Towards Responsible Multimodal Medical Reasoning via Context-Aligned Vision-Language Models

Medical vision-language models (VLMs) show strong performance on radiology tasks but often produce fluent yet weakly grounded conclusions due to over-reliance on a dominant modality. We introduce a context-aligned reasoning framework that enforces agreement across heterogeneous clinical evidence before generating diagnostic conclusions. The proposed approach augments a frozen VLM with structured contextual signals derived from radiomic statistics, explainability activations, and vocabulary-grounded semantic cues. Instead of producing free-form responses, the model generates structured outputs containing supporting evidence, uncertainty estimates, limitations, and safety notes. We observe that auxiliary signals alone provide limited benefit; performance gains emerge only when these signals are integrated through contextual verification. Experiments on chest X-ray datasets demonstrate that context alignment improves discriminative performance (AUC 0.918 to 0.925) while maintaining calibrated uncertainty. The framework also substantially reduces hallucinated keywords (1.14 to 0.25) and produces more concise reasoning explanations (19.4 to 15.3 words) without increasing model confidence (0.70 to 0.68). Cross-dataset evaluation on CheXpert further reveals that modality informativeness significantly influences reasoning behavior. These results suggest that enforcing multi-evidence agreement improves both reliability and trustworthiness in medical multimodal reasoning, while preserving the underlying model architecture.

Beyond Anatomy: Explainable ASD Classification from rs-fMRI via Functional Parcellation and Graph Attention Networks

Anatomical brain parcellations dominate rs-fMRI-based Autism Spectrum Disorder (ASD) classification, yet their rigid boundaries may fail to capture the idiosyncratic connectivity patterns that characterise ASD. We present a graph-based deep learning framework comparing anatomical (AAL, 116 ROIs) and functionally-derived (MSDL, 39 ROIs) parcellation strategies on the ABIDE I dataset. Our FSL preprocessing pipeline handles multi-site heterogeneity across 400 balanced subjects, with site-stratified 70/15/15 splits to prevent data leakage. Gaussian noise augmentation within training folds expands samples from 280 to 1,680. A three phase pipeline progresses from a baseline GCN with AAL (73.3% accuracy, AUC=0.74), to an optimised GCN with MSDL (84.0%, AUC=0.84), to a Graph Attention Network ensemble achieving 95.0% accuracy (AUC=0.98), outperforming all recent GNN-based benchmarks on ABIDE I. The 10.7-point gain from atlas substitution alone demonstrates that functional parcellation is the most impactful modelling decision. Gradient-based saliency and GNNExplainer analyses converge on the Posterior Cingulate Cortex and Precuneus as core Default Mode Network hubs, validating that model decisions reflect ASD neuropathology rather than acquisition artefacts. All code and datasets will be publicly released upon acceptance.