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

Towards Multimodal Retrieval-Augmented Generation for Medical Visual Question Answering

A novel multimodal RAG framework tailored for MedVQA is proposed, which leverages multimodal data, including medical images, reports, and generated captions, to provide more accurate clinical answers, and introduces a training paradigm that uses captions as auxiliary supervision, enhancing cross-modal alignment via contrastive learning.

Adaptive Diffusion Vision-Language Models for Reliable Medical Image Understanding

Biomedical vision–language models increasingly support image-grounded clinical dialogue, yet most deployable systems still depend on autoregressive language generation. Such systems tend to truncate answers, react poorly to length instructions, and offer no principled way to signal uncertainty when image evidence is weak. We present MedDiffVL, a biomedical vision-language model that pairs a masked language diffusion backbone with a SigLIP-2 visual encoder and a multimodal alignment pipeline that injects modality and question-type cues. Three inference-time mechanisms target the failure modes of diffusion-based generators in the clinical setting. An adaptive confidence-guided remasking rule uses a time-aware threshold and a short-window stability check to remove repetitive low-quality candidates. A clinically aware length controller selects a target length from question type, modality, and an internal uncertainty estimate. A reliability gate combines visual-evidence and answer-confidence scores to emit, hedge, or escalate a response. On VQA-RAD, SLAKE, and PathVQA, the model reaches 85.42, 92.78, and 94.91% closed-form accuracy and an overall conversation score of 53.42 against a fixed reference. Token repetition falls from 0.18 to 0.06. An ECE falls from 0.137 to 0.034, but this reflects an ECE-surrogate training loss and is not independently validated. These gains are not uniform. The closed-form gains over the prior diffusion model lie within run-to-run variance, and latency stays higher than autoregressive baselines. The main contribution is controllability and reliability-aware decoding, not higher closed-form accuracy. The results indicate that confidence-guided masked diffusion with reliability-aware decoding is a useful direction for controllable and reliability-aware clinical assistants.

Med-OPD: Improving Medical Vision-Language Models via Evidence-Aware On-Policy Distillation

Experiments on OmniMedVQA subsets show that Med-OPD consistently outperforms SFT and standard OPD across CT, MRI, Disease Diagnosis, and Lesion Grading, and demonstrate that evidence-aware distillation can better strengthen medical VLMs'reliance on key visual evidence and improve reliable multimodal medical reasoning.

Hierarchical Conditional Energy Modeling for Medical Vision–Language Pretraining

MedARC: Training-Free Adaptive Redundancy Compression of Visual Tokens for 3D Medical Vision-Language Models

Integrating 3D medical images with vision-language models (VLMs) holds substantial promise for computer-aided diagnosis. However, volumetric images generate prohibitively long visual-token sequences with considerable spatial and inter-slice redundancy. Existing token compression methods typically apply uniform reduction or rely on a single importance signal, increasing the risk of removing regions that are clinically relevant to the query or structurally distinctive. To address this limitation, we propose MedARC, a unified, training-free framework for Adaptive Redundancy Compression of visual tokens in 3D medical VLMs. MedARC estimates token importance by integrating three complementary cues: self-attention from the VLM vision encoder, which reflects the model's intrinsic visual focus; similarity between projected visual tokens and text embeddings, which identifies query-relevant regions; and deviations of local visual foundation model features from the volume-level feature center, which highlight structurally distinctive anatomy. The resulting importance distribution guides a saliency-aware merging strategy that preserves informative tokens while consolidating redundant ones rather than simply discarding them. Experiments on CT-RATE and MR-RATE show that MedARC reduces visual-token overhead and inference time while preserving or improving diagnostic performance. Its multi-cue scoring cost is outweighed by the savings from processing fewer tokens, with greater benefits expected for larger language models.

Linguistically-Aligned and Visually-Grounded Preference Optimization for Clinically-Augmented Medical Report Generation

Despite significant advances in Medical Report Generation (MRG), the reliability remains constrained by the prevalence of factual errors. While Direct Preference Optimization (DPO) has emerged as a promising post-training paradigm to enhance the performance of Supervised Fine-Tuned (SFT) MRG models, existing DPO-based MRG methods typically adopt a naive preference construction that directly pairs model-generated reports with ground truth reports. This strategy inadvertently entangles critical clinical findings with clinically irrelevant linguistic characteristics, and fundamentally lacks explicit vision-language alignment. To address these challenges, we propose DPO-Clin, a novel post-training framework that focuses preference optimization on clinical findings and cross-modal alignment. First, we introduce the Entity-level Clinical Diagnostic (ECD) module to perform a precise entity-level factual diagnosis. ECD guides the generation of linguistically-aligned report preference pairs, isolating clinical discrepancies from linguistic variations. Second, to achieve fine-grained cross-modal alignment, we develop M2DPO, a retrieval-augmented multi-modal DPO variant that enforces textual preference inversion triggered by visual context switches. Third, we locate correct yet highly uncertain predicted entities and apply counterfactual modifications to construct targeted preference data for latent risk mitigation, thereby further enhancing the model reliability. Extensive experiments on two public chest X-ray datasets (MIMIC-CXR and IU X-Ray) and an in-house endoscopy dataset demonstrate that DPO-Clin significantly improves the SFT baselines on clinical-aware metrics. Furthermore, it achieves superior performance over existing DPO-based MRG methods, exhibiting robust generalizability across distinct baseline architectures and diverse medical imaging modalities.