What Matters is the Prompt: Prompt Sensitivity and Prompt Generation in Foundation Models for Lung Nodule Segmentation

Lung nodule segmentation in computed tomography is essential for extracting clinically relevant information for lung cancer assessment and treatment planning. Foundation models have shown notable segmentation capabilities, but state-of-the-art approaches often depend on input prompts, such as points or boxes, making their performance sensitive to prompt quality and placement. Understanding the limitations and constraints of prompt-based foundation models is therefore essential for designing reliable medical image segmentation solutions. In this work, we investigate how prompt quality affects foundation models performance for lung nodule segmentation. We further propose a synthetic prompt-generation model to test if the dependence on manually provided prompts can be mitigated by generating synthetic prompts that can also improve segmentation performance. Perturbation experiments show that bounding box prompts generally outperform point prompts, while latest specialized medical imaging models achieve better performance than general purpose ones. The proposed approach obtains a Dice coefficient of 0.85, suggesting that synthetic prompt generation as a promising strategy for lung nodule segmentation with foundation models.

Global Logic and Local Search: Dual-Stream Multimodal In-Context Learning for Verifiable Industrial Anomaly Detection

Large Multimodal Models (LMMs) show strong few-shot generalization, but industrial anomaly detection remains difficult because defects are small, input resolution is limited, and textual standards are not always grounded in visual evidence. Recent optimization-based methods improve alignment through fine-tuning, but they often require many defective samples, which are unavailable in early deployment. We present Global Logic and Local Search (GLLS), a training-free framework for reference-guided multimodal in-context verification. GLLS uses a Part-Aware Visual-Logical Atlas to organize normal references and structured specifications in the inference context. It combines a Global & Logic Stream, where SAM 3 extracts partially checkable visual facts, with a Fine-Grained & Actions Stream, where MCTS selects local evidence crops under a fixed budget. Experiments on MMAD-QA and additional anomaly detection datasets show consistent gains over matched and general-purpose baselines, while keeping the final diagnostic decision traceable to explicit visual evidence throughout the inspection trace.

Medical Image Understanding Improves Survival Prediction via Visual Instruction Tuning

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.

Energy-Guided Decoding for Object Hallucination Mitigation

Mitigating object hallucination in large vision-language models (LVLMs) is critical to their safe deployment. Existing methods either are restricted to specific decoding methods, or demand sophisticated modifications to visual inputs, or rely on knowledge from external models. In this work, we first reveal the phenomenon that VLMs exhibit significant imbalance in the ``Yes'' ratio ( \ie, the fraction of ``Yes'' answers among the total number of questions) across three different visual question answering (VQA) datasets. Furthermore, we propose an energy-based decoding method, which dynamically selects the hidden states from the layer with minimal energy score. It is simple yet effective in reducing the bias for the yes ratio while boosting performance across three benchmarks (POPE, MME, and MMVP). Our method consistently improves accuracy and F1 score on three VQA datasets across three commonly used VLMs over several baseline methods. The average accuracy improvement is 4.82% compared to greedy decoding. Moreover, the average yes-ratio gap reduction is 8.81%, meaning the proposed method is less biased as shown in Figure 1.