Chest X-rays (CXRs) are the most frequently performed imaging examinations in clinical settings. Recent advancements in Medical Large Multimodal Models (MLMMs) have enabled automated CXR interpretation, improving diagnostic accuracy and efficiency.

Vision-language models (VLMs) exhibit strong zero-shot generalization on natural images and show early promise in interpretable medical image analysis. However, existing benchmarks do not systematically evaluate whether these models truly reason like human clinicians or merely imitate superficial patterns. To address this gap, we propose DrVD-Bench, the first multimodal benchmark for clinical visual reasoning. DrVD-Bench consists of three modules: Visual Evidence Comprehension, Reasoning Trajectory Assessment, and Report Generation Evaluation, comprising a total of 7,789 image-question pairs. Our benchmark covers 20 task types, 17 diagnostic categories, and five imaging modalities--CT, MRI, ultrasound, radiography, and pathology. DrVD-Bench is explicitly structured to reflect the clinical reasoning workflow from modality recognition to lesion identification and diagnosis. We benchmark 19 VLMs, including general-purpose and medicalspecific, open-source and proprietary models, and observe that performance drops sharply as reasoning complexity increases. While some models begin to exhibit traces of human-like reasoning, they often still rely on shortcut correlations rather than grounded visual understanding. DrVD-Bench offers a rigorous and structured evaluation framework to guide the development of clinically trustworthy VLMs.

Recent progress in vision-language modeling for 3D medical imaging has been fueled by large-scale computed tomography (CT) corpora with paired free-text reports, stronger architectures, and powerful pretrained models. This has enabled applications such as automated report generation and text-conditioned 3D image synthesis. Yet, current approaches struggle with high-resolution, long-sequence volumes: contrastive pretraining often yields vision encoders that are misaligned with clinical language, and slice-wise tokenization blurs fine anatomy, reducing diagnostic performance on downstream tasks. We introduce BTB3D (Better Tokens for Better 3D), a causal convolutional encoder-decoder that unifies 2D and 3D training and inference while producing compact, frequency-aware volumetric tokens. A three-stage training curriculum enables (i) local reconstruction, (ii) overlapping-window tiling, and (iii) long-context decoder refinement, during which the model learns from short slice excerpts yet generalizes to scans exceeding $300$ slices without additional memory overhead. BTB3D sets a new state-of-the-art on two key tasks: it improves BLEU scores and increases clinical F1 by 40\% over CT2Rep, CT-CHAT, and Merlin for report generation; and it reduces FID by 75\% and halves FVD compared to GenerateCT and MedSyn for text-to-CT synthesis, producing anatomically consistent $512\times512\times241$ volumes. These results confirm that precise three-dimensional tokenization, rather than larger language backbones alone, is essential for scalable vision-language modeling in 3D medical imaging.

Neural Information Processing Systems http://nips.cc/

Medical phrase grounding (MPG) maps textual descriptions of radiological findings to corresponding image regions. These grounded reports are easier to interpret, especially for non-experts. Existing MPG systems mostly follow the referring expression comprehension (REC) paradigm and return exactly one bounding box per phrase. Real reports often violate this assumption. They contain multi-region findings, non-diagnostic text, and non-groundable phrases, such as negations or descriptions of normal anatomy. Motivated by this, we reformulate the task as generalised medical phrase grounding (GMPG), where each sentence is mapped to zero, one, or multiple scored regions. To realise this formulation, we introduce the first GMPG model: MedGrounder. We adopted a two-stage training regime: pre-training on report sentence--anatomy box alignment datasets and fine-tuning on report sentence--human annotated box datasets. Experiments on PadChest-GR and MS-CXR show that MedGrounder achieves strong zero-shot transfer and outperforms REC-style and grounded report generation baselines on multi-region and non-groundable phrases, while using far fewer human box annotations. Finally, we show that MedGrounder can be composed with existing report generators to produce grounded reports without retraining the generator.

Radiology reporting is an essential yet time-consuming and error-prone task for radiologists in clinical examinations, especially for volumetric medical images. Rigorous quality control is also critical but tedious, ensuring that the final report meets clinical standards. Existing automated approaches, including radiology report generation methods and medical vision-language models, focus mainly on the report generation phase and neglect the crucial quality control procedure, limiting their capability to provide comprehensive support to radiologists. We propose Radiologist Copilot, an agentic AI assistant equipped with orchestrated tools designed for automated radiology reporting with quality control. Leveraging large language models as the reasoning backbone, the agentic system autonomously selects tools, plans, and executes actions, emulating the behavior of radiologists throughout the holistic radiology reporting process. The orchestrated tools include region localization, think with image paradigm directed region analysis planning, strategic template selection for report generation, quality assessment and feedback-driven adaptive refinement for quality control. Therefore, Radiologist Copilot facilitates accurate, complete, and efficient radiology reporting, assisting radiologists and improving clinical efficiency. Experimental results demonstrate that Radiologist Copilot significantly surpasses other state-of-the-art methods in radiology reporting. The source code will be released upon acceptance.

Purpose: To benchmark open-source or commercial medical image-specific VLMs against real-world radiologist-written reports. Methods: This retrospective study included adult patients who presented to the emergency department between January 2022 and April 2025 and underwent same-day CXR and CT for febrile or respiratory symptoms. Reports from five VLMs (AIRead, Lingshu, MAIRA-2, MedGemma, and MedVersa) and radiologist-written reports were randomly presented and blindly evaluated by three thoracic radiologists using four criteria: RADPEER, clinical acceptability, hallucination, and language clarity. Comparative performance was assessed using generalized linear mixed models, with radiologist-written reports treated as the reference. Finding-level analyses were also performed with CT as the reference. Results: A total of 478 patients (median age, 67 years [interquartile range, 50-78]; 282 men [59.0%]) were included. AIRead demonstrated the lowest RADPEER 3b rate (5.3% [76/1434] vs. radiologists 13.9% [200/1434]; P<.001), whereas other VLMs showed higher disagreement rates (16.8-43.0%; P<.05). Clinical acceptability was the highest with AIRead (84.5% [1212/1434] vs. radiologists 74.3% [1065/1434]; P<.001), while other VLMs performed worse (41.1-71.4%; P<.05). Hallucinations were rare with AIRead, comparable to radiologists (0.3% [4/1425]) vs. 0.1% [1/1425]; P=.21), but frequent with other models (5.4-17.4%; P<.05). Language clarity was higher with AIRead (82.9% [1189/1434]), Lingshu (88.0% [1262/1434]), and MedVersa (88.4% [1268/1434]) compared with radiologists (78.1% [1120/1434]; P<.05). Sensitivity varied substantially across VLMs for the common findings: AIRead, 15.5-86.7%; Lingshu, 2.4-86.7%; MAIRA-2, 6.0-72.0%; MedGemma, 4.8-76.7%; and MedVersa, 20.2-69.3%. Conclusion: Medical VLMs for CXR report generation exhibited variable performance in report quality and diagnostic measures.