EviRAG: Evidence-Guided Retrieval-Augmented Generation for Medical Vision-Language Models

Linguistically-Aligned and Visually-Grounded Preference Optimization for Clinically-Augmented Medical Report Generation

Despite significant advances in Medical Report Generation (MRG), the reliability remains constrained by the prevalence of factual errors. While Direct Preference Optimization (DPO) has emerged as a promising post-training paradigm to enhance the performance of Supervised Fine-Tuned (SFT) MRG models, existing DPO-based MRG methods typically adopt a naive preference construction that directly pairs model-generated reports with ground truth reports. This strategy inadvertently entangles critical clinical findings with clinically irrelevant linguistic characteristics, and fundamentally lacks explicit vision-language alignment. To address these challenges, we propose DPO-Clin, a novel post-training framework that focuses preference optimization on clinical findings and cross-modal alignment. First, we introduce the Entity-level Clinical Diagnostic (ECD) module to perform a precise entity-level factual diagnosis. ECD guides the generation of linguistically-aligned report preference pairs, isolating clinical discrepancies from linguistic variations. Second, to achieve fine-grained cross-modal alignment, we develop M2DPO, a retrieval-augmented multi-modal DPO variant that enforces textual preference inversion triggered by visual context switches. Third, we locate correct yet highly uncertain predicted entities and apply counterfactual modifications to construct targeted preference data for latent risk mitigation, thereby further enhancing the model reliability. Extensive experiments on two public chest X-ray datasets (MIMIC-CXR and IU X-Ray) and an in-house endoscopy dataset demonstrate that DPO-Clin significantly improves the SFT baselines on clinical-aware metrics. Furthermore, it achieves superior performance over existing DPO-based MRG methods, exhibiting robust generalizability across distinct baseline architectures and diverse medical imaging modalities.

MG-Hybrid: mask-guided hybrid state space models with semantic alignment for radiology report generation

A Multimodal Retrieval-Augmented Generation Framework for Context-Aware Semantic Querying

Retrieval-Augmented Generation (RAG) has established itself as a compelling strategy for grounding large language model outputs in documentary evidence. However, production deployments continue to rely almost exclusively on homogeneous text corpora, even as enterprise repositories grow increasingly heterogeneous blending technical schematics, radiological images, annotated diagrams, and unstructured prose within the same archival system. This mismatch between system design and data reality motivates the present work. We propose a Multimodal RAG framework that unifies text and image retrieval through four tightly coupled components: a dual-stream embedding engine, a learned four-class AI query router, an adaptive confidence threshold, and a session-aware context store. Text is encoded with the allmpnet-base-v2 Sentence Transformer; images are embedded in the same 768-dimensional space via a domain-adapted CLIP ViT-L/14 model fine-tuned on approximately 120,000 technical and clinical text-image pairs. Concatenating 768-d vectors yields a 1,536-d composite query that drives a single approximate nearest-neighbor (ANN) search simultaneously across both modalities. A fine-tuned DistilBERT router assigns each query to one of four retrieval pathways text-only, image-only, hybrid, or conversational at 91.3% accuracy. Experiments were run on three enterprise corpora (engineering manuals, clinical case summaries, and legal paperwork) with the results being a mean F1@5 of 0.90, an increase of 22% over a dense text-only baseline, and a reduction of 49% in the number of hallucinations. The median first-token latency is 1.34s, which meets the interactive-use target deployment-contexts. These results show that it is possible to implement modality-aware retrieval in a simple and realistic setting with real-world organizational constraints and that the results are reproducible.

ClinAlign: Clinical Workflow Aligned Memory Retrieval for Radiology Report Generation

Towards Multimodal Retrieval-Augmented Generation for Medical Visual Question Answering

A novel multimodal RAG framework tailored for MedVQA is proposed, which leverages multimodal data, including medical images, reports, and generated captions, to provide more accurate clinical answers, and introduces a training paradigm that uses captions as auxiliary supervision, enhancing cross-modal alignment via contrastive learning.

DistMedVL: Distributional Vision-Language Alignment for Uncertainty-Aware Medical Image Segmentation

Cross-modal alignment of visual and textual representations is fundamental to multimodal medical image understanding, yet remains hindered by uncertainty in both modalities under real-world clinical conditions. Existing vision-language segmentation methods rely on deterministic cross-modal matching, which overlooks aleatoric uncertainty from ambiguous boundaries and epistemic uncertainty from limited training data, leading to fragile performance under domain shift. To address this issue, we propose DistMedVL, a probabilistic vision-language framework that introduces a lightweight Probabilistic Cross-Modal Adapter (PCM-Adapter) upon frozen encoders to explicitly model representational uncertainty. Specifically, the PCM-Adapter comprises two sequential modules for progressive probabilistic alignment. We first devise a Mahalanobis Alignment Module (MAM) that models textual tokens as Gaussian distributions and computes patch-text compatibility via Mahalanobis distance, yielding variance-conditioned matching that downweights unreliable feature dimensions. Moreover, we devise a Distribution Flow Module (DFM) that estimates modality-wise confidence parameters and performs vision-guided refinement of textual distributions, accommodating distributional variation across imaging modalities. Extensive experiments across eight medical segmentation benchmarks demonstrate that DistMedVL outperforms state-of-the-art methods with only 6.3M trainable parameters, exhibiting superior data efficiency, perturbation robustness and cross-dataset generalization.