LLM to jointly exploit the visual and cue tokens. We evaluate InViC on three public Med-VQA benchmarks (VQA-RAD, SLAKE, and ImageCLEF VQA-Med 2019) across multiple representative MLLMs. InViC consistently improves over zero-shot inference and standard LoRA fine-tuning, demonstrating that intent-aware visual cues with bottlenecked training is a practical and effective strategy for improving trustworthy Med-VQA.

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

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

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.

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

The reasoning gap between large and compact vision-language models (VLMs) limits the deployment of medical AI on portable clinical devices. Compact VLMs of 2--4B parameters can run on resource-constrained hardware but lack the multi-step reasoning capacity needed for interpretable clinical decision support. Existing knowledge distillation methods transfer answers without the reasoning process behind them. Medical visual question answering (VQA) serves as a testbed for this problem, as it requires models to integrate visual evidence with clinical knowledge through structured reasoning chains. We introduce LiteMedCoT-VL, a pipeline that transfers chain-of-thought reasoning from a 235B teacher model to 2B student models through LoRA-based fine-tuning on explanation-enriched training data. All inference is conducted without image captions by default, simulating the clinical scenario in which a physician interprets a medical image directly without an accompanying radiology report. On the PMC-VQA benchmark, LiteMedCoT-VL achieves 64.9% accuracy, exceeding the zero-shot Qwen3-VL-4B baseline of 53.9% by 11.0 percentage points and outperforming all published baselines. This result indicates that a 2B model with reasoning distillation can match or exceed models with twice the parameters. Visual grounding analysis shows that the model relies on image content rather than exploiting textual priors. Our code is publicly available at https://anonymous.4open.science/r/LiteMedCoT-VL.

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

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.

Recent advancements in surgical computer vision have been driven by vision-only models, which lack language semantics, relying on manually annotated videos to predict fixed object categories. This limits their generalizability to unseen surgical procedures and tasks. We propose leveraging surgical video lectures from e-learning platforms to provide effective vision and language supervisory signals for multi-modal representation learning, bypassing manual annotations. We address surgery-specific linguistic challenges using multiple automatic speech recognition systems for text transcriptions. We introduce SurgVLP - Surgical Vision Language Pre-training - a novel method for multi-modal representation learning. SurgVLP employs a new contrastive learning objective, aligning video clip embeddings with corresponding multiple text embeddings in a joint latent space. We demonstrate the representational capability of this space through several vision-and-language surgical tasks and vision-only tasks specific to surgery. Unlike current fully supervised approaches, SurgVLP adapts to different surgical procedures and tasks without specific fine-tuning, achieving zero-shot adaptation to tasks such as surgical tool, phase, and triplet recognition without manual annotation. These results highlight the transferability and versatility of the learned multi-modal representations in surgical video analysis. The code is available at https://github.com/CAMMA-public/SurgVLP

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

This paper describes our approach to Subtask 1 of the ImageCLEFmed MEDVQA 2025 Challenge, which targets visual question answering (VQA) for gastrointestinal endoscopy. We adopt the Florence model-a large-scale multimodal foundation model-as the backbone of our VQA pipeline, pairing a powerful vision encoder with a text encoder to interpret endoscopic images and produce clinically relevant answers. To improve generalization, we apply domain-specific augmentations that preserve medical features while increasing training diversity. Experiments on the KASVIR dataset show that fine-tuning Florence yields accurate responses on the official challenge metrics. Our results highlight the potential of large multimodal models in medical VQA and provide a strong baseline for future work on explainability, robustness, and clinical integration. The code is publicly available at: https://github.com/TiwariLaxuu/VQA-Florence.git

Medical vision-language models (VLMs) and AI agents have made significant progress in learning to analyze and reason about clinical images. However, existing medical visual question answering (VQA) benchmarks collapse model capabilities into a single accuracy score, obscuring where and why models fail. We propose DeepTumorVQA, a hierarchical benchmark that follows the multi-stage evidence chain in tumor diagnosis and decomposes 3D CT reasoning into four stages: recognition, measurement, visual reasoning, and medical reasoning. Higher-level questions remain independently scorable, while their ground-truth evidence chains are defined over lower-level primitives. The benchmark contains 476K questions across 42 clinical subtypes on 9,262 3D CT volumes. In addition to a direct reasoning mode for VLMs, DeepTumorVQA provides tool-interaction environments for agent evaluation, where a model can call external tools, including segmentation models, measurement programs, and medical knowledge modules, before answering the question. Evaluating over 30 model configurations, we find that reliable quantitative measurement is the primary bottleneck, making later-stage visual and medical reasoning harder for VLMs, while tool augmentation substantially mitigates this issue. When tools are available, leveraging medical knowledge and tools to reason about medical images becomes a new challenge. We further show that ground-truth step-by-step tool-use traces from DeepTumorVQA can supervise agents and reduce tool-use and reasoning failures. This stage-wise progression from recognition to measurement to visual and medical reasoning provides a concrete roadmap for future medical VLM and AI agent studies. All data and code are released at https://github.com/Schuture/DeepTumorVQA.

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

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

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

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

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.

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

Recent advancements in Large Language Models (LLMs) and Large Vision Language Models (LVLMs) have enabled general-purpose systems to demonstrate promising capabilities in complex reasoning tasks, including those in the medical domain. Medical Visual Question Answering (MedVQA) has particularly benefited from these developments. However, despite Bangla being one of the most widely spoken languages globally, there exists no established MedVQA benchmark for it. To address this gap, we introduce BanglaMedVQA, a dataset comprising clinically validated image-question-answer pairs, along with a comprehensive evaluation of current foundation models on this resource. Consistent with prior findings that report low performance of current models on English MedVQA benchmarks, our analysis reveals that Bangla performance is substantially lower, reflecting the challenges inherent to low-resource languages. Even top-performing models such as Gemini and GPT-4.1 mini fail to accurately answer specialized diagnostic questions, indicating severe limitations in fine-grained medical reasoning. Although certain open-source models, such as Gemma-3, occasionally outperform these models in general categories, they too struggle with clinically complex questions, underscoring the urgent need for top-notch evaluation method.

Surgical video-language pretraining (VLP) faces unique challenges due to the knowledge domain gap and the scarcity of multi-modal data. This study aims to bridge the gap by addressing issues regarding textual information loss in surgical lecture videos and the spatial-temporal challenges of surgical VLP. We propose a hierarchical knowledge augmentation approach and a novel Procedure-Encoded Surgical Knowledge-Augmented Video-Language Pretraining (PeskaVLP) framework to tackle these issues. The knowledge augmentation uses large language models (LLM) for refining and enriching surgical concepts, thus providing comprehensive language supervision and reducing the risk of overfitting. PeskaVLP combines language supervision with visual self-supervision, constructing hard negative samples and employing a Dynamic Time Warping (DTW) based loss function to effectively comprehend the cross-modal procedural alignment. Extensive experiments on multiple public surgical scene understanding and cross-modal retrieval datasets show that our proposed method significantly improves zero-shot transferring performance and offers a generalist visual representation for further advancements in surgical scene understanding.The code is available at https://github.com/CAMMA-public/SurgVLP

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

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.

Large vision language models (VLMs) report strong accuracy on medical question-answering, yet it remains unclear whether they reason from visual evidence or exploit textual shortcuts. We introduce a counterfactual evaluation framework that decouples visual and textual contributions by substituting input images with controlled surrogates blank, pixel-shuffled, image-absent, and CLIP-retrieved hard negatives and derive a suite of grounding metrics including the Visual Reliance Score (VRS) and Visual Hallucination Rate (VHR). We further introduce CORAL (COntrastive Retrieval-Augmented Learning), a 7B-parameter LoRA fine-tune of Qwen2.5-VL-7B trained with a Contrastive Grounding Objective (CGO) that penalises answer invariance under hard-negative image swaps. On a paired controlled evaluation across four closed-form medical VQA benchmarks (PathVQA, PMC-VQA, SLAKE, VQA-RAD; n=400 total), CORAL improves macro accuracy by +6.7 pp (P(Delta>0)=0.988) and reduces VHR by 8.0 pp (P<0.001) over the matched Qwen2.5-VL-7B base; neither MedVLThinker RL variant achieves a significant gain on either metric. Cross-domain diagnostics further reveal that image substitution costs only <=6.5 pp on medical benchmarks versus 48-61 pp on general-domain tasks, situating the grounding gap that CGO targets. We discuss evaluation limitations openly including train/eval benchmark overlap and underpowered secondary metrics and release our framework, training code, and model weights to support reproducible grounding audits of medical VLMs.

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.

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

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

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

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

In this work, we introduce RadImageNet-VQA, a large-scale dataset designed to advance radiologic visual question answering (VQA) on CT and MRI exams. Existing medical VQA datasets are limited in scale, dominated by X-ray imaging or biomedical illustrations, and often prone to text-based shortcuts. RadImageNet-VQA is built from expert-curated annotations and provides 750K images paired with 7.5M question-answer samples. It covers three key tasks - abnormality detection, anatomy recognition, and pathology identification - spanning eight anatomical regions and 97 pathology categories, and supports open-ended, closed-ended, and multiple-choice questions. Extensive experiments show that state-of-the-art vision-language models still struggle with fine-grained pathology identification, particularly in open-ended settings and even after fine-tuning. Text-only analysis further reveals that model performance collapses to near-random without image inputs, confirming that RadImageNet-VQA is free from linguistic shortcuts. The full dataset and benchmark are publicly available at https://huggingface.co/datasets/raidium/RadImageNet-VQA.

We introduce SurgAtlas, the largest surgical video-language dataset to date, comprising 15,291 videos (2,391 hours) spanning 18 surgical specialties and over 5,000 procedure types, sourced entirely from publicly available YouTube content. SurgAtlas is also the first surgical video-language dataset to include open surgery at scale, with 6,182 open procedure videos alongside over 9,000 minimally invasive recordings, and the first to establish standardized benchmarks for open-surgery video understanding. We additionally provide an expert-validated subset with verified visual question-answer pairs across diverse open and minimally invasive procedures, serving as a clinically grounded benchmark for surgical reasoning. Compared with existing surgical video-language datasets, SurgAtlas provides one of the most diverse annotation schemas, combining segment-level captions, step- and phase-level descriptions, video-level surgical descriptions, and reasoning-oriented question-answer pairs organized within a hierarchical taxonomy. These annotations are constructed through an automated multi-tier pipeline with LLM-based enrichment and a staged VQA generation framework with explicit groundedness verification. The scale and diversity of SurgAtlas enable training surgical foundation models with broad procedural coverage: we finetune Qwen3-VL-8B through a two-stage captioning-then-instruction pipeline and achieve competitive or state-of-the-art results on multiple established surgical benchmarks, including phase recognition, triplet detection, and reasoning question answering. More broadly, SurgAtlas provides a large native public video corpus that can support future large-scale pretraining of multimodal surgical AI systems and contribute to the development of next-generation foundation models for surgery.

Current vision-language models (VLMs) in medicine are primarily designed for categorical question answering (e.g., "Is this normal or abnormal?") or qualitative descriptive tasks. However, clinical decision-making often relies on quantitative assessments, such as measuring the size of a tumor or the angle of a joint, from which physicians draw their own diagnostic conclusions. This quantitative reasoning capability remains underexplored and poorly supported in existing VLMs. In this work, we introduce MedVision, a large-scale dataset and benchmark specifically designed to evaluate and improve VLMs on quantitative medical image analysis. MedVision spans 22 public datasets covering diverse anatomies and modalities, with 30.8 million image-annotation pairs. We focus on three representative quantitative tasks: (1) detection of anatomical structures and abnormalities, (2) tumor/lesion (T/L) size estimation, and (3) angle/distance (A/D) measurement. Our benchmarks show that current off-the-shelf VLMs perform poorly on these tasks. However, with supervised fine-tuning on MedVision, we significantly enhance their performance across detection, T/L estimation, and A/D measurement, demonstrating reduced error rates and improved precision. This work provides a foundation for developing VLMs with robust quantitative reasoning capabilities in medical imaging. Code and data are available at https://medvision-vlm.github.io.

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

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

Developing 3D vision-language models with robust clinical reasoning remains a challenge due to the inherent complexity of volumetric medical imaging, the tendency of models to overfit superficial report patterns, and the lack of interpretability-aware reward designs. In this paper, we propose Med3D-R1, a reinforcement learning framework with a two-stage training process: Supervised Fine-Tuning (SFT) and Reinforcement Learning (RL). During SFT stage, we introduce a residual alignment mechanism to bridge the gap between high-dimensional 3D features and textual embeddings, and an abnormality re-weighting strategy to emphasize clinically informative tokens and reduce structural bias in reports. In RL stage, we redesign the consistency reward to explicitly promote coherent, step-by-step diagnostic reasoning. We evaluate our method on medical multiple-choice visual question answering using two 3D diagnostic benchmarks, CT-RATE and RAD-ChestCT, where our model attains state-of-the-art accuracies of 41.92\% on CT-RATE and 44.99\% on RAD-ChestCT. These results indicate improved abnormality diagnosis and clinical reasoning and outperform prior methods on both benchmarks. Overall, our approach holds promise for enhancing real-world diagnostic workflows by enabling more reliable and transparent 3D medical vision-language systems.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

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

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

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

Brain tumor diagnosis is largely dependent on Magnetic Resonance Imaging (MRI) evaluation, which requires radiologists to synthesize thousands of images across multiple 3D sequences and longitudinal studies. This process requires advanced neuro-radiology training, poses substantial cognitive load, and is highly time-consuming. Despite increasing demands in radiology, this expertise is difficult to scale, straining the current health systems. Vision-Language Models (VLMs) provide an opportunity to reduce this burden through a semi-automated, interactive interpretation of complex brain MRIs. However, they are currently underutilized in neuro-oncology due to a lack of specialized benchmarks for evaluating them. We introduce a clinically relevant visual question answering (VQA) benchmark -- the UCSF-PDGM-VQA dataset -- consisting of 2,387 QA pairs from 473 glioma-related MRI studies in the public UCSF-PDGM dataset. We further establish a performance baseline for six state-of-the-art vision-language models (VLMs) and one large language model on this dataset. We find that current models are incapable of effectively processing multi-sequence, 3-dimensional MRI scans, thus resulting in a suppression of visual features and over-reliance on language priors, causing modality collapse. These findings underscore a critical deficiency in current model reliability and safety within clinical settings, necessitating the development of robust, domain-specific VLMs.

Surgical scene understanding is critical for surgical training and robotic decision-making in robot-assisted surgery. Recent advances in Multimodal Large Language Models (MLLMs) have demonstrated great potential for advancing scene perception in the medical domain, facilitating surgeons to understand surgical scenes and procedures. However, these methods are primarily oriented towards image-based analysis or global video understanding, overlooking the fine-grained video reasoning that is crucial for analyzing specific processes and capturing detailed task execution within a surgical procedure. To bridge this gap, we propose SurgVidLM, the first video language model designed to address both full and fine-grained surgical video comprehension. To train our SurgVidLM, we construct the SVU-31K that is a large-scale dataset with over 31K video-instruction pairs, enabling both holistic understanding and detailed analysis of surgical procedures. Building on this resource, SurgVidLM incorporates a two-stage StageFocus mechanism: the first stage extracts global procedural context, while the second stage performs high-frequency local analysis guided by temporal cues. We also develop the Multi-frequency Fusion Attention to effectively integrate low- and high-frequency visual tokens, ensuring the preservation of critical task-specific details. Experimental results demonstrate that SurgVidLM significantly outperforms state-of-the-art Vid-LLMs of comparable parameter scale in both full and fine-grained video understanding tasks, showcasing its superior capability in capturing the context of complex robot-assisted surgeries. Our code and dataset will be publicly accessible soon.

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

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

This paper presents a state-of-the-art model for visual question answering (VQA), which won the first place in the 2017 VQA Challenge. VQA is a task of significant importance for research in artificial intelligence, given its multimodal nature, clear evaluation protocol, and potential real-world applications. The performance of deep neural networks for VQA is very dependent on choices of architectures and hyperparameters. To help further research in the area, we describe in detail our high-performing, though relatively simple model. Through a massive exploration of architectures and hyperparameters representing more than 3,000 GPU-hours, we identified tips and tricks that lead to its success, namely: sigmoid outputs, soft training targets, image features from bottom-up attention, gated tanh activations, output embeddings initialized using GloVe and Google Images, large mini-batches, and smart shuffling of training data. We provide a detailed analysis of their impact on performance to assist others in making an appropriate selection.

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

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.

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

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

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

Existing medical 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.

We present a simple method that achieves unexpectedly superior performance for Complex Reasoning involved Visual Question Answering. Our solution collects statistical features from high-frequency words of all the questions asked about an image and use them as accurate knowledge for answering further questions of the same image. We are fully aware that this setting is not ubiquitously applicable, and in a more common setting one should assume the questions are asked separately and they cannot be gathered to obtain a knowledge base. Nonetheless, we use this method as an evidence to demonstrate our observation that the bottleneck effect is more severe on the feature extraction part than it is on the knowledge reasoning part. We show significant gaps when using the same reasoning model with 1) ground-truth features; 2) statistical features; 3) detected features from completely learned detectors, and analyze what these gaps mean to researches on visual reasoning topics. Our model with the statistical features achieves the 2nd place in the GQA Challenge 2019.

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

Visual Question Answering (VQA) is a core task for evaluating the capabilities of Vision-Language Models (VLMs). Existing VQA benchmarks primarily feature clear and unambiguous image-question pairs, whereas real-world scenarios often involve varying degrees of ambiguity that require nuanced reasoning and context-appropriate response strategies. Although recent studies have begun to address ambiguity in VQA, they lack (1) a systematic categorization of ambiguity levels and (2) datasets and models that support strategy-aware responses. In this paper, we introduce Ambiguous Visual Question Answering (AQuA), a fine-grained dataset that classifies ambiguous VQA instances into four levels according to the nature and degree of ambiguity, along with the optimal response strategy for each case. Our evaluation of diverse open-source and proprietary VLMs shows that most models fail to adapt their strategy to the ambiguity type, frequently producing overconfident answers rather than seeking clarification or acknowledging uncertainty. To address this challenge, we fine-tune VLMs on AQuA, enabling them to adaptively choose among multiple response strategies, such as directly answering, inferring intent from contextual cues, listing plausible alternatives, or requesting clarification. VLMs trained on AQuA achieve strategic response generation for ambiguous VQA, demonstrating the ability to recognize ambiguity, manage uncertainty, and respond with context-appropriate strategies, while outperforming both open-source and closed-source baselines.

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

High-stakes clinical use of large vision-language models (LVLMs) requires reasoning that is grounded in visual evidence and clinical knowledge, not just correct final answers. We introduce OpenMedReason, a large-scale, open multimodal medical reasoning corpus comprising approximately 450K image-question-answer instances whose reasoning traces are primarily derived from curated biomedical, human-authored scientific articles. OpenMedReason provides high-fidelity supervision beyond synthetic chains of thought, covering diverse medical domain vision modalities such as radiological scans, microscopic images, visible light photographs, charts, and others. We complement it with OpenMedReason-Bench, a held-out benchmark that allows fine-grained evaluation of LVLMs along three complementary axes of capability, including perception, medical knowledge, and rationale, enabling diagnostic evaluation beyond final-answer accuracy. OpenMedReason is a rich training resource that exhibits its effectiveness in both supervised fine-tuning (SFT) and reinforcement-based alignment. Training with OpenMedReason yields a 20% average improvement in VQA accuracy over the base model and achieves performance within 4.2% of the strongest comparable-scale medical LVLMs. Fine-grained performance analysis confirms that the gains are not concentrated in any single axis: OpenMedReason improves perception, medical knowledge, and rationale jointly, and its reasoning traces are preferred over those of the base model in 86.1% of pairwise comparisons. We release the code and dataset at huggingface.co/datasets/neginb/OpenMedReason.

Visual Question Answering (VQA) is of tremendous interest to the research community with important applications such as aiding visually impaired users and image-based search. In this work, we explore the use of scene graphs for solving the VQA task. We conduct experiments on the GQA dataset which presents a challenging set of questions requiring counting, compositionality and advanced reasoning capability, and provides scene graphs for a large number of images. We adopt image + question architectures for use with scene graphs, evaluate various scene graph generation techniques for unseen images, propose a training curriculum to leverage human-annotated and auto-generated scene graphs, and build late fusion architectures to learn from multiple image representations. We present a multi-faceted study into the use of scene graphs for VQA, making this work the first of its kind.

Vision-Language Models (VLMs) have great potential in medical tasks, like Visual Question Answering (VQA), where they could act as interactive assistants for both patients and clinicians. Yet their robustness to distribution shifts on unseen data remains a key concern for safe deployment. Evaluating such robustness requires a controlled experimental setup that allows for systematic insights into the model's behavior. However, we demonstrate that current setups fail to offer sufficiently thorough evaluations. To address this gap, we introduce a novel framework, called SURE-VQA, centered around three key requirements to overcome current pitfalls and systematically analyze VLM robustness: 1) Since robustness on synthetic shifts does not necessarily translate to real-world shifts, it should be measured on real-world shifts that are inherent to the VQA data; 2) Traditional token-matching metrics often fail to capture underlying semantics, necessitating the use of large language models (LLMs) for more accurate semantic evaluation; 3) Model performance often lacks interpretability due to missing sanity baselines, thus meaningful baselines should be reported that allow assessing the multimodal impact on the VLM. To demonstrate the relevance of this framework, we conduct a study on the robustness of various Fine-Tuning (FT) methods across three medical datasets with four types of distribution shifts. Our study highlights key insights into robustness: 1) No FT method consistently outperforms others in robustness, and 2) robustness trends are more stable across FT methods than across distribution shifts. Additionally, we find that simple sanity baselines that do not use the image data can perform surprisingly well and confirm LoRA as the best-performing FT method on in-distribution data. Code is provided at https://github.com/IML-DKFZ/sure-vqa.

Recent multimodal large language models have shown great promise in clinical image reasoning, but existing post-training pipelines remain predominantly outcome-centric, relying on final answer correctness or sequence-level preferences. This suffers from sparse credit assignment, making it difficult to optimize the reasoning process essential for clinical applications. Our analysis reveals that cascading errors from early-stage reasoning failures are a leading cause of incorrect predictions in medical visual question answering (VQA) benchmarks. Motivated by this, we propose Medical Reasoning-aware Policy Optimization (MRPO), an RL algorithm that incorporates step-wise process rewards. When the final answer is incorrect, MRPO assigns exponentially larger penalties to tokens in earlier invalid reasoning steps, breaking failure cascades without compromising successful paths. Across three multimodal LLM backbones, MRPO consistently outperforms standard GRPO and a recent RL baseline, and on Qwen3-VL-8B-Instruct even surpasses substantially larger medical MLLMs such as HuatuoGPT-Vision-34B by 2.79 points. Moreover, MRPO reduces early-stage reasoning failures from 64.0% to 13.0%, showing that targeted mitigation of cascading failures improves both reasoning quality and final answer accuracy. Our code is available at https://github.com/dmis-lab/MRPO

We introduce a new task, named video corpus visual answer localization (VCVAL), which aims to locate the visual answer in a large collection of untrimmed instructional videos using a natural language question. This task requires a range of skills - the interaction between vision and language, video retrieval, passage comprehension, and visual answer localization. In this paper, we propose a cross-modal contrastive global-span (CCGS) method for the VCVAL, jointly training the video corpus retrieval and visual answer localization subtasks with the global-span matrix. We have reconstructed a dataset named MedVidCQA, on which the VCVAL task is benchmarked. Experimental results show that the proposed method outperforms other competitive methods both in the video corpus retrieval and visual answer localization subtasks. Most importantly, we perform detailed analyses on extensive experiments, paving a new path for understanding the instructional videos, which ushers in further research.

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

Recent advancements in Large Vision Language Models (LVLMs) have significantly improved performance in Visual Question Answering (VQA) tasks through multimodal Retrieval-Augmented Generation (RAG). However, existing methods still face challenges, such as the scarcity of knowledge with reasoning examples and erratic responses from retrieved knowledge. To address these issues, in this study, we propose a multimodal RAG framework, termed RCTS, which enhances LVLMs by constructing a Reasoning Context-enriched knowledge base and a Tree Search re-ranking method. Specifically, we introduce a self-consistent evaluation mechanism to enrich the knowledge base with intrinsic reasoning patterns. We further propose a Monte Carlo Tree Search with Heuristic Rewards (MCTS-HR) to prioritize the most relevant examples. This ensures that LVLMs can leverage high-quality contextual reasoning for better and more consistent responses. Extensive experiments demonstrate that our framework achieves state-of-the-art performance on multiple VQA datasets, significantly outperforming In-Context Learning (ICL) and Vanilla-RAG methods. It highlights the effectiveness of our knowledge base and re-ranking method in improving LVLMs. Our code is available at https://github.com/yannqi/RCTS-RAG.

With advances in multimodal research and deep learning, Multimodal Large Language Models (MLLMs) have emerged as a powerful paradigm for a wide range of multimodal tasks. As a core problem in vision-language research, Visual Question Answering (VQA) has increasingly employed MLLMs to improve performance, particularly in open-domain settings where external knowledge is essential. In this work, we aim to further enhance retrieval-based VQA by more effectively integrating MLLMs with structured reasoning and knowledge acquisition. We introduce a logical prompting strategy that fuses Chain-of-Thought (CoT) reasoning with Visual Question Decomposition (VQD), termed CoVQD, to guide retrieval toward more accurate and relevant knowledge for MLLM inference. Building on this idea, we propose a new framework, CoVQD-guided RAG (CgRAG), which enables MLLMs to access more comprehensive and coherent external knowledge while benefiting from structured visual-text reasoning guidance, thereby improving generalization and reliability in complex cross-domain VQA scenarios. Extensive experiments on E-VQA, InfoSeek, and OKVQA benchmarks demonstrate the effectiveness of the proposed method.

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

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

This paper reveals that many state-of-the-art large language models (LLMs) lack hierarchical knowledge about our visual world, unaware of even well-established biology taxonomies. This shortcoming makes LLMs a bottleneck for vision LLMs' hierarchical visual understanding (e.g., recognizing Anemone Fish but not Vertebrate). We arrive at these findings using about one million four-choice visual question answering (VQA) tasks constructed from six taxonomies and four image datasets. Interestingly, finetuning a vision LLM using our VQA tasks reaffirms LLMs' bottleneck effect to some extent because the VQA tasks improve the LLM's hierarchical consistency more than the vision LLM's. We conjecture that one cannot make vision LLMs understand visual concepts fully hierarchical until LLMs possess corresponding taxonomy knowledge.

Surgical video understanding is a crucial prerequisite for advancing Computer-Assisted Surgery. While vision-language models (VLMs) have recently been applied to the surgical domain, existing surgical vision-language datasets lack in capturing and evaluating complex, interleaved spatial-temporal dynamics. Creating large scale datasets that accurately represent fine-grained spatial-temporal relationships in surgical videos is challenging due to costly manual annotations or error-prone generation using large language models. To address this gap, we introduce the SurgSTU-Pipeline, a deterministic generation pipeline featuring temporal and spatial continuity filtering to reliably create surgical datasets for fine-grained spatial-temporal multimodal understanding. Applying this pipeline to publicly available surgical datasets, we create the SurgSTU dataset, comprising 7515 video clips densely extended with 150k fine-grained spatial-temporal question-answer samples. Our comprehensive evaluation shows that while state-of-the-art generalist VLMs struggle in zero-shot settings, their spatial-temporal capabilities can be improved through in-context learning. A fine-tuned VLM on the SurgSTU training dataset achieves highest performance among all spatial-temporal tasks, validating the dataset's efficacy to improve spatial-temporal understanding of VLMs in surgical videos. Code will be made publicly available.

Visual Question Answering requires models to generate accurate answers by integrating visual and textual understanding. However, VQA models still struggle with hallucinations, producing convincing but incorrect answers, particularly in knowledge-driven and Out-of-Distribution scenarios. We introduce FilterRAG, a retrieval-augmented framework that combines BLIP-VQA with Retrieval-Augmented Generation to ground answers in external knowledge sources like Wikipedia and DBpedia. FilterRAG achieves 36.5% accuracy on the OK-VQA dataset, demonstrating its effectiveness in reducing hallucinations and improving robustness in both in-domain and Out-of-Distribution settings. These findings highlight the potential of FilterRAG to improve Visual Question Answering systems for real-world deployment.

Although Vision Language Models (VLMs) have seen tremendous progress across all kinds of use cases, they still fall behind in answering questions regard-ing diagrams compared to photos. Although progress has been made in the area of bar charts, line charts and other diagrams like that there is still few research concerned with other types of diagrams, e.g. in the computer science domain. Our work presents a benchmark for visual question answering based on UML class diagrams which is both challenging and manageable. We further construct a large-scale training dataset with 16.000 image-question-answer triples and show that a LoRA-based finetune easily outperforms Qwen 3.5 27B, which is a recent and well-performing VLM in many other benchmarks.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

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

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

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

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

This paper revisits visual representation in knowledge-based visual question answering (VQA) and demonstrates that using regional information in a better way can significantly improve the performance. While visual representation is extensively studied in traditional VQA, it is under-explored in knowledge-based VQA even though these two tasks share the common spirit, i.e., rely on visual input to answer the question. Specifically, we observe that in most state-of-the-art knowledge-based VQA methods: 1) visual features are extracted either from the whole image or in a sliding window manner for retrieving knowledge, and the important relationship within/among object regions is neglected; 2) visual features are not well utilized in the final answering model, which is counter-intuitive to some extent. Based on these observations, we propose a new knowledge-based VQA method REVIVE, which tries to utilize the explicit information of object regions not only in the knowledge retrieval stage but also in the answering model. The key motivation is that object regions and inherent relationship are important for knowledge-based VQA. We perform extensive experiments on the standard OK-VQA dataset and achieve new state-of-the-art performance, i.e., 58.0% accuracy, surpassing previous state-of-the-art method by a large margin (+3.6%). We also conduct detailed analysis and show the necessity of regional information in different framework components for knowledge-based VQA. Code is publicly available at https://github.com/yzleroy/REVIVE.

We propose the VLR-Bench, a visual question answering (VQA) benchmark for evaluating vision language models (VLMs) based on retrieval augmented generation (RAG). Unlike existing evaluation datasets for external knowledge-based VQA, the proposed VLR-Bench includes five input passages. This allows testing of the ability to determine which passage is useful for answering a given query, a capability lacking in previous research. In this context, we constructed a dataset of 32,000 automatically generated instruction-following examples, which we denote as VLR-IF. This dataset is specifically designed to enhance the RAG capabilities of VLMs by enabling them to learn how to generate appropriate answers based on input passages. We evaluated the validity of the proposed benchmark and training data and verified its performance using the state-of-the-art Llama3-based VLM, the Llava-Llama-3 model. The proposed VLR-Bench and VLR-IF datasets are publicly available online.

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

Visual Question Answering (VQA) task has showcased a new stage of interaction between language and vision, two of the most pivotal components of artificial intelligence. However, it has mostly focused on generating short and repetitive answers, mostly single words, which fall short of rich linguistic capabilities of humans. We introduce Full-Sentence Visual Question Answering (FSVQA) dataset, consisting of nearly 1 million pairs of questions and full-sentence answers for images, built by applying a number of rule-based natural language processing techniques to original VQA dataset and captions in the MS COCO dataset. This poses many additional complexities to conventional VQA task, and we provide a baseline for approaching and evaluating the task, on top of which we invite the research community to build further improvements.

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

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.

Pathological images are inherently multi-scale, requiring pathologists to integrate evidence from global tissue architecture at low magnification to cellular morphology at higher magnification for accurate diagnosis. While existing pathological datasets for vision-language models (VLMs) include various scales, they often lack explicit cross-scale reasoning objectives. This limitation prevents VLMs from capturing essential cross-scale representations and learning evidence-based reasoning. To bridge this gap, we introduce the first cross-scale training and evaluation paradigm that formulates pathology interpretation as multi-magnification reasoning. However, creating such a task reveals a critical challenge: multi-image visual question answering (VQA) is prone to text-only shortcuts, which allow models to guess answers using magnification-dependent artifacts rather than visual evidence. To address this, we propose a leakage-aware curation pipeline that combines adversarial text-only screening with constraint-guided question design. Using this pipeline, we construct Scale-VQA, a high-quality benchmark with 4,685 multiple-choice questions grounded in 2,537 pathology images across multiple magnification levels. Finally, we present ScaleReasoner-R1, a model trained via reinforcement learning to optimize performance on cross-scale VQA tasks. ScaleReasoner-R1 achieves state-of-the-art performance on our cross-scale reasoning benchmark and generalizes to SOTA performance on established single-scale benchmarks. Findings suggest that even the limited cross-scale supervision can significantly improve pathological understanding. Code is available at https://github.com/iMVR-PL/ScaleReasoner-R1.

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

We introduce an evaluation methodology for visual question answering (VQA) to better diagnose cases of shortcut learning. These cases happen when a model exploits spurious statistical regularities to produce correct answers but does not actually deploy the desired behavior. There is a need to identify possible shortcuts in a dataset and assess their use before deploying a model in the real world. The research community in VQA has focused exclusively on question-based shortcuts, where a model might, for example, answer "What is the color of the sky" with "blue" by relying mostly on the question-conditional training prior and give little weight to visual evidence. We go a step further and consider multimodal shortcuts that involve both questions and images. We first identify potential shortcuts in the popular VQA v2 training set by mining trivial predictive rules such as co-occurrences of words and visual elements. We then introduce VQA-CounterExamples (VQA-CE), an evaluation protocol based on our subset of CounterExamples i.e. image-question-answer triplets where our rules lead to incorrect answers. We use this new evaluation in a large-scale study of existing approaches for VQA. We demonstrate that even state-of-the-art models perform poorly and that existing techniques to reduce biases are largely ineffective in this context. Our findings suggest that past work on question-based biases in VQA has only addressed one facet of a complex issue. The code for our method is available at https://github.com/cdancette/detect-shortcuts.

Current architectures for multi-modality tasks such as visual question answering suffer from their high complexity. As a result, these architectures are difficult to train and require high computational resources. To address these problems we present a CLIP-based architecture that does not require any fine-tuning of the feature extractors. A simple linear classifier is used on the concatenated features of the image and text encoder. During training an auxiliary loss is added which operates on the answer types. The resulting classification is then used as an attention gate on the answer class selection. On the VizWiz 2022 Visual Question Answering Challenge we achieve 60.15 % accuracy on Task 1: Predict Answer to a Visual Question and AP score of 83.78 % on Task 2: Predict Answerability of a Visual Question.

Large vision-language models (LVLMs) have shown great promise in medical applications, particularly in visual question answering (MedVQA) and diagnosis from medical images. However, existing datasets and models often fail to consider critical aspects of medical diagnostics, such as the integration of historical records and the analysis of disease progression over time. In this paper, we introduce MMXU (Multimodal and MultiX-ray Understanding), a novel dataset for MedVQA that focuses on identifying changes in specific regions between two patient visits. Unlike previous datasets that primarily address single-image questions, MMXU enables multi-image questions, incorporating both current and historical patient data. We demonstrate the limitations of current LVLMs in identifying disease progression on MMXU-test, even those that perform well on traditional benchmarks. To address this, we propose a MedRecord-Augmented Generation (MAG) approach, incorporating both global and regional historical records. Our experiments show that integrating historical records significantly enhances diagnostic accuracy by at least 20\%, bridging the gap between current LVLMs and human expert performance. Additionally, we fine-tune models with MAG on MMXU-dev, which demonstrates notable improvements. We hope this work could illuminate the avenue of advancing the use of LVLMs in medical diagnostics by emphasizing the importance of historical context in interpreting medical images. Our dataset is released at https://github.com/linjiemu/MMXU{https://github.com/linjiemu/MMXU}.

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

With the breakthrough of multi-modal large language models, answering complex visual questions that demand advanced reasoning abilities and world knowledge has become a much more important testbed for developing AI models than ever. However, equipping AI models with robust cross-modality reasoning ability remains challenging since the cognition scheme of humans has not been understood systematically. In this paper, we believe that if we can collect visual clues in the given image as much as possible, we will recognize the image more accurately, understand the question better, recall relevant knowledge more easily, and finally reason out the answer. We discover these rich visual clues by mining question-answer pairs in images and sending them into multi-modal large language models as prompts. We call the proposed method Q&A Prompts. Specifically, we first use the image-answer pairs and the corresponding questions in the training set as inputs and outputs to train a visual question generation model. Then, we use an image tagging model to identify various instances and send packaged image-tag pairs into the visual question generation model to generate relevant questions with the extracted image tags as answers. Finally, we encode these generated question-answer pairs as prompts with a visual-aware prompting module and send them into pre-trained multi-modal large language models to reason out the final answers. Experimental results show that, compared with state-of-the-art methods, our Q&A Prompts achieves substantial improvements on the challenging visual question answering datasets requiring reasoning over diverse world knowledge, such as OK-VQA and A-OKVQA.

Synthetic datasets have successfully been used to probe visual question-answering datasets for their reasoning abilities. CLEVR (johnson2017clevr), for example, tests a range of visual reasoning abilities. The questions in CLEVR focus on comparisons of shapes, colors, and sizes, numerical reasoning, and existence claims. This paper introduces a minimally biased, diagnostic visual question-answering dataset, QLEVR, that goes beyond existential and numerical quantification and focus on more complex quantifiers and their combinations, e.g., asking whether there are more than two red balls that are smaller than at least three blue balls in an image. We describe how the dataset was created and present a first evaluation of state-of-the-art visual question-answering models, showing that QLEVR presents a formidable challenge to our current models. Code and Dataset are available at https://github.com/zechenli03/QLEVR

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

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

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.

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

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

There has been an explosion of work in the vision & language community during the past few years from image captioning to video transcription, and answering questions about images. These tasks have focused on literal descriptions of the image. To move beyond the literal, we choose to explore how questions about an image are often directed at commonsense inference and the abstract events evoked by objects in the image. In this paper, we introduce the novel task of Visual Question Generation (VQG), where the system is tasked with asking a natural and engaging question when shown an image. We provide three datasets which cover a variety of images from object-centric to event-centric, with considerably more abstract training data than provided to state-of-the-art captioning systems thus far. We train and test several generative and retrieval models to tackle the task of VQG. Evaluation results show that while such models ask reasonable questions for a variety of images, there is still a wide gap with human performance which motivates further work on connecting images with commonsense knowledge and pragmatics. Our proposed task offers a new challenge to the community which we hope furthers interest in exploring deeper connections between vision & language.

Vision-language models (VLMs) adapted to the medical domain have shown strong performance on visual question answering benchmarks, yet their robustness against two critical failure modes, hallucination and sycophancy, remains poorly understood, particularly in combination. We evaluate six VLMs (three general-purpose, three medical-specialist) on three medical VQA datasets and uncover a grounding-sycophancy tradeoff: models with the lowest hallucination propensity are the most sycophantic, while the most pressure-resistant model hallucinates more than all medical-specialist models. To characterize this tradeoff, we propose three metrics: L-VASE, a logit-space reformulation of VASE that avoids its double-normalization; CCS, a confidence-calibrated sycophancy score that penalizes high-confidence capitulation; and Clinical Safety Index (CSI), a unified safety index that combines grounding, autonomy, and calibration via a geometric mean. Across 1,151 test cases, no model achieves a CSI above 0.35, indicating that none of the evaluated 7-8B parameter VLMs is simultaneously well-grounded and robust to social pressure. Our findings suggest that joint evaluation of both properties is necessary before these models can be considered for clinical use. Code is available at https://github.com/UTSA-VIRLab/AgreeOrRight

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

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.

Large Vision-Language Models (LVLMs) hold significant promise for medical applications, yet their deployment is often constrained by insufficient alignment and reliability. While Direct Preference Optimization (DPO) has emerged as a potent framework for refining model responses, its efficacy in high-stakes medical contexts remains underexplored, lacking the rigorous empirical groundwork necessary to guide future methodological advances. To bridge this gap, we present the first comprehensive examination of diverse DPO variants within the medical domain, evaluating nine distinct formulations across two medical LVLMs: LLaVA-Med and HuatuoGPT-Vision. Our results reveal several critical limitations: current DPO approaches often yield inconsistent gains over supervised fine-tuning, with their efficacy varying significantly across different tasks and backbones. Furthermore, they frequently fail to resolve fundamental visual misinterpretation errors. Building on these insights, we present a targeted preference construction strategy as a proof-of-concept that explicitly addresses visual misinterpretation errors frequently observed in existing DPO models. This design yields a 3.6% improvement over the strongest existing DPO baseline on visual question-answering tasks. To support future research, we release our complete framework, including all training data, model checkpoints, and our codebase at https://github.com/dmis-lab/med-vlm-dpo.

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

Natural language could play an important role in developing generalist surgical models by providing a broad source of supervision from raw texts. This flexible form of supervision can enable the model's transferability across datasets and tasks as natural language can be used to reference learned visual concepts or describe new ones. In this work, we present HecVL, a novel hierarchical video-language pretraining approach for building a generalist surgical model. Specifically, we construct a hierarchical video-text paired dataset by pairing the surgical lecture video with three hierarchical levels of texts: at clip-level, atomic actions using transcribed audio texts; at phase-level, conceptual text summaries; and at video-level, overall abstract text of the surgical procedure. Then, we propose a novel fine-to-coarse contrastive learning framework that learns separate embedding spaces for the three video-text hierarchies using a single model. By disentangling embedding spaces of different hierarchical levels, the learned multi-modal representations encode short-term and long-term surgical concepts in the same model. Thanks to the injected textual semantics, we demonstrate that the HecVL approach can enable zero-shot surgical phase recognition without any human annotation. Furthermore, we show that the same HecVL model for surgical phase recognition can be transferred across different surgical procedures and medical centers. The code is available at https://github.com/CAMMA-public/SurgVLP

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

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

Large vision-language models (LVLMs) have demonstrated remarkable achievements, yet the generation of non-factual responses remains prevalent in fact-seeking question answering (QA). Current multimodal fact-seeking benchmarks primarily focus on comparing model outputs to ground truth answers, providing limited insights into the performance of modality-specific modules. To bridge this gap, we introduce VisualSimpleQA, a multimodal fact-seeking benchmark with two key features. First, it enables streamlined and decoupled evaluation of LVLMs in visual and linguistic modalities. Second, it incorporates well-defined difficulty criteria to guide human annotation and facilitates the extraction of a challenging subset, VisualSimpleQA-hard. Experiments on 15 LVLMs show that even state-of-the-art models such as GPT-4o achieve merely 60%+ correctness in multimodal fact-seeking QA on VisualSimpleQA and 30%+ on VisualSimpleQA-hard. Furthermore, the decoupled evaluation across these models highlights substantial opportunities for improvement in both visual and linguistic modules. The dataset is available at https://huggingface.co/datasets/WYLing/VisualSimpleQA.

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.

Large Multimodal Models (LMMs) excel in natural language and visual understanding but are challenged by exacting tasks such as Knowledge-based Visual Question Answering (KB-VQA) which involve the retrieval of relevant information from document collections to use in shaping answers to questions. We present an extensive training and evaluation framework, M2KR, for KB-VQA. M2KR contains a collection of vision and language tasks which we have incorporated into a single suite of benchmark tasks for training and evaluating general-purpose multi-modal retrievers. We use M2KR to develop PreFLMR, a pre-trained version of the recently developed Fine-grained Late-interaction Multi-modal Retriever (FLMR) approach to KB-VQA, and we report new state-of-the-art results across a range of tasks. We also present investigations into the scaling behaviors of PreFLMR intended to be useful in future developments in general-purpose multi-modal retrievers.

Multimodal large language models are promising for clinical visual question answering tasks, but scaling to 3D imaging is hindered by high computational costs. Prior methods often rely on 2D slices or fixed-length token compression, disrupting volumetric continuity and obscuring subtle findings. We present Photon, a framework that represents 3D medical volumes with token sequences of variable length. Photon introduces instruction-conditioned token scheduling and surrogate gradient propagation to adaptively reduce tokens during both training and inference, which lowers computational cost while mitigating the attention dilution caused by redundant tokens. It incorporates a custom backpropagation rule with gradient restoration to enable differentiable optimization despite discrete token drop. To stabilize token compression and ensure reliable use of visual evidence, Photon further applies regularization objectives that mitigate language-only bias and improve reliability. Experiments on diverse medical visual question answering tasks show that Photon achieves state-of-the-art accuracy while reducing resource usage and accelerating both training and inference.

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

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

We introduce KorMedMCQA-V, a Korean medical licensing-exam-style multimodal multiple-choice question answering benchmark for evaluating vision-language models (VLMs). The dataset consists of 1,534 questions with 2,043 associated images from Korean Medical Licensing Examinations (2012-2023), with about 30% containing multiple images requiring cross-image evidence integration. Images cover clinical modalities including X-ray, computed tomography (CT), electrocardiography (ECG), ultrasound, endoscopy, and other medical visuals. We benchmark over 50 VLMs across proprietary and open-source categories-spanning general-purpose, medical-specialized, and Korean-specialized families-under a unified zero-shot evaluation protocol. The best proprietary model (Gemini-3.0-Pro) achieves 96.9% accuracy, the best open-source model (Qwen3-VL-32B-Thinking) 83.7%, and the best Korean-specialized model (VARCO-VISION-2.0-14B) only 43.2%. We further find that reasoning-oriented model variants gain up to +20 percentage points over instruction-tuned counterparts, medical domain specialization yields inconsistent gains over strong general-purpose baselines, all models degrade on multi-image questions, and performance varies notably across imaging modalities. By complementing the text-only KorMedMCQA benchmark, KorMedMCQA-V forms a unified evaluation suite for Korean medical reasoning across text-only and multimodal conditions. The dataset is available via Hugging Face Datasets: https://huggingface.co/datasets/seongsubae/KorMedMCQA-V.