SIVA-RL: Sensitivity-Invariance Visual Alignment for Multimodal Reinforcement Learning

Reinforcement learning with verifiable rewards (RLVR) drives multimodal reasoning, but answer-level correctness does not guarantee that a vision-language model grounds its predictions in visual evidence. Existing visual-intervention methods contrast policy behavior on original and modified images, yet assign supervision by the type of intervention rather than its observed effect. This assumption fails: identical operators produce heterogeneous outcomes across samples. We propose SIVA-RL, a Sensitivity-Invariance Visual Alignment framework that replaces operator-conditioned regularization with sample-wise, outcome-conditioned supervision. SIVA-RL constructs localized interventions through token-aligned, distance-constrained within-image PatchSwap. A frozen audit policy then scores each clean-intervention pair, and the observed reward drop becomes soft routing weights. Large-drop pairs drive sensitivity alignment, low-drop pairs drive clean-anchored invariance alignment, and ambiguous pairs are down-weighted. This design decouples intervention construction from supervision assignment and is compatible with both GRPO and DAPO backbones. Across nine multimodal reasoning benchmarks spanning mathematical, logical, and vision-dependent tasks, SIVA-RL improves 3B and 7B models over matched RL baselines in every setting. It yields an 8.79 percentage-point gain on vision-dependent reasoning and up to 14.9% relative overall improvement across all four GRPO- and DAPO-based configurations.

EvoGraph-R1: Self-Evolving Multimodal Knowledge Hypergraphs for Agentic Retrieval

Retrieval-augmented generation (RAG) has emerged as a critical paradigm for grounding Multimodal Large Language Models (MLLMs) in external knowledge. Recent GraphRAG methods introduce structured entity-relation graphs to improve retrieval and reasoning. However, they remain limited by treating knowledge graphs as static data structures built offline and queried in a single pass. This static paradigm misaligns with the interactive, iterative nature of knowledge-intensive reasoning, creating three bottlenecks: (i) text-centric fragmentation that impedes cross-modal reasoning, (ii) frozen structures unable to incorporate new evidence or correct errors, and (iii) rigid single-pass retrieval without adaptive refinement. To overcome these limitations, we introduce EvoGraph-R1, a self-evolving GraphRAG framework that reconceptualizes knowledge graphs as dynamic environments shaped through agent interactions. We formulate retrieval as a Markov Decision Process (MDP) where the agent observes the graph state and executes actions to query (GraphRetrieve), expand (WebSearch), refine (GraphEdit), or terminate (Answer) the reasoning. These actions reshape the hypergraph structure and generate feedback signals that guide subsequent evolution. Through this closed loop, the hypergraph evolves by integrating new evidence, correcting errors, and refining structure to support multi-hop reasoning. Experiments on multimodal VQA and text QA benchmarks demonstrate substantial improvements over existing RAG baselines in accuracy, coverage, and traceability, establishing self-evolving knowledge graphs as a fundamental paradigm across modalities.

C^2GR: Coupled Comprehensive Generative Replay for a Continually Learnable Universal Segmentation Model

Universal segmentation models exhibit significant potential for diverse tasks involving different imaging modalities and segmentation objectives. Task-Incremental Learning provides a privacy-preserving approach to continually evolve a universal model on tasks from sequentially-arriving medical departments. However, training the model solely on the incoming task induces forgetting on past tasks, since consecutive tasks exhibit concurrent shifts in image appearance and segmentation objective. To address this problem, we propose a novel Coupled Comprehensive Generative Replay (C^2GR) framework that simultaneously synthesizes image-mask pairs of previous tasks to mitigate forgetting under concurrent appearance and objective shifts. This requires preserving image-mask correspondence for structure-realistic generation and bridging asynchronous optimization of the generator and segmentor for segmentation-oriented generation. Specifically, we propose a Bayesian Joint Diffusion (BJD) method that formulates the correspondence as conditional distributions optimized via conditional denoising. Furthermore, we develop a Relation-aware Unified Prompt Synchronization (RUPS) scheme to simultaneously modulate the generator and segmentor via a shared task-relation-aware prompt for synchronizing their optimization. Experiments on 20 tasks spanning diverse modalities and objectives demonstrate that C^2GR exhibits only a 2.44% drop in overall performance compared to joint training with all task data, effectively alleviating forgetting from the concurrent shifts. Our code will be made publicly available at https://github.com/mar-cry/C2GR.

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.

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.