ReportQA: QA-Based Radiology Report Evaluation

Radiology report evaluation is essential for advancing automated report generation. Natural language generation metrics have limited clinical relevance. Clinical efficacy (CE) metrics evaluate important medical findings, but focus mainly on presence and cover only a limited set of entities. Due to heavy reliance on manual annotations, it is difficult for CE metrics to extend clinical entities or attributes. In clinical practice, radiology reports serve as a medium for information transfer. Clinicians use them to perform downstream diagnostic tasks without directly inspecting images. Based on this insight, we propose ReportQA, a clinical-related and flexible radiology report evaluation framework, supporting detailed quantitative analysis of radiology report generation systems. We first collect datasets covering multiple imaging modalities and anatomical regions. We then construct knowledge trees of clinical entities and attributes with radiologist guidance, and use large language models (LLMs) to extract structured information from raw reports. Next, we generate QA pairs from predefined templates and apply quality control through self-filtering and report-based filtering. During evaluation, the report is treated as context, and an LLM acts as a judge model to answer the QA pairs. Based on the resulting QA accuracy, we introduce QAScore metric. Compared with existing metrics, QAScore shows better alignment with radiologist judgments. Experiments on multiple state-of-the-art vision-language models reveal that current report-based inference paradigms struggle to learn fine-grained clinical representations and exhibit strong negative prior biases. In contrast, question-driven inference provides a more effective alternative. For reproducibility and extensibility, we release the knowledge trees, structured reports, and QA pairs, along with the pipeline code for QA construction and evaluation.

Lost in the Hype: Revealing and Dissecting the Performance Degradation of Medical Multimodal Large Language Models in Image Classification

The rise of multimodal large language models (MLLMs) has sparked an unprecedented wave of applications in the field of medical imaging analysis. However, as one of the earliest and most fundamental tasks integrated into this paradigm, medical image classification reveals a sobering reality: state-of-the-art medical MLLMs consistently underperform compared to traditional deep learning models, despite their overwhelming advantages in pre-training data and model parameters. This paradox prompts a critical rethinking: where exactly does the performance degradation originate? In this paper, we conduct extensive experiments on 14 open-source medical MLLMs across three representative image classification datasets. Moving beyond superficial performance benchmarking, we employ feature probing to track the information flow of visual features module-by-module and layer-by-layer throughout the entire MLLM pipeline, enabling explicit visualization of where and how classification signals are distorted, diluted, or overridden. As the first attempt to dissect classification performance degradation in medical MLLMs, our findings reveal four failure modes: 1) quality limitation in visual representation, 2) fidelity loss in connector projection, 3) comprehension deficit in LLM reasoning, and 4) misalignment of semantic mapping. Meanwhile, we introduce quantitative scores that characterize the healthiness of feature evolution, enabling principled comparisons across diverse MLLMs and datasets. Furthermore, we provide insightful discussions centered on the critical barriers that prevent current medical MLLMs from fulfilling their promised clinical potential. We hope that our work provokes rethinking within the community-highlighting that the road from high expectations to clinically deployable MLLMs remains long and winding.

MedM-VL: What Makes a Good Medical LVLM?

Medical image analysis is a fundamental component. As deep learning progresses, the focus has shifted from single-task applications, such as classification and segmentation, to more complex multimodal tasks, including medical visual question answering and report generation. Traditional shallow and task-specific models are increasingly limited in addressing the complexity and scalability required in clinical practice. The emergence of large language models (LLMs) has driven the development of medical Large Vision-Language Models (LVLMs), offering a unified solution for diverse vision-language tasks. In this study, we investigate various architectural designs for medical LVLMs based on the widely adopted LLaVA framework, which follows an encoder-connector-LLM paradigm. We construct two distinct models targeting 2D and 3D modalities, respectively. These models are designed to support both general-purpose medical tasks and domain-specific fine-tuning, thereby serving as effective foundation models. To facilitate reproducibility and further research, we develop a modular and extensible codebase, MedM-VL, and release two LVLM variants: MedM-VL-2D for 2D medical image analysis and MedM-VL-CT-Chest for 3D CT-based applications. The code and models are available at: https://github.com/MSIIP/MedM-VL