Med-StepBench: A Hierarchical Reasoning Framework for Evaluating Hallucinations in Medical Vision-Language Models

Large vision-language models (VLMs) demonstrate strong performance in medical image understanding, but frequently generate clinically plausible yet incorrect statements, raising significant safety concerns. Existing medical hallucination benchmarks primarily focus on 2D imaging with one-shot diagnostic questions, offering limited insight into whether predictions are grounded in correct localization and abnormality identification, allowing critical reasoning errors to remain hidden behind seemingly correct diagnoses. We introduce Med-StepBench, the first large-scale benchmark for step-wise hallucination detection in 3D oncological PET/CT, comprising over 12,000 images and more than 1,000,000 image-statement pairs across volumetric and multi-view 2D data, which decomposes clinical reasoning into four expert-designed diagnostic stages. Using clinician-verified annotations, we perform the first step-level evaluation of general-purpose and medical VLMs, revealing systematic failure modes obscured by aggregate accuracy metrics. Furthermore, we show that current VLMs are highly susceptible to adversarial yet clinically plausible intermediate explanations, which significantly amplify hallucinations despite contradictory visual evidence. Together, our findings highlight fundamental limitations in grounding multi-step clinical reasoning and establish Med-StepBench as a rigorous benchmark for developing safer and more reliable medical VLMs.

Region-Grounded Report Generation for 3D Medical Imaging: A Fine-Grained Dataset and Graph-Enhanced Framework

Automated medical report generation for 3D PET/CT imaging is fundamentally challenged by the high-dimensional nature of volumetric data and a critical scarcity of annotated datasets, particularly for low-resource languages. Current black-box methods map whole volumes to reports, ignoring the clinical workflow of analyzing localized Regions of Interest (RoIs) to derive diagnostic conclusions. In this paper, we bridge this gap by introducing VietPET-RoI, the first large-scale 3D PET/CT dataset with fine-grained RoI annotation for a low-resource language, comprising 600 PET/CT samples and 1,960 manually annotated RoIs, paired with corresponding clinical reports. Furthermore, to demonstrate the utility of this dataset, we propose HiRRA, a novel framework that mimics the professional radiologist diagnostic workflow by employing graph-based relational modules to capture dependencies between RoI attributes. This approach shifts from global pattern matching toward localized clinical findings. Additionally, we introduce new clinical evaluation metrics, namely RoI Coverage and RoI Quality Index, that measure both RoI localization accuracy and attribute description fidelity using LLM-based extraction. Extensive evaluation demonstrates that our framework achieves SOTA performance, surpassing existing models by 19.7% in BLEU and 4.7% in ROUGE-L, while achieving a remarkable 45.8% improvement in clinical metrics, indicating enhanced clinical reliability and reduced hallucination. Our code and dataset are available on GitHub.

PADM: A Physics-aware Diffusion Model for Attenuation Correction

Attenuation artifacts remain a significant challenge in cardiac Myocardial Perfusion Imaging (MPI) using Single-Photon Emission Computed Tomography (SPECT), often compromising diagnostic accuracy and reducing clinical interpretability. While hybrid SPECT/CT systems mitigate these artifacts through CT-derived attenuation maps, their high cost, limited accessibility, and added radiation exposure hinder widespread clinical adoption. In this study, we propose a novel CT-free solution to attenuation correction in cardiac SPECT. Specifically, we introduce Physics-aware Attenuation Correction Diffusion Model (PADM), a diffusion-based generative method that incorporates explicit physics priors via a teacher--student distillation mechanism. This approach enables attenuation artifact correction using only Non-Attenuation-Corrected (NAC) input, while still benefiting from physics-informed supervision during training. To support this work, we also introduce CardiAC, a comprehensive dataset comprising 424 patient studies with paired NAC and Attenuation-Corrected (AC) reconstructions, alongside high-resolution CT-based attenuation maps. Extensive experiments demonstrate that PADM outperforms state-of-the-art generative models, delivering superior reconstruction fidelity across both quantitative metrics and visual assessment.

CT to PET Translation: A Large-scale Dataset and Domain-Knowledge-Guided Diffusion Approach

Positron Emission Tomography (PET) and Computed Tomography (CT) are essential for diagnosing, staging, and monitoring various diseases, particularly cancer. Despite their importance, the use of PET/CT systems is limited by the necessity for radioactive materials, the scarcity of PET scanners, and the high cost associated with PET imaging. In contrast, CT scanners are more widely available and significantly less expensive. In response to these challenges, our study addresses the issue of generating PET images from CT images, aiming to reduce both the medical examination cost and the associated health risks for patients. Our contributions are twofold: First, we introduce a conditional diffusion model named CPDM, which, to our knowledge, is one of the initial attempts to employ a diffusion model for translating from CT to PET images. Second, we provide the largest CT-PET dataset to date, comprising 2,028,628 paired CT-PET images, which facilitates the training and evaluation of CT-to-PET translation models. For the CPDM model, we incorporate domain knowledge to develop two conditional maps: the Attention map and the Attenuation map. The former helps the diffusion process focus on areas of interest, while the latter improves PET data correction and ensures accurate diagnostic information. Experimental evaluations across various benchmarks demonstrate that CPDM surpasses existing methods in generating high-quality PET images in terms of multiple metrics. The source code and data samples are available at https://github.com/thanhhff/CPDM.