Constructing Ophthalmic MLLM for Positioning-diagnosis Collaboration Through Clinical Cognitive Chain Reasoning

Multimodal large language models (MLLMs) demonstrate significant potential in the field of medical diagnosis. However, they face critical challenges in specialized domains such as ophthalmology, particularly the fragmentation of annotation granularity and inconsistencies in clinical reasoning logic, which hinder precise cross-modal understanding. This paper introduces FundusExpert, an ophthalmology-specific MLLM with integrated positioning-diagnosis reasoning capabilities, along with FundusGen, a dataset constructed through the intelligent Fundus-Engine system. Fundus-Engine automates localization and leverages MLLM-based semantic expansion to integrate global disease classification, local object detection, and fine-grained feature analysis within a single fundus image. Additionally, by constructing a clinically aligned cognitive chain, it guides the model to generate interpretable reasoning paths. FundusExpert, fine-tuned with instruction data from FundusGen, achieves the best performance in ophthalmic question-answering tasks, surpassing the average accuracy of the 40B MedRegA by 26.6%. It also excels in zero-shot report generation tasks, achieving a clinical consistency of 77.0%, significantly outperforming GPT-4o's 47.6%. Furthermore, we reveal a scaling law between data quality and model capability ($L \propto N^{0.068}$), demonstrating that the cognitive alignment annotations in FundusGen enhance data utilization efficiency. By integrating region-level localization with diagnostic reasoning chains, our work develops a scalable, clinically-aligned MLLM and explores a pathway toward bridging the visual-language gap in specific MLLMs. Our project can be found at https://github.com/MeteorElf/FundusExpert.

Mitigating Multi-Sequence 3D Prostate MRI Data Scarcity through Domain Adaptation using Locally-Trained Latent Diffusion Models for Prostate Cancer Detection

Objective: Latent diffusion models (LDMs) could mitigate data scarcity challenges affecting machine learning development for medical image interpretation. The recent CCELLA LDM improved prostate cancer detection performance using synthetic MRI for classifier training but was limited to the axial T2-weighted (AxT2) sequence, did not investigate inter-institutional domain shift, and prioritized radiology over histopathology outcomes. We propose CCELLA++ to address these limitations and improve clinical utility. Methods: CCELLA++ expands CCELLA for simultaneous biparametric prostate MRI (bpMRI) generation, including the AxT2, high b-value diffusion series (HighB) and apparent diffusion coefficient map (ADC). Domain adaptation was investigated by pretraining classifiers on real or LDM-generated synthetic data from an internal institution, followed with fine-tuning on progressively smaller fractions of an out-of-distribution, external dataset. Results: CCELLA++ improved 3D FID for HighB and ADC but not AxT2 (0.013, 0.012, 0.063 respectively) sequences compared to CCELLA (0.060). Classifier pretraining with CCELLA++ bpMRI outperformed real bpMRI in AP and AUC for all domain adaptation scenarios. CCELLA++ pretraining achieved highest classifier performance below 50% (n=665) external dataset volume. Conclusion: Synthetic bpMRI generated by our method can improve downstream classifier generalization and performance beyond real bpMRI or CCELLA-generated AxT2-only images. Future work should seek to quantify medical image sample quality, balance multi-sequence LDM training, and condition the LDM with additional information. Significance: The proposed CCELLA++ LDM can generate synthetic bpMRI that outperforms real data for domain adaptation with a limited target institution dataset. Our code is available at https://github.com/grabkeem/CCELLA-plus-plus

HybridQ: Hybrid Classical-Quantum Generative Adversarial Network for Skin Disease Image Generation

Machine learning-assisted diagnosis is gaining traction in skin disease detection, but training effective models requires large amounts of high-quality data. Skin disease datasets often suffer from class imbalance, privacy concerns, and object bias, making data augmentation essential. While classical generative models are widely used, they demand extensive computational resources and lengthy training time. Quantum computing offers a promising alternative, but existing quantum-based image generation methods can only yield grayscale low-quality images. Through a novel classical-quantum latent space fusion technique, our work overcomes this limitation and introduces the first classical-quantum generative adversarial network (GAN) capable of generating color medical images. Our model outperforms classical deep convolutional GANs and existing hybrid classical-quantum GANs in both image generation quality and classification performance boost when used as data augmentation. Moreover, the performance boost is comparable with that achieved using state-of-the-art classical generative models, yet with over 25 times fewer parameters and 10 times fewer training epochs. Such results suggest a promising future for quantum image generation as quantum hardware advances. Finally, we demonstrate the robust performance of our model on real IBM quantum machine with hardware noise.

TITAN: Query-Token based Domain Adaptive Adversarial Learning

We focus on the source-free domain adaptive object detection (SF-DAOD) problem when source data is unavailable during adaptation and the model must adapt to an unlabeled target domain. The majority of approaches for the problem employ a self-supervised approach using a student-teacher (ST) framework where pseudo-labels are generated via a source-pretrained model for further fine-tuning. We observe that the performance of a student model often degrades drastically, due to the collapse of the teacher model, primarily caused by high noise in pseudo-labels, resulting from domain bias, discrepancies, and a significant domain shift across domains. To obtain reliable pseudo-labels, we propose a Target-based Iterative Query-Token Adversarial Network (TITAN), which separates the target images into two subsets: those similar to the source (easy) and those dissimilar (hard). We propose a strategy to estimate variance to partition the target domain. This approach leverages the insight that higher detection variances correspond to higher recall and greater similarity to the source domain. Also, we incorporate query-token-based adversarial modules into a student-teacher baseline framework to reduce the domain gaps between two feature representations. Experiments conducted on four natural imaging datasets and two challenging medical datasets have substantiated the superior performance of TITAN compared to existing state-of-the-art (SOTA) methodologies. We report an mAP improvement of +22.7, +22.2, +21.1, and +3.7 percent over the current SOTA on C2F, C2B, S2C, and K2C benchmarks, respectively.

Semantic Scene Graph for Ultrasound Image Explanation and Scanning Guidance

Understanding medical ultrasound imaging remains a long-standing challenge due to significant visual variability caused by differences in imaging and acquisition parameters. Recent advancements in large language models (LLMs) have been used to automatically generate terminology-rich summaries orientated to clinicians with sufficient physiological knowledge. Nevertheless, the increasing demand for improved ultrasound interpretability and basic scanning guidance among non-expert users, e.g., in point-of-care settings, has not yet been explored. In this study, we first introduce the scene graph (SG) for ultrasound images to explain image content to ordinary and provide guidance for ultrasound scanning. The ultrasound SG is first computed using a transformer-based one-stage method, eliminating the need for explicit object detection. To generate a graspable image explanation for ordinary, the user query is then used to further refine the abstract SG representation through LLMs. Additionally, the predicted SG is explored for its potential in guiding ultrasound scanning toward missing anatomies within the current imaging view, assisting ordinary users in achieving more standardized and complete anatomical exploration. The effectiveness of this SG-based image explanation and scanning guidance has been validated on images from the left and right neck regions, including the carotid and thyroid, across five volunteers. The results demonstrate the potential of the method to maximally democratize ultrasound by enhancing its interpretability and usability for ordinaries.

Interpreting Biomedical VLMs on High-Imbalance Out-of-Distributions: An Insight into BiomedCLIP on Radiology

In this paper, we construct two research objectives: i) explore the learned embedding space of BiomedCLIP, an open-source large vision language model, to analyse meaningful class separations, and ii) quantify the limitations of BiomedCLIP when applied to a highly imbalanced, out-of-distribution multi-label medical dataset. We experiment on IU-xray dataset, which exhibits the aforementioned criteria, and evaluate BiomedCLIP in classifying images (radiographs) in three contexts: zero-shot inference, full finetuning, and linear probing. The results show that the model under zero-shot settings over-predicts all labels, leading to poor precision and inter-class separability. Full fine-tuning improves classification of distinct diseases, while linear probing detects overlapping features. We demonstrate visual understanding of the model using Grad-CAM heatmaps and compare with 15 annotations by a radiologist. We highlight the need for careful adaptations of the models to foster reliability and applicability in a real-world setting. The code for the experiments in this work is available and maintained on GitHub.

FOAM: A General Frequency-Optimized Anti-Overlapping Framework for Overlapping Object Perception

Overlapping object perception aims to decouple the randomly overlapping foreground-background features, extracting foreground features while suppressing background features, which holds significant application value in fields such as security screening and medical auxiliary diagnosis. Despite some research efforts to tackle the challenge of overlapping object perception, most solutions are confined to the spatial domain. Through frequency domain analysis, we observe that the degradation of contours and textures due to the overlapping phenomenon can be intuitively reflected in the magnitude spectrum. Based on this observation, we propose a general Frequency-Optimized Anti-Overlapping Framework (FOAM) to assist the model in extracting more texture and contour information, thereby enhancing the ability for anti-overlapping object perception. Specifically, we design the Frequency Spatial Transformer Block (FSTB), which can simultaneously extract features from both the frequency and spatial domains, helping the network capture more texture features from the foreground. In addition, we introduce the Hierarchical De-Corrupting (HDC) mechanism, which aligns adjacent features in the separately constructed base branch and corruption branch using a specially designed consistent loss during the training phase. This mechanism suppresses the response to irrelevant background features of FSTBs, thereby improving the perception of foreground contour. We conduct extensive experiments to validate the effectiveness and generalization of the proposed FOAM, which further improves the accuracy of state-of-the-art models on four datasets, specifically for the three overlapping object perception tasks: Prohibited Item Detection, Prohibited Item Segmentation, and Pneumonia Detection. The code will be open source once the paper is accepted.

Improving Medical Visual Representation Learning with Pathological-level Cross-Modal Alignment and Correlation Exploration

Learning medical visual representations from image-report pairs through joint learning has garnered increasing research attention due to its potential to alleviate the data scarcity problem in the medical domain. The primary challenges stem from the lengthy reports that feature complex discourse relations and semantic pathologies. Previous works have predominantly focused on instance-wise or token-wise cross-modal alignment, often neglecting the importance of pathological-level consistency. This paper presents a novel framework PLACE that promotes the Pathological-Level Alignment and enriches the fine-grained details via Correlation Exploration without additional human annotations. Specifically, we propose a novel pathological-level cross-modal alignment (PCMA) approach to maximize the consistency of pathology observations from both images and reports. To facilitate this, a Visual Pathology Observation Extractor is introduced to extract visual pathological observation representations from localized tokens. The PCMA module operates independently of any external disease annotations, enhancing the generalizability and robustness of our methods. Furthermore, we design a proxy task that enforces the model to identify correlations among image patches, thereby enriching the fine-grained details crucial for various downstream tasks. Experimental results demonstrate that our proposed framework achieves new state-of-the-art performance on multiple downstream tasks, including classification, image-to-text retrieval, semantic segmentation, object detection and report generation.

Do you see what I see? An Ambiguous Optical Illusion Dataset exposing limitations of Explainable AI

From uncertainty quantification to real-world object detection, we recognize the importance of machine learning algorithms, particularly in safety-critical domains such as autonomous driving or medical diagnostics. In machine learning, ambiguous data plays an important role in various machine learning domains. Optical illusions present a compelling area of study in this context, as they offer insight into the limitations of both human and machine perception. Despite this relevance, optical illusion datasets remain scarce. In this work, we introduce a novel dataset of optical illusions featuring intermingled animal pairs designed to evoke perceptual ambiguity. We identify generalizable visual concepts, particularly gaze direction and eye cues, as subtle yet impactful features that significantly influence model accuracy. By confronting models with perceptual ambiguity, our findings underscore the importance of concepts in visual learning and provide a foundation for studying bias and alignment between human and machine vision. To make this dataset useful for general purposes, we generate optical illusions systematically with different concepts discussed in our bias mitigation section. The dataset is accessible in Kaggle via https://kaggle.com/datasets/693bf7c6dd2cb45c8a863f9177350c8f9849a9508e9d50526e2ffcc5559a8333. Our source code can be found at https://github.com/KDD-OpenSource/Ambivision.git.

Point, Detect, Count: Multi-Task Medical Image Understanding with Instruction-Tuned Vision-Language Models

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.