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[Submitted on 28 Sep 2026] Title:Medical Image Alignment Assessment as a Test of Generalist Visual Reasoning in Frontier Multimodal Models View a PDF of the paper titled Medical Image Alignment Assessment as a Test of Generalist Visual Reasoning in Frontier Multimodal Models, by Ross Callaghan and 2 other authors View PDF HTML (experimental) Abstract:Frontier multimodal large language models (MLLMs) are increasingly positioned as general purpose visual reasoners as part of the quest for artificial general intelligence. A key test of this generality is whether they can perform novel visual judgments that humans can make reliably from visual evidence and task instructions, without task-specific parameter optimisation. We investigate this question through the task of medical image alignment assessment, where the goal is to establish whether there is anatomical correspondence between two images. Human visual assessment of image alignment is still the gold standard and most common approach; however, it requires trained operators and is impractical to scale for large datasets. We evaluate recent generations of MLLMs on two exemplar medical image alignment tasks, varying both prompting strategies and image-presentation methods. We compare against a locally fine-tuned MLLM and a task-specific CNN to examine the trade-off between frontier general purpose models and smaller models that require specific task optimisation but can be used locally. We show that are reaching an inflection point, where frontier MLLMs can now perform effective visual assessment of medical image alignment. Models released only a few months ago generalise poorly and, in some settings, perform barely above chance, whereas GPT-6 achieves over 85% across almost all scenarios tested. Fine-tuned local models can match or exceed frontier-model performance on the tasks on which they are trained, but transfer substantially less effectively to unseen settings. These findings identify medical image alignment as a useful test bed for generalist visual reasoning and suggest that frontier multimodal models are beginning to acquire capabilities that could support a common quality-control mechanism across heterogeneous medical-imaging pipelines. Subjects: Computer Vision and Pattern Recognition (cs.CV) Cite as: arXiv:2610.06896 [cs.CV] (or arXiv:2610.06896v1 [cs.CV] for this version) https://doi.org/10.48550/arXiv.2610.06896 arXiv-issued DOI via DataCite Submission history From: Ross Callaghan [view email] [v1] Mon, 28 Sep 2026 17:17:27 UTC (6,177 KB) Full-text links: Access Paper: View a PDF of the paper titled Medical Image Alignment Assessment as a Test of Generalist Visual Reasoning in Frontier Multimodal Models, by Ross Callaghan and 2 other authors View PDF HTML (experimental) TeX Source view license Additional Features Audio Summary Current browse context: cs.CV new | recent | 2026-10 Change to browse by: cs References & Citations NASA ADS Google Scholar Semantic Scholar Loading... Data provided by: Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Code, Data and Media Associated with this Article alphaXiv Toggle alphaXiv (What is alphaXiv?) Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) DagsHub Toggle DagsHub (What is DagsHub?) GotitPub Toggle Gotit.pub (What is GotitPub?) Huggingface Toggle Hugging Face (What is Huggingface?) ScienceCast Toggle ScienceCast (What is ScienceCast?) Demos Demos Replicate Toggle Replicate (What is Replicate?) Spaces Toggle Hugging Face Spaces (What is Spaces?) Spaces Toggle TXYZ.AI (What is TXYZ.AI?) Related Papers Recommenders and Search Tools Link to Influence Flower Influence Flower (What are Influence Flowers?) Core recommender toggle CORE Recommender (What is CORE?) Author Venue Institution Topic About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)