MedProbeBench: Systematic Benchmarking at Deep Evidence Integration for Expert-level Medical Guideline

Recent advances in deep research systems enable large language models to retrieve, synthesize, and reason over large-scale external knowledge. In medicine, developing clinical guidelines critically depends on such deep evidence integration. However, existing benchmarks fail to evaluate this capability in realistic workflows requiring multi-step evidence integration and expert-level judgment. To address this gap, we introduce MedProbeBench, the first benchmark leveraging high-quality clinical guidelines as expert-level references. Medical guidelines, with their rigorous standards in neutrality and verifiability, represent the pinnacle of medical expertise and pose substantial challenges for deep research agents. For evaluation, we propose MedProbe-Eval, a comprehensive evaluation framework featuring: (1) Holistic Rubrics with 1,200+ task-adaptive rubric criteria for comprehensive quality assessment, and (2) Fine-grained Evidence Verification for rigorous validation of evidence precision, grounded in 5,130+ atomic claims. Evaluation of 17 LLMs and deep research agents reveals critical gaps in evidence integration and guideline generation, underscoring the substantial distance between current capabilities and expert-level clinical guideline development. Project: https://github.com/uni-medical/MedProbeBench

MMRareBench: A Rare-Disease Multimodal and Multi-Image Medical Benchmark

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

Project Imaging-X: A Survey of 1000+ Open-Access Medical Imaging Datasets for Foundation Model Development

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

MedQ-Engine: A Closed-Loop Data Engine for Evolving MLLMs in Medical Image Quality Assessment

Medical image quality assessment (Med-IQA) is a prerequisite for clinical AI deployment, yet multimodal large language models (MLLMs) still fall substantially short of human experts, particularly when required to provide descriptive assessments with clinical reasoning beyond simple quality scores. However, improving them is hindered by the high cost of acquiring descriptive annotations and by the inability of one-time data collection to adapt to the model's evolving weaknesses. To address these challenges, we propose MedQ-Engine, a closed-loop data engine that iteratively evaluates the model to discover failure prototypes via data-driven clustering, explores a million-scale image pool using these prototypes as retrieval anchors with progressive human-in-the-loop annotation, and evolves through quality-assured fine-tuning, forming a self-improving cycle. Models are evaluated on complementary perception and description tasks. An entropy-guided routing mechanism triages annotations to minimize labeling cost. Experiments across five medical imaging modalities show that MedQ-Engine elevates an 8B-parameter model to surpass GPT-4o by over 13% and narrow the gap with human experts to only 4.34%, using only 10K annotations with more than 4x sample efficiency over random sampling.

MedQ-UNI: Toward Unified Medical Image Quality Assessment and Restoration via Vision-Language Modeling

Existing medical image restoration (Med-IR) methods are typically modality-specific or degradation-specific, failing to generalize across the heterogeneous degradations encountered in clinical practice. We argue this limitation stems from the isolation of Med-IR from medical image quality assessment (Med-IQA), as restoration models without explicit quality understanding struggle to adapt to diverse degradation types across modalities. To address these challenges, we propose MedQ-UNI, a unified vision-language model that follows an assess-then-restore paradigm, explicitly leveraging Med-IQA to guide Med-IR across arbitrary modalities and degradation types. MedQ-UNI adopts a multimodal autoregressive dual-expert architecture with shared attention: a quality assessment expert first identifies degradation issues through structured natural language descriptions, and a restoration expert then conditions on these descriptions to perform targeted image restoration. To support this paradigm, we construct a large-scale dataset of approximately 50K paired samples spanning three imaging modalities and five restoration tasks, each annotated with structured quality descriptions for joint Med-IQA and Med-IR training, along with a 2K-sample benchmark for evaluation. Extensive experiments demonstrate that a single MedQ-UNI model, without any task-specific adaptation, achieves state-of-the-art restoration performance across all tasks while generating superior descriptions, confirming that explicit quality understanding meaningfully improves restoration fidelity and interpretability.

TopoVST: Toward Topology-fidelitous Vessel Skeleton Tracking

Automatic extraction of vessel skeletons is crucial for many clinical applications. However, achieving topologically faithful delineation of thin vessel skeletons remains highly challenging, primarily due to frequent discontinuities and the presence of spurious skeleton segments. To address these difficulties, we propose TopoVST, a topology-fidelitious vessel skeleton tracker. TopoVST constructs multi-scale sphere graphs to sample the input image and employs graph neural networks to jointly estimate tracking directions and vessel radii. The utilization of multi-scale representations is enhanced through a gating-based feature fusion mechanism, while the issue of class imbalance during training is mitigated by embedding a geometry-aware weighting scheme into the directional loss. In addition, we design a wave-propagation-based skeleton tracking algorithm that explicitly mitigates the generation of spurious skeletons through space-occupancy filtering. We evaluate TopoVST on two vessel datasets with different geometries. Extensive comparisons with state-of-the-art baselines demonstrate that TopoVST achieves competitive performance in both overlapping and topological metrics. Our source code is available at: https://github.com/EndoluminalSurgicalVision-IMR/TopoVST.

Open World MRI Reconstruction with Bias-Calibrated Adaptation

Real-world MRI reconstruction systems face the open-world challenge: test data from unseen imaging centers, anatomical structures, or acquisition protocols can differ drastically from training data, causing severe performance degradation. Existing methods struggle with this challenge. To address this, we propose BiasRecon, a bias-calibrated adaptation framework grounded in the minimal intervention principle: preserve what transfers, calibrate what does not. Concretely, BiasRecon formulates open-world adaptation as an alternating optimization framework that jointly optimizes three components: (1) frequency-guided prior calibration that introduces layer-wise calibration variables to selectively modulate frequency-specific features of the pre-trained score network via self-supervised k-space signals, (2) score-based denoising that leverages the calibrated generative prior for high-fidelity image reconstruction, and (3) adaptive regularization that employs Stein's Unbiased Risk Estimator to dynamically balance the prior-measurement trade-off, matching test-time noise characteristics without requiring ground truth. By intervening minimally and precisely through this alternating scheme, BiasRecon achieves robust adaptation with fewer than 100 tunable parameters. Extensive experiments across four datasets demonstrate state-of-the-art performance on open-world reconstruction tasks.

MedQ-Deg: A Multidimensional Benchmark for Evaluating MLLMs Across Medical Image Quality Degradations

Despite impressive performance on standard benchmarks, multimodal large language models (MLLMs) face critical challenges in real-world clinical environments where medical images inevitably suffer various quality degradations. Existing benchmarks exhibit two key limitations: (1) absence of large-scale, multidimensional assessment across medical image quality gradients and (2) no systematic confidence calibration analysis. To address these gaps, we present MedQ-Deg, a comprehensive benchmark for evaluating medical MLLMs under image quality degradations. MedQ-Deg provides multi-dimensional evaluation spanning 18 distinct degradation types, 30 fine-grained capability dimensions, and 7 imaging modalities, with 24,894 question-answer pairs. Each degradation is implemented at 3 severity degrees, calibrated by expert radiologists. We further introduce Calibration Shift metric, which quantifies the gap between a model's perceived confidence and actual performance to assess metacognitive reliability under degradation. Our comprehensive evaluation of 40 mainstream MLLMs reveals several critical findings: (1) overall model performance degrades systematically as degradation severity increases, (2) models universally exhibit the AI Dunning-Kruger Effect, maintaining inappropriately high confidence despite severe accuracy collapse, and (3) models display markedly differentiated behavioral patterns across capability dimensions, imaging modalities, and degradation types. We hope MedQ-Deg drives progress toward medical MLLMs that are robust and trustworthy in real clinical practice.

Training-Free Acceleration for Document Parsing Vision-Language Model with Hierarchical Speculative Decoding

Document parsing is a fundamental task in multimodal understanding, supporting a wide range of downstream applications such as information extraction and intelligent document analysis. Benefiting from strong semantic modeling and robust generalization, VLM-based end-to-end approaches have emerged as the mainstream paradigm in recent years. However, these models often suffer from substantial inference latency, as they must auto-regressively generate long token sequences when processing long-form documents. In this work, motivated by the extremely long outputs and complex layout structures commonly found in document parsing, we propose a training-free and highly efficient acceleration method. Inspired by speculative decoding, we employ a lightweight document parsing pipeline as a draft model to predict batches of future tokens, while the more accurate VLM verifies these draft predictions in parallel. Moreover, we further exploit the layout-structured nature of documents by partitioning each page into independent regions, enabling parallel decoding of each region using the same draft-verify strategy. The final predictions are then assembled according to the natural reading order. Experimental results demonstrate the effectiveness of our approach: on the general-purpose OmniDocBench, our method provides a 2.42x lossless acceleration for the dots.ocr model, and achieves up to 4.89x acceleration on long-document parsing tasks. We will release our code to facilitate reproducibility and future research.

MedScope: Incentivizing "Think with Videos" for Clinical Reasoning via Coarse-to-Fine Tool Calling

Long-form clinical videos are central to visual evidence-based decision-making, with growing importance for applications such as surgical robotics and related settings. However, current multimodal large language models typically process videos with passive sampling or weakly grounded inspection, which limits their ability to iteratively locate, verify, and justify predictions with temporally targeted evidence. To close this gap, we propose MedScope, a tool-using clinical video reasoning model that performs coarse-to-fine evidence seeking over long-form procedures. By interleaving intermediate reasoning with targeted tool calls and verification on retrieved observations, MedScope produces more accurate and trustworthy predictions that are explicitly grounded in temporally localized visual evidence. To address the lack of high-fidelity supervision, we build ClinVideoSuite, an evidence-centric, fine-grained clinical video suite. We then optimize MedScope with Grounding-Aware Group Relative Policy Optimization (GA-GRPO), which directly reinforces tool use with grounding-aligned rewards and evidence-weighted advantages. On full and fine-grained video understanding benchmarks, MedScope achieves state-of-the-art performance in both in-domain and out-of-domain evaluations. Our approach illuminates a path toward medical AI agents that can genuinely "think with videos" through tool-integrated reasoning. We will release our code, models, and data.