Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...
Medical Large Vision-Language Models (Med-LVLMs) have been widely adopted for medical report generation. Despite Med-LVLMs producing state-of-the-art performance, they exhibit a bias toward predicting all findings as normal, leading to reports that overlook critical abnormalities. Furthermore, these models often fail to provide comprehensive descriptions of radiologically relevant regions necessary for accurate diagnosis. To address these challenges, we proposeMedical Report Generation Agents (MRGAgents), a novel multi-agent framework that fine-tunes specialized agents for different disease categories. By curating subsets of the IU X-ray and MIMIC-CXR datasets to train disease-specific agents, MRGAgents generates reports that more effectively balance normal and abnormal findings while ensuring a comprehensive description of clinically relevant regions. Our experiments demonstrate that MRGAgents outperformed the state-of-the-art, improving both report comprehensiveness and diagnostic utility.
Agentic AI systems powered by Large Language Models (LLMs) as their foundational reasoning engine, are transforming clinical workflows such as medical report generation and clinical summarization by autonomously analyzing sensitive healthcare data and executing decisions with minimal human oversight. However, their adoption demands strict compliance with regulatory frameworks such as Health Insurance Portability and Accountability Act (HIPAA), particularly when handling Protected Health Information (PHI). This work-in-progress paper introduces a HIPAA-compliant Agentic AI framework that enforces regulatory compliance through dynamic, context-aware policy enforcement. Our framework integrates three core mechanisms: (1) Attribute-Based Access Control (ABAC) for granular PHI governance, (2) a hybrid PHI sanitization pipeline combining regex patterns and BERT-based model to minimize leakage, and (3) immutable audit trails for compliance verification.
Large vision-language models (LVMs) hold a great promise for automating medical report generation, potentially reducing the burden of manual reporting. State-of-the-art (SOTA) research fine-tunes general LVMs with medical data to align radiology images to corresponding medical reports. However, there are two key factors that limit these LVM's performance. Firstly, LVMs lack complex reasoning capability that leads to logical inconsistencies and potential diagnostic errors in generated reports. Secondly, LVMs lack reflection mechanism that leads to an inability to discover errors in the thinking process. To address these gaps, we propose LVMed-R2, a new fine-tuning strategy that introduces complex reasoning and reflection mechanisms for LVMs to enhance medical report generation. To the best of our knowledge, this is the first work to introduce complex reasoning to the medical report generation (MRG) task. Our proposed complex reasoning contains medical knowledge injection and perception-enhancing modules which improve the accuracy of LVMs diagnosis, coupled with a perception tree to provide guidance to limit the perception range. Further, the reflection mechanism forces self-verification for outputs to correct for potential errors. We experimented by fine-tuning LVMs with our proposed LVMed-R2 strategy, using IU-Xray and MIMIC-CXR datasets. Our results, measured on natural language generation (NLG) metrics and clinical efficacy (CE) metrics, demonstrate that LVMs fine-tuned with the proposed reflection mechanism possess the ability to correct outputs and complex reasoning effectively and improve LVMs performance for MRG.
Medical report generation is a critical task in healthcare that involves the automatic creation of detailed and accurate descriptions from medical images. Traditionally, this task has been approached as a sequence generation problem, relying on vision-and-language techniques to generate coherent and contextually relevant reports. However, in this paper, we propose a novel perspective: rethinking medical report generation as a multi-label classification problem. By framing the task this way, we leverage the radiology nodes from the commonly used knowledge graph, which can be better captured through classification techniques. To verify our argument, we introduce a novel report generation framework based on BLIP integrated with classified key nodes, which allows for effective report generation with accurate classification of multiple key aspects within the medical images. This approach not only simplifies the report generation process but also significantly enhances performance metrics. Our extensive experiments demonstrate that leveraging key nodes can achieve state-of-the-art (SOTA) performance, surpassing existing approaches across two benchmark datasets. The results underscore the potential of re-envisioning traditional tasks with innovative methodologies, paving the way for more efficient and accurate medical report generation.
Medical report generation requires specialized expertise that general large models often fail to accurately capture. Moreover, the inherent repetition and similarity in medical data make it difficult for models to extract meaningful features, resulting in a tendency to overfit. So in this paper, we propose a multimodal model, Co-Attention Triple-LSTM Network (CA-TriNet), a deep learning model that combines transformer architectures with a Multi-LSTM network. Its Co-Attention module synergistically links a vision transformer with a text transformer to better differentiate medical images with similarities, augmented by an adaptive weight operator to catch and amplify image labels with minor similarities. Furthermore, its Triple-LSTM module refines generated sentences using targeted image objects. Extensive evaluations over three public datasets have demonstrated that CA-TriNet outperforms state-of-the-art models in terms of comprehensive ability, even pre-trained large language models on some metrics.
Retrieval-augmented generation (RAG) has emerged as a pivotal technique in artificial intelligence (AI), particularly in enhancing the capabilities of large language models (LLMs) by enabling access to external, reliable, and up-to-date knowledge sources. In the context of AI-Generated Content (AIGC), RAG has proven invaluable by augmenting model outputs with supplementary, relevant information, thus improving their quality. Recently, the potential of RAG has extended beyond natural language processing, with emerging methods integrating retrieval-augmented strategies into the computer vision (CV) domain. These approaches aim to address the limitations of relying solely on internal model knowledge by incorporating authoritative external knowledge bases, thereby improving both the understanding and generation capabilities of vision models. This survey provides a comprehensive review of the current state of retrieval-augmented techniques in CV, focusing on two main areas: (I) visual understanding and (II) visual generation. In the realm of visual understanding, we systematically review tasks ranging from basic image recognition to complex applications such as medical report generation and multimodal question answering. For visual content generation, we examine the application of RAG in tasks related to image, video, and 3D generation. Furthermore, we explore recent advancements in RAG for embodied AI, with a particular focus on applications in planning, task execution, multimodal perception, interaction, and specialized domains. Given that the integration of retrieval-augmented techniques in CV is still in its early stages, we also highlight the key limitations of current approaches and propose future research directions to drive the development of this promising area.
With the rapid advancement of deep learning, particularly in the field of medical image analysis, an increasing number of Vision-Language Models (VLMs) are being widely applied to solve complex health and biomedical challenges. However, existing research has primarily focused on specific tasks or single modalities, which limits their applicability and generalization across diverse medical scenarios. To address this challenge, we propose UMIT, a unified multi-modal, multi-task VLM designed specifically for medical imaging tasks. UMIT is able to solve various tasks, including visual question answering, disease detection, and medical report generation. In addition, it is applicable to multiple imaging modalities (e.g., X-ray, CT and PET), covering a wide range of applications from basic diagnostics to complex lesion analysis. Moreover, UMIT supports both English and Chinese, expanding its applicability globally and ensuring accessibility to healthcare services in different linguistic contexts. To enhance the model's adaptability and task-handling capability, we design a unique two-stage training strategy and fine-tune UMIT with designed instruction templates. Through extensive empirical evaluation, UMIT outperforms previous methods in five tasks across multiple datasets. The performance of UMIT indicates that it can significantly enhance diagnostic accuracy and workflow efficiency, thus providing effective solutions for medical imaging applications.
Automatic medical report generation supports clinical diagnosis, reduces the workload of radiologists, and holds the promise of improving diagnosis consistency. However, existing evaluation metrics primarily assess the accuracy of key medical information coverage in generated reports compared to human-written reports, while overlooking crucial details such as the location and certainty of reported abnormalities. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs NER-F1 calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = 0.70 for Rexval dataset and Kendall coefficient = 0.54 for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.
Despite significant progress in Vision-Language Pre-training (VLP), current approaches predominantly emphasize feature extraction and cross-modal comprehension, with limited attention to generating or transforming visual content. This gap hinders the model's ability to synthesize coherent and novel visual representations from textual prompts, thereby reducing the effectiveness of multi-modal learning. In this work, we propose MedUnifier, a unified VLP framework tailored for medical data. MedUnifier seamlessly integrates text-grounded image generation capabilities with multi-modal learning strategies, including image-text contrastive alignment, image-text matching and image-grounded text generation. Unlike traditional methods that reply on continuous visual representations, our approach employs visual vector quantization, which not only facilitates a more cohesive learning strategy for cross-modal understanding but also enhances multi-modal generation quality by effectively leveraging discrete representations. Our framework's effectiveness is evidenced by the experiments on established benchmarks, including uni-modal tasks (supervised fine-tuning), cross-modal tasks (image-text retrieval and zero-shot image classification), and multi-modal tasks (medical report generation, image synthesis), where it achieves state-of-the-art performance across various tasks. MedUnifier also offers a highly adaptable tool for a wide range of language and vision tasks in healthcare, marking advancement toward the development of a generalizable AI model for medical applications.
The interpretation of histopathology cases underlies many important diagnostic and treatment decisions in medicine. Notably, this process typically requires pathologists to integrate and summarize findings across multiple slides per case. Existing vision-language capabilities in computational pathology have so far been largely limited to small regions of interest, larger regions at low magnification, or single whole-slide images (WSIs). This limits interpretation of findings that span multiple high-magnification regions across multiple WSIs. By making use of Gemini 1.5 Flash, a large multimodal model (LMM) with a 1-million token context window, we demonstrate the ability to generate bottom-line diagnoses from up to 40,000 768x768 pixel image patches from multiple WSIs at 10X magnification. This is the equivalent of up to 11 hours of video at 1 fps. Expert pathologist evaluations demonstrate that the generated report text is clinically accurate and equivalent to or preferred over the original reporting for 68% (95% CI: [60%, 76%]) of multi-slide examples with up to 5 slides. While performance decreased for examples with 6 or more slides, this study demonstrates the promise of leveraging the long-context capabilities of modern LMMs for the uniquely challenging task of medical report generation where each case can contain thousands of image patches.
Generative artificial intelligence (AI) models, such as diffusion models and OpenAI's ChatGPT, are transforming medicine by enhancing diagnostic accuracy and automating clinical workflows. The field has advanced rapidly, evolving from text-only large language models for tasks such as clinical documentation and decision support to multimodal AI systems capable of integrating diverse data modalities, including imaging, text, and structured data, within a single model. The diverse landscape of these technologies, along with rising interest, highlights the need for a comprehensive review of their applications and potential. This scoping review explores the evolution of multimodal AI, highlighting its methods, applications, datasets, and evaluation in clinical settings. Adhering to PRISMA-ScR guidelines, we systematically queried PubMed, IEEE Xplore, and Web of Science, prioritizing recent studies published up to the end of 2024. After rigorous screening, 144 papers were included, revealing key trends and challenges in this dynamic field. Our findings underscore a shift from unimodal to multimodal approaches, driving innovations in diagnostic support, medical report generation, drug discovery, and conversational AI. However, critical challenges remain, including the integration of heterogeneous data types, improving model interpretability, addressing ethical concerns, and validating AI systems in real-world clinical settings. This review summarizes the current state of the art, identifies critical gaps, and provides insights to guide the development of scalable, trustworthy, and clinically impactful multimodal AI solutions in healthcare.
X-ray image based medical report generation achieves significant progress in recent years with the help of the large language model, however, these models have not fully exploited the effective information in visual image regions, resulting in reports that are linguistically sound but insufficient in describing key diseases. In this paper, we propose a novel associative memory-enhanced X-ray report generation model that effectively mimics the process of professional doctors writing medical reports. It considers both the mining of global and local visual information and associates historical report information to better complete the writing of the current report. Specifically, given an X-ray image, we first utilize a classification model along with its activation maps to accomplish the mining of visual regions highly associated with diseases and the learning of disease query tokens. Then, we employ a visual Hopfield network to establish memory associations for disease-related tokens, and a report Hopfield network to retrieve report memory information. This process facilitates the generation of high-quality reports based on a large language model and achieves state-of-the-art performance on multiple benchmark datasets, including the IU X-ray, MIMIC-CXR, and Chexpert Plus. The source code of this work is released on \url{https://github.com/Event-AHU/Medical_Image_Analysis}.
Medical report generation is crucial for clinical diagnosis and patient management, summarizing diagnoses and recommendations based on medical imaging. However, existing work often overlook the clinical pipeline involved in report writing, where physicians typically conduct an initial quick review followed by a detailed examination. Moreover, current alignment methods may lead to misaligned relationships. To address these issues, we propose DAMPER, a dual-stage framework for medical report generation that mimics the clinical pipeline of report writing in two stages. In the first stage, a MeSH-Guided Coarse-Grained Alignment (MCG) stage that aligns chest X-ray (CXR) image features with medical subject headings (MeSH) features to generate a rough keyphrase representation of the overall impression. In the second stage, a Hypergraph-Enhanced Fine-Grained Alignment (HFG) stage that constructs hypergraphs for image patches and report annotations, modeling high-order relationships within each modality and performing hypergraph matching to capture semantic correlations between image regions and textual phrases. Finally,the coarse-grained visual features, generated MeSH representations, and visual hypergraph features are fed into a report decoder to produce the final medical report. Extensive experiments on public datasets demonstrate the effectiveness of DAMPER in generating comprehensive and accurate medical reports, outperforming state-of-the-art methods across various evaluation metrics.
Recent advances in deep learning and natural language generation have significantly improved image captioning, enabling automated, human-like descriptions for visual content. In this work, we apply these captioning techniques to generate clinician-like interpretations of ECG data. This study leverages existing ECG datasets accompanied by free-text reports authored by healthcare professionals (HCPs) as training data. These reports, while often inconsistent, provide a valuable foundation for automated learning. We introduce an encoder-decoder-based method that uses these reports to train models to generate detailed descriptions of ECG episodes. This represents a significant advancement in ECG analysis automation, with potential applications in zero-shot classification and automated clinical decision support. The model is tested on various datasets, including both 1- and 12-lead ECGs. It significantly outperforms the state-of-the-art reference model by Qiu et al., achieving a METEOR score of 55.53% compared to 24.51% achieved by the reference model. Furthermore, several key design choices are discussed, providing a comprehensive overview of current challenges and innovations in this domain. The source codes for this research are publicly available in our Git repository https://git.zib.de/ableich/ecg-comment-generation-public
Medical vision-language model models often struggle with generating accurate quantitative measurements in radiology reports, leading to hallucinations that undermine clinical reliability. We introduce FactCheXcker, a modular framework that de-hallucinates radiology report measurements by leveraging an improved query-code-update paradigm. Specifically, FactCheXcker employs specialized modules and the code generation capabilities of large language models to solve measurement queries generated based on the original report. After extracting measurable findings, the results are incorporated into an updated report. We evaluate FactCheXcker on endotracheal tube placement, which accounts for an average of 78% of report measurements, using the MIMIC-CXR dataset and 11 medical report-generation models. Our results show that FactCheXcker significantly reduces hallucinations, improves measurement precision, and maintains the quality of the original reports. Specifically, FactCheXcker improves the performance of all 11 models and achieves an average improvement of 94.0% in reducing measurement hallucinations measured by mean absolute error.
Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.
Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.
With the increasing application of large language models (LLMs) in the medical domain, evaluating these models' performance using benchmark datasets has become crucial. This paper presents a comprehensive survey of various benchmark datasets employed in medical LLM tasks. These datasets span multiple modalities including text, image, and multimodal benchmarks, focusing on different aspects of medical knowledge such as electronic health records (EHRs), doctor-patient dialogues, medical question-answering, and medical image captioning. The survey categorizes the datasets by modality, discussing their significance, data structure, and impact on the development of LLMs for clinical tasks such as diagnosis, report generation, and predictive decision support. Key benchmarks include MIMIC-III, MIMIC-IV, BioASQ, PubMedQA, and CheXpert, which have facilitated advancements in tasks like medical report generation, clinical summarization, and synthetic data generation. The paper summarizes the challenges and opportunities in leveraging these benchmarks for advancing multimodal medical intelligence, emphasizing the need for datasets with a greater degree of language diversity, structured omics data, and innovative approaches to synthesis. This work also provides a foundation for future research in the application of LLMs in medicine, contributing to the evolving field of medical artificial intelligence.
The paper proposes a novel evaluation metric for automatic medical report generation from X-ray images, VLScore. It aims to overcome the limitations of existing evaluation methods, which either focus solely on textual similarities, ignoring clinical aspects, or concentrate only on a single clinical aspect, the pathology, neglecting all other factors. The key idea of our metric is to measure the similarity between radiology reports while considering the corresponding image. We demonstrate the benefit of our metric through evaluation on a dataset where radiologists marked errors in pairs of reports, showing notable alignment with radiologists' judgments. In addition, we provide a new dataset for evaluating metrics. This dataset includes well-designed perturbations that distinguish between significant modifications (e.g., removal of a diagnosis) and insignificant ones. It highlights the weaknesses in current evaluation metrics and provides a clear framework for analysis.