MedReasoner: Reinforcement Learning Drives Reasoning Grounding from Clinical Thought to Pixel-Level Precision

Accurately grounding regions of interest (ROIs) is critical for diagnosis and treatment planning in medical imaging. While multimodal large language models (MLLMs) combine visual perception with natural language, current medical-grounding pipelines still rely on supervised fine-tuning with explicit spatial hints, making them ill-equipped to handle the implicit queries common in clinical practice. This work makes three core contributions. We first define Unified Medical Reasoning Grounding (UMRG), a novel vision-language task that demands clinical reasoning and pixel-level grounding. Second, we release U-MRG-14K, a dataset of 14K samples featuring pixel-level masks alongside implicit clinical queries and reasoning traces, spanning 10 modalities, 15 super-categories, and 108 specific categories. Finally, we introduce MedReasoner, a modular framework that distinctly separates reasoning from segmentation: an MLLM reasoner is optimized with reinforcement learning, while a frozen segmentation expert converts spatial prompts into masks, with alignment achieved through format and accuracy rewards. MedReasoner achieves state-of-the-art performance on U-MRG-14K and demonstrates strong generalization to unseen clinical queries, underscoring the significant promise of reinforcement learning for interpretable medical grounding.

Utilizing Machine Learning Models to Predict Acute Kidney Injury in Septic Patients from MIMIC-III Database

Sepsis is a severe condition that causes the body to respond incorrectly to an infection. This reaction can subsequently cause organ failure, a major one being acute kidney injury (AKI). For septic patients, approximately 50% develop AKI, with a mortality rate above 40%. Creating models that can accurately predict AKI based on specific qualities of septic patients is crucial for early detection and intervention. Using medical data from septic patients during intensive care unit (ICU) admission from the Medical Information Mart for Intensive Care 3 (MIMIC-III) database, we extracted 3301 patients with sepsis, with 73% of patients developing AKI. The data was randomly divided into a training set (n = 1980, 40%), a test set (n = 661, 10%), and a validation set (n = 660, 50%). The proposed model was logistic regression, and it was compared against five baseline models: XGBoost, K Nearest Neighbors (KNN), Support Vector Machines (SVM), Random Forest (RF), and LightGBM. Area Under the Curve (AUC), Accuracy, F1-Score, and Recall were calculated for each model. After analysis, we were able to select 23 features to include in our model, the top features being urine output, maximum bilirubin, minimum bilirubin, weight, maximum blood urea nitrogen, and minimum estimated glomerular filtration rate. The logistic regression model performed the best, achieving an AUC score of 0.887 (95% CI: [0.861-0.915]), an accuracy of 0.817, an F1 score of 0.866, a recall score of 0.827, and a Brier score of 0.13. Compared to the best existing literature in this field, our model achieved an 8.57% improvement in AUC while using 13 fewer variables, showcasing its effectiveness in determining AKI in septic patients. While the features selected for predicting AKI in septic patients are similar to previous literature, the top features that influenced our model's performance differ.