Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence

Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations still undermine trustworthy use: models can produce fluent conclusions that conflict with imaging evidence. Existing mitigation strategies typically rely on additional training, external retrieval/knowledge bases, or multi-stage post-hoc verification, which increases cost and pipeline complexity and often generalizes poorly across models and tasks.To address this, we propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection. By leveraging ROI priors acquired using MedSAM in our implementation, we recalibrate the visual perception trajectory via ROI-guided activation modulation while anchoring the textual reasoning trajectory by mapping anatomical coordinates into discrete semantic tokens as verifiable external memory. Then we introduce a task-aware dynamic router to select modality-specific interventions based on task semantics, balancing perceptual grounding and linguistic fluency. We conduct systematic evaluations on 2 tasks and 5 datasets using \texttt{LLaVA-1.5-7B}, \texttt{LLaVA-Med-1.5-7B}, \texttt{Qwen3-VL-8B/32B}, and \texttt{InternVL-3.5-8B/38B}. Controlled ablations and visualizations further validate the framework, which consistently outperforms baselines across medical benchmarks, improving close-ended accuracy by up to $\sim\mathbf{6}\%\uparrow$ and reducing open-ended hallucinations by $\sim\mathbf{35}\%\downarrow$. The code has been made available on GitHub: \href{https://github.com/Henry991115/SPRG}{\textcolor{blue}{https://github.com/Henry991115/SPRG}}.

Granulon: Awakening Pixel-Level Visual Encoders with Adaptive Multi-Granularity Semantics for MLLM

Recent advances in multimodal large language models largely rely on CLIP-based visual encoders, which emphasize global semantic alignment but struggle with fine-grained visual understanding. In contrast, DINOv3 provides strong pixel-level perception yet lacks coarse-grained semantic abstraction, leading to limited multi-granularity reasoning. To address this gap, we propose Granulon, a novel DINOv3-based MLLM with adaptive granularity augmentation. Granulon introduces a text-conditioned granularity Controller that dynamically adjusts the visual abstraction level according to the semantic scope of the textual input, and an Adaptive Token Aggregation module that performs granularity-guided pooling and relation-aware clustering to produce compact, semantically rich visual tokens. This design enables unified "pixel-to-fine-to-coarse" reasoning within a single forward pass. Extensive and interpretable experiments demonstrate that Granulon improves accuracy by ~30% and reduces hallucination by ~20%, outperforming all visual encoders under identical settings.