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Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence

This paper proposes a training-free evidence-injection framework that systematically mitigates hallucinations in medical MLLMs by recalibrating visual perception and anchoring textual reasoning with ROI priors from MedSAM and anatomical coordinate mapping. Evaluations show up to ~6% improvement in close-ended accuracy and ~35% reduction in open-ended hallucinations.

SourcearXiv Computer VisionAuthor: Rui Hao, Qiankun Li, Junyuan Mao, Linghao Meng, Dirui Xie, Dayu Tan, Zhigang Zeng

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[Submitted on 30 Jun 2026]

Title:Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence

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Abstract:Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations still undermine trustworthy use: models can produce fluent conclusions that conflict with imaging evidence. Existing mitigation strategies typically rely on additional training, external retrieval/knowledge bases, or multi-stage post-hoc verification, which increases cost and pipeline complexity and often generalizes poorly across models and this http URL address this, we propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection. By leveraging ROI priors acquired using MedSAM in our implementation, we recalibrate the visual perception trajectory via ROI-guided activation modulation while anchoring the textual reasoning trajectory by mapping anatomical coordinates into discrete semantic tokens as verifiable external memory. Then we introduce a task-aware dynamic router to select modality-specific interventions based on task semantics, balancing perceptual grounding and linguistic fluency. We conduct systematic evaluations on 2 tasks and 5 datasets using \texttt{LLaVA-1.5-7B}, \texttt{LLaVA-Med-1.5-7B}, \texttt{Qwen3-VL-8B/32B}, and \texttt{InternVL-3.5-8B/38B}. Controlled ablations and visualizations further validate the framework, which consistently outperforms baselines across medical benchmarks, improving close-ended accuracy by up to $\sim\mathbf{6}\%\uparrow$ and reducing open-ended hallucinations by $\sim\mathbf{35}\%\downarrow$. The code has been made available on GitHub: \href{this https URL}{\textcolor{blue}{this https URL}}.

Comments: Accepted by MICCAI 2026 (Early Accept, Top 9%)

Subjects:

Computer Vision and Pattern Recognition (cs.CV)

Cite as: arXiv:2607.00060 [cs.CV]

(or arXiv:2607.00060v1 [cs.CV] for this version)

https://doi.org/10.48550/arXiv.2607.00060

arXiv-issued DOI via DataCite (pending registration)

Submission history

From: Qiankun Li [view email] [v1] Tue, 30 Jun 2026 08:07:25 UTC (2,073 KB)

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