A Modular Agent for Reliable and Auditable Spatial Relation Verification in CT Scans
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The paper introduces SPAR‑Bench, a set of eight probes designed to test whether medical vision models can reason about anatomy in abdominal CT scans. Experiments across five architectures and three foundation models—both frozen and fine‑tuned—show that while models can recall canonical organ locations, they fail to perform relational reasoning or spatial comparisons within a patient, even under zero‑shot transfer. The study also demonstrates that pooled probing underestimates a model’s relational capabilities and that open‑weight multimodal large language models perform poorly on these tasks.
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.
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