Toward Effective Reinforcement Learning Fine-Tuning for Medical VQA in Vision-Language Models

Recently, reinforcement learning (RL)-based tuning has shifted the trajectory of Multimodal Large Language Models (MLLMs), particularly following the introduction of Group Relative Policy Optimization (GRPO). However, directly applying it to medical tasks remains challenging for achieving clinically grounded model behavior. Motivated by the need to align model response with clinical expectations, we investigate four critical dimensions that affect the effectiveness of RL-based tuning in medical visual question answering (VQA): base model initialization strategy, the role of medical semantic alignment, the impact of length-based rewards on long-chain reasoning, and the influence of bias. We conduct extensive experiments to analyze these factors for medical MLLMs, providing new insights into how models are domain-specifically fine-tuned. Additionally, our results also demonstrate that GRPO-based RL tuning consistently outperforms standard supervised fine-tuning (SFT) in both accuracy and reasoning quality.

DRA-GRPO: Exploring Diversity-Aware Reward Adjustment for R1-Zero-Like Training of Large Language Models

Recent advances in reinforcement learning for language model post-training, such as Group Relative Policy Optimization (GRPO), have shown promise in low-resource settings. However, GRPO typically relies on solution-level and scalar reward signals that fail to capture the semantic diversity among sampled completions. This leads to what we identify as a diversity-quality inconsistency, where distinct reasoning paths may receive indistinguishable rewards. To address this limitation, we propose $\textit{Diversity-aware Reward Adjustment}$ (DRA), a method that explicitly incorporates semantic diversity into the reward computation. DRA uses Submodular Mutual Information (SMI) to downweight redundant completions and amplify rewards for diverse ones. This encourages better exploration during learning, while maintaining stable exploitation of high-quality samples. Our method integrates seamlessly with both GRPO and its variant DR.~GRPO, resulting in $\textit{DRA-GRPO}$ and $\textit{DGA-DR.~GRPO}$. We evaluate our method on five mathematical reasoning benchmarks and find that it outperforms recent strong baselines. It achieves state-of-the-art performance with an average accuracy of 58.2%, using only 7,000 fine-tuning samples and a total training cost of approximately $55. The code is available at https://github.com/xiwenc1/DRA-GRPO.

Talk Before You Retrieve: Agent-Led Discussions for Better RAG in Medical QA

Medical question answering (QA) is a reasoning-intensive task that remains challenging for large language models (LLMs) due to hallucinations and outdated domain knowledge. Retrieval-Augmented Generation (RAG) provides a promising post-training solution by leveraging external knowledge. However, existing medical RAG systems suffer from two key limitations: (1) a lack of modeling for human-like reasoning behaviors during information retrieval, and (2) reliance on suboptimal medical corpora, which often results in the retrieval of irrelevant or noisy snippets. To overcome these challenges, we propose Discuss-RAG, a plug-and-play module designed to enhance the medical QA RAG system through collaborative agent-based reasoning. Our method introduces a summarizer agent that orchestrates a team of medical experts to emulate multi-turn brainstorming, thereby improving the relevance of retrieved content. Additionally, a decision-making agent evaluates the retrieved snippets before their final integration. Experimental results on four benchmark medical QA datasets show that Discuss-RAG consistently outperforms MedRAG, especially significantly improving answer accuracy by up to 16.67% on BioASQ and 12.20% on PubMedQA. The code is available at: https://github.com/LLM-VLM-GSL/Discuss-RAG.

Enhancing 3T BOLD fMRI SNR using Unpaired 7T Data with Schrödinger Bridge Diffusion

High spatial and temporal resolution, coupled with a strong signal-to-noise ratio (SNR), has made BOLD 7 Tesla fMRI an invaluable tool for understanding how the brain processes visual stimuli. However, the limited availability of 7T MRI systems means that most research relies on 3T MRI systems, which offer lower spatial and temporal resolution and SNR. This naturally raises the question: Can we enhance the spatiotemporal resolution and SNR of 3T BOLD fMRI data to approximate 7T quality? In this study, we propose a novel framework that aligns 7T and 3T fMRI data from different subjects and datasets in a shared parametric domain. We then apply an unpaired Brain Disk Schr\"odinger Bridge diffusion model to enhance the spatiotemporal resolution and SNR of the 3T data. Our approach addresses the challenge of limited 7T data by improving the 3T scan quality. We demonstrate its effectiveness by testing it on two distinct fMRI retinotopy datasets (one 7T and one 3T), as well as synthetic data. The results show that our method significantly improves the SNR and goodness-of-fit of the population receptive field (pRF) model in the enhanced 3T data, making it comparable to 7T quality. The codes will be available at Github.

RetinalGPT: A Retinal Clinical Preference Conversational Assistant Powered by Large Vision-Language Models

Recently, Multimodal Large Language Models (MLLMs) have gained significant attention for their remarkable ability to process and analyze non-textual data, such as images, videos, and audio. Notably, several adaptations of general-domain MLLMs to the medical field have been explored, including LLaVA-Med. However, these medical adaptations remain insufficiently advanced in understanding and interpreting retinal images. In contrast, medical experts emphasize the importance of quantitative analyses for disease detection and interpretation. This underscores a gap between general-domain and medical-domain MLLMs: while general-domain MLLMs excel in broad applications, they lack the specialized knowledge necessary for precise diagnostic and interpretative tasks in the medical field. To address these challenges, we introduce \textit{RetinalGPT}, a multimodal conversational assistant for clinically preferred quantitative analysis of retinal images. Specifically, we achieve this by compiling a large retinal image dataset, developing a novel data pipeline, and employing customized visual instruction tuning to enhance both retinal analysis and enrich medical knowledge. In particular, RetinalGPT outperforms MLLM in the generic domain by a large margin in the diagnosis of retinal diseases in 8 benchmark retinal datasets. Beyond disease diagnosis, RetinalGPT features quantitative analyses and lesion localization, representing a pioneering step in leveraging LLMs for an interpretable and end-to-end clinical research framework. The code is available at https://github.com/Retinal-Research/RetinalGPT

EyeBench: A Call for More Rigorous Evaluation of Retinal Image Enhancement

Over the past decade, generative models have achieved significant success in enhancement fundus images.However, the evaluation of these models still presents a considerable challenge. A comprehensive evaluation benchmark for fundus image enhancement is indispensable for three main reasons: 1) The existing denoising metrics (e.g., PSNR, SSIM) are hardly to extend to downstream real-world clinical research (e.g., Vessel morphology consistency). 2) There is a lack of comprehensive evaluation for both paired and unpaired enhancement methods, along with the need for expert protocols to accurately assess clinical value. 3) An ideal evaluation system should provide insights to inform future developments of fundus image enhancement. To this end, we propose a novel comprehensive benchmark, EyeBench, to provide insights that align enhancement models with clinical needs, offering a foundation for future work to improve the clinical relevance and applicability of generative models for fundus image enhancement. EyeBench has three appealing properties: 1) multi-dimensional clinical alignment downstream evaluation: In addition to evaluating the enhancement task, we provide several clinically significant downstream tasks for fundus images, including vessel segmentation, DR grading, denoising generalization, and lesion segmentation. 2) Medical expert-guided evaluation design: We introduce a novel dataset that promote comprehensive and fair comparisons between paired and unpaired methods and includes a manual evaluation protocol by medical experts. 3) Valuable insights: Our benchmark study provides a comprehensive and rigorous evaluation of existing methods across different downstream tasks, assisting medical experts in making informed choices. Additionally, we offer further analysis of the challenges faced by existing methods. The code is available at \url{https://github.com/Retinal-Research/EyeBench}

Many-MobileNet: Multi-Model Augmentation for Robust Retinal Disease Classification

In this work, we propose Many-MobileNet, an efficient model fusion strategy for retinal disease classification using lightweight CNN architecture. Our method addresses key challenges such as overfitting and limited dataset variability by training multiple models with distinct data augmentation strategies and different model complexities. Through this fusion technique, we achieved robust generalization in data-scarce domains while balancing computational efficiency with feature extraction capabilities.

TPOT: Topology Preserving Optimal Transport in Retinal Fundus Image Enhancement

Retinal fundus photography enhancement is important for diagnosing and monitoring retinal diseases. However, early approaches to retinal image enhancement, such as those based on Generative Adversarial Networks (GANs), often struggle to preserve the complex topological information of blood vessels, resulting in spurious or missing vessel structures. The persistence diagram, which captures topological features based on the persistence of topological structures under different filtrations, provides a promising way to represent the structure information. In this work, we propose a topology-preserving training paradigm that regularizes blood vessel structures by minimizing the differences of persistence diagrams. We call the resulting framework Topology Preserving Optimal Transport (TPOT). Experimental results on a large-scale dataset demonstrate the superiority of the proposed method compared to several state-of-the-art supervised and unsupervised techniques, both in terms of image quality and performance in the downstream blood vessel segmentation task. The code is available at https://github.com/Retinal-Research/TPOT.

EViT-Unet: U-Net Like Efficient Vision Transformer for Medical Image Segmentation on Mobile and Edge Devices

With the rapid development of deep learning, CNN-based U-shaped networks have succeeded in medical image segmentation and are widely applied for various tasks. However, their limitations in capturing global features hinder their performance in complex segmentation tasks. The rise of Vision Transformer (ViT) has effectively compensated for this deficiency of CNNs and promoted the application of ViT-based U-networks in medical image segmentation. However, the high computational demands of ViT make it unsuitable for many medical devices and mobile platforms with limited resources, restricting its deployment on resource-constrained and edge devices. To address this, we propose EViT-UNet, an efficient ViT-based segmentation network that reduces computational complexity while maintaining accuracy, making it ideal for resource-constrained medical devices. EViT-UNet is built on a U-shaped architecture, comprising an encoder, decoder, bottleneck layer, and skip connections, combining convolutional operations with self-attention mechanisms to optimize efficiency. Experimental results demonstrate that EViT-UNet achieves high accuracy in medical image segmentation while significantly reducing computational complexity.

STA-Unet: Rethink the semantic redundant for Medical Imaging Segmentation

In recent years, significant progress has been made in the medical image analysis domain using convolutional neural networks (CNNs). In particular, deep neural networks based on a U-shaped architecture (UNet) with skip connections have been adopted for several medical imaging tasks, including organ segmentation. Despite their great success, CNNs are not good at learning global or semantic features. Especially ones that require human-like reasoning to understand the context. Many UNet architectures attempted to adjust with the introduction of Transformer-based self-attention mechanisms, and notable gains in performance have been noted. However, the transformers are inherently flawed with redundancy to learn at shallow layers, which often leads to an increase in the computation of attention from the nearby pixels offering limited information. The recently introduced Super Token Attention (STA) mechanism adapts the concept of superpixels from pixel space to token space, using super tokens as compact visual representations. This approach tackles the redundancy by learning efficient global representations in vision transformers, especially for the shallow layers. In this work, we introduce the STA module in the UNet architecture (STA-UNet), to limit redundancy without losing rich information. Experimental results on four publicly available datasets demonstrate the superiority of STA-UNet over existing state-of-the-art architectures in terms of Dice score and IOU for organ segmentation tasks. The code is available at \url{https://github.com/Retinal-Research/STA-UNet}.