Daily Papers

Recent advances in reasoning-enhanced large language models (LLMs) and multimodal LLMs (MLLMs) have significantly improved performance in complex tasks, yet medical AI models often overlook the structured reasoning processes inherent in clinical practice. In this work, we present ChestX-Reasoner, a radiology diagnosis MLLM designed to leverage process supervision mined directly from clinical reports, reflecting the step-by-step reasoning followed by radiologists. We construct a large dataset by extracting and refining reasoning chains from routine radiology reports. Our two-stage training framework combines supervised fine-tuning and reinforcement learning guided by process rewards to better align model reasoning with clinical standards. We introduce RadRBench-CXR, a comprehensive benchmark featuring 59K visual question answering samples with 301K clinically validated reasoning steps, and propose RadRScore, a metric evaluating reasoning factuality, completeness, and effectiveness. ChestX-Reasoner outperforms existing medical and general-domain MLLMs in both diagnostic accuracy and reasoning ability, achieving 16%, 5.9%, and 18% improvements in reasoning ability compared to the best medical MLLM, the best general MLLM, and its base model, respectively, as well as 3.3%, 24%, and 27% improvements in outcome accuracy. All resources are open-sourced to facilitate further research in medical reasoning MLLMs.

Multimodal large language models (MLLMs) have begun to demonstrate robust reasoning capabilities on general tasks, yet their application in the medical domain remains in its early stages. Constructing chain-of-thought (CoT) training data is essential for bolstering the reasoning abilities of medical MLLMs. However, existing approaches exhibit a deficiency in offering a comprehensive framework for searching and evaluating effective reasoning paths towards critical diagnosis. To address this challenge, we propose Mentor-Intern Collaborative Search (MICS), a novel reasoning-path searching scheme to generate rigorous and effective medical CoT data. MICS first leverages mentor models to initialize the reasoning, one step at a time, then prompts each intern model to continue the thinking along those initiated paths, and finally selects the optimal reasoning path according to the overall reasoning performance of multiple intern models. The reasoning performance is determined by an MICS-Score, which assesses the quality of generated reasoning paths. Eventually, we construct MMRP, a multi-task medical reasoning dataset with ranked difficulty, and Chiron-o1, a new medical MLLM devised via a curriculum learning strategy, with robust visual question-answering and generalizable reasoning capabilities. Extensive experiments demonstrate that Chiron-o1, trained on our CoT dataset constructed using MICS, achieves state-of-the-art performance across a list of medical visual question answering and reasoning benchmarks. Codes are available at GitHub - manglu097/Chiron-o1: Enhancing Step-by-Step and Verifiable Medical Reasoning in MLLMs

Multimodal large language models (MLLMs) have demonstrated promising prospects in healthcare, particularly for addressing complex medical tasks, supporting multidisciplinary treatment (MDT), and enabling personalized precision medicine. However, their practical deployment faces critical challenges in resource efficiency, diagnostic accuracy, clinical considerations, and ethical privacy. To address these limitations, we propose Infi-Med, a comprehensive framework for medical MLLMs that introduces three key innovations: (1) a resource-efficient approach through curating and constructing high-quality supervised fine-tuning (SFT) datasets with minimal sample requirements, with a forward-looking design that extends to both pretraining and posttraining phases; (2) enhanced multimodal reasoning capabilities for cross-modal integration and clinical task understanding; and (3) a systematic evaluation system that assesses model performance across medical modalities and task types. Our experiments demonstrate that Infi-Med achieves state-of-the-art (SOTA) performance in general medical reasoning while maintaining rapid adaptability to clinical scenarios. The framework establishes a solid foundation for deploying MLLMs in real-world healthcare settings by balancing model effectiveness with operational constraints.

We present MedXIAOHE, a medical vision-language foundation model designed to advance general-purpose medical understanding and reasoning in real-world clinical applications. MedXIAOHE achieves state-of-the-art performance across diverse medical benchmarks and surpasses leading closed-source multimodal systems on multiple capabilities. To achieve this, we propose an entity-aware continual pretraining framework that organizes heterogeneous medical corpora to broaden knowledge coverage and reduce long-tail gaps (e.g., rare diseases). For medical expert-level reasoning and interaction, MedXIAOHE incorporates diverse medical reasoning patterns via reinforcement learning and tool-augmented agentic training, enabling multi-step diagnostic reasoning with verifiable decision traces. To improve reliability in real-world use, MedXIAOHE integrates user-preference rubrics, evidence-grounded reasoning, and low-hallucination long-form report generation, with improved adherence to medical instructions. We release this report to document our practical design choices, scaling insights, and evaluation framework, hoping to inspire further research.

Multimodal Large Language Models (MLLMs) show promise for medical applications, yet progress in dermatology lags due to limited training data, narrow task coverage, and lack of clinically-grounded supervision that mirrors expert diagnostic workflows. We present a comprehensive framework to address these gaps. First, we introduce DermoInstruct, a large-scale morphology-anchored instruction corpus comprising 211,243 images and 772,675 trajectories across five task formats, capturing the complete diagnostic pipeline from morphological observation and clinical reasoning to final diagnosis. Second, we establish DermoBench, a rigorous benchmark evaluating 11 tasks across four clinical axes: Morphology, Diagnosis, Reasoning, and Fairness, including a challenging subset of 3,600 expert-verified open-ended instances and human performance baselines. Third, we develop DermoGPT, a dermatology reasoning MLLM trained via supervised fine-tuning followed by our Morphologically-Anchored Visual-Inference-Consistent (MAVIC) reinforcement learning objective, which enforces consistency between visual observations and diagnostic conclusions. At inference, we deploy Confidence-Consistency Test-time adaptation (CCT) for robust predictions. Experiments show DermoGPT significantly outperforms 16 representative baselines across all axes, achieving state-of-the-art performance while substantially narrowing the human-AI gap. DermoInstruct, DermoBench and DermoGPT will be made publicly available at https://github.com/mendicant04/DermoGPT upon acceptance.

Multimodal Large Language Models (MLLMs) have demonstrated remarkable effectiveness in various general-domain scenarios, such as visual question answering and image captioning. Recently, researchers have increasingly focused on empowering MLLMs with medical conversational abilities, which hold significant promise for clinical applications. However, medical data presents unique challenges due to its heterogeneous nature -- encompassing diverse modalities including 2D images, 3D volumetric scans, and temporal video sequences. The substantial domain gap and data format inconsistencies across these modalities have hindered the development of unified medical MLLMs. To address these challenges, we propose Fleming-VL, a unified end-to-end framework for comprehensive medical visual understanding across heterogeneous modalities. Fleming-VL tackles this problem from a data-centric perspective through three key strategies: (1) scaling up pretraining by integrating long-context data from both natural and medical-specific domains; (2) complementing fine-tuning with rare medical data, including holistic video analysis and underrepresented 2D modalities such as ultrasound and dermoscopy images; (3) extending existing evaluation frameworks to incorporate 3D volumetric and video understanding benchmarks. Through supervised fine-tuning (SFT) and group relative policy optimization (GRPO), we develop Fleming-VL in multiple model scales. Extensive experiments demonstrate that Fleming-VL achieves state-of-the-art performance across multiple benchmarks, including medical VQA, video QA, and 3D medical image understanding. We publicly release Fleming-VL to promote transparent, reproducible, and auditable progress in medical AI.

Recent reasoning based medical MLLMs have made progress in generating step by step textual reasoning chains. However, they still struggle with complex tasks that necessitate dynamic and iterative focusing on fine-grained visual regions to achieve precise grounding and diagnosis. We introduce Ophiuchus, a versatile, tool-augmented framework that equips an MLLM to (i) decide when additional visual evidence is needed, (ii) determine where to probe and ground within the medical image, and (iii) seamlessly weave the relevant sub-image content back into an interleaved, multimodal chain of thought. In contrast to prior approaches limited by the performance ceiling of specialized tools, Ophiuchus integrates the model's inherent grounding and perception capabilities with external tools, thereby fostering higher-level reasoning. The core of our method is a three-stage training strategy: cold-start training with tool-integrated reasoning data to achieve basic tool selection and adaptation for inspecting key regions; self-reflection fine-tuning to strengthen reflective reasoning and encourage revisiting tool outputs; and Agentic Tool Reinforcement Learning to directly optimize task-specific rewards and emulate expert-like diagnostic behavior. Extensive experiments show that Ophiuchus consistently outperforms both closed-source and open-source SOTA methods across diverse medical benchmarks, including VQA, detection, and reasoning-based segmentation. Our approach illuminates a path toward medical AI agents that can genuinely "think with images" through tool-integrated reasoning. Datasets, codes, and trained models will be released publicly.

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...

Chain-of-Thought (CoT) reasoning has proven effective in enhancing large language models by encouraging step-by-step intermediate reasoning, and recent advances have extended this paradigm to Multimodal Large Language Models (MLLMs). In the medical domain, where diagnostic decisions depend on nuanced visual cues and sequential reasoning, CoT aligns naturally with clinical thinking processes. However, Current benchmarks for medical image understanding generally focus on the final answer while ignoring the reasoning path. An opaque process lacks reliable bases for judgment, making it difficult to assist doctors in diagnosis. To address this gap, we introduce a new M3CoTBench benchmark specifically designed to evaluate the correctness, efficiency, impact, and consistency of CoT reasoning in medical image understanding. M3CoTBench features 1) a diverse, multi-level difficulty dataset covering 24 examination types, 2) 13 varying-difficulty tasks, 3) a suite of CoT-specific evaluation metrics (correctness, efficiency, impact, and consistency) tailored to clinical reasoning, and 4) a performance analysis of multiple MLLMs. M3CoTBench systematically evaluates CoT reasoning across diverse medical imaging tasks, revealing current limitations of MLLMs in generating reliable and clinically interpretable reasoning, and aims to foster the development of transparent, trustworthy, and diagnostically accurate AI systems for healthcare. Project page at https://juntaojianggavin.github.io/projects/M3CoTBench/.

Incentivizing the reasoning ability of Multimodal Large Language Models (MLLMs) is essential for medical applications to transparently analyze medical scans and provide reliable diagnosis. However, existing medical MLLMs rely solely on internal knowledge during reasoning, leading to hallucinated reasoning and factual inaccuracies when encountering cases beyond their training scope. Although recent Agentic Retrieval-Augmented Generation (RAG) methods elicit the medical model's proactive retrieval ability during reasoning, they are confined to unimodal LLMs, neglecting the crucial visual information during reasoning and retrieval. Consequently, we propose the first Multimodal Medical Reasoning-with-Retrieval framework, Med-RwR, which actively retrieves external knowledge by querying observed symptoms or domain-specific medical concepts during reasoning. Specifically, we design a two-stage reinforcement learning strategy with tailored rewards that stimulate the model to leverage both visual diagnostic findings and textual clinical information for effective retrieval. Building on this foundation, we further propose a Confidence-Driven Image Re-retrieval (CDIR) method for test-time scaling when low prediction confidence is detected. Evaluation on various public medical benchmarks demonstrates Med-RwR's significant improvements over baseline models, proving the effectiveness of enhancing reasoning capabilities with external knowledge integration. Furthermore, Med-RwR demonstrates remarkable generalizability to unfamiliar domains, evidenced by 8.8% performance gain on our proposed EchoCardiography Benchmark (ECBench), despite the scarcity of echocardiography data in the training corpus. Our data, model, and codes will be made publicly available at https://github.com/xmed-lab/Med-RwR.

Medical Image Quality Assessment (IQA) serves as the first-mile safety gate for clinical AI, yet existing approaches remain constrained by scalar, score-based metrics and fail to reflect the descriptive, human-like reasoning process central to expert evaluation. To address this gap, we introduce MedQ-Bench, a comprehensive benchmark that establishes a perception-reasoning paradigm for language-based evaluation of medical image quality with Multi-modal Large Language Models (MLLMs). MedQ-Bench defines two complementary tasks: (1) MedQ-Perception, which probes low-level perceptual capability via human-curated questions on fundamental visual attributes; and (2) MedQ-Reasoning, encompassing both no-reference and comparison reasoning tasks, aligning model evaluation with human-like reasoning on image quality. The benchmark spans five imaging modalities and over forty quality attributes, totaling 2,600 perceptual queries and 708 reasoning assessments, covering diverse image sources including authentic clinical acquisitions, images with simulated degradations via physics-based reconstructions, and AI-generated images. To evaluate reasoning ability, we propose a multi-dimensional judging protocol that assesses model outputs along four complementary axes. We further conduct rigorous human-AI alignment validation by comparing LLM-based judgement with radiologists. Our evaluation of 14 state-of-the-art MLLMs demonstrates that models exhibit preliminary but unstable perceptual and reasoning skills, with insufficient accuracy for reliable clinical use. These findings highlight the need for targeted optimization of MLLMs in medical IQA. We hope that MedQ-Bench will catalyze further exploration and unlock the untapped potential of MLLMs for medical image quality evaluation.

Pretrained Multimodal Large Language Models (MLLMs) are increasingly deployed in medical AI systems for clinical reasoning, diagnosis support, and report generation. However, their training on sensitive patient data raises critical privacy and compliance challenges under regulations such as HIPAA and GDPR, which enforce the "right to be forgotten". Unlearning, the process of tuning models to selectively remove the influence of specific training data points, offers a potential solution, yet its effectiveness in complex medical settings remains underexplored. To systematically study this, we introduce MedForget, a Hierarchy-Aware Multimodal Unlearning Testbed with explicit retain and forget splits and evaluation sets containing rephrased variants. MedForget models hospital data as a nested hierarchy (Institution -> Patient -> Study -> Section), enabling fine-grained assessment across eight organizational levels. The benchmark contains 3840 multimodal (image, question, answer) instances, each hierarchy level having a dedicated unlearning target, reflecting distinct unlearning challenges. Experiments with four SOTA unlearning methods on three tasks (generation, classification, cloze) show that existing methods struggle to achieve complete, hierarchy-aware forgetting without reducing diagnostic performance. To test whether unlearning truly deletes hierarchical pathways, we introduce a reconstruction attack that progressively adds hierarchical level context to prompts. Models unlearned at a coarse granularity show strong resistance, while fine-grained unlearning leaves models vulnerable to such reconstruction. MedForget provides a practical, HIPAA-aligned testbed for building compliant medical AI systems.

Accurately grounding regions of interest (ROIs) is critical for diagnosis and treatment planning in medical imaging. While multimodal large language models (MLLMs) combine visual perception with natural language, current medical-grounding pipelines still rely on supervised fine-tuning with explicit spatial hints, making them ill-equipped to handle the implicit queries common in clinical practice. This work makes three core contributions. We first define Unified Medical Reasoning Grounding (UMRG), a novel vision-language task that demands clinical reasoning and pixel-level grounding. Second, we release U-MRG-14K, a dataset of 14K samples featuring pixel-level masks alongside implicit clinical queries and reasoning traces, spanning 10 modalities, 15 super-categories, and 108 specific categories. Finally, we introduce MedReasoner, a modular framework that distinctly separates reasoning from segmentation: an MLLM reasoner is optimized with reinforcement learning, while a frozen segmentation expert converts spatial prompts into masks, with alignment achieved through format and accuracy rewards. MedReasoner achieves state-of-the-art performance on U-MRG-14K and demonstrates strong generalization to unseen clinical queries, underscoring the significant promise of reinforcement learning for interpretable medical grounding.

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.

Visual grounding is essential for precise perception and reasoning in multimodal large language models (MLLMs), especially in medical imaging domains. While existing medical visual grounding benchmarks primarily focus on single-image scenarios, real-world clinical applications often involve sequential images, where accurate lesion localization across different modalities and temporal tracking of disease progression (e.g., pre- vs. post-treatment comparison) require fine-grained cross-image semantic alignment and context-aware reasoning. To remedy the underrepresentation of image sequences in existing medical visual grounding benchmarks, we propose MedSG-Bench, the first benchmark tailored for Medical Image Sequences Grounding. It comprises eight VQA-style tasks, formulated into two paradigms of the grounding tasks, including 1) Image Difference Grounding, which focuses on detecting change regions across images, and 2) Image Consistency Grounding, which emphasizes detection of consistent or shared semantics across sequential images. MedSG-Bench covers 76 public datasets, 10 medical imaging modalities, and a wide spectrum of anatomical structures and diseases, totaling 9,630 question-answer pairs. We benchmark both general-purpose MLLMs (e.g., Qwen2.5-VL) and medical-domain specialized MLLMs (e.g., HuatuoGPT-vision), observing that even the advanced models exhibit substantial limitations in medical sequential grounding tasks. To advance this field, we construct MedSG-188K, a large-scale instruction-tuning dataset tailored for sequential visual grounding, and further develop MedSeq-Grounder, an MLLM designed to facilitate future research on fine-grained understanding across medical sequential images. The benchmark, dataset, and model are available at https://huggingface.co/MedSG-Bench

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

The accelerating development of general medical artificial intelligence (GMAI), powered by multimodal large language models (MLLMs), offers transformative potential for addressing persistent healthcare challenges, including workforce deficits and escalating costs. The parallel development of systematic evaluation benchmarks emerges as a critical imperative to enable performance assessment and provide technological guidance. Meanwhile, as an invaluable knowledge source, the potential of medical textbooks for benchmark development remains underexploited. Here, we present MedBookVQA, a systematic and comprehensive multimodal benchmark derived from open-access medical textbooks. To curate this benchmark, we propose a standardized pipeline for automated extraction of medical figures while contextually aligning them with corresponding medical narratives. Based on this curated data, we generate 5,000 clinically relevant questions spanning modality recognition, disease classification, anatomical identification, symptom diagnosis, and surgical procedures. A multi-tier annotation system categorizes queries through hierarchical taxonomies encompassing medical imaging modalities (42 categories), body anatomies (125 structures), and clinical specialties (31 departments), enabling nuanced analysis across medical subdomains. We evaluate a wide array of MLLMs, including proprietary, open-sourced, medical, and reasoning models, revealing significant performance disparities across task types and model categories. Our findings highlight critical capability gaps in current GMAI systems while establishing textbook-derived multimodal benchmarks as essential evaluation tools. MedBookVQA establishes textbook-derived benchmarking as a critical paradigm for advancing clinical AI, exposing limitations in GMAI systems while providing anatomically structured performance metrics across specialties.

Reliable interpretation of multimodal data in dentistry is essential for automated oral healthcare, yet current multimodal large language models (MLLMs) struggle to capture fine-grained dental visual details and lack sufficient reasoning ability for precise diagnosis. To address these limitations, we present DentalGPT, a specialized dental MLLM developed through high-quality domain knowledge injection and reinforcement learning. Specifically, the largest annotated multimodal dataset for dentistry to date was constructed by aggregating over 120k dental images paired with detailed descriptions that highlight diagnostically relevant visual features, making it the multimodal dataset with the most extensive collection of dental images to date. Training on this dataset significantly enhances the MLLM's visual understanding of dental conditions, while the subsequent reinforcement learning stage further strengthens its capability for multimodal complex reasoning. Comprehensive evaluations on intraoral and panoramic benchmarks, along with dental subsets of medical VQA benchmarks, show that DentalGPT achieves superior performance in disease classification and dental VQA tasks, outperforming many state-of-the-art MLLMs despite having only 7B parameters. These results demonstrate that high-quality dental data combined with staged adaptation provides an effective pathway for building capable and domain-specialized dental MLLMs.

Multimodal large language models (MLLMs) have shown great potential in general domains but perform poorly in some specific domains due to a lack of domain-specific data, such as image-text data or vedio-text data. In some specific domains, there is abundant graphic and textual data scattered around, but lacks standardized arrangement. In the field of medical ultrasound, there are ultrasonic diagnostic books, ultrasonic clinical guidelines, ultrasonic diagnostic reports, and so on. However, these ultrasonic materials are often saved in the forms of PDF, images, etc., and cannot be directly used for the training of MLLMs. This paper proposes a novel image-text reasoning supervised fine-tuning data generation pipeline to create specific domain quadruplets (image, question, thinking trace, and answer) from domain-specific materials. A medical ultrasound domain dataset ReMUD is established, containing over 45,000 reasoning and non-reasoning supervised fine-tuning Question Answering (QA) and Visual Question Answering (VQA) data. The ReMUD-7B model, fine-tuned on Qwen2.5-VL-7B-Instruct, outperforms general-domain MLLMs in medical ultrasound field. To facilitate research, the ReMUD dataset, data generation codebase, and ReMUD-7B parameters will be released at https://github.com/ShiDaizi/ReMUD, addressing the data shortage issue in specific domain MLLMs.

Medical image segmentation is fundamental for biomedical discovery. Existing methods lack generalizability and demand extensive, time-consuming manual annotation for new clinical application. Here, we propose MedSAM-3, a text promptable medical segmentation model for medical image and video segmentation. By fine-tuning the Segment Anything Model (SAM) 3 architecture on medical images paired with semantic conceptual labels, our MedSAM-3 enables medical Promptable Concept Segmentation (PCS), allowing precise targeting of anatomical structures via open-vocabulary text descriptions rather than solely geometric prompts. We further introduce the MedSAM-3 Agent, a framework that integrates Multimodal Large Language Models (MLLMs) to perform complex reasoning and iterative refinement in an agent-in-the-loop workflow. Comprehensive experiments across diverse medical imaging modalities, including X-ray, MRI, Ultrasound, CT, and video, demonstrate that our approach significantly outperforms existing specialist and foundation models. We will release our code and model at https://github.com/Joey-S-Liu/MedSAM3.

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities with reinforcement learning paradigm. Although several multimodal reasoning models have been explored in the medical domain, most of them focus exclusively on basic reasoning, which refers to shallow inference based on visual feature matching. However, real-world clinical diagnosis extends beyond basic reasoning, demanding reasoning processes that integrate heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, the first ophthalmic multimodal dataset with the full spectrum of perception and reasoning. It encompasses both basic reasoning tasks and complex reasoning tasks, aiming to enhance visual-centric fundamental reasoning capabilities and emulate realistic clinical thinking patterns. Building upon MM-Retinal-Reason, we propose OphthaReason, the first ophthalmology-specific multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we specifically design a novel method called Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates the model's exploration depth using a shaped advantage mechanism. Comprehensive experiments demonstrate that our model achieves state-of-the-art performance on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 24.92\%, 15.00\%, 21.20\%, and 17.66\%. Project Page: https://github.com/lxirich/OphthaReason{link}.

Brain imaging analysis is vital for diagnosing and treating brain disorders, and multimodal large language models (MLLMs) are increasingly assisting in that analysis. However, current brain-oriented visual question-answering (VQA) benchmarks either cover a few imaging modalities or are limited to coarse-grained pathological descriptions, hindering a comprehensive assessment of MLLMs throughout the full clinical continuum. To address these, we introduce OmniBrainBench, the first comprehensive multimodal VQA benchmark specifically designed to assess the multimodal comprehension capabilities of MLLMs in brain imaging analysis.OmniBrainBench consists of 15 distinct brain imaging modalities collected from 30 verified medical sources, yielding 9,527 validated VQA pairs and 31,706 images. It simulates clinical workflows and encompasses 15 multi-stage clinical tasks rigorously validated by a professional radiologist. Evaluation of 24 state-of-the-art models, including open-source, medical, and proprietary MLLMs, highlights the substantial challenges posed by OmniBrainBench. Our experiments reveal: (1) proprietary MLLMs (e.g., GPT-5) beat open-source and medical models but lag physicians; (2) medical MLLMs vary widely in performance; (3) open-source MLLMs trail overall but excel in specific tasks; (4) MLLMs underperform sharply in complex preoperative tasks, revealing a visual-to-clinical reasoning gap. OmniBrainBench sets a new standard for evaluating and advancing MLLMs in brain imaging analysis, highlighting gaps compared to expert clinical reasoning. We release it at benchmark \& code.

In recent advancements, multimodal large language models (MLLMs) have been fine-tuned on specific medical image datasets to address medical visual question answering (Med-VQA) tasks. However, this common approach of task-specific fine-tuning is costly and necessitates separate models for each downstream task, limiting the exploration of zero-shot capabilities. In this paper, we introduce MC-CoT, a modular cross-modal collaboration Chain-of-Thought (CoT) framework designed to enhance the zero-shot performance of MLLMs in Med-VQA by leveraging large language models (LLMs). MC-CoT improves reasoning and information extraction by integrating medical knowledge and task-specific guidance, where LLM provides various complex medical reasoning chains and MLLM provides various observations of medical images based on instructions of the LLM. Our experiments on datasets such as SLAKE, VQA-RAD, and PATH-VQA show that MC-CoT surpasses standalone MLLMs and various multimodality CoT frameworks in recall rate and accuracy. These findings highlight the importance of incorporating background information and detailed guidance in addressing complex zero-shot Med-VQA tasks.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

Recent progress in the reasoning capabilities of multimodal large language models (MLLMs) has empowered them to address more complex tasks such as scientific analysis and mathematical reasoning. Despite their promise, MLLMs' reasoning abilities across different scenarios in real life remain largely unexplored and lack standardized benchmarks for evaluation. To address this gap, we introduce MMR-Life, a comprehensive benchmark designed to evaluate the diverse multimodal multi-image reasoning capabilities of MLLMs across real-life scenarios. MMR-Life consists of 2,646 multiple-choice questions based on 19,108 images primarily sourced from real-world contexts, comprehensively covering seven reasoning types: abductive, analogical, causal, deductive, inductive, spatial, and temporal. Unlike existing reasoning benchmarks, MMR-Life does not rely on domain-specific expertise but instead requires models to integrate information across multiple images and apply diverse reasoning abilities. The evaluation of 37 advanced models highlights the substantial challenge posed by MMR-Life. Even top models like GPT-5 achieve only 58% accuracy and display considerable variance in performance across reasoning types. Moreover, we analyze the reasoning paradigms of existing MLLMs, exploring how factors such as thinking length, reasoning method, and reasoning type affect their performance. In summary, MMR-Life establishes a comprehensive foundation for evaluating, analyzing, and improving the next generation of multimodal reasoning systems.

Logical reasoning is a fundamental aspect of human intelligence and an essential capability for multimodal large language models (MLLMs). Despite the significant advancement in multimodal reasoning, existing benchmarks fail to comprehensively evaluate their reasoning abilities due to the lack of explicit categorization for logical reasoning types and an unclear understanding of reasoning. To address these issues, we introduce MME-Reasoning, a comprehensive benchmark designed to evaluate the reasoning ability of MLLMs, which covers all three types of reasoning (i.e., inductive, deductive, and abductive) in its questions. We carefully curate the data to ensure that each question effectively evaluates reasoning ability rather than perceptual skills or knowledge breadth, and extend the evaluation protocols to cover the evaluation of diverse questions. Our evaluation reveals substantial limitations of state-of-the-art MLLMs when subjected to holistic assessments of logical reasoning capabilities. Even the most advanced MLLMs show limited performance in comprehensive logical reasoning, with notable performance imbalances across reasoning types. In addition, we conducted an in-depth analysis of approaches such as ``thinking mode'' and Rule-based RL, which are commonly believed to enhance reasoning abilities. These findings highlight the critical limitations and performance imbalances of current MLLMs in diverse logical reasoning scenarios, providing comprehensive and systematic insights into the understanding and evaluation of reasoning capabilities.

Scientific reasoning, the process through which humans apply logic, evidence, and critical thinking to explore and interpret scientific phenomena, is essential in advancing knowledge reasoning across diverse fields. However, despite significant progress, current scientific reasoning models still struggle with generalization across domains and often fall short of multimodal perception. Multimodal Large Language Models (MLLMs), which integrate text, images, and other modalities, present an exciting opportunity to overcome these limitations and enhance scientific reasoning. Therefore, this position paper argues that MLLMs can significantly advance scientific reasoning across disciplines such as mathematics, physics, chemistry, and biology. First, we propose a four-stage research roadmap of scientific reasoning capabilities, and highlight the current state of MLLM applications in scientific reasoning, noting their ability to integrate and reason over diverse data types. Second, we summarize the key challenges that remain obstacles to achieving MLLM's full potential. To address these challenges, we propose actionable insights and suggestions for the future. Overall, our work offers a novel perspective on MLLM integration with scientific reasoning, providing the LLM community with a valuable vision for achieving Artificial General Intelligence (AGI).

Multimodal large language models (MLLMs) hold significant potential in medical applications, including disease diagnosis and clinical decision-making. However, these tasks require highly accurate, context-sensitive, and professionally aligned responses, making reliable reward models and judges critical. Despite their importance, medical reward models (MRMs) and judges remain underexplored, with no dedicated benchmarks addressing clinical requirements. Existing benchmarks focus on general MLLM capabilities or evaluate models as solvers, neglecting essential evaluation dimensions like diagnostic accuracy and clinical relevance. To address this, we introduce Med-RewardBench, the first benchmark specifically designed to evaluate MRMs and judges in medical scenarios. Med-RewardBench features a multimodal dataset spanning 13 organ systems and 8 clinical departments, with 1,026 expert-annotated cases. A rigorous three-step process ensures high-quality evaluation data across six clinically critical dimensions. We evaluate 32 state-of-the-art MLLMs, including open-source, proprietary, and medical-specific models, revealing substantial challenges in aligning outputs with expert judgment. Additionally, we develop baseline models that demonstrate substantial performance improvements through fine-tuning.

Multi-modal Large Language Models (MLLMs) are increasingly prominent in the field of artificial intelligence. These models not only excel in traditional vision-language tasks but also demonstrate impressive performance in contemporary multi-modal benchmarks. Although many of these benchmarks attempt to holistically evaluate MLLMs, they typically concentrate on basic reasoning tasks, often yielding only simple yes/no or multi-choice responses. These methods naturally lead to confusion and difficulties in conclusively determining the reasoning capabilities of MLLMs. To mitigate this issue, we manually curate a benchmark dataset specifically designed for MLLMs, with a focus on complex reasoning tasks. Our benchmark comprises three key reasoning categories: deductive, abductive, and analogical reasoning. The queries in our dataset are intentionally constructed to engage the reasoning capabilities of MLLMs in the process of generating answers. For a fair comparison across various MLLMs, we incorporate intermediate reasoning steps into our evaluation criteria. In instances where an MLLM is unable to produce a definitive answer, its reasoning ability is evaluated by requesting intermediate reasoning steps. If these steps align with our manual annotations, appropriate scores are assigned. This evaluation scheme resembles methods commonly used in human assessments, such as exams or assignments, and represents what we consider a more effective assessment technique compared with existing benchmarks. We evaluate a selection of representative MLLMs using this rigorously developed open-ended multi-step elaborate reasoning benchmark, designed to challenge and accurately measure their reasoning capabilities. The code and data will be released at https://core-mm.github.io/

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Reasoning is a critical frontier for advancing medical image analysis, where transparency and trustworthiness play a central role in both clinician trust and regulatory approval. Although Medical Visual Language Models (VLMs) show promise for radiological tasks, most existing VLMs merely produce final answers without revealing the underlying reasoning. To address this gap, we introduce MedVLM-R1, a medical VLM that explicitly generates natural language reasoning to enhance transparency and trustworthiness. Instead of relying on supervised fine-tuning (SFT), which often suffers from overfitting to training distributions and fails to foster genuine reasoning, MedVLM-R1 employs a reinforcement learning framework that incentivizes the model to discover human-interpretable reasoning paths without using any reasoning references. Despite limited training data (600 visual question answering samples) and model parameters (2B), MedVLM-R1 boosts accuracy from 55.11% to 78.22% across MRI, CT, and X-ray benchmarks, outperforming larger models trained on over a million samples. It also demonstrates robust domain generalization under out-of-distribution tasks. By unifying medical image analysis with explicit reasoning, MedVLM-R1 marks a pivotal step toward trustworthy and interpretable AI in clinical practice.

Recent advances in generative medical models are constrained by modality-specific scenarios that hinder the integration of complementary evidence from imaging, pathology, and clinical notes. This fragmentation limits their evolution into foundation models that can learn and reason across the full spectrum of biomedical data. We propose MeDiM, the first medical discrete diffusion model that learns shared distributions across modalities without modality-specific components. MeDiM unifies multiple generative tasks: translating between images and text, and jointly producing image-report pairs across domains in response to prompts. Built on a discrete diffusion framework, MeDiM bridges vision and language representations through a shared probabilistic space. To enable unified and flexible medical generation, we employ a multimodal large language model (MLLM) as the diffusion backbone, leveraging its prior knowledge and cross-modal reasoning. Two key designs are introduced: (1) removing the causal attention mask for bidirectional context, and (2) injecting continuous timestep embeddings for diffusion awareness. Experiments demonstrate high-fidelity medical generation (FID 16.60 on MIMIC-CXR and FID 24.19 on PathGen) and accurate report generation (METEOR 0.2650 and 0.2580). Jointly generated image-report pairs further enhance downstream performance (plus6.43 percent BLEU-1, plus18.57 percent BLEU-2, plus31.58 percent BLEU-3, plus4.80 percent METEOR), showing that MeDiM supports coherent and clinically grounded multimodal outputs.

Strong Artificial Intelligence (Strong AI) or Artificial General Intelligence (AGI) with abstract reasoning ability is the goal of next-generation AI. Recent advancements in Large Language Models (LLMs), along with the emerging field of Multimodal Large Language Models (MLLMs), have demonstrated impressive capabilities across a wide range of multimodal tasks and applications. Particularly, various MLLMs, each with distinct model architectures, training data, and training stages, have been evaluated across a broad range of MLLM benchmarks. These studies have, to varying degrees, revealed different aspects of the current capabilities of MLLMs. However, the reasoning abilities of MLLMs have not been systematically investigated. In this survey, we comprehensively review the existing evaluation protocols of multimodal reasoning, categorize and illustrate the frontiers of MLLMs, introduce recent trends in applications of MLLMs on reasoning-intensive tasks, and finally discuss current practices and future directions. We believe our survey establishes a solid base and sheds light on this important topic, multimodal reasoning.

Multimodal Large Language Models (MLLMs) inherit the superior text understanding capabilities of LLMs and extend these capabilities to multimodal scenarios. These models achieve excellent results in the general domain of multimodal tasks. However, in the medical domain, the substantial training costs and the requirement for extensive medical data pose challenges to the development of medical MLLMs. Furthermore, due to the free-text form of answers, tasks such as visual grounding that need to produce output in a prescribed form become difficult for MLLMs. So far, there have been no medical MLLMs works in medical visual grounding area. For the medical vision grounding task, which involves identifying locations in medical images based on short text descriptions, we propose Parameter-efficient Fine-tuning medical multimodal large language models for Medcial Visual Grounding (PFMVG). To validate the performance of the model, we evaluate it on a public benchmark dataset for medical visual grounding, where it achieves competitive results, and significantly outperforming GPT-4v. Our code will be open sourced after peer review.

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using Protocol-Guided Instruction Data Generation, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with Interleaved Modality Dropout to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present Reinforcement Learning with ECG Diagnostic Evidence Rewards to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at https://github.com/PKUDigitalHealth/ECG-R1{here}, and an online platform can be accessed at http://ai.heartvoice.com.cn/ECG-R1/{here}.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

Multimodal large language models (MLLMs) have rapidly advanced, yet their adoption in medicine remains limited by gaps in domain coverage, modality alignment, and grounded reasoning. In this work, we introduce MedMO, a medical foundation model built upon a generalized MLLM architecture and trained exclusively on large-scale, domain-specific data. MedMO follows a multi-stage training recipe: (i) cross-modal pretraining to align heterogeneous visual encoders with a medical language backbone; (ii) instruction tuning on multi-task supervision that spans captioning, VQA, report generation, retrieval, and grounded disease localization with bounding boxes; and (iii) reinforcement learning with verifiable rewards that combine factuality checks with a box-level GIoU reward to strengthen spatial grounding and step-by-step reasoning in complex clinical scenarios. MedMO consistently outperforms strong open-source medical MLLMs across multiple modalities and tasks. On VQA benchmarks, MedMO achieves an average accuracy improvement of +13.7% over the baseline and performs within 1.9% of the SOTA Fleming-VL. For text-based QA, it attains +6.9% over the baseline and +14.5% over Fleming-VL. In medical report generation, MedMO delivers significant gains in both semantic and clinical accuracy. Moreover, it exhibits strong grounding capability, achieving an IoU improvement of +40.4 over the baseline and +37.0% over Fleming-VL, underscoring its robust spatial reasoning and localization performance. Evaluations across radiology, ophthalmology, and pathology-microscopy confirm MedMO's broad cross-modality generalization. We release two versions of MedMO: 4B and 8B. Project is available at https://genmilab.github.io/MedMO-Page

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Large language models (LLMs) and multimodal LLMs (MLLMs) excel at chain-of-thought reasoning but face distribution shift at test-time and a lack of verifiable supervision. Recent test-time reinforcement learning (TTRL) methods derive label-free pseudo-rewards from self-consistency voting over sampled trajectories, yet they often collapse: the majority-vote reward prevails, responses shorten, and Pass@1 declines. We trace this to uniform sequence updates in which most tokens are low-entropy followers, while a small high-entropy subset determines the reasoning branches. Thus we propose SPINE, a token-selective test-time reinforcement learning framework that (i) updates only forking tokens, the high-entropy branch points identified from forward-pass statistics, and (ii) applies an entropy-band regularizer at those tokens to sustain exploration when entropy is too low and to suppress noisy supervision when it is too high. SPINE plugs into GRPO-style objectives, optionally with a KL anchor, and requires no labels or reward models. Across ten benchmarks spanning multimodal VQA, general and expert QA, mathematical reasoning, and medical QA, SPINE consistently improves Pass@1 over TTRL while avoiding response-length collapse and yielding more stable training dynamics on both LLM and MLLM backbones. These results indicate that aligning updates with chain-of-thought branch points is a simple and label-free mechanism for stable and effective test-time adaptation in reasoning models. Code is available at https://github.com/JianghaoWu/SPINE.

Though reasoning-based large language models (LLMs) have excelled in mathematics and programming, their capabilities in knowledge-intensive medical question answering remain underexplored. To address this, we introduce ReasonMed, the largest medical reasoning dataset, comprising 370k high-quality examples distilled from 1.7 million initial reasoning paths generated by various LLMs. ReasonMed is constructed through a multi-agent verification and refinement process, where we design an Error Refiner to enhance the reasoning paths by identifying and correcting error-prone steps flagged by a verifier. Leveraging ReasonMed, we systematically investigate best practices for training medical reasoning models and find that combining detailed Chain-of-Thought (CoT) reasoning with concise answer summaries yields the most effective fine-tuning strategy. Based on this strategy, we train ReasonMed-7B, which sets a new benchmark for sub-10B models, outperforming the prior best by 4.17\% and even exceeding LLaMA3.1-70B on PubMedQA by 4.60\%.

Recent advances in Multi-Modal Large Language Models (MLLMs) have enabled unified processing of language, vision, and structured inputs, opening the door to complex tasks such as logical deduction, spatial reasoning, and scientific analysis. Despite their promise, the reasoning capabilities of MLLMs, particularly those augmented with intermediate thinking traces (MLLMs-T), remain poorly understood and lack standardized evaluation benchmarks. Existing work focuses primarily on perception or final answer correctness, offering limited insight into how models reason or fail across modalities. To address this gap, we introduce the MMMR, a new benchmark designed to rigorously evaluate multi-modal reasoning with explicit thinking. The MMMR comprises 1) a high-difficulty dataset of 1,083 questions spanning six diverse reasoning types with symbolic depth and multi-hop demands and 2) a modular Reasoning Trace Evaluation Pipeline (RTEP) for assessing reasoning quality beyond accuracy through metrics like relevance, consistency, and structured error annotations. Empirical results show that MLLMs-T overall outperform non-thinking counterparts, but even top models like Claude-3.7-Sonnet and Gemini-2.5 Pro suffer from reasoning pathologies such as inconsistency and overthinking. This benchmark reveals persistent gaps between accuracy and reasoning quality and provides an actionable evaluation pipeline for future model development. Overall, the MMMR offers a scalable foundation for evaluating, comparing, and improving the next generation of multi-modal reasoning systems.

Medical reasoning in large language models (LLMs) aims to emulate clinicians' diagnostic thinking, but current benchmarks such as MedQA-USMLE, MedMCQA, and PubMedQA often mix reasoning with factual recall. We address this by separating 11 biomedical QA benchmarks into reasoning- and knowledge-focused subsets using a PubMedBERT classifier that reaches 81 percent accuracy, comparable to human performance. Our analysis shows that only 32.8 percent of questions require complex reasoning. We evaluate biomedical models (HuatuoGPT-o1, MedReason, m1) and general-domain models (DeepSeek-R1, o4-mini, Qwen3), finding consistent gaps between knowledge and reasoning performance. For example, m1 scores 60.5 on knowledge but only 47.1 on reasoning. In adversarial tests where models are misled with incorrect initial reasoning, biomedical models degrade sharply, while larger or RL-trained general models show more robustness. To address this, we train BioMed-R1 using fine-tuning and reinforcement learning on reasoning-heavy examples. It achieves the strongest performance among similarly sized models. Further gains may come from incorporating clinical case reports and training with adversarial and backtracking scenarios.

While large language models (LLMs) are still being adopted to new domains and utilized in novel applications, we are experiencing an influx of the new generation of foundation models, namely multi-modal large language models (MLLMs). These models integrate verbal and visual information, opening new possibilities to demonstrate more complex reasoning abilities at the intersection of the two modalities. However, despite the revolutionizing prospect of MLLMs, our understanding of their reasoning abilities is limited. In this study, we assess the nonverbal abstract reasoning abilities of open-source and closed-source MLLMs using variations of Raven's Progressive Matrices. Our experiments expose the difficulty of solving such problems while showcasing the immense gap between open-source and closed-source models. We also reveal critical shortcomings with individual visual and textual modules, subjecting the models to low-performance ceilings. Finally, to improve MLLMs' performance, we experiment with various methods, such as Chain-of-Thought prompting, resulting in a significant (up to 100%) boost in performance.

There is a growing interest in Universal Multimodal Embeddings (UME), where models are required to generate task-specific representations. While recent studies show that Multimodal Large Language Models (MLLMs) perform well on such tasks, they treat MLLMs solely as encoders, overlooking their generative capacity. However, such an encoding paradigm becomes less effective as instructions become more complex and require compositional reasoning. Inspired by the proven effectiveness of chain-of-thought reasoning, we propose a general Think-Then-Embed (TTE) framework for UME, composed of a reasoner and an embedder. The reasoner MLLM first generates reasoning traces that explain complex queries, followed by an embedder that produces representations conditioned on both the original query and the intermediate reasoning. This explicit reasoning step enables more nuanced understanding of complex multimodal instructions. Our contributions are threefold. First, by leveraging a powerful MLLM reasoner, we achieve state-of-the-art performance on the MMEB-V2 benchmark, surpassing proprietary models trained on massive in-house datasets. Second, to reduce the dependency on large MLLM reasoners, we finetune a smaller MLLM reasoner using high-quality embedding-centric reasoning traces, achieving the best performance among open-source models with a 7% absolute gain over recently proposed models. Third, we investigate strategies for integrating the reasoner and embedder into a unified model for improved efficiency without sacrificing performance.

Large Language Models (LLMs) and Multimodal Large Language Models (MLLMs) have made significant advancements in reasoning capabilities. However, they still face challenges such as high computational demands and privacy concerns. This paper focuses on developing efficient Small Language Models (SLMs) and Multimodal Small Language Models (MSLMs) that retain competitive reasoning abilities. We introduce a novel training pipeline that enhances reasoning capabilities and facilitates deployment on edge devices, achieving state-of-the-art performance while minimizing development costs. \InfR~ aims to advance AI systems by improving reasoning, reducing adoption barriers, and addressing privacy concerns through smaller model sizes. Resources are available at https://github. com/Reallm-Labs/InfiR.

Large Reasoning Models (LRMs) have introduced a new paradigm in AI by enabling models to ``think before responding" via chain-of-thought reasoning. However, the absence of open and reproducible recipes for building reasoning-centric medical LMMs hinders community-wide research, analysis, and comparison. In this paper, we present MedVLThinker, a suite of simple yet strong baselines. Our fully open recipe consists of: (1) systematic data curation for both text-only and image-text medical data, filtered according to varying levels of reasoning difficulty, and (2) two training paradigms: Supervised Fine-Tuning (SFT) on distilled reasoning traces and Reinforcement Learning with Verifiable Rewards (RLVR) based on final answer correctness. Across extensive experiments on the Qwen2.5-VL model family (3B, 7B) and six medical QA benchmarks, we find that RLVR consistently and significantly outperforms SFT. Additionally, under the RLVR framework, a key, counter-intuitive finding is that training on our curated text-only reasoning data provides a more substantial performance boost than training on multimodal image-text data. Our best open 7B model, trained using the RLVR recipe on text-only data, establishes a new state-of-the-art on existing public VQA benchmarks, surpassing all previous open-source medical LMMs. Furthermore, scaling our model to 32B achieves performance on par with the proprietary GPT-4o. We release all curated data, models, and code to provide the community with a strong, open foundation for future research in multimodal medical reasoning.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

Large language models (LLMs) and multimodal large language models (MLLMs) have significantly advanced artificial intelligence. However, visual reasoning, reasoning involving both visual and textual inputs, remains underexplored. Recent advancements, including the reasoning models like OpenAI o1 and Gemini 2.0 Flash Thinking, which incorporate image inputs, have opened this capability. In this ongoing work, we focus specifically on photography-related tasks because a photo is a visual snapshot of the physical world where the underlying physics (i.e., illumination, blur extent, etc.) interplay with the camera parameters. Successfully reasoning from the visual information of a photo to identify these numerical camera settings requires the MLLMs to have a deeper understanding of the underlying physics for precise visual comprehension, representing a challenging and intelligent capability essential for practical applications like photography assistant agents. We aim to evaluate MLLMs on their ability to distinguish visual differences related to numerical camera settings, extending a methodology previously proposed for vision-language models (VLMs). Our preliminary results demonstrate the importance of visual reasoning in photography-related tasks. Moreover, these results show that no single MLLM consistently dominates across all evaluation tasks, demonstrating ongoing challenges and opportunities in developing MLLMs with better visual reasoning.

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

Large Language Models (LLMs) have attained human-level accuracy on medical question-answer (QA) benchmarks. However, their limitations in navigating open-ended clinical scenarios have recently been shown, raising concerns about the robustness and generalizability of LLM reasoning across diverse, real-world medical tasks. To probe potential LLM failure modes in clinical problem-solving, we present the medical abstraction and reasoning corpus (M-ARC). M-ARC assesses clinical reasoning through scenarios designed to exploit the Einstellung effect -- the fixation of thought arising from prior experience, targeting LLM inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning. We find that LLMs, including current state-of-the-art o1 and Gemini models, perform poorly compared to physicians on M-ARC, often demonstrating lack of commonsense medical reasoning and a propensity to hallucinate. In addition, uncertainty estimation analyses indicate that LLMs exhibit overconfidence in their answers, despite their limited accuracy. The failure modes revealed by M-ARC in LLM medical reasoning underscore the need to exercise caution when deploying these models in clinical settings.

Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs to predict free-form answers as a generative task to solve medical visual question answering (Med-VQA) tasks. In this paper, we propose a parameter efficient framework for fine-tuning MLLM specifically tailored to Med-VQA applications, and empirically validate it on a public benchmark dataset. To accurately measure the performance, we employ human evaluation and the results reveal that our model achieves an overall accuracy of 81.9%, and outperforms the GPT-4v model by a significant margin of 26% absolute accuracy on closed-ended questions. The code will be available here: https://github.com/jinlHe/PeFoMed.

Recent advancements in large language models (LLMs) have shown promise in medical applications such as disease diagnosis and treatment planning. However, most existing medical LLMs struggle with the advanced reasoning required for complex clinical scenarios, such as differential diagnosis or personalized treatment suggestions. We proposed FineMedLM-o1, which leverages high-quality synthetic medical data and long-form reasoning data for Supervised Fine-Tuning (SFT) and Direct Preference Optimization (DPO), enabling advanced dialogue and deep reasoning capabilities. Additionally, we introduced Test-Time Training (TTT) in the medical domain for the first time, facilitating domain adaptation and ensuring reliable, accurate reasoning. Experimental results demonstrate that FineMedLM-o1 achieves a 23% average performance improvement over prior models on key medical benchmarks. Furthermore, the introduction of TTT provides an additional 14% performance boost, highlighting its effectiveness in enhancing medical reasoning capabilities. To support this process, we also proposed a novel method for synthesizing medical dialogue. Compared to other open-source datasets, our dataset stands out as superior in both quality and complexity. The project and data will be released on GitHub.

In recent years, Multimodal Large Language Models (MLLM) have achieved notable advancements, demonstrating the feasibility of developing an intelligent biomedical assistant. However, current biomedical MLLMs predominantly focus on image-level understanding and restrict interactions to textual commands, thus limiting their capability boundaries and the flexibility of usage. In this paper, we introduce a novel end-to-end multimodal large language model for the biomedical domain, named MedPLIB, which possesses pixel-level understanding. Excitingly, it supports visual question answering (VQA), arbitrary pixel-level prompts (points, bounding boxes, and free-form shapes), and pixel-level grounding. We propose a novel Mixture-of-Experts (MoE) multi-stage training strategy, which divides MoE into separate training phases for a visual-language expert model and a pixel-grounding expert model, followed by fine-tuning using MoE. This strategy effectively coordinates multitask learning while maintaining the computational cost at inference equivalent to that of a single expert model. To advance the research of biomedical MLLMs, we introduce the Medical Complex Vision Question Answering Dataset (MeCoVQA), which comprises an array of 8 modalities for complex medical imaging question answering and image region understanding. Experimental results indicate that MedPLIB has achieved state-of-the-art outcomes across multiple medical visual language tasks. More importantly, in zero-shot evaluations for the pixel grounding task, MedPLIB leads the best small and large models by margins of 19.7 and 15.6 respectively on the mDice metric. The codes, data, and model checkpoints will be made publicly available at https://github.com/ShawnHuang497/MedPLIB.

Multimodal large language models (MLLMs) that integrate visual and textual reasoning leverage chain-of-thought (CoT) prompting to tackle complex visual tasks, yet continue to exhibit visual hallucinations and an over-reliance on textual priors. We present a systematic diagnosis of state-of-the-art vision-language models using a three-stage evaluation framework, uncovering key failure modes. To address these, we propose an agent-based architecture that combines LLM reasoning with lightweight visual modules, enabling fine-grained analysis and iterative refinement of reasoning chains. Our results highlight future visual reasoning models should focus on integrating a broader set of specialized tools for analyzing visual content. Our system achieves significant gains (+10.3 on MMMU, +6.0 on MathVista over a 7B baseline), matching or surpassing much larger models. We will release our framework and evaluation suite to facilitate future research.

Recent advancements in large language models (LLMs) have demonstrated substantial progress in reasoning capabilities, such as DeepSeek-R1, which leverages rule-based reinforcement learning to enhance logical reasoning significantly. However, extending these achievements to multimodal large language models (MLLMs) presents critical challenges, which are frequently more pronounced for Multimodal Small Language Models (MSLMs) given their typically weaker foundational reasoning abilities: (1) the scarcity of high-quality multimodal reasoning datasets, (2) the degradation of reasoning capabilities due to the integration of visual processing, and (3) the risk that direct application of reinforcement learning may produce complex yet incorrect reasoning processes. To address these challenges, we design a novel framework Infi-MMR to systematically unlock the reasoning potential of MSLMs through a curriculum of three carefully structured phases and propose our multimodal reasoning model Infi-MMR-3B. The first phase, Foundational Reasoning Activation, leverages high-quality textual reasoning datasets to activate and strengthen the model's logical reasoning capabilities. The second phase, Cross-Modal Reasoning Adaptation, utilizes caption-augmented multimodal data to facilitate the progressive transfer of reasoning skills to multimodal contexts. The third phase, Multimodal Reasoning Enhancement, employs curated, caption-free multimodal data to mitigate linguistic biases and promote robust cross-modal reasoning. Infi-MMR-3B achieves both state-of-the-art multimodal math reasoning ability (43.68% on MathVerse testmini, 27.04% on MathVision test, and 21.33% on OlympiadBench) and general reasoning ability (67.2% on MathVista testmini). Resources are available at https://huggingface.co/Reallm-Labs/Infi-MMR-3B.

Recently, reasoning-based MLLMs have achieved a degree of success in generating long-form textual reasoning chains. However, they still struggle with complex tasks that necessitate dynamic and iterative focusing on and revisiting of visual regions to achieve precise grounding of textual reasoning in visual evidence. We introduce VLM-R^3 (Visual Language Model with Region Recognition and Reasoning), a framework that equips an MLLM with the ability to (i) decide when additional visual evidence is needed, (ii) determine where to ground within the image, and (iii) seamlessly weave the relevant sub-image content back into an interleaved chain-of-thought. The core of our method is Region-Conditioned Reinforcement Policy Optimization (R-GRPO), a training paradigm that rewards the model for selecting informative regions, formulating appropriate transformations (e.g.\ crop, zoom), and integrating the resulting visual context into subsequent reasoning steps. To bootstrap this policy, we compile a modest but carefully curated Visuo-Lingual Interleaved Rationale (VLIR) corpus that provides step-level supervision on region selection and textual justification. Extensive experiments on MathVista, ScienceQA, and other benchmarks show that VLM-R^3 sets a new state of the art in zero-shot and few-shot settings, with the largest gains appearing on questions demanding subtle spatial reasoning or fine-grained visual cue extraction.

Medical tasks such as diagnosis and treatment planning require precise and complex reasoning, particularly in life-critical domains. Unlike mathematical reasoning, medical reasoning demands meticulous, verifiable thought processes to ensure reliability and accuracy. However, there is a notable lack of datasets that provide transparent, step-by-step reasoning to validate and enhance the medical reasoning ability of AI models. To bridge this gap, we introduce MedReason, a large-scale high-quality medical reasoning dataset designed to enable faithful and explainable medical problem-solving in large language models (LLMs). We utilize a structured medical knowledge graph (KG) to convert clinical QA pairs into logical chains of reasoning, or ``thinking paths'', which trace connections from question elements to answers via relevant KG entities. Each path is validated for consistency with clinical logic and evidence-based medicine. Our pipeline generates detailed reasoning for various medical questions from 7 medical datasets, resulting in a dataset of 32,682 question-answer pairs, each with detailed, step-by-step explanations. Experiments demonstrate that fine-tuning with our dataset consistently boosts medical problem-solving capabilities, achieving significant gains of up to 7.7% for DeepSeek-Ditill-8B. Our top-performing model, MedReason-8B, outperforms the Huatuo-o1-8B, a state-of-the-art medical reasoning model, by up to 4.2% on the clinical benchmark MedBullets. We also engage medical professionals from diverse specialties to assess our dataset's quality, ensuring MedReason offers accurate and coherent medical reasoning. Our data, models, and code will be publicly available.

Large Language Models (LLMs) are highly proficient in language-based tasks. Their language capabilities have positioned them at the forefront of the future AGI (Artificial General Intelligence) race. However, on closer inspection, Valmeekam et al. (2024); Zecevic et al. (2023); Wu et al. (2024) highlight a significant gap between their language proficiency and reasoning abilities. Reasoning in LLMs and Vision Language Models (VLMs) aims to bridge this gap by enabling these models to think and re-evaluate their actions and responses. Reasoning is an essential capability for complex problem-solving and a necessary step toward establishing trust in Artificial Intelligence (AI). This will make AI suitable for deployment in sensitive domains, such as healthcare, banking, law, defense, security etc. In recent times, with the advent of powerful reasoning models like OpenAI O1 and DeepSeek R1, reasoning endowment has become a critical research topic in LLMs. In this paper, we provide a detailed overview and comparison of existing reasoning techniques and present a systematic survey of reasoning-imbued language models. We also study current challenges and present our findings.

Multimodal large language models (MLLMs) have recently achieved significant progress in visual tasks, including semantic scene understanding and text-image alignment, with reasoning variants enhancing performance on complex tasks involving mathematics and logic. However, their capacity for reasoning tasks involving fine-grained visual understanding remains insufficiently evaluated. To address this gap, we introduce ReasonMap, a benchmark designed to assess the fine-grained visual understanding and spatial reasoning abilities of MLLMs. ReasonMap encompasses high-resolution transit maps from 30 cities across 13 countries and includes 1,008 question-answer pairs spanning two question types and three templates. Furthermore, we design a two-level evaluation pipeline that properly assesses answer correctness and quality. Comprehensive evaluations of 15 popular MLLMs, including both base and reasoning variants, reveal a counterintuitive pattern: among open-source models, base models outperform reasoning ones, while the opposite trend is observed in closed-source models. Additionally, performance generally degrades when visual inputs are masked, indicating that while MLLMs can leverage prior knowledge to answer some questions, fine-grained visual reasoning tasks still require genuine visual perception for strong performance. Our benchmark study offers new insights into visual reasoning and contributes to investigating the gap between open-source and closed-source models.

DeepSeek-R1-Zero has successfully demonstrated the emergence of reasoning capabilities in LLMs purely through Reinforcement Learning (RL). Inspired by this breakthrough, we explore how RL can be utilized to enhance the reasoning capability of MLLMs. However, direct training with RL struggles to activate complex reasoning capabilities such as questioning and reflection in MLLMs, due to the absence of substantial high-quality multimodal reasoning data. To address this issue, we propose the reasoning MLLM, Vision-R1, to improve multimodal reasoning capability. Specifically, we first construct a high-quality multimodal CoT dataset without human annotations by leveraging an existing MLLM and DeepSeek-R1 through modality bridging and data filtering to obtain a 200K multimodal CoT dataset, Vision-R1-cold dataset. It serves as cold-start initialization data for Vision-R1. To mitigate the optimization challenges caused by overthinking after cold start, we propose Progressive Thinking Suppression Training (PTST) strategy and employ Group Relative Policy Optimization (GRPO) with the hard formatting result reward function to gradually refine the model's ability to learn correct and complex reasoning processes on a 10K multimodal math dataset. Comprehensive experiments show our model achieves an average improvement of sim6% across various multimodal math reasoning benchmarks. Vision-R1-7B achieves a 73.5% accuracy on the widely used MathVista benchmark, which is only 0.4% lower than the leading reasoning model, OpenAI O1. The datasets and code will be released in: https://github.com/Osilly/Vision-R1 .

Solving complex chart Q&A tasks requires advanced visual reasoning abilities in multimodal large language models (MLLMs). Recent studies highlight that these abilities consist of two main parts: recognizing key information from visual inputs and conducting reasoning over it. Thus, a promising approach to enhance MLLMs is to construct relevant training data focusing on the two aspects. However, collecting and annotating complex charts and questions is costly and time-consuming, and ensuring the quality of annotated answers remains a challenge. In this paper, we propose Code-as-Intermediary Translation (CIT), a cost-effective, efficient and easily scalable data synthesis method for distilling visual reasoning abilities from LLMs to MLLMs. The code serves as an intermediary that translates visual chart representations into textual representations, enabling LLMs to understand cross-modal information. Specifically, we employ text-based synthesizing techniques to construct chart-plotting code and produce ReachQA, a dataset containing 3k reasoning-intensive charts and 20k Q&A pairs to enhance both recognition and reasoning abilities. Experiments show that when fine-tuned with our data, models not only perform well on chart-related benchmarks, but also demonstrate improved multimodal reasoning abilities on general mathematical benchmarks like MathVista. The code and dataset are publicly available at https://github.com/hewei2001/ReachQA.

The breakthrough of OpenAI o1 highlights the potential of enhancing reasoning to improve LLM. Yet, most research in reasoning has focused on mathematical tasks, leaving domains like medicine underexplored. The medical domain, though distinct from mathematics, also demands robust reasoning to provide reliable answers, given the high standards of healthcare. However, verifying medical reasoning is challenging, unlike those in mathematics. To address this, we propose verifiable medical problems with a medical verifier to check the correctness of model outputs. This verifiable nature enables advancements in medical reasoning through a two-stage approach: (1) using the verifier to guide the search for a complex reasoning trajectory for fine-tuning LLMs, (2) applying reinforcement learning (RL) with verifier-based rewards to enhance complex reasoning further. Finally, we introduce HuatuoGPT-o1, a medical LLM capable of complex reasoning, which outperforms general and medical-specific baselines using only 40K verifiable problems. Experiments show complex reasoning improves medical problem-solving and benefits more from RL. We hope our approach inspires advancements in reasoning across medical and other specialized domains.

Multimodal Large Language Models (MLLMs) have achieved significant advances in integrating visual and linguistic information, yet their ability to reason about complex and real-world scenarios remains limited. The existing benchmarks are usually constructed in the task-oriented manner without guarantee that different task samples come from the same data distribution, thus they often fall short in evaluating the synergistic effects of lower-level perceptual capabilities on higher-order reasoning. To lift this limitation, we contribute Lens, a multi-level benchmark with 3.4K contemporary images and 60K+ human-authored questions covering eight tasks and 12 daily scenarios, forming three progressive task tiers, i.e., perception, understanding, and reasoning. One feature is that each image is equipped with rich annotations for all tasks. Thus, this dataset intrinsically supports to evaluate MLLMs to handle image-invariable prompts, from basic perception to compositional reasoning. In addition, our images are manully collected from the social media, in which 53% were published later than Jan. 2025. We evaluate 15+ frontier MLLMs such as Qwen2.5-VL-72B, InternVL3-78B, GPT-4o and two reasoning models QVQ-72B-preview and Kimi-VL. These models are released later than Dec. 2024, and none of them achieve an accuracy greater than 60% in the reasoning tasks. Project page: https://github.com/Lens4MLLMs/lens. ICCV 2025 workshop page: https://lens4mllms.github.io/mars2-workshop-iccv2025/

Recent advancements in multimodal large language models (MLLMs) have demonstrated exceptional performance in multimodal perception and understanding. However, leading open-source MLLMs exhibit significant limitations in complex and structured reasoning, particularly in tasks requiring deep reasoning for decision-making and problem-solving. In this work, we present Corvid, an MLLM with enhanced chain-of-thought (CoT) reasoning capabilities. Architecturally, Corvid incorporates a hybrid vision encoder for informative visual representation and a meticulously designed connector (GateMixer) to facilitate cross-modal alignment. To enhance Corvid's CoT reasoning capabilities, we introduce MCoT-Instruct-287K, a high-quality multimodal CoT instruction-following dataset, refined and standardized from diverse public reasoning sources. Leveraging this dataset, we fine-tune Corvid with a two-stage CoT-formatted training approach to progressively enhance its step-by-step reasoning abilities. Furthermore, we propose an effective inference-time scaling strategy that enables Corvid to mitigate over-reasoning and under-reasoning through self-verification. Extensive experiments demonstrate that Corvid outperforms existing o1-like MLLMs and state-of-the-art MLLMs with similar parameter scales, with notable strengths in mathematical reasoning and science problem-solving. Project page: https://mm-vl.github.io/corvid.

Recent advancements in Multimodal Large Language Models (MLLMs), particularly through Reinforcement Learning with Verifiable Rewards (RLVR), have significantly enhanced their reasoning abilities. However, a critical gap persists: these models struggle with dynamic spatial interactions, a capability essential for real-world applications. To bridge this gap, we introduce M2-Reasoning-7B, a model designed to excel in both general and spatial reasoning. Our approach integrates two key innovations: (1) a novel data pipeline that generates 294.2K high-quality data samples (168K for cold-start fine-tuning and 126.2K for RLVR), which feature logically coherent reasoning trajectories and have undergone comprehensive assessment; and (2) a dynamic multi-task training strategy with step-wise optimization to mitigate conflicts between data, and task-specific rewards for delivering tailored incentive signals. This combination of curated data and advanced training allows M2-Reasoning-7B to set a new state-of-the-art (SOTA) across 8 benchmarks, showcasing superior performance in both general and spatial reasoning domains.

Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Multimodal large language models (MLLMs) have shown remarkable potential in various domains, yet their application in the medical field is hindered by several challenges. General-purpose MLLMs often lack the specialized knowledge required for medical tasks, leading to uncertain or hallucinatory responses. Knowledge distillation from advanced models struggles to capture domain-specific expertise in radiology and pharmacology. Additionally, the computational cost of continual pretraining with large-scale medical data poses significant efficiency challenges. To address these issues, we propose InfiMed-Foundation-1.7B and InfiMed-Foundation-4B, two medical-specific MLLMs designed to deliver state-of-the-art performance in medical applications. We combined high-quality general-purpose and medical multimodal data and proposed a novel five-dimensional quality assessment framework to curate high-quality multimodal medical datasets. We employ low-to-high image resolution and multimodal sequence packing to enhance training efficiency, enabling the integration of extensive medical data. Furthermore, a three-stage supervised fine-tuning process ensures effective knowledge extraction for complex medical tasks. Evaluated on the MedEvalKit framework, InfiMed-Foundation-1.7B outperforms Qwen2.5VL-3B, while InfiMed-Foundation-4B surpasses HuatuoGPT-V-7B and MedGemma-27B-IT, demonstrating superior performance in medical visual question answering and diagnostic tasks. By addressing key challenges in data quality, training efficiency, and domain-specific knowledge extraction, our work paves the way for more reliable and effective AI-driven solutions in healthcare. InfiMed-Foundation-4B model is available at https://huggingface.co/InfiX-ai/InfiMed-Foundation-4B{InfiMed-Foundation-4B}.

Recent advances in Reasoning LLMs (e.g., DeepSeek-R1 and OpenAI-o1) have showcased impressive reasoning capabilities via reinforcement learning. However, extending these capabilities to Multimodal LLMs (MLLMs) is hampered by the prohibitive costs of retraining and the scarcity of high-quality, verifiable multimodal reasoning datasets. This paper introduces FRANK Model, a training-FRee ANd r1-liKe MLLM that imbues off-the-shelf MLLMs with reasoning and reflection abilities, without any gradient updates or extra supervision. Our key insight is to decouple perception and reasoning across MLLM decoder layers. Specifically, we observe that compared to the deeper decoder layers, the shallow decoder layers allocate more attention to visual tokens, while the deeper decoder layers concentrate on textual semantics. This observation motivates a hierarchical weight merging approach that combines a visual-pretrained MLLM with a reasoning-specialized LLM. To this end, we propose a layer-wise, Taylor-derived closed-form fusion mechanism that integrates reasoning capacity into deep decoder layers while preserving visual grounding in shallow decoder layers. Extensive experiments on challenging multimodal reasoning benchmarks demonstrate the effectiveness of our approach. On the MMMU benchmark, our model FRANK-38B achieves an accuracy of 69.2, outperforming the strongest baseline InternVL2.5-38B by +5.3, and even surpasses the proprietary GPT-4o model. Our project homepage is at: http://iip.whu.edu.cn/frank/index.html

Multimodal Large Language Model (MLLM) recently has been a new rising research hotspot, which uses powerful Large Language Models (LLMs) as a brain to perform multimodal tasks. The surprising emergent capabilities of MLLM, such as writing stories based on images and OCR-free math reasoning, are rare in traditional methods, suggesting a potential path to artificial general intelligence. In this paper, we aim to trace and summarize the recent progress of MLLM. First of all, we present the formulation of MLLM and delineate its related concepts. Then, we discuss the key techniques and applications, including Multimodal Instruction Tuning (M-IT), Multimodal In-Context Learning (M-ICL), Multimodal Chain of Thought (M-CoT), and LLM-Aided Visual Reasoning (LAVR). Finally, we discuss existing challenges and point out promising research directions. In light of the fact that the era of MLLM has only just begun, we will keep updating this survey and hope it can inspire more research. An associated GitHub link collecting the latest papers is available at https://github.com/BradyFU/Awesome-Multimodal-Large-Language-Models.

In this work, we aim to develop an MLLM that understands and solves questions by learning to create each intermediate step of the reasoning involved till the final answer. To this end, we propose Collective Monte Carlo Tree Search (CoMCTS), a new learning-to-reason method for MLLMs, which introduces the concept of collective learning into ``tree search'' for effective and efficient reasoning-path searching and learning. The core idea of CoMCTS is to leverage collective knowledge from multiple models to collaboratively conjecture, search and identify effective reasoning paths toward correct answers via four iterative operations including Expansion, Simulation and Error Positioning, Backpropagation, and Selection. Using CoMCTS, we construct Mulberry-260k, a multimodal dataset with a tree of rich, explicit and well-defined reasoning nodes for each question. With Mulberry-260k, we perform collective SFT to train our model, Mulberry, a series of MLLMs with o1-like step-by-step Reasoning and Reflection capabilities. Extensive experiments demonstrate the superiority of our proposed methods on various benchmarks. Code will be available at https://github.com/HJYao00/Mulberry

Pre-trained on extensive text and image corpora, current Multi-Modal Large Language Models (MLLM) have shown strong capabilities in general visual reasoning tasks. However, their performance is still lacking in physical domains that require understanding diagrams with complex physical structures and quantitative analysis based on multi-modal information. To address this, we develop a new framework, named Multi-Modal Scientific Reasoning with Physics Perception and Simulation (MAPS) based on an MLLM. MAPS decomposes expert-level multi-modal reasoning task into physical diagram understanding via a Physical Perception Model (PPM) and reasoning with physical knowledge via a simulator. The PPM module is obtained by fine-tuning a visual language model using carefully designed synthetic data with paired physical diagrams and corresponding simulation language descriptions. At the inference stage, MAPS integrates the simulation language description of the input diagram provided by PPM and results obtained through a Chain-of-Simulation process with MLLM to derive the underlying rationale and the final answer. Validated using our collected college-level circuit analysis problems, MAPS significantly improves reasoning accuracy of MLLM and outperforms all existing models. The results confirm MAPS offers a promising direction for enhancing multi-modal scientific reasoning ability of MLLMs. We will release our code, model and dataset used for our experiments upon publishing of this paper.

With the rapid development of MLLMs, evaluating their visual capabilities has become increasingly crucial. Current benchmarks primarily fall into two main types: basic perception benchmarks, which focus on local details but lack deep reasoning (e.g., "what is in the image?"), and mainstream reasoning benchmarks, which concentrate on prominent image elements but may fail to assess subtle clues requiring intricate analysis. However, profound visual understanding and complex reasoning depend more on interpreting subtle, inconspicuous local details than on perceiving salient, macro-level objects. These details, though occupying minimal image area, often contain richer, more critical information for robust analysis. To bridge this gap, we introduce the VER-Bench, a novel framework to evaluate MLLMs' ability to: 1) identify fine-grained visual clues, often occupying on average just 0.25% of the image area; 2) integrate these clues with world knowledge for complex reasoning. Comprising 374 carefully designed questions across Geospatial, Temporal, Situational, Intent, System State, and Symbolic reasoning, each question in VER-Bench is accompanied by structured evidence: visual clues and question-related reasoning derived from them. VER-Bench reveals current models' limitations in extracting subtle visual evidence and constructing evidence-based arguments, highlighting the need to enhance models's capabilities in fine-grained visual evidence extraction, integration, and reasoning for genuine visual understanding and human-like analysis. Dataset and additional materials are available https://github.com/verbta/ACMMM-25-Materials.

Multimodal Large Language Models (MLLMs) excel in solving text-based mathematical problems, but they struggle with mathematical diagrams since they are primarily trained on natural scene images. For humans, visual aids generally enhance problem-solving, but MLLMs perform worse as information shifts from textual to visual modality. This decline is mainly due to their shortcomings in aligning images and text. To tackle aforementioned challenges, we propose Math-PUMA, a methodology focused on Progressive Upward Multimodal Alignment. This approach is designed to improve the mathematical reasoning skills of MLLMs through a three-stage training process, with the second stage being the critical alignment stage. We first enhance the language model's mathematical reasoning capabilities with extensive set of textual mathematical problems. We then construct a multimodal dataset with varying degrees of textual and visual information, creating data pairs by presenting each problem in at least two forms. By leveraging the Kullback-Leibler (KL) divergence of next-token prediction distributions to align visual and textual modalities, consistent problem-solving abilities are ensured. Finally, we utilize multimodal instruction tuning for MLLMs with high-quality multimodal data. Experimental results on multiple mathematical reasoning benchmarks demonstrate that the MLLMs trained with Math-PUMA surpass most open-source MLLMs. Our approach effectively narrows the performance gap for problems presented in different modalities. The code and data are available at: https://github.com/wwzhuang01/Math-PUMA.

Precise spatial modeling in the operating room (OR) is foundational to many clinical tasks, supporting intraoperative awareness, hazard avoidance, and surgical decision-making. While existing approaches leverage large-scale multimodal datasets for latent-space alignment to implicitly learn spatial relationships, they overlook the 3D capabilities of MLLMs. However, this approach raises two issues: (1) Operating rooms typically lack multiple video and audio sensors, making multimodal 3D data difficult to obtain; (2) Training solely on readily available 2D data fails to capture fine-grained details in complex scenes. To address this gap, we introduce Spatial-ORMLLM, the first large vision-language model for 3D spatial reasoning in operating rooms using only RGB modality to infer volumetric and semantic cues, enabling downstream medical tasks with detailed and holistic spatial context. Spatial-ORMLLM incorporates a Spatial-Enhanced Feature Fusion Block, which integrates 2D modality inputs with rich 3D spatial knowledge extracted by the estimation algorithm and then feeds the combined features into the visual tower. By employing a unified end-to-end MLLM framework, it combines powerful spatial features with textual features to deliver robust 3D scene reasoning without any additional expert annotations or sensor inputs. Experiments on multiple benchmark clinical datasets demonstrate that Spatial-ORMLLM achieves state-of-the-art performance and generalizes robustly to previously unseen surgical scenarios and downstream tasks.

Multimodal Large Language Models (MLLMs) have demonstrated impressive performance in general vision-language tasks. However, recent studies have exposed critical limitations in their spatial reasoning capabilities. This deficiency in spatial reasoning significantly constrains MLLMs' ability to interact effectively with the physical world, thereby limiting their broader applications. We argue that spatial reasoning capabilities will not naturally emerge from merely scaling existing architectures and training methodologies. Instead, this challenge demands dedicated attention to fundamental modifications in the current MLLM development approach. In this position paper, we first establish a comprehensive framework for spatial reasoning within the context of MLLMs. We then elaborate on its pivotal role in real-world applications. Through systematic analysis, we examine how individual components of the current methodology, from training data to reasoning mechanisms, influence spatial reasoning capabilities. This examination reveals critical limitations while simultaneously identifying promising avenues for advancement. Our work aims to direct the AI research community's attention toward these crucial yet underexplored aspects. By highlighting these challenges and opportunities, we seek to catalyze progress toward achieving human-like spatial reasoning capabilities in MLLMs.

Open-source multimodal large language models (MLLMs) excel in various tasks involving textual and visual inputs but still struggle with complex multimodal mathematical reasoning, lagging behind proprietary models like GPT-4V(ision) and Gemini-Pro. Although fine-tuning with intermediate steps (i.e., rationales) elicits some mathematical reasoning skills, the resulting models still fall short in visual comprehension due to inadequate visual-centric supervision, which leads to inaccurate interpretation of math figures. To address this issue, we propose a two-step training pipeline VCAR, which emphasizes the Visual Comprehension training in Addition to mathematical Reasoning learning. It first improves the visual comprehension ability of MLLMs through the visual description generation task, followed by another training step on generating rationales with the assistance of descriptions. Experimental results on two popular benchmarks demonstrate that VCAR substantially outperforms baseline methods solely relying on rationale supervision, especially on problems with high visual demands.

Medical Visual Language Models have shown great potential in various healthcare applications, including medical image captioning and diagnostic assistance. However, most existing models rely on text-based instructions, limiting their usability in real-world clinical environments especially in scenarios such as surgery, text-based interaction is often impractical for physicians. In addition, current medical image analysis models typically lack comprehensive reasoning behind their predictions, which reduces their reliability for clinical decision-making. Given that medical diagnosis errors can have life-changing consequences, there is a critical need for interpretable and rational medical assistance. To address these challenges, we introduce an end-to-end speech-driven medical VLM, SilVar-Med, a multimodal medical image assistant that integrates speech interaction with VLMs, pioneering the task of voice-based communication for medical image analysis. In addition, we focus on the interpretation of the reasoning behind each prediction of medical abnormalities with a proposed reasoning dataset. Through extensive experiments, we demonstrate a proof-of-concept study for reasoning-driven medical image interpretation with end-to-end speech interaction. We believe this work will advance the field of medical AI by fostering more transparent, interactive, and clinically viable diagnostic support systems. Our code and dataset are publicly available at SiVar-Med.

Multimodal large language models (MLLMs) hold significant potential in the medical field, but their capabilities are often limited by insufficient data in certain medical domains, highlighting the need for understanding what kinds of images can be used by MLLMs for generalization. Current research suggests that multi-task training outperforms single-task as different tasks can benefit each other, but they often overlook the internal relationships within these tasks, providing limited guidance on selecting datasets to enhance specific tasks. To analyze this phenomenon, we attempted to employ compositional generalization (CG)-the ability of models to understand novel combinations by recombining learned elements-as a guiding framework. Since medical images can be precisely defined by Modality, Anatomical area, and Task, naturally providing an environment for exploring CG. Therefore, we assembled 106 medical datasets to create Med-MAT for comprehensive experiments. The experiments confirmed that MLLMs can use CG to understand unseen medical images and identified CG as one of the main drivers of the generalization observed in multi-task training. Additionally, further studies demonstrated that CG effectively supports datasets with limited data and delivers consistent performance across different backbones, highlighting its versatility and broad applicability. Med-MAT is publicly available at https://github.com/FreedomIntelligence/Med-MAT.

Multimodal Large Language Models (MLLMs) have demonstrated remarkable capabilities in visual mathematical reasoning across various existing benchmarks. However, these benchmarks are predominantly based on clean or processed multimodal inputs, without incorporating the images provided by real-world Kindergarten through 12th grade (K-12) educational users. To address this gap, we introduce MathReal, a meticulously curated dataset comprising 2,000 mathematical questions with images captured by handheld mobile devices in authentic scenarios. Each question is an image, containing the question text and visual element. We systematically classify the real images into three primary categories: image quality degradation, perspective variation, and irrelevant content interference, which are further delineated into 14 subcategories. Additionally, MathReal spans five core knowledge and ability categories, which encompass three question types and are divided into three difficulty levels. To comprehensively evaluate the multimodal mathematical reasoning abilities of state-of-the-art MLLMs in real-world scenarios, we design six experimental settings that enable a systematic analysis of their performance. Through extensive experimentation, we find that the problem-solving abilities of existing MLLMs are significantly challenged in realistic educational contexts. Based on this, we conduct a thorough analysis of their performance and error patterns, providing insights into their recognition, comprehension, and reasoning capabilities, and outlining directions for future improvements. Data and code: https://github.com/junfeng0288/MathReal.

Endoscopic procedures are essential for diagnosing and treating internal diseases, and multi-modal large language models (MLLMs) are increasingly applied to assist in endoscopy analysis. However, current benchmarks are limited, as they typically cover specific endoscopic scenarios and a small set of clinical tasks, failing to capture the real-world diversity of endoscopic scenarios and the full range of skills needed in clinical workflows. To address these issues, we introduce EndoBench, the first comprehensive benchmark specifically designed to assess MLLMs across the full spectrum of endoscopic practice with multi-dimensional capacities. EndoBench encompasses 4 distinct endoscopic scenarios, 12 specialized clinical tasks with 12 secondary subtasks, and 5 levels of visual prompting granularities, resulting in 6,832 rigorously validated VQA pairs from 21 diverse datasets. Our multi-dimensional evaluation framework mirrors the clinical workflow--spanning anatomical recognition, lesion analysis, spatial localization, and surgical operations--to holistically gauge the perceptual and diagnostic abilities of MLLMs in realistic scenarios. We benchmark 23 state-of-the-art models, including general-purpose, medical-specialized, and proprietary MLLMs, and establish human clinician performance as a reference standard. Our extensive experiments reveal: (1) proprietary MLLMs outperform open-source and medical-specialized models overall, but still trail human experts; (2) medical-domain supervised fine-tuning substantially boosts task-specific accuracy; and (3) model performance remains sensitive to prompt format and clinical task complexity. EndoBench establishes a new standard for evaluating and advancing MLLMs in endoscopy, highlighting both progress and persistent gaps between current models and expert clinical reasoning. We publicly release our benchmark and code.

Despite their success, current training pipelines for reasoning VLMs focus on a limited range of tasks, such as mathematical and logical reasoning. As a result, these models face difficulties in generalizing their reasoning capabilities to a wide range of domains, primarily due to the scarcity of readily available and verifiable reward data beyond these narrowly defined areas. Moreover, integrating data from multiple domains is challenging, as the compatibility between domain-specific datasets remains uncertain. To address these limitations, we build a comprehensive RL-ready visual reasoning dataset from 46 data sources across 8 dimensions, covering a wide range of tasks such as infographic, mathematical, spatial, cross-image, graphic user interface, medical, common sense and general science. We propose an influence function based data selection and difficulty based filtering strategy to identify high-quality training samples from this dataset. Subsequently, we train the VLM, referred to as Vision-G1, using multi-round RL with a data curriculum to iteratively improve its visual reasoning capabilities. Our model achieves state-of-the-art performance across various visual reasoning benchmarks, outperforming similar-sized VLMs and even proprietary models like GPT-4o and Gemini-1.5 Flash. The model, code and dataset are publicly available at https://github.com/yuh-zha/Vision-G1.

Recent studies generally enhance MLLMs' reasoning capabilities via supervised fine-tuning on high-quality chain-of-thought reasoning data, which often leads models to merely imitate successful reasoning paths without understanding what the wrong reasoning paths are. In this work, we aim to enhance the MLLMs' reasoning ability beyond passively imitating positive reasoning paths. To this end, we design Step-wise Group Relative Policy Optimization (StepGRPO), a new online reinforcement learning framework that enables MLLMs to self-improve reasoning ability via simple, effective and dense step-wise rewarding. Specifically, StepGRPO introduces two novel rule-based reasoning rewards: Step-wise Reasoning Accuracy Reward (StepRAR) and Step-wise Reasoning Validity Reward (StepRVR). StepRAR rewards the reasoning paths that contain necessary intermediate reasoning steps via a soft key-step matching technique, while StepRAR rewards reasoning paths that follow a well-structured and logically consistent reasoning process through a reasoning completeness and logic evaluation strategy. With the proposed StepGRPO, we introduce R1-VL, a series of MLLMs with outstanding capabilities in step-by-step reasoning. Extensive experiments over 8 benchmarks demonstrate the superiority of our methods.

Multi-Modal Large Language Models (MLLMs), despite being successful, exhibit limited generality and often fall short when compared to specialized models. Recently, LLM-based agents have been developed to address these challenges by selecting appropriate specialized models as tools based on user inputs. However, such advancements have not been extensively explored within the medical domain. To bridge this gap, this paper introduces the first agent explicitly designed for the medical field, named Multi-modal Medical Agent (MMedAgent). We curate an instruction-tuning dataset comprising six medical tools solving seven tasks across five modalities, enabling the agent to choose the most suitable tools for a given task. Comprehensive experiments demonstrate that MMedAgent achieves superior performance across a variety of medical tasks compared to state-of-the-art open-source methods and even the closed-source model, GPT-4o. Furthermore, MMedAgent exhibits efficiency in updating and integrating new medical tools. Codes and models are all available.

Multi-modal Large Language Models (MLLMs) have shown impressive abilities in generating reasonable responses with respect to multi-modal contents. However, there is still a wide gap between the performance of recent MLLM-based applications and the expectation of the broad public, even though the most powerful OpenAI's GPT-4 and Google's Gemini have been deployed. This paper strives to enhance understanding of the gap through the lens of a qualitative study on the generalizability, trustworthiness, and causal reasoning capabilities of recent proprietary and open-source MLLMs across four modalities: ie, text, code, image, and video, ultimately aiming to improve the transparency of MLLMs. We believe these properties are several representative factors that define the reliability of MLLMs, in supporting various downstream applications. To be specific, we evaluate the closed-source GPT-4 and Gemini and 6 open-source LLMs and MLLMs. Overall we evaluate 230 manually designed cases, where the qualitative results are then summarized into 12 scores (ie, 4 modalities times 3 properties). In total, we uncover 14 empirical findings that are useful to understand the capabilities and limitations of both proprietary and open-source MLLMs, towards more reliable downstream multi-modal applications.

Current Large Language Models (LLMs) exhibit significant limitations, notably in structured, interpretable, and verifiable medical reasoning, alongside practical deployment challenges related to computational resources and data privacy. This report focused on the development of WiNGPT-3.0, the 32-billion parameter LLMs, engineered with the objective of enhancing its capacity for medical reasoning and exploring its potential for effective integration within healthcare IT infrastructures. The broader aim is to advance towards clinically applicable models. The approach involved a multi-stage training pipeline tailored for general, medical, and clinical reasoning. This pipeline incorporated supervised fine-tuning (SFT) and reinforcement learning (RL), leveraging curated Long Chain-of-Thought (CoT) datasets, auxiliary reward models, and an evidence-based diagnostic chain simulation. WiNGPT-3.0 demonstrated strong performance: specific model variants achieved scores of 66.6 on MedCalc and 87.1 on MedQA-USMLE. Furthermore, targeted training improved performance on a clinical reasoning task from a baseline score of 58.1 to 62.5. These findings suggest that reinforcement learning, even when applied with a limited dataset of only a few thousand examples, can enhance medical reasoning accuracy. Crucially, this demonstration of RL's efficacy with limited data and computation paves the way for more trustworthy and practically deployable LLMs within clinical workflows and health information infrastructures.

Multimodal large language models (MLLMs) have demonstrated remarkable capabilities in vision-language answering tasks. Despite their strengths, these models often encounter challenges in achieving complex reasoning tasks such as mathematical problem-solving. Previous works have focused on fine-tuning on specialized mathematical datasets. However, these datasets are typically distilled directly from teacher models, which capture only static reasoning patterns and leaving substantial gaps compared to student models. This reliance on fixed teacher-derived datasets not only restricts the model's ability to adapt to novel or more intricate questions that extend beyond the confines of the training data, but also lacks the iterative depth needed for robust generalization. To overcome these limitations, we propose \method, a Mathematical Self-Evolving framework for MLLMs. In contrast to traditional one-shot fine-tuning paradigms, \method iteratively refines the model through cycles of inference, reflection, and reward-based feedback. Specifically, we leverage iterative fine-tuning by incorporating correct reasoning paths derived from previous-stage inference and integrating reflections from a specialized Outcome Reward Model (ORM). To verify the effectiveness of \method, we evaluate it on a suite of challenging benchmarks, demonstrating significant performance gains over backbone models. Notably, our experimental results on MathVL-test surpass the leading open-source multimodal mathematical reasoning model QVQ. Our code and models are available at https://zheny2751\allowbreak-dotcom.github.io/\allowbreak MathSE.github.io/.

Recently, multimodal large language models (MLLMs) have achieved significant advancements across various domains, and corresponding evaluation benchmarks have been continuously refined and improved. In this process, benchmarks in the scientific domain have played an important role in assessing the reasoning capabilities of MLLMs. However, existing benchmarks still face three key challenges: 1) Insufficient evaluation of models' reasoning abilities in multilingual scenarios; 2) Inadequate assessment of MLLMs' comprehensive modality coverage; 3) Lack of fine-grained annotation of scientific knowledge points. To address these gaps, we propose MME-SCI, a comprehensive and challenging benchmark. We carefully collected 1,019 high-quality question-answer pairs, which involve 3 distinct evaluation modes. These pairs cover four subjects, namely mathematics, physics, chemistry, and biology, and support five languages: Chinese, English, French, Spanish, and Japanese. We conducted extensive experiments on 16 open-source models and 4 closed-source models, and the results demonstrate that MME-SCI is widely challenging for existing MLLMs. For instance, under the Image-only evaluation mode, o4-mini achieved accuracy of only 52.11%, 24.73%, 36.57%, and 29.80% in mathematics, physics, chemistry, and biology, respectively, indicating a significantly higher difficulty level compared to existing benchmarks. More importantly, using MME-SCI's multilingual and fine-grained knowledge attributes, we analyzed existing models' performance in depth and identified their weaknesses in specific domains. The Data and Evaluation Code are available at https://github.com/JCruan519/MME-SCI.

With the development of Multimodal Large Language Models (MLLMs), the evaluation of multimodal models in the context of mathematical problems has become a valuable research field. Multimodal visual-textual mathematical reasoning serves as a critical indicator for evaluating the comprehension and complex multi-step quantitative reasoning abilities of MLLMs. However, previous multimodal math benchmarks have not sufficiently integrated visual and textual information. To address this gap, we proposed MathScape, a new benchmark that emphasizes the understanding and application of combined visual and textual information. MathScape is designed to evaluate photo-based math problem scenarios, assessing the theoretical understanding and application ability of MLLMs through a categorical hierarchical approach. We conduct a multi-dimensional evaluation on 11 advanced MLLMs, revealing that our benchmark is challenging even for the most sophisticated models. By analyzing the evaluation results, we identify the limitations of MLLMs, offering valuable insights for enhancing model performance.

Multi-modal large language models (MLLMs) have demonstrated promising capabilities across various tasks by integrating textual and visual information to achieve visual understanding in complex scenarios. Despite the availability of several benchmarks aims to evaluating MLLMs in tasks from visual question answering to complex problem-solving, most focus predominantly on mathematics or general visual understanding tasks. This reveals a critical gap in current benchmarks, which often overlook the inclusion of other key scientific disciplines such as physics and chemistry. To address this gap, we meticulously construct a comprehensive benchmark, named VisScience, which is utilized to assess the multi-modal scientific reasoning across the three disciplines of mathematics, physics, and chemistry. This benchmark comprises 3,000 questions drawn from K12 education - spanning elementary school through high school - equally distributed across three disciplines, with 1,000 questions per discipline. The questions within VisScience span 21 distinct subjects and are categorized into five difficulty levels, offering a broad spectrum of topics within each discipline. With VisScience, we present a detailed evaluation of the performance of 25 representative MLLMs in scientific reasoning. Experimental results demonstrate that closed-source MLLMs generally outperform open-source models. The best performance observed include a 53.4\% accuracy in mathematics by Claude3.5-Sonnet, 38.2\% in physics by GPT-4o, and 47.0\% in chemistry by Gemini-1.5-Pro. These results underscore the strengths and limitations of MLLMs, suggesting areas for future improvement and highlighting the importance of developing models that can effectively handle the diverse demands of multi-modal scientific reasoning.

Understanding time series data is crucial for multiple real-world applications. While large language models (LLMs) show promise in time series tasks, current approaches often rely on numerical data alone, overlooking the multimodal nature of time-dependent information, such as textual descriptions, visual data, and audio signals. Moreover, these methods underutilize LLMs' reasoning capabilities, limiting the analysis to surface-level interpretations instead of deeper temporal and multimodal reasoning. In this position paper, we argue that multimodal LLMs (MLLMs) can enable more powerful and flexible reasoning for time series analysis, enhancing decision-making and real-world applications. We call on researchers and practitioners to leverage this potential by developing strategies that prioritize trust, interpretability, and robust reasoning in MLLMs. Lastly, we highlight key research directions, including novel reasoning paradigms, architectural innovations, and domain-specific applications, to advance time series reasoning with MLLMs.

CoT has significantly enhanced the reasoning ability of LLMs while it faces challenges when extended to multimodal domains, particularly in mathematical tasks. Existing MLLMs typically perform textual reasoning solely from a single static mathematical image, overlooking dynamic visual acquisition during reasoning. In contrast, humans repeatedly examine visual image and employ step-by-step reasoning to prove intermediate propositions. This strategy of decomposing the problem-solving process into key logical nodes adheres to Miller's Law in cognitive science. Inspired by this insight, we propose a ViRC framework for multimodal mathematical tasks, introducing a Reason Chunking mechanism that structures multimodal mathematical CoT into consecutive Critical Reasoning Units (CRUs) to simulate human expert problem-solving patterns. CRUs ensure intra-unit textual coherence for intermediate proposition verification while integrating visual information across units to generate subsequent propositions and support structured reasoning. To this end, we present CRUX dataset by using three visual tools and four reasoning patterns to provide explicitly annotated CRUs across multiple reasoning paths for each mathematical problem. Leveraging the CRUX dataset, we propose a progressive training strategy inspired by human cognitive learning, which includes Instructional SFT, Practice SFT, and Strategic RL, aimed at further strengthening the Reason Chunking ability of the model. The resulting ViRC-7B model achieves a 18.8% average improvement over baselines across multiple mathematical benchmarks. Code is available at https://github.com/Leon-LihongWang/ViRC.

By integrating the perception capabilities of multimodal encoders with the generative power of Large Language Models (LLMs), Multimodal Large Language Models (MLLMs), exemplified by GPT-4V, have achieved great success in various multimodal tasks, pointing toward a promising pathway to artificial general intelligence. Despite this progress, the limited quality of multimodal data, poor performance on many complex downstream tasks, and inadequate evaluation protocols continue to hinder the reliability and broader applicability of MLLMs across diverse domains. Inspired by the human ability to leverage external tools for enhanced reasoning and problem-solving, augmenting MLLMs with external tools (e.g., APIs, expert models, and knowledge bases) offers a promising strategy to overcome these challenges. In this paper, we present a comprehensive survey on leveraging external tools to enhance MLLM performance. Our discussion is structured along four key dimensions about external tools: (1) how they can facilitate the acquisition and annotation of high-quality multimodal data; (2) how they can assist in improving MLLM performance on challenging downstream tasks; (3) how they enable comprehensive and accurate evaluation of MLLMs; (4) the current limitations and future directions of tool-augmented MLLMs. Through this survey, we aim to underscore the transformative potential of external tools in advancing MLLM capabilities, offering a forward-looking perspective on their development and applications. The project page of this paper is publicly available athttps://github.com/Lackel/Awesome-Tools-for-MLLMs.

Recent progress in Multi-modal Large Language Models (MLLMs) has enabled step-by-step multi-modal mathematical reasoning by performing visual operations based on the textual instructions. A promising approach uses code as an intermediate representation to precisely express and manipulate the images in the reasoning steps. However, existing evaluations focus mainly on text-only reasoning outputs, leaving the MLLM's ability to perform accurate visual operations via code largely unexplored. This work takes a first step toward addressing that gap by evaluating MLLM's code-based capabilities in multi-modal mathematical reasoning.Specifically, our framework focuses on two key evaluation aspects: (1) Multi-modal Code Generation (MCG) evaluates the model's ability to accurately understand and construct visualizations from scratch. (2) Multi-modal Code Editing (MCE) assesses the model's capacity for fine-grained operations, which include three types: Deletion, Modification and Annotation. To evaluate the above tasks, we incorporate a dataset that covers the five most popular types of mathematical figures, including geometric diagrams, function plots, and three types of statistical charts, to provide a comprehensive and effective measurement of existing MLLMs. Our experimental evaluation involves nine mainstream MLLMs, and the results reveal that existing models still lag significantly behind human performance in performing fine-grained visual operations.

Multimodal large language models (MLLMs) have achieved remarkable success across a broad range of vision tasks. However, constrained by the capacity of their internal world knowledge, prior work has proposed augmenting MLLMs by ``reasoning-then-tool-call'' for visual and textual search engines to obtain substantial gains on tasks requiring extensive factual information. However, these approaches typically define multimodal search in a naive setting, assuming that a single full-level or entity-level image query and few text query suffices to retrieve the key evidence needed to answer the question, which is unrealistic in real-world scenarios with substantial visual noise. Moreover, they are often limited in the reasoning depth and search breadth, making it difficult to solve complex questions that require aggregating evidence from diverse visual and textual sources. Building on this, we propose Vision-DeepResearch, which proposes one new multimodal deep-research paradigm, i.e., performs multi-turn, multi-entity and multi-scale visual and textual search to robustly hit real-world search engines under heavy noise. Our Vision-DeepResearch supports dozens of reasoning steps and hundreds of engine interactions, while internalizing deep-research capabilities into the MLLM via cold-start supervision and RL training, resulting in a strong end-to-end multimodal deep-research MLLM. It substantially outperforming existing multimodal deep-research MLLMs, and workflows built on strong closed-source foundation model such as GPT-5, Gemini-2.5-pro and Claude-4-Sonnet. The code will be released in https://github.com/Osilly/Vision-DeepResearch.

While multi-modal large language models (MLLMs) have made significant progress in complex reasoning tasks via reinforcement learning, it is commonly believed that extensive training data is necessary for improving multi-modal reasoning ability, inevitably leading to data redundancy and substantial computational costs. However, can smaller high-value datasets match or outperform full corpora for multi-modal reasoning in MLLMs? In this work, we challenge this assumption through a key observation: meaningful multi-modal reasoning is triggered by only a sparse subset of training samples, termed cognitive samples, whereas the majority contribute marginally. Building on this insight, we propose a novel data selection paradigm termed Reasoning Activation Potential (RAP), which identifies cognitive samples by estimating each sample's potential to stimulate genuine multi-modal reasoning by two complementary estimators: 1) Causal Discrepancy Estimator (CDE) based on the potential outcome model principle, eliminates samples that overly rely on language priors by comparing outputs between multi-modal and text-only inputs; 2) Attention Confidence Estimator (ACE), which exploits token-level self-attention to discard samples dominated by irrelevant but over-emphasized tokens in intermediate reasoning stages. Moreover, we introduce a Difficulty-aware Replacement Module (DRM) to substitute trivial instances with cognitively challenging ones, thereby ensuring complexity for robust multi-modal reasoning. Experiments on six datasets show that our RAP method consistently achieves superior performance using only 9.3% of the training data, while reducing computational costs by over 43%. Our code is available at https://github.com/Leo-ssl/RAP.

Although large language models (LLMs) have demonstrated impressive reasoning capabilities across general domains, their effectiveness in real-world clinical practice remains limited. This is likely due to their insufficient exposure to real-world clinical data during training, as such data is typically not included due to privacy concerns. To address this, we propose enhancing the clinical reasoning capabilities of LLMs by leveraging real-world clinical data. We constructed reasoning-intensive questions from a nationwide sepsis registry and fine-tuned Phi-4 on these questions using reinforcement learning, resulting in C-Reason. C-Reason exhibited strong clinical reasoning capabilities on the in-domain test set, as evidenced by both quantitative metrics and expert evaluations. Furthermore, its enhanced reasoning capabilities generalized to a sepsis dataset involving different tasks and patient cohorts, an open-ended consultations on antibiotics use task, and other diseases. Future research should focus on training LLMs with large-scale, multi-disease clinical datasets to develop more powerful, general-purpose clinical reasoning models.

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Inspired by recent advancements in LLM reasoning, the field of multimodal reasoning has seen remarkable progress, achieving significant performance gains on intricate tasks such as mathematical problem-solving. Despite this progress, current multimodal large reasoning models exhibit two key limitations. They tend to employ computationally expensive reasoning even for simple queries, leading to inefficiency. Furthermore, this focus on specialized reasoning often impairs their broader, more general understanding capabilities. In this paper, we propose Metis-HOME: a Hybrid Optimized Mixture-of-Experts framework designed to address this trade-off. Metis-HOME enables a ''Hybrid Thinking'' paradigm by structuring the original dense model into two distinct expert branches: a thinking branch tailored for complex, multi-step reasoning, and a non-thinking branch optimized for rapid, direct inference on tasks like general VQA and OCR. A lightweight, trainable router dynamically allocates queries to the most suitable expert. We instantiate Metis-HOME by adapting the Qwen2.5-VL-7B into an MoE architecture. Comprehensive evaluations reveal that our approach not only substantially enhances complex reasoning abilities but also improves the model's general capabilities, reversing the degradation trend observed in other reasoning-specialized models. Our work establishes a new paradigm for building powerful and versatile MLLMs, effectively resolving the prevalent reasoning-vs-generalization dilemma.

A key frontier for Multimodal Large Language Models (MLLMs) is the ability to perform deep mathematical and spatial reasoning directly from images, moving beyond their established success in semantic description. Mathematical surface plots provide a rigorous testbed for this capability, as they isolate the task of reasoning from the semantic noise common in natural images. To measure progress on this frontier, we introduce MaRVL-QA (Mathematical Reasoning over Visual Landscapes), a new benchmark designed to quantitatively evaluate these core reasoning skills. The benchmark comprises two novel tasks: Topological Counting, identifying and enumerating features like local maxima; and Transformation Recognition, recognizing applied geometric transformations. Generated from a curated library of functions with rigorous ambiguity filtering, our evaluation on MaRVL-QA reveals that even state-of-the-art MLLMs struggle significantly, often resorting to superficial heuristics instead of robust spatial reasoning. MaRVL-QA provides a challenging new tool for the research community to measure progress, expose model limitations, and guide the development of MLLMs with more profound reasoning abilities.

Multimodal Large Language Models (MLLMs) have demonstrated proficiency in handling a variety of visual-language tasks. However, current MLLM benchmarks are predominantly designed to evaluate reasoning based on static information about a single image, and the ability of modern MLLMs to extrapolate from image sequences, which is essential for understanding our ever-changing world, has been less investigated. To address this challenge, this paper introduces Mementos, a new benchmark designed to assess MLLMs' sequential image reasoning abilities. Mementos features 4,761 diverse image sequences with varying lengths. We also employ a GPT-4 assisted method to evaluate MLLM reasoning performance. Through a careful evaluation of nine recent MLLMs on Mementos, including GPT-4V and Gemini, we find that they struggle to accurately describe dynamic information about given image sequences, often leading to hallucinations/misrepresentations of objects and their corresponding behaviors. Our quantitative analysis and case studies identify three key factors impacting MLLMs' sequential image reasoning: the correlation between object and behavioral hallucinations, the influence of cooccurring behaviors, and the compounding impact of behavioral hallucinations. Our dataset is available at https://github.com/umd-huang-lab/Mementos.

Cross-Video Reasoning (CVR) presents a significant challenge in video understanding, which requires simultaneous understanding of multiple videos to aggregate and compare information across groups of videos. Most existing video understanding benchmarks focus on single-video analysis, failing to assess the ability of multimodal large language models (MLLMs) to simultaneously reason over various videos. Recent benchmarks evaluate MLLMs' capabilities on multi-view videos that capture different perspectives of the same scene. However, their limited tasks hinder a thorough assessment of MLLMs in diverse real-world CVR scenarios. To this end, we introduce CrossVid, the first benchmark designed to comprehensively evaluate MLLMs' spatial-temporal reasoning ability in cross-video contexts. Firstly, CrossVid encompasses a wide spectrum of hierarchical tasks, comprising four high-level dimensions and ten specific tasks, thereby closely reflecting the complex and varied nature of real-world video understanding. Secondly, CrossVid provides 5,331 videos, along with 9,015 challenging question-answering pairs, spanning single-choice, multiple-choice, and open-ended question formats. Through extensive experiments on various open-source and closed-source MLLMs, we observe that Gemini-2.5-Pro performs best on CrossVid, achieving an average accuracy of 50.4%. Notably, our in-depth case study demonstrates that most current MLLMs struggle with CVR tasks, primarily due to their inability to integrate or compare evidence distributed across multiple videos for reasoning. These insights highlight the potential of CrossVid to guide future advancements in enhancing MLLMs' CVR capabilities.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

Despite strong performance on vision-language tasks, Multimodal Large Language Models (MLLMs) struggle with mathematical problem-solving, with both open-source and state-of-the-art models falling short of human performance on visual-math benchmarks. To systematically examine visual-mathematical reasoning in MLLMs, we (1) evaluate their understanding of geometric primitives, (2) test multi-step reasoning, and (3) explore a potential solution to improve visual reasoning capabilities. Our findings reveal fundamental shortcomings in shape recognition, with top models achieving under 50% accuracy in identifying regular polygons. We analyze these failures through the lens of dual-process theory and show that MLLMs rely on System 1 (intuitive, memorized associations) rather than System 2 (deliberate reasoning). Consequently, MLLMs fail to count the sides of both familiar and novel shapes, suggesting they have neither learned the concept of sides nor effectively process visual inputs. Finally, we propose Visually Cued Chain-of-Thought (VC-CoT) prompting, which enhances multi-step mathematical reasoning by explicitly referencing visual annotations in diagrams, boosting GPT-4o's accuracy on an irregular polygon side-counting task from 7% to 93%. Our findings suggest that System 2 reasoning in MLLMs remains an open problem, and visually-guided prompting is essential for successfully engaging visual reasoning. Code available at: https://github.com/rsinghlab/Shape-Blind.

The analysis of 3D medical images is crucial for modern healthcare, yet traditional task-specific models are becoming increasingly inadequate due to limited generalizability across diverse clinical scenarios. Multimodal large language models (MLLMs) offer a promising solution to these challenges. However, existing MLLMs have limitations in fully leveraging the rich, hierarchical information embedded in 3D medical images. Inspired by clinical practice, where radiologists focus on both 3D spatial structure and 2D planar content, we propose Med-2E3, a novel MLLM for 3D medical image analysis that integrates 3D and 2D encoders. To aggregate 2D features more effectively, we design a Text-Guided Inter-Slice (TG-IS) scoring module, which scores the attention of each 2D slice based on slice contents and task instructions. To the best of our knowledge, Med-2E3 is the first MLLM to integrate both 3D and 2D features for 3D medical image analysis. Experiments on a large-scale, open-source 3D medical multimodal benchmark demonstrate that Med-2E3 exhibits task-specific attention distribution and significantly outperforms current state-of-the-art models, with a 14% improvement in report generation and a 5% gain in medical visual question answering (VQA), highlighting the model's potential in addressing complex multimodal clinical tasks. The code will be released upon acceptance.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Recently, slow-thinking reasoning systems, built upon large language models (LLMs), have garnered widespread attention by scaling the thinking time during inference. There is also growing interest in adapting this capability to multimodal large language models (MLLMs). Given that MLLMs handle more complex data semantics across different modalities, it is intuitively more challenging to implement multimodal slow-thinking systems. To address this issue, in this paper, we explore a straightforward approach by fine-tuning a capable MLLM with a small amount of textual long-form thought data, resulting in a multimodal slow-thinking system, Virgo (Visual reasoning with long thought). We find that these long-form reasoning processes, expressed in natural language, can be effectively transferred to MLLMs. Moreover, it seems that such textual reasoning data can be even more effective than visual reasoning data in eliciting the slow-thinking capacities of MLLMs. While this work is preliminary, it demonstrates that slow-thinking capacities are fundamentally associated with the language model component, which can be transferred across modalities or domains. This finding can be leveraged to guide the development of more powerful slow-thinking reasoning systems. We release our resources at https://github.com/RUCAIBox/Virgo.

Multimodal Large Language Models (MLLMs) have recently been applied to universal multimodal retrieval, where Chain-of-Thought (CoT) reasoning improves candidate reranking. However, existing approaches remain largely language-driven, relying on static visual encodings and lacking the ability to actively verify fine-grained visual evidence, which often leads to speculative reasoning in visually ambiguous cases. We propose V-Retrver, an evidence-driven retrieval framework that reformulates multimodal retrieval as an agentic reasoning process grounded in visual inspection. V-Retrver enables an MLLM to selectively acquire visual evidence during reasoning via external visual tools, performing a multimodal interleaved reasoning process that alternates between hypothesis generation and targeted visual verification.To train such an evidence-gathering retrieval agent, we adopt a curriculum-based learning strategy combining supervised reasoning activation, rejection-based refinement, and reinforcement learning with an evidence-aligned objective. Experiments across multiple multimodal retrieval benchmarks demonstrate consistent improvements in retrieval accuracy (with 23.0% improvements on average), perception-driven reasoning reliability, and generalization.

There are two main barriers to using large language models (LLMs) in clinical reasoning. Firstly, while LLMs exhibit significant promise in Natural Language Processing (NLP) tasks, their performance in complex reasoning and planning falls short of expectations. Secondly, LLMs use uninterpretable methods to make clinical decisions that are fundamentally different from the clinician's cognitive processes. This leads to user distrust. In this paper, we present a multi-agent framework called ArgMed-Agents, which aims to enable LLM-based agents to make explainable clinical decision reasoning through interaction. ArgMed-Agents performs self-argumentation iterations via Argumentation Scheme for Clinical Discussion (a reasoning mechanism for modeling cognitive processes in clinical reasoning), and then constructs the argumentation process as a directed graph representing conflicting relationships. Ultimately, use symbolic solver to identify a series of rational and coherent arguments to support decision. We construct a formal model of ArgMed-Agents and present conjectures for theoretical guarantees. ArgMed-Agents enables LLMs to mimic the process of clinical argumentative reasoning by generating explanations of reasoning in a self-directed manner. The setup experiments show that ArgMed-Agents not only improves accuracy in complex clinical decision reasoning problems compared to other prompt methods, but more importantly, it provides users with decision explanations that increase their confidence.

Multimodal large language models (MLLMs) are proficient in perception and instruction-following, but they still struggle with spatial reasoning: the ability to mentally track and manipulate objects across multiple views and over time. Spatial reasoning is a key component of human intelligence, but most existing benchmarks focus on static images or final outputs, failing to account for the sequential and viewpoint-dependent nature of this skill. To close this gap, we introduce GamiBench, a benchmark designed to evaluate spatial reasoning and 2D-to-3D planning in MLLMs through origami-inspired folding tasks. GamiBench includes 186 regular and 186 impossible 2D crease patterns paired with their corresponding 3D folded shapes, produced from six distinct viewpoints across three visual question-answering (VQA) tasks: predicting 3D fold configurations, distinguishing valid viewpoints, and detecting impossible patterns. Unlike previous benchmarks that assess only final predictions, GamiBench holistically evaluates the entire reasoning process--measuring cross-view consistency, physical feasibility through impossible-fold detection, and interpretation of intermediate folding steps. It further introduces new diagnostic metrics--viewpoint consistency (VC) and impossible fold selection rate (IFSR)--to measure how well models handle folds of varying complexity. Our experiments show that even leading models such as GPT-5 and Gemini-2.5-Pro struggle on single-step spatial understanding. These contributions establish a standardized framework for evaluating geometric understanding and spatial reasoning in MLLMs. Dataset and code: https://github.com/stvngo/GamiBench.

Multimodal large language models (MLLMs) have recently achieved remarkable progress in radiology by integrating visual perception with natural language understanding. However, they often generate clinically unsupported descriptions, known as medical hallucinations, which pose serious risks in medical applications that demand accuracy and image-grounded outputs. Through empirical analysis, we find that prompt-induced hallucinations remain prevalent in radiology MLLMs, largely due to over-sensitivity to clinical sections. To address this, we introduce Clinical Contrastive Cecoding (CCD), a training-free and retrieval-free inference framework that integrates structured clinical signals from task-specific radiology expert models. CCD introduces a dual-stage contrastive mechanism to refine token-level logits during generation, thereby enhancing clinical fidelity without modifying the base MLLM. Experiments on three datasets and multiple models demonstrate that CCD consistently improves overall performance on radiology report generation (RRG). On the MIMIC-CXR dataset, it yields up to a 17% improvement in RadGraph-F1 when applied to state-of-the-art RRG models. Our approach provides a lightweight and generalisable solution for mitigating medical hallucinations, effectively bridging expert models and MLLMs in radiology.

While large language models (LLMs) have shown to perform well on monolingual mathematical and commonsense reasoning, they remain unreliable for multilingual medical reasoning applications, hindering their deployment in multilingual healthcare settings. We address this by first introducing CUREMED-BENCH, a high-quality multilingual medical reasoning dataset with open-ended reasoning queries with a single verifiable answer, spanning thirteen languages, including underrepresented languages such as Amharic, Yoruba, and Swahili. Building on this dataset, we propose CURE-MED, a curriculum-informed reinforcement learning framework that integrates code-switching-aware supervised fine-tuning and Group Relative Policy Optimization to jointly improve logical correctness and language stability. Across thirteen languages, our approach consistently outperforms strong baselines and scales effectively, achieving 85.21% language consistency and 54.35% logical correctness at 7B parameters, and 94.96% language consistency and 70.04% logical correctness at 32B parameters. These results support reliable and equitable multilingual medical reasoning in LLMs. The code and dataset are available at https://cure-med.github.io/

Visual abductive reasoning (VAR) is a challenging task that requires AI systems to infer the most likely explanation for incomplete visual observations. While recent MLLMs develop strong general-purpose multimodal reasoning capabilities, they fall short in abductive inference, as compared to human beings. To bridge this gap, we draw inspiration from the interplay between verbal and pictorial abduction in human cognition, and propose to strengthen abduction of MLLMs by mimicking such dual-mode behavior. Concretely, we introduce AbductiveMLLM comprising of two synergistic components: REASONER and IMAGINER. The REASONER operates in the verbal domain. It first explores a broad space of possible explanations using a blind LLM and then prunes visually incongruent hypotheses based on cross-modal causal alignment. The remaining hypotheses are introduced into the MLLM as targeted priors, steering its reasoning toward causally coherent explanations. The IMAGINER, on the other hand, further guides MLLMs by emulating human-like pictorial thinking. It conditions a text-to-image diffusion model on both the input video and the REASONER's output embeddings to "imagine" plausible visual scenes that correspond to verbal explanation, thereby enriching MLLMs' contextual grounding. The two components are trained jointly in an end-to-end manner. Experiments on standard VAR benchmarks show that AbductiveMLLM achieves state-of-the-art performance, consistently outperforming traditional solutions and advanced MLLMs.

Multimodal hallucination in multimodal large language models (MLLMs) restricts the correctness of MLLMs. However, multimodal hallucinations are multi-sourced and arise from diverse causes. Existing benchmarks fail to adequately distinguish between perception-induced hallucinations and reasoning-induced hallucinations. This failure constitutes a significant issue and hinders the diagnosis of multimodal reasoning failures within MLLMs. To address this, we propose the {\dataset} benchmark, which isolates reasoning hallucinations by constructing questions where input images are correctly perceived by MLLMs yet reasoning errors persist. {\dataset} introduces multi-granular evaluation metrics: accuracy, factuality, and LLMs hallucination score for hallucination quantification. Our analysis reveals that (1) the model scale, data scale, and training stages significantly affect the degree of logical, fabrication, and factual hallucinations; (2) current MLLMs show no effective improvement on spatial hallucinations caused by misinterpreted spatial relationships, indicating their limited visual reasoning capabilities; and (3) question types correlate with distinct hallucination patterns, highlighting targeted challenges and potential mitigation strategies. To address these challenges, we propose {\method}, a method that combines curriculum reinforcement fine-tuning to encourage models to generate logic-consistent reasoning chains by stepwise reducing learning difficulty, and collaborative hint inference to reduce reasoning complexity. {\method} establishes a baseline on {\dataset}, and reduces the logical hallucinations in original base models.

Enhancing the multimodal reasoning capabilities of Multimodal Large Language Models (MLLMs) is a challenging task that has attracted increasing attention in the community. Recently, several studies have applied Reinforcement Learning with Verifiable Rewards (RLVR) to the multimodal domain in order to enhance the reasoning abilities of MLLMs. However, these works largely overlook the enhancement of multimodal perception capabilities in MLLMs, which serve as a core prerequisite and foundational component of complex multimodal reasoning. Through McNemar's test, we find that existing RLVR method fails to effectively enhance the multimodal perception capabilities of MLLMs, thereby limiting their further improvement in multimodal reasoning. To address this limitation, we propose Perception-R1, which introduces a novel visual perception reward that explicitly encourages MLLMs to perceive the visual content accurately, thereby can effectively incentivizing both their multimodal perception and reasoning capabilities. Specifically, we first collect textual visual annotations from the CoT trajectories of multimodal problems, which will serve as visual references for reward assignment. During RLVR training, we employ a judging LLM to assess the consistency between the visual annotations and the responses generated by MLLM, and assign the visual perception reward based on these consistency judgments. Extensive experiments on several multimodal reasoning benchmarks demonstrate the effectiveness of our Perception-R1, which achieves state-of-the-art performance on most benchmarks using only 1,442 training data.

Although Multimodal Large Language Models (MLLMs) have demonstrated increasingly impressive performance in chart understanding, most of them exhibit alarming hallucinations and significant performance degradation when handling non-annotated charts. Therefore, a question arises: Do MLLMs really understand the charts? Since a human is capable of understanding charts and estimating the values by visual reasoning, we first carefully establish a comprehensive Chart Reasoning Benchmark CRBench to rigorously evaluate the visual reasoning abilities of MLLMs on non-annotated charts. We argue that MLLMs are primarily relying on recognition rather than reasoning to interpret the charts. To steer MLLMs to reasonable chart understanding, we propose ChartReasoner that mimics human behavior by grounding their estimation in chart understanding. Extensive results on the proposed CRBench show that ChartReasnoner-3B/7B achieves superior performance in chart reasoning, even compared to GPT-4o and Gemini-2.5-Flash. More importantly, ChartReasnoner also demonstrates the visual reasoning abilities in general chart comprehension on public benchmarks, leading to significant performance gains and enabling MLLMs to rationally understand the charts. The code and dataset will be publicly available upon publication.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.