Daily Papers

Contrastive vision-language learning uses paired chest CT volumes and radiology reports to learn abnormality classifiers without manually annotated labels. However, two characteristics of chest CT challenge conventional global contrastive learning. First, many critical abnormalities are small or anatomically localized, and pooling an en- tire volume into a single embedding may dilute their visual evidence. Second, the standard contrastive objective treats every other scan in a batch as a negative. Because many chest CTs share abnormalities, this objective incorrectly pushes co-positive pairs apart. We propose Anatomy-Routed Contrastive Learning for 3D Chest CT (ARC-CT), a region-aware framework that addresses these limitations using only la- bels extracted from reports by an LLM, with no manual annotations or bounding boxes. ARC-CT combines three components: (1) an Anato- myQFormer localizing evidence via queries constrained by automatically generated organ masks; (2) a label-Jaccard soft InfoNCE objective in- tegrating the standard one-hot target with the label-set overlap of each pair, which reduces false-negative penalties between studies that share clinical findings; and (3) an organ-level alignment loss connecting mask- pooled visual features to organ-specific report text extracted offline with a large language model. ARC-CT achieves a 0.86 mask-free macro AUC across 18 abnormalities using a compact 3D ResNet-18 backbone. Over- all, ARC-CT outperforms both comparable efficient baselines and sev- eral larger transformer models. Our code and weights are available at https://github.com/arc-ct/arc-ct.

While reinforcement learning for large language model alignment has progressed rapidly in recent years, transferring these paradigms to high-stakes medical question answering reveals a fundamental paradigm mismatch. Reinforcement Learning from Human Feedback relies on preference annotations that are prohibitively expensive and often fail to reflect the absolute correctness of medical facts. Reinforcement Learning from Verifiable Rewards lacks effective automatic verifiers and struggles to handle complex clinical contexts. Meanwhile, medical alignment requires the simultaneous optimization of correctness, safety, and compliance, yet multi-objective heterogeneous reward signals are prone to scale mismatch and optimization conflicts.To address these challenges, we propose a robust medical alignment paradigm. We first construct a holistic multi-dimensional medical alignment matrix that decomposes alignment objectives into four categories: fundamental capabilities, expert knowledge, online feedback, and format specifications. Within each category, we establish a closed loop of where observable metrics inform attributable diagnosis, which in turn drives optimizable rewards, thereby providing fine-grained, high-resolution supervision signals for subsequent iterative optimization. To resolve gradient domination and optimization instability problem caused by heterogeneous signals, we further propose a unified optimization mechanism. This mechanism employs Reference-Frozen Normalization to align reward scales and implements a Tri-Factor Adaptive Dynamic Weighting strategy to achieve collaborative optimization that is weakness-oriented, risk-prioritized, and redundancy-reducing. Experimental results demonstrate the effectiveness of our proposed paradigm in real-world medical scenario evaluations, establishing a new paradigm for complex alignment in vertical domains.

Artificial and biological systems may evolve similar computational solutions despite fundamental differences in architecture and learning mechanisms -- a form of convergent evolution. We demonstrate this phenomenon through large-scale analysis of alignment between human brain activity and internal representations of over 600 AI models spanning language and vision domains, from 1.33M to 72B parameters. Analyzing 60 million alignment measurements reveals that higher-performing models spontaneously develop stronger brain alignment without explicit neural constraints, with language models showing markedly stronger correlation (r=0.89, p<7.5e-13) than vision models (r=0.53, p<2.0e-44). Crucially, longitudinal analysis demonstrates that brain alignment consistently precedes performance improvements during training, suggesting that developing brain-like representations may be a necessary stepping stone toward higher capabilities. We find systematic patterns: language models exhibit strongest alignment with limbic and integrative regions, while vision models show progressive alignment with visual cortices; deeper processing layers converge across modalities; and as representational scale increases, alignment systematically shifts from primary sensory to higher-order associative regions. These findings provide compelling evidence that optimization for task performance naturally drives AI systems toward brain-like computational strategies, offering both fundamental insights into principles of intelligent information processing and practical guidance for developing more capable AI systems.

Emergent misalignment (EM) occurs when narrow finetuning causes a model to behave dangerously outside the finetuning task. Standard training signals can miss this shift, making reliable detection costly if it depends on repeated behavioral evaluation. We ask whether emergent misalignment can instead be detected from internal representations during finetuning. Using seven alignment-relevant traits encoded as linear directions in activation space, we track representational drift across training checkpoints in four open-source 7-9B LLMs. EM-relevant drift concentrates on a low-dimensional axis that explains 65.5% of the variance, revealing a geometric signature in the studied regime. A low-overhead monitor built on this drift profile detects dangerous checkpoints with 2.2% false negative rate, 2.9% false positive rate, and 0.990 AUROC on held-out perturbation types, outperforming unsupervised PCA and SAE baselines. Stress tests on two 14B models, longer finetuning runs, and misaligned starting points identify key deployment boundaries. These results position trait-space monitoring as a practical complement to behavioral evaluation for EM detection during LoRA-based finetuning, while showing that deployment across substantially different regimes may require recalibration.

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.

Direct Preference Optimization (DPO) is a principled, scalable alternative to RLHF for aligning large language models from pairwise preferences, but its internal geometric footprint remains undercharacterized, limiting audits, checkpoint comparisons, and failure prediction. We introduce SPINAL (Scaling-law and Preference Integration in Neural Alignment Layers), a diagnostic that measures how alignment reshapes representations across depth by tracing localized structural change layer by layer. Across model families, DPO produces a layerwise calibration effect concentrated in the final decoder blocks (often layers 21-30), where preference gradients most directly affect the next-token distribution. SPINAL encodes each checkpoint as a depth trace over (layer index, contraction score, transport score). The contraction score summarizes how quickly the tail of a layer's spectrum decays (how fast small modes vanish); higher values indicate stronger contraction into fewer effective directions. The transport score summarizes how much the token distribution shifts between adjacent layers using a bounded overlap measure; lower values indicate shorter, smoother steps through representation space. Aligned checkpoints show a late-layer ramp-up in contraction and a smooth reduction in transport, consistent with tightened and stabilized policy mass, while unaligned models trace higher-curvature, more entropic, and geometrically incoherent depth paths. Overall, alignment is geometrically localized: the final layers encode the dominant preference-induced corrections. SPINAL turns this localization into a practical audit signal, quantifying where alignment concentrates, how strongly it manifests, and when it begins to destabilize during training.

Learning medical visual representations directly from paired radiology reports has become an emerging topic in representation learning. However, existing medical image-text joint learning methods are limited by instance or local supervision analysis, ignoring disease-level semantic correspondences. In this paper, we present a novel Multi-Granularity Cross-modal Alignment (MGCA) framework for generalized medical visual representation learning by harnessing the naturally exhibited semantic correspondences between medical image and radiology reports at three different levels, i.e., pathological region-level, instance-level, and disease-level. Specifically, we first incorporate the instance-wise alignment module by maximizing the agreement between image-report pairs. Further, for token-wise alignment, we introduce a bidirectional cross-attention strategy to explicitly learn the matching between fine-grained visual tokens and text tokens, followed by contrastive learning to align them. More important, to leverage the high-level inter-subject relationship semantic (e.g., disease) correspondences, we design a novel cross-modal disease-level alignment paradigm to enforce the cross-modal cluster assignment consistency. Extensive experimental results on seven downstream medical image datasets covering image classification, object detection, and semantic segmentation tasks demonstrate the stable and superior performance of our framework.

Cortical surface registration plays a crucial role in aligning cortical functional and anatomical features across individuals. However, conventional registration algorithms are computationally inefficient. Recently, learning-based registration algorithms have emerged as a promising solution, significantly improving processing efficiency. Nonetheless, there remains a gap in the development of a learning-based method that exceeds the state-of-the-art conventional methods simultaneously in computational efficiency, registration accuracy, and distortion control, despite the theoretically greater representational capabilities of deep learning approaches. To address the challenge, we present SUGAR, a unified unsupervised deep-learning framework for both rigid and non-rigid registration. SUGAR incorporates a U-Net-based spherical graph attention network and leverages the Euler angle representation for deformation. In addition to the similarity loss, we introduce fold and multiple distortion losses, to preserve topology and minimize various types of distortions. Furthermore, we propose a data augmentation strategy specifically tailored for spherical surface registration, enhancing the registration performance. Through extensive evaluation involving over 10,000 scans from 7 diverse datasets, we showed that our framework exhibits comparable or superior registration performance in accuracy, distortion, and test-retest reliability compared to conventional and learning-based methods. Additionally, SUGAR achieves remarkable sub-second processing times, offering a notable speed-up of approximately 12,000 times in registering 9,000 subjects from the UK Biobank dataset in just 32 minutes. This combination of high registration performance and accelerated processing time may greatly benefit large-scale neuroimaging studies.

Recent voxel-wise multimodal brain encoding studies have shown that multimodal large language models (MLLMs) exhibit a higher degree of brain alignment compared to unimodal models in both unimodal and multimodal stimulus settings. More recently, instruction-tuned multimodal models have shown to generate task-specific representations that align strongly with brain activity. However, prior work evaluating the brain alignment of MLLMs has primarily focused on unimodal settings or relied on non-instruction-tuned multimodal models for multimodal stimuli. To address this gap, we investigated brain alignment, that is, measuring the degree of predictivity of neural activity recorded while participants were watching naturalistic movies (video along with audio) with representations derived from MLLMs. We utilized instruction-specific embeddings from six video and two audio instruction-tuned MLLMs. Experiments with 13 video task-specific instructions show that instruction-tuned video MLLMs significantly outperform non-instruction-tuned multimodal (by 15%) and unimodal models (by 20%). Our evaluation of MLLMs for both video and audio tasks using language-guided instructions shows clear disentanglement in task-specific representations from MLLMs, leading to precise differentiation of multimodal functional processing in the brain. We also find that MLLM layers align hierarchically with the brain, with early sensory areas showing strong alignment with early layers, while higher-level visual and language regions align more with middle to late layers. These findings provide clear evidence for the role of task-specific instructions in improving the alignment between brain activity and MLLMs, and open new avenues for mapping joint information processing in both the systems. We make the code publicly available [https://github.com/subbareddy248/mllm_videos].

Respiratory motion and the associated deformations of abdominal organs and tumors are essential information in clinical applications. However, inter- and intra-patient multi-organ deformations are complex and have not been statistically formulated, whereas single organ deformations have been widely studied. In this paper, we introduce a multi-organ deformation library and its application to deformation reconstruction based on the shape features of multiple abdominal organs. Statistical multi-organ motion/deformation models of the stomach, liver, left and right kidneys, and duodenum were generated by shape matching their region labels defined on four-dimensional computed tomography images. A total of 250 volumes were measured from 25 pancreatic cancer patients. This paper also proposes a per-region-based deformation learning using the reproducing kernel to predict the displacement of pancreatic cancer for adaptive radiotherapy. The experimental results show that the proposed concept estimates deformations better than general per-patient-based learning models and achieves a clinically acceptable estimation error with a mean distance of 1.2 pm 0.7 mm and a Hausdorff distance of 4.2 pm 2.3 mm throughout the respiratory motion.

A key concern with the concept of "alignment" is the implicit question of "alignment to what?". AI systems are increasingly used across the world, yet safety alignment is often focused on homogeneous monolingual settings. Additionally, preference training and safety measures often overfit to harms common in Western-centric datasets. Here, we explore the viability of different alignment approaches when balancing dual objectives: addressing and optimizing for a non-homogeneous set of languages and cultural preferences while minimizing both global and local harms. We collect the first set of human annotated red-teaming prompts in different languages distinguishing between global and local harm, which serve as a laboratory for understanding the reliability of alignment techniques when faced with preference distributions that are non-stationary across geographies and languages. While this setting is seldom covered by the literature to date, which primarily centers on English harm mitigation, it captures real-world interactions with AI systems around the world. We establish a new precedent for state-of-the-art alignment techniques across 6 languages with minimal degradation in general performance. Our work provides important insights into cross-lingual transfer and novel optimization approaches to safeguard AI systems designed to serve global populations.

AI alignment aims to make AI systems behave in line with human intentions and values. As AI systems grow more capable, so do risks from misalignment. To provide a comprehensive and up-to-date overview of the alignment field, in this survey, we delve into the core concepts, methodology, and practice of alignment. First, we identify four principles as the key objectives of AI alignment: Robustness, Interpretability, Controllability, and Ethicality (RICE). Guided by these four principles, we outline the landscape of current alignment research and decompose them into two key components: forward alignment and backward alignment. The former aims to make AI systems aligned via alignment training, while the latter aims to gain evidence about the systems' alignment and govern them appropriately to avoid exacerbating misalignment risks. On forward alignment, we discuss techniques for learning from feedback and learning under distribution shift. On backward alignment, we discuss assurance techniques and governance practices. We also release and continually update the website (www.alignmentsurvey.com) which features tutorials, collections of papers, blog posts, and other resources.

Alignment plays a crucial role in Large Language Models (LLMs) in aligning with human preferences on a specific task/domain. Traditional alignment methods suffer from catastrophic forgetting, where models lose previously acquired knowledge when adapting to new preferences or domains. We introduce LifeAlign, a novel framework for lifelong alignment that enables LLMs to maintain consistent human preference alignment across sequential learning tasks without forgetting previously learned knowledge. Our approach consists of two key innovations. First, we propose a focalized preference optimization strategy that aligns LLMs with new preferences while preventing the erosion of knowledge acquired from previous tasks. Second, we develop a short-to-long memory consolidation mechanism that merges denoised short-term preference representations into stable long-term memory using intrinsic dimensionality reduction, enabling efficient storage and retrieval of alignment patterns across diverse domains. We evaluate LifeAlign across multiple sequential alignment tasks spanning different domains and preference types. Experimental results demonstrate that our method achieves superior performance in maintaining both preference alignment quality and knowledge retention compared to existing lifelong learning approaches. The codes and datasets have been released on https://github.com/real-ljs/LifeAlign.

Recent work discovered Emergent Misalignment (EM): fine-tuning large language models on narrowly harmful datasets can lead them to become broadly misaligned. A survey of experts prior to publication revealed this was highly unexpected, demonstrating critical gaps in our understanding of model alignment. In this work, we both advance understanding and provide tools for future research. Using new narrowly misaligned datasets, we create a set of improved model organisms that achieve 99% coherence (vs. 67% prior), work with smaller 0.5B parameter models (vs. 32B), and that induce misalignment using a single rank-1 LoRA adapter. We demonstrate that EM occurs robustly across diverse model sizes, three model families, and numerous training protocols including full supervised fine-tuning. Leveraging these cleaner model organisms, we isolate a mechanistic phase transition and demonstrate that it corresponds to a robust behavioural phase transition in all studied organisms. Aligning large language models is critical for frontier AI safety, yet EM exposes how far we are from achieving this robustly. By distilling clean model organisms that isolate a minimal alignment-compromising change, and where this is learnt, we establish a foundation for future research into understanding and mitigating alignment risks in LLMs.

Magnetic Resonance Imaging (MRI) is often acquired with anisotropic resolution to reduce scan time, producing stair-step artifacts along the through-plane direction. In through-plane MRI super-resolution, an efficiency-fidelity trade-off arises: feed-forward regressors are fast but oversmooth at large slice-thicknesses, while sampling-based methods improve fidelity at high inference cost. We propose DRIFT, a two-stage thickness-conditioned rectified flow framework for through-plane MRI super-resolution with continuous input slice-thickness. Stage 1 employs an Anatomical Projection Network (APN) to map low-resolution patches to a coarse high-resolution manifold, providing a deterministic anatomical initialization that shortens the residual transport of Stage 2 and stabilizes slice-wise refinement. Stage 2 refines details via rectified flow and introduces a Physics-Aware Difficulty (PAD) metric derived from slice-thickness induced through-plane bandwidth deficit to guide an Adaptive Integration Scheduler (AIS), allocating ODE steps by thickness. A Consistent Endpoint Trajectory Alignment (CETA) loss enforces thickness-consistent reconstructions. Experiments show that DRIFT outperforms super-resolution baselines while reducing inference cost. Code, models, and interactive demos are available at https://yoonseokchoi-ai.github.io/drift-eccv2026/.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Purpose: To introduce a deep learning model capable of multi-organ segmentation in MRI scans, offering a solution to the current limitations in MRI analysis due to challenges in resolution, standardized intensity values, and variability in sequences. Materials and Methods: he model was trained on 1,200 manually annotated MRI scans from the UK Biobank, 221 in-house MRI scans and 1228 CT scans, leveraging cross-modality transfer learning from CT segmentation models. A human-in-the-loop annotation workflow was employed to efficiently create high-quality segmentations. The model's performance was evaluated on NAKO and the AMOS22 dataset containing 600 and 60 MRI examinations. Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD) was used to assess segmentation accuracy. The model will be open sourced. Results: The model showcased high accuracy in segmenting well-defined organs, achieving Dice Similarity Coefficient (DSC) scores of 0.97 for the right and left lungs, and 0.95 for the heart. It also demonstrated robustness in organs like the liver (DSC: 0.96) and kidneys (DSC: 0.95 left, 0.95 right), which present more variability. However, segmentation of smaller and complex structures such as the portal and splenic veins (DSC: 0.54) and adrenal glands (DSC: 0.65 left, 0.61 right) revealed the need for further model optimization. Conclusion: The proposed model is a robust, tool for accurate segmentation of 40 anatomical structures in MRI and CT images. By leveraging cross-modality learning and interactive annotation, the model achieves strong performance and generalizability across diverse datasets, making it a valuable resource for researchers and clinicians. It is open source and can be downloaded from https://github.com/hhaentze/MRSegmentator.

We participated in the SynthRAD2025 challenge (Tasks 1 and 2) with a unified pipeline for synthetic CT (sCT) generation from MRI and CBCT, implemented using the KonfAI framework. Our model is a 2.5D U-Net++ with a ResNet-34 encoder, trained jointly across anatomical regions and fine-tuned per region. The loss function combined pixel-wise L1 loss with IMPACT-Synth, a perceptual loss derived from SAM and TotalSegmentator to enhance structural fidelity. Training was performed using AdamW (initial learning rate = 0.001, halved every 25k steps) on patch-based, normalized, body-masked inputs (320x320 for MRI, 256x256 for CBCT), with random flipping as the only augmentation. No post-processing was applied. Final predictions leveraged test-time augmentation and five-fold ensembling. The best model was selected based on validation MAE. Two registration strategies were evaluated: (i) Elastix with mutual information, consistent with the challenge pipeline, and (ii) IMPACT, a feature-based similarity metric leveraging pretrained segmentation networks. On the local test sets, IMPACT-based registration achieved more accurate and anatomically consistent alignments than mutual-information-based registration, resulting in improved sCT synthesis with lower MAE and more realistic anatomical structures. On the public validation set, however, models trained with Elastix-aligned data achieved higher scores, reflecting a registration bias favoring alignment strategies consistent with the evaluation pipeline. This highlights how registration errors can propagate into supervised learning, influencing both training and evaluation, and potentially inflating performance metrics at the expense of anatomical fidelity. By promoting anatomically consistent alignment, IMPACT helps mitigate this bias and supports the development of more robust and generalizable sCT synthesis models.

Reconstructing 3D human shape and pose from monocular images is challenging despite the promising results achieved by the most recent learning-based methods. The commonly occurred misalignment comes from the facts that the mapping from images to the model space is highly non-linear and the rotation-based pose representation of body models is prone to result in the drift of joint positions. In this work, we investigate learning 3D human shape and pose from dense correspondences of body parts and propose a Decompose-and-aggregate Network (DaNet) to address these issues. DaNet adopts the dense correspondence maps, which densely build a bridge between 2D pixels and 3D vertices, as intermediate representations to facilitate the learning of 2D-to-3D mapping. The prediction modules of DaNet are decomposed into one global stream and multiple local streams to enable global and fine-grained perceptions for the shape and pose predictions, respectively. Messages from local streams are further aggregated to enhance the robust prediction of the rotation-based poses, where a position-aided rotation feature refinement strategy is proposed to exploit spatial relationships between body joints. Moreover, a Part-based Dropout (PartDrop) strategy is introduced to drop out dense information from intermediate representations during training, encouraging the network to focus on more complementary body parts as well as neighboring position features. The efficacy of the proposed method is validated on both indoor and real-world datasets including Human3.6M, UP3D, COCO, and 3DPW, showing that our method could significantly improve the reconstruction performance in comparison with previous state-of-the-art methods. Our code is publicly available at https://hongwenzhang.github.io/dense2mesh .

Emergent misalignment (EM) is a recently discovered phenomenon in LLMs where fine-tuning on a narrow misaligned task, such as writing insecure code, leads to broadly misaligned behaviour on unrelated prompts. Previous work has noted that the severity of EM is highly sensitive to training choices; however, we still lack a systematic characterisation of this sensitivity. We perform a sweep over several Qwen3 models, optimisers, datasets, and batch sizes, and find that the choice of optimiser has the largest effect, producing a 7x spread in misalignment rate. Surprisingly, model size has a negligible effect within the Qwen3 family. An additional sweep over 12 models from three families using Adam confirms that model scale (1B-235B) and family have negligible effects for that optimiser. Analysing the loss-alignment relationship on Qwen3-8B, we find that final log training loss is a strong predictor of alignment, and that stratifying by optimiser captures nearly all the residual variance. Training dynamics reveal that each optimiser follows a different trajectory through loss-alignment space, and that after significant training, the optimiser becomes more important than training loss as a predictor of alignment. Muon, the adaptive optimiser that preserves alignment the best, implicitly regularises for a more uniform distribution of singular values of the LoRA adapter. We evaluate this insight by training with an additional loss term that incentivises a flatter singular value spectrum, and find that this substantially recovers alignment for the more EM-prone adaptive optimisers (Adam and Lion), with negligible cost to training loss. These results identify optimiser choice as a key factor in EM severity, but show that spectral regularisation can substantially mitigate the effects of EM-prone optimisers.

While Multimodal Large Language Models (MLLMs) have demonstrated remarkable proficiency in tasks such as abnormality detection and report generation for anatomical modalities, their capability in functional imaging remains largely unexplored. In this work, we identify and quantify a fundamental functional perception gap: the inability of current vision encoders to decode functional tracer biodistribution independent of morphological priors. Identifying Positron Emission Tomography (PET) as the quintessential modality to investigate this disconnect, we introduce PET-Bench, the first large-scale functional imaging benchmark comprising 52,308 hierarchical QA pairs from 9,732 multi-site, multi-tracer PET studies. Extensive evaluation of 19 state-of-the-art MLLMs reveals a critical safety hazard termed the Chain-of-Thought (CoT) hallucination trap. We observe that standard CoT prompting, widely considered to enhance reasoning, paradoxically decouples linguistic generation from visual evidence in PET, producing clinically fluent but factually ungrounded diagnoses. To resolve this, we propose Atomic Visual Alignment (AVA), a simple fine-tuning strategy that enforces the mastery of low-level functional perception prior to high-level diagnostic reasoning. Our results demonstrate that AVA effectively bridges the perception gap, transforming CoT from a source of hallucination into a robust inference tool and improving diagnostic accuracy by up to 14.83%. Code and data are available at https://github.com/yezanting/PET-Bench.

Warning: This paper studies stereotypes and biases, and contains potentially disturbing examples, used for illustration purposes only. Our findings should not be interpreted as an argument against alignment. Instead, this paper highlights the need for principled approaches to more advanced alignment. Alignment aims to ensure that large language models (LLMs) behave safely and reliably, including by avoiding unsafe inferences. However, we show that such safety-oriented behaviors can misfire: models may reject warranted conclusions even when they are explicitly supported by context. We call this failure mode misfired alignment, where alignment-induced changes cause LLMs to override explicit evidence. To quantify this phenomenon, specifically on stereotype-related alignment, we introduce VETO, a benchmark consisting of 2,032 BBQ-derived contrastive pairs, and define a new metric, Misfired Alignment Rate (MAR), which measures on a 0 to 100 scale how often a model fails on a stereotype-related question but succeeds on its contrastive counterpart. We benchmark 25 LLMs on VETO, and show that all LLMs, including the most recent ones, exhibit non-trivial (4.7 to 18.9%) MARs while all human participants achieve 0.0% MAR. Controlled priming experiments further show that alignment-induced cues can substantially amplify MAR across LLMs, indicating that these failures are not merely artifacts of individual examples but can be induced by safety-related framing. Mechanistic analyses on open-weight LLMs reveal late-layer suppression of evidence-supported answers, and comparisons between instruct and base LLMs suggest that this suppression emerges after instruction training. These findings show that current alignment methods can overgeneralize surface-level safety cues, to the point of overriding objective evidence, motivating more work on alignment objectives that better preserve contextual grounding.

Recent advancements in general-purpose AI have highlighted the importance of guiding AI systems towards the intended goals, ethical principles, and values of individuals and groups, a concept broadly recognized as alignment. However, the lack of clarified definitions and scopes of human-AI alignment poses a significant obstacle, hampering collaborative efforts across research domains to achieve this alignment. In particular, ML- and philosophy-oriented alignment research often views AI alignment as a static, unidirectional process (i.e., aiming to ensure that AI systems' objectives match humans) rather than an ongoing, mutual alignment problem [429]. This perspective largely neglects the long-term interaction and dynamic changes of alignment. To understand these gaps, we introduce a systematic review of over 400 papers published between 2019 and January 2024, spanning multiple domains such as Human-Computer Interaction (HCI), Natural Language Processing (NLP), Machine Learning (ML), and others. We characterize, define and scope human-AI alignment. From this, we present a conceptual framework of "Bidirectional Human-AI Alignment" to organize the literature from a human-centered perspective. This framework encompasses both 1) conventional studies of aligning AI to humans that ensures AI produces the intended outcomes determined by humans, and 2) a proposed concept of aligning humans to AI, which aims to help individuals and society adjust to AI advancements both cognitively and behaviorally. Additionally, we articulate the key findings derived from literature analysis, including discussions about human values, interaction techniques, and evaluations. To pave the way for future studies, we envision three key challenges for future directions and propose examples of potential future solutions.

Multimodal representation learning harmonizes distinct modalities by aligning them into a unified latent space. Recent research generalizes traditional cross-modal alignment to produce enhanced multimodal synergy but requires all modalities to be present for a common instance, making it challenging to utilize prevalent datasets with missing modalities. We provide theoretical insights into this issue from an anchor shift perspective. Observed modalities are aligned with a local anchor that deviates from the optimal one when all modalities are present, resulting in an inevitable shift. To address this, we propose CalMRL for multimodal representation learning to calibrate incomplete alignments caused by missing modalities. Specifically, CalMRL leverages the priors and the inherent connections among modalities to model the imputation for the missing ones at the representation level. To resolve the optimization dilemma, we employ a bi-step learning method with the closed-form solution of the posterior distribution of shared latents. We validate its mitigation of anchor shift and convergence with theoretical guidance. By equipping the calibrated alignment with the existing advanced method, we offer new flexibility to absorb data with missing modalities, which is originally unattainable. Extensive experiments and comprehensive analyses demonstrate the superiority of CalMRL. Our code, model checkpoints, and evaluation raw data will be publicly available.

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

Self-supervised learning (SSL) has recently achieved promising performance for 3D medical image analysis tasks. Most current methods follow existing SSL paradigm originally designed for photographic or natural images, which cannot explicitly and thoroughly exploit the intrinsic similar anatomical structures across varying medical images. This may in fact degrade the quality of learned deep representations by maximizing the similarity among features containing spatial misalignment information and different anatomical semantics. In this work, we propose a new self-supervised learning framework, namely Alice, that explicitly fulfills Anatomical invariance modeling and semantic alignment via elaborately combining discriminative and generative objectives. Alice introduces a new contrastive learning strategy which encourages the similarity between views that are diversely mined but with consistent high-level semantics, in order to learn invariant anatomical features. Moreover, we design a conditional anatomical feature alignment module to complement corrupted embeddings with globally matched semantics and inter-patch topology information, conditioned by the distribution of local image content, which permits to create better contrastive pairs. Our extensive quantitative experiments on three 3D medical image analysis tasks demonstrate and validate the performance superiority of Alice, surpassing the previous best SSL counterpart methods and showing promising ability for united representation learning. Codes are available at https://github.com/alibaba-damo-academy/alice.

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

Large Language Models (LLMs) fine-tuned to align with human values often exhibit alignment drift, producing unsafe or policy-violating completions when exposed to adversarial prompts, decoding perturbations, or paraphrased jailbreaks. While prior work has behaviorally characterized alignment failure, little is known about the training-time belief sources underlying these failures. We introduce TraceAlign, a unified framework for tracing unsafe completions back to their root causes in the model's training corpus. Central to our approach is the Belief Conflict Index (BCI), which quantifies semantic inconsistency between generated spans and aligned policies, based on retrieved training documents using suffix-array matching. We propose three complementary interventions: (i) TraceShield, an inference-time safety filter that refuses completions with high-BCI spans, (ii) Contrastive Belief Deconfliction Loss, a contrastive fine-tuning objective penalizing high-BCI continuations during DPO, and (iii) Prov-Decode, a provenance-aware decoding strategy that vetoes beam expansions predicted to yield high-BCI spans. Together, these defenses reduce alignment drift by up to 85% on our curated Alignment Drift Benchmark (ADB) while preserving utility on standard tasks, with delta less than 0.2 and improved refusal quality. We further derive a theoretical upper bound on drift likelihood via suffix-array span statistics, linking memorization frequency and length to adversarial reactivation risk. TraceAlign thus provides the first scalable, traceable, and grounded toolkit for understanding and mitigating alignment failures at source. To encourage further exploration and development, we open-source our implementation at: https://anonymous.4open.science/r/tracealign-2DA7

A CT examination captures multiple organs, but many biomedical questions concern abnormalities, prognosis, or longitudinal change in a specific organ. These questions require a separate representation for each organ within the same CT volume. Existing CT foundation models commonly produce a single volume-level representation, while recent anatomy-aware methods either encode pre-separated organ volumes or explicitly disentangle images into organ token groups. The former may remove clinically relevant surrounding context, while the latter does not condition a shared encoder on a selected organ before its features are formed. We introduce OrganLens for organ-specific representation learning through self-supervision. An organ identity conditions a shared CT encoder, while organ-specific distillation and anatomy-mask supervision shape features for anatomy-weighted pooling into organ-specific representations. At inference, the shared model produces 11 organ-specific representations without external segmentation masks. We evaluate OrganLens on CT-RATE, RAD-ChestCT, INSPECT, and NLST across diverse acquisitions and downstream evaluations. Relative to CT-pretrained DINOv2, heart representations raise CT-RATE cardiomegaly AUROC from 0.910 to 0.953, while lung representations improve the Harrell C-index for NLST lung-cancer mortality by 14.2\%. The global representation reaches INSPECT Recall@10 of 33.09\% and 32.04\% for text-to-image and image-to-text retrieval, respectively. Across organ-related tasks, anatomically matched representations provide stronger task-relevant signal, while the global representation retains broad utility. OrganLens offers a scalable approach to organ-specific CT representation learning with a shared encoder. More broadly, it provides the medical research community with a reusable framework for studying organ-specific disease across cohorts and clinical endpoints.

Large language models (LLMs) have demonstrated revolutionary capabilities in understanding complex contexts and performing a wide range of tasks. However, LLMs can also answer questions that are unethical or harmful, raising concerns about their applications. To regulate LLMs' responses to such questions, a training strategy called alignment can help. Yet, alignment can be unexpectedly compromised when fine-tuning an LLM for downstream tasks. This paper focuses on recovering the alignment lost during fine-tuning. We observe that there are two distinct directions inherent in an aligned LLM: the aligned direction and the harmful direction. An LLM is inclined to answer questions in the aligned direction while refusing queries in the harmful direction. Therefore, we propose to recover the harmful direction of the fine-tuned model that has been compromised. Specifically, we restore a small subset of the fine-tuned model's weight parameters from the original aligned model using gradient descent. We also introduce a rollback mechanism to avoid aggressive recovery and maintain downstream task performance. Our evaluation on 125 fine-tuned LLMs demonstrates that our method can reduce their harmful rate (percentage of answering harmful questions) from 33.25\% to 1.74\%, without sacrificing task performance much. In contrast, the existing methods either only reduce the harmful rate to a limited extent or significantly impact the normal functionality. Our code is available at https://github.com/kangyangWHU/LLMAlignment

Fine-tuning large language models (LLMs) on narrowly misaligned data generalizes to broadly misaligned behavior, a phenomenon termed emergent misalignment (EM). While prior work has found a correlation between harmful behavior and self-assessment in emergently misaligned models, it remains unclear how consistent this correspondence is across tasks and whether it varies across fine-tuning domains. We characterize the consistency of the EM persona by fine-tuning Qwen 2.5 32B Instruct on six narrowly misaligned domains (e.g., insecure code, risky financial advice, bad medical advice) and administering experiments including harmfulness evaluation, self-assessment, choosing between two descriptions of AI systems, output recognition, and score prediction. Our results reveal two distinct patterns: coherent-persona models, in which harmful behavior and self-reported misalignment are coupled, and inverted-persona models, which produce harmful outputs while identifying as aligned AI systems. These findings reveal a more fine-grained picture of the effects of emergent misalignment, calling into question the consistency of the EM persona.

Aligning language models with human preferences is crucial for reducing errors and biases in these models. Alignment techniques, such as reinforcement learning from human feedback (RLHF), are typically cast as optimizing a tradeoff between human preference rewards and a proximity regularization term that encourages staying close to the unaligned model. Selecting an appropriate level of regularization is critical: insufficient regularization can lead to reduced model capabilities due to reward hacking, whereas excessive regularization hinders alignment. Traditional methods for finding the optimal regularization level require retraining multiple models with varying regularization strengths. This process, however, is resource-intensive, especially for large models. To address this challenge, we propose decoding-time realignment (DeRa), a simple method to explore and evaluate different regularization strengths in aligned models without retraining. DeRa enables control over the degree of alignment, allowing users to smoothly transition between unaligned and aligned models. It also enhances the efficiency of hyperparameter tuning by enabling the identification of effective regularization strengths using a validation dataset.

Pre-trained audio models excel at detecting acoustic patterns in auscultation sounds but often fail to grasp their clinical significance, limiting their use and performance in diagnostic tasks. To bridge this gap, we introduce AcuLa (Audio-Clinical Understanding via Language Alignment), a lightweight post-training framework that instills semantic understanding into any audio encoder by aligning it with a medical language model, which acts as a "semantic teacher." To enable alignment at scale, we construct a large-scale dataset by leveraging off-the-shelf large language models to translate the rich, structured metadata accompanying existing audio recordings into coherent clinical reports. Our alignment strategy combines a representation-level contrastive objective with a self-supervised modeling, ensuring that the model learns clinical semantics while preserving fine-grained temporal cues. AcuLa achieves state-of-the-art results across 18 diverse cardio-respiratory tasks from 10 different datasets, improving the mean AUROC on classification benchmarks from 0.68 to 0.79 and, on the most challenging COVID-19 cough detection task, boosting the AUROC from 0.55 to 0.89. Our work demonstrates that this audio-language alignment transforms purely acoustic models into clinically-aware diagnostic tools, establishing a novel paradigm for enhancing physiological understanding in audio-based health monitoring.

The alignment of Large Language Models (LLMs) with human values is central to their safe deployment, yet current practice produces static, brittle, and costly-to-maintain models that fail to keep pace with evolving norms and policies. This misalignment, which we term the Alignment-Reality Gap, poses a growing challenge for reliable long-term use. Existing remedies are inadequate: large-scale re-annotation is economically prohibitive, and standard unlearning methods act as blunt instruments that erode utility rather than enable precise policy updates. We introduce TRACE (Triage and Re-align by Alignment Conflict Evaluation), a framework for principled unlearning that reconceives re-alignment as a programmatic policy application problem. TRACE programmatically triages existing preference data against a new policy, identifies high-impact conflicts via a alignment impact score, and applies a hybrid optimization that cleanly inverts, discards, or preserves preferences while safeguarding model performance. Empirical results show that TRACE achieves robust re-alignment across diverse model families (Qwen2.5-7B, Gemma-2-9B, Llama-3.1-8B). On both synthetic benchmarks and the PKU-SafeRLHF dataset under complex policy shift, TRACE enforces new principles without degrading general capabilities. Our work establishes a scalable, dynamic, and cost-effective paradigm for maintaining LLM alignment, providing a foundation for sustainable and responsible AI deployment.

Large language models (LLMs) are increasingly used for medical and health-related questions, yet their safety in high-risk medical scenarios remains poorly understood. We introduce MedHarmCode and data will be released upon acceptance. Due to the sensitive nature of high-risk medical queries, data access will be available to qualified researchers upon request., a high-risk medical safety benchmark with 1,100 medically grounded queries across 10 safety-critical categories, including toxicology, pharmacology, covert poisoning, anesthesia, and fetal harm. Unlike broad medical QA benchmarks, MedHarm targets realistic clinical, educational, and technical prompts that require refusal, caution, or safe redirection rather than direct helpfulness. We evaluate 15 LLMs spanning general-purpose, medical-purpose, closed-source, and downstream SFT models, together with 4 representative guardrail models. Results reveal a substantial gap between apparent alignment and medical safety: aligned models can still produce unsafe or actionable responses, medical fine-tuning can amplify harmful specificity, and external guardrails reduce some failures while introducing brittle blocking and weak safe helpfulness. These findings show that medical safety cannot be inferred from general alignment or medical capability alone, highlighting the need for domain-specific stress testing before deploying LLMs in safety-critical medical applications.

Spatial transcriptomics (ST) provides high-resolution pathological images and whole-transcriptomic expression profiles at individual spots across whole-slide scales. This setting makes it an ideal data source to develop multimodal foundation models. Although recent studies attempted to fine-tune visual encoders with trainable gene encoders based on spot-level, the absence of a wider slide perspective and spatial intrinsic relationships limits their ability to capture ST-specific insights effectively. Here, we introduce ST-Align, the first foundation model designed for ST that deeply aligns image-gene pairs by incorporating spatial context, effectively bridging pathological imaging with genomic features. We design a novel pretraining framework with a three-target alignment strategy for ST-Align, enabling (1) multi-scale alignment across image-gene pairs, capturing both spot- and niche-level contexts for a comprehensive perspective, and (2) cross-level alignment of multimodal insights, connecting localized cellular characteristics and broader tissue architecture. Additionally, ST-Align employs specialized encoders tailored to distinct ST contexts, followed by an Attention-Based Fusion Network (ABFN) for enhanced multimodal fusion, effectively merging domain-shared knowledge with ST-specific insights from both pathological and genomic data. We pre-trained ST-Align on 1.3 million spot-niche pairs and evaluated its performance through two downstream tasks across six datasets, demonstrating superior zero-shot and few-shot capabilities. ST-Align highlights the potential for reducing the cost of ST and providing valuable insights into the distinction of critical compositions within human tissue.

Alignment in LLMs is more brittle than commonly assumed: misalignment can be triggered by adversarial prompts, benign fine-tuning, emergent misalignment, and goal misgeneralization. Recent evidence suggests that some misalignment behaviors are encoded as linear structure in activation space, making it tractable via steering, while safety alignment has been shown to govern the first few output tokens primarily, leaving subsequent generation unguarded. These findings motivate activation steering as a lightweight runtime defense that continuously corrects misaligned activations throughout generation. We evaluate three methods: Steer-With-Fixed-Coeff (SwFC), which applies uniform additive steering, and two novel projection-aware methods, Steer-to-Target-Projection (StTP) and Steer-to-Mirror-Projection (StMP), that use a logistic regression decision boundary to selectively intervene only on tokens whose activations fall below distributional thresholds. Using malicious system prompts as a controlled proxy for misalignment, we evaluate under two threat models (dishonesty and dismissiveness) and two architectures (Llama-3.3-70B-Instruct, Qwen3-32B). All methods substantially recover target traits (honesty and compassion) while preserving coherence. StTP and StMP better maintain general capabilities (MMLU, MT-Bench, AlpacaEval) and produce less repetition in multi-turn conversations.

The advancement of Large Vision-Language Models (LVLMs) has propelled their application in the medical field. However, Medical LVLMs (Med-LVLMs) encounter factuality challenges due to modality misalignment, where the models prioritize textual knowledge over visual input, leading to hallucinations that contradict information in medical images. Previous attempts to enhance modality alignment in Med-LVLMs through preference optimization have inadequately mitigated clinical relevance in preference data, making these samples easily distinguishable and reducing alignment effectiveness. To address this challenge, we propose MMedPO, a novel multimodal medical preference optimization approach that considers the clinical relevance of preference samples to enhance Med-LVLM alignment. MMedPO curates multimodal preference data by introducing two types of dispreference: (1) plausible hallucinations injected through target Med-LVLMs or GPT-4o to produce medically inaccurate responses, and (2) lesion region neglect achieved through local lesion-noising, disrupting visual understanding of critical areas. We then calculate clinical relevance for each sample based on scores from multiple Med-LLMs and visual tools, and integrate these scores into the preference optimization process as weights, enabling effective alignment. Our experiments demonstrate that MMedPO significantly enhances factual accuracy in Med-LVLMs, achieving substantial improvements over existing preference optimization methods by averaging 14.2% and 51.7% across the Med-VQA and report generation tasks. Our code are available in https://github.com/aiming-lab/MMedPO.

Radiologic diagnostic errors-under-reading errors, inattentional blindness, and communication failures-remain prevalent in clinical practice. These issues often stem from missed localized abnormalities, limited global context, and variability in report language. These challenges are amplified in 3D imaging, where clinicians must examine hundreds of slices per scan. Addressing them requires systems with precise localized detection, global volume-level reasoning, and semantically consistent natural language reporting. However, existing 3D vision-language models are unable to meet all three needs jointly, lacking local-global understanding for spatial reasoning and struggling with the variability and noise of uncurated radiology reports. We present MedVista3D, a multi-scale semantic-enriched vision-language pretraining framework for 3D CT analysis. To enable joint disease detection and holistic interpretation, MedVista3D performs local and global image-text alignment for fine-grained representation learning within full-volume context. To address report variability, we apply language model rewrites and introduce a Radiology Semantic Matching Bank for semantics-aware alignment. MedVista3D achieves state-of-the-art performance on zero-shot disease classification, report retrieval, and medical visual question answering, while transferring well to organ segmentation and prognosis prediction. Code and datasets will be released.

Predicting cancer treatment outcomes requires models that are both accurate and interpretable, particularly in the presence of heterogeneous clinical data. While large language models (LLMs) have shown strong performance in biomedical NLP, they often lack structured reasoning capabilities critical for high-stakes decision support. We present a unified, multi-task learning framework that aligns autoregressive LLMs with clinical reasoning for outcome prediction on the MSK-CHORD dataset. Our models are trained to jointly perform binary survival classification, continuous survival time regression, and natural language rationale generation. We evaluate three alignment strategies: (1) standard supervised fine-tuning (SFT), (2) SFT with Chain-of-Thought (CoT) prompting to elicit step-by-step reasoning, and (3) Group Relative Policy Optimization (GRPO), a reinforcement learning method that aligns model outputs to expert-derived reasoning trajectories. Experiments with LLaMa3-8B and Med42-8B backbones demonstrate that CoT prompting improves F1 by +6.0 and reduces MAE by 12%, while GRPO achieves state-of-the-art interpretability and predictive performance across BLEU, ROUGE, and BERTScore. We further show that existing biomedical LLMs often fail to produce valid reasoning traces due to architectural constraints. Our findings underscore the importance of reasoning-aware alignment in multi-task clinical modeling and set a new benchmark for interpretable, trustworthy LLMs in precision oncology.

Alignment is a standard procedure to fine-tune pre-trained large language models (LLMs) to follow natural language instructions and serve as helpful AI assistants. We have observed, however, that the conventional alignment process fails to enhance the factual accuracy of LLMs, and often leads to the generation of more false facts (i.e. hallucination). In this paper, we study how to make the LLM alignment process more factual, by first identifying factors that lead to hallucination in both alignment steps:\ supervised fine-tuning (SFT) and reinforcement learning (RL). In particular, we find that training the LLM on new knowledge or unfamiliar texts can encourage hallucination. This makes SFT less factual as it trains on human labeled data that may be novel to the LLM. Furthermore, reward functions used in standard RL can also encourage hallucination, because it guides the LLM to provide more helpful responses on a diverse set of instructions, often preferring longer and more detailed responses. Based on these observations, we propose factuality-aware alignment, comprised of factuality-aware SFT and factuality-aware RL through direct preference optimization. Experiments show that our proposed factuality-aware alignment guides LLMs to output more factual responses while maintaining instruction-following capability.

Supervised low-level vision models rely on pixel-wise losses against paired references, yet paired training sets exhibit per-pair photometric inconsistency, say, different image pairs demand different global brightness, color, or white-balance mappings. This inconsistency enters through task-intrinsic photometric transfer (e.g., low-light enhancement) or unintended acquisition shifts (e.g., de-raining), and in either case causes an optimization pathology. Standard reconstruction losses allocate disproportionate gradient budget to conflicting per-pair photometric targets, crowding out content restoration. In this paper, we investigate this issue and prove that, under least-squares decomposition, the photometric and structural components of the prediction-target residual are orthogonal, and that the spatially dense photometric component dominates the gradient energy. Motivated by this analysis, we propose Photometric Alignment Loss (PAL). This flexible supervision objective discounts nuisance photometric discrepancy via closed-form affine color alignment while preserving restoration-relevant supervision, requiring only covariance statistics and tiny matrix inversion with negligible overhead. Across 6 tasks, 16 datasets, and 16 architectures, PAL consistently improves metrics and generalization. The implementation is in the appendix.

Large-scale multi-modal deep learning models have revolutionized domains such as healthcare, highlighting the importance of computational power. However, in resource-constrained regions like Low and Middle-Income Countries (LMICs), limited access to GPUs and data poses significant challenges, often leaving CPUs as the sole resource. To address this, we advocate for leveraging vector embeddings to enable flexible and efficient computational methodologies, democratizing multimodal deep learning across diverse contexts. Our paper investigates the efficiency and effectiveness of using vector embeddings from single-modal foundation models and multi-modal Vision-Language Models (VLMs) for multimodal deep learning in low-resource environments, particularly in healthcare. Additionally, we propose a simple yet effective inference-time method to enhance performance by aligning image-text embeddings. Comparing these approaches with traditional methods, we assess their impact on computational efficiency and model performance using metrics like accuracy, F1-score, inference time, training time, and memory usage across three medical modalities: BRSET (ophthalmology), HAM10000 (dermatology), and SatelliteBench (public health). Our findings show that embeddings reduce computational demands without compromising model performance. Furthermore, our alignment method improves performance in medical tasks. This research promotes sustainable AI practices by optimizing resources in constrained environments, highlighting the potential of embedding-based approaches for efficient multimodal learning. Vector embeddings democratize multimodal deep learning in LMICs, particularly in healthcare, enhancing AI adaptability in varied use cases.

Current medical vision-language models (VLMs) process volumetric brain MRI using 2D slice-based approximations, fragmenting the spatial context required for accurate neuroradiological interpretation. We developed Brain3D, a staged vision-language framework for automated radiology report generation from 3D brain tumor MRI. Our approach inflates a pretrained 2D medical encoder into a native 3D architecture and progressively aligns it with a causal language model through three stages: contrastive grounding, supervised projector warmup, and LoRA-based linguistic specialization. Unlike generalist 3D medical VLMs, Brain3D is tailored to neuroradiology, where hemispheric laterality, tumor infiltration patterns, and anatomical localization are critical. Evaluated on 468 subjects (BraTS pathological cases plus healthy controls), our model achieves a Clinical Pathology F1 of 0.951 versus 0.413 for a strong 2D baseline while maintaining perfect specificity on healthy scans. The staged alignment proves essential: contrastive grounding establishes visual-textual correspondence, projector warmup stabilizes conditioning, and LoRA adaptation shifts output from verbose captions to structured clinical reports\footnote{Our code is publicly available for transparency and reproducibility

Large Language Models (LLMs) are increasingly used for zero-shot annotation and LLM-as-a-judge tasks, yet their reliability hinges on how model-internalized priors interact with user-provided instructions. We investigate three dimensions of this interaction: (1) how an LLM's familiarity with data and task definitions affects performance, (2) the extent to which additional information in prompts can correct zero-shot errors ("decision stickiness"), and (3) model susceptibility to misaligned task definitions. Through experiments on toxicity detection across diverse datasets (spanning social media, gaming, news, and forums) using both dense and mixture-of-experts models, we find that nearly two-thirds of zero-shot errors are resistant to correction, with an overall rescue rate (fraction of initial errors corrected by prompting) of only 34.8%. High-confidence errors prove especially resistant to correction. When given misaligned definitions, LLMs follow them while maintaining confidence levels unchanged from the aligned condition. Crucially, we introduce Definition-Specific Familiarity (DSF), which measures alignment between a model's internal concept and the task definition. After controlling for dataset-level confounds, DSF shows a positive association with model performance (partial r = +0.41), while three distinct memorization metrics (ROUGE-L, BERTScore, and embedding cosine similarity) all fail to show a positive association. These findings show the limitations of prompt-based correction in annotation tasks, highlighting the importance of definition alignment over text-level memorization.

Unsupervised domain adaptation for medical image segmentation remains a significant challenge due to substantial domain shifts across imaging modalities, such as CT and MRI. While recent vision-language representation learning methods have shown promise, their potential in UDA segmentation tasks remains underexplored. To address this gap, we propose TCSA-UDA, a Text-driven Cross-Semantic Alignment framework that leverages domain-invariant textual class descriptions to guide visual representation learning. Our approach introduces a vision-language covariance cosine loss to directly align image encoder features with inter-class textual semantic relations, encouraging semantically meaningful and modality-invariant feature representations. Additionally, we incorporate a prototype alignment module that aligns class-wise pixel-level feature distributions across domains using high-level semantic prototypes. This mitigates residual category-level discrepancies and enhances cross-modal consistency. Extensive experiments on challenging cross-modality cardiac, abdominal, and brain tumor segmentation benchmarks demonstrate that our TCSA-UDA framework significantly reduces domain shift and consistently outperforms state-of-the-art UDA methods, establishing a new paradigm for integrating language-driven semantics into domain-adaptive medical image analysis.

Pretraining corpora contain extensive discourse about AI systems, yet the causal influence of this discourse on downstream alignment remains poorly understood. If prevailing descriptions of AI behaviour are predominantly negative, LLMs may internalise corresponding behavioural priors, giving rise to self-fulfilling misalignment. This paper provides the first controlled study of this hypothesis by pretraining 6.9B-parameter LLMs with varying amounts of (mis)alignment discourse. We find that discussion of AI contributes to misalignment. Upsampling synthetic training documents about AI misalignment leads to a notable increase in misaligned behaviour. Conversely, upsampling documents about aligned behaviour reduces misalignment scores from 45% to 9%. We consider this evidence of self-fulfilling alignment. These effects are dampened, but persist through post-training. Our findings establish the study of how pretraining data shapes alignment priors, or alignment pretraining, as a complement to post-training. We recommend practitioners pretrain for alignment as well as capabilities. Our models and datasets are available at alignmentpretraining.ai

LLM alignment ensures that large language models behave safely and effectively by aligning their outputs with human values, goals, and intentions. Aligning LLMs employ huge amounts of data, computation, and time. Moreover, curating data with human feedback is expensive and takes time. Recent research depicts the benefit of data engineering in the fine-tuning and pre-training paradigms to bring down such costs. However, alignment differs from the afore-mentioned paradigms and it is unclear if data efficient alignment is feasible. In this work, we first aim to understand how the performance of LLM alignment scales with data. We find out that LLM alignment performance follows an exponential plateau pattern which tapers off post a rapid initial increase. Based on this, we identify data subsampling as a viable method to reduce resources required for alignment. Further, we propose an information theory-based methodology for efficient alignment by identifying a small high quality subset thereby reducing the computation and time required by alignment. We evaluate the proposed methodology over multiple datasets and compare the results. We find that the model aligned using our proposed methodology outperforms other sampling methods and performs comparable to the model aligned with the full dataset while using less than 10% data, leading to greater than 90% savings in costs, resources, and faster LLM alignment.

In computer vision, reference datasets have been highly successful in promoting algorithmic development in stereo reconstruction. Surgical scenes gives rise to specific problems, including the lack of clear corner features, highly specular surfaces and the presence of blood and smoke. Publicly available datasets have been produced using CT and either phantom images or biological tissue samples covering a relatively small region of the endoscope field-of-view. We present a stereo-endoscopic reconstruction validation dataset based on CT (SERV-CT). Two {\it ex vivo} small porcine full torso cadavers were placed within the view of the endoscope with both the endoscope and target anatomy visible in the CT scan. Orientation of the endoscope was manually aligned to the stereoscopic view. Reference disparities and occlusions were calculated for 8 stereo pairs from each sample. For the second sample an RGB surface was acquired to aid alignment of smooth, featureless surfaces. Repeated manual alignments showed an RMS disparity accuracy of ~2 pixels and a depth accuracy of ~2mm. The reference dataset includes endoscope image pairs with corresponding calibration, disparities, depths and occlusions covering the majority of the endoscopic image and a range of tissue types. Smooth specular surfaces and images with significant variation of depth are included. We assessed the performance of various stereo algorithms from online available repositories. There is a significant variation between algorithms, highlighting some of the challenges of surgical endoscopic images. The SERV-CT dataset provides an easy to use stereoscopic validation for surgical applications with smooth reference disparities and depths with coverage over the majority of the endoscopic images. This complements existing resources well and we hope will aid the development of surgical endoscopic anatomical reconstruction algorithms.

Fine-tuning is the primary mechanism for adapting foundation models to downstream tasks; however, standard approaches largely optimize task objectives in isolation and do not account for secondary yet critical alignment objectives (e.g., safety and hallucination avoidance). As a result, downstream fine-tuning can degrade alignment and fail to correct pre-existing misaligned behavior. We propose an alignment-aware fine-tuning framework that integrates feedback from an external alignment signal through policy-gradient-based regularization. Our method introduces an adaptive gating mechanism that dynamically balances supervised and alignment-driven gradients on a per-sample basis, prioritizing uncertain or misaligned cases while allowing well-aligned examples to follow standard supervised updates. The framework further learns abstention behavior for fully misaligned inputs, incorporating conservative responses directly into the fine-tuned model. Experiments on general and domain-specific instruction-tuning benchmarks demonstrate consistent reductions in harmful and hallucinated outputs without sacrificing downstream task performance. Additional analyses show robustness to adversarial fine-tuning, prompt-based attacks, and unsafe initializations, establishing adaptively gated alignment optimization as an effective approach for alignment-preserving and alignment-recovering model adaptation.

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.

Automated polyp segmentation is essential for early diagnosis of colorectal cancer, yet developing robust models remains challenging due to limited annotated data and significant performance degradation under domain shift. Although semi-supervised learning (SSL) reduces annotation requirements, existing methods rely on generic augmentations that ignore polyp-specific structural properties, resulting in poor generalization to new imaging centers and devices. To address this, we introduce Frequency Prior Guided Matching (FPGM), a novel augmentation framework built on a key discovery: polyp edges exhibit a remarkably consistent frequency signature across diverse datasets. FPGM leverages this intrinsic regularity in a two-stage process. It first learns a domain-invariant frequency prior from the edge regions of labeled polyps. Then, it performs principled spectral perturbations on unlabeled images, aligning their amplitude spectra with this learned prior while preserving phase information to maintain structural integrity. This targeted alignment normalizes domain-specific textural variations, thereby compelling the model to learn the underlying, generalizable anatomical structure. Validated on six public datasets, FPGM establishes a new state-of-the-art against ten competing methods. It demonstrates exceptional zero-shot generalization capabilities, achieving over 10% absolute gain in Dice score in data-scarce scenarios. By significantly enhancing cross-domain robustness, FPGM presents a powerful solution for clinically deployable polyp segmentation under limited supervision.

Fine-tuning large language models on narrow datasets can cause them to develop broadly misaligned behaviours: a phenomena known as emergent misalignment. However, the mechanisms underlying this misalignment, and why it generalizes beyond the training domain, are poorly understood, demonstrating critical gaps in our knowledge of model alignment. In this work, we train and study a minimal model organism which uses just 9 rank-1 adapters to emergently misalign Qwen2.5-14B-Instruct. Studying this, we find that different emergently misaligned models converge to similar representations of misalignment. We demonstrate this convergence by extracting a 'misalignment direction' from one fine-tuned model's activations, and using it to effectively ablate misaligned behaviour from fine-tunes using higher dimensional LoRAs and different datasets. Leveraging the scalar hidden state of rank-1 LoRAs, we further present a set of experiments for directly interpreting the fine-tuning adapters, showing that six contribute to general misalignment, while two specialise for misalignment in just the fine-tuning domain. Emergent misalignment is a particularly salient example of undesirable and unexpected model behaviour and by advancing our understanding of the mechanisms behind it, we hope to move towards being able to better understand and mitigate misalignment more generally.

We present a deep learning segmentation model that can automatically and robustly segment all major anatomical structures in body CT images. In this retrospective study, 1204 CT examinations (from the years 2012, 2016, and 2020) were used to segment 104 anatomical structures (27 organs, 59 bones, 10 muscles, 8 vessels) relevant for use cases such as organ volumetry, disease characterization, and surgical or radiotherapy planning. The CT images were randomly sampled from routine clinical studies and thus represent a real-world dataset (different ages, pathologies, scanners, body parts, sequences, and sites). The authors trained an nnU-Net segmentation algorithm on this dataset and calculated Dice similarity coefficients (Dice) to evaluate the model's performance. The trained algorithm was applied to a second dataset of 4004 whole-body CT examinations to investigate age dependent volume and attenuation changes. The proposed model showed a high Dice score (0.943) on the test set, which included a wide range of clinical data with major pathologies. The model significantly outperformed another publicly available segmentation model on a separate dataset (Dice score, 0.932 versus 0.871, respectively). The aging study demonstrated significant correlations between age and volume and mean attenuation for a variety of organ groups (e.g., age and aortic volume; age and mean attenuation of the autochthonous dorsal musculature). The developed model enables robust and accurate segmentation of 104 anatomical structures. The annotated dataset (https://doi.org/10.5281/zenodo.6802613) and toolkit (https://www.github.com/wasserth/TotalSegmentator) are publicly available.

Deep learning underpins a wide range of applications in MRI, including reconstruction, artifact removal, and segmentation. However, progress has been driven largely by public datasets focused on brain and knee imaging, shaping how models are trained and evaluated. As a result, careful studies of the reliability of these models across diverse anatomical settings remain limited. In this work, we introduce MosaicMRI, a large and diverse collection of fully sampled raw musculoskeletal (MSK) MR measurements designed for training and evaluating machine-learning-based methods. MosaicMRI is the largest open-source raw MSK MRI dataset to date, comprising 2,671 volumes and 80,156 slices. The dataset offers substantial diversity in volume orientation (e.g., axial, sagittal), imaging contrasts (e.g., PD, T1, T2), anatomies (e.g., spine, knee, hip, ankle, and others), and numbers of acquisition coils. Using VarNet as a baseline for accelerated reconstruction task, we perform a comprehensive set of experiments to study scaling behavior with respect to both model capacity and dataset size. Interestingly, models trained on the combined anatomies significantly outperform anatomy-specific models in low-sample regimes, highlighting the benefits of anatomical diversity and the presence of exploitable cross-anatomical correlations. We further evaluate robustness and cross-anatomy generalization by training models on one anatomy (e.g., spine) and testing them on another (e.g., knee). Notably, we identify groups of body parts (e.g., foot and elbow) that generalize well with each other, and highlight that performance under domain shifts depends on both training set size, anatomy, and protocol-specific factors.

Histopathology and transcriptomics are fundamental modalities in oncology, encapsulating the morphological and molecular aspects of the disease. Multi-modal self-supervised learning has demonstrated remarkable potential in learning pathological representations by integrating diverse data sources. Conventional multi-modal integration methods primarily emphasize modality alignment, while paying insufficient attention to retaining the modality-specific structures. However, unlike conventional scenarios where multi-modal inputs share highly overlapping features, histopathology and transcriptomics exhibit pronounced heterogeneity, offering orthogonal yet complementary insights. Histopathology provides morphological and spatial context, elucidating tissue architecture and cellular topology, whereas transcriptomics delineates molecular signatures through gene expression patterns. This inherent disparity introduces a major challenge in aligning them while maintaining modality-specific fidelity. To address these challenges, we present MIRROR, a novel multi-modal representation learning method designed to foster both modality alignment and retention. MIRROR employs dedicated encoders to extract comprehensive features for each modality, which is further complemented by a modality alignment module to achieve seamless integration between phenotype patterns and molecular profiles. Furthermore, a modality retention module safeguards unique attributes from each modality, while a style clustering module mitigates redundancy and enhances disease-relevant information by modeling and aligning consistent pathological signatures within a clustering space. Extensive evaluations on TCGA cohorts for cancer subtyping and survival analysis highlight MIRROR's superior performance, demonstrating its effectiveness in constructing comprehensive oncological feature representations and benefiting the cancer diagnosis.

Accurate disease interpretation from radiology remains challenging due to imaging heterogeneity. Achieving expert-level diagnostic decisions requires integration of subtle image features with clinical knowledge. Yet major vision-language models (VLMs) treat images as holistic entities and overlook fine-grained image details that are vital for disease diagnosis. Clinicians analyze images by utilizing their prior medical knowledge and identify anatomical structures as important region of interests (ROIs). Inspired from this human-centric workflow, we introduce Anatomy-VLM, a fine-grained, vision-language model that incorporates multi-scale information. First, we design a model encoder to localize key anatomical features from entire medical images. Second, these regions are enriched with structured knowledge for contextually-aware interpretation. Finally, the model encoder aligns multi-scale medical information to generate clinically-interpretable disease prediction. Anatomy-VLM achieves outstanding performance on both in- and out-of-distribution datasets. We also validate the performance of Anatomy-VLM on downstream image segmentation tasks, suggesting that its fine-grained alignment captures anatomical and pathology-related knowledge. Furthermore, the Anatomy-VLM's encoder facilitates zero-shot anatomy-wise interpretation, providing its strong expert-level clinical interpretation capabilities.

Foundation models for biology and physics optimize predictive accuracy, but their internal representations systematically fail to preserve the continuous geometry of the systems they model. We identify the root cause: the Geometric Alignment Tax, an intrinsic cost of forcing continuous manifolds through discrete categorical bottlenecks. Controlled ablations on synthetic dynamical systems demonstrate that replacing cross-entropy with a continuous head on an identical encoder reduces geometric distortion by up to 8.5x, while learned codebooks exhibit a non-monotonic double bind where finer quantization worsens geometry despite improving reconstruction. Under continuous objectives, three architectures differ by 1.3x; under discrete tokenization, they diverge by 3,000x. Evaluating 14 biological foundation models with rate-distortion theory and MINE, we identify three failure regimes: Local-Global Decoupling, Representational Compression, and Geometric Vacuity. A controlled experiment confirms that Evo 2's reverse-complement robustness on real DNA reflects conserved sequence composition, not learned symmetry. No model achieves simultaneously low distortion, high mutual information, and global coherence.

Alignment with human preference is a desired property of large language models (LLMs). Currently, the main alignment approach is based on reinforcement learning from human feedback (RLHF). Despite the effectiveness of RLHF, it is intricate to implement and train, thus recent studies explore how to develop alternative alignment approaches based on supervised fine-tuning (SFT). A major limitation of SFT is that it essentially does imitation learning, which cannot fully understand what are the expected behaviors. To address this issue, we propose an improved alignment approach named FIGA. Different from prior methods, we incorporate fine-grained (i.e., token or phrase level) quality signals that are derived by contrasting good and bad responses. Our approach has made two major contributions. Firstly, we curate a refined alignment dataset that pairs initial responses and the corresponding revised ones. Secondly, we devise a new loss function can leverage fine-grained quality signals to instruct the learning of LLMs for alignment. Extensive experiments have demonstrated the effectiveness of our approaches by comparing a number of competitive baselines.

Reconstructions of visual perception from brain activity have improved tremendously, but the practical utility of such methods has been limited. This is because such models are trained independently per subject where each subject requires dozens of hours of expensive fMRI training data to attain high-quality results. The present work showcases high-quality reconstructions using only 1 hour of fMRI training data. We pretrain our model across 7 subjects and then fine-tune on minimal data from a new subject. Our novel functional alignment procedure linearly maps all brain data to a shared-subject latent space, followed by a shared non-linear mapping to CLIP image space. We then map from CLIP space to pixel space by fine-tuning Stable Diffusion XL to accept CLIP latents as inputs instead of text. This approach improves out-of-subject generalization with limited training data and also attains state-of-the-art image retrieval and reconstruction metrics compared to single-subject approaches. MindEye2 demonstrates how accurate reconstructions of perception are possible from a single visit to the MRI facility. All code is available on GitHub.

Post-training alignment algorithms are predominantly evaluated as black boxes, obscuring how they reshape language models' internal computations. We present a systematic mechanistic analysis of six preference-optimization methods: PPO, DPO, SimPO, ORPO, GRPO, and KTO across three open-weight model families. By integrating layer-wise linear probing, Sparse Autoencoders, and crosscoders, we localize preference representations and quantify alignment-induced geometric transformations in latent space. We find that preference signals consistently concentrate in early--mid or mid--late layers, but different objectives induce qualitatively distinct representational shifts. KTO and GRPO enhance linear separability through constructive feature sharing and sparse, high-salience recruitment. In contrast, DPO and ORPO degrade separability via non-constructive geometric rotation and feature attenuation, while PPO and SimPO largely preserve baseline geometry. These transformations exhibit architecture-dependent variability, demonstrating that behavioral alignment does not imply uniform internal restructuring. Our findings establish alignment as a heterogeneous intervention, motivate standardized feature-level auditing for safety and interpretability, and highlight the need for mechanism-aware optimization objectives.

Image enhancement improves visual quality and helps reveal details that are hard to see in the original image. In medical imaging, it can support clinical decision-making, but current models often over-edit. This can distort organs, create false findings, and miss small tumors because these models do not understand anatomy or contrast dynamics. We propose SMILE, an anatomy-aware diffusion model that learns how organs are shaped and how they take up contrast. It enhances only clinically relevant regions while leaving all other areas unchanged. SMILE introduces three key ideas: (1) structure-aware supervision that follows true organ boundaries and contrast patterns; (2) registration-free learning that works directly with unaligned multi-phase CT scans; (3) unified inference that provides fast and consistent enhancement across all contrast phases. Across six external datasets, SMILE outperforms existing methods in image quality (14.2% higher SSIM, 20.6% higher PSNR, 50% better FID) and in clinical usefulness by producing anatomically accurate and diagnostically meaningful images. SMILE also improves cancer detection from non-contrast CT, raising the F1 score by up to 10 percent.

Big models, exemplified by Large Language Models (LLMs), are models typically pre-trained on massive data and comprised of enormous parameters, which not only obtain significantly improved performance across diverse tasks but also present emergent capabilities absent in smaller models. However, the growing intertwining of big models with everyday human lives poses potential risks and might cause serious social harm. Therefore, many efforts have been made to align LLMs with humans to make them better follow user instructions and satisfy human preferences. Nevertheless, `what to align with' has not been fully discussed, and inappropriate alignment goals might even backfire. In this paper, we conduct a comprehensive survey of different alignment goals in existing work and trace their evolution paths to help identify the most essential goal. Particularly, we investigate related works from two perspectives: the definition of alignment goals and alignment evaluation. Our analysis encompasses three distinct levels of alignment goals and reveals a goal transformation from fundamental abilities to value orientation, indicating the potential of intrinsic human values as the alignment goal for enhanced LLMs. Based on such results, we further discuss the challenges of achieving such intrinsic value alignment and provide a collection of available resources for future research on the alignment of big models.

Cats and humans differ in ocular anatomy. Most notably, Felis Catus (domestic cats) have vertically elongated pupils linked to ambush predation; yet, how such specializations manifest in downstream visual representations remains incompletely understood. We present a unified, frozen-encoder benchmark that quantifies feline-human cross-species representational alignment in the wild, across convolutional networks, supervised Vision Transformers, windowed transformers, and self-supervised ViTs (DINO), using layer-wise Centered Kernel Alignment (linear and RBF) and Representational Similarity Analysis, with additional distributional and stability tests reported in the paper. Across models, DINO ViT-B/16 attains the most substantial alignment (mean CKA-RBF approx0.814, mean CKA-linear approx0.745, mean RSA approx0.698), peaking at early blocks, indicating that token-level self-supervision induces early-stage features that bridge species-specific statistics. Supervised ViTs are competitive on CKA yet show weaker geometric correspondence than DINO (e.g., ViT-B/16 RSA approx0.53 at block8; ViT-L/16 approx0.47 at block14), revealing depth-dependent divergences between similarity and representational geometry. CNNs remain strong baselines but below plain ViTs on alignment, and windowed transformers underperform plain ViTs, implicating architectural inductive biases in cross-species alignment. Results indicate that self-supervision coupled with ViT inductive biases yields representational geometries that more closely align feline and human visual systems than widely used CNNs and windowed Transformers, providing testable neuroscientific hypotheses about where and how cross-species visual computations converge. We release our code and dataset for reference and reproducibility.

Multimodal Large Language Models (MLLMs) are widely regarded as crucial in the exploration of Artificial General Intelligence (AGI). The core of MLLMs lies in their capability to achieve cross-modal alignment. To attain this goal, current MLLMs typically follow a two-phase training paradigm: the pre-training phase and the instruction-tuning phase. Despite their success, there are shortcomings in the modeling of alignment capabilities within these models. Firstly, during the pre-training phase, the model usually assumes that all image-text pairs are uniformly aligned, but in fact the degree of alignment between different image-text pairs is inconsistent. Secondly, the instructions currently used for finetuning incorporate a variety of tasks, different tasks's instructions usually require different levels of alignment capabilities, but previous MLLMs overlook these differentiated alignment needs. To tackle these issues, we propose a new multimodal large language model AlignGPT. In the pre-training stage, instead of treating all image-text pairs equally, we assign different levels of alignment capabilities to different image-text pairs. Then, in the instruction-tuning phase, we adaptively combine these different levels of alignment capabilities to meet the dynamic alignment needs of different instructions. Extensive experimental results show that our model achieves competitive performance on 12 benchmarks.

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

The Platonic Representation Hypothesis suggests that neural networks trained on different modalities (e.g., text and images) align and eventually converge toward the same representation of reality. If true, this has significant implications for whether modality choice matters at all. We show that the experimental evidence for this hypothesis is fragile and depends critically on the evaluation regime. Alignment is measured using mutual nearest neighbors on small datasets (approx1K samples) and degrades substantially as the dataset is scaled to millions of samples. The alignment that remains between model representations reflects coarse semantic overlap rather than consistent fine-grained structure. Moreover, the evaluations in Huh et al. are done in a one-to-one image-caption setting, a constraint that breaks down in realistic many-to-many settings and further reduces alignment. We also find that the reported trend of stronger language models increasingly aligning with vision does not appear to hold for newer models. Overall, our findings suggest that the current evidence for cross-modal representational convergence is considerably weaker than subsequent works have taken it to be. Models trained on different modalities may learn equally rich representations of the world, just not the same one.

Pediatric medical imaging presents unique challenges due to significant anatomical and developmental differences compared to adults. Direct application of segmentation models trained on adult data often yields suboptimal performance, particularly for small or rapidly evolving structures. To address these challenges, several strategies leveraging the nnU-Net framework have been proposed, differing along four key axes: (i) the fingerprint dataset (adult, pediatric, or a combination thereof) from which the Training Plan -including the network architecture-is derived; (ii) the Learning Set (adult, pediatric, or mixed), (iii) Data Augmentation parameters, and (iv) the Transfer learning method (finetuning versus continual learning). In this work, we introduce PSAT (Pediatric Segmentation Approaches via Adult Augmentations and Transfer learning), a systematic study that investigates the impact of these axes on segmentation performance. We benchmark the derived strategies on two pediatric CT datasets and compare them with state-of-theart methods, including a commercial radiotherapy solution. PSAT highlights key pitfalls and provides actionable insights for improving pediatric segmentation. Our experiments reveal that a training plan based on an adult fingerprint dataset is misaligned with pediatric anatomy-resulting in significant performance degradation, especially when segmenting fine structures-and that continual learning strategies mitigate institutional shifts, thus enhancing generalization across diverse pediatric datasets. The code is available at https://github.com/ICANS-Strasbourg/PSAT.

Cancer progression arises from interactions across multiple biological layers, especially beyond morphological and across molecular layers that remain invisible to image-only models. To capture this broader biological landscape, we present EXAONE Path 2.5, a pathology foundation model that jointly models histologic, genomic, epigenetic and transcriptomic modalities, producing an integrated patient representation that reflects tumor biology more comprehensively. Our approach incorporates three key components: (1) multimodal SigLIP loss enabling all-pairwise contrastive learning across heterogeneous modalities, (2) a fragment-aware rotary positional encoding (F-RoPE) module that preserves spatial structure and tissue-fragment topology in WSI, and (3) domain-specialized internal foundation models for both WSI and RNA-seq to provide biologically grounded embeddings for robust multimodal alignment. We evaluate EXAONE Path 2.5 against six leading pathology foundation models across two complementary benchmarks: an internal real-world clinical dataset and the Patho-Bench benchmark covering 80 tasks. Our framework demonstrates high data and parameter efficiency, achieving on-par performance with state-of-the-art foundation models on Patho-Bench while exhibiting the highest adaptability in the internal clinical setting. These results highlight the value of biologically informed multimodal design and underscore the potential of integrated genotype-to-phenotype modeling for next-generation precision oncology.

Does the relationship between learning rules and brain alignment generalize across species? We extend our prior finding that untrained CNNs match backpropagation at human V1 by testing the same five learning rules against macaque electrophysiology. The rules are backpropagation (BP), feedback alignment (FA), predictive coding (PC), spike-timing-dependent plasticity (STDP), and an untrained random-weights baseline. The macaque data come from two datasets: MajajHong2015 (V4/IT, 3,200 stimulus presentations, 88/168 neurons) and FreemanZiemba2013 (V1/V2, 135 stimuli, 102/103 neurons). Using RSA with identical model weights from our human study, we find: (1) all models achieve higher alignment with macaque early visual cortex (rho = 0.15-0.30 at V1/V2) than with human fMRI (rho = 0.01-0.08), consistent with the higher signal-to-noise ratio of electrophysiology; (2) STDP and PC produce the highest macaque V1/V2 alignment (rho ~ 0.30 and 0.28), consistent with their leading position among trained rules in human V1; (3) at IT, learning rule rankings show no detectable correlation across species (Kendall's tau = 0.00, p = 1.00), though this null result is expected given that n = 5 provides power only at tau = +/-1.0, and is further confounded by stimulus set differences; (4) a pretrained ResNet-50 (ImageNet) achieves rho = 0.25 at macaque IT, substantially above all custom CNN conditions (rho = 0.07-0.14), suggesting IT alignment is limited by model capacity and training data rather than by the learning rule. Noise ceilings, multi-seed variability (5 seeds), and a stimulus-control analysis are reported. These results demonstrate that early visual alignment is robust across species, while higher-area alignment is modulated by model capacity and stimulus domain.

Safety post-training can improve the harmfulness and policy compliance of Large Language Models (LLMs), but it may also reduce general utility, a phenomenon often described as the alignment tax. We study this trade-off through the lens of continual learning: sequential alignment stages expose the model to shifted data distributions and objectives, and their gradients may interfere with directions that support previously acquired general capabilities. This view does not claim that all alignment degradation has a single cause; rather, it provides a useful first-order mechanism for mitigating one important source of capability regression. We propose Orthogonal Gradient Projection for Safety Alignment (OGPSA), a lightweight update rule that estimates a low-rank reference subspace from gradients on a small set of general-capability data and removes from each safety gradient the component lying in this subspace. The resulting update is the steepest local safety-descent direction subject to first-order preservation constraints on the reference objectives. OGPSA is compatible with standard post-training pipelines and avoids large-scale replay, although it introduces periodic reference-gradient computation. Across Supervised Fine-Tuning (SFT), Direct Preference Optimization (DPO), and sequential SFTrightarrowDPO settings, OGPSA improves the observed safety--utility trade-off over standard baselines. Under the sequential SFTrightarrowDPO pipeline, the average performance gain increases from 33.98\% to 42.74\% on Qwen2.5-7B-Instruct and from 19.74\% to 32.98\% on Llama3.1-8B-Instruct. We have open sourced our code at https://github.com/SunGL001/OGPSA.

Image registration is fundamental in medical imaging, enabling precise alignment of anatomical structures for diagnosis, treatment planning, image-guided treatment or longitudinal monitoring. This work introduces IMPACT (Image Metric with Pretrained model-Agnostic Comparison for Transmodality registration), a generic semantic similarity metric designed for seamless integration into diverse image registration frameworks (such as Elastix and Voxelmorph). It compares deep learning-based features extracted from medical images without requiring task-specific training, ensuring broad applicability across various modalities. By leveraging the features of the large-scale pretrained TotalSegmentator models and the ability to integrate Segment Anything Model (SAM) and other large-scale segmentation networks, this approach offers significant advantages. It provides robust, scalable, and efficient solutions for multimodal image registration. The IMPACT loss was evaluated on five challenging registration tasks involving thoracic CT/CBCT, and pelvic MR/CT datasets. Quantitative metrics, such as Target Registration Error and Dice Similarity Coefficient, demonstrated significant improvements in anatomical alignment compared to baseline methods. Qualitative analyses further confirmed the increased robustness of the proposed metric in the face of noise, artifacts, and modality variations. IMPACT's versatility and efficiency make it a valuable tool for advancing registration performance in clinical and research applications, addressing critical challenges in multimodal medical imaging.

Due to the remarkable capabilities and growing impact of large language models (LLMs), they have been deeply integrated into many aspects of society. Thus, ensuring their alignment with human values and intentions has emerged as a critical challenge. This survey provides a comprehensive overview of practical alignment techniques, training protocols, and empirical findings in LLM alignment. We analyze the development of alignment methods across diverse paradigms, characterizing the fundamental trade-offs between core alignment objectives. Our analysis shows that while supervised fine-tuning enables basic instruction-following, preference-based methods offer more flexibility for aligning with nuanced human intent. We discuss state-of-the-art techniques, including Direct Preference Optimization (DPO), Constitutional AI, brain-inspired methods, and alignment uncertainty quantification (AUQ), highlighting their approaches to balancing quality and efficiency. We review existing evaluation frameworks and benchmarking datasets, emphasizing limitations such as reward misspecification, distributional robustness, and scalable oversight. We summarize strategies adopted by leading AI labs to illustrate the current state of practice. We conclude by outlining open problems in oversight, value pluralism, robustness, and continuous alignment. This survey aims to inform both researchers and practitioners navigating the evolving landscape of LLM alignment.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: https://dddraxxx.github.io/Volume-Preserving-Registration/.

Large Language Models (LLMs) are usually aligned with "human values/preferences" to prevent harmful output. Discussions around the alignment of Large Language Models (LLMs) generally focus on preventing harmful outputs. However, in this paper, we argue that in health-related queries, over-alignment-leading to overly cautious responses-can itself be harmful, especially for people with anxiety and obsessive-compulsive disorder (OCD). This is not only unethical but also dangerous to the user, both mentally and physically. We also showed qualitative results that some LLMs exhibit varying degrees of alignment. Finally, we call for the development of LLMs with stronger reasoning capabilities that provide more tailored and nuanced responses to health queries. Warning: This paper contains materials that could trigger health anxiety or OCD.

Prior work has shown that fine-tuning large language models on malicious or incorrect outputs in narrow domains can induce broad misalignment and harmful behavior, a phenomenon known as emergent misalignment. However, efficient methods for reversing such misalignment remain limited. In this work, we make two contributions. First, we identify sycophancy fine-tuning, i.e., training models to passively agree with users' incorrect opinions, as a previously underexplored driver of emergent misalignment, and show that it induces broad and severe misaligned behavior. Second, we propose Alignment Gating, an efficient method for reversing emergent misalignment that inserts learnable and controllable gates into the model during fine-tuning. Through fine-tuning, these gates learn to identify the internal representations responsible for unsafe responses. Thus, amplifying or suppressing these representations then exacerbates or mitigates EM, respectively. We further find that alignment gating module exhibits strong generalization: gating weights obtained from narrow-domain fine-tuning substantially suppress broad-domain misaligned behavior while preserving the model's general capabilities.

Medical image segmentation using deep learning (DL) has enabled the development of automated analysis pipelines for large-scale population studies. However, state-of-the-art DL methods are prone to hallucinations, which can result in anatomically implausible segmentations. With manual correction impractical at scale, automated quality control (QC) techniques have to address the challenge. While promising, existing QC methods are organ-specific, limiting their generalizability and usability beyond their original intended task. To overcome this limitation, we propose no-new Quality Control (nnQC), a robust QC framework based on a diffusion-generative paradigm that self-adapts to any input organ dataset. Central to nnQC is a novel Team of Experts (ToE) architecture, where two specialized experts independently encode 3D spatial awareness, represented by the relative spatial position of an axial slice, and anatomical information derived from visual features from the original image. A weighted conditional module dynamically combines the pair of independent embeddings, or opinions to condition the sampling mechanism within a diffusion process, enabling the generation of a spatially aware pseudo-ground truth for predicting QC scores. Within its framework, nnQC integrates fingerprint adaptation to ensure adaptability across organs, datasets, and imaging modalities. We evaluated nnQC on seven organs using twelve publicly available datasets. Our results demonstrate that nnQC consistently outperforms state-of-the-art methods across all experiments, including cases where segmentation masks are highly degraded or completely missing, confirming its versatility and effectiveness across different organs.

Reinforcement Learning from Human Feedback (RLHF) is widely used for aligning large language models, yet practitioners face a persistent puzzle: improving safety often reduces fairness, scaling to diverse populations becomes computationally intractable, and making systems robust often amplifies majority biases. We formalize this tension as the Alignment Trilemma: no RLHF system can simultaneously achieve (i) epsilon-representativeness across diverse human values, (ii) polynomial tractability in sample and compute complexity, and (iii) delta-robustness against adversarial perturbations and distribution shift. Through a complexity-theoretic analysis integrating statistical learning theory and robust optimization, we prove that achieving both representativeness (epsilon <= 0.01) and robustness (delta <= 0.001) for global-scale populations requires Omega(2^{d_context}) operations, which is super-polynomial in the context dimensionality. We show that current RLHF implementations resolve this trilemma by sacrificing representativeness: they collect only 10^3--10^4 samples from homogeneous annotator pools while 10^7--10^8 samples are needed for true global representation. Our framework provides a unified explanation for documented RLHF pathologies including preference collapse, sycophancy, and systematic bias amplification. We conclude with concrete directions for navigating these fundamental trade-offs through strategic relaxations of alignment requirements.

Large Language Models (LLMs) rely on safety alignment to produce socially acceptable responses. This is typically achieved through instruction tuning and reinforcement learning from human feedback. However, this alignment is known to be brittle: further fine-tuning, even on benign or lightly contaminated data, can degrade safety and reintroduce harmful behaviors. A growing body of work suggests that alignment may correspond to identifiable geometric directions in weight space, forming subspaces that could, in principle, be isolated or preserved to defend against misalignment. In this work, we conduct a comprehensive empirical study of this geometric perspective. We examine whether safety-relevant behavior is concentrated in specific subspaces, whether it can be separated from general-purpose learning, and whether harmfulness arises from distinguishable patterns in internal representations. Across both parameter and activation space, our findings are consistent: subspaces that amplify safe behaviors also amplify unsafe ones, and prompts with different safety implications activate overlapping representations. We find no evidence of a subspace that selectively governs safety. These results challenge the assumption that alignment is geometrically localized. Rather than residing in distinct directions, safety appears to emerge from entangled, high-impact components of the model's broader learning dynamics. This suggests that subspace-based defenses may face fundamental limitations and underscores the need for alternative strategies to preserve alignment under continued training. We corroborate these findings through multiple experiments on five open-source LLMs. Our code is publicly available at: https://github.com/CERT-Lab/safety-subspaces.

This paper presents a novel framework for aligning learnable latent spaces to arbitrary target distributions by leveraging flow-based generative models as priors. Our method first pretrains a flow model on the target features to capture the underlying distribution. This fixed flow model subsequently regularizes the latent space via an alignment loss, which reformulates the flow matching objective to treat the latents as optimization targets. We formally prove that minimizing this alignment loss establishes a computationally tractable surrogate objective for maximizing a variational lower bound on the log-likelihood of latents under the target distribution. Notably, the proposed method eliminates computationally expensive likelihood evaluations and avoids ODE solving during optimization. As a proof of concept, we demonstrate in a controlled setting that the alignment loss landscape closely approximates the negative log-likelihood of the target distribution. We further validate the effectiveness of our approach through large-scale image generation experiments on ImageNet with diverse target distributions, accompanied by detailed discussions and ablation studies. With both theoretical and empirical validation, our framework paves a new way for latent space alignment.

Low-rank adaptation (LoRA) has become a standard tool for efficiently fine-tuning large language models (LLMs). Yet, even minor LoRA updates can induce alignment drift, weakening safety and behavioral constraints through entangled parameter changes. To address this, we propose AlignGuard-LoRA (AGL), a principled framework for preserving alignment during finetuning. AGL introduces several key components: a primary task loss for supervision, Fisher Information Matrix-based regularization to restrict updates in alignment-sensitive subspaces, and task-specific regularization to stabilize the integration of new knowledge. We further introduce collision-aware regularization, blending Riemannian overlap -- which penalizes coordinate-wise interference -- and geodesic separation -- which encourages disjoint update geometry. We curate DriftCaps, a targeted diagnostic benchmark of safe and unsafe prompts designed to quantify alignment drift and safety degradation. Empirical evaluations show that AGL mitigates alignment drift by up to 50% on safety-critical benchmarks without degrading downstream task performance. Comprehensive ablation confirms that each component contributes distinctly to preserving latent safety behaviors. Finally, we derive and validate a scaling law for catastrophic forgetting, revealing that AGL flattens post-finetuning loss escalation while preserving adaptation dynamics. AGL is a structurally grounded refinement of LoRA, ensuring alignment preservation with minimal trade-offs. To encourage further exploration and development, we open-source our implementation.

Medical report generation from X-ray images is a challenging task, particularly in an unpaired setting where paired image-report data is unavailable for training. To address this challenge, we propose a novel model that leverages the available information in two distinct datasets, one comprising reports and the other consisting of images. The core idea of our model revolves around the notion that combining auto-encoding report generation with multi-modal (report-image) alignment can offer a solution. However, the challenge persists regarding how to achieve this alignment when pair correspondence is absent. Our proposed solution involves the use of auxiliary tasks, particularly contrastive learning and classification, to position related images and reports in close proximity to each other. This approach differs from previous methods that rely on pre-processing steps, such as using external information stored in a knowledge graph. Our model, named MedRAT, surpasses previous state-of-the-art methods, demonstrating the feasibility of generating comprehensive medical reports without the need for paired data or external tools.

As multimodal foundational models start being deployed experimentally in Self-Driving cars, a reasonable question we ask ourselves is how similar to humans do these systems respond in certain driving situations -- especially those that are out-of-distribution? To study this, we create the Robusto-1 dataset that uses dashcam video data from Peru, a country with one of the worst (aggressive) drivers in the world, a high traffic index, and a high ratio of bizarre to non-bizarre street objects likely never seen in training. In particular, to preliminarly test at a cognitive level how well Foundational Visual Language Models (VLMs) compare to Humans in Driving, we move away from bounding boxes, segmentation maps, occupancy maps or trajectory estimation to multi-modal Visual Question Answering (VQA) comparing both humans and machines through a popular method in systems neuroscience known as Representational Similarity Analysis (RSA). Depending on the type of questions we ask and the answers these systems give, we will show in what cases do VLMs and Humans converge or diverge allowing us to probe on their cognitive alignment. We find that the degree of alignment varies significantly depending on the type of questions asked to each type of system (Humans vs VLMs), highlighting a gap in their alignment.

Despite notable advancements in Multimodal Large Language Models (MLLMs), most state-of-the-art models have not undergone thorough alignment with human preferences. This gap exists because current alignment research has primarily achieved progress in specific areas (e.g., hallucination reduction), while the broader question of whether aligning models with human preferences can systematically enhance MLLM capability remains largely unexplored. To this end, we introduce MM-RLHF, a dataset containing 120k fine-grained, human-annotated preference comparison pairs. This dataset represents a substantial advancement over existing resources, offering superior size, diversity, annotation granularity, and quality. Leveraging this dataset, we propose several key innovations to improve both the quality of reward models and the efficiency of alignment algorithms. Notably, we introduce a Critique-Based Reward Model, which generates critiques of model outputs before assigning scores, offering enhanced interpretability and more informative feedback compared to traditional scalar reward mechanisms. Additionally, we propose Dynamic Reward Scaling, a method that adjusts the loss weight of each sample according to the reward signal, thereby optimizing the use of high-quality comparison pairs. Our approach is rigorously evaluated across 10 distinct dimensions and 27 benchmarks, with results demonstrating significant and consistent improvements in model performance. Specifically, fine-tuning LLaVA-ov-7B with MM-RLHF and our alignment algorithm leads to a 19.5% increase in conversational abilities and a 60% improvement in safety. We have open-sourced the preference dataset, reward model, training and evaluation code, as well as reward modeling and safety benchmarks. For more details, please visit our project page: https://mm-rlhf.github.io.

Robust validation metrics remain essential in contemporary deep learning, not only to detect overfitting and poor generalization, but also to monitor training dynamics. In the supervised classification setting, we investigate whether interactions between training data and model weights can yield such a metric that both tracks generalization during training and attributes performance to individual training samples. We introduce Gradient-Weight Alignment (GWA), quantifying the coherence between per-sample gradients and model weights. We show that effective learning corresponds to coherent alignment, while misalignment indicates deteriorating generalization. GWA is efficiently computable during training and reflects both sample-specific contributions and dataset-wide learning dynamics. Extensive experiments show that GWA accurately predicts optimal early stopping, enables principled model comparisons, and identifies influential training samples, providing a validation-set-free approach for model analysis directly from the training data.

Radiographic assessment of lower-limb alignment (LLA) is important for predicting joint health and surgical outcomes in total knee arthroplasty. Traditional measurement methods are manual and time-consuming, while recent machine learning approaches typically rely on locating a fixed set of anatomical landmarks. This dependence limits flexibility and may require re-annotation when clinical definitions change. To address this, we propose an automated workflow using Implicit Neural Shape Functions (INSF). Rather than relying on explicit landmark coordinates, we encode the anatomy into a compact latent space and regress clinical alignment measurements directly from these latent codes. This architecture allows for rapid extendability to new tasks without altering the backbone representation. We trained our method on an internal dataset of 566 knee radiographs, each annotated with the outline of the femur and tibia. We evaluated it on both an internal test dataset of 50 patients and a separate external set of 402 preoperative cases from the MRKR dataset. Manual clinical measurements are available for these data, and the MRKR measurements will be made publicly accessible. Performance was comparable to state-of-the-art landmark-based methods and manual agreement, while offering a flexible shape representation that can be extended to additional measurement tasks.

Medical imaging is crucial for diagnosing a patient's health condition, and accurate segmentation of these images is essential for isolating regions of interest to ensure precise diagnosis and treatment planning. Existing methods primarily rely on bounding boxes or point-based prompts, while few have explored text-related prompts, despite clinicians often describing their observations and instructions in natural language. To address this gap, we first propose a RAG-based free-form text prompt generator, that leverages the domain corpus to generate diverse and realistic descriptions. Then, we introduce FLanS, a novel medical image segmentation model that handles various free-form text prompts, including professional anatomy-informed queries, anatomy-agnostic position-driven queries, and anatomy-agnostic size-driven queries. Additionally, our model also incorporates a symmetry-aware canonicalization module to ensure consistent, accurate segmentations across varying scan orientations and reduce confusion between the anatomical position of an organ and its appearance in the scan. FLanS is trained on a large-scale dataset of over 100k medical images from 7 public datasets. Comprehensive experiments demonstrate the model's superior language understanding and segmentation precision, along with a deep comprehension of the relationship between them, outperforming SOTA baselines on both in-domain and out-of-domain datasets.

Recent alignment algorithms such as direct preference optimization (DPO) have been developed to improve the safety of large language models (LLMs) by training these models to match human behaviors exemplified by preference data. However, these methods are both computationally intensive and lacking in controllability and transparency, making them prone to jailbreaking and inhibiting their widespread use. Furthermore, these tuning-based methods require large-scale preference data for training and are susceptible to noisy preference data. In this paper, we introduce a tuning-free alignment alternative (DeTox) and demonstrate its effectiveness under the use case of toxicity reduction. Grounded on theory from factor analysis, DeTox is a sample-efficient model editing approach that identifies a toxic subspace in the model parameter space and reduces model toxicity by projecting away the detected subspace. The toxic sub-space is identified by extracting preference data embeddings from the language model, and removing non-toxic information from these embeddings. We show that DeTox is more sample-efficient than DPO, further showcasing greater robustness to noisy data. Finally, we establish both theoretical and empirical connections between DeTox and DPO, showing that DeTox can be interpreted as a denoised version of a single DPO step.

The performance of machine learning models is determined by the quality of their learned features. They should be invariant under irrelevant data variation but sensitive to task-relevant details. To visualize whether this is the case, we propose a method to analyze feature extractors by sampling from their fibers -- equivalence classes defined by their invariances -- given an arbitrary representative. Unlike existing work where a dedicated generative model is trained for each feature detector, our algorithm is training-free and exploits a pretrained diffusion or flow-matching model as a prior. The fiber loss -- which penalizes mismatch in features -- guides the denoising process toward the desired equivalence class, via non-linear diffusion trajectory matching. This replaces days of training for invariance learning with a single guided generation procedure at comparable fidelity. Experiments on popular datasets (ImageNet, CheXpert) and model types (ResNet, DINO, BiomedClip) demonstrate that our framework can reveal invariances ranging from very desirable to concerning behaviour. For instance, we show how Qwen-2B places patients with situs inversus (heart on the right side) in the same fiber as typical anatomy.

Emergent misalignment can arise when a language model is fine-tuned on a narrowly scoped supervised objective: the model learns the target behavior, yet also develops undesirable out-of-domain behaviors. We investigate a mechanistic approach to preventing emergent misalignment by identifying a small set of internal features that reliably control the misaligned behavior and then discouraging the model from strengthening these features during fine-tuning. Across six fine-tuning domains, blocking (i.e., constraining) a fixed set of features achieves up to 95\% relative reduction in emergent misalignment with no degradation in model quality or target-task performance. We strengthen validity with disjoint selection/evaluation splits, multiple independent judges, multiple random seeds for key settings, quality metrics, and extensive ablations demonstrating that the reduction in misalignment is specific to the identified mechanism. We also characterize a limiting regime in which misalignment re-emerges under prolonged fine-tuning, present evidence consistent with rerouting through alternative features or layers, and evaluate modifications that partially restore the misalignment-blocking effect. Overall, our results show that targeted training-time constraints on internal mechanisms can mitigate emergent misalignment without degrading target-task performance.

Despite impressive performance on standard benchmarks, multimodal large language models (MLLMs) face critical challenges in real-world clinical environments where medical images inevitably suffer various quality degradations. Existing benchmarks exhibit two key limitations: (1) absence of large-scale, multidimensional assessment across medical image quality gradients and (2) no systematic confidence calibration analysis. To address these gaps, we present MedQ-Deg, a comprehensive benchmark for evaluating medical MLLMs under image quality degradations. MedQ-Deg provides multi-dimensional evaluation spanning 18 distinct degradation types, 30 fine-grained capability dimensions, and 7 imaging modalities, with 24,894 question-answer pairs. Each degradation is implemented at 3 severity degrees, calibrated by expert radiologists. We further introduce Calibration Shift metric, which quantifies the gap between a model's perceived confidence and actual performance to assess metacognitive reliability under degradation. Our comprehensive evaluation of 40 mainstream MLLMs reveals several critical findings: (1) overall model performance degrades systematically as degradation severity increases, (2) models universally exhibit the AI Dunning-Kruger Effect, maintaining inappropriately high confidence despite severe accuracy collapse, and (3) models display markedly differentiated behavioral patterns across capability dimensions, imaging modalities, and degradation types. We hope MedQ-Deg drives progress toward medical MLLMs that are robust and trustworthy in real clinical practice.

Vision-language models (VLMs) often produce chain-of-thought (CoT) explanations that sound plausible yet fail to reflect the underlying decision process, undermining trust in high-stakes clinical use. Existing evaluations rarely catch this misalignment, prioritizing answer accuracy or adherence to formats. We present a clinically grounded framework for chest X-ray visual question answering (VQA) that probes CoT faithfulness via controlled text and image modifications across three axes: clinical fidelity, causal attribution, and confidence calibration. In a reader study (n=4), evaluator-radiologist correlations fall within the observed inter-radiologist range for all axes, with strong alignment for attribution (Kendall's tau_b=0.670), moderate alignment for fidelity (tau_b=0.387), and weak alignment for confidence tone (tau_b=0.091), which we report with caution. Benchmarking six VLMs shows that answer accuracy and explanation quality are decoupled, acknowledging injected cues does not ensure grounding, and text cues shift explanations more than visual cues. While some open-source models match final answer accuracy, proprietary models score higher on attribution (25.0% vs. 1.4%) and often on fidelity (36.1% vs. 31.7%), highlighting deployment risks and the need to evaluate beyond final answer accuracy.

Multimodal learning has advanced significantly by aligning different modalities within shared latent spaces, enabling tasks such as cross-modal understanding and generation. Current alignment strategies in multimodal learning primarily include direct alignment using pre-trained or unified encoders and single-directional alignment via modality-specific connectors. Direct alignment struggles to fully leverage rich intra-modal knowledge, often requiring extensive training data to achieve cross-modal representation. Meanwhile, single-directional alignment methods, despite leveraging pre-trained knowledge, restrict task adaptability and hinder the model's ability to capture bidirectional relationships, leading to incomplete knowledge fusion and underutilization of complementary modality-specific information. To address these limitations, we introduce Alt-MoE, a scalable multimodal alignment framework that employs a mixture of experts (MoE) model as a multi-directional connector across modalities. By utilizing a sequential alternating one-way alignment strategy, Alt-MoE iteratively refines the model to achieve bidirectional alignment. Alt-MoE operates in latent space, enabling efficient vector pre-storage and real-time retrieval via MoE, optimizing large-scale data processing. Extensive empirical studies demonstrate that Alt-MoE achieves competitive performance on cross-modal retrieval and visual question answering by integrating diverse modality-specific knowledge, generalizing to unseen data, and easily scaling to new tasks and modalities through dynamic adjustment of MoE capacity and expert activation.

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

The transcriptional response to genetic perturbation reveals fundamental insights into complex cellular systems. While current approaches have made progress in predicting genetic perturbation responses, they provide limited biological understanding and cannot systematically refine existing knowledge. Overcoming these limitations requires an end-to-end integration of data-driven learning and existing knowledge. However, this integration is challenging due to inconsistencies between data and knowledge bases, such as noise, misannotation, and incompleteness. To address this challenge, we propose ALIGNED (Adaptive aLignment for Inconsistent Genetic kNowledgE and Data), a neuro-symbolic framework based on the Abductive Learning (ABL) paradigm. This end-to-end framework aligns neural and symbolic components and performs systematic knowledge refinement. We introduce a balanced consistency metric to evaluate the predictions' consistency against both data and knowledge. Our results show that ALIGNED outperforms state-of-the-art methods by achieving the highest balanced consistency, while also re-discovering biologically meaningful knowledge. Our work advances beyond existing methods to enable both the transparency and the evolution of mechanistic biological understanding.

Nonrigid registration is conventionally divided into point set registration, which aligns sparse geometries, and image registration, which aligns continuous intensity fields on regular grids. However, this dichotomy creates a critical bottleneck for emerging scientific data, such as spatial transcriptomics, where high-dimensional vector-valued functions, e.g., gene expression, are defined on irregular, sparse manifolds. Consequently, researchers currently face a forced choice: either sacrifice single-cell resolution via voxelization to utilize image-based tools, or ignore the critical functional signal to utilize geometric tools. To resolve this dilemma, we propose Domain Elastic Transform (DET), a grid-free probabilistic framework that unifies geometric and functional alignment. By treating data as functions on irregular domains, DET registers high-dimensional signals directly without binning. We formulate the problem within a rigorous Bayesian framework, modeling domain deformation as an elastic motion guided by a joint spatial-functional likelihood. The method is fully unsupervised and scalable, utilizing feature-sensitive downsampling to handle massive atlases. We demonstrate that DET achieves 92\% topological preservation on MERFISH data where state-of-the-art optimal transport methods struggle (<5\%), and successfully registers whole-embryo Stereo-seq atlases across developmental stages -- a task involving massive scale and complex nonrigid growth. The implementation of DET is available on {https://github.com/ohirose/bcpd} (since Mar, 2025).

Fine-tuning on harmless data can partially undo behaviors acquired earlier in training. Safety can erode under benign post-alignment updates, unlearned capabilities can re-emerge, latent traits can transfer through apparently unrelated supervision, and related post-alignment fragility appears in other generative settings. We argue these phenomena are usefully viewed through a common training-history lens. Our hypothesis is geometric: large early training phases create dominant behavioral manifolds, while later alignment or specialization phases are shallower displacements from them. Subsequent fine-tuning can therefore inherit a persistent reversion component pointing back toward a witness of the dominant manifold. We call this the gravitational interpretation of fine-tuning reversion. Across our main settings, representational drift rapidly acquires a component along a history-defined reversion direction (v_rev). In our main track, alignment with v_rev rises from cos = 0.429 +/- 0.052 after the first update to 0.647 +/- 0.021 by step 20. Across 24 run-step pairs, every observed alignment exceeds the p99 of an isotropic activation-space null. We demonstrate that selectively blocking motion along v_rev changes the final alignment at T=100 from 0.648 +/- 0.009 to -0.211 +/- 0.021 and reduces harmfulness from 19.0% +/- 4.0% to 8.5% +/- 1.5% with little task cost. These results support v_rev as a causally relevant mediator of early post-alignment reversion in our setup. Importantly, we do not claim that v_rev is the unique safety direction, nor that the dominant manifold is directly observed; rather, we identify a robust, history-defined direction that explains and partially controls early reversion dynamics.

Despite their significant advancements, Multimodal Large Language Models (MLLMs) often generate factually inaccurate information, referred to as hallucination. In this work, we address object hallucinations in MLLMs, where information is generated about an object not present in the input image. We introduce Data-augmented Phrase-level Alignment (DPA), a novel loss which can be applied to instruction-tuned off-the-shelf MLLMs to mitigate hallucinations, while preserving their general vision-language capabilities. To fine-tune MLLMs with DPA, we first generate a set of `hallucinated' and `correct' response pairs through generative data augmentation by selectively altering the ground-truth information of the correct responses at a phrase level. The DPA loss is then used to train MLLMs to reduce the likelihood of hallucinated phrases compared to the correct ones. Our thorough evaluation on various benchmarks confirms the effectiveness of DPA in mitigating hallucination while retaining the out-of-the-box performance of the MLLMs on general tasks. For instance, MLLMs finetuned with DPA, which we refer to as Hallucination Attenuated Language and Vision Assistant (HALVA), improve F1 by up to 13.4% on hallucination visual question-answering and reduce the hallucination rate by up to 4.2% on image description tasks.

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

To ensure safe usage, Large Language Models (LLMs) typically undergo alignment with human-defined values. However, this alignment often relies on primarily English data and is biased towards Western-centric values, limiting its effectiveness in low-resource language settings. In this paper, we describe our approach for aligning SEA-Lion-v2.1-Instruct (a Llama3-8B variant) to minimize toxicity in Singlish, an English creole specific to Singapore. We find that supervised fine-tuning and Kahneman-Tversky Optimization (KTO) on paired and unpaired preferences is more sample efficient and yields significantly better results than Direct Preference Optimization (DPO). Our analysis reveals that DPO implicitly enforces a weaker safety objective than KTO, and that SFT complements KTO by improving training stability. Finally, we introduce a simple but novel modification to KTO, KTO-S, which improves training stability through better gradient exploitation. Overall, we present a general approach for safety alignment conducive to low-resource English languages, successfully reducing toxicity by 99\% on our Singlish benchmark, with gains generalizing to the broader TOXIGEN dataset while maintaining strong performance across standard LLM benchmarks.

With the rapid advances in high-throughput sequencing technologies, the focus of survival analysis has shifted from examining clinical indicators to incorporating genomic profiles with pathological images. However, existing methods either directly adopt a straightforward fusion of pathological features and genomic profiles for survival prediction, or take genomic profiles as guidance to integrate the features of pathological images. The former would overlook intrinsic cross-modal correlations. The latter would discard pathological information irrelevant to gene expression. To address these issues, we present a Cross-Modal Translation and Alignment (CMTA) framework to explore the intrinsic cross-modal correlations and transfer potential complementary information. Specifically, we construct two parallel encoder-decoder structures for multi-modal data to integrate intra-modal information and generate cross-modal representation. Taking the generated cross-modal representation to enhance and recalibrate intra-modal representation can significantly improve its discrimination for comprehensive survival analysis. To explore the intrinsic crossmodal correlations, we further design a cross-modal attention module as the information bridge between different modalities to perform cross-modal interactions and transfer complementary information. Our extensive experiments on five public TCGA datasets demonstrate that our proposed framework outperforms the state-of-the-art methods.

The ability to translate diverse patterns of inputs into structured patterns of behavior has been thought to rest on both humans' and machines' ability to learn robust representations of relevant concepts. The rapid advancement of transformer-based large language models (LLMs) has led to a diversity of computational ingredients -- architectures, fine tuning methods, and training datasets among others -- but it remains unclear which of these ingredients are most crucial for building models that develop human-like representations. Further, most current LLM benchmarks are not suited to measuring representational alignment between humans and models, making benchmark scores unreliable for assessing if current LLMs are making progress towards becoming useful cognitive models. We address these limitations by first evaluating a set of over 70 models that widely vary in their computational ingredients on a triplet similarity task, a method well established in the cognitive sciences for measuring human conceptual representations, using concepts from the THINGS database. Comparing human and model representations, we find that models that undergo instruction-finetuning and which have larger dimensionality of attention heads are among the most human aligned, while multimodal pretraining and parameter size have limited bearing on alignment. Correlations between alignment scores and scores on existing benchmarks reveal that while some benchmarks (e.g., MMLU) are better suited than others (e.g., MUSR) for capturing representational alignment, no existing benchmark is capable of fully accounting for the variance of alignment scores, demonstrating their insufficiency in capturing human-AI alignment. Taken together, our findings help highlight the computational ingredients most essential for advancing LLMs towards models of human conceptual representation and address a key benchmarking gap in LLM evaluation.

Human perception integrates multiple modalities, such as vision, hearing, and language, into a unified understanding of the surrounding reality. While recent multimodal models have achieved significant progress by aligning pairs of modalities via contrastive learning, their solutions are unsuitable when scaling to multiple modalities. These models typically align each modality to a designated anchor without ensuring the alignment of all modalities with each other, leading to suboptimal performance in tasks requiring a joint understanding of multiple modalities. In this paper, we structurally rethink the pairwise conventional approach to multimodal learning and we present the novel Gramian Representation Alignment Measure (GRAM), which overcomes the above-mentioned limitations. GRAM learns and then aligns n modalities directly in the higher-dimensional space in which modality embeddings lie by minimizing the Gramian volume of the k-dimensional parallelotope spanned by the modality vectors, ensuring the geometric alignment of all modalities simultaneously. GRAM can replace cosine similarity in any downstream method, holding for 2 to n modalities and providing more meaningful alignment with respect to previous similarity measures. The novel GRAM-based contrastive loss function enhances the alignment of multimodal models in the higher-dimensional embedding space, leading to new state-of-the-art performance in downstream tasks such as video-audio-text retrieval and audio-video classification. The project page, the code, and the pretrained models are available at https://ispamm.github.io/GRAM/.

Cross-entropy pretraining and preference alignment update the same transformer weights, but leave geometrically distinct traces. We characterise this asymmetry with a relative-subspace-fraction probe that tracks how weight deltas align with residual-stream activation subspaces and with the prediction subspace defined by the unembedding. Alignment deltas concentrate in the read pathway (W_Q, W_K), along principal directions of attention-input activations, while remaining near-isotropic in the write pathway (W_O, W_2) relative to the prediction subspace. We explain this pattern through anisotropic gradient accumulation: updates to a matrix W are sums of outer products δ_t a_t^top, and inherit directional structure from whichever side has concentrated covariance. For read-pathway matrices, this side is the input activation a_t, whose covariance is spiked in trained transformers and therefore produces objective-agnostic concentration. For write-pathway matrices, the relevant side is the upstream gradient δ_t, whose anisotropy depends on the loss. Cross-entropy supplies the canonical sharp per-sample signal, inducing write-pathway prediction geometry during pretraining; alignment objectives typically add little further write-side concentration. We support this explanation with a within-checkpoint trajectory, a graded contrastive-objective control, and a closed-form rank-1 intervention with matched direction controls, providing causal evidence for the proposed weight-space geometry.

Recent advances in context optimization (CoOp) guided by large language model (LLM)-distilled medical semantic priors offer a scalable alternative to manual prompt engineering and full fine-tuning for adapting biomedical CLIP-based vision-language models (VLMs). However, prompt learning in this context is challenged by semantic misalignment between LLMs and CLIP variants due to divergent training corpora and model architectures; it further lacks scalability across continuously evolving families of foundation models. More critically, pairwise multimodal alignment via conventional Euclidean-space optimization lacks the capacity to model unified representations or apply localized geometric constraints, which tends to amplify modality gaps in complex biomedical imaging and destabilize few-shot adaptation. In this work, we propose vMFCoOp, a framework that inversely estimates von Mises-Fisher (vMF) distributions on a shared Hyperspherical Manifold, aligning semantic biases between arbitrary LLMs and CLIP backbones via Unified Semantic Anchors to achieve robust biomedical prompting and superior few-shot classification. Grounded in three complementary constraints, vMFCoOp demonstrates consistent improvements across 14 medical datasets, 12 medical imaging modalities, and 13 anatomical regions, outperforming state-of-the-art methods in accuracy, generalization, and clinical applicability. This work aims to continuously expand to encompass more downstream applications, and the corresponding resources are intended to be shared through https://github.com/VinyehShaw/UniEqui.

Misalignment between model predictions and intended usage can be detrimental for the deployment of computer vision models. The issue is exacerbated when the task involves complex structured outputs, as it becomes harder to design procedures which address this misalignment. In natural language processing, this is often addressed using reinforcement learning techniques that align models with a task reward. We adopt this approach and show its surprising effectiveness across multiple computer vision tasks, such as object detection, panoptic segmentation, colorization and image captioning. We believe this approach has the potential to be widely useful for better aligning models with a diverse range of computer vision tasks.

Fine-grained visual representations are essential for medical image analysis, particularly when diagnostically relevant evidence is subtle and spatially localized. Modern transformer-based medical vision encoders must therefore learn patch-level representations that are both clinically meaningful and spatially consistent. Without these properties, large vision-language models (LVLMs) operate on an ambiguous visual foundation, limiting their ability to generate clinically reliable and spatially grounded responses. However, existing training strategies for medical vision encoders rarely achieve both objectives. Image-text alignment provides clinically meaningful supervision primarily at the image level, leaving the spatial localization of diagnostic evidence weakly constrained. In contrast, self-supervised learning promotes spatial consistency but lacks the semantic supervision needed to distinguish visually similar yet clinically distinct regions. To address this gap, we present LoFi, a medical vision foundation model built on location-aware fine-grained representation learning. LoFi trains a vision encoder with a lightweight large language model under grounding and grounded captioning objectives. Because these objectives require predicting location from clinical text and vice versa, spatial consistency emerges without any explicit patch-level regularization. To enable training at scale, we construct MedG, a large-scale medical grounding dataset of 4.48M image-text-box triplets curated from 84 datasets spanning 7 modalities. Across phrase grounding, visual question answering, and region-based organ classification under perturbations, LoFi consistently outperforms general-purpose and medical vision foundation models as well as state-of-the-art LVLMs. Code is available at https://github.com/myeongkyunkang/lofi-medg.

Large language models (LLMs) can handle a wide variety of general tasks with simple prompts, without the need for task-specific training. Multimodal Large Language Models (MLLMs), built upon LLMs, have demonstrated impressive potential in tackling complex tasks involving visual, auditory, and textual data. However, critical issues related to truthfulness, safety, o1-like reasoning, and alignment with human preference remain insufficiently addressed. This gap has spurred the emergence of various alignment algorithms, each targeting different application scenarios and optimization goals. Recent studies have shown that alignment algorithms are a powerful approach to resolving the aforementioned challenges. In this paper, we aim to provide a comprehensive and systematic review of alignment algorithms for MLLMs. Specifically, we explore four key aspects: (1) the application scenarios covered by alignment algorithms, including general image understanding, multi-image, video, and audio, and extended multimodal applications; (2) the core factors in constructing alignment datasets, including data sources, model responses, and preference annotations; (3) the benchmarks used to evaluate alignment algorithms; and (4) a discussion of potential future directions for the development of alignment algorithms. This work seeks to help researchers organize current advancements in the field and inspire better alignment methods. The project page of this paper is available at https://github.com/BradyFU/Awesome-Multimodal-Large-Language-Models/tree/Alignment.

The rapid development of large language models (LLMs) has not only provided numerous opportunities but also presented significant challenges. This becomes particularly evident when LLMs inadvertently generate harmful or toxic content, either unintentionally or because of intentional inducement. Existing alignment methods usually direct LLMs toward the favorable outcomes by utilizing human-annotated, flawless instruction-response pairs. Conversely, this study proposes a novel alignment technique based on mistake analysis, which deliberately exposes LLMs to erroneous content to learn the reasons for mistakes and how to avoid them. In this case, mistakes are repurposed into valuable data for alignment, effectively helping to avoid the production of erroneous responses. Without external models or human annotations, our method leverages a model's intrinsic ability to discern undesirable mistakes and improves the safety of its generated responses. Experimental results reveal that our method outperforms existing alignment approaches in enhancing model safety while maintaining the overall utility.

Training multimodal large language models has long been limited by the scarcity of high-quality paired multimodal data. Recent studies show that the shared representation space of pretrained multimodal contrastive models can serve as a bridge, enabling models to perform multimodal training with unimodal data. However, the key premise of this paradigm remains insufficiently understood: can representations from different modalities be reliably interchanged? The core obstacle lies in the persistent Modality Gap in the shared space. In this work, we revisit the geometric nature of the modality gap. We find that modality representations already share compatible dominant semantic geometry. What truly hinders modality interchangeability is not a simple global shift, but an anisotropic residual structure concentrated along a small number of dominant directions. Based on this finding, we further propose the principle of anisotropic modality gap alignment: effective modality alignment should align with the target-modality distribution while preserving the semantic structure of the source modality. Guided by this principle, we propose an anisotropic geometric correction framework, AnisoAlign, for unpaired modality alignment. This framework leverages the internal geometric prior of the target modality and performs bounded correction on source-modality representations, thereby constructing substitute representations in the target modality. Experiments confirm its benefits in both geometric diagnostics and text-only MLLM training. Overall, this work recasts the modality gap from an empirical observation into a correctable, structured geometric phenomenon and provides a new representation alignment perspective for training multimodal models with unimodal data.

Multi-organ medical segmentation is a crucial component of medical image processing, essential for doctors to make accurate diagnoses and develop effective treatment plans. Despite significant progress in this field, current multi-organ segmentation models often suffer from inaccurate details, dependence on geometric prompts and loss of spatial information. Addressing these challenges, we introduce a novel model named CRISP-SAM2 with CRoss-modal Interaction and Semantic Prompting based on SAM2. This model represents a promising approach to multi-organ medical segmentation guided by textual descriptions of organs. Our method begins by converting visual and textual inputs into cross-modal contextualized semantics using a progressive cross-attention interaction mechanism. These semantics are then injected into the image encoder to enhance the detailed understanding of visual information. To eliminate reliance on geometric prompts, we use a semantic prompting strategy, replacing the original prompt encoder to sharpen the perception of challenging targets. In addition, a similarity-sorting self-updating strategy for memory and a mask-refining process is applied to further adapt to medical imaging and enhance localized details. Comparative experiments conducted on seven public datasets indicate that CRISP-SAM2 outperforms existing models. Extensive analysis also demonstrates the effectiveness of our method, thereby confirming its superior performance, especially in addressing the limitations mentioned earlier. Our code is available at: https://github.com/YU-deep/CRISP\_SAM2.git.

Machine learning models often struggle with distribution shifts in real-world scenarios, whereas humans exhibit robust adaptation. Models that better align with human perception may achieve higher out-of-distribution generalization. In this study, we investigate how various characteristics of large-scale computer vision models influence their alignment with human capabilities and robustness. Our findings indicate that increasing model and data size and incorporating rich semantic information and multiple modalities enhance models' alignment with human perception and their overall robustness. Our empirical analysis demonstrates a strong correlation between out-of-distribution accuracy and human alignment.

In the latest advancements in multimodal learning, effectively addressing the spatial and semantic losses of visual data after encoding remains a critical challenge. This is because the performance of large multimodal models is positively correlated with the coupling between visual encoders and large language models. Existing approaches often face issues such as vector gaps or semantic disparities, resulting in information loss during the propagation process. To address these issues, we propose MAGE (Multimodal Alignment and Generation Enhancement), a novel framework that bridges the semantic spaces of vision and text through an innovative alignment mechanism. By introducing the Intelligent Alignment Network (IAN), MAGE achieves dimensional and semantic alignment. To reduce the gap between synonymous heterogeneous data, we employ a training strategy that combines cross-entropy and mean squared error, significantly enhancing the alignment effect. Moreover, to enhance MAGE's "Any-to-Any" capability, we developed a fine-tuning dataset for multimodal tool-calling instructions to expand the model's output capability boundaries. Finally, our proposed multimodal large model architecture, MAGE, achieved significantly better performance compared to similar works across various evaluation benchmarks, including MME, MMBench, and SEED. Complete code and appendix are available at: https://github.com/GTCOM-NLP/MAGE.

Loss explosions in training deep neural networks can nullify multi-million dollar training runs. Conventional monitoring metrics like weight and gradient norms are often lagging and ambiguous predictors, as their values vary dramatically across different models and even between layers of the same model, making it difficult to establish a unified standard for detecting impending failure. We introduce Spectral Alignment (SA), a novel, theoretically-grounded metric that monitors the distributional alignment between layer inputs and the principal singular vectors of weight matrices. We show that a collapse in the sign diversity of this alignment is a powerful early predictor of representational collapse and training divergence. Empirical results on language models demonstrate that monitoring the SA distribution provides a significantly earlier and clearer warning of loss explosions than traditional scalar metrics. SA's low computational overhead makes it a practical tool for safeguarding model training.

Public LLMs such as the Llama 2-Chat have driven huge activity in LLM research. These models underwent alignment training and were considered safe. Recently Qi et al. (2023) reported that even benign fine-tuning (e.g., on seemingly safe datasets) can give rise to unsafe behaviors in the models. The current paper is about methods and best practices to mitigate such loss of alignment. Through extensive experiments on several chat models (Meta's Llama 2-Chat, Mistral AI's Mistral 7B Instruct v0.2, and OpenAI's GPT-3.5 Turbo), this paper uncovers that the prompt templates used during fine-tuning and inference play a crucial role in preserving safety alignment, and proposes the "Pure Tuning, Safe Testing" (PTST) principle -- fine-tune models without a safety prompt, but include it at test time. Fine-tuning experiments on GSM8K, ChatDoctor, and OpenOrca show that PTST significantly reduces the rise of unsafe behaviors, and even almost eliminates them in some cases.

Despite the considerable progress in automatic abdominal multi-organ segmentation from CT/MRI scans in recent years, a comprehensive evaluation of the models' capabilities is hampered by the lack of a large-scale benchmark from diverse clinical scenarios. Constraint by the high cost of collecting and labeling 3D medical data, most of the deep learning models to date are driven by datasets with a limited number of organs of interest or samples, which still limits the power of modern deep models and makes it difficult to provide a fully comprehensive and fair estimate of various methods. To mitigate the limitations, we present AMOS, a large-scale, diverse, clinical dataset for abdominal organ segmentation. AMOS provides 500 CT and 100 MRI scans collected from multi-center, multi-vendor, multi-modality, multi-phase, multi-disease patients, each with voxel-level annotations of 15 abdominal organs, providing challenging examples and test-bed for studying robust segmentation algorithms under diverse targets and scenarios. We further benchmark several state-of-the-art medical segmentation models to evaluate the status of the existing methods on this new challenging dataset. We have made our datasets, benchmark servers, and baselines publicly available, and hope to inspire future research. Information can be found at https://amos22.grand-challenge.org.

Patient education materials for solid-organ transplantation vary substantially across U.S. centers, yet no systematic method exists to quantify this heterogeneity at scale. We introduce a framework that grounds the same patient questions in different centers' handbooks using retrieval-augmented language models and compares the resulting answers using a five-label consistency taxonomy. Applied to 102 handbooks from 23 centers and 1,115 benchmark questions, the framework quantifies heterogeneity across four dimensions: question, topic, organ, and center. We find that 20.8% of non-absent pairwise comparisons exhibit clinically meaningful divergence, concentrated in condition monitoring and lifestyle topics. Coverage gaps are even more prominent: 96.2% of question-handbook pairs miss relevant content, with reproductive health at 95.1% absence. Center-level divergence profiles are stable and interpretable, where heterogeneity reflects systematic institutional differences, likely due to patient diversity. These findings expose an information gap in transplant patient education materials, with document-grounded medical question answering highlighting opportunities for content improvement.

Post-training alignment is central to deploying large language models (LLMs), yet practical workflows remain split across backend-specific tools and ad-hoc glue code, making experiments hard to reproduce. We identify backend interference, reward fragmentation, and irreproducible pipelines as key obstacles in alignment research. We introduce AlignTune, a modular toolkit exposing a unified interface for supervised fine-tuning (SFT) and RLHF-style optimization with interchangeable TRL and Unsloth backends. AlignTune standardizes configuration, provides an extensible reward layer (rule-based and learned), and integrates evaluation over standard benchmarks and custom tasks. By isolating backend-specific logic behind a single factory boundary, AlignTune enables controlled comparisons and reproducible alignment experiments.