MedHorizon: Towards Long-context Medical Video Understanding in the Wild

Medical multimodal large language models (MLLMs) have advanced image understanding and short-video analysis, but real clinical review often requires full-procedure video understanding. Unlike general long videos, medical procedures contain highly redundant anatomical views, while decisive evidence is temporally sparse, spatially subtle, and context dependent. Existing benchmarks often assume this evidence has already been localized through images, short clips, or pre-segmented videos, leaving the retrieval-before-reasoning problem under-tested. We introduce MedHorizon, an in-the-wild benchmark for long-context medical video understanding. MedHorizon preserves 759 hours of full-length clinical procedures and provides 1,253 evidence-grounded multiple-choice questionsthat jointly evaluate sparse evidence understanding and multi-hop clinical reasoning. Its evidence is extremely sparse, with only 0.166% evidence frames on average, requiring models to search noisy procedural streams before interpreting and aggregating findings. We evaluate representative general-domain, medical-domain, and long-video MLLMs. The best model reaches only 41.1% accuracy, showing that current systems remain far from robust full-procedure understanding. Further analysis yields four key findings: performance does not scale reliably with more frames, evidence retrieval and clinical interpretation remain primary bottlenecks; these bottlenecks are rooted in weak procedural reasoning and attention drift under redundancy, and generic sampling methods only partially balances local detail with global coverage. MedHorizon provides a rigorous testbed for MLLMs that retrieve sparse evidence and reason over complete clinical workflows.

Distribution-Aware Reward Estimation for Test-Time Reinforcement Learning

Test-time reinforcement learning (TTRL) enables large language models (LLMs) to self-improve on unlabeled inputs, but its effectiveness critically depends on how reward signals are estimated without ground-truth supervision. Most existing TTRL methods rely on majority voting (MV) over rollouts to produce deterministic rewards, implicitly assuming that the majority rollout provides a reliable learning signal. We show that this assumption is fragile: MV reduces the rollout distribution into a single outcome, discarding information about non-majority but correct actions candidates, and yields systematically biased reward estimates. To address this, we propose Distribution-AwareReward Estimation (DARE), which shifts reward estimation from a single majority outcome to the full empirical rollout distribution. DARE further augments this distribution-based reward with an exploration bonus and a distribution pruning mechanism for non-majority rollout exploration and reward denoise, yielding a more informative and robust reward estimation. Extensive experiments on challenging reasoning benchmarks show that DARE improves optimization stability and final performance over recent baselines, achieving relative improvements of 25.3% on challenging AIME 2024 and 5.3% on AMC.

Radiology Workflow-Guided Hierarchical Reinforcement Fine-Tuning for Medical Report Generation

Radiologists compose diagnostic reports through a structured workflow: they describe visual findings, summarize them into impressions, and carefully refine statements in clinically critical cases. However, most existing medical report generation (MRG) systems treat reports as flat sequences, overlooking this hierarchical organization and leading to inconsistencies between descriptive and diagnostic content. To align model behavior with real-world reporting practices, we propose RadFlow, a hierarchical workflow-guided reinforcement optimization framework that explicitly models the structured nature of clinical reporting. RadFlow introduces a clinically grounded reward hierarchy that mirrors the organization of radiological reports. At the global level, the reward integrates linguistic fluency, medical-domain correctness, and cross-sectional consistency between Finding and Impression, promoting coherent and clinically faithful narratives. At the local level, a section-specific reward emphasizes Impression quality, reflecting its central role in diagnostic accuracy. Furthermore, a critical-aware policy optimization mechanism adaptively regularizes learning for high-risk or clinically sensitive cases, emulating the cautious refinement behavior of radiologists when documenting critical findings. Together, these components translate the structured reporting paradigm into the reinforcement fine-tuning process, enabling the model to generate reports that are both linguistically consistent and clinically aligned. Experiments on chest X-ray and carotid ultrasound datasets demonstrate that RadFlow consistently improves diagnostic coherence and overall report quality compared with state-of-the-art baselines.

Multi-Modal Explainable Medical AI Assistant for Trustworthy Human-AI Collaboration

Generalist Medical AI (GMAI) systems have demonstrated expert-level performance in biomedical perception tasks, yet their clinical utility remains limited by inadequate multi-modal explainability and suboptimal prognostic capabilities. Here, we present XMedGPT, a clinician-centric, multi-modal AI assistant that integrates textual and visual interpretability to support transparent and trustworthy medical decision-making. XMedGPT not only produces accurate diagnostic and descriptive outputs, but also grounds referenced anatomical sites within medical images, bridging critical gaps in interpretability and enhancing clinician usability. To support real-world deployment, we introduce a reliability indexing mechanism that quantifies uncertainty through consistency-based assessment via interactive question-answering. We validate XMedGPT across four pillars: multi-modal interpretability, uncertainty quantification, and prognostic modeling, and rigorous benchmarking. The model achieves an IoU of 0.703 across 141 anatomical regions, and a Kendall's tau-b of 0.479, demonstrating strong alignment between visual rationales and clinical outcomes. For uncertainty estimation, it attains an AUC of 0.862 on visual question answering and 0.764 on radiology report generation. In survival and recurrence prediction for lung and glioma cancers, it surpasses prior leading models by 26.9%, and outperforms GPT-4o by 25.0%. Rigorous benchmarking across 347 datasets covers 40 imaging modalities and external validation spans 4 anatomical systems confirming exceptional generalizability, with performance gains surpassing existing GMAI by 20.7% for in-domain evaluation and 16.7% on 11,530 in-house data evaluation. Together, XMedGPT represents a significant leap forward in clinician-centric AI integration, offering trustworthy and scalable support for diverse healthcare applications.

Rethinking the Graph Polynomial Filter via Positive and Negative Coupling Analysis

Recently, the optimization of polynomial filters within Spectral Graph Neural Networks (GNNs) has emerged as a prominent research focus. Existing spectral GNNs mainly emphasize polynomial properties in filter design, introducing computational overhead and neglecting the integration of crucial graph structure information. We argue that incorporating graph information into basis construction can enhance understanding of polynomial basis, and further facilitate simplified polynomial filter design. Motivated by this, we first propose a Positive and Negative Coupling Analysis (PNCA) framework, where the concepts of positive and negative activation are defined and their respective and mixed effects are analysed. Then, we explore PNCA from the message propagation perspective, revealing the subtle information hidden in the activation process. Subsequently, PNCA is used to analyze the mainstream polynomial filters, and a novel simple basis that decouples the positive and negative activation and fully utilizes graph structure information is designed. Finally, a simple GNN (called GSCNet) is proposed based on the new basis. Experimental results on the benchmark datasets for node classification verify that our GSCNet obtains better or comparable results compared with existing state-of-the-art GNNs while demanding relatively less computational time.