MedUP: Awakening Unified Understanding and Perception in Medical Vision-Language Models

Medical Vision-Language Models (Med-VLMs) excel at verbalizing visual content, yet precise visual perception, segmentation, and grounding remain challenging. Existing approaches either verbalize regions as coordinate strings or rely on external modules that decouple perception from understanding, creating representation gaps for region-language alignment. We present MedUP, a Med-VLM that natively unifies perception and understanding within a shared token space. At its core lies UniMedTok, a region tokenizer that encodes masks as discrete tokens in the LLM vocabulary, enabling the model to seamlessly interleave mask tokens with text. We curate UniMed-Train, a 1.84M-instance corpus spanning text-guided segmentation, region-grounded understanding, medical VQA and CoT-based segmentation, and introduce UniMed-Bench for unified evaluation. Extensive experiments show that MedUP outperforms native, agentic, and dual-decoder Med-VLMs across all tasks while remaining competitive with specialist segmentors, demonstrating the strong potential of unified understanding and perception modeling.

FUSEP: A Multi-Center Benchmark for Diverse Tasks in Early Pregnancy Fetal Ultrasound Screening

A large number of infants with congenital anomalies are born each year globally, especially in areas with underdeveloped medical resources. Currently, fetal ultrasound screening is the most common modality for early pregnancy anatomy detection. This modality can detect anomalies earlier and provide opportune treatment advice. However, the lack of an ultrasound dataset on early fetal gestation has slowed down the development of automated assisted diagnosis. In this work, we present a benchmark dataset for Fetal Ultrasound Screening in Early Pregnancy to facilitate intelligent ultrasound examination and assisted diagnosis called FUSEP. Our dataset consists of two ultrasound views recommended by the international guideline, i.e., Crown-rump Length (CRL) and Nuchal Translucency (NT) views in three hospitals, totaling 4,017 ultrasound images, with 45,820 box-level expert-level annotations. Our dataset and baseline present the following three contributions: 1) Our medical experts annotated a total of 14 key anatomical structures in two views using a box-level format; 2) Our data is collected extensively from different sonographers, devices, scanning angles, hospitals, etc; 3) We report the performance of the semi-supervised learning, fully supervised learning, unsupervised domain adaptation (UDA), and source-free UDA in ultrasound images multi-object detection. To the best of our knowledge, this is the first publicly available dataset and benchmark for fetal early pregnancy ultrasound screening. We believe that FUSEP and benchmark can contribute to the medical community in the development of multiple tasks such as standard plane recognition, quality control on ultrasound images, automated assisted diagnostics in early fetal pregnancy, medical multi-object detection, domain adaptation for object detection, etc.

ClinFusion: A Vision-Centric Multimodal LLM System for Holistic Medical Understanding

Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations. We propose a compositional and cascaded vision encoder architecture featuring a Cascade Spatial-Aware Locality Fusion operator that unifies diverse 2D and native 3D medical image understanding within a fused encoder. We further introduce a vision-grounded evaluation framework, including MedIF-Bench for instruction-following assessment and a region-of-interest-grounded method for clinically aligned and factualness-driven report generation evaluation. We show that ClinFusion sets a new state-of-the-art across a comprehensive suite of 2D and 3D multimodal medical benchmarks---spanning visual question answering, report generation, and instruction following---as well as textual medical tasks, outperforming leading open-source medical MLLMs (\textit{e.g.}, Hulu-Med, Lingshu) on 20 out of 24 benchmarks and demonstrating multimodal capabilities better than powerful proprietary models such as GPT-5.2 and Gemini-3-Flash on 13 out of 16 benchmarks, and can be further augmented with agentic tool use for retrieval-augmented and tool-assisted clinical workflows. A blinded evaluation by board-certified radiologists confirms that ClinFusion produces the highest-ranked reports, and validates our RoI-grounded metric as achieving the strongest correlation with expert judgment among all automatic evaluation metrics examined.

LongMedBench: Benchmarking Medical Agents for Long-Horizon Clinical Decision-Making

In this work, we introduce LongMedBench, a real-world EHR-based benchmark for long-horizon clinical decision-making. Prior evaluations of LLM-based medical agents have largely emphasized short-context knowledge QA and tool use. However, real-world medical care is inherently longitudinal, and clinicians must aggregate evidence across repeated visits, tests, and evolving treatments. Therefore, long-horizon interaction is essential for realistic assessment. LongMedBench is constructed via a reproducible pipeline that integrates MIMIC-IV admission records and clinical notes into time-series event streams and long-context memory datasets, enabling long-horizon, multi-session interactions between agents and a clinical environment. It comprises 335 patients, with 19.72 inpatient visits per patient on average and 44.91 medical events per visit. Guided by the long-horizon decision process, we propose an evaluation taxonomy with three suites: fact-based QA, temporal reasoning, and long-horizon decision-making. This taxonomy measures how agents understand and leverage historical patient information over extended horizons. Our experiments show that while recent LLMs can make good use of explicit timestamps, they have challenges in implicit time inference; The RAG and agent memory system can improve the performance of information retrieval tasks, but the performance of decision-making tasks is highly dependent on the model's immediate context.

MedStreamBench: A Time-Aware Benchmark for Streaming and Proactive Medical Video Understanding

Existing medical video benchmarks primarily evaluate whether a model produces the correct answer, but rarely assess whether it answers at the right time. In real clinical settings, AI systems must decide not only what to predict, but also when to answer, defer judgment, or proactively raise alerts. This creates a critical gap between benchmark evaluation and deployment requirements. We present MedStreamBench, a benchmark for time-aware medical video understanding. MedStreamBench integrates 22 medical datasets and 5,419 QA instances across four temporal settings: retrospective, present, future, and proactive. Unlike conventional benchmarks that assume full-video access, MedStreamBench restricts models to temporally bounded evidence windows and supports both single-turn and streaming evaluation. We further introduce a proactive monitoring setting that requires models to determine whether and when clinically relevant alerts should be triggered. Beyond answer correctness, MedStreamBench evaluates temporal behavior through responsiveness and post-evidence stability. Experiments on leading general-purpose and medical vision-language models reveal a substantial gap between offline recognition and temporally grounded decision-making, with performance dropping markedly in streaming and proactive settings. Our benchmark is available at https://huggingface.co/datasets/Venn2024/MedStreamBench.

BioMedVR: Confusion-Aware Mixture-of-Prompt Experts for Biomedical Visual Reprogramming

Recent advances in vision-language models (VLMs) such as CLIP have demonstrated strong generalization across natural-image domains. However, adapting these models to biomedical imaging is non-trivial: full-model fine-tuning is computationally expensive, while medical data are often scarce and exhibit subtle, fine-grained inter-class differences, making parameter-efficient adaptation particularly critical. Visual Reprogramming (VR) offers a parameter-efficient alternative by injecting learnable perturbations into the input space, but existing VR approaches for VLMs mainly focus on positive class prompts and overlook confusing negatives, leading to miscalibrated predictions in fine-grained medical scenarios. We present BioMedVR, the first VR-based framework for biomedical imaging, enabling few-shot adaptation of pretrained VLMs through compact learnable VR modules. To mitigate class confusion, we introduce a Confusion Minimization Mechanism that leverages LLM-generated confusion-aware attributes together with a Confusion-Suppression Loss to explicitly reduce false-positive alignment. Moreover, the designed Mixture-of-Prompt Experts combines a positive expert for main-class discrimination and a negative expert for confusion suppression, balanced via adaptive gating. Extensive experiments on 18 datasets, including 11 biomedical datasets and 7 natural image benchmarks, demonstrate that BioMedVR achieves superior accuracy and generalization, effectively bridging VR and VLMs in biomedical domains.

VideoWeaver: Evaluating and Evolving Skills for Agentic Long Video Generation

Recent agent frameworks such as Claude Code, Codex, and OpenClaw are strong at tool use and orchestration, but whether they can handle long video generation, a long-horizon multimodal task, remains underexplored. Unlike earlier video agents whose pipeline is handcrafted, these frameworks can build and refine their own workflows. We introduce VideoWeaver, an agent harness and benchmark that evaluates and evolves skills for long video generation, where an agent turns a single instruction into a long video by composing foundation skills into its own workflow rather than following a predefined pipeline. The benchmark has 16 task categories and 285 cases, with references spanning text, image, audio, video, and their combinations. Because errors can arise at any stage and not just in the final video, we propose an agent-as-judge that inspects both the execution trace and the final video, grounding its scores in evidence such as metadata and intermediate files. Using this feedback, we further design a skill evolution algorithm that refines and merges the agent's skills. Across multiple frameworks and models, we find that an explicit composition skill improves the generation process over using foundation skills alone, that skill evolution further improves output quality, and that performance varies notably across harness and model choices. The proposed agent-as-judge also aligns well with human judgments, especially on process metrics. Code and dataset is available at https://github.com/JianhuiWei7/VideoWeaver

Med-R2: An Adversarial Benchmark for Evidence-Grounded Reasoning in Medical VLMs

Vision-language models have demonstrated impressive capabilities in general medical visual question answering, yet due to limited interpretability, it remains unclear whether their predictions reflect evidence-grounded clinical reasoning or reliance on spurious priors. We introduce Med-R2 Bench, a hierarchical benchmark aligned with the clinical workflow to evaluate adversarial robustness with visual grounding. We design stepwise QA tasks to assess whether reasoning chains are strictly grounded in visual evidence across the four clinical stages, and employ adversarial perturbations to test robustness against misleading cues. Med-R2 comprises 42,432 images, 31 task categories, and 110,406 QA pairs. Evaluation across 14 VLMs reveals a sequential performance degradation along the four-stage clinical workflow. Adversarial experiments show that models rely heavily on correct prompts to guess answers. Even when provided with explicit visual cues, the models struggle to accurately align textual descriptions. Finally, we demonstrate stepwise fine-tuning using our hierarchical data significantly improves reasoning robustness, highlighting its potential to drive future improvements in evidence-based medical AI.

How Far Are Video Models from True Multimodal Reasoning?

Despite remarkable progress toward general-purpose video models, a critical question remains unanswered: how far are these models from achieving true multimodal reasoning? Existing benchmarks fail to address this question rigorously, as they remain constrained by straightforward task designs and fragmented evaluation metrics that neglect complex multimodal reasoning. To bridge this gap, we introduce CLVG-Bench, an evaluation framework designed to probe video models' zero-shot reasoning capabilities via Context Learning in Video Generation. CLVG-Bench comprises more than 1,000 high-quality, manually annotated metadata across 6 categories and 47 subcategories, covering complex scenarios including physical simulation, logical reasoning, and interactive contexts. To enable rigorous and scalable assessment, we further propose an Adaptive Video Evaluator (AVE) that aligns with human expert perception using minimal annotations, delivering interpretable textual feedback across diverse video context tasks. Extensive experiments reveal a striking answer to our central question: while state-of-the-art (SOTA) video models, such as Seedance 2.0, demonstrate competence on certain understanding and reasoning subtasks, they fall substantially short with logically grounded and interactive generation tasks (achieving success rates <25% and ~0%, respectively), exposing multimodal reasoning and physical grounding as critical bottlenecks. By systematically quantifying these limitations, the proposed method provides actionable feedbacks and a clear roadmap toward truly robust, general-purpose video models. CLVG-Bench and code are released here.

PBE-UNet: A light weight Progressive Boundary-Enhanced U-Net with Scale-Aware Aggregation for Ultrasound Image Segmentation

Accurate lesion segmentation in ultrasound images is essential for preventive screening and clinical diagnosis, yet remains challenging due to low contrast, blurry boundaries, and significant scale variations. Although existing deep learning-based methods have achieved remarkable performance, these methods still struggle with scale variations and indistinct tumor boundaries. To address these challenges, we propose a progressive boundary enhanced U-Net (PBE-UNet). Specially, we first introduce a scale-aware aggregation module (SAAM) that dynamically adjusts its receptive field to capture robust multi-scale contextual information. Then, we propose a boundary-guided feature enhancement (BGFE) module to enhance the feature representations. We find that there are large gaps between the narrow boundary and the wide segmentation error areas. Unlike existing methods that treat boundaries as static masks, the BGFE module progressively expands the narrow boundary prediction into broader spatial attention maps. Thus, broader spatial attention maps could effectively cover the wider segmentation error regions and enhance the model's focus on these challenging areas. We conduct expensive experiments on four benchmark ultrasound datasets, BUSI, Dataset B, TN3K, and BP. The experimental results how that our proposed PBE-UNet outperforms state-of-the-art ultrasound image segmentation methods. The code is at https://github.com/cruelMouth/PBE-UNet.