CoRE: Concept-Reasoning Expansion for Continual Brain Lesion Segmentation

Accurate brain lesion segmentation in MRI is vital for effective clinical diagnosis and treatment planning. Due to high annotation costs and strict data privacy regulations, universal models require employing Continual Learning (CL) to adapt to evolving clinical tasks without losing previously acquired knowledge. However, existing CL paradigms often suffer from capacity limits or redundant parameter growth, and even advanced dynamic methods rely mostly on image-perception strategies that struggle to handle the substantial pathological and multimodal heterogeneity inherent in brain imaging. To address this issue, we propose Concept-Reasoning Expansion (CoRE) framework, which establishes a joint decision-making mechanism by integrating visual features with structured concepts. Through the alignment of image tokens with a hierarchical concept library, CoRE simulates clinical reasoning to guide both interpretable expert routing and demand-based model growth. This collaborative process ensures model evolution is grounded in clinical priors, preventing redundant parameter expansion while maximizing knowledge reuse. Extensive evaluations across 12 sequential brain lesion MRI tasks demonstrate that CoRE achieves state-of-the-art performance and provides a high knowledge starting point for efficient future adaptation. Its superior few-shot transferability and clinical interpretability further validate its effectiveness in managing non-stationary clinical data streams. Our code will be released soon.

Med-Scout: Curing MLLMs' Geometric Blindness in Medical Perception via Geometry-Aware RL Post-Training

Despite recent Multimodal Large Language Models (MLLMs)' linguistic prowess in medical diagnosis, we find even state-of-the-art MLLMs suffer from a critical perceptual deficit: geometric blindness. This failure to ground outputs in objective geometric constraints leads to plausible yet factually incorrect hallucinations, rooted in training paradigms that prioritize linguistic fluency over geometric fidelity. This paper introduces Med-Scout, a novel framework that "cures" this blindness via Reinforcement Learning (RL) that leverages the intrinsic geometric logic latent within unlabeled medical images. Instead of relying on costly expert annotations, Med-Scout derives verifiable supervision signals through three strategic proxy tasks: Hierarchical Scale Localization, Topological Jigsaw Reconstruction, and Anomaly Consistency Detection. To rigorously quantify this deficit, we present Med-Scout-Bench, a new benchmark specifically designed to evaluate geometric perception. Extensive evaluations show that Med-Scout significantly mitigates geometric blindness, outperforming leading proprietary and open-source MLLMs by over 40% on our benchmark. Furthermore, this enhanced geometric perception generalizes to broader medical understanding, achieving superior results on radiological and comprehensive medical VQA tasks.