AOR: Anatomical Ontology-Guided Reasoning for Medical Large Multimodal Model in Chest X-Ray Interpretation

Chest X-rays (CXRs) are the most frequently performed imaging examinations in clinical settings. Recent advancements in Large Multimodal Models (LMMs) have enabled automated CXR interpretation, enhancing diagnostic accuracy and efficiency. However, despite their strong visual understanding, current Medical LMMs (MLMMs) still face two major challenges: (1) Insufficient region-level understanding and interaction, and (2) Limited accuracy and interpretability due to single-step reasoning. In this paper, we empower MLMMs with anatomy-centric reasoning capabilities to enhance their interactivity and explainability. Specifically, we first propose an Anatomical Ontology-Guided Reasoning (AOR) framework, which centers on cross-modal region-level information to facilitate multi-step reasoning. Next, under the guidance of expert physicians, we develop AOR-Instruction, a large instruction dataset for MLMMs training. Our experiments demonstrate AOR's superior performance in both VQA and report generation tasks.

Anatomical Structure-Guided Medical Vision-Language Pre-training

Learning medical visual representations through vision-language pre-training has reached remarkable progress. Despite the promising performance, it still faces challenges, i.e., local alignment lacks interpretability and clinical relevance, and the insufficient internal and external representation learning of image-report pairs. To address these issues, we propose an Anatomical Structure-Guided (ASG) framework. Specifically, we parse raw reports into triplets <anatomical region, finding, existence>, and fully utilize each element as supervision to enhance representation learning. For anatomical region, we design an automatic anatomical region-sentence alignment paradigm in collaboration with radiologists, considering them as the minimum semantic units to explore fine-grained local alignment. For finding and existence, we regard them as image tags, applying an image-tag recognition decoder to associate image features with their respective tags within each sample and constructing soft labels for contrastive learning to improve the semantic association of different image-report pairs. We evaluate the proposed ASG framework on two downstream tasks, including five public benchmarks. Experimental results demonstrate that our method outperforms the state-of-the-art methods.