Beyond the Global Scores: Fine-Grained Token Grounding as a Robust Detector of LVLM Hallucinations

Large vision-language models (LVLMs) achieve strong performance on visual reasoning tasks but remain highly susceptible to hallucination. Existing detection methods predominantly rely on coarse, whole-image measures of how an object token relates to the input image. This global strategy is limited: hallucinated tokens may exhibit weak but widely scattered correlations across many local regions, which aggregate into deceptively high overall relevance, thus evading the current global hallucination detectors. We begin with a simple yet critical observation: a faithful object token must be strongly grounded in a specific image region. Building on this insight, we introduce a patch-level hallucination detection framework that examines fine-grained token-level interactions across model layers. Our analysis uncovers two characteristic signatures of hallucinated tokens: (i) they yield diffuse, non-localized attention patterns, in contrast to the compact, well-focused attention seen in faithful tokens; and (ii) they fail to exhibit meaningful semantic alignment with any visual region. Guided by these findings, we develop a lightweight and interpretable detection method that leverages patch-level statistical features, combined with hidden-layer representations. Our approach achieves up to 90% accuracy in token-level hallucination detection, demonstrating the superiority of fine-grained structural analysis for detecting hallucinations.

DGRNet: Disagreement-Guided Refinement for Uncertainty-Aware Brain Tumor Segmentation

Accurate brain tumor segmentation from MRI scans is critical for diagnosis and treatment planning. Despite the strong performance of recent deep learning approaches, two fundamental limitations remain: (1) the lack of reliable uncertainty quantification in single-model predictions, which is essential for clinical deployment because the level of uncertainty may impact treatment decision-making, and (2) the under-utilization of rich information in radiology reports that can guide segmentation in ambiguous regions. In this paper, we propose the Disagreement-Guided Refinement Network (DGRNet), a novel framework that addresses both limitations through multi-view disagreement-based uncertainty estimation and text-conditioned refinement. DGRNet generates diverse predictions via four lightweight view-specific adapters attached to a shared encoder-decoder, enabling efficient uncertainty quantification within a single forward pass. Afterward, we build disagreement maps to identify regions of high segmentation uncertainty, which are then selectively refined according to clinical reports. Moreover, we introduce a diversity-preserving training strategy that combines pairwise similarity penalties and gradient isolation to prevent view collapse. The experimental results on the TextBraTS dataset show that DGRNet favorably improves state-of-the-art segmentation accuracy by 2.4% and 11% in main metrics Dice and HD95, respectively, while providing meaningful uncertainty estimates.

Hierarchical Text-Guided Brain Tumor Segmentation via Sub-Region-Aware Prompts

Brain tumor segmentation remains challenging because the three standard sub-regions, i.e., whole tumor (WT), tumor core (TC), and enhancing tumor (ET), often exhibit ambiguous visual boundaries. Integrating radiological description texts with imaging has shown promise. However, most multimodal approaches typically compress a report into a single global text embedding shared across all sub-regions, overlooking their distinct clinical characteristics. We propose TextCSP (text-modulated soft cascade architecture), a hierarchical text-guided framework that builds on the TextBraTS baseline with three novel components: (1) a text-modulated soft cascade decoder that predicts WT->TC->ET in a coarse-to-fine manner consistent with their anatomical containment hierarchy. (2) sub-region-aware prompt tuning, which uses learnable soft prompts with a LoRA-adapted BioBERT encoder to generate specialized text representations tailored for each sub-region; (3) text-semantic channel modulators that convert the aforementioned representations into channel-wise refinement signals, enabling the decoder to emphasize features aligned with clinically described patterns. Experiments on the TextBraTS dataset demonstrate consistent improvements across all sub-regions against state-of-the-art methods by 1.7% and 6% on the main metrics Dice and HD95.

Overthinking Causes Hallucination: Tracing Confounder Propagation in Vision Language Models

Vision Language models (VLMs) often hallucinate non-existent objects. Detecting hallucination is analogous to detecting deception: a single final statement is insufficient, one must examine the underlying reasoning process. Yet existing detectors rely mostly on final-layer signals. Attention-based methods assume hallucinated tokens exhibit low attention, while entropy-based ones use final-step uncertainty. Our analysis reveals the opposite: hallucinated objects can exhibit peaked attention due to contextual priors; and models often express high confidence because intermediate layers have already converged to an incorrect hypothesis. We show that the key to hallucination detection lies within the model's thought process, not its final output. By probing decoder layers, we uncover a previously overlooked behavior, overthinking: models repeatedly revise object hypotheses across layers before committing to an incorrect answer. Once the model latches onto a confounded hypothesis, it can propagate through subsequent layers, ultimately causing hallucination. To capture this behavior, we introduce the Overthinking Score, a metric to measure how many competing hypotheses the model entertains and how unstable these hypotheses are across layers. This score significantly improves hallucination detection: 78.9% F1 on MSCOCO and 71.58% on AMBER.

Interpreting Chest X-rays Like a Radiologist: A Benchmark with Clinical Reasoning

Artificial intelligence (AI)-based chest X-ray (CXR) interpretation assistants have demonstrated significant progress and are increasingly being applied in clinical settings. However, contemporary medical AI models often adhere to a simplistic input-to-output paradigm, directly processing an image and an instruction to generate a result, where the instructions may be integral to the model's architecture. This approach overlooks the modeling of the inherent diagnostic reasoning in chest X-ray interpretation. Such reasoning is typically sequential, where each interpretive stage considers the images, the current task, and the contextual information from previous stages. This oversight leads to several shortcomings, including misalignment with clinical scenarios, contextless reasoning, and untraceable errors. To fill this gap, we construct CXRTrek, a new multi-stage visual question answering (VQA) dataset for CXR interpretation. The dataset is designed to explicitly simulate the diagnostic reasoning process employed by radiologists in real-world clinical settings for the first time. CXRTrek covers 8 sequential diagnostic stages, comprising 428,966 samples and over 11 million question-answer (Q&A) pairs, with an average of 26.29 Q&A pairs per sample. Building on the CXRTrek dataset, we propose a new vision-language large model (VLLM), CXRTrekNet, specifically designed to incorporate the clinical reasoning flow into the VLLM framework. CXRTrekNet effectively models the dependencies between diagnostic stages and captures reasoning patterns within the radiological context. Trained on our dataset, the model consistently outperforms existing medical VLLMs on the CXRTrek benchmarks and demonstrates superior generalization across multiple tasks on five diverse external datasets. The dataset and model can be found in our repository (https://github.com/guanjinquan/CXRTrek).

Seeing the Trees for the Forest: Rethinking Weakly-Supervised Medical Visual Grounding

Visual grounding (VG) is the capability to identify the specific regions in an image associated with a particular text description. In medical imaging, VG enhances interpretability by highlighting relevant pathological features corresponding to textual descriptions, improving model transparency and trustworthiness for wider adoption of deep learning models in clinical practice. Current models struggle to associate textual descriptions with disease regions due to inefficient attention mechanisms and a lack of fine-grained token representations. In this paper, we empirically demonstrate two key observations. First, current VLMs assign high norms to background tokens, diverting the model's attention from regions of disease. Second, the global tokens used for cross-modal learning are not representative of local disease tokens. This hampers identifying correlations between the text and disease tokens. To address this, we introduce simple, yet effective Disease-Aware Prompting (DAP) process, which uses the explainability map of a VLM to identify the appropriate image features. This simple strategy amplifies disease-relevant regions while suppressing background interference. Without any additional pixel-level annotations, DAP improves visual grounding accuracy by 20.74% compared to state-of-the-art methods across three major chest X-ray datasets.

Localizing Before Answering: A Hallucination Evaluation Benchmark for Grounded Medical Multimodal LLMs

Medical Large Multi-modal Models (LMMs) have demonstrated remarkable capabilities in medical data interpretation. However, these models frequently generate hallucinations contradicting source evidence, particularly due to inadequate localization reasoning. This work reveals a critical limitation in current medical LMMs: instead of analyzing relevant pathological regions, they often rely on linguistic patterns or attend to irrelevant image areas when responding to disease-related queries. To address this, we introduce HEAL-MedVQA (Hallucination Evaluation via Localization MedVQA), a comprehensive benchmark designed to evaluate LMMs' localization abilities and hallucination robustness. HEAL-MedVQA features (i) two innovative evaluation protocols to assess visual and textual shortcut learning, and (ii) a dataset of 67K VQA pairs, with doctor-annotated anatomical segmentation masks for pathological regions. To improve visual reasoning, we propose the Localize-before-Answer (LobA) framework, which trains LMMs to localize target regions of interest and self-prompt to emphasize segmented pathological areas, generating grounded and reliable answers. Experimental results demonstrate that our approach significantly outperforms state-of-the-art biomedical LMMs on the challenging HEAL-MedVQA benchmark, advancing robustness in medical VQA.

Interactive Medical Image Analysis with Concept-based Similarity Reasoning

The ability to interpret and intervene model decisions is important for the adoption of computer-aided diagnosis methods in clinical workflows. Recent concept-based methods link the model predictions with interpretable concepts and modify their activation scores to interact with the model. However, these concepts are at the image level, which hinders the model from pinpointing the exact patches the concepts are activated. Alternatively, prototype-based methods learn representations from training image patches and compare these with test image patches, using the similarity scores for final class prediction. However, interpreting the underlying concepts of these patches can be challenging and often necessitates post-hoc guesswork. To address this issue, this paper introduces the novel Concept-based Similarity Reasoning network (CSR), which offers (i) patch-level prototype with intrinsic concept interpretation, and (ii) spatial interactivity. First, the proposed CSR provides localized explanation by grounding prototypes of each concept on image regions. Second, our model introduces novel spatial-level interaction, allowing doctors to engage directly with specific image areas, making it an intuitive and transparent tool for medical imaging. CSR improves upon prior state-of-the-art interpretable methods by up to 4.5\% across three biomedical datasets. Our code is released at https://github.com/tadeephuy/InteractCSR.

ProjectedEx: Enhancing Generation in Explainable AI for Prostate Cancer

Prostate cancer, a growing global health concern, necessitates precise diagnostic tools, with Magnetic Resonance Imaging (MRI) offering high-resolution soft tissue imaging that significantly enhances diagnostic accuracy. Recent advancements in explainable AI and representation learning have significantly improved prostate cancer diagnosis by enabling automated and precise lesion classification. However, existing explainable AI methods, particularly those based on frameworks like generative adversarial networks (GANs), are predominantly developed for natural image generation, and their application to medical imaging often leads to suboptimal performance due to the unique characteristics and complexity of medical image. To address these challenges, our paper introduces three key contributions. First, we propose ProjectedEx, a generative framework that provides interpretable, multi-attribute explanations, effectively linking medical image features to classifier decisions. Second, we enhance the encoder module by incorporating feature pyramids, which enables multiscale feedback to refine the latent space and improves the quality of generated explanations. Additionally, we conduct comprehensive experiments on both the generator and classifier, demonstrating the clinical relevance and effectiveness of ProjectedEx in enhancing interpretability and supporting the adoption of AI in medical settings. Code will be released at https://github.com/Richardqiyi/ProjectedEx

A Survey of Medical Vision-and-Language Applications and Their Techniques

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.