The article reviews how multimodal large language models (MLLMs) are expanding radiology AI beyond image‑specific tasks to multimodal reasoning, yet volumetric radiology poses a representational challenge because clinical interpretation needs full 3‑D spatial context and quantitative data. It surveys over 200 studies, categorizing advances in volumetric representation, multimodal understanding, and agentic orchestration, and introduces a Claim‑Design‑Validation framework to align technical, workflow, and clinical claims. The review emphasizes that native volumetric modeling and agentic capabilities must match spatial, quantitative, contextual, and workflow demands, and that clinical credibility hinges on faithful 3‑D representation, traceable behavior, proper validation, and defined human oversight.
By Zanting Ye, Shengyuan Liu, Xin Liu, Chenhui Wang, Zhisong Wang, Jiashuai Liu, Zipei Wang, Cheng Wang, Wentao Pan, Mengjie Fang, Di Dong, Mohammad Salmanpour, Arman Rahmim, Yu Gu, Yong Xia, Hongming Shan, Yixuan Yuan, Yefeng Zheng, Lijun Lu
arXiv:2604.16729v2 Announce Type: replace-cross
Abstract: State-of-the-art large language models (LLMs) show high performance in general visual question answering. However, a fundamental limitation r...
By Ayhan Can Erdur, Daniel Scholz, Jiazhen Pan, Benedikt Wiestler, Daniel Rueckert, Jan C. Peeken
SurgRAW introduces a multi‑agent, chain‑of‑thought workflow for robotic surgical video analysis, leveraging a new SurgCoTBench benchmark with 14,256 QA pairs across five surgical tasks. The system uses an orchestrator to split scene understanding into two reasoning streams, panel‑discussion‑style collaboration among task‑specific agents, and retrieval‑augmented generation to incorporate surgical knowledge. Experiments show SurgRAW outperforms mainstream vision‑language models and a supervised baseline by 14.61% accuracy.
By Chang Han Low, Ziyue Wang, Tianyi Zhang, Zhu Zhuo, Zhitao Zeng, Evangelos B. Mazomenos, Yueming Jin
arXiv:2607. 24743v1 Announce Type: cross Abstract: Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment.
By Hangjie Yuan, Yichen Qian, Zhiwei Tang, Xianzhe Xu, Lirong Wu, Sicheng Yang, Jinwang Wang, Pengju Wang, Zhitao Zeng, Yizeng Han, Yan Xing, Shengxuan Luo, Tao Feng, Qing Xie, Weigen Yao, Yi Yang, Zuozhu Liu, Jiasheng Tang, Shaocheng Wang, Jitao Wang, Jiahong Dong, Weihua Chen, Feng Xu, Fan Wang
arXiv:2606. 14766v1 Announce Type: cross Abstract: Autonomous medical and robotic systems increasingly rely on intelligent perception and reasoning capabilities to interpret visual data and support clinical decision making.
By Hamza Riaz, Arham Haroon, Maha Baig, Muhammad Dawood Rizwan, Muhammad Naseer Bajwa, Muhammad Moazam Fraz
The paper introduces ReasonCVS, a structured reasoning framework for assessing the Critical View of Safety in laparoscopic cholecystectomy. It uses a Vision‑Language Model to build an Anatomical Scene Graph Abstraction and a Large Language Model–based Rationale‑Aware Reasoning Agent to verify sub‑criteria, producing a final verdict with traceable clinical rationale. Experiments on the Endoscapes‑CVS201 benchmark show ReasonCVS outperforms existing methods with a 68.1% mAP while offering interpretable, criterion‑level explanations.
By Qing Xu, Yuxiang Luo, Zhen Chen
Lingshu is a medical‑specialized multimodal large language model that addresses key limitations of existing medical MLLMs, such as narrow knowledge coverage, hallucinations, and weak reasoning. The authors curate a comprehensive dataset combining medical imaging, texts, and general‑domain data, then train Lingshu in multiple stages to embed medical expertise and improve task performance. They also introduce MedEvalKit, a unified evaluation framework, and demonstrate that Lingshu outperforms current open‑source multimodal models on multimodal QA, text‑based QA, and medical report generation.
By Weiwen Xu, Hou Pong Chan, Long Li, Mahani Aljunied, Ruifeng Yuan, Jianyu Wang, Chenghao Xiao, Guizhen Chen, Chaoqun Liu, Zhaodonghui Li, Yu Sun, Junao Shen, Chaojun Wang, Jie Tan, Deli Zhao, Tingyang Xu, Hao Zhang, Yu Rong
arXiv:2609.37283v1 Announce Type: new
Abstract: Medical multimodal large language models (MLLMs) are increasingly expected not only to answer clinical questions, but also to localize the visual evide...
By Xuyang Cao, Enyou Liu, Jun Zhao, Zhuoyun Liu, Jintao Fei, Leo
arXiv:2605. 09366v3 Announce Type: replace Abstract: Transforming neuroimaging data into clinically actionable biomarkers is a knowledge-intensive and labor-intensive process.
By Keqi Han, Songlin Zhao, Yao Su, Xiang Li, Yixuan Yuan, Lifang He, Carl Yang
The paper introduces MedREAL, a unified framework that aligns linguistic reasoning with spatial grounding for medical visual question answering and segmentation. MedREAL employs Seg Anchored Reasoning Pooling (SARP) to extract semantic evidence from segmentation tokens and a Reasoning-to-Visual (R2V) fusion mechanism to integrate these features into a segmentation pipeline. Using the newly created MedRAVS-13K dataset, MedREAL achieves superior performance, reporting 68.49% gIoU and 70.47% cIoU, and generates evidence masks that consistently match textual diagnoses.
By Haowen Gu, Gensheng Pei, Junzhu Mao, Qiong Wang, Mingwu Ren, Yazhou Yao
Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations.
arXiv:2505.03380v2 Announce Type: replace
Abstract: Accurate delineation of tumors and surrounding organs-at-risk is essential for radiotherapy, surgery and treatment response assessment, yet remains...
By Haonan Wang, Jiaji Mao, Lehan Wang, Qixiang Zhang, Marawan Elbatel, Yi Qin, Huijun Hu, Baoxun Li, Wenhui Deng, Weifeng Qin, Hongrui Li, Jialin Liang, Jun Shen, Xiaomeng Li