Regulating Anatomy-Aware Rewards via Trajectory-Integral Feedback for Volumetric Computed Tomography Analysis

Medical vision-language models (VLMs) have rapidly advanced as general-purpose multimodal assistants, yet their deployment in 3D Computed Tomography (CT) analysis remains constrained by a persistent mismatch between optimization objectives and clinical rigor. Current Reinforcement Learning (RL) paradigms still rely on lexical proxy signals that induce ``\textit{Evaluation Hallucinations}'', where models optimize linguistic fluency rather than factual clinical correctness, leading to diagnostically critical errors. To bridge this gap, we introduce the \textbf{Clinical Abnormality Benchmarking Substrate (CABS)}, a structured system that decomposes radiology reports into verifiable clinical semantic units. Using CABS, we identify a ``\textit{Mechanistic Divergence}'' in standard RL, where surface-similarity rewards drive policy gradients to bypass medical facts. We therefore propose \textbf{Trajectory-Integral Feedback GRPO (TIF-GRPO)}, a novel framework integrating control-theoretic principles into policy optimization. By formulating clinical reasoning as a pseudo-temporal trajectory for anomaly discovery, TIF-GRPO regulates anatomy-aware rewards via an integral feedback loop that penalizes persistent omissions as cumulative state errors and suppresses hallucinations as excessive control effort. Experiments on 3D CT benchmarks demonstrate that our approach significantly enhances abnormality detection and clinical faithfulness, establishing a new paradigm for fine-grained regulation in medical VLMs. Our project is available at \href{https://github.com/ZJU4HealthCare/TIF-GRPO}{GitHub}.

CLEAR-Mamba:Towards Accurate, Adaptive and Trustworthy Multi-Sequence Ophthalmic Angiography Classification

Medical image classification is a core task in computer-aided diagnosis (CAD), playing a pivotal role in early disease detection, treatment planning, and patient prognosis assessment. In ophthalmic practice, fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) provide hemodynamic and lesion-structural information that conventional fundus photography cannot capture. However, due to the single-modality nature, subtle lesion patterns, and significant inter-device variability, existing methods still face limitations in generalization and high-confidence prediction. To address these challenges, we propose CLEAR-Mamba, an enhanced framework built upon MedMamba with optimizations in both architecture and training strategy. Architecturally, we introduce HaC, a hypernetwork-based adaptive conditioning layer that dynamically generates parameters according to input feature distributions, thereby improving cross-domain adaptability. From a training perspective, we develop RaP, a reliability-aware prediction scheme built upon evidential uncertainty learning, which encourages the model to emphasize low-confidence samples and improves overall stability and reliability. We further construct a large-scale ophthalmic angiography dataset covering both FFA and ICGA modalities, comprising multiple retinal disease categories for model training and evaluation. Experimental results demonstrate that CLEAR-Mamba consistently outperforms multiple baseline models, including the original MedMamba, across various metrics-showing particular advantages in multi-disease classification and reliability-aware prediction. This study provides an effective solution that balances generalizability and reliability for modality-specific medical image classification tasks.