Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s). LLaVA-Med exhibits excellent multimodal conversational capability and can follow open-ended instruction to assist with inquiries about a biomedical image. On three standard biomedical visual question answering datasets, LLaVA-Med outperforms previous supervised state-of-the-art on certain metrics. To facilitate biomedical multimodal research, we will release our instruction-following data and the LLaVA-Med model.

In high-stakes medical applications, consistent answering across diverse question phrasings is essential for reliable diagnosis. However, we reveal that current Medical Vision-Language Models (Med-VLMs) exhibit concerning fragility in Medical Visual Question Answering, as their answers fluctuate significantly when faced with semantically equivalent rephrasings of medical questions. We attribute this to two limitations: (1) insufficient alignment of medical concepts, leading to divergent reasoning patterns, and (2) hidden biases in training data that prioritize syntactic shortcuts over semantic understanding. To address these challenges, we construct RoMed, a dataset built upon original VQA datasets containing 144k questions with variations spanning word-level, sentence-level, and semantic-level perturbations. When evaluating state-of-the-art (SOTA) models like LLaVA-Med on RoMed, we observe alarming performance drops (e.g., a 40\% decline in Recall) compared to original VQA benchmarks, exposing critical robustness gaps. To bridge this gap, we propose Consistency and Contrastive Learning (CCL), which integrates two key components: (1) knowledge-anchored consistency learning, aligning Med-VLMs with medical knowledge rather than shallow feature patterns, and (2) bias-aware contrastive learning, mitigating data-specific priors through discriminative representation refinement. CCL achieves SOTA performance on three popular VQA benchmarks and notably improves answer consistency by 50\% on the challenging RoMed test set, demonstrating significantly enhanced robustness. Code will be released.

Ultrasound (US) report generation is a challenging task due to the variability of US images, operator dependence, and the need for standardized text. Unlike X-ray and CT, US imaging lacks consistent datasets, making automation difficult. In this study, we propose a unified framework for multi-organ and multilingual US report generation, integrating fragment-based multilingual training and leveraging the standardized nature of US reports. By aligning modular text fragments with diverse imaging data and curating a bilingual English-Chinese dataset, the method achieves consistent and clinically accurate text generation across organ sites and languages. Fine-tuning with selective unfreezing of the vision transformer (ViT) further improves text-image alignment. Compared to the previous state-of-the-art KMVE method, our approach achieves relative gains of about 2\% in BLEU scores, approximately 3\% in ROUGE-L, and about 15\% in CIDEr, while significantly reducing errors such as missing or incorrect content. By unifying multi-organ and multi-language report generation into a single, scalable framework, this work demonstrates strong potential for real-world clinical workflows.

Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s).

Accurate diagnosis and prognosis assisted by pathology images are essential for cancer treatment selection and planning. Despite the recent trend of adopting deep-learning approaches for analyzing complex pathology images, they fall short as they often overlook the domain-expert understanding of tissue structure and cell composition. In this work, we focus on a challenging Open-ended Pathology VQA (PathVQA-Open) task and propose a novel framework named Path-RAG, which leverages HistoCartography to retrieve relevant domain knowledge from pathology images and significantly improves performance on PathVQA-Open. Admitting the complexity of pathology image analysis, Path-RAG adopts a human-centered AI approach by retrieving domain knowledge using HistoCartography to select the relevant patches from pathology images. Our experiments suggest that domain guidance can significantly boost the accuracy of LLaVA-Med from 38% to 47%, with a notable gain of 28% for H&E-stained pathology images in the PathVQA-Open dataset. For longer-form question and answer pairs, our model consistently achieves significant improvements of 32.5% in ARCH-Open PubMed and 30.6% in ARCH-Open Books on H\&E images. Our code and dataset is available here (https://github.com/embedded-robotics/path-rag).

Artificial intelligence has made significant strides in medical visual question answering (Med-VQA), yet prevalent studies often interpret images holistically, overlooking the visual regions of interest that may contain crucial information, potentially aligning with a doctor's prior knowledge that can be incorporated with minimal annotations (e.g., bounding boxes). To address this gap, this paper introduces R-LLaVA, designed to enhance biomedical VQA understanding by integrating simple medical annotations as prior knowledge directly into the image space through CLIP. These annotated visual regions of interest are then fed into the LLaVA model during training, aiming to enrich the model's understanding of biomedical queries. Experimental evaluation on four standard Med-VQA datasets demonstrates R-LLaVA's superiority over existing state-of-the-art (SoTA) methods. Additionally, to verify the model's capability in visual comprehension, a novel multiple-choice medical visual understanding dataset is introduced, confirming the positive impact of focusing on visual regions of interest in advancing biomedical VQA understanding.

State-of-the-art medical multi-modal large language models (med-MLLM), like LLaVA-Med or BioMedGPT, leverage instruction-following data in pre-training. However, those models primarily focus on scaling the model size and data volume to boost performance while mainly relying on the autoregressive learning objectives. Surprisingly, we reveal that such learning schemes might result in a weak alignment between vision and language modalities, making these models highly reliant on extensive pre-training datasets - a significant challenge in medical domains due to the expensive and time-consuming nature of curating high-quality instruction-following instances. We address this with LoGra-Med, a new multi-graph alignment algorithm that enforces triplet correlations across image modalities, conversation-based descriptions, and extended captions. This helps the model capture contextual meaning, handle linguistic variability, and build cross-modal associations between visuals and text. To scale our approach, we designed an efficient end-to-end learning scheme using black-box gradient estimation, enabling faster LLaMa 7B training. Our results show LoGra-Med matches LLAVA-Med performance on 600K image-text pairs for Medical VQA and significantly outperforms it when trained on 10% of the data. For example, on VQA-RAD, we exceed LLAVA-Med by 20.13% and nearly match the 100% pre-training score (72.52% vs. 72.64%). We also surpass SOTA methods like BiomedGPT on visual chatbots and RadFM on zero-shot image classification with VQA, highlighting the effectiveness of multi-graph alignment.