SARE: Sample-wise Adaptive Reasoning for Training-free Fine-grained Visual Recognition

Recent advances in Large Vision-Language Models (LVLMs) have enabled training-free Fine-Grained Visual Recognition (FGVR). However, effectively exploiting LVLMs for FGVR remains challenging due to the inherent visual ambiguity of subordinate-level categories. Existing methods predominantly adopt either retrieval-oriented or reasoning-oriented paradigms to tackle this challenge, but both are constrained by two fundamental limitations:(1) They apply the same inference pipeline to all samples without accounting for uneven recognition difficulty, thereby leading to suboptimal accuracy and efficiency; (2) The lack of mechanisms to consolidate and reuse error-specific experience causes repeated failures on similar challenging cases. To address these limitations, we propose SARE, a Sample-wise Adaptive textbfREasoning framework for training-free FGVR. Specifically, SARE adopts a cascaded design that combines fast candidate retrieval with fine-grained reasoning, invoking the latter only when necessary. In the reasoning process, SARE incorporates a self-reflective experience mechanism that leverages past failures to provide transferable discriminative guidance during inference, without any parameter updates. Extensive experiments across 14 datasets substantiate that SARE achieves state-of-the-art performance while substantially reducing computational overhead.

COMPARE: Clinical Optimization with Modular Planning and Assessment via RAG-Enhanced AI-OCT: Superior Decision Support for Percutaneous Coronary Intervention Compared to ChatGPT-5 and Junior Operators

Background: While intravascular imaging, particularly optical coherence tomography (OCT), improves percutaneous coronary intervention (PCI) outcomes, its interpretation is operator-dependent. General-purpose artificial intelligence (AI) shows promise but lacks domain-specific reliability. We evaluated the performance of CA-GPT, a novel large model deployed on an AI-OCT system, against that of the general-purpose ChatGPT-5 and junior physicians for OCT-guided PCI planning and assessment. Methods: In this single-center analysis of 96 patients who underwent OCT-guided PCI, the procedural decisions generated by the CA-GPT, ChatGPT-5, and junior physicians were compared with an expert-derived procedural record. Agreement was assessed using ten pre-specified metrics across pre-PCI and post-PCI phases. Results: For pre-PCI planning, CA-GPT demonstrated significantly higher median agreement scores (5[IQR 3.75-5]) compared to both ChatGPT-5 (3[2-4], P<0.001) and junior physicians (4[3-4], P<0.001). CA-GPT significantly outperformed ChatGPT-5 across all individual pre-PCI metrics and showed superior performance to junior physicians in stent diameter (90.3% vs. 72.2%, P<0.05) and length selection (80.6% vs. 52.8%, P<0.01). In post-PCI assessment, CA-GPT maintained excellent overall agreement (5[4.75-5]), significantly higher than both ChatGPT-5 (4[4-5], P<0.001) and junior physicians (5[4-5], P<0.05). Subgroup analysis confirmed CA-GPT's robust performance advantage in complex scenarios. Conclusion: The CA-GPT-based AI-OCT system achieved superior decision-making agreement versus a general-purpose large language model and junior physicians across both PCI planning and assessment phases. This approach provides a standardized and reliable method for intravascular imaging interpretation, demonstrating significant potential to augment operator expertise and optimize OCT-guided PCI.