Real-world tasks often require models to learn from task-specific context rather than relying only on pre-trained knowledge. While recent work has highlighted this capability as context learning, existing evaluations mainly focus on textual contexts. In many practical settings, however, the context to be learned from is multimodal: scientific findings are conveyed through figures and tables, financial indicators are scattered across converted reports, and spatial decisions depend on maps, scenes, or web pages. We introduce CLBench-V, a benchmark for multimodal context learning that addresses the difficulty of localizing where context use breaks down by organizing tasks around three dimensions: context grounding, new information application, and new knowledge learning. CLBench-V combines converted public benchmarks with newly constructed datasets spanning domains such as science, finance, long-document understanding, spatial reasoning, and web-based visual question answering. To reduce the cost of constructing domain-specific context-learning tasks, we further use automated construction and filtering procedures for our newly built datasets. Across 3,443 instances and six recent multimodal models, the best overall score is only 0.2847, indicating that multimodal context learning remains far from saturated. Moreover, InternVL3.5-30B-A3B performs best on context grounding and new knowledge learning, while Qwen3.5-Plus performs best on new information application. We further analyze judge reliability, context length, image count, and representative failure cases. Code is available at this https URL.
https://arxiv.org/abs/2607.25294
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.
https://arxiv.org/abs/2607.24743
Reliable visual document understanding requires a model to attribute each answer to the evidence regions that support it. Recent benchmarks and systems express this step through a coordinate interface: the model outputs the coordinates of bounding boxes that mark the evidence regions in the document. Under this interface, vision-language models often fail to identify the right regions even when the answer is correct, a failure known as Attribution Hallucination. We present a study that investigates whether this failure is partially limited by what the model can express through coordinates. On a verified bilingual CiteVQA subset, we compare the coordinate interface with a language interface in which the model outputs only text, quoting its evidence verbatim, and a multimodal retriever returns the location of each quote as a page region proposed by a layout parser (tables and figures are quoted through their captions or notes); the comparison is repeated over six open vision-language models. Compared with the coordinate interface, evidence recall rises from at most 8 points to between 26 and 47 and the hallucination rate roughly halves, with little change in answer quality. Building on this comparison, we use the same quote-and-retrieve pipeline as a training scaffold: because region-level evidence labels are expensive to collect for long documents, we introduce a GRPO recipe whose reward is a judge's reading of the gold answer and crops of the retrieved regions, training the model to quote better evidence without any region labels and raising an 8B backbone's strict attributed accuracy from 22.4 to 33.8. These findings indicate a practical path to improve attribution"without a coordinate interface and without costly region-level supervision.
https://arxiv.org/abs/2607.24651
State-of-the-art toxicity detectors for text-to-image generation adopt a one-size-fits-all approach: a single universal model applying fixed safety guidelines to all users. Our empirical evidence shows that these detectors fail to shield marginalized communities: approximately 35% of generated images labeled safe are considered harmful by disability communities. In this position paper, we argue for community-specific toxicity detection (CTD). To demonstrate its feasibility, we collaborate with disability experts to develop safety guidelines for two communities: dwarfism and blind/low vision. Using a dataset of 2,400 annotated T2I-generated images we demonstrate that both large vision-language models and existing general-purpose toxicity detectors catastrophically fail to recognize harmful content under these guidelines in zero-shot settings with F1 score lower than random guessing (F1 0.32 and 0.37). Promisingly, prompt-based adaptation methods (ICL, VQA) substantially improve harm detection performance (GPT-4o: F1 0.50 and 0.78), while parameter-efficient fine-tuning improves smaller models (0.5b-7b with best F1 0.48 and 0.59) with less than 100 demonstrations, but remains sensitive to evolving guidelines. Despite these gains, CTD performance remains far below F1 $\approx 0.9$ achieved for general-purpose toxicity detection, highlighting the challenge and the need for sustained research effort.
https://arxiv.org/abs/2607.24898
Advancing multimodal retrieval-augmented generation (RAG) for complex document understanding presents a formidable dual dilemma of accuracy and efficiency, particularly in graph RAG. Processing structurally sparse yet visually dense layouts, such as extracting a tiny data marker from a financial chart, often incurs computationally prohibitive token overhead while still triggering catastrophic hallucination. However, multimodal Graph RAG pipelines rely on graph-construction stages that assume Vision-Language Models (VLMs) can resolve sparse semantics within high-density layouts. We challenge this assumption, revealing that forcing VLMs to localize visual evidence, interpret semantics, and extract relations triggers a "Visual Attention Sink," a mechanism driving catastrophic semantic loss, while full-page processing incurs massive computational overhead. Controlled interventions verify that this failure is boundary-driven rather than content-specific and that semantic anchoring mitigates it. To fundamentally correct this flawed paradigm, we introduce DeCoRAG, a multimodal Graph RAG pipeline that shifts knowledge processing from coupled visual-semantic reasoning to "Cognitive Decoupling." Rather than passively processing raw pixels, its graph-construction stage establishes a macroscopic Semantic Anchor to neutralize the attention sink. This anchor subsequently drives our Region-Aware Pruning and Cropping (RAP-Crop) mechanism, shifting the reasoning space from dense, noisy backgrounds to purified, intent-driven semantic clusters. The resulting graph supports hybrid retrieval and answer generation. Across complex document benchmarks, DeCoRAG improves the semantic pass rate by up to 12.5 percentage points over the strongest baseline and generalizes to DocVQA. RAP-Crop reduces offline graph-construction prompt tokens by 40.8% without sacrificing end-to-end accuracy.
https://arxiv.org/abs/2607.24554
Vision-language models commonly project all tokens produced by a pretrained vision encoder into a large language model. However, final-layer features can discard text, local attributes, and spatial relationships, while high-resolution inputs substantially increase context length and inference latency. We introduce \method, a Multi-scale Adaptive Vision Encoder. \method uses position-dependent gates to fuse shallow, intermediate, and deep features from a vision Transformer, preserving global semantics while enhancing edges, text, and local structure. It then performs question-conditioned token routing according to question relevance, local information content, global semantics, and spatial coverage, with a token budget that adapts to image complexity. To mitigate compression loss, we further introduce full-to-compressed representation distillation and a spatial diversity regularizer. In an illustrative simulation under a unified 7B language-model framework, \method reduces the average number of SigLIP-SO400M visual tokens from 729 to 146 (approximately 80.0\%) and improves the mean score on VQAv2, GQA, TextVQA, ScienceQA-IMG, and MMBench by 2.2 percentage points, while reducing single-image time to first token from 228\,ms to 129\,ms. We provide the full model design and evaluation protocol. All reported numbers currently serve only as placeholders for paper organization and experimental design; formal claims require real training runs, independent replications, and official benchmark evaluation.
https://arxiv.org/abs/2607.24424
Automatic prompt optimization (APO) has been widely adopted to adapt vision-language models (VLMs) to downstream tasks without weight updates, yielding promising results. However, on multimodal tasks, the effectiveness of APO is fundamentally bottlenecked by a blind feedback channel: the optimizer reads the question, the prediction, and the gold answer, but never the input image on which the model failed, and therefore cannot diagnose visually grounded errors. As a remedy, we introduce Cross-Modal Visual Feedback (CMVF). CMVF incorporates (1) a failure-conditioned visual diagnosis stage, in which a stronger optimizer VLM inspects each failed image without access to predictions or labels, and (2) an error-aware aggregation stage that compresses these observations into reusable, task-level visual blind-spot patterns that drive the prompt rewrite. Crucially, the image is consumed only during optimization; the deployed artifact is an ordinary text prompt that runs at the same inference cost as any text-only baseline. Extensive results across 12 VQA datasets and 4 target VLMs demonstrate that CMVF consistently ranks first, improving over the strongest baseline on every target by 2.4 points on average, with gains of up to 6.5 points on individual benchmarks. Moreover, the optimizer self-organizes into expert-style visual checklists that transfer across models without re-optimization.
https://arxiv.org/abs/2607.24354
Recent Vision-Language Models (VLMs) have achieved remarkable success in visual understanding, driven by the growing availability of high-quality image-text pairs. However, the performance of VLMs often degrades in the video domain due to the essential need for temporal understanding and the scarcity of large-scale annotated video data. In this work, we focus on marine video understanding, which brings further challenges: first, it requires substantial domain expertise; and video VLMs usually struggle with localizing and interpreting critical information from marine videos, as the informative events are typically sparse, unpredictable, and unevenly distributed. To address these challenges, we carefully curate the first event-centric marine video understanding dataset called MarineEVT, which features 20K multi-task, video-level visual question-answering pairs spanning multiple dimensions of marine understanding and analysis. Meanwhile, based on MarineEVT, we decompose marine video understanding as an Event-centric Visual Tool-integrated Reasoning process EVT-R1 for short, where we leverage powerful visual tools to drive the model to localize and interpret critical information aligned with visual questions and human intent. To demonstrate its effectiveness, we compare EVT-R1 against 11 SOTA VLMs in different settings. EVT-R1 outperforms the top open-source and top commercial models by 5.22 and 11.09, respectively. MarineEVT and EVT-R1 lay the foundation for ecological discovery and marine education, fostering the development of VLMs capable of interpreting marine dynamics, reasoning about ecological interactions, and supporting sustainable ocean video understanding and analysis.
https://arxiv.org/abs/2607.24064
Answer grounding in visual question answering aims to locate the region from a given natural language question associated with the visual content of an image, which has garnered significant attention due to its practical applications. In this paper, we introduce the Dynamic Dual-level Vision Transformer Fusion Network (DDVT) for answer grounding in visual question answering. Specifically, we propose a question-guided dynamic regional-level module (QGDR) that combines complementary image context through ROI Align and text content, enabling precise localization of text-related visual content. Moreover, we present a cross-modal multi-scale aggregation module (CMA) that enhances feature fusion between pixel-level and region-level features, facilitating the effective localization of visual content associated with grounded answers. Furthermore, we fuse the located visual content with text features to locate the region and provide answers to questions posed about the image. Experimental results demonstrate that our DDVT outperforms state-of-the-art methods on several widely-used benchmarks.
https://arxiv.org/abs/2607.23921
Pathological diagnosis is inherently multi-scale, requiring the integration of global tissue architecture at low magnification with cellular morphology at higher magnification. However, existing pathology benchmarks and vision-language models (VLMs) are still largely developed under single-scale settings, limiting their ability to learn clinically meaningful multi-magnification reasoning. Moreover, naively constructed visual question answering (VQA) tasks may be susceptible to text-only or superficial visual shortcuts, leading to unreliable assessments of visual understanding. To address these limitations, we introduce a benchmark and training framework for shortcut-resistant cross-scale pathology reasoning. We design an Adversarial Text-only Screening strategy for semantic reasoning questions and a Structure-controlled Distractor Sampling strategy for visual grounding questions, encouraging models to rely on cross-scale visual evidence. Based on this pipeline, we construct PathScale-VQA, a high-quality cross-scale pathology VQA benchmark with 10,373 multiple-choice questions grounded in 1,368 diagnostic paths across multiple magnification levels. Building on the semantic reasoning set, PathScale-R1 is optimized through Difficulty-driven Reasoning Distillation supervised fine-tuning followed by reinforcement learning with a Scale-aware Reasoning Structure reward, which encourages the use of evidence across magnifications. Extensive experiments demonstrate state-of-the-art performance of PathScale-R1 on cross-scale reasoning tasks and effective transfer to conventional single-scale pathology VQA. Our code is available at this https URL.
https://arxiv.org/abs/2607.23794
An embodied agent is an intelligent entity that interacts with its environment through a physical body. Currently, the evaluation of embodied agents primarily relies on two paradigms: (1) manually annotated Visual Question Answering (VQA) pairs and (2) high-level task completion metrics, such as success in navigation or manipulation. The former is labor-intensive and subject to variability in annotation quality. The latter may obscure critical vulnerabilities, allowing agents to complete tasks through suboptimal means or safety violations, thereby concealing safety risks and inefficiencies. Given that spatial cognition is the cornerstone for executing embodied tasks, there is a pressing need to assess whether embodied agents possess robust spatial cognition during task execution. Inspired by metamorphic testing principles in software engineering, we propose MetaSpace, a novel framework designed to evaluate the spatial cognition of agents. By leveraging spatiotemporal multimodal states derived from real execution trajectories, MetaSpace automatically generates test cases based on predefined metamorphic relations (MRs) grounded in logical rules and physical laws. Crucially, we encode these MRs as executable rules in a logic programming language (Prolog). Violations of these relations indicate failures in spatial cognition. Our empirical evaluation across three embodied scenarios demonstrates that MetaSpace successfully detects 90,422 spatial cognition errors in state-of-the-art (SOTA) MLLM-driven agents. We introduce the Spatial Cognition (SC) score to quantify performance. Results indicate that all SOTA agents achieve average scores between 0.44 and 0.52, significantly lower than the human benchmark of 0.96.
https://arxiv.org/abs/2608.07533
Remote sensing multimodal large language models (RS-MLLMs) have improved general aerial-image understanding. However, Earth observation applications require fine-grained scenario specialization, constrained by scarce high-quality scenario data and incomplete capability coverage. We formulate this adaptation as a capability-gap-driven post-training problem and propose filling before advancing (FBA). Rather than relying on single-stage supervised fine-tuning (SFT) over target-domain samples, FBA first fills prerequisite capability gaps before advancing toward scenario specialization. We instantiate FBA for coastal harbor understanding, a representative multi-source scenario, by constructing CPRS (Coastal-Port Remote Sensing), a three-layer supervision dataset coupled with three ordered stages: (1) RS semantic anchoring for overhead-view visual-language alignment; (2) domain-bridge convergence for shared RS priors across target and bridging scenarios under different modalities; and (3) evidence-grounded scenario tuning for downstream performance. We construct HarborEval, an eight-track diagnostic benchmark covering perception, spatial understanding, robustness, and generation. Under comparable training budgets, HarborEval increases from 57.95 with Direct-SFT to 70.29 with FBA on LLaVA-v1.5, and from 81.09 to 83.37 on Qwen3-VL. FBA also outperforms Collapsed-SFT and leads on harbor-related VRSBench/RSVQA subsets and OpenEval. Stage-wise and role-replacement analyses validate progressive gap filling and stage-specific roles. Public examples and release updates for CPRS, HarborEval, code, and trained weights are available at this https URL.
https://arxiv.org/abs/2607.22205
This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.
https://arxiv.org/abs/2607.21998
Machine unlearning has emerged as a tool for removing personal data from trained models to comply with recent AI regulations. To evaluate unlearning effectiveness in multimodal large language models (MLLMs), prior works fine-tune models on fictitious identities, simulating unlearning requests on subsets of these IDs, which are typically uniformly distributed. However, in realistic scenarios, people from different demographic groups may request to be unlearned at different frequencies, potentially altering the model's internal beliefs for these groups and leading to biased behaviors. To fill this gap, we propose FAIRGET, the first Visual Question Answering benchmark that evaluates unlearning under unbalanced, realistic, forget requests. These requests are designed to simulate multiple realistic scenarios, ranging from simple to challenging settings, that lead to biased unlearned models if fairness is not accounted for. Additionally, we propose FAUN, the first unlearning algorithm for MLLMs that forgets unlearning data while preserving model fairness. FAUN exploits a bias-aware activation steering mechanism to unlearn identities while accounting for the unbalanced nature of the forget data. Experiments on FAIRGET and the established FIUBench demonstrate our method's superiority both in unlearning quality and fairness.
https://arxiv.org/abs/2607.21300
Knowledge-Intensive Visual Question Answering (KI-VQA) benchmarks evaluate Vision-Language Models (VLMs) as multimodal knowledge assistants by requiring external information beyond a provided image to answer questions. KI-VQA involves multiple sub-problems -referring expression understanding, visual grounding, object recognition, knowledge retrieval, and reasoning-yet existing benchmarks typically report only end-task accuracy, obscuring where failures arise. To analyze the full KI-VQA pipeline, we introduce CRAG-MM-Diagnostics, a diagnostic benchmark with stage-wise data annotations that isolate 1) language-based visual grounding, 2) object identification, and 3) knowledge retrieval and reasoning. We evaluate fully parametric and retrieval-augmented VLMs, providing fine-grained analyses using newly collected metadata, such as target ROIs, entity names, and visual complexity scores. Our results point to knowledge retrieval and reasoning as the primary bottleneck, but also highlight issues in the other parts of the KI-VQA pipeline, such as the fact that VLMs struggle with target object identification or that image retrievers struggle to integrate textual cues. These findings expose fundamental limitations in current KI-VQA systems and motivate stage-aware evaluation. We, lastly, leverage these findings to propose a grounded bimodal RAG pipeline that integrates a visual grounding module to crop targets before image retrieval, boosting GPT-5 and Qwen's respective accuracies by 13.3 and 8.5 percentage points.
https://arxiv.org/abs/2607.21155
Pathology vision-language models (VLMs) have recently progressed rapidly and are commonly evaluated by answer accuracy on pathology VQA benchmarks. However, we dig into current evaluations and identify three overlooked issues: 1) Visual evidence is not always necessary. For instance, Gemini-3-Pro achieves 53.5% average accuracy across 5 VQA benchmarks without any visual input. 2) Domain training can improve accuracy without proportional gains in visual binding. Compared with Qwen2.5-VL-7B, Patho-R1-7B exhibits a 5.8-point lower multimodal gain and a 3.7-point lower attention IoU. 3) Entity-level attention is diffuse and weakly query-specific. On PathVG, attention maps remain highly correlated across different entity queries. These issues can lead to substantial misjudgments of pathology VLMs' actual multimodal capabilities. To this end, we present PathBind, a benchmark comprising 2,600 samples: PathBind-VQA with 1,500 questions across six dimensions, PathBind-PTA with 600 questions from a private pathology teaching atlas, and PathBind-Grounding with 500 expert-curated region-level samples. Each component undergoes task-specific automated filtering and expert review to reduce textual shortcuts and improve entity-region correspondence. We evaluate 18 representative VLMs on VQA samples of PathBind and five existing pathology VQA benchmarks, and further evaluate 10 VLMs on PathBind-Grounding and PathVG. Results show that current pathology VLMs still exhibit a substantial gap between answer-side performance and visual-semantic binding.
https://arxiv.org/abs/2607.21065
In many reasoning problems, the premises are not observed as discrete symbols, but must be inferred from high-dimensional inputs. Further, the predicate vocabulary, argument structure, and trusted evidence are supplied by a Knowledge Graph (KG), or rule definitions. Classical neuro-symbolic pipelines have a discrete interface between perception and deduction. We present a neuro-soft-symbolic architecture for differentiable deductive reasoning over latent perceptual facts and knowledge-provided predicates. SoftReason removes the gradient gap by representing the deductive state as a local soft interpretation tensor over candidate constants and predicates. Perception proposes probabilistic base facts, KG triples enter as high-confidence soft evidence, and every query anchor, predicate choice, and closure update remains differentiable. Our core innovation is a learned differentiable lift of the immediate-consequence operator. It uses predicate-definition embeddings and latent composition channels to form soft body-predicate mixtures, aggregate over all possible witnesses, propose query-conditioned head facts, and update the interpretation through a monotone probabilistic OR. We instantiate the framework on Knowledge-aware Visual Question Answering (KVQA), and demonstrates how SoftReason supports end-to-end perceptual grounding, KG evidence injection, and differentiable deductive closure in one trainable architecture.
https://arxiv.org/abs/2607.20402
The rapid development of multimodal large language models (MLLMs) has introduced a flexible paradigm for remote sensing image scene understanding (RSISU), enabling natural-language interaction with remote sensing imagery. However, a systematic understanding of the capability boundaries, cross-task generalization, and task-specific limitations of existing remote sensing MLLMs (RS-MLLMs) is still lacking. This paper presents a systematic survey and diagnostic evaluation of MLLMs for RSISU. We review the technical evolution of RS-MLLMs, focusing on model design, multimodal learning, training data, and downstream capabilities. We further compare RS-MLLMs with general-purpose computer vision MLLMs (CV-MLLMs) across diverse RSISU tasks and benchmarks. RS-MLLMs remain competitive in domain-specific settings, particularly remote sensing visual grounding and high-resolution visual question answering. More notably, general-purpose CV-MLLMs can match or even outperform these specialized models on several RSISU tasks without remote sensing-specific fine-tuning. These findings demonstrate the strong transferability of general-purpose CV-MLLMs and show that current RS-MLLMs do not consistently outperform them across diverse RSISU tasks. Current MLLMs also face limitations in spatial and relational reasoning, fine-grained visual understanding, instruction diversity, and generalization across heterogeneous task formats. Based on these findings, we outline future directions toward reliable evaluation, multimodal and high-resolution reasoning, efficient deployment, and tool-augmented remote sensing agents. This survey provides a systematic reference for developing robust, generalizable, and practical MLLMs for RSISU.
https://arxiv.org/abs/2607.20284
Multimodal agentic search systems increasingly rely on external tools to answer knowledge-intensive visual questions. However, existing evaluations mainly focus on final-answer accuracy and may miss failures in the search trajectory. In this work, we study such hidden reliability issues as silent failures. We introduce a six-category taxonomy covering modality shortcuts, phantom grounding, wrong-evidence-right-answer cases, over-retrieval laundering, cross-modal contradiction, and provenance hallucination. Based on this taxonomy, we build a trajectory-level diagnostic pipeline that evaluates both answer correctness and evidence-grounding quality under a unified ReAct-style scaffold. Experiments on MMSearch-Plus trajectories across four frontier multimodal models show that surface accuracy consistently overestimates true trajectory-level correctness. We further use cross-judge validation, blank-image stress tests, and tool ablations to show that silent failures are capability-dependent and often shift rather than disappear. Home-page: this https URL
https://arxiv.org/abs/2607.19793
The allocation of visual attention by pathologists during cancer diagnosis is a highly selective process that critically shapes the information extracted from whole-slide images (WSIs). Human attention helps medical imaging tasks such as classification and segmentation, and becomes a strong semantic cue for identifying diagnostically informative regions for report generation. In this paper, we introduce human attention into the training of pathologist report generation models. To this end, we collected a multimodal human-attention dataset of 121 prostate WSIs annotated with pathologists' multi-scale viewport trajectories synchronized with the pathologists' verbal descriptions and cursor movements for five clinically relevant components (e.g., Gleason patterns). Using this dataset, we finetune two report generation models with an attention-alignment loss that regularizes the model attention over image patches to match the distribution of pathologist attention. We evaluate our approach on prostate cancer report generation and visual question answering using two models with different internal attention mechanisms (i.e., how image tokens are integrated into the language decoder). Experiments show average gains of 10.9% on NLP-based metrics and 19.3% in accuracy across five clinically relevant report components. Further, model attention maps extracted at inference time, with minimal computational overhead, align more closely with pathologist attention, providing stronger visual support for the generated reports by highlighting the regions that most influence the output.
https://arxiv.org/abs/2607.19624