Daily Papers

Accurate inpatient risk prediction requires modeling heterogeneous clinical evidence that accumulates irregularly over time. This challenge spans in-hospital mortality, prolonged length of stay, and readmission, each with task-specific observation windows. Existing multimodal approaches combine structured health record data, chest x-rays, and clinical text, but primarily focus on modality fusion or missing-modality compensation, with limited attention to temporal trajectories over an admission. We propose TRACE (TRAjectory modeling of multimodal Clinical Events), a daily-scale framework organizing clinical events into day-level trajectories, separating day-invariant global context from day-specific local events drawn from EHR data, chest x-rays, radiology reports, and discharge summaries. The trajectory is encoded using temporal attention, allowing unavailable modalities to emit no tokens. A phenotype-guided contrastive objective further organizes admissions under heterogeneous disease distributions. Across cohorts from MIMIC-IV, eICU, and MIMIC-III comprising nearly 180,000 total stays, we evaluate TRACE on mortality, length of stay, and readmission prediction. TRACE achieves the highest AUROC across all nine dataset-task settings and the highest ACC in eight, outperforming baselines. Ablation studies validate our attention masks and contrastive learning, while trajectory-level attribution localizes risk-associated hospital days and modalities.

The digitization of healthcare has generated vast, longitudinal, and multimodal patient records over a lifetime, yet fully exploiting these data to represent and predict patient state trajectories remains a critical challenge. Current AI models often struggle to capture the complex, irregular temporal dynamics and inherent stochasticity of real-world multimodal patient data. Existing AI approaches for modeling longitudinal patient records are predominantly discriminative, limited to a few modalities, constrained by closed categorical vocabularies, treating time as a monotonic inductive bias, or they are limited in forecasting future patient states. We introduce NOAH, a time-aware, task-agnostic, generative transformer model representing and forecasting the full multimodal patient journey. NOAH features a novel bidirectional time integration and a variational latent space to capture the continuous evolution of patient states and the stochasticity of clinical trajectories. Built from over 559 million clinical events from 431,000 hospital visits of 299,000 patients across the MIMIC dataset family, NOAH natively processes medical images, time-series and numeric signals, categorical events, as well as structured and unstructured clinical records. NOAH is the first truly holistic generative model in its field, enabling autoregressive forecasting with optional time control, zero-shot classification, and counterfactual intervention simulation. It generates highly informative and predictive patient state representations that demonstrate strong performance in probing for clinical outcomes, 15 ICD chapters, and 29 comorbidities, as well as in time-to-event prediction. Seamlessly handling diverse modalities and complex temporal dynamics, NOAH provides a versatile, task-agnostic, scalable foundation for intelligent predictive systems in personalized clinical care and digital medicine.

Background: AI-driven prediction algorithms have the potential to enhance emergency medicine by enabling rapid and accurate decision-making regarding patient status and potential deterioration. However, the integration of multimodal data, including raw waveform signals, remains underexplored in clinical decision support. Methods: We present a dataset and benchmarking protocol designed to advance multimodal decision support in emergency care. Our models utilize demographics, biometrics, vital signs, laboratory values, and electrocardiogram (ECG) waveforms as inputs to predict both discharge diagnoses and patient deterioration. Results: The diagnostic model achieves area under the receiver operating curve (AUROC) scores above 0.8 for 609 out of 1,428 conditions, covering both cardiac (e.g., myocardial infarction) and non-cardiac (e.g., renal disease, diabetes) diagnoses. The deterioration model attains AUROC scores above 0.8 for 14 out of 15 targets, accurately predicting critical events such as cardiac arrest, mechanical ventilation, ICU admission, and mortality. Conclusions: Our study highlights the positive impact of incorporating raw waveform data into decision support models, improving predictive performance. By introducing a unique, publicly available dataset and baseline models, we provide a foundation for measurable progress in AI-driven decision support for emergency care.

Accurate prediction of major adverse cardiovascular events recurrence risk in acute myocardial infarction patients based on postoperative cardiac MRI and associated clinical notes is crucial for precision treatment and personalized intervention. Existing methods primarily focus on risk stratification capability while overlooking the need for intermediate robust reasoning and model interpretability in clinical practice. Moreover, end-to-end risk prediction using LLM/VLM faces significant challenges due to data limitations and modeling complexity. To bridge this gap, we propose CardioCoT, a novel two-stage hierarchical reasoning-enhanced survival analysis framework designed to enhance both model interpretability and predictive performance. In the first stage, we employ an evidence-augmented self-refinement mechanism to guide LLM/VLMs in generating robust hierarchical reasoning trajectories based on associated radiological findings. In the second stage, we integrate the reasoning trajectories with imaging data for risk model training and prediction. CardioCoT demonstrates superior performance in MACE recurrence risk prediction while providing interpretable reasoning processes, offering valuable insights for clinical decision-making.

Modern medicine generates vast multimodal data across siloed systems, yet no existing model integrates the full breadth and temporal depth of the clinical record into a unified patient representation. We introduce Apollo, a multimodal temporal foundation model trained and evaluated on over three decades of longitudinal hospital records from a major US hospital system, composed of 25 billion records from 7.2 million patients, representing 28 distinct medical modalities and 12 major medical specialties. Apollo learns a unified representation space integrating over 100 thousand unique medical events in our clinical vocabulary as well as images and clinical text. This "atlas of medical concepts" forms a computational substrate for modeling entire patient care journeys comprised of sequences of structured and unstructured events, which are compressed by Apollo into virtual patient representations. To assess the potential of these whole-patient representations, we created 322 prognosis and retrieval tasks from a held-out test set of 1.4 million patients. We demonstrate the generalized clinical forecasting potential of Apollo embeddings, including predicting new disease onset risk up to five years in advance (95 tasks), disease progression (78 tasks), treatment response (59 tasks), risk of treatment-related adverse events (17 tasks), and hospital operations endpoints (12 tasks). Using feature attribution techniques, we show that model predictions align with clinically-interpretable multimodal biomarkers. We evaluate semantic similarity search on 61 retrieval tasks, and moreover demonstrate the potential of Apollo as a multimodal medical search engine using text and image queries. Together, these modeling capabilities establish the foundation for computable medicine, where the full context of patient care becomes accessible to computational reasoning.

Clinical trials are pivotal for developing new medical treatments but typically carry risks such as patient mortality and enrollment failure that waste immense efforts spanning over a decade. Applying artificial intelligence (AI) to predict key events in clinical trials holds great potential for providing insights to guide trial designs. However, complex data collection and question definition requiring medical expertise have hindered the involvement of AI thus far. This paper tackles these challenges by presenting a comprehensive suite of 23 meticulously curated AI-ready datasets covering multi-modal input features and 8 crucial prediction challenges in clinical trial design, encompassing prediction of trial duration, patient dropout rate, serious adverse event, mortality rate, trial approval outcome, trial failure reason, drug dose finding, design of eligibility criteria. Furthermore, we provide basic validation methods for each task to ensure the datasets' usability and reliability. We anticipate that the availability of such open-access datasets will catalyze the development of advanced AI approaches for clinical trial design, ultimately advancing clinical trial research and accelerating medical solution development.

Hand gesture understanding is essential for several applications in human-computer interaction, including automatic clinical assessment of hand dexterity. While deep learning has advanced static gesture recognition, dynamic gesture understanding remains challenging due to complex spatiotemporal variations. Moreover, existing datasets often lack multimodal and multi-view diversity, precise ground-truth tracking, and an action quality component embedded within gestures. This paper introduces EHWGesture, a multimodal video dataset for gesture understanding featuring five clinically relevant gestures. It includes over 1,100 recordings (6 hours), captured from 25 healthy subjects using two high-resolution RGB-Depth cameras and an event camera. A motion capture system provides precise ground-truth hand landmark tracking, and all devices are spatially calibrated and synchronized to ensure cross-modal alignment. Moreover, to embed an action quality task within gesture understanding, collected recordings are organized in classes of execution speed that mirror clinical evaluations of hand dexterity. Baseline experiments highlight the dataset's potential for gesture classification, gesture trigger detection, and action quality assessment. Thus, EHWGesture can serve as a comprehensive benchmark for advancing multimodal clinical gesture understanding.

With the advancement of telemedicine, both researchers and medical practitioners are working hand-in-hand to develop various techniques to automate various medical operations, such as diagnosis report generation. In this paper, we first present a multi-modal clinical conversation summary generation task that takes a clinician-patient interaction (both textual and visual information) and generates a succinct synopsis of the conversation. We propose a knowledge-infused, multi-modal, multi-tasking medical domain identification and clinical conversation summary generation (MM-CliConSummation) framework. It leverages an adapter to infuse knowledge and visual features and unify the fused feature vector using a gated mechanism. Furthermore, we developed a multi-modal, multi-intent clinical conversation summarization corpus annotated with intent, symptom, and summary. The extensive set of experiments, both quantitatively and qualitatively, led to the following findings: (a) critical significance of visuals, (b) more precise and medical entity preserving summary with additional knowledge infusion, and (c) a correlation between medical department identification and clinical synopsis generation. Furthermore, the dataset and source code are available at https://github.com/NLP-RL/MM-CliConSummation.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

Automatic analysis of multimodal speech has shown strong potential for computationally detecting and monitoring a wide range of neurological, psychiatric, and respiratory conditions. However, progress in this field is limited by existing publicly accessible datasets, which are often small in scale, focused on a single condition or disease, and primarily speech focused. Moreover, if key confounding variables such as education, medication use, comorbidities, or mood state are insufficiently documented, the reliability and interpretability of computational analyses are further compromised. To address these limitations, we introduce CARE v1.0, a curated multimodal English dataset of approximately 144 hours of short video interviews collected from 612 individuals across 12 medical conditions plus a control cohort. For each video, a comprehensive set of clinically relevant multimodal descriptors is provided, alongside structured metadata covering factors such as medication, life impacts, and expressed emotions. The corpus's breadth and heterogeneity support a wide range of applications, including automatic disease and symptom detection, multimodal modelling of speech and non-verbal behaviour under emotionally charged contexts, and studies of disease trajectories and coping processes.

The mining of adverse drug events (ADEs) is pivotal in pharmacovigilance, enhancing patient safety by identifying potential risks associated with medications, facilitating early detection of adverse events, and guiding regulatory decision-making. Traditional ADE detection methods are reliable but slow, not easily adaptable to large-scale operations, and offer limited information. With the exponential increase in data sources like social media content, biomedical literature, and Electronic Medical Records (EMR), extracting relevant ADE-related information from these unstructured texts is imperative. Previous ADE mining studies have focused on text-based methodologies, overlooking visual cues, limiting contextual comprehension, and hindering accurate interpretation. To address this gap, we present a MultiModal Adverse Drug Event (MMADE) detection dataset, merging ADE-related textual information with visual aids. Additionally, we introduce a framework that leverages the capabilities of LLMs and VLMs for ADE detection by generating detailed descriptions of medical images depicting ADEs, aiding healthcare professionals in visually identifying adverse events. Using our MMADE dataset, we showcase the significance of integrating visual cues from images to enhance overall performance. This approach holds promise for patient safety, ADE awareness, and healthcare accessibility, paving the way for further exploration in personalized healthcare.

We address a challenging and practical task of labeling questions in speech in real time during telephone calls to emergency medical services in English, which embeds within a broader decision support system for emergency call-takers. We propose a novel multimodal approach to real-time sequence labeling in speech. Our model treats speech and its own textual representation as two separate modalities or views, as it jointly learns from streamed audio and its noisy transcription into text via automatic speech recognition. Our results show significant gains of jointly learning from the two modalities when compared to text or audio only, under adverse noise and limited volume of training data. The results generalize to medical symptoms detection where we observe a similar pattern of improvements with multimodal learning.

Medicine is inherently multimodal, requiring clinicians to synthesize information across diverse data streams. Yet the development of multimodal foundation models is constrained by limited access to large-scale, high-quality clinical data. Although PubMed Central (PMC) offers a complementary source of expert-authored image-text data, existing PMC-derived resources remain limited in fidelity, reproducibility, and clinical validation. We introduce MedPMC, an automated, continuously updatable framework that transforms permissively licensed literature into high-fidelity infrastructure for medical multimodal models. Applied to 6.1 million PMC articles, MedPMC curated 11 million medical image-text pairs. Component evaluations showed strong performance for initial screening (F1 = 93.2), multi-panel figure detection (F1 = 96.5), figure separation (mAP = 89.8), caption separation and alignment (F1 = 81.4; ROUGE-L = 85.3), and medical figure classification (F1 = 96.5). Manual review by five annotators, three with medical training, found 95.3% of MedPMC images medically relevant, versus 19.7% in a prior PMC-derived dataset. Across 26 benchmarks spanning 11 specialties, a MedPMC-trained CLIP-style model improved average zero-shot AUC by 7.1 percentage points over the strongest architecture-matched biomedical CLIP baseline despite using fewer than half as many image-text pairs. As the vision encoder in a multimodal large language model, it improved medical visual question-answering by 1.9 and 16.9 percentage points across two benchmarks. In 10,524 Yale New Haven Health System dermatology photographs, it improved morphology-to-image retrieval Recall@5 by 11.7 percentage points. These findings show that high-fidelity literature curation strengthens medical multimodal foundation models across benchmark and clinical settings. We publicly release the framework, corpus, benchmarks, and pretrained models.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

Biomedical data is inherently multimodal, consisting of electronic health records, medical imaging, digital pathology, genome sequencing, wearable sensors, and more. The application of artificial intelligence tools to these multifaceted sensing technologies has the potential to revolutionize the prognosis, diagnosis, and management of human health and disease. However, current approaches to biomedical AI typically only train and evaluate with one or a small set of medical modalities and tasks. This limitation hampers the development of comprehensive tools that can leverage the rich interconnected information across many heterogeneous biomedical sensors. To address this challenge, we present MultiMed, a benchmark designed to evaluate and enable large-scale learning across a wide spectrum of medical modalities and tasks. MultiMed consists of 2.56 million samples across ten medical modalities such as medical reports, pathology, genomics, and protein data, and is structured into eleven challenging tasks, including disease prognosis, protein structure prediction, and medical question answering. Using MultiMed, we conduct comprehensive experiments benchmarking state-of-the-art unimodal, multimodal, and multitask models. Our analysis highlights the advantages of training large-scale medical models across many related modalities and tasks. Moreover, MultiMed enables studies of generalization across related medical concepts, robustness to real-world noisy data and distribution shifts, and novel modality combinations to improve prediction performance. MultiMed will be publicly available and regularly updated and welcomes inputs from the community.

Multimodal large language models (MLLMs) have demonstrated promising prospects in healthcare, particularly for addressing complex medical tasks, supporting multidisciplinary treatment (MDT), and enabling personalized precision medicine. However, their practical deployment faces critical challenges in resource efficiency, diagnostic accuracy, clinical considerations, and ethical privacy. To address these limitations, we propose Infi-Med, a comprehensive framework for medical MLLMs that introduces three key innovations: (1) a resource-efficient approach through curating and constructing high-quality supervised fine-tuning (SFT) datasets with minimal sample requirements, with a forward-looking design that extends to both pretraining and posttraining phases; (2) enhanced multimodal reasoning capabilities for cross-modal integration and clinical task understanding; and (3) a systematic evaluation system that assesses model performance across medical modalities and task types. Our experiments demonstrate that Infi-Med achieves state-of-the-art (SOTA) performance in general medical reasoning while maintaining rapid adaptability to clinical scenarios. The framework establishes a solid foundation for deploying MLLMs in real-world healthcare settings by balancing model effectiveness with operational constraints.

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

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

Healthcare data now span EHRs, medical imaging, genomics, and wearable sensors, but most diagnostic models still process these modalities in isolation. This limits their ability to capture early, cross-modal disease signatures. This paper introduces a multimodal foundation model built on a transformer architecture that integrates heterogeneous clinical data through modality-specific encoders and cross-modal attention. Each modality is mapped into a shared latent space and fused using multi-head attention with residual normalization. We implement the framework using a multimodal dataset that simulates early-stage disease patterns across EHR sequences, imaging patches, genomic profiles, and wearable signals, including missing-modality scenarios and label noise. The model is trained using supervised classification together with self-supervised reconstruction and contrastive alignment to improve robustness. Experimental evaluation demonstrates strong performance in early-detection settings, with stable classification metrics, reliable uncertainty estimates, and interpretable attention patterns. The approach moves toward a flexible, pretrain-and-fine-tune foundation model that supports precision diagnostics, handles incomplete inputs, and improves early disease detection across oncology, cardiology, and neurology applications.

Medical decision-making requires integrating diverse medical information, from imaging to clinical narratives. These medical modalities are often acquired in a many-to-many manner. However, current medical vision-language pretraining models (Med-VLPMs) fail to directly account for this many-to-many mapping in their model training and embeddings. To address this, we present Probabilistic Modality-Enhanced Diagnosis (ProbMED), a multimodal Med-VLPM that employs probabilistic contrastive learning to model distributions over embeddings rather than deterministic estimates. ProbMED aligns four distinct modalities -- chest X-rays, electrocardiograms, echocardiograms, and clinical text -- into a unified probabilistic embedding space. We use InfoNCE loss with Hellinger distance to integrate inter-modality distributions. We introduce a probabilistic synthetic sampling loss that captures modality-specific mean and variance to improve intra-modality binding. Extensive experiments across 13 medical datasets demonstrate that our model outperforms current Med-VLPMs in cross-modality retrieval, zero-shot, and few-shot classification. We also demonstrate the robust integration of multiple modalities for prognostication, showing improved intra- and inter-medical modality binding.

The complexity and heterogeneity of data in many real-world applications pose significant challenges for traditional machine learning and signal processing techniques. For instance, in medicine, effective analysis of diverse physiological signals is crucial for patient monitoring and clinical decision-making and yet highly challenging. We introduce MedTsLLM, a general multimodal large language model (LLM) framework that effectively integrates time series data and rich contextual information in the form of text to analyze physiological signals, performing three tasks with clinical relevance: semantic segmentation, boundary detection, and anomaly detection in time series. These critical tasks enable deeper analysis of physiological signals and can provide actionable insights for clinicians. We utilize a reprogramming layer to align embeddings of time series patches with a pretrained LLM's embedding space and make effective use of raw time series, in conjunction with textual context. Given the multivariate nature of medical datasets, we develop methods to handle multiple covariates. We additionally tailor the text prompt to include patient-specific information. Our model outperforms state-of-the-art baselines, including deep learning models, other LLMs, and clinical methods across multiple medical domains, specifically electrocardiograms and respiratory waveforms. MedTsLLM presents a promising step towards harnessing the power of LLMs for medical time series analysis that can elevate data-driven tools for clinicians and improve patient outcomes.

How are we able to learn about complex current events just from short snippets of video? While natural language enables straightforward ways to represent under-specified, partially observable events, visual data does not facilitate analogous methods and, consequently, introduces unique challenges in event understanding. With the growing prevalence of vision-capable AI agents, these systems must be able to model events from collections of unstructured video data. To tackle robust event modeling in multimodal settings, we introduce a multimodal formulation for partially-defined events and cast the extraction of these events as a three-stage span retrieval task. We propose a corresponding benchmark for this task, MultiVENT-G, that consists of 14.5 hours of densely annotated current event videos and 1,168 text documents, containing 22.8K labeled event-centric entities. We propose a collection of LLM-driven approaches to the task of multimodal event analysis, and evaluate them on MultiVENT-G. Results illustrate the challenges that abstract event understanding poses and demonstrates promise in event-centric video-language systems.

Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.

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

Multimodal large language models (MLLMs) hold significant potential in medical applications, including disease diagnosis and clinical decision-making. However, these tasks require highly accurate, context-sensitive, and professionally aligned responses, making reliable reward models and judges critical. Despite their importance, medical reward models (MRMs) and judges remain underexplored, with no dedicated benchmarks addressing clinical requirements. Existing benchmarks focus on general MLLM capabilities or evaluate models as solvers, neglecting essential evaluation dimensions like diagnostic accuracy and clinical relevance. To address this, we introduce Med-RewardBench, the first benchmark specifically designed to evaluate MRMs and judges in medical scenarios. Med-RewardBench features a multimodal dataset spanning 13 organ systems and 8 clinical departments, with 1,026 expert-annotated cases. A rigorous three-step process ensures high-quality evaluation data across six clinically critical dimensions. We evaluate 32 state-of-the-art MLLMs, including open-source, proprietary, and medical-specific models, revealing substantial challenges in aligning outputs with expert judgment. Additionally, we develop baseline models that demonstrate substantial performance improvements through fine-tuning.

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.

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

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

Predicting in-hospital mortality for intensive care unit (ICU) patients is key to final clinical outcomes. AI has shown advantaged accuracy but suffers from the lack of explainability. To address this issue, this paper proposes an eXplainable Multimodal Mortality Predictor (X-MMP) approaching an efficient, explainable AI solution for predicting in-hospital mortality via multimodal ICU data. We employ multimodal learning in our framework, which can receive heterogeneous inputs from clinical data and make decisions. Furthermore, we introduce an explainable method, namely Layer-Wise Propagation to Transformer, as a proper extension of the LRP method to Transformers, producing explanations over multimodal inputs and revealing the salient features attributed to prediction. Moreover, the contribution of each modality to clinical outcomes can be visualized, assisting clinicians in understanding the reasoning behind decision-making. We construct a multimodal dataset based on MIMIC-III and MIMIC-III Waveform Database Matched Subset. Comprehensive experiments on benchmark datasets demonstrate that our proposed framework can achieve reasonable interpretation with competitive prediction accuracy. In particular, our framework can be easily transferred to other clinical tasks, which facilitates the discovery of crucial factors in healthcare research.

Electronic health records (EHRs) are multimodal by nature, consisting of structured tabular features like lab tests and unstructured clinical notes. In real-life clinical practice, doctors use complementary multimodal EHR data sources to get a clearer picture of patients' health and support clinical decision-making. However, most EHR predictive models do not reflect these procedures, as they either focus on a single modality or overlook the inter-modality interactions/redundancy. In this work, we propose MEDFuse, a Multimodal EHR Data Fusion framework that incorporates masked lab-test modeling and large language models (LLMs) to effectively integrate structured and unstructured medical data. MEDFuse leverages multimodal embeddings extracted from two sources: LLMs fine-tuned on free clinical text and masked tabular transformers trained on structured lab test results. We design a disentangled transformer module, optimized by a mutual information loss to 1) decouple modality-specific and modality-shared information and 2) extract useful joint representation from the noise and redundancy present in clinical notes. Through comprehensive validation on the public MIMIC-III dataset and the in-house FEMH dataset, MEDFuse demonstrates great potential in advancing clinical predictions, achieving over 90% F1 score in the 10-disease multi-label classification task.

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

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

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

Health conditions among patients in intensive care units (ICUs) are monitored via electronic health records (EHRs), composed of numerical time series and lengthy clinical note sequences, both taken at irregular time intervals. Dealing with such irregularity in every modality, and integrating irregularity into multimodal representations to improve medical predictions, is a challenging problem. Our method first addresses irregularity in each single modality by (1) modeling irregular time series by dynamically incorporating hand-crafted imputation embeddings into learned interpolation embeddings via a gating mechanism, and (2) casting a series of clinical note representations as multivariate irregular time series and tackling irregularity via a time attention mechanism. We further integrate irregularity in multimodal fusion with an interleaved attention mechanism across temporal steps. To the best of our knowledge, this is the first work to thoroughly model irregularity in multimodalities for improving medical predictions. Our proposed methods for two medical prediction tasks consistently outperforms state-of-the-art (SOTA) baselines in each single modality and multimodal fusion scenarios. Specifically, we observe relative improvements of 6.5\%, 3.6\%, and 4.3\% in F1 for time series, clinical notes, and multimodal fusion, respectively. These results demonstrate the effectiveness of our methods and the importance of considering irregularity in multimodal EHRs.

In this paper, we introduce a novel Multi-Modal Contrastive Pre-training Framework that synergistically combines X-rays, electrocardiograms (ECGs), and radiology/cardiology reports. Our approach leverages transformers to encode these diverse modalities into a unified representation space, aiming to enhance diagnostic accuracy and facilitate comprehensive patient assessments. We utilize LoRA-Peft to significantly reduce trainable parameters in the LLM and incorporate recent linear attention dropping strategy in the Vision Transformer(ViT) for smoother attention. Furthermore, we provide novel multimodal attention explanations and retrieval for our model. To the best of our knowledge, we are the first to propose an integrated model that combines X-ray, ECG, and Radiology/Cardiology Report with this approach. By utilizing contrastive loss, MoRE effectively aligns modality-specific features into a coherent embedding, which supports various downstream tasks such as zero-shot classification and multimodal retrieval. Employing our proposed methodology, we achieve state-of-the-art (SOTA) on the Mimic-IV, CheXpert, Edema Severity, and PtbXl downstream datasets, surpassing existing multimodal approaches. Our proposed framework shows significant improvements in capturing intricate inter-modal relationships and its robustness in medical diagnosis that establishes a framework for future research in multimodal learning in the healthcare sector.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

Medical Multimodal Large Language Models (Med-MLLMs) require egocentric clinical intent understanding for real-world deployment, yet existing benchmarks fail to evaluate this critical capability. To address these challenges, we introduce MedGaze-Bench, the first benchmark leveraging clinician gaze as a Cognitive Cursor to assess intent understanding across surgery, emergency simulation, and diagnostic interpretation. Our benchmark addresses three fundamental challenges: visual homogeneity of anatomical structures, strict temporal-causal dependencies in clinical workflows, and implicit adherence to safety protocols. We propose a Three-Dimensional Clinical Intent Framework evaluating: (1) Spatial Intent: discriminating precise targets amid visual noise, (2) Temporal Intent: inferring causal rationale through retrospective and prospective reasoning, and (3) Standard Intent: verifying protocol compliance through safety checks. Beyond accuracy metrics, we introduce Trap QA mechanisms to stress-test clinical reliability by penalizing hallucinations and cognitive sycophancy. Experiments reveal current MLLMs struggle with egocentric intent due to over-reliance on global features, leading to fabricated observations and uncritical acceptance of invalid instructions.

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

As Vision-Language Models (VLMs) increasingly gain traction in medical applications, clinicians are progressively expecting AI systems not only to generate textual diagnoses but also to produce corresponding medical images that integrate seamlessly into authentic clinical workflows. Despite the growing interest, existing medical visual benchmarks present notable limitations. They often rely on ambiguous queries that lack sufficient relevance to image content, oversimplify complex diagnostic reasoning into closed-ended shortcuts, and adopt a text-centric evaluation paradigm that overlooks the importance of image generation capabilities. To address these challenges, we introduce MedGEN-Bench, a comprehensive multimodal benchmark designed to advance medical AI research. MedGEN-Bench comprises 6,422 expert-validated image-text pairs spanning six imaging modalities, 16 clinical tasks, and 28 subtasks. It is structured into three distinct formats: Visual Question Answering, Image Editing, and Contextual Multimodal Generation. What sets MedGEN-Bench apart is its focus on contextually intertwined instructions that necessitate sophisticated cross-modal reasoning and open-ended generative outputs, moving beyond the constraints of multiple-choice formats. To evaluate the performance of existing systems, we employ a novel three-tier assessment framework that integrates pixel-level metrics, semantic text analysis, and expert-guided clinical relevance scoring. Using this framework, we systematically assess 10 compositional frameworks, 3 unified models, and 5 VLMs.

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities with reinforcement learning paradigm. Although several multimodal reasoning models have been explored in the medical domain, most of them focus exclusively on basic reasoning, which refers to shallow inference based on visual feature matching. However, real-world clinical diagnosis extends beyond basic reasoning, demanding reasoning processes that integrate heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, the first ophthalmic multimodal dataset with the full spectrum of perception and reasoning. It encompasses both basic reasoning tasks and complex reasoning tasks, aiming to enhance visual-centric fundamental reasoning capabilities and emulate realistic clinical thinking patterns. Building upon MM-Retinal-Reason, we propose OphthaReason, the first ophthalmology-specific multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we specifically design a novel method called Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates the model's exploration depth using a shaped advantage mechanism. Comprehensive experiments demonstrate that our model achieves state-of-the-art performance on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 24.92\%, 15.00\%, 21.20\%, and 17.66\%. Project Page: https://github.com/lxirich/OphthaReason{link}.

Patient world models and clinical agents aim to predict changes in patients' health and support clinical work. Developing these systems requires reliable histories of patient conditions, treatments, and the information available at each decision. Electronic health records (EHRs) contain these histories, but differences in how events are recorded make them difficult to use consistently. We present EHR2Trace, a system that converts EHRs from different sources into traceable patient events for model training and evaluation. It links events to source records, separates event time from information availability, and distinguishes medication orders, dispensing, and administration. A shared event representation supports both OMOP and MEDS exports, with automated validation and reproducible builds. Across three clinical datasets, EHR2Trace converted 846.4 million events, with every applicable check passing except one unit-consistency check on MIMIC-IV, and detected all 28 injected faults. A controlled prediction experiment showed that assigning later diagnoses to admission time substantially inflated measured performance, and that a model trained on such data lost accuracy when deployed on histories filtered by availability. EHR2Trace provides a reusable data foundation for patient world models and clinical agents, helping researchers inspect patient histories, check conversion decisions, and evaluate models with explicit data rules.

Accurate clinical prognosis requires synthesizing structured Electronic Health Records (EHRs) with real-time physiological signals like the Electrocardiogram (ECG). Large Language Models (LLMs) offer a powerful reasoning engine for this task but struggle to natively process these heterogeneous, non-textual data types. To address this, we propose UniPACT (Unified Prognostic Question Answering for Clinical Time-series), a unified framework for prognostic question answering that bridges this modality gap. UniPACT's core contribution is a structured prompting mechanism that converts numerical EHR data into semantically rich text. This textualized patient context is then fused with representations learned directly from raw ECG waveforms, enabling an LLM to reason over both modalities holistically. We evaluate UniPACT on the comprehensive MDS-ED benchmark, it achieves a state-of-the-art mean AUROC of 89.37% across a diverse set of prognostic tasks including diagnosis, deterioration, ICU admission, and mortality, outperforming specialized baselines. Further analysis demonstrates that our multimodal, multi-task approach is critical for performance and provides robustness in missing data scenarios.

Medical image segmentation has achieved remarkable success through the continuous advancement of UNet-based and Transformer-based foundation backbones. However, clinical diagnosis in the real world often requires integrating domain knowledge, especially textual information. Conducting multimodal learning involves visual and text modalities shown as a solution, but collecting paired vision-language datasets is expensive and time-consuming, posing significant challenges. Inspired by the superior ability in numerous cross-modal tasks for Large Language Models (LLMs), we proposed a novel Vision-LLM union framework to address the issues. Specifically, we introduce frozen LLMs for zero-shot instruction generation based on corresponding medical images, imitating the radiology scanning and report generation process. {To better approximate real-world diagnostic processes}, we generate more precise text instruction from multimodal radiology images (e.g., T1-w or T2-w MRI and CT). Based on the impressive ability of semantic understanding and rich knowledge of LLMs. This process emphasizes extracting special features from different modalities and reunion the information for the ultimate clinical diagnostic. With generated text instruction, our proposed union segmentation framework can handle multimodal segmentation without prior collected vision-language datasets. To evaluate our proposed method, we conduct comprehensive experiments with influential baselines, the statistical results and the visualized case study demonstrate the superiority of our novel method.}

The increasing interest in developing Artificial Intelligence applications in the medical domain, suffers from the lack of high-quality dataset, mainly due to privacy-related issues. Moreover, the recent rising of Multimodal Large Language Models (MLLM) leads to a need for multimodal medical datasets, where clinical reports and findings are attached to the corresponding CT or MR scans. This paper illustrates the entire workflow for building the data set MedPix 2.0. Starting from the well-known multimodal dataset MedPix\textregistered, mainly used by physicians, nurses and healthcare students for Continuing Medical Education purposes, a semi-automatic pipeline was developed to extract visual and textual data followed by a manual curing procedure where noisy samples were removed, thus creating a MongoDB database. Along with the dataset, we developed a GUI aimed at navigating efficiently the MongoDB instance, and obtaining the raw data that can be easily used for training and/or fine-tuning MLLMs. To enforce this point, we also propose a CLIP-based model trained on MedPix 2.0 for scan classification tasks.

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

Large Vision-Language Models (LVLMs) are increasingly being explored for applications in telemedicine, yet their ability to engage with diverse patient behaviors remains underexplored. We introduce 3MDBench (Medical Multimodal Multi-agent Dialogue Benchmark), an open-source evaluation framework designed to assess LLM-driven medical consultations. Unlike existing benchmarks, 3MDBench simulates real-world patient variability by incorporating four temperament-driven Patient Agents and an Assessor Agent that evaluates diagnostic accuracy and dialogue quality. The benchmark integrates textual and image-based patient data across 34 common diagnoses, mirroring real-world telemedicine interactions. Under different diagnostic strategies, we evaluate state-of-the-art LVLMs. Our findings demonstrate that incorporating dialogue improves the F1 score from 50.4 to 54.2 compared to non-dialogue settings, underscoring the value of context-driven, information-seeking questioning. Additionally, we demonstrate that multimodal inputs enhance diagnostic efficiency. Image-supported models outperform text-only counterparts by raising the diagnostic F1 score from 52.8 to 54.2 in a similar dialogue setting. Finally, we suggest an approach that improves the diagnostic F1-score to 70.3 by training the CNN model on the diagnosis prediction task and incorporating its top-3 predictions into the LVLM context. 3MDBench provides a reproducible and extendable evaluation framework for AI-driven medical assistants. It offers insights into how patient temperament, dialogue strategies, and multimodal reasoning influence diagnosis quality. By addressing real-world complexities in telemedicine, our benchmark paves the way for more empathetic, reliable, and context-aware AI-driven healthcare solutions. The source code of our benchmark is publicly available: https://github.com/univanxx/3mdbench

In this work, we introduce Multiple Embedding Model for EHR (MEME), an approach that views Electronic Health Records (EHR) as multimodal data. This approach incorporates "pseudo-notes", textual representations of tabular EHR concepts such as diagnoses and medications, and allows us to effectively employ Large Language Models (LLMs) for EHR representation. This framework also adopts a multimodal approach, embedding each EHR modality separately. We demonstrate the effectiveness of MEME by applying it to several tasks within the Emergency Department across multiple hospital systems. Our findings show that MEME surpasses the performance of both single modality embedding methods and traditional machine learning approaches. However, we also observe notable limitations in generalizability across hospital institutions for all tested models.

Medical guidelines encode rich, evidence-based decision logic, yet the specific decision artifact a clinician needs is hard to locate within a guideline, let alone across guidelines covering plausible diseases and treatments. While guideline passages have supported end-to-end question answering, flowcharts remain largely underused in decision support despite their ability to encode actionable clinical pathways. We therefore introduce Case2Flow, a task designed to retrieve the most relevant guideline flowchart for a given patient case from a collection of guideline documents. To support it, we construct FlowAtlas, a curated corpus of 202 flowcharts extracted from 2,080 medical guidelines, together with a pipeline that synthesises 1,911 aligned case-flowchart pairs. Our evaluation of multimodal retrieval methods reveals systematic failure modes, including overreliance on keywords and spurious token-patch matches induced by uninformative background regions in flowcharts. Motivated by this, we propose CRISP, a training-free scoring method that sharpens late-interaction retrieval by suppressing uninformative patches, discounting ambiguous token matches, and incorporating bidirectional query-image alignment. CRISP improves Recall@1 by up to 18.71 percentage points, while a blinded physician assessment on published case narratives provides preliminary feasibility evidence beyond synthetic queries.

Artificial intelligence (AI) is vital in ophthalmology, tackling tasks like diagnosis, classification, and visual question answering (VQA). However, existing AI models in this domain often require extensive annotation and are task-specific, limiting their clinical utility. While recent developments have brought about foundation models for ophthalmology, they are limited by the need to train separate weights for each imaging modality, preventing a comprehensive representation of multi-modal features. This highlights the need for versatile foundation models capable of handling various tasks and modalities in ophthalmology. To address this gap, we present EyeFound, a multimodal foundation model for ophthalmic images. Unlike existing models, EyeFound learns generalizable representations from unlabeled multimodal retinal images, enabling efficient model adaptation across multiple applications. Trained on 2.78 million images from 227 hospitals across 11 ophthalmic modalities, EyeFound facilitates generalist representations and diverse multimodal downstream tasks, even for detecting challenging rare diseases. It outperforms previous work RETFound in diagnosing eye diseases, predicting systemic disease incidents, and zero-shot multimodal VQA. EyeFound provides a generalizable solution to improve model performance and lessen the annotation burden on experts, facilitating widespread clinical AI applications for retinal imaging.

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images. Our approach leverages latent diffusion models for patient-specific generation strategically conditioned on a previous CXR image and EHR time series, providing information regarding anatomical structures and disease progressions, respectively. In this way, the interaction across modalities could be better captured by the latent CXR generation process, ultimately improving the prediction performance. Experiments using MIMIC datasets show that the proposed model could effectively address asynchronicity in multimodal fusion and consistently outperform existing methods.

Most medical multimodal benchmarks focus on static tasks such as image question answering, report generation, and plain-language rewriting. Patient education is more demanding: systems must identify relevant evidence across images, show patients where to look, explain findings in accessible language, and handle confusion or distress. Yet most patient education work remains text-only, even though combined image-and-text explanations may better support understanding. We introduce MedImageEdu, a benchmark for multi-turn, evidence-grounded radiology patient education. Each case provides a radiology report with report text and case images. A DoctorAgent interacts with a PatientAgent, conditioned on a hidden profile that captures factors such as education level, health literacy, and personality. When a patient question would benefit from visual support, the DoctorAgent can issue drawing instructions grounded in the report, case images, and the current question to a benchmark-provided drawing tool. The tool returns image(s), after which the DoctorAgent produces a final multimodal response consisting of the image(s) and a grounded plain-language explanation. MedImageEdu contains 150 cases from three sources and evaluates both the consultation process and the final multimodal response along five dimensions: Consultation, Safety and Scope, Language Quality, Drawing Quality, and Image-Text Response Quality. Across representative open- and closed-source vision-language model agents, we find three consistent gaps: fluent language often outpaces faithful visual grounding, safety is the weakest dimension across disease categories, and emotionally tense interactions are harder than low education or low health literacy. MedImageEdu provides a controlled testbed for assessing whether multimodal agents can teach from evidence rather than merely answer from text.

Clinical diagnosis of the eye is performed over multifarious data modalities including scalar clinical labels, vectorized biomarkers, two-dimensional fundus images, and three-dimensional Optical Coherence Tomography (OCT) scans. Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME). Enabling usage of machine learning algorithms within the ophthalmic medical domain requires research into the relationships and interactions between all relevant data over a treatment period. Existing datasets are limited in that they neither provide data nor consider the explicit relationship modeling between the data modalities. In this paper, we introduce the Ophthalmic Labels for Investigating Visual Eye Semantics (OLIVES) dataset that addresses the above limitation. This is the first OCT and near-IR fundus dataset that includes clinical labels, biomarker labels, disease labels, and time-series patient treatment information from associated clinical trials. The dataset consists of 1268 near-IR fundus images each with at least 49 OCT scans, and 16 biomarkers, along with 4 clinical labels and a disease diagnosis of DR or DME. In total, there are 96 eyes' data averaged over a period of at least two years with each eye treated for an average of 66 weeks and 7 injections. We benchmark the utility of OLIVES dataset for ophthalmic data as well as provide benchmarks and concrete research directions for core and emerging machine learning paradigms within medical image analysis.

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

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}.

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/

Multimodal Large Language Models (MLLMs) have demonstrated remarkable effectiveness in various general-domain scenarios, such as visual question answering and image captioning. Recently, researchers have increasingly focused on empowering MLLMs with medical conversational abilities, which hold significant promise for clinical applications. However, medical data presents unique challenges due to its heterogeneous nature -- encompassing diverse modalities including 2D images, 3D volumetric scans, and temporal video sequences. The substantial domain gap and data format inconsistencies across these modalities have hindered the development of unified medical MLLMs. To address these challenges, we propose Fleming-VL, a unified end-to-end framework for comprehensive medical visual understanding across heterogeneous modalities. Fleming-VL tackles this problem from a data-centric perspective through three key strategies: (1) scaling up pretraining by integrating long-context data from both natural and medical-specific domains; (2) complementing fine-tuning with rare medical data, including holistic video analysis and underrepresented 2D modalities such as ultrasound and dermoscopy images; (3) extending existing evaluation frameworks to incorporate 3D volumetric and video understanding benchmarks. Through supervised fine-tuning (SFT) and group relative policy optimization (GRPO), we develop Fleming-VL in multiple model scales. Extensive experiments demonstrate that Fleming-VL achieves state-of-the-art performance across multiple benchmarks, including medical VQA, video QA, and 3D medical image understanding. We publicly release Fleming-VL to promote transparent, reproducible, and auditable progress in medical AI.

Financial organizations collect a huge amount of data about clients that typically has a temporal (sequential) structure and is collected from various sources (modalities). Due to privacy issues, there are no large-scale open-source multimodal datasets of event sequences, which significantly limits the research in this area. In this paper, we present the industrial-scale publicly available multimodal banking dataset, MBD, that contains more than 1.5M corporate clients with several modalities: 950M bank transactions, 1B geo position events, 5M embeddings of dialogues with technical support and monthly aggregated purchases of four bank's products. All entries are properly anonymized from real proprietary bank data. Using this dataset, we introduce a novel benchmark with two business tasks: campaigning (purchase prediction in the next month) and matching of clients. We provide numerical results that demonstrate the superiority of our multi-modal baselines over single-modal techniques for each task. As a result, the proposed dataset can open new perspectives and facilitate the future development of practically important large-scale multimodal algorithms for event sequences. HuggingFace Link: https://huggingface.co/datasets/ai-lab/MBD Github Link: https://github.com/Dzhambo/MBD

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

MLLMs MLLMs are beginning to appear in clinical workflows, but their ability to perform complex medical reasoning remains unclear. We present Med-CMR, a fine-grained Medical Complex Multimodal Reasoning benchmark. Med-CMR distinguishes from existing counterparts by three core features: 1) Systematic capability decomposition, splitting medical multimodal reasoning into fine-grained visual understanding and multi-step reasoning to enable targeted evaluation; 2) Challenging task design, with visual understanding across three key dimensions (small-object detection, fine-detail discrimination, spatial understanding) and reasoning covering four clinically relevant scenarios (temporal prediction, causal reasoning, long-tail generalization, multi-source integration); 3) Broad, high-quality data coverage, comprising 20,653 Visual Question Answering (VQA) pairs spanning 11 organ systems and 12 imaging modalities, validated via a rigorous two-stage (human expert + model-assisted) review to ensure clinical authenticity. We evaluate 18 state-of-the-art MLLMs with Med-CMR, revealing GPT-5 as the top-performing commercial model: 57.81 accuracy on multiple-choice questions (MCQs) and a 48.70 open-ended score, outperforming Gemini 2.5 Pro (49.87 MCQ accuracy, 45.98 open-ended score) and leading open-source model Qwen3-VL-235B-A22B (49.34 MCQ accuracy, 42.62 open-ended score). However, specialized medical MLLMs do not reliably outperform strong general models, and long-tail generalization emerges as the dominant failure mode. Med-CMR thus provides a stress test for visual-reasoning integration and rare-case robustness in medical MLLMs, and a rigorous yardstick for future clinical systems.

The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed's large-scale, de-identified medical image-text pairs to address these limitations, they still fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an 'unblinded' capacity to denoise and reformat the data, resulting in the creation of the PubMedVision dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of current MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM HuatuoGPT-Vision, which shows superior performance in medical multimodal scenarios among open-source MLLMs.

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce SurgΣ, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies SurgΣ-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. SurgΣ-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. SurgΣ-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, SurgΣ-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon SurgΣ-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

The pervasive influence of misinformation has far-reaching and detrimental effects on both individuals and society. The COVID-19 pandemic has witnessed an alarming surge in the dissemination of medical misinformation. However, existing datasets pertaining to misinformation predominantly focus on textual information, neglecting the inclusion of visual elements, and tend to center solely on COVID-19-related misinformation, overlooking misinformation surrounding other diseases. Furthermore, the potential of Large Language Models (LLMs), such as the ChatGPT developed in late 2022, in generating misinformation has been overlooked in previous works. To overcome these limitations, we present Med-MMHL, a novel multi-modal misinformation detection dataset in a general medical domain encompassing multiple diseases. Med-MMHL not only incorporates human-generated misinformation but also includes misinformation generated by LLMs like ChatGPT. Our dataset aims to facilitate comprehensive research and development of methodologies for detecting misinformation across diverse diseases and various scenarios, including human and LLM-generated misinformation detection at the sentence, document, and multi-modal levels. To access our dataset and code, visit our GitHub repository: https://github.com/styxsys0927/Med-MMHL.

Different medical imaging modalities capture diagnostic information at varying spatial resolutions, from coarse global patterns to fine-grained localized structures. However, most existing vision-language frameworks in the medical domain apply a uniform strategy for local feature extraction, overlooking the modality-specific demands. In this work, we present MedMoE, a modular and extensible vision-language processing framework that dynamically adapts visual representation based on the diagnostic context. MedMoE incorporates a Mixture-of-Experts (MoE) module conditioned on the report type, which routes multi-scale image features through specialized expert branches trained to capture modality-specific visual semantics. These experts operate over feature pyramids derived from a Swin Transformer backbone, enabling spatially adaptive attention to clinically relevant regions. This framework produces localized visual representations aligned with textual descriptions, without requiring modality-specific supervision at inference. Empirical results on diverse medical benchmarks demonstrate that MedMoE improves alignment and retrieval performance across imaging modalities, underscoring the value of modality-specialized visual representations in clinical vision-language systems.

Our experience of the world is multimodal - we see objects, hear sounds, feel texture, smell odors, and taste flavors. Modality refers to the way in which something happens or is experienced and a research problem is characterized as multimodal when it includes multiple such modalities. In order for Artificial Intelligence to make progress in understanding the world around us, it needs to be able to interpret such multimodal signals together. Multimodal machine learning aims to build models that can process and relate information from multiple modalities. It is a vibrant multi-disciplinary field of increasing importance and with extraordinary potential. Instead of focusing on specific multimodal applications, this paper surveys the recent advances in multimodal machine learning itself and presents them in a common taxonomy. We go beyond the typical early and late fusion categorization and identify broader challenges that are faced by multimodal machine learning, namely: representation, translation, alignment, fusion, and co-learning. This new taxonomy will enable researchers to better understand the state of the field and identify directions for future research.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

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

With the increasing use of RetrievalAugmented Generation (RAG), strong retrieval models have become more important than ever. In healthcare, multimodal retrieval models that combine information from both text and images offer major advantages for many downstream tasks such as question answering, cross-modal retrieval, and multimodal summarization, since medical data often includes both formats. However, there is currently no standard benchmark to evaluate how well these models perform in medical settings. To address this gap, we introduce M3Retrieve, a Multimodal Medical Retrieval Benchmark. M3Retrieve, spans 5 domains,16 medical fields, and 4 distinct tasks, with over 1.2 Million text documents and 164K multimodal queries, all collected under approved licenses. We evaluate leading multimodal retrieval models on this benchmark to explore the challenges specific to different medical specialities and to understand their impact on retrieval performance. By releasing M3Retrieve, we aim to enable systematic evaluation, foster model innovation, and accelerate research toward building more capable and reliable multimodal retrieval systems for medical applications. The dataset and the baselines code are available in this github page https://github.com/AkashGhosh/M3Retrieve.

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

Clinical diagnostic workups typically follow a modality escalation pathway: after initial clinical evaluation, clinicians begin with routine structural imaging (e.g., MRI), selectively add sequences such as FLAIR or T2 to refine the differential, and reserve molecular imaging (e.g., amyloid-PET) for cases that remain uncertain after standard evaluation. Consequently, patients are observed with heterogeneous and often incomplete modality subsets. However, most current AI models assume fixed data modalities as the model inputs. In this paper, we present BrainAnytime, a unified pretraining framework pretrained on 34,899 3D brain scans from five datasets that support brain image analysis under arbitrary modality availability spanning multi-sequence MRI and amyloid-PET. A single model accepts whatever imaging is available, from a lone T1 scan to a full multimodal workup. Pretraining learns structural-molecular correspondences between MRI and PET via cross-modal distillation (RCMD) and prioritizes disease-vulnerable anatomy via atlas-guided curriculum masking (PACM), all within a shared 3D masked autoencoder (Multi-MAE3D). Across four downstream tasks and five clinically motivated modality settings, BrainAnytime largely outperforms modality-specific models, missing-modality baselines, and large-scale brain MRI pretrained foundation models on most modality settings. Notably, it surpasses the strongest missing-modality baselines with relative improvements of 6.2% and 7.0% in average accuracy on CN vs. AD and CN vs. MCI classification, respectively. Code is available at https://github.com/SDH-Lab/BrainAnytime.

Recent advances in learning multi-modal representation have witnessed the success in biomedical domains. While established techniques enable handling multi-modal information, the challenges are posed when extended to various clinical modalities and practical modalitymissing setting due to the inherent modality gaps. To tackle these, we propose an innovative Modality-prompted Heterogeneous Graph for Omnimodal Learning (GTP-4o), which embeds the numerous disparate clinical modalities into a unified representation, completes the deficient embedding of missing modality and reformulates the cross-modal learning with a graph-based aggregation. Specially, we establish a heterogeneous graph embedding to explicitly capture the diverse semantic properties on both the modality-specific features (nodes) and the cross-modal relations (edges). Then, we design a modality-prompted completion that enables completing the inadequate graph representation of missing modality through a graph prompting mechanism, which generates hallucination graphic topologies to steer the missing embedding towards the intact representation. Through the completed graph, we meticulously develop a knowledge-guided hierarchical cross-modal aggregation consisting of a global meta-path neighbouring to uncover the potential heterogeneous neighbors along the pathways driven by domain knowledge, and a local multi-relation aggregation module for the comprehensive cross-modal interaction across various heterogeneous relations. We assess the efficacy of our methodology on rigorous benchmarking experiments against prior state-of-the-arts. In a nutshell, GTP-4o presents an initial foray into the intriguing realm of embedding, relating and perceiving the heterogeneous patterns from various clinical modalities holistically via a graph theory. Project page: https://gtp-4-o.github.io/.

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

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate clinical quality, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

While multimodal large language models (MLLMs) excel in medical applications, most of them favor static images or short-term signals. In the critical field of dynamic electrocardiograms (ECG), models struggle with complex temporal reasoning and diagnostic report generation due to a lack of high-quality datasets and benchmarks. To address this, we introduce (i) Holtercare-23K, a large-scale multimodal dynamic ECG dataset comprising 22,980 QA pairs derived from 788 clinical Holter records and featuring a novel signal-video-text tri-modal alignment. Based on this dataset, we present (ii) Holtercare-Bench, a multimodal benchmark that evaluates models on temporal localization, clinical diagnosis, and global summarization. Zero-shot evaluations of leading MLLMs reveal a significant performance gap in processing ultra-long pathological sequences. However, fine-tuning representative models yields substantial improvements. This work illuminates the limitations of current MLLMs in electrophysiology and provides a foundational benchmark for long-term medical MLLMs. Our project is available at https://github.com/ZJU4HealthCare/Holtercare-Bench.

The integration of multimodal data including pathology images and gene profiles is widely applied in precise survival prediction. Despite recent advances in multimodal survival models, collecting complete modalities for multimodal fusion still poses a significant challenge, hindering their application in clinical settings. Current approaches tackling incomplete modalities often fall short, as they typically compensate for only a limited part of the knowledge of missing modalities. To address this issue, we propose a Distilled Prompt Learning framework (DisPro) to utilize the strong robustness of Large Language Models (LLMs) to missing modalities, which employs two-stage prompting for compensation of comprehensive information for missing modalities. In the first stage, Unimodal Prompting (UniPro) distills the knowledge distribution of each modality, preparing for supplementing modality-specific knowledge of the missing modality in the subsequent stage. In the second stage, Multimodal Prompting (MultiPro) leverages available modalities as prompts for LLMs to infer the missing modality, which provides modality-common information. Simultaneously, the unimodal knowledge acquired in the first stage is injected into multimodal inference to compensate for the modality-specific knowledge of the missing modality. Extensive experiments covering various missing scenarios demonstrated the superiority of the proposed method. The code is available at https://github.com/Innse/DisPro.

Recent advances in generative medical models are constrained by modality-specific scenarios that hinder the integration of complementary evidence from imaging, pathology, and clinical notes. This fragmentation limits their evolution into foundation models that can learn and reason across the full spectrum of biomedical data. We propose MeDiM, the first medical discrete diffusion model that learns shared distributions across modalities without modality-specific components. MeDiM unifies multiple generative tasks: translating between images and text, and jointly producing image-report pairs across domains in response to prompts. Built on a discrete diffusion framework, MeDiM bridges vision and language representations through a shared probabilistic space. To enable unified and flexible medical generation, we employ a multimodal large language model (MLLM) as the diffusion backbone, leveraging its prior knowledge and cross-modal reasoning. Two key designs are introduced: (1) removing the causal attention mask for bidirectional context, and (2) injecting continuous timestep embeddings for diffusion awareness. Experiments demonstrate high-fidelity medical generation (FID 16.60 on MIMIC-CXR and FID 24.19 on PathGen) and accurate report generation (METEOR 0.2650 and 0.2580). Jointly generated image-report pairs further enhance downstream performance (plus6.43 percent BLEU-1, plus18.57 percent BLEU-2, plus31.58 percent BLEU-3, plus4.80 percent METEOR), showing that MeDiM supports coherent and clinically grounded multimodal outputs.

Predicting multiple real-world tasks in a single model often requires a particularly diverse feature space. Multimodal (MM) models aim to extract the synergistic predictive potential of multiple data types to create a shared feature space with aligned semantic meaning across inputs of drastically varying sizes (i.e. images, text, sound). Most current MM architectures fuse these representations in parallel, which not only limits their interpretability but also creates a dependency on modality availability. We present MultiModN, a multimodal, modular network that fuses latent representations in a sequence of any number, combination, or type of modality while providing granular real-time predictive feedback on any number or combination of predictive tasks. MultiModN's composable pipeline is interpretable-by-design, as well as innately multi-task and robust to the fundamental issue of biased missingness. We perform four experiments on several benchmark MM datasets across 10 real-world tasks (predicting medical diagnoses, academic performance, and weather), and show that MultiModN's sequential MM fusion does not compromise performance compared with a baseline of parallel fusion. By simulating the challenging bias of missing not-at-random (MNAR), this work shows that, contrary to MultiModN, parallel fusion baselines erroneously learn MNAR and suffer catastrophic failure when faced with different patterns of MNAR at inference. To the best of our knowledge, this is the first inherently MNAR-resistant approach to MM modeling. In conclusion, MultiModN provides granular insights, robustness, and flexibility without compromising performance.

Longitudinal multimodal data, including electronic health records (EHR) and sequential chest X-rays (CXRs), is critical for modeling disease progression, yet remains underutilized due to two key challenges: (1) redundancy in consecutive CXR sequences, where static anatomical regions dominate over clinically-meaningful dynamics, and (2) temporal misalignment between sparse, irregular imaging and continuous EHR data. We introduce DiPro, a novel framework that addresses these challenges through region-aware disentanglement and multi-timescale alignment. First, we disentangle static (anatomy) and dynamic (pathology progression) features in sequential CXRs, prioritizing disease-relevant changes. Second, we hierarchically align these static and dynamic CXR features with asynchronous EHR data via local (pairwise interval-level) and global (full-sequence) synchronization to model coherent progression pathways. Extensive experiments on the MIMIC dataset demonstrate that DiPro could effectively extract temporal clinical dynamics and achieve state-of-the-art performance on both disease progression identification and general ICU prediction tasks.

The primary goal of drug safety researchers and regulators is to promptly identify adverse drug reactions. Doing so may in turn prevent or reduce the harm to patients and ultimately improve public health. Evaluating and monitoring drug safety (i.e., pharmacovigilance) involves analyzing an ever growing collection of spontaneous reports from health professionals, physicians, and pharmacists, and information voluntarily submitted by patients. In this scenario, facilitating analysis of such reports via automation has the potential to rapidly identify safety signals. Unfortunately, public resources for developing natural language models for this task are scant. We present PHEE, a novel dataset for pharmacovigilance comprising over 5000 annotated events from medical case reports and biomedical literature, making it the largest such public dataset to date. We describe the hierarchical event schema designed to provide coarse and fine-grained information about patients' demographics, treatments and (side) effects. Along with the discussion of the dataset, we present a thorough experimental evaluation of current state-of-the-art approaches for biomedical event extraction, point out their limitations, and highlight open challenges to foster future research in this area.

Cancer has relational information residing at varying scales, modalities, and resolutions of the acquired data, such as radiology, pathology, genomics, proteomics, and clinical records. Integrating diverse data types can improve the accuracy and reliability of cancer diagnosis and treatment. There can be disease-related information that is too subtle for humans or existing technological tools to discern visually. Traditional methods typically focus on partial or unimodal information about biological systems at individual scales and fail to encapsulate the complete spectrum of the heterogeneous nature of data. Deep neural networks have facilitated the development of sophisticated multimodal data fusion approaches that can extract and integrate relevant information from multiple sources. Recent deep learning frameworks such as Graph Neural Networks (GNNs) and Transformers have shown remarkable success in multimodal learning. This review article provides an in-depth analysis of the state-of-the-art in GNNs and Transformers for multimodal data fusion in oncology settings, highlighting notable research studies and their findings. We also discuss the foundations of multimodal learning, inherent challenges, and opportunities for integrative learning in oncology. By examining the current state and potential future developments of multimodal data integration in oncology, we aim to demonstrate the promising role that multimodal neural networks can play in cancer prevention, early detection, and treatment through informed oncology practices in personalized settings.

Despite the success of Large Language Models (LLMs) in general image tasks, a gap persists in the medical field for a multimodal large model adept at handling the nuanced diversity of medical images. Addressing this, we propose MedXChat, a unified multimodal large model designed for seamless interactions between medical assistants and users. MedXChat encompasses three key functionalities: CXR(Chest X-ray)-to-Report generation, CXR-based visual question-answering (VQA), and Text-to-CXR synthesis. Our contributions are as follows. Firstly, our model showcases exceptional cross-task adaptability, displaying adeptness across all three defined tasks and outperforming the benchmark models on the MIMIC dataset in medical multimodal applications. Secondly, we introduce an innovative Text-to-CXR synthesis approach that utilizes instruction-following capabilities within the Stable Diffusion (SD) architecture. This technique integrates smoothly with the existing model framework, requiring no extra parameters, thereby maintaining the SD's generative strength while also bestowing upon it the capacity to render fine-grained medical images with high fidelity. Comprehensive experiments validate MedXChat's synergistic enhancement across all tasks. Our instruction data and model will be open-sourced.

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

The rapid progress of multimodal large language models (MLLMs) has led to increasing interest in agent-based systems. While most prior work in medical imaging concentrates on automating routine clinical workflows, we study an underexplored yet clinically significant setting: distinguishing visually hard-to-separate diseases in a zero-shot setting. We benchmark representative agents on two imaging-only proxy diagnostic tasks, (1) melanoma vs. atypical nevus and (2) pulmonary edema vs. pneumonia, where visual features are highly confounded despite substantial differences in clinical management. We introduce a multi-agent framework based on contrastive adjudication. Experimental results show improved diagnostic performance (an 11-percentage-point gain in accuracy on dermoscopy data) and reduced unsupported claims on qualitative samples, although overall performance remains insufficient for clinical deployment. We acknowledge the inherent uncertainty in human annotations and the absence of clinical context, which further limit the translation to real-world settings. Within this controlled setting, this pilot study provides preliminary insights into zero-shot agent performance in visually confounded scenarios.

Multi-modal fusion approaches aim to integrate information from different data sources. Unlike natural datasets, such as in audio-visual applications, where samples consist of "paired" modalities, data in healthcare is often collected asynchronously. Hence, requiring the presence of all modalities for a given sample is not realistic for clinical tasks and significantly limits the size of the dataset during training. In this paper, we propose MedFuse, a conceptually simple yet promising LSTM-based fusion module that can accommodate uni-modal as well as multi-modal input. We evaluate the fusion method and introduce new benchmark results for in-hospital mortality prediction and phenotype classification, using clinical time-series data in the MIMIC-IV dataset and corresponding chest X-ray images in MIMIC-CXR. Compared to more complex multi-modal fusion strategies, MedFuse provides a performance improvement by a large margin on the fully paired test set. It also remains robust across the partially paired test set containing samples with missing chest X-ray images. We release our code for reproducibility and to enable the evaluation of competing models in the future.

Current artificial intelligence models for medical imaging are predominantly single modality and single disease. Attempts to create multimodal and multi-disease models have resulted in inconsistent clinical accuracy. Furthermore, training these models typically requires large, labour-intensive, well-labelled datasets. We developed MerMED-FM, a state-of-the-art multimodal, multi-specialty foundation model trained using self-supervised learning and a memory module. MerMED-FM was trained on 3.3 million medical images from over ten specialties and seven modalities, including computed tomography (CT), chest X-rays (CXR), ultrasound (US), pathology patches, color fundus photography (CFP), optical coherence tomography (OCT) and dermatology images. MerMED-FM was evaluated across multiple diseases and compared against existing foundational models. Strong performance was achieved across all modalities, with AUROCs of 0.988 (OCT); 0.982 (pathology); 0.951 (US); 0.943 (CT); 0.931 (skin); 0.894 (CFP); 0.858 (CXR). MerMED-FM has the potential to be a highly adaptable, versatile, cross-specialty foundation model that enables robust medical imaging interpretation across diverse medical disciplines.

Large language models (LLMs) have been increasingly used in time series analysis. However, the potential of multimodal LLMs (MLLMs), particularly vision-language models, for time series remains largely under-explored. One natural way for humans to detect time series anomalies is through visualization and textual description. Motivated by this, we raise a critical and practical research question: Can multimodal LLMs perform time series anomaly detection? To answer this, we propose VisualTimeAnomaly benchmark to evaluate MLLMs in time series anomaly detection (TSAD). Our approach transforms time series numerical data into the image format and feed these images into various MLLMs, including proprietary models (GPT-4o and Gemini-1.5) and open-source models (LLaVA-NeXT and Qwen2-VL), each with one larger and one smaller variant. In total, VisualTimeAnomaly contains 12.4k time series images spanning 3 scenarios and 3 anomaly granularities with 9 anomaly types across 8 MLLMs. Starting with the univariate case (point- and range-wise anomalies), we extend our evaluation to more practical scenarios, including multivariate and irregular time series scenarios, and variate-wise anomalies. Our study reveals several key insights: 1) MLLMs detect range- and variate-wise anomalies more effectively than point-wise anomalies. 2) MLLMs are highly robust to irregular time series, even with 25% of the data missing. 3) Open-source MLLMs perform comparably to proprietary models in TSAD. While open-source MLLMs excel on univariate time series, proprietary MLLMs demonstrate superior effectiveness on multivariate time series. To the best of our knowledge, this is the first work to comprehensively investigate MLLMs for TSAD, particularly for multivariate and irregular time series scenarios. We release our dataset and code at https://github.com/mllm-ts/VisualTimeAnomaly to support future research.

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

Multimodal pathology-genomic analysis is critical for cancer survival prediction. However, existing approaches predominantly integrate formalin-fixed paraffin-embedded (FFPE) slides with genomic data, while neglecting the availability of other preservation slides, such as Fresh Froze (FF) slides. Moreover, as the high-resolution spatial nature of pathology data tends to dominate the cross-modality fusion process, it hinders effective multimodal fusion and leads to modality imbalance challenges between pathology and genomics. These methods also typically require complete data modalities, limiting their clinical applicability with incomplete modalities, such as missing either pathology or genomic data. In this paper, we propose a multimodal survival prediction framework that leverages hypergraph learning to effectively integrate multi-WSI information and cross-modality interactions between pathology slides and genomics data while addressing modality imbalance. In addition, we introduce a memory mechanism that stores previously learned paired pathology-genomic features and dynamically compensates for incomplete modalities. Experiments on five TCGA datasets demonstrate that our model outperforms advanced methods by over 2.3% in C-Index. Under incomplete modality scenarios, our approach surpasses pathology-only (3.3%) and gene-only models (7.9%). Code: https://github.com/MCPathology/M2Surv

Multimodal large language models (MLLMs) hold significant potential in the medical field, but their capabilities are often limited by insufficient data in certain medical domains, highlighting the need for understanding what kinds of images can be used by MLLMs for generalization. Current research suggests that multi-task training outperforms single-task as different tasks can benefit each other, but they often overlook the internal relationships within these tasks, providing limited guidance on selecting datasets to enhance specific tasks. To analyze this phenomenon, we attempted to employ compositional generalization (CG)-the ability of models to understand novel combinations by recombining learned elements-as a guiding framework. Since medical images can be precisely defined by Modality, Anatomical area, and Task, naturally providing an environment for exploring CG. Therefore, we assembled 106 medical datasets to create Med-MAT for comprehensive experiments. The experiments confirmed that MLLMs can use CG to understand unseen medical images and identified CG as one of the main drivers of the generalization observed in multi-task training. Additionally, further studies demonstrated that CG effectively supports datasets with limited data and delivers consistent performance across different backbones, highlighting its versatility and broad applicability. Med-MAT is publicly available at https://github.com/FreedomIntelligence/Med-MAT.

Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations. We propose a compositional and cascaded vision encoder architecture featuring a Cascade Spatial-Aware Locality Fusion operator that unifies diverse 2D and native 3D medical image understanding within a fused encoder. We further introduce a vision-grounded evaluation framework, including MedIF-Bench for instruction-following assessment and a region-of-interest-grounded method for clinically aligned and factualness-driven report generation evaluation. We show that ClinFusion sets a new state-of-the-art across a comprehensive suite of 2D and 3D multimodal medical benchmarks---spanning visual question answering, report generation, and instruction following---as well as textual medical tasks, outperforming leading open-source medical MLLMs (e.g., Hulu-Med, Lingshu) on 20 out of 24 benchmarks and demonstrating multimodal capabilities better than powerful proprietary models such as GPT-5.2 and Gemini-3-Flash on 13 out of 16 benchmarks, and can be further augmented with agentic tool use for retrieval-augmented and tool-assisted clinical workflows. A blinded evaluation by board-certified radiologists confirms that ClinFusion produces the highest-ranked reports, and validates our RoI-grounded metric as achieving the strongest correlation with expert judgment among all automatic evaluation metrics examined.

Breast fibroadenoma (FA) and phyllodes tumor (PT) are fibroepithelial breast lesions with highly overlapping appearances on B-mode ultrasound, making benign and borderline PT prone to being misclassified as FA and complicating preoperative decision-making. Existing computer-aided diagnosis methods commonly rely on single-modal imaging features and insufficiently exploit complementary clinical and textual information. To address this limitation, we construct the FAPT-M Dataset, a pathology-confirmed multimodal dataset comprising 910 patients with strictly reviewed ultrasound images, structured clinical attributes, and ultrasound diagnostic descriptions. Based on this dataset, we propose a clinically guided multimodal framework that integrates DenseNet-based visual encoding, CLIP-inspired text encoding, and lightweight clinical encoding, and further introduces clinical-conditioned adaptive modulation, cross-modal Transformer fusion, and dual-path representation learning to improve feature alignment and multimodal interaction. Under patient-level five-fold cross-validation, the proposed method achieves an accuracy of 77.64%, F1-score of 73.38%, and AUC of 89.74%, outperforming representative CNN-, Transformer-, and vision-language-based baselines. Ablation studies and class-balanced evaluations further confirm the contribution of three-modality fusion and the key architectural components. Overall, this work provides an effective multimodal approach for fine-grained FA-PT classification and establishes a high-quality benchmark for multimodal breast ultrasound analysis.

Large Language Models (LLMs) are at the forefront of NLP achievements but fall short in dealing with shortcut learning, factual inconsistency, and vulnerability to adversarial inputs.These shortcomings are especially critical in medical contexts, where they can misrepresent actual model capabilities. Addressing this, we present SemEval-2024 Task 2: Safe Biomedical Natural Language Inference for ClinicalTrials. Our contributions include the refined NLI4CT-P dataset (i.e., Natural Language Inference for Clinical Trials - Perturbed), designed to challenge LLMs with interventional and causal reasoning tasks, along with a comprehensive evaluation of methods and results for participant submissions. A total of 106 participants registered for the task contributing to over 1200 individual submissions and 25 system overview papers. This initiative aims to advance the robustness and applicability of NLI models in healthcare, ensuring safer and more dependable AI assistance in clinical decision-making. We anticipate that the dataset, models, and outcomes of this task can support future research in the field of biomedical NLI. The dataset, competition leaderboard, and website are publicly available.

Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

Multimodal magnetic resonance imaging (MRI) constitutes the first line of investigation for clinicians in the care of brain tumors, providing crucial insights for surgery planning, treatment monitoring, and biomarker identification. Pre-training on large datasets have been shown to help models learn transferable representations and adapt with minimal labeled data. This behavior is especially valuable in medical imaging, where annotations are often scarce. However, applying this paradigm to multimodal medical data introduces a challenge: most existing approaches assume that all imaging modalities are available during both pre-training and fine-tuning. In practice, missing modalities often occur due to acquisition issues, specialist unavailability, or specific experimental designs on small in-house datasets. Consequently, a common approach involves training a separate model for each desired modality combination, making the process both resource-intensive and impractical for clinical use. Therefore, we introduce BM-MAE, a masked image modeling pre-training strategy tailored for multimodal MRI data. The same pre-trained model seamlessly adapts to any combination of available modalities, extracting rich representations that capture both intra- and inter-modal information. This allows fine-tuning on any subset of modalities without requiring architectural changes, while still benefiting from a model pre-trained on the full set of modalities. Extensive experiments show that the proposed pre-training strategy outperforms or remains competitive with baselines that require separate pre-training for each modality subset, while substantially surpassing training from scratch on several downstream tasks. Additionally, it can quickly and efficiently reconstruct missing modalities, highlighting its practical value. Code and trained models are available at: https://github.com/Lucas-rbnt/BM-MAE

Lung cancer patients frequently experience breakthrough pain episodes, with up to 91% requiring timely intervention. To enable proactive pain management, we propose a hybrid machine learning and large language model pipeline that predicts pain episodes within 48 and 72 hours of hospitalization using both structured and unstructured electronic health record data. A retrospective cohort of 266 inpatients was analyzed, with features including demographics, tumor stage, vital signs, and WHO-tiered analgesic use. The machine learning module captured temporal medication trends, while the large language model interpreted ambiguous dosing records and free-text clinical notes. Integrating these modalities improved sensitivity and interpretability. Our framework achieved an accuracy of 0.874 (48h) and 0.917 (72h), with an improvement in sensitivity of 8.6% and 10.4% due to the augmentation of large language model. This hybrid approach offers a clinically interpretable and scalable tool for early pain episode forecasting, with potential to enhance treatment precision and optimize resource allocation in oncology care.

Recent advances in multimodal large language models enable new possibilities for image-based decision support. However, their reliability and operational trade-offs in neuroimaging remain insufficiently understood. We present a comprehensive benchmarking study of vision-enabled large language models for 2D neuroimaging using curated MRI and CT datasets covering multiple sclerosis, stroke, brain tumors, other abnormalities, and normal controls. Models are required to generate multiple outputs simultaneously, including diagnosis, diagnosis subtype, imaging modality, specialized sequence, and anatomical plane. Performance is evaluated across four directions: discriminative classification with abstention, calibration, structured-output validity, and computational efficiency. A multi-phase framework ensures fair comparison while controlling for selection bias. Across twenty frontier multimodal models, the results show that technical imaging attributes such as modality and plane are nearly solved, whereas diagnostic reasoning, especially subtype prediction, remains challenging. Tumor classification emerges as the most reliable task, stroke is moderately solvable, while multiple sclerosis and rare abnormalities remain difficult. Few-shot prompting improves performance for several models but increases token usage, latency, and cost. Gemini-2.5-Pro and GPT-5-Chat achieve the strongest overall diagnostic performance, while Gemini-2.5-Flash offers the best efficiency-performance trade-off. Among open-weight architectures, MedGemma-1.5-4B demonstrates the most promising results, as under few-shot prompting, it approaches the zero-shot performance of several proprietary models, while maintaining perfect structured output. These findings provide practical insights into performance, reliability, and efficiency trade-offs, supporting standardized evaluation of multimodal LLMs in neuroimaging.

Vision-threatening eye diseases pose a major global health burden, with timely diagnosis limited by workforce shortages and restricted access to specialized care. While multimodal large language models (MLLMs) show promise for medical image interpretation, advancing MLLMs for ophthalmology is hindered by the lack of comprehensive benchmark datasets suitable for evaluating generative models. We present a large-scale multimodal ophthalmology benchmark comprising 32,633 instances with multi-granular annotations across 12 common ophthalmic conditions and 5 imaging modalities. The dataset integrates imaging, anatomical structures, demographics, and free-text annotations, supporting anatomical structure recognition, disease screening, disease staging, and demographic prediction for bias evaluation. This work extends our preliminary LMOD benchmark with three major enhancements: (1) nearly 50% dataset expansion with substantial enlargement of color fundus photography; (2) broadened task coverage including binary disease diagnosis, multi-class diagnosis, severity classification with international grading standards, and demographic prediction; and (3) systematic evaluation of 24 state-of-the-art MLLMs. Our evaluations reveal both promise and limitations. Top-performing models achieved ~58% accuracy in disease screening under zero-shot settings, and performance remained suboptimal for challenging tasks like disease staging. We will publicly release the dataset, curation pipeline, and leaderboard to potentially advance ophthalmic AI applications and reduce the global burden of vision-threatening diseases.

Combining pre-trained expert models offers substantial potential for scalable multimodal reasoning, but building a unified framework remains challenging due to the increasing diversity of input modalities and task complexity. For instance, medical diagnosis requires precise reasoning over structured clinical tables, while financial forecasting depends on interpreting plot-based data to make informed predictions. To tackle this challenge, we introduce MEXA, a training-free framework that performs modality- and task-aware aggregation of multiple expert models to enable effective multimodal reasoning across diverse and distinct domains. MEXA dynamically selects expert models based on the input modality and the task-specific reasoning demands (i.e., skills). Each expert model, specialized in a modality task pair, generates interpretable textual reasoning outputs. MEXA then aggregates and reasons over these outputs using a Large Reasoning Model (LRM) to produce the final answer. This modular design allows flexible and transparent multimodal reasoning across diverse domains without additional training overhead. We extensively evaluate our approach on diverse multimodal benchmarks, including Video Reasoning, Audio Reasoning, 3D Understanding, and Medical QA. MEXA consistently delivers performance improvements over strong multimodal baselines, highlighting the effectiveness and broad applicability of our expert-driven selection and aggregation in diverse multimodal reasoning tasks.

Electronic Health Records (EHRs) contain rich temporal dynamics that conventional encoding approaches fail to adequately capture. While Large Language Models (LLMs) show promise for EHR modeling, they struggle to reason about sequential clinical events and temporal dependencies. We propose Next Event Prediction (NEP), a framework that enhances LLMs' temporal reasoning through autoregressive fine-tuning on clinical event sequences. By reformulating EHRs as timestamped event chains and predicting future medical events, NEP explicitly models disease progression patterns and causal relationships. Extensive evaluations across oncology survival prediction and clinical diagnosis tasks demonstrate NEP's superiority, outperforming specialized EHR models by 4.6% AUROC and general-purpose LLMs by 7.2% C-index in temporal reasoning tasks. Our analyses reveal dual benefits: state-of-the-art prediction accuracy combined with clinically interpretable attention patterns that align with known disease pathways.

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

Pathological diagnosis remains the definitive standard for identifying tumors. The rise of multimodal large models has simplified the process of integrating image analysis with textual descriptions. Despite this advancement, the substantial costs associated with training and deploying these complex multimodal models, together with a scarcity of high-quality training datasets, create a significant divide between cutting-edge technology and its application in the clinical setting. We had meticulously compiled a dataset of approximately 45,000 cases, covering over 6 different tasks, including the classification of organ tissues, generating pathology report descriptions, and addressing pathology-related questions and answers. We have fine-tuned multimodal large models, specifically LLaVA, Qwen-VL, InternLM, with this dataset to enhance instruction-based performance. We conducted a qualitative assessment of the capabilities of the base model and the fine-tuned model in performing image captioning and classification tasks on the specific dataset. The evaluation results demonstrate that the fine-tuned model exhibits proficiency in addressing typical pathological questions. We hope that by making both our models and datasets publicly available, they can be valuable to the medical and research communities.

Multimodal large language models (MLLMs) hold great potential for medicine, as they inherit knowledge from LLM and allow multiple data modalities to be integrated, analysed and interpreted in natural language. However, the field of medical MLLMs is constrained by non-trivial challenges, notably the scarcity of high-quality training data and the frequent occurrence of missing data in the real-world clinical setting. Here, we propose a novel unified multimodal model, UniBrain, for brain magnetic resonance image (MRI) analysis. To address potential missing brain MRI modalities, we employ a unified training strategy to perform joint imaging modality imputation and brain image understanding. During training, an interleaved and description-enriched data flow is constructed to train the model in an autoregressive manner, enabling medical reasoning with generated multimodal data. A self-alignment strategy is introduced to leverage dense image embeddings to learn fine-grained anatomical features without requiring detailed image captions. Furthermore, we propose a dynamic hidden state mechanism to alleviate the exposure bias during long-context multimodal inference. Extensive experiments on multi-disease brain MRI dataset demonstrate that UniBrain achieves high performance for brain image imputation, understanding, and disease diagnosis under various extents of modality incompleteness.

Time-series analysis is increasingly studied in multimodal settings, yet most benchmarks pair temporal signals with text or with visualizations derived from the same signal. This leaves open whether multimodal large language models (MLLMs) can integrate time series with real-world visual evidence. We introduce MMTA (multimodal temporal analysis), a benchmark of tri-modal tasks with diverse cross-modal complementarity patterns among time series, text, and vision. MMTA spans nine domains -- robotics, autonomous driving, human action, manufacturing, AR assistance, healthcare, recommendation, finance, and climate -- under video+TS and image+TS layouts, with a 3,524-sample test split covering classification and forecasting. The benchmark standardizes heterogeneous real-world sources into a shared schema with domain-specific prompts, provenance documentation, and success-weighted metrics that penalize both wrong answers and failed generations. Evaluating eight open-source and proprietary MLLMs reveals a shared bottleneck: representing time series as text creates very long token sequences and weakens fine-grained alignment with visual evidence, especially in long-video settings. We then introduce TimeOmni-v, a multimodal LLM extension with a dedicated time-series encoder, temporal positional alignment, modality-aware token layout, and a forecasting head. TimeOmni-v improves long-video classification and time-series inference efficiency, showing that MMTA not only exposes representation and grounding failures but also motivates targeted model design.

The work in this paper evaluates zero-shot and few-shot large language models (LLMs) for safety-critical clinical action extraction using the CLIP discharge-note dataset, with particular emphasis on transitions of care and post-discharge patient safety. To manage the complexity of clinical documentation, we introduce a two-stage extraction framework that decomposes discharge notes, that are written in narrative form, into fine-grained, explicitly actionable clinical tasks through a staged prompting strategy. Our contributions include a systematic assessment of generative LLMs for clinical action extraction, a detailed comparison between general-purpose LLMs and task-specific supervised BERT-based models, and an analysis of annotation inconsistencies across different action categories. We show that contemporary LLMs achieve performance comparable to or exceeding supervised models on binary actionability detection, while supervised baselines retain a meaningful advantage on fine-grained multi-label category classification, despite the absence of task-specific fine-tuning and under strict data-privacy constraints. Qualitative error analysis reveals that many failures stem from misalignment between model reasoning and dataset annotation conventions, particularly in cases involving implicit clinical actions and rigid structural labeling rules. These results indicate that reported performance reflects model limitations due to lack of clinical reasoning, that is not captured by plain annotations. Labels without rationales make it impossible to distinguish clinical reasoning failures from annotation convention mismatches. Advancing clinical NLP requires reasoning-annotated datasets that document why specific spans are actionable, not merely which spans were labeled, enabling proper evaluation of model clinical understanding.

Recent advancements in mixed-modal generative models have enabled flexible integration of information across image-text content. These models have opened new avenues for developing unified biomedical assistants capable of analyzing biomedical images, answering complex questions about them, and predicting the impact of medical procedures on a patient's health. However, existing resources face challenges such as limited data availability, narrow domain coverage, and restricted sources (e.g., medical papers). To address these gaps, we present MedMax, the first large-scale multimodal biomedical instruction-tuning dataset for mixed-modal foundation models. With 1.47 million instances, MedMax encompasses a diverse range of tasks, including multimodal content generation (interleaved image-text data), biomedical image captioning and generation, visual chatting, and report understanding. These tasks span diverse medical domains such as radiology and histopathology. Subsequently, we fine-tune a mixed-modal foundation model on the MedMax dataset, achieving significant performance improvements: a 26% gain over the Chameleon model and an 18.3% improvement over GPT-4o across 12 downstream biomedical visual question-answering tasks. Additionally, we introduce a unified evaluation suite for biomedical tasks, providing a robust framework to guide the development of next-generation mixed-modal biomedical AI assistants.

Metadata are general characteristics of the data in a well-curated and condensed format, and have been proven to be useful for decision making, knowledge discovery, and also heterogeneous data organization of biobank. Among all data types in the biobank, pathology is the key component of the biobank and also serves as the gold standard of diagnosis. To maximize the utility of biobank and allow the rapid progress of biomedical science, it is essential to organize the data with well-populated pathology metadata. However, manual annotation of such information is tedious and time-consuming. In the study, we develop a multimodal multitask learning framework to predict four major slide-level metadata of pathology images. The framework learns generalizable representations across tissue slides, pathology reports, and case-level structured data. We demonstrate improved performance across all four tasks with the proposed method compared to a single modal single task baseline on two test sets, one external test set from a distinct data source (TCGA) and one internal held-out test set (TTH). In the test sets, the performance improvements on the averaged area under receiver operating characteristic curve across the four tasks are 16.48% and 9.05% on TCGA and TTH, respectively. Such pathology metadata prediction system may be adopted to mitigate the effort of expert annotation and ultimately accelerate the data-driven research by better utilization of the pathology biobank.

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

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

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

Alzheimer's disease (AD) is a common neurodegenerative disease among the elderly. Early prediction and timely intervention of its prodromal stage, mild cognitive impairment (MCI), can decrease the risk of advancing to AD. Combining information from various modalities can significantly improve predictive accuracy. However, challenges such as missing data and heterogeneity across modalities complicate multimodal learning methods as adding more modalities can worsen these issues. Current multimodal fusion techniques often fail to adapt to the complexity of medical data, hindering the ability to identify relationships between modalities. To address these challenges, we propose an innovative multimodal approach for predicting MCI conversion, focusing specifically on the issues of missing positron emission tomography (PET) data and integrating diverse medical information. The proposed incomplete triple-modal MCI conversion prediction network is tailored for this purpose. Through the missing modal generation module, we synthesize the missing PET data from the magnetic resonance imaging and extract features using specifically designed encoders. We also develop a channel aggregation module and a triple-modal co-attention fusion module to reduce feature redundancy and achieve effective multimodal data fusion. Furthermore, we design a loss function to handle missing modality issues and align cross-modal features. These components collectively harness multimodal data to boost network performance. Experimental results on the ADNI1 and ADNI2 datasets show that our method significantly surpasses existing unimodal and other multimodal models. Our code is available at https://github.com/justinhxy/ITFC.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

Publishing open-source academic video recordings is an emergent and prevalent approach to sharing knowledge online. Such videos carry rich multimodal information including speech, the facial and body movements of the speakers, as well as the texts and pictures in the slides and possibly even the papers. Although multiple academic video datasets have been constructed and released, few of them support both multimodal content recognition and understanding tasks, which is partially due to the lack of high-quality human annotations. In this paper, we propose a novel multimodal, multigenre, and multipurpose audio-visual academic lecture dataset (M^3AV), which has almost 367 hours of videos from five sources covering computer science, mathematics, and medical and biology topics. With high-quality human annotations of the spoken and written words, in particular high-valued name entities, the dataset can be used for multiple audio-visual recognition and understanding tasks. Evaluations performed on contextual speech recognition, speech synthesis, and slide and script generation tasks demonstrate that the diversity of M^3AV makes it a challenging dataset.

Incentivizing the reasoning ability of Multimodal Large Language Models (MLLMs) is essential for medical applications to transparently analyze medical scans and provide reliable diagnosis. However, existing medical MLLMs rely solely on internal knowledge during reasoning, leading to hallucinated reasoning and factual inaccuracies when encountering cases beyond their training scope. Although recent Agentic Retrieval-Augmented Generation (RAG) methods elicit the medical model's proactive retrieval ability during reasoning, they are confined to unimodal LLMs, neglecting the crucial visual information during reasoning and retrieval. Consequently, we propose the first Multimodal Medical Reasoning-with-Retrieval framework, Med-RwR, which actively retrieves external knowledge by querying observed symptoms or domain-specific medical concepts during reasoning. Specifically, we design a two-stage reinforcement learning strategy with tailored rewards that stimulate the model to leverage both visual diagnostic findings and textual clinical information for effective retrieval. Building on this foundation, we further propose a Confidence-Driven Image Re-retrieval (CDIR) method for test-time scaling when low prediction confidence is detected. Evaluation on various public medical benchmarks demonstrates Med-RwR's significant improvements over baseline models, proving the effectiveness of enhancing reasoning capabilities with external knowledge integration. Furthermore, Med-RwR demonstrates remarkable generalizability to unfamiliar domains, evidenced by 8.8% performance gain on our proposed EchoCardiography Benchmark (ECBench), despite the scarcity of echocardiography data in the training corpus. Our data, model, and codes will be made publicly available at https://github.com/xmed-lab/Med-RwR.

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

Traditional metrics for Medical Report Generation (MRG) predominantly rely on surface-level n-gram overlap, which fails to capture clinical factual accuracy and often overlooks catastrophic diagnostic errors. We address this fundamental limitation by proposing AtomiMed, a universal, modality-agnostic evaluation framework that decomposes complex medical narratives into a standardized, multi-level hierarchy of Atomic Clinical Facts, encompassing Disease-level entities and Attribute-level descriptors, including location, morphology, and severity. By implementing an Agentic Cross-Verification loop between ground-truth and predicted reports, AtomiMed simulates a multi-radiologist peer-review process to verify clinical consistency, thus enabling the decoupled assessment of diagnostic detection and descriptive accuracy. To facilitate standardized evaluation, we introduce MRGEvalKit, an open-source toolkit for automated hierarchical extraction, and curate OmniMRG-Bench, a comprehensive multi-modal benchmark covering X-ray, CT, MRI, and Ultrasound. Extensive experiments on multiple expert-annotated reader studies demonstrate that AtomiMed achieves significantly higher correlation with human radiologist judgment compared to traditional and model-based metrics. Our code are release at https://github.com/Venn2336/MRGEvalkit

Large language models (LLMs) and agentic systems have shown promise for clinical decision support, but existing works largely assume that evidence has already been curated and handed to the model. Real-world clinical workflows instead require agents to actively seek, iteratively plan, and synthesize multimodal evidence from heterogeneous sources. In this paper, we introduce ClinSeekAgent, an automated agentic framework for dynamic multimodal evidence seeking that shifts the paradigm from passive evidence consumption to active evidence acquisition. Given only a clinical query and access to raw data sources, ClinSeekAgent gathers evidence by querying medical knowledge bases, navigating raw EHRs, and invoking medical imaging tools; refines its hypotheses as new information emerges; and integrates the collected evidence into grounded clinical decisions. ClinSeekAgent serves both as an inference-time agent for frontier LLMs and as a training-time pipeline for distilling high-quality agent trajectories into compact open-source models. To validate its inference-time effectiveness, we construct ClinSeek-Bench, which pairs Curated Input reasoning from fixed pre-selected evidence with Automated Evidence-Seeking over raw clinical data. On text-only EHR tasks, ClinSeekAgent improves Claude Opus 4.6 from 60.0 to 63.2 overall F1 and MiniMax M2.5 from 43.1 to 47.3, with positive risk-prediction gains in 7 out of 9 evaluated host models. On multimodal tasks, ClinSeekAgent improves Claude Opus 4.6 from 47.5 to 62.6 (+15.1); all evaluated models improve across the three CXR-related task groups. We further validate ClinSeekAgent as a training pipeline by distilling agentic evidence-seeking trajectories into ClinSeek-35B-A3B, which achieves 34.0 average F1 on existing AgentEHR-Bench, improving over its Qwen3.5-35B-A3B baseline by +11.9 points and approaching Claude Opus 4.6.

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

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.

Echocardiography records ultrasound videos of the heart, enabling clinicians to assess cardiac function. Recent advances in large-scale vision-language models (VLMs) have spurred interest in automating echocardiographic interpretation. However, most existing medical VLMs rely on single-frame (image) inputs, which can reduce diagnostic accuracy for conditions identifiable only through cardiac motion. In addition, echocardiographic videos are captured from multiple views, each varying in suitability for detecting specific conditions. Leveraging multiple views may therefore improve diagnostic performance. We developed a video-language model that processes full video sequences from five standard views, trained on 60,747 echocardiographic video-report pairs. We evaluated the gains in retrieval performance from video input and multi-view support, including the contributions of various pretrained models.