Daily Papers

Large language models (LLMs) face significant challenges in specialized biomedical tasks due to the inherent complexity of medical reasoning and the sensitive nature of clinical data. Existing LLMs often struggle with intricate medical terminology and the need for accurate clinical insights, leading to performance reduction when quantized for resource-constrained deployment. To address these issues, we propose Quantized Medical Tree of Thought (QM-ToT), a path-based reasoning framework. QM-ToT leverages a Tree of Thought (ToT) reasoning approach to decompose complex medical problems into manageable subtasks, coupled with evaluator assessment layers. This framework facilitates substantial performance improvements in INT4-quantized models on the challenging MedQAUSMLE dataset. Specifically, we demonstrate a remarkable accuracy increase from 34% to 50% for the LLaMA2-70b model and from 58.77% to 69.49% for LLaMA-3.1-8b. Besides, we also proposed an effect data distillation method based on ToT. Compared to the traditional distillation method, we achieved an improvement of 86. 27% while using only 3.9% of the data.This work, for the first time, showcases the potential of ToT to significantly enhance performance on complex biomedical tasks, establishing a crucial foundation for future advances in deploying high-performing quantized LLM in resource-limited medical settings.

Automatic medical report generation (MRG), which possesses significant research value as it can aid radiologists in clinical diagnosis and report composition, has garnered increasing attention. Despite recent progress, generating accurate reports remains arduous due to the requirement for precise clinical comprehension and disease diagnosis inference. Furthermore, owing to the limited accessibility of medical data and the imbalanced distribution of diseases, the underrepresentation of rare diseases in training data makes large-scale medical visual language models (LVLMs) prone to hallucinations, such as omissions or fabrications, severely undermining diagnostic performance and further intensifying the challenges for MRG in practice. In this study, to effectively mitigate hallucinations in medical report generation, we propose a chain-of-medical-thought approach (CoMT), which intends to imitate the cognitive process of human doctors by decomposing diagnostic procedures. The radiological features with different importance are structured into fine-grained medical thought chains to enhance the inferential ability during diagnosis, thereby alleviating hallucination problems and enhancing the diagnostic accuracy of MRG. The code and dataset have been released at https://github.com/FRENKIE-CHIANG/CoMT.

Large Language Models (LLMs) have revolutionized natural language processing through their state of art reasoning capabilities. This paper explores the convergence of LLM reasoning techniques and feature generation for machine learning tasks. We examine four key reasoning approaches: Chain of Thought, Tree of Thoughts, Retrieval-Augmented Generation, and Thought Space Exploration. Our analysis reveals how these approaches can be used to identify effective feature generation rules without having to manually specify search spaces. The paper categorizes LLM-based feature generation methods across various domains including finance, healthcare, and text analytics. LLMs can extract key information from clinical notes and radiology reports in healthcare, by enabling more efficient data utilization. In finance, LLMs facilitate text generation, summarization, and entity extraction from complex documents. We analyze evaluation methodologies for assessing feature quality and downstream performance, with particular attention to OCTree's decision tree reasoning approach that provides language-based feedback for iterative improvements. Current challenges include hallucination, computational efficiency, and domain adaptation. As of March 2025, emerging approaches include inference-time compute scaling, reinforcement learning, and supervised fine-tuning with model distillation. Future directions point toward multimodal feature generation, self-improving systems, and neuro-symbolic approaches. This paper provides a detailed overview of an emerging field that promises to automate and enhance feature engineering through language model reasoning.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

With the widespread use of large language models (LLMs) in NLP tasks, researchers have discovered the potential of Chain-of-thought (CoT) to assist LLMs in accomplishing complex reasoning tasks by generating intermediate steps. However, human thought processes are often non-linear, rather than simply sequential chains of thoughts. Therefore, we propose Graph-of-Thought (GoT) reasoning, which models human thought processes not only as a chain but also as a graph. By representing thought units as nodes and connections between them as edges, our approach captures the non-sequential nature of human thinking and allows for a more realistic modeling of thought processes. Similar to Multimodal-CoT, we modeled GoT reasoning as a two-stage framework, generating rationales first and then producing the final answer. Specifically, we employ an additional graph-of-thoughts encoder for GoT representation learning and fuse the GoT representation with the original input representation through a gated fusion mechanism. We implement a GoT reasoning model on the T5 pre-trained model and evaluate its performance on a text-only reasoning task (GSM8K) and a multimodal reasoning task (ScienceQA). Our model achieves significant improvement over the strong CoT baseline with 3.41% and 5.08% on the GSM8K test set with T5-base and T5-large architectures, respectively. Additionally, our model boosts accuracy from 84.91% to 91.54% using the T5-base model and from 91.68% to 92.77% using the T5-large model over the state-of-the-art Multimodal-CoT on the ScienceQA test set. Experiments have shown that GoT achieves comparable results to Multimodal-CoT(large) with over 700M parameters, despite having fewer than 250M backbone model parameters, demonstrating the effectiveness of GoT.

Chest X-ray imaging is crucial for diagnosing pulmonary and cardiac diseases, yet its interpretation demands extensive clinical experience and suffers from inter-observer variability. While deep learning models offer high diagnostic accuracy, their black-box nature hinders clinical adoption in high-stakes medical settings. To address this, we propose X-Ray-CoT (Chest X-Ray Chain-of-Thought), a novel framework leveraging Vision-Language Large Models (LVLMs) for intelligent chest X-ray diagnosis and interpretable report generation. X-Ray-CoT simulates human radiologists' "chain-of-thought" by first extracting multi-modal features and visual concepts, then employing an LLM-based component with a structured Chain-of-Thought prompting strategy to reason and produce detailed natural language diagnostic reports. Evaluated on the CORDA dataset, X-Ray-CoT achieves competitive quantitative performance, with a Balanced Accuracy of 80.52% and F1 score of 78.65% for disease diagnosis, slightly surpassing existing black-box models. Crucially, it uniquely generates high-quality, explainable reports, as validated by preliminary human evaluations. Our ablation studies confirm the integral role of each proposed component, highlighting the necessity of multi-modal fusion and CoT reasoning for robust and transparent medical AI. This work represents a significant step towards trustworthy and clinically actionable AI systems in medical imaging.

Large Language Models (LLMs) have demonstrated remarkable performance across multiple tasks through in-context learning. For complex reasoning tasks that require step-by-step thinking, Chain-of-Thought (CoT) prompting has given impressive results, especially when combined with self-consistency. Nonetheless, some tasks remain particularly difficult for LLMs to solve. Tree of Thoughts (ToT) and Graph of Thoughts (GoT) emerged as alternatives, dividing the complex problem into paths of subproblems. In this paper, we propose Tree of Problems (ToP), a simpler version of ToT, which we hypothesise can work better for complex tasks that can be divided into identical subtasks. Our empirical results show that our approach outperforms ToT and GoT, and in addition performs better than CoT on complex reasoning tasks. All code for this paper is publicly available here: https://github.com/ArmelRandy/tree-of-problems.

Medical tasks such as diagnosis and treatment planning require precise and complex reasoning, particularly in life-critical domains. Unlike mathematical reasoning, medical reasoning demands meticulous, verifiable thought processes to ensure reliability and accuracy. However, there is a notable lack of datasets that provide transparent, step-by-step reasoning to validate and enhance the medical reasoning ability of AI models. To bridge this gap, we introduce MedReason, a large-scale high-quality medical reasoning dataset designed to enable faithful and explainable medical problem-solving in large language models (LLMs). We utilize a structured medical knowledge graph (KG) to convert clinical QA pairs into logical chains of reasoning, or ``thinking paths'', which trace connections from question elements to answers via relevant KG entities. Each path is validated for consistency with clinical logic and evidence-based medicine. Our pipeline generates detailed reasoning for various medical questions from 7 medical datasets, resulting in a dataset of 32,682 question-answer pairs, each with detailed, step-by-step explanations. Experiments demonstrate that fine-tuning with our dataset consistently boosts medical problem-solving capabilities, achieving significant gains of up to 7.7% for DeepSeek-Ditill-8B. Our top-performing model, MedReason-8B, outperforms the Huatuo-o1-8B, a state-of-the-art medical reasoning model, by up to 4.2% on the clinical benchmark MedBullets. We also engage medical professionals from diverse specialties to assess our dataset's quality, ensuring MedReason offers accurate and coherent medical reasoning. Our data, models, and code will be publicly available.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Medical images are characterized by intricate and complex features, requiring interpretation by physicians with medical knowledge and experience. Classical neural networks can reduce the workload of physicians, but can only handle these complex features to a limited extent. Theoretically, quantum computing can explore a broader parameter space with fewer parameters, but it is currently limited by the constraints of quantum hardware.Considering these factors, we propose a distributed hybrid quantum convolutional neural network based on quantum circuit splitting. This model leverages the advantages of quantum computing to effectively capture the complex features of medical images, enabling efficient classification even in resource-constrained environments. Our model employs a quantum convolutional neural network (QCNN) to extract high-dimensional features from medical images, thereby enhancing the model's expressive capability.By integrating distributed techniques based on quantum circuit splitting, the 8-qubit QCNN can be reconstructed using only 5 qubits.Experimental results demonstrate that our model achieves strong performance across 3 datasets for both binary and multiclass classification tasks. Furthermore, compared to recent technologies, our model achieves superior performance with fewer parameters, and experimental results validate the effectiveness of our model.

Knowledge of the medical decision process, which can be modeled as medical decision trees (MDTs), is critical to build clinical decision support systems. However, the current MDT construction methods rely heavily on time-consuming and laborious manual annotation. In this work, we propose a novel task, Text2MDT, to explore the automatic extraction of MDTs from medical texts such as medical guidelines and textbooks. We normalize the form of the MDT and create an annotated Text-to-MDT dataset in Chinese with the participation of medical experts. We investigate two different methods for the Text2MDT tasks: (a) an end-to-end framework which only relies on a GPT style large language models (LLM) instruction tuning to generate all the node information and tree structures. (b) The pipeline framework which decomposes the Text2MDT task to three subtasks. Experiments on our Text2MDT dataset demonstrate that: (a) the end-to-end method basd on LLMs (7B parameters or larger) show promising results, and successfully outperform the pipeline methods. (b) The chain-of-thought (COT) prompting method Wei2022ChainOT can improve the performance of the fine-tuned LLMs on the Text2MDT test set. (c) the lightweight pipelined method based on encoder-based pretrained models can perform comparably with LLMs with model complexity two magnititudes smaller. Our Text2MDT dataset is open-sourced at https://tianchi.aliyun.com/dataset/95414, and the source codes are open-sourced at https://github.com/michael-wzhu/text2dt.

Faithful reasoning in medical vision-language models (VLMs) requires not only accurate predictions but also transparent alignment between textual rationales and visual evidence. While Chain-of-Thought (CoT) prompting has shown promise in medical visual question answering (VQA), no large-scale expert-level dataset has captured stepwise reasoning with precise visual grounding. We introduce S-Chain, the first large-scale dataset of 12,000 expert-annotated medical images with bounding boxes and structured visual CoT (SV-CoT), explicitly linking visual regions to reasoning steps. The dataset further supports 16 languages, totaling over 700k VQA pairs for broad multilingual applicability. Using S-Chain, we benchmark state-of-the-art medical VLMs (ExGra-Med, LLaVA-Med) and general-purpose VLMs (Qwen2.5-VL, InternVL2.5), showing that SV-CoT supervision significantly improves interpretability, grounding fidelity, and robustness. Beyond benchmarking, we study its synergy with retrieval-augmented generation, revealing how domain knowledge and visual grounding interact during autoregressive reasoning. Finally, we propose a new mechanism that strengthens the alignment between visual evidence and reasoning, improving both reliability and efficiency. S-Chain establishes a new benchmark for grounded medical reasoning and paves the way toward more trustworthy and explainable medical VLMs.

Recent advances in inference time scaling with extended long chain-of thought have significantly improved the reasoning capabilities of both general and medical large language models (LLMs). However, these models tend to engage in lengthy reasoning processes regardless of the difficulty of the input question, leading to increased inference costs in real-world applications. Therefore, enabling adaptive thinking where models think less for simpler questions and think more for complex ones is critical for the effective use of medical LLMs in practice. Despite its importance, there is a lack of end-to-end approaches designed to enhance the adaptive thinking capabilities of medical LLMs while providing a comprehensive examination of the trade-off between performance and computational cost. To bridge this gap, we propose AdaThink-Med, the first end-to-end framework designed to enhance adaptive thinking ability in medical reasoning models with uncertainty-guided length calibration. AdaThink-Med first generates multiple candidate outputs for each question, evaluates the correctness and uncertainty of each candidate, and then estimates problem difficulty via an uncertainty-guided length calibration module. For outputs with low difficulty and correct answers, the framework penalizes longer reasoning paths; whereas for those with high difficulty and incorrect answers, it encourages extending the chain of thought to explore alternative solutions. On six public medical QA benchmarks, AdaThink-Med achieves up to 6.4x length reduction on average while retaining performance with only minimal degradation. Intriguingly, we observe that AdaThink-Med spontaneously develops two distinct reasoning modes, which we characterize as "non-thinking" and "thinking", demonstrating the model's ability to suppress redundant reasoning processes dynamically.

Chain-of-Thought (CoT) reasoning has proven effective in enhancing large language models by encouraging step-by-step intermediate reasoning, and recent advances have extended this paradigm to Multimodal Large Language Models (MLLMs). In the medical domain, where diagnostic decisions depend on nuanced visual cues and sequential reasoning, CoT aligns naturally with clinical thinking processes. However, Current benchmarks for medical image understanding generally focus on the final answer while ignoring the reasoning path. An opaque process lacks reliable bases for judgment, making it difficult to assist doctors in diagnosis. To address this gap, we introduce a new M3CoTBench benchmark specifically designed to evaluate the correctness, efficiency, impact, and consistency of CoT reasoning in medical image understanding. M3CoTBench features 1) a diverse, multi-level difficulty dataset covering 24 examination types, 2) 13 varying-difficulty tasks, 3) a suite of CoT-specific evaluation metrics (correctness, efficiency, impact, and consistency) tailored to clinical reasoning, and 4) a performance analysis of multiple MLLMs. M3CoTBench systematically evaluates CoT reasoning across diverse medical imaging tasks, revealing current limitations of MLLMs in generating reliable and clinically interpretable reasoning, and aims to foster the development of transparent, trustworthy, and diagnostically accurate AI systems for healthcare. Project page at https://juntaojianggavin.github.io/projects/M3CoTBench/.

Large reasoning models have recently made significant strides in mathematical and code reasoning, yet their success has not transferred smoothly to the medical domain. While multiple factors contribute to this disparity, a critical issue is the inadequate focus on the quality of intermediate reflection steps, which is particularly crucial in high-stakes medical scenarios. To address this challenge, we propose Med-REFL, a \textbf{Med}ical \textbf{R}easoning \textbf{E}nhancement via self-corrected \textbf{F}ine-grained ref\textbf{L}ection. Our method leverages a tree-of-thought approach to decompose medical questions into fine-grained reasoning paths, quantitatively evaluating each step and its subsequent reflections. These assessments enable automatic construction of direct preference optimization data, reducing reliance on expensive expert annotations while guiding models to identify and correct reasoning errors. Experimental results on the MedQA-USMLE benchmark demonstrate Med-REFL achieves consistent improvements, with average gains up to 4.11\%. Notably, it further boosts the state-of-the-art performance of 7B/8B models by an additional 4.13\%. Furthermore, Med-REFL exhibits strong generalization capabilities and robustness across several challenging medical question-answering datasets. Our work illustrates that prioritizing reflection quality leads to more accurate and trustworthy reasoning in medical AI applications. Checkpoints, code, and data can be found https://github.com/TianYin123/Med-REFL{here}.

Large Reasoning Models (LRMs) achieve superior performance by extending the thought length. However, a lengthy thinking trajectory leads to reduced efficiency. Most of the existing methods are stuck in the assumption of overthinking and attempt to reason efficiently by compressing the Chain-of-Thought, but this often leads to performance degradation. To address this problem, we introduce A*-Thought, an efficient tree search-based unified framework designed to identify and isolate the most essential thoughts from the extensive reasoning chains produced by these models. It formulates the reasoning process of LRMs as a search tree, where each node represents a reasoning span in the giant reasoning space. By combining the A* search algorithm with a cost function specific to the reasoning path, it can efficiently compress the chain of thought and determine a reasoning path with high information density and low cost. In addition, we also propose a bidirectional importance estimation mechanism, which further refines this search process and enhances its efficiency beyond uniform sampling. Extensive experiments on several advanced math tasks show that A*-Thought effectively balances performance and efficiency over a huge search space. Specifically, A*-Thought can improve the performance of QwQ-32B by 2.39times with low-budget and reduce the length of the output token by nearly 50% with high-budget. The proposed method is also compatible with several other LRMs, demonstrating its generalization capability. The code can be accessed at: https://github.com/AI9Stars/AStar-Thought.

Recent medical vision-language models have shown promise on tasks such as VQA, report generation, and anomaly detection. However, most are adapted to structured adult imaging and underperform in fetal ultrasound, which poses challenges of multi-view image reasoning, numerous diseases, and image diversity. To bridge this gap, we introduce FetalMind, a medical AI system tailored to fetal ultrasound for both report generation and diagnosis. Guided by clinical workflow, we propose Salient Epistemic Disentanglement (SED), which injects an expert-curated bipartite graph into the model to decouple view-disease associations and to steer preference selection along clinically faithful steps via reinforcement learning. This design mitigates variability across diseases and heterogeneity across views, reducing learning bottlenecks while aligning the model's inference with obstetric practice. To train FetalMind at scale, we curate FetalSigma-1M dataset, the first large-scale fetal ultrasound report corpus, comprising 20K reports from twelve medical centers, addressing the scarcity of domain data. Extensive experiments show that FetalMind outperforms open- and closed-source baselines across all gestational stages, achieving +14% average gains and +61.2% higher accuracy on critical conditions while remaining efficient, stable, and scalable. Project Page: https://hexiao0275.github.io/FetalMind.

While large language models show promise in medical applications, achieving expert-level clinical reasoning remains challenging due to the need for both accurate answers and transparent reasoning processes. To address this challenge, we introduce Fleming-R1, a model designed for verifiable medical reasoning through three complementary innovations. First, our Reasoning-Oriented Data Strategy (RODS) combines curated medical QA datasets with knowledge-graph-guided synthesis to improve coverage of underrepresented diseases, drugs, and multi-hop reasoning chains. Second, we employ Chain-of-Thought (CoT) cold start to distill high-quality reasoning trajectories from teacher models, establishing robust inference priors. Third, we implement a two-stage Reinforcement Learning from Verifiable Rewards (RLVR) framework using Group Relative Policy Optimization, which consolidates core reasoning skills while targeting persistent failure modes through adaptive hard-sample mining. Across diverse medical benchmarks, Fleming-R1 delivers substantial parameter-efficient improvements: the 7B variant surpasses much larger baselines, while the 32B model achieves near-parity with GPT-4o and consistently outperforms strong open-source alternatives. These results demonstrate that structured data design, reasoning-oriented initialization, and verifiable reinforcement learning can advance clinical reasoning beyond simple accuracy optimization. We release Fleming-R1 publicly to promote transparent, reproducible, and auditable progress in medical AI, enabling safer deployment in high-stakes clinical environments.

Complex Question Answering (QA) is a fundamental and challenging task in NLP. While large language models (LLMs) exhibit impressive performance in QA, they suffer from significant performance degradation when facing complex and abstract QA tasks due to insufficient reasoning capabilities. Works such as Chain-of-Thought (CoT) and Tree-of-Thought (ToT) aim to enhance LLMs' reasoning abilities, but they face issues such as in-layer redundancy in tree structures and single paths in chain structures. Although some studies utilize Retrieval-Augmented Generation (RAG) methods to assist LLMs in reasoning, the challenge of effectively utilizing large amounts of information involving multiple entities and hops remains critical. To address this, we propose the Matrix of Thought (MoT), a novel and efficient LLM thought structure. MoT explores the problem in both horizontal and vertical dimensions through the "column-cell communication" mechanism, enabling LLMs to actively engage in multi-strategy and deep-level thinking, reducing redundancy within the column cells and enhancing reasoning capabilities. Furthermore, we develop a fact-correction mechanism by constructing knowledge units from retrieved knowledge graph triples and raw text to enhance the initial knowledge for LLM reasoning and correct erroneous answers. This leads to the development of an efficient and accurate QA framework (MTQA). Experimental results show that our framework outperforms state-of-the-art methods on four widely-used datasets in terms of F1 and EM scores, with reasoning time only 14.4\% of the baseline methods, demonstrating both its efficiency and accuracy. The code for this framework is available at https://github.com/lyfiter/mtqa.

Large Language Models (LLMs) have demonstrated impressive reasoning capabilities, yet their performance is highly dependent on the prompting strategy and model scale. While reinforcement learning and fine-tuning have been deployed to boost reasoning, these approaches incur substantial computational and data overhead. In this work, we introduce Adaptive Graph of Thoughts (AGoT), a dynamic, graph-based inference framework that enhances LLM reasoning solely at test time. Rather than relying on fixed-step methods like Chain of Thought (CoT) or Tree of Thoughts (ToT), AGoT recursively decomposes complex queries into structured subproblems, forming an dynamic directed acyclic graph (DAG) of interdependent reasoning steps. By selectively expanding only those subproblems that require further analysis, AGoT unifies the strengths of chain, tree, and graph paradigms into a cohesive framework that allocates computation where it is most needed. We validate our approach on diverse benchmarks spanning multi-hop retrieval, scientific reasoning, and mathematical problem-solving, achieving up to 46.2% improvement on scientific reasoning tasks (GPQA) - comparable to gains achieved through computationally intensive reinforcement learning approaches and outperforming state-of-the-art iterative approaches. These results suggest that dynamic decomposition and structured recursion offer a scalable, cost-effective alternative to post-training modifications, paving the way for more robust, general-purpose reasoning in LLMs.

We introduce Graph of Thoughts (GoT): a framework that advances prompting capabilities in large language models (LLMs) beyond those offered by paradigms such as Chain-of-Thought or Tree of Thoughts (ToT). The key idea and primary advantage of GoT is the ability to model the information generated by an LLM as an arbitrary graph, where units of information ("LLM thoughts") are vertices, and edges correspond to dependencies between these vertices. This approach enables combining arbitrary LLM thoughts into synergistic outcomes, distilling the essence of whole networks of thoughts, or enhancing thoughts using feedback loops. We illustrate that GoT offers advantages over state of the art on different tasks, for example increasing the quality of sorting by 62% over ToT, while simultaneously reducing costs by >31%. We ensure that GoT is extensible with new thought transformations and thus can be used to spearhead new prompting schemes. This work brings the LLM reasoning closer to human thinking or brain mechanisms such as recurrence, both of which form complex networks.

The Quantum-Inspired Stacked Integrated Concept Graph Model (QISICGM) is an innovative machine learning framework that harnesses quantum-inspired techniques to predict diabetes risk with exceptional accuracy and efficiency. Utilizing the PIMA Indians Diabetes dataset augmented with 2,000 synthetic samples to mitigate class imbalance (total: 2,768 samples, 1,949 positives), QISICGM integrates a self-improving concept graph with a stacked ensemble comprising Random Forests (RF), Extra Trees (ET), transformers, convolutional neural networks (CNNs), and feed-forward neural networks (FFNNs). This approach achieves an out-of-fold (OOF) F1 score of 0.8933 and an AUC of 0.8699, outperforming traditional methods. Quantum inspired elements, such as phase feature mapping and neighborhood sequence modeling, enrich feature representations, enabling CPU-efficient inference at 8.5 rows per second. This paper presents a detailed architecture, theoretical foundations, code insights, and performance evaluations, including visualizations from the outputs subfolder. The open-source implementation (v1.0.0) is available at https://github.com/keninayoung/QISICGM, positioning QISICGM as a potential benchmark for AI-assisted clinical triage in diabetes and beyond. Ultimately, this work emphasizes trustworthy AI through calibration, interpretability, and open-source reproducibility.

Multimodal large language models (MLLMs) have begun to demonstrate robust reasoning capabilities on general tasks, yet their application in the medical domain remains in its early stages. Constructing chain-of-thought (CoT) training data is essential for bolstering the reasoning abilities of medical MLLMs. However, existing approaches exhibit a deficiency in offering a comprehensive framework for searching and evaluating effective reasoning paths towards critical diagnosis. To address this challenge, we propose Mentor-Intern Collaborative Search (MICS), a novel reasoning-path searching scheme to generate rigorous and effective medical CoT data. MICS first leverages mentor models to initialize the reasoning, one step at a time, then prompts each intern model to continue the thinking along those initiated paths, and finally selects the optimal reasoning path according to the overall reasoning performance of multiple intern models. The reasoning performance is determined by an MICS-Score, which assesses the quality of generated reasoning paths. Eventually, we construct MMRP, a multi-task medical reasoning dataset with ranked difficulty, and Chiron-o1, a new medical MLLM devised via a curriculum learning strategy, with robust visual question-answering and generalizable reasoning capabilities. Extensive experiments demonstrate that Chiron-o1, trained on our CoT dataset constructed using MICS, achieves state-of-the-art performance across a list of medical visual question answering and reasoning benchmarks. Codes are available at GitHub - manglu097/Chiron-o1: Enhancing Step-by-Step and Verifiable Medical Reasoning in MLLMs

Chain-of-thought (CoT) decoding enables language models to improve reasoning performance at the cost of high generation latency in decoding. Recent proposals have explored variants of contemplation tokens, a term we introduce that refers to special tokens used during inference to allow for extra computation. Prior work has considered fixed-length sequences drawn from a discrete set of embeddings as contemplation tokens. Here we propose Compressed Chain-of-Thought (CCoT), a framework to generate contentful and continuous contemplation tokens of variable sequence length. The generated contemplation tokens are compressed representations of explicit reasoning chains, and our method can be applied to off-the-shelf decoder language models. Through experiments, we illustrate how CCoT enables additional reasoning over dense contentful representations to achieve corresponding improvements in accuracy. Moreover, the reasoning improvements can be adaptively modified on demand by controlling the number of contemplation tokens generated.

Large reasoning models (LRMs) have shown significant progress in test-time scaling through chain-of-thought prompting. Current approaches like search-o1 integrate retrieval augmented generation (RAG) into multi-step reasoning processes but rely on a single, linear reasoning chain while incorporating unstructured textual information in a flat, context-agnostic manner. As a result, these approaches can lead to error accumulation throughout the reasoning chain, which significantly limits its effectiveness in medical question-answering (QA) tasks where both accuracy and traceability are critical requirements. To address these challenges, we propose MIRAGE (Multi-chain Inference with Retrieval-Augmented Graph Exploration), a novel test-time scalable reasoning framework that performs dynamic multi-chain inference over structured medical knowledge graphs. Specifically, MIRAGE 1) decomposes complex queries into entity-grounded sub-questions, 2) executes parallel inference chains, 3) retrieves evidence adaptively via neighbor expansion and multi-hop traversal, and 4) integrates answers using cross-chain verification to resolve contradictions. Experiments on three medical QA benchmarks (GenMedGPT-5k, CMCQA, and ExplainCPE) show that MIRAGE consistently outperforms GPT-4o, Tree-of-Thought variants, and other retrieval-augmented baselines in both automatic and human evaluations. Additionally, MIRAGE improves interpretability by generating explicit reasoning chains that trace each factual claim to concrete chains within the knowledge graph, making it well-suited for complex medical reasoning scenarios. The code will be available for further research.

Clinical dialogue represents a complex duality requiring both the empathetic fluency of natural conversation and the rigorous precision of evidence-based medicine. While Large Language Models possess unprecedented linguistic capabilities, their architectural reliance on reactive and stateless processing often favors probabilistic plausibility over factual veracity. This structural limitation has catalyzed a paradigm shift in medical AI from generative text prediction to agentic autonomy, where the model functions as a central reasoning engine capable of deliberate planning and persistent memory. Moving beyond existing reviews that primarily catalog downstream applications, this survey provides a first-principles analysis of the cognitive architecture underpinning this shift. We introduce a novel taxonomy structured along the orthogonal axes of knowledge source and agency objective to delineate the provenance of clinical knowledge against the system's operational scope. This framework facilitates a systematic analysis of the intrinsic trade-offs between creativity and reliability by categorizing methods into four archetypes: Latent Space Clinicians, Emergent Planners, Grounded Synthesizers, and Verifiable Workflow Automators. For each paradigm, we deconstruct the technical realization across the entire cognitive pipeline, encompassing strategic planning, memory management, action execution, collaboration, and evolution to reveal how distinct architectural choices balance the tension between autonomy and safety.

Current Large Language Models (LLMs) exhibit significant limitations, notably in structured, interpretable, and verifiable medical reasoning, alongside practical deployment challenges related to computational resources and data privacy. This report focused on the development of WiNGPT-3.0, the 32-billion parameter LLMs, engineered with the objective of enhancing its capacity for medical reasoning and exploring its potential for effective integration within healthcare IT infrastructures. The broader aim is to advance towards clinically applicable models. The approach involved a multi-stage training pipeline tailored for general, medical, and clinical reasoning. This pipeline incorporated supervised fine-tuning (SFT) and reinforcement learning (RL), leveraging curated Long Chain-of-Thought (CoT) datasets, auxiliary reward models, and an evidence-based diagnostic chain simulation. WiNGPT-3.0 demonstrated strong performance: specific model variants achieved scores of 66.6 on MedCalc and 87.1 on MedQA-USMLE. Furthermore, targeted training improved performance on a clinical reasoning task from a baseline score of 58.1 to 62.5. These findings suggest that reinforcement learning, even when applied with a limited dataset of only a few thousand examples, can enhance medical reasoning accuracy. Crucially, this demonstration of RL's efficacy with limited data and computation paves the way for more trustworthy and practically deployable LLMs within clinical workflows and health information infrastructures.

Recent developments in Large Language Model (LLM)-based agents have shown impressive capabilities spanning multiple domains, exemplified by deep research systems that demonstrate superior performance on complex information-seeking and synthesis tasks. While general-purpose deep research agents have shown impressive capabilities, they struggle significantly with medical domain challenges, as evidenced by leading proprietary systems achieving limited accuracy on complex medical benchmarks. The key limitations are: (1) the model lacks sufficient dense medical knowledge for clinical reasoning, and (2) the framework is constrained by the absence of specialized retrieval tools tailored for medical contexts.We present a medical deep research agent that addresses these challenges through two core innovations. First, we develop a novel data synthesis framework using medical knowledge graphs, extracting the longest chains from subgraphs around rare medical entities to generate complex multi-hop question-answer pairs. Second, we integrate a custom-built private medical retrieval engine alongside general-purpose tools, enabling accurate medical information synthesis. Our approach generates 2100+ diverse trajectories across 12 medical specialties, each averaging 4.2 tool interactions.Through a two-stage training paradigm combining supervised fine-tuning and online reinforcement learning with composite rewards, our MedResearcher-R1-32B model demonstrates exceptional performance, establishing new state-of-the-art results on medical benchmarks while maintaining competitive performance on general deep research tasks. Our work demonstrates that strategic domain-specific innovations in architecture, tool design, and training data construction can enable smaller open-source models to outperform much larger proprietary systems in specialized domains.

Large Reasoning Models(LRMs) such as OpenAI o1 and DeepSeek-R1 have shown remarkable reasoning capabilities by scaling test-time compute and generating long Chain-of-Thought(CoT). Distillation--post-training on LRMs-generated data--is a straightforward yet effective method to enhance the reasoning abilities of smaller models, but faces a critical bottleneck: we found that distilled long CoT data poses learning difficulty for small models and leads to the inheritance of biases (i.e. over-thinking) when using Supervised Fine-tuning(SFT) and Reinforcement Learning(RL) methods. To alleviate this bottleneck, we propose constructing tree-based CoT data from scratch via Monte Carlo Tree Search(MCTS). We then exploit a set of CoT-aware approaches, including Thoughts Length Balance, Fine-grained DPO, and Joint Post-training Objective, to enhance SFT and RL on the construted data.

Large language models (LLMs) have shown promise for generative and knowledge-intensive tasks including question-answering (QA) tasks. However, the practical deployment still faces challenges, notably the issue of "hallucination", where models generate plausible-sounding but unfaithful or nonsensical information. This issue becomes particularly critical in the medical domain due to the uncommon professional concepts and potential social risks involved. This paper analyses the phenomenon of hallucination in medical generative QA systems using widely adopted LLMs and datasets. Our investigation centers on the identification and comprehension of common problematic answers, with a specific emphasis on hallucination. To tackle this challenge, we present an interactive self-reflection methodology that incorporates knowledge acquisition and answer generation. Through this feedback process, our approach steadily enhances the factuality, consistency, and entailment of the generated answers. Consequently, we harness the interactivity and multitasking ability of LLMs and produce progressively more precise and accurate answers. Experimental results on both automatic and human evaluation demonstrate the superiority of our approach in hallucination reduction compared to baselines.

Traditional Chinese medicine (TCM) plays a vital role in health protection and disease treatment, but its practical application requires extensive medical knowledge and clinical experience. Existing TCM Large Language Models (LLMs) exhibit critical limitations of uncomprehensive medical consultation and diagnoses, and inaccurate syndrome differentiation-based treatment. To address these issues, this study establishes JingFang (JF): a novel TCM Large Language Model that demonstrates the expert-level capability of medical diagnosis and syndrome differentiation-based treatment. We innovate a Multi-agent Dynamic Collaborative Chain-of-Thought Mechanism (MDCCTM) for medical consultation, enabling JF with effective and accurate diagnostic ability. In addition, a Syndrome Agent and a Dual-Stage Retrieval Scheme (DSRS) are developed to significantly enhance the capacity of JF for disease treatment based on syndrome differentiation. JingFang not only facilitates the application of LLMs but also promotes the effective practice of TCM in human health protection and disease treatment.

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

Medical language models (MLMs) have become pivotal in advancing medical natural language processing. However, prior models that rely on pre-training or supervised fine-tuning often exhibit low data efficiency and limited practicality in real-world clinical applications. While OpenAIs O1 highlights test-time scaling in mathematics, attempts to replicate this approach in medicine typically distill responses from GPT-series models to open-source models, focusing primarily on multiple-choice tasks. This strategy, though straightforward, neglects critical concerns like data privacy and realistic deployment in clinical settings. In this work, we present a deployable, small-scale medical language model, \mone, designed for long-chain reasoning in clinical tasks using a self-evolution paradigm. Starting with a seed dataset of around 8,000 instances spanning five domains and 16 datasets, we prompt a base policy model to perform Monte Carlo Tree Search (MCTS) to construct verifiable reasoning chains. Each reasoning step is assigned an evolution rollout value, allowing verified trajectories to train the policy model and the reward model. During inference, the policy model generates multiple responses, and the reward model selects the one with the highest reward score. Experiments on eleven evaluation datasets demonstrate that \mone outperforms prior open-source models by 2 points, with the addition of the reward model further boosting performance (sim13 points), surpassing GPT-4o-mini. Code and data are available at https://github.com/pixas/MedSSS.

This paper presents our team's participation in the MEDIQA-ClinicalNLP2024 shared task B. We present a novel approach to diagnosing clinical dermatology cases by integrating large multimodal models, specifically leveraging the capabilities of GPT-4V under a retriever and a re-ranker framework. Our investigation reveals that GPT-4V, when used as a retrieval agent, can accurately retrieve the correct skin condition 85% of the time using dermatological images and brief patient histories. Additionally, we empirically show that Naive Chain-of-Thought (CoT) works well for retrieval while Medical Guidelines Grounded CoT is required for accurate dermatological diagnosis. Further, we introduce a Multi-Agent Conversation (MAC) framework and show its superior performance and potential over the best CoT strategy. The experiments suggest that using naive CoT for retrieval and multi-agent conversation for critique-based diagnosis, GPT-4V can lead to an early and accurate diagnosis of dermatological conditions. The implications of this work extend to improving diagnostic workflows, supporting dermatological education, and enhancing patient care by providing a scalable, accessible, and accurate diagnostic tool.

Recent advancements in large language models have showcased their remarkable generalizability across various domains. However, their reasoning abilities still have significant room for improvement, especially when confronted with scenarios requiring multi-step reasoning. Although large language models possess extensive knowledge, their behavior, particularly in terms of reasoning, often fails to effectively utilize this knowledge to establish a coherent thinking paradigm. Generative language models sometimes show hallucinations as their reasoning procedures are unconstrained by logical principles. Aiming to improve the zero-shot chain-of-thought reasoning ability of large language models, we propose Logical Chain-of-Thought (LogiCoT), a neurosymbolic framework that leverages principles from symbolic logic to verify and revise the reasoning processes accordingly. Experimental evaluations conducted on language tasks in diverse domains, including arithmetic, commonsense, symbolic, causal inference, and social problems, demonstrate the efficacy of the enhanced reasoning paradigm by logic.

Improving performance on complex tasks and enabling interpretable decision making in large language models (LLMs), especially for clinical applications, requires effective reasoning. Yet this remains challenging without supervised fine-tuning (SFT) on costly chain-of-thought (CoT) data distilled from closed-source models (e.g., GPT-4o). In this work, we present AlphaMed, the first medical LLM to show that reasoning capability can emerge purely through reinforcement learning (RL), using minimalist rule-based rewards on public multiple-choice QA datasets, without relying on SFT or distilled CoT data. AlphaMed achieves state-of-the-art results on six medical QA benchmarks, outperforming models trained with conventional SFT+RL pipelines. On challenging benchmarks (e.g., MedXpert), AlphaMed even surpasses larger or closed-source models such as DeepSeek-V3-671B and Claude-3.5-Sonnet. To understand the factors behind this success, we conduct a comprehensive data-centric analysis guided by three questions: (i) Can minimalist rule-based RL incentivize reasoning without distilled CoT supervision? (ii) How do dataset quantity and diversity impact reasoning? (iii) How does question difficulty shape the emergence and generalization of reasoning? Our findings show that dataset informativeness is a key driver of reasoning performance, and that minimalist RL on informative, multiple-choice QA data is effective at inducing reasoning without CoT supervision. We also observe divergent trends across benchmarks, underscoring limitations in current evaluation and the need for more challenging, reasoning-oriented medical QA benchmarks.

Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...

Classical self-supervised networks suffer from convergence problems and reduced segmentation accuracy due to forceful termination. Qubits or bi-level quantum bits often describe quantum neural network models. In this article, a novel self-supervised shallow learning network model exploiting the sophisticated three-level qutrit-inspired quantum information system referred to as Quantum Fully Self-Supervised Neural Network (QFS-Net) is presented for automated segmentation of brain MR images. The QFS-Net model comprises a trinity of a layered structure of qutrits inter-connected through parametric Hadamard gates using an 8-connected second-order neighborhood-based topology. The non-linear transformation of the qutrit states allows the underlying quantum neural network model to encode the quantum states, thereby enabling a faster self-organized counter-propagation of these states between the layers without supervision. The suggested QFS-Net model is tailored and extensively validated on Cancer Imaging Archive (TCIA) data set collected from Nature repository and also compared with state of the art supervised (U-Net and URes-Net architectures) and the self-supervised QIS-Net model. Results shed promising segmented outcome in detecting tumors in terms of dice similarity and accuracy with minimum human intervention and computational resources.

Objective: To transform heterogeneous clinical data from electronic health records into clinically meaningful constructed features using data driven method that rely, in part, on temporal relations among data. Materials and Methods: The clinically meaningful representations of medical concepts and patients are the key for health analytic applications. Most of existing approaches directly construct features mapped to raw data (e.g., ICD or CPT codes), or utilize some ontology mapping such as SNOMED codes. However, none of the existing approaches leverage EHR data directly for learning such concept representation. We propose a new way to represent heterogeneous medical concepts (e.g., diagnoses, medications and procedures) based on co-occurrence patterns in longitudinal electronic health records. The intuition behind the method is to map medical concepts that are co-occuring closely in time to similar concept vectors so that their distance will be small. We also derive a simple method to construct patient vectors from the related medical concept vectors. Results: For qualitative evaluation, we study similar medical concepts across diagnosis, medication and procedure. In quantitative evaluation, our proposed representation significantly improves the predictive modeling performance for onset of heart failure (HF), where classification methods (e.g. logistic regression, neural network, support vector machine and K-nearest neighbors) achieve up to 23% improvement in area under the ROC curve (AUC) using this proposed representation. Conclusion: We proposed an effective method for patient and medical concept representation learning. The resulting representation can map relevant concepts together and also improves predictive modeling performance.

Large Reasoning Models (LRMs) have introduced a new paradigm in AI by enabling models to ``think before responding" via chain-of-thought reasoning. However, the absence of open and reproducible recipes for building reasoning-centric medical LMMs hinders community-wide research, analysis, and comparison. In this paper, we present MedVLThinker, a suite of simple yet strong baselines. Our fully open recipe consists of: (1) systematic data curation for both text-only and image-text medical data, filtered according to varying levels of reasoning difficulty, and (2) two training paradigms: Supervised Fine-Tuning (SFT) on distilled reasoning traces and Reinforcement Learning with Verifiable Rewards (RLVR) based on final answer correctness. Across extensive experiments on the Qwen2.5-VL model family (3B, 7B) and six medical QA benchmarks, we find that RLVR consistently and significantly outperforms SFT. Additionally, under the RLVR framework, a key, counter-intuitive finding is that training on our curated text-only reasoning data provides a more substantial performance boost than training on multimodal image-text data. Our best open 7B model, trained using the RLVR recipe on text-only data, establishes a new state-of-the-art on existing public VQA benchmarks, surpassing all previous open-source medical LMMs. Furthermore, scaling our model to 32B achieves performance on par with the proprietary GPT-4o. We release all curated data, models, and code to provide the community with a strong, open foundation for future research in multimodal medical reasoning.

By extending the advantage of chain-of-thought (CoT) reasoning in human-like step-by-step processes to multimodal contexts, multimodal CoT (MCoT) reasoning has recently garnered significant research attention, especially in the integration with multimodal large language models (MLLMs). Existing MCoT studies design various methodologies and innovative reasoning paradigms to address the unique challenges of image, video, speech, audio, 3D, and structured data across different modalities, achieving extensive success in applications such as robotics, healthcare, autonomous driving, and multimodal generation. However, MCoT still presents distinct challenges and opportunities that require further focus to ensure consistent thriving in this field, where, unfortunately, an up-to-date review of this domain is lacking. To bridge this gap, we present the first systematic survey of MCoT reasoning, elucidating the relevant foundational concepts and definitions. We offer a comprehensive taxonomy and an in-depth analysis of current methodologies from diverse perspectives across various application scenarios. Furthermore, we provide insights into existing challenges and future research directions, aiming to foster innovation toward multimodal AGI.

Language models are increasingly being deployed for general problem solving across a wide range of tasks, but are still confined to token-level, left-to-right decision-making processes during inference. This means they can fall short in tasks that require exploration, strategic lookahead, or where initial decisions play a pivotal role. To surmount these challenges, we introduce a new framework for language model inference, Tree of Thoughts (ToT), which generalizes over the popular Chain of Thought approach to prompting language models, and enables exploration over coherent units of text (thoughts) that serve as intermediate steps toward problem solving. ToT allows LMs to perform deliberate decision making by considering multiple different reasoning paths and self-evaluating choices to decide the next course of action, as well as looking ahead or backtracking when necessary to make global choices. Our experiments show that ToT significantly enhances language models' problem-solving abilities on three novel tasks requiring non-trivial planning or search: Game of 24, Creative Writing, and Mini Crosswords. For instance, in Game of 24, while GPT-4 with chain-of-thought prompting only solved 4% of tasks, our method achieved a success rate of 74%. Code repo with all prompts: https://github.com/ysymyth/tree-of-thought-llm.

Recent advancements in reasoning language models have demonstrated remarkable performance in complex tasks, but their extended chain-of-thought reasoning process increases inference overhead. While quantization has been widely adopted to reduce the inference cost of large language models, its impact on reasoning models remains understudied. In this study, we conduct the first systematic study on quantized reasoning models, evaluating the open-sourced DeepSeek-R1-Distilled Qwen and LLaMA families ranging from 1.5B to 70B parameters, and QwQ-32B. Our investigation covers weight, KV cache, and activation quantization using state-of-the-art algorithms at varying bit-widths, with extensive evaluation across mathematical (AIME, MATH-500), scientific (GPQA), and programming (LiveCodeBench) reasoning benchmarks. Our findings reveal that while lossless quantization can be achieved with W8A8 or W4A16 quantization, lower bit-widths introduce significant accuracy risks. We further identify model size, model origin, and task difficulty as critical determinants of performance. Contrary to expectations, quantized models do not exhibit increased output lengths. In addition, strategically scaling the model sizes or reasoning steps can effectively enhance the performance. All quantized models and codes will be open-sourced in https://github.com/ruikangliu/Quantized-Reasoning-Models.

Medical conversational AI (AI) plays a pivotal role in the development of safer and more effective medical dialogue systems. However, existing benchmarks and evaluation frameworks for assessing the information-gathering and diagnostic reasoning abilities of medical large language models (LLMs) have not been rigorously evaluated. To address these gaps, we present MedDialogRubrics, a novel benchmark comprising 5,200 synthetically constructed patient cases and over 60,000 fine-grained evaluation rubrics generated by LLMs and subsequently refined by clinical experts, specifically designed to assess the multi-turn diagnostic capabilities of LLM. Our framework employs a multi-agent system to synthesize realistic patient records and chief complaints from underlying disease knowledge without accessing real-world electronic health records, thereby mitigating privacy and data-governance concerns. We design a robust Patient Agent that is limited to a set of atomic medical facts and augmented with a dynamic guidance mechanism that continuously detects and corrects hallucinations throughout the dialogue, ensuring internal coherence and clinical plausibility of the simulated cases. Furthermore, we propose a structured LLM-based and expert-annotated rubric-generation pipeline that retrieves Evidence-Based Medicine (EBM) guidelines and utilizes the reject sampling to derive a prioritized set of rubric items ("must-ask" items) for each case. We perform a comprehensive evaluation of state-of-the-art models and demonstrate that, across multiple assessment dimensions, current models face substantial challenges. Our results indicate that improving medical dialogue will require advances in dialogue management architectures, not just incremental tuning of the base-model.

We introduce a novel graph-based Retrieval-Augmented Generation (RAG) framework specifically designed for the medical domain, called MedGraphRAG, aimed at enhancing Large Language Model (LLM) capabilities and generating evidence-based results, thereby improving safety and reliability when handling private medical data. Our comprehensive pipeline begins with a hybrid static-semantic approach to document chunking, significantly improving context capture over traditional methods. Extracted entities are used to create a three-tier hierarchical graph structure, linking entities to foundational medical knowledge sourced from medical papers and dictionaries. These entities are then interconnected to form meta-graphs, which are merged based on semantic similarities to develop a comprehensive global graph. This structure supports precise information retrieval and response generation. The retrieval process employs a U-retrieve method to balance global awareness and indexing efficiency of the LLM. Our approach is validated through a comprehensive ablation study comparing various methods for document chunking, graph construction, and information retrieval. The results not only demonstrate that our hierarchical graph construction method consistently outperforms state-of-the-art models on multiple medical Q\&A benchmarks, but also confirms that the responses generated include source documentation, significantly enhancing the reliability of medical LLMs in practical applications. Code will be at: https://github.com/MedicineToken/Medical-Graph-RAG/tree/main

Iterative human engagement is a common and effective means of leveraging the advanced language processing power of large language models (LLMs). Using well-structured prompts in a conversational manner, human users can effectively influence an LLM to develop more thoughtful and accurate responses. Motivated by this insight, we propose the Iteration of Thought (IoT) framework for enhancing LLM responses by generating "thought"-provoking prompts vis a vis an input query and the current iteration of an LLM's response. Unlike static or semi-static approaches, e.g. Chain of Thought (CoT) or Tree of Thoughts (ToT), IoT adapts its reasoning path dynamically, based on evolving context, and without generating alternate explorative thoughts which are ultimately discarded. The three components of the IoT framework are (1) an Inner Dialogue Agent (IDA) responsible for generating instructive, context-specific prompts; (2) an LLM Agent (LLMA) that processes these prompts to refine its responses; and (3) an iterative prompting loop that implements a conversation between the former two components. We introduce two variants of our framework: Autonomous Iteration of Thought (AIoT), where an LLM decides when to stop iterating, and Guided Iteration of Thought (GIoT), which always forces a fixed number iterations. We investigate the performance of IoT across various datasets, spanning complex reasoning tasks from the GPQA dataset, explorative problem-solving in Game of 24, puzzle solving in Mini Crosswords, and multi-hop question answering from the HotpotQA dataset. Our results show that IoT represents a viable paradigm for autonomous response refinement in LLMs, showcasing significant improvements over CoT and thereby enabling more adaptive and efficient reasoning systems that minimize human intervention.

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

While recent advancements in commercial large language models (LM) have shown promising results in medical tasks, their closed-source nature poses significant privacy and security concerns, hindering their widespread use in the medical field. Despite efforts to create open-source models, their limited parameters often result in insufficient multi-step reasoning capabilities required for solving complex medical problems. To address this, we introduce Meerkat-7B, a novel medical AI system with 7 billion parameters. Meerkat-7B was trained using our new synthetic dataset consisting of high-quality chain-of-thought reasoning paths sourced from 18 medical textbooks, along with diverse instruction-following datasets. Our system achieved remarkable accuracy across seven medical benchmarks, surpassing GPT-3.5 by 13.1%, as well as outperforming the previous best 7B models such as MediTron-7B and BioMistral-7B by 13.4% and 9.8%, respectively. Notably, it surpassed the passing threshold of the United States Medical Licensing Examination (USMLE) for the first time for a 7B-parameter model. Additionally, our system offered more detailed free-form responses to clinical queries compared to existing 7B and 13B models, approaching the performance level of GPT-3.5. This significantly narrows the performance gap with large LMs, showcasing its effectiveness in addressing complex medical challenges.

The increasing administrative burden of medical documentation, particularly through Electronic Health Records (EHR), significantly reduces the time available for direct patient care and contributes to physician burnout. To address this issue, we propose MediNotes, an advanced generative AI framework designed to automate the creation of SOAP (Subjective, Objective, Assessment, Plan) notes from medical conversations. MediNotes integrates Large Language Models (LLMs), Retrieval-Augmented Generation (RAG), and Automatic Speech Recognition (ASR) to capture and process both text and voice inputs in real time or from recorded audio, generating structured and contextually accurate medical notes. The framework also incorporates advanced techniques like Quantized Low-Rank Adaptation (QLoRA) and Parameter-Efficient Fine-Tuning (PEFT) for efficient model fine-tuning in resource-constrained environments. Additionally, MediNotes offers a query-based retrieval system, allowing healthcare providers and patients to access relevant medical information quickly and accurately. Evaluations using the ACI-BENCH dataset demonstrate that MediNotes significantly improves the accuracy, efficiency, and usability of automated medical documentation, offering a robust solution to reduce the administrative burden on healthcare professionals while improving the quality of clinical workflows.

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities with reinforcement learning paradigm. Although several multimodal reasoning models have been explored in the medical domain, most of them focus exclusively on basic reasoning, which refers to shallow inference based on visual feature matching. However, real-world clinical diagnosis extends beyond basic reasoning, demanding reasoning processes that integrate heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, the first ophthalmic multimodal dataset with the full spectrum of perception and reasoning. It encompasses both basic reasoning tasks and complex reasoning tasks, aiming to enhance visual-centric fundamental reasoning capabilities and emulate realistic clinical thinking patterns. Building upon MM-Retinal-Reason, we propose OphthaReason, the first ophthalmology-specific multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we specifically design a novel method called Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates the model's exploration depth using a shaped advantage mechanism. Comprehensive experiments demonstrate that our model achieves state-of-the-art performance on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 24.92\%, 15.00\%, 21.20\%, and 17.66\%. Project Page: https://github.com/lxirich/OphthaReason{link}.

Medical visual question answering aims to support clinical decision-making by enabling models to answer natural language questions based on medical images. While recent advances in multi-modal learning have significantly improved performance, current methods still suffer from limited answer reliability and poor interpretability, impairing the ability of clinicians and patients to understand and trust model-generated answers. To address this, this work first proposes a Thinking with Visual Grounding (ThinkVG) dataset wherein the answer generation is decomposed into intermediate reasoning steps that explicitly ground relevant visual regions of the medical image, thereby providing fine-grained explainability. Furthermore, we introduce a novel verifiable reward mechanism for reinforcement learning to guide post-training, improving the alignment between the model's reasoning process and its final answer. Remarkably, our method achieves comparable performance using only one-eighth of the training data, demonstrating the efficiency and effectiveness of the proposal. The dataset is available at https://huggingface.co/datasets/BoKelvin/GEMeX-ThinkVG.

Counterfactual medical image generation effectively addresses data scarcity and enhances the interpretability of medical images. However, due to the complex and diverse pathological features of medical images and the imbalanced class distribution in medical data, generating high-quality and diverse medical images from limited data is significantly challenging. Additionally, to fully leverage the information in limited data, such as anatomical structure information and generate more structurally stable medical images while avoiding distortion or inconsistency. In this paper, in order to enhance the clinical relevance of generated data and improve the interpretability of the model, we propose a novel medical image generation framework, which generates independent pathological and structural features based on causal disentanglement and utilizes text-guided modeling of pathological features to regulate the generation of counterfactual images. First, we achieve feature separation through causal disentanglement and analyze the interactions between features. Here, we introduce group supervision to ensure the independence of pathological and identity features. Second, we leverage a diffusion model guided by pathological findings to model pathological features, enabling the generation of diverse counterfactual images. Meanwhile, we enhance accuracy by leveraging a large language model to extract lesion severity and location from medical reports. Additionally, we improve the performance of the latent diffusion model on long-tailed categories through initial noise optimization.

While deep networks have achieved broad success in analyzing natural images, when applied to medical scans, they often fail in unexcepted situations. We investigate this challenge and focus on model sensitivity to domain shifts, such as data sampled from different hospitals or data confounded by demographic variables such as sex, race, etc, in the context of chest X-rays and skin lesion images. A key finding we show empirically is that existing visual backbones lack an appropriate prior from the architecture for reliable generalization in these settings. Taking inspiration from medical training, we propose giving deep networks a prior grounded in explicit medical knowledge communicated in natural language. To this end, we introduce Knowledge-enhanced Bottlenecks (KnoBo), a class of concept bottleneck models that incorporates knowledge priors that constrain it to reason with clinically relevant factors found in medical textbooks or PubMed. KnoBo uses retrieval-augmented language models to design an appropriate concept space paired with an automatic training procedure for recognizing the concept. We evaluate different resources of knowledge and recognition architectures on a broad range of domain shifts across 20 datasets. In our comprehensive evaluation with two imaging modalities, KnoBo outperforms fine-tuned models on confounded datasets by 32.4% on average. Finally, evaluations reveal that PubMed is a promising resource for making medical models less sensitive to domain shift, outperforming other resources on both diversity of information and final prediction performance.

Large language models (LLMs) demonstrate significant reasoning capabilities, particularly through long chain-of-thought (CoT) processes, which can be elicited by reinforcement learning (RL). However, prolonged CoT reasoning presents limitations, primarily verbose outputs due to excessive introspection. The reasoning process in these LLMs often appears to follow a trial-and-error methodology rather than a systematic, logical deduction. In contrast, tree-of-thoughts (ToT) offers a conceptually more advanced approach by modeling reasoning as an exploration within a tree structure. This reasoning structure facilitates the parallel generation and evaluation of multiple reasoning branches, allowing for the active identification, assessment, and pruning of unproductive paths. This process can potentially lead to improved performance and reduced token costs. Building upon the long CoT capability of LLMs, we introduce tree-of-thoughts RL (ToTRL), a novel on-policy RL framework with a rule-based reward. ToTRL is designed to guide LLMs in developing the parallel ToT strategy based on the sequential CoT strategy. Furthermore, we employ LLMs as players in a puzzle game during the ToTRL training process. Solving puzzle games inherently necessitates exploring interdependent choices and managing multiple constraints, which requires the construction and exploration of a thought tree, providing challenging tasks for cultivating the ToT reasoning capability. Our empirical evaluations demonstrate that our ToTQwen3-8B model, trained with our ToTRL, achieves significant improvement in performance and reasoning efficiency on complex reasoning tasks.

While Chain-of-Thought (CoT) prompting enables sophisticated symbolic reasoning in LLMs, it remains confined to discrete text and cannot simulate the continuous, physics-governed dynamics of the real world. Recent video generation models have emerged as potential world simulators through Chain-of-Frames (CoF) reasoning -- materializing thought as frame-by-frame visual sequences, with each frame representing a physically-grounded reasoning step. Despite compelling demonstrations, a challenge persists: existing benchmarks, focusing on fidelity or alignment, do not assess CoF reasoning and thus cannot measure core cognitive abilities in multi-step planning, algorithmic logic, or abstract pattern extrapolation. This evaluation void prevents systematic understanding of model capabilities and principled guidance for improvement. We introduce Gen-ViRe (Generative Visual Reasoning Benchmark), a framework grounded in cognitive science and real-world AI applications, which decomposes CoF reasoning into six cognitive dimensions -- from perceptual logic to abstract planning -- and 24 subtasks. Through multi-source data curation, minimal prompting protocols, and hybrid VLM-assisted evaluation with detailed criteria, Gen-ViRe delivers the first quantitative assessment of video models as reasoners. Our experiments on SOTA systems reveal substantial discrepancies between impressive visual quality and actual reasoning depth, establishing baselines and diagnostic tools to advance genuine world simulators.

Recent advancements in Large Language Models (LLMs) have revolutionized decision-making by breaking down complex problems into more manageable language sequences referred to as ``thoughts''. An effective thought design should consider three key perspectives: performance, efficiency, and flexibility. However, existing thought can at most exhibit two of these attributes. To address these limitations, we introduce a novel thought prompting approach called ``Everything of Thoughts'' (XoT) to defy the law of ``Penrose triangle of existing thought paradigms. XoT leverages pretrained reinforcement learning and Monte Carlo Tree Search (MCTS) to incorporate external domain knowledge into thoughts, thereby enhancing LLMs' capabilities and enabling them to generalize to unseen problems efficiently. Through the utilization of the MCTS-LLM collaborative thought revision framework, this approach autonomously produces high-quality comprehensive cognitive mappings with minimal LLM interactions. Additionally, XoT empowers LLMs to engage in unconstrained thinking, allowing for flexible cognitive mappings for problems with multiple solutions.

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Large language models (LLMs) have demonstrated strong performance and rapid progress in a wide range of medical reasoning tasks. However, their sequential autoregressive decoding forces inherently parallel clinical reasoning, such as differential diagnosis, into a single linear reasoning path, limiting both efficiency and reliability for complex medical problems. To address this, we propose MedVerse, a reasoning framework for complex medical inference that reformulates medical reasoning as a parallelizable directed acyclic graph (DAG) process based on Petri net theory. The framework adopts a full-stack design across data, model architecture, and system execution. For data creation, we introduce the MedVerse Curator, an automated pipeline that synthesizes knowledge-grounded medical reasoning paths and transforms them into Petri net-structured representations. At the architectural level, we propose a topology-aware attention mechanism with adaptive position indices that supports parallel reasoning while preserving logical consistency. Systematically, we develop a customized inference engine that supports parallel execution without additional overhead. Empirical evaluations show that MedVerse improves strong general-purpose LLMs by up to 8.9%. Compared to specialized medical LLMs, MedVerse achieves comparable performance while delivering a 1.3x reduction in inference latency and a 1.7x increase in generation throughput, enabled by its parallel decoding capability.

Medical imaging provides critical evidence for clinical diagnosis, treatment planning, and surgical decisions, yet most existing imaging models are narrowly focused and require multiple specialized networks, limiting their generalization. Although large-scale language and multimodal models exhibit strong reasoning and multi-task capabilities, real-world clinical applications demand precise visual grounding, multimodal integration, and chain-of-thought reasoning. We introduce Citrus-V, a multimodal medical foundation model that combines image analysis with textual reasoning. The model integrates detection, segmentation, and multimodal chain-of-thought reasoning, enabling pixel-level lesion localization, structured report generation, and physician-like diagnostic inference in a single framework. We propose a novel multimodal training approach and release a curated open-source data suite covering reasoning, detection, segmentation, and document understanding tasks. Evaluations demonstrate that Citrus-V outperforms existing open-source medical models and expert-level imaging systems across multiple benchmarks, delivering a unified pipeline from visual grounding to clinical reasoning and supporting precise lesion quantification, automated reporting, and reliable second opinions.

Large language models (LLMs) are capable of answering knowledge-intensive complex questions with chain-of-thought (CoT) reasoning. However, they tend to generate factually incorrect reasoning steps when the required knowledge is not available or up-to-date in models' parameters. Recent works turn to retrieving external knowledge to augment CoT reasoning. Despite being promising, these chain-based methods suffer from: 1) Negative retrieval. Unnecessary or incorrect retrieval may mislead the reasoning; 2) Limited sight. Lacking the ability to look backward or forward, a local error in one step will propagate along the chain. In this paper, we propose a novel approach: Probabilistic Tree-of-thought Reasoning (ProbTree). First, LLMs translate a complex question into a query tree, in which each non-root node denotes a sub-question of its parent node. Then, probabilistic reasoning is conducted over the tree, by solving questions from leaf to root considering the confidence of both question decomposing and answering. During reasoning, for leaf nodes, LLMs choose a more confident answer from Closed-book QA that employs parametric knowledge and Open-book QA that employs retrieved external knowledge, thus eliminating the negative retrieval problem. For non-leaf nodes, with the hierarchical structure, LLMs have broader sights and are able to globally reason with the information from child nodes, thus recovering from local errors. The experiments on three Complex QA datasets under the open-domain setting show that our approach outperforms SOTA methods significantly, demonstrating the effect of probabilistic tree-of-thought reasoning.

Generating Natural Language Explanations (NLEs) for model predictions on medical images, particularly those depicting thoracic pathologies, remains a critical and challenging task. Existing methodologies often struggle due to general models' insufficient domain-specific medical knowledge and privacy concerns associated with retrieval-based augmentation techniques. To address these issues, we propose a novel Vision-Language framework augmented with a Knowledge Graph (KG)-based datastore, which enhances the model's understanding by incorporating additional domain-specific medical knowledge essential for generating accurate and informative NLEs. Our framework employs a KG-based retrieval mechanism that not only improves the precision of the generated explanations but also preserves data privacy by avoiding direct data retrieval. The KG datastore is designed as a plug-and-play module, allowing for seamless integration with various model architectures. We introduce and evaluate three distinct frameworks within this paradigm: KG-LLaVA, which integrates the pre-trained LLaVA model with KG-RAG; Med-XPT, a custom framework combining MedCLIP, a transformer-based projector, and GPT-2; and Bio-LLaVA, which adapts LLaVA by incorporating the Bio-ViT-L vision model. These frameworks are validated on the MIMIC-NLE dataset, where they achieve state-of-the-art results, underscoring the effectiveness of KG augmentation in generating high-quality NLEs for thoracic pathologies.

Bridging clinical diagnostic reasoning with AI remains a central challenge in medical imaging. We introduce MedCLM, an automated pipeline that converts detection datasets into large-scale medical visual question answering (VQA) data with Chain-of-Thought (CoT) reasoning by linking lesion boxes to organ segmentation and structured rationales. These contextual signals enable medical vision-language models to generate question-answer pairs with step-by-step reasoning. To utilize this data effectively, we propose an Integrated CoT-Curriculum Strategy composed of an Easy stage with explicit lesion boxes for visual grounding, a Medium stage that encourages implicit localization, and a Hard stage for weakly supervised reasoning. Experimental results demonstrate that MedCLM attains state-of-the-art performance on several medical VQA benchmarks, providing a scalable framework for developing clinically aligned medical vision-language models.

The rapid advancement of large language models (LLMs) has significantly impacted various domains, including healthcare and biomedicine. However, the phenomenon of hallucination, where LLMs generate outputs that deviate from factual accuracy or context, poses a critical challenge, especially in high-stakes domains. This paper conducts a scoping study of existing techniques for mitigating hallucinations in knowledge-based task in general and especially for medical domains. Key methods covered in the paper include Retrieval-Augmented Generation (RAG)-based techniques, iterative feedback loops, supervised fine-tuning, and prompt engineering. These techniques, while promising in general contexts, require further adaptation and optimization for the medical domain due to its unique demands for up-to-date, specialized knowledge and strict adherence to medical guidelines. Addressing these challenges is crucial for developing trustworthy AI systems that enhance clinical decision-making and patient safety as well as accuracy of biomedical scientific research.

Numerous applications of large language models (LLMs) rely on their ability to perform step-by-step reasoning. However, the reasoning behavior of LLMs remains poorly understood, posing challenges to research, development, and safety. To address this gap, we introduce landscape of thoughts-the first visualization tool for users to inspect the reasoning paths of chain-of-thought and its derivatives on any multi-choice dataset. Specifically, we represent the states in a reasoning path as feature vectors that quantify their distances to all answer choices. These features are then visualized in two-dimensional plots using t-SNE. Qualitative and quantitative analysis with the landscape of thoughts effectively distinguishes between strong and weak models, correct and incorrect answers, as well as different reasoning tasks. It also uncovers undesirable reasoning patterns, such as low consistency and high uncertainty. Additionally, users can adapt our tool to a model that predicts the property they observe. We showcase this advantage by adapting our tool to a lightweight verifier that evaluates the correctness of reasoning paths. The code is publicly available at: https://github.com/tmlr-group/landscape-of-thoughts.

In medical scenarios, effectively retrieving external knowledge and leveraging it for rigorous logical reasoning is of significant importance. Despite their potential, existing work has predominantly focused on enhancing either retrieval or reasoning capabilities of the models in isolation, with little attention given to their joint optimization, which leads to limited coordination between the two processes. Additionally, current methods rely heavily on supervised fine-tuning (SFT), which can cause models to memorize existing problem-solving pathways, thereby restricting their generalization ability when confronted with novel problem contexts. Furthermore, while some studies have explored to improve retrieval-augmented reasoning in general domains via reinforcement learning, their reward function designs do not adequately capture the specific demands of the medical domain. To address these challenges, we introduce **Med-R^3**, a **Med**ical **R**etrieval-augmented **R**easoning framework driven by progressive **R**einforcement learning. In this framework, we first develop the model's ability to perform logical reasoning over medical problems. Subsequently, on the basis of this foundation, we adaptively optimize the retrieval capability to better align with the characteristics of knowledge corpus and external information utilization throughout the reasoning process. Finally, we conduct joint optimization of the model's retrieval and reasoning coordination. Extensive experiments indicate that **Med-R^3** could achieve state-of-the-art performances, with LLaMA3.1-8B-Instruct + Med-R^3 surpassing closed-sourced GPT-4o-mini by 3.93\% at a comparable parameter scale, while Qwen2.5-14B augmented with Med-R^3 shows a more substantial gain of 13.53\%.

Humans can develop internal world models that encode common sense knowledge, telling them how the world works and predicting the consequences of their actions. This concept has emerged as a promising direction for establishing general-purpose machine-learning models in recent preliminary works, e.g., for visual representation learning. In this paper, we present CheXWorld, the first effort towards a self-supervised world model for radiographic images. Specifically, our work develops a unified framework that simultaneously models three aspects of medical knowledge essential for qualified radiologists, including 1) local anatomical structures describing the fine-grained characteristics of local tissues (e.g., architectures, shapes, and textures); 2) global anatomical layouts describing the global organization of the human body (e.g., layouts of organs and skeletons); and 3) domain variations that encourage CheXWorld to model the transitions across different appearance domains of radiographs (e.g., varying clarity, contrast, and exposure caused by collecting radiographs from different hospitals, devices, or patients). Empirically, we design tailored qualitative and quantitative analyses, revealing that CheXWorld successfully captures these three dimensions of medical knowledge. Furthermore, transfer learning experiments across eight medical image classification and segmentation benchmarks showcase that CheXWorld significantly outperforms existing SSL methods and large-scale medical foundation models. Code & pre-trained models are available at https://github.com/LeapLabTHU/CheXWorld.

The recent development of chain-of-thought (CoT) decoding has enabled large language models (LLMs) to generate explicit logical reasoning paths for complex problem-solving. However, research indicates that these paths are not always deliberate and optimal. The tree-of-thought (ToT) method employs tree-searching to extensively explore the reasoning space and find better reasoning paths that CoT decoding might overlook. This deliberation, however, comes at the cost of significantly increased inference complexity. In this work, we demonstrate that fine-tuning LLMs leveraging the search tree constructed by ToT allows CoT to achieve similar or better performance, thereby avoiding the substantial inference burden. This is achieved through Chain of Preference Optimization (CPO), where LLMs are fine-tuned to align each step of the CoT reasoning paths with those of ToT using the inherent preference information in the tree-search process. Extensive experimental results show that CPO significantly improves LLM performance in solving a variety of complex problems, including question answering, fact verification, and arithmetic reasoning, demonstrating its effectiveness. Our code is available at https://github.com/sail-sg/CPO.

Large Multimodal Models (LMMs) are increasingly capable of answering medical questions that require joint reasoning over images and text, yet training general medical VQA systems is impeded by the lack of large, openly usable, high-quality corpora. We present MedVLSynther, a rubric-guided generator-verifier framework that synthesizes high-quality multiple-choice VQA items directly from open biomedical literature by conditioning on figures, captions, and in-text references. The generator produces self-contained stems and parallel, mutually exclusive options under a machine-checkable JSON schema; a multi-stage verifier enforces essential gates (self-containment, single correct answer, clinical validity, image-text consistency), awards fine-grained positive points, and penalizes common failure modes before acceptance. Applying this pipeline to PubMed Central yields MedSynVQA: 13,087 audited questions over 14,803 images spanning 13 imaging modalities and 28 anatomical regions. Training open-weight LMMs with reinforcement learning using verifiable rewards improves accuracy across six medical VQA benchmarks, achieving averages of 55.85 (3B) and 58.15 (7B), with up to 77.57 on VQA-RAD and 67.76 on PathVQA, outperforming strong medical LMMs. A Ablations verify that both generation and verification are necessary and that more verified data consistently helps, and a targeted contamination analysis detects no leakage from evaluation suites. By operating entirely on open literature and open-weight models, MedVLSynther offers an auditable, reproducible, and privacy-preserving path to scalable medical VQA training data.

Reasoning ability is one of the most crucial capabilities of a foundation model, signifying its capacity to address complex reasoning tasks. Chain-of-Thought (CoT) technique is widely regarded as one of the effective methods for enhancing the reasoning ability of foundation models and has garnered significant attention. However, the reasoning process of CoT is linear, step-by-step, similar to personal logical reasoning, suitable for solving general and slightly complicated problems. On the contrary, the thinking pattern of an expert owns two prominent characteristics that cannot be handled appropriately in CoT, i.e., high-order multi-hop reasoning and multimodal comparative judgement. Therefore, the core motivation of this paper is transcending CoT to construct a reasoning paradigm that can think like an expert. The hyperedge of a hypergraph could connect various vertices, making it naturally suitable for modelling high-order relationships. Inspired by this, this paper innovatively proposes a multimodal Hypergraph-of-Thought (HoT) reasoning paradigm, which enables the foundation models to possess the expert-level ability of high-order multi-hop reasoning and multimodal comparative judgement. Specifically, a textual hypergraph-of-thought is constructed utilizing triple as the primary thought to model higher-order relationships, and a hyperedge-of-thought is generated through multi-hop walking paths to achieve multi-hop inference. Furthermore, we devise a visual hypergraph-of-thought to interact with the textual hypergraph-of-thought via Cross-modal Co-Attention Graph Learning for multimodal comparative verification. Experimentations on the ScienceQA benchmark demonstrate the proposed HoT-based T5 outperforms CoT-based GPT3.5 and chatGPT, which is on par with CoT-based GPT4 with a lower model size.

Incentivizing the reasoning ability of Multimodal Large Language Models (MLLMs) is essential for medical applications to transparently analyze medical scans and provide reliable diagnosis. However, existing medical MLLMs rely solely on internal knowledge during reasoning, leading to hallucinated reasoning and factual inaccuracies when encountering cases beyond their training scope. Although recent Agentic Retrieval-Augmented Generation (RAG) methods elicit the medical model's proactive retrieval ability during reasoning, they are confined to unimodal LLMs, neglecting the crucial visual information during reasoning and retrieval. Consequently, we propose the first Multimodal Medical Reasoning-with-Retrieval framework, Med-RwR, which actively retrieves external knowledge by querying observed symptoms or domain-specific medical concepts during reasoning. Specifically, we design a two-stage reinforcement learning strategy with tailored rewards that stimulate the model to leverage both visual diagnostic findings and textual clinical information for effective retrieval. Building on this foundation, we further propose a Confidence-Driven Image Re-retrieval (CDIR) method for test-time scaling when low prediction confidence is detected. Evaluation on various public medical benchmarks demonstrates Med-RwR's significant improvements over baseline models, proving the effectiveness of enhancing reasoning capabilities with external knowledge integration. Furthermore, Med-RwR demonstrates remarkable generalizability to unfamiliar domains, evidenced by 8.8% performance gain on our proposed EchoCardiography Benchmark (ECBench), despite the scarcity of echocardiography data in the training corpus. Our data, model, and codes will be made publicly available at https://github.com/xmed-lab/Med-RwR.

In this paper, we address the challenging task of multimodal mathematical reasoning by incorporating the ability of "slow thinking" into multimodal large language models (MLLMs). Our core idea is that different levels of reasoning abilities can be combined dynamically to tackle questions with different complexity. To this end, we propose a paradigm of Self-structured Chain of Thought (SCoT), which is composed of minimal semantic atomic steps. Different from existing methods that rely on structured templates or free-form paradigms, our method can not only generate cognitive CoT structures for various complex tasks but also mitigates the phenomenon of overthinking. To introduce structured reasoning capabilities into visual understanding models, we further design a novel AtomThink framework with four key modules, including (i) a data engine to generate high-quality multimodal reasoning paths; (ii) a supervised fine-tuning process with serialized inference data; (iii) a policy-guided multi-turn inference method; and (iv) an atomic capability metric to evaluate the single step utilization rate. We conduct extensive experiments to show that the proposed AtomThink significantly improves the performance of baseline MLLMs, achieving more than 10\% average accuracy gains on MathVista and MathVerse. Compared to state-of-the-art structured CoT approaches, our method not only achieves higher accuracy but also improves data utilization by 5 times and boosts inference efficiency by 85.3\%. Our code is now public available in https://github.com/Quinn777/AtomThink.

Consistency learning with feature perturbation is a widely used strategy in semi-supervised medical image segmentation. However, many existing perturbation methods rely on dropout, and thus require a careful manual tuning of the dropout rate, which is a sensitive hyperparameter and often difficult to optimize and may lead to suboptimal regularization. To overcome this limitation, we propose VQ-Seg, the first approach to employ vector quantization (VQ) to discretize the feature space and introduce a novel and controllable Quantized Perturbation Module (QPM) that replaces dropout. Our QPM perturbs discrete representations by shuffling the spatial locations of codebook indices, enabling effective and controllable regularization. To mitigate potential information loss caused by quantization, we design a dual-branch architecture where the post-quantization feature space is shared by both image reconstruction and segmentation tasks. Moreover, we introduce a Post-VQ Feature Adapter (PFA) to incorporate guidance from a foundation model (FM), supplementing the high-level semantic information lost during quantization. Furthermore, we collect a large-scale Lung Cancer (LC) dataset comprising 828 CT scans annotated for central-type lung carcinoma. Extensive experiments on the LC dataset and other public benchmarks demonstrate the effectiveness of our method, which outperforms state-of-the-art approaches. Code available at: https://github.com/script-Yang/VQ-Seg.

Medical Dialogue Generation serves a critical role in telemedicine by facilitating the dissemination of medical expertise to patients. Existing studies focus on incorporating textual representations, which have limited their ability to represent the semantics of text, such as ignoring important medical entities. To enhance the model's understanding of the textual semantics and the medical knowledge including entities and relations, we introduce the use of Abstract Meaning Representations (AMR) to construct graphical representations that delineate the roles of language constituents and medical entities within the dialogues. In this paper, We propose a novel framework that models dialogues between patients and healthcare professionals using AMR graphs, where the neural networks incorporate textual and graphical knowledge with a dual attention mechanism. Experimental results show that our framework outperforms strong baseline models in medical dialogue generation, demonstrating the effectiveness of AMR graphs in enhancing the representations of medical knowledge and logical relationships. Furthermore, to support future research in this domain, we provide the corresponding source code at https://github.com/Bernard-Yang/MedDiaAMR.

Large Language Models (LLMs), despite their remarkable capabilities, rely on singular, pre-dominant reasoning paradigms, hindering their performance on intricate problems that demand diverse cognitive strategies. To address this, we introduce Composite Reasoning (CR), a novel reasoning approach empowering LLMs to dynamically explore and combine multiple reasoning styles like deductive, inductive, and abductive for more nuanced problem-solving. Evaluated on scientific and medical question-answering benchmarks, our approach outperforms existing baselines like Chain-of-Thought (CoT) and also surpasses the accuracy of DeepSeek-R1 style reasoning (SR) capabilities, while demonstrating superior sample efficiency and adequate token usage. Notably, CR adaptively emphasizes domain-appropriate reasoning styles. It prioritizes abductive and deductive reasoning for medical question answering, but shifts to causal, deductive, and inductive methods for scientific reasoning. Our findings highlight that by cultivating internal reasoning style diversity, LLMs acquire more robust, adaptive, and efficient problem-solving abilities.

Large Language Models (LLMs) have revolutionized natural language processing and hold immense potential for advancing Artificial Intelligence. However, the core architecture of most mainstream LLMs -- the Transformer -- has inherent limitations in computational depth, rendering them theoretically incapable of solving many reasoning tasks that demand increasingly deep computations. Chain of Thought (CoT) prompting has emerged as a technique to address these architectural limitations, as evidenced by several theoretical studies. It offers a promising approach to solving complex reasoning tasks that were previously beyond the capabilities of these models. Despite its successes, CoT and its variants (such as Tree of Thought, Graph of Thought, etc.) rely on a "one-prompt-for-all" approach, using a single prompt structure (e.g., "think step by step") for a wide range of tasks -- from counting and sorting to solving mathematical and algorithmic problems. This approach poses significant challenges for models to generate the correct reasoning steps, as the model must navigate through a vast prompt template space to find the appropriate template for each task. In this work, we build upon previous theoretical analyses of CoT to demonstrate how the one-prompt-for-all approach can negatively affect the computability of LLMs. We partition the solution search space into two: the prompt space and the answer space. Our findings show that task-specific supervision is essential for navigating the prompt space accurately and achieving optimal performance. Through experiments with state-of-the-art LLMs, we reveal a gap in reasoning performance when supervision is applied versus when it is not.

Instructing the model to generate a sequence of intermediate steps, a.k.a., a chain of thought (CoT), is a highly effective method to improve the accuracy of large language models (LLMs) on arithmetics and symbolic reasoning tasks. However, the mechanism behind CoT remains unclear. This work provides a theoretical understanding of the power of CoT for decoder-only transformers through the lens of expressiveness. Conceptually, CoT empowers the model with the ability to perform inherently serial computation, which is otherwise lacking in transformers, especially when depth is low. Given input length n, previous works have shown that constant-depth transformers with finite precision poly(n) embedding size can only solve problems in TC^0 without CoT. We first show an even tighter expressiveness upper bound for constant-depth transformers with constant-bit precision, which can only solve problems in AC^0, a proper subset of TC^0. However, with T steps of CoT, constant-depth transformers using constant-bit precision and O(log n) embedding size can solve any problem solvable by boolean circuits of size T. Empirically, enabling CoT dramatically improves the accuracy for tasks that are hard for parallel computation, including the composition of permutation groups, iterated squaring, and circuit value problems, especially for low-depth transformers.

Multimodal large language models (MLLMs) have recently achieved remarkable progress in radiology by integrating visual perception with natural language understanding. However, they often generate clinically unsupported descriptions, known as medical hallucinations, which pose serious risks in medical applications that demand accuracy and image-grounded outputs. Through empirical analysis, we find that prompt-induced hallucinations remain prevalent in radiology MLLMs, largely due to over-sensitivity to clinical sections. To address this, we introduce Clinical Contrastive Cecoding (CCD), a training-free and retrieval-free inference framework that integrates structured clinical signals from task-specific radiology expert models. CCD introduces a dual-stage contrastive mechanism to refine token-level logits during generation, thereby enhancing clinical fidelity without modifying the base MLLM. Experiments on three datasets and multiple models demonstrate that CCD consistently improves overall performance on radiology report generation (RRG). On the MIMIC-CXR dataset, it yields up to a 17% improvement in RadGraph-F1 when applied to state-of-the-art RRG models. Our approach provides a lightweight and generalisable solution for mitigating medical hallucinations, effectively bridging expert models and MLLMs in radiology.

Recent advances such as Chain-of-Thought prompting have significantly improved large language models (LLMs) in zero-shot medical reasoning. However, prompting-based methods often remain shallow and unstable, while fine-tuned medical LLMs suffer from poor generalization under distribution shifts and limited adaptability to unseen clinical scenarios. To address these limitations, we present TAGS, a test-time framework that combines a broadly capable generalist with a domain-specific specialist to offer complementary perspectives without any model fine-tuning or parameter updates. To support this generalist-specialist reasoning process, we introduce two auxiliary modules: a hierarchical retrieval mechanism that provides multi-scale exemplars by selecting examples based on both semantic and rationale-level similarity, and a reliability scorer that evaluates reasoning consistency to guide final answer aggregation. TAGS achieves strong performance across nine MedQA benchmarks, boosting GPT-4o accuracy by 13.8%, DeepSeek-R1 by 16.8%, and improving a vanilla 7B model from 14.1% to 23.9%. These results surpass several fine-tuned medical LLMs, without any parameter updates. The code will be available at https://github.com/JianghaoWu/TAGS.

Medical diagnostic applications require models that can process multimodal medical inputs (images, patient histories, lab results) and generate diverse outputs including both textual reports and visual content (annotations, segmentation masks, and images). Despite this need, existing medical AI systems disrupt this unified process: medical image understanding models interpret images but cannot generate visual outputs, while medical image generation models synthesize images but cannot provide textual explanations. This leads to gaps in data representation, feature integration, and task-level multimodal capabilities. To this end, we propose a multi-level framework that draws inspiration from diagnostic workflows through the Observation-Knowledge-Analysis (OKA) paradigm. Specifically, at the observation level, we construct UniMed-5M, a dataset comprising over 5.6M samples that reformat diverse unimodal data into multimodal pairs for foundational observation. At the knowledge level, we propose Progressive Curriculum Learning that systematically introduces medical multimodal knowledge. At the analysis level, we introduce UniMedVL, the first medical unified multimodal model for the simultaneous analysis of image understanding and generation tasks within a single architecture. UniMedVL achieves superior performance on five medical image understanding benchmarks, while matching specialized models in generation quality across eight medical imaging modalities. Crucially, our unified architecture enables bidirectional knowledge sharing: generation tasks enhance visual understanding features, demonstrating that integrating traditionally separate capabilities within a single medical framework unlocks improvements across diverse medical vision-language tasks. Code is available at https://github.com/uni-medical/UniMedVL.

While chain-of-thought (CoT) prompting has revolutionized how LLMs perform reasoning tasks, its current methods and variations (e.g, Self-consistency, ReACT, Reflexion, Tree-of-Thoughts (ToT), Cumulative Reasoning (CR)) suffer from limitations like slowness, limited context grounding, hallucination and inconsistent outputs. To overcome these challenges, we introduce Evidence to Generate (E2G), a novel single-agent, two-step prompting framework. Instead of unverified reasoning claims, this innovative approach leverages the power of "evidence for decision making" by first focusing exclusively on the thought sequences (the series of intermediate steps) explicitly mentioned in the context which then serve as extracted evidence, guiding the LLM's output generation process with greater precision and efficiency. This simple yet powerful approach unlocks the true potential of chain-of-thought like prompting, paving the way for faster, more reliable, and more contextually aware reasoning in LLMs. \tool achieves remarkable results robustly across a wide range of knowledge-intensive reasoning and generation tasks, surpassing baseline approaches with state-of-the-art LLMs. For example, (i) on LogiQA benchmark using GPT-4 as backbone model, \tool achieves a new state-of-the Accuracy of 53.8% exceeding CoT by 18%, ToT by 11%, CR by 9% (ii) a variant of E2G with PaLM2 outperforms the variable-shot performance of Gemini Ultra by 0.9 F1 points, reaching an F1 score of 83.3 on a subset of DROP.

Large language models (LLMs), particularly those with reasoning capabilities, have rapidly advanced in recent years, demonstrating significant potential across a wide range of applications. However, their deployment in healthcare, especially in disease reasoning tasks, is hindered by the challenge of acquiring expert-level cognitive data. In this paper, we introduce Citrus, a medical language model that bridges the gap between clinical expertise and AI reasoning by emulating the cognitive processes of medical experts. The model is trained on a large corpus of simulated expert disease reasoning data, synthesized using a novel approach that accurately captures the decision-making pathways of clinicians. This approach enables Citrus to better simulate the complex reasoning processes involved in diagnosing and treating medical conditions.To further address the lack of publicly available datasets for medical reasoning tasks, we release the last-stage training data, including a custom-built medical diagnostic dialogue dataset. This open-source contribution aims to support further research and development in the field. Evaluations using authoritative benchmarks such as MedQA, covering tasks in medical reasoning and language understanding, show that Citrus achieves superior performance compared to other models of similar size. These results highlight Citrus potential to significantly enhance medical decision support systems, providing a more accurate and efficient tool for clinical decision-making.

Large language models have achieved strong performance on medical reasoning benchmarks, yet their deployment in clinical settings demands rigorous verification to ensure factual accuracy. While reward models offer a scalable approach for reasoning trace verification, existing methods face two limitations: they produce only scalar reward values without explicit justification, and they rely on single-pass retrieval that precludes adaptive knowledge access as verification unfolds. We introduce method, an agentic framework that addresses these limitations by training medical reasoning verifiers to iteratively query external medical corpora during evaluation. Our approach combines tool-augmented verification with an iterative reinforcement learning paradigm that requires only trace-level supervision, alongside an adaptive curriculum mechanism that dynamically adjusts training data distribution. Across four medical reasoning benchmarks, method achieves substantial gains over existing methods, improving MedQA accuracy by 23.5% and MedXpertQA by 32.0% relative to the base generator in particular. Crucially, method demonstrates an 8times reduction in sampling budget requirement compared to prior reward model baselines. These findings establish that grounding verification in dynamically retrieved evidence offers a principled path toward more reliable medical reasoning systems.

In recent advancements, multimodal large language models (MLLMs) have been fine-tuned on specific medical image datasets to address medical visual question answering (Med-VQA) tasks. However, this common approach of task-specific fine-tuning is costly and necessitates separate models for each downstream task, limiting the exploration of zero-shot capabilities. In this paper, we introduce MC-CoT, a modular cross-modal collaboration Chain-of-Thought (CoT) framework designed to enhance the zero-shot performance of MLLMs in Med-VQA by leveraging large language models (LLMs). MC-CoT improves reasoning and information extraction by integrating medical knowledge and task-specific guidance, where LLM provides various complex medical reasoning chains and MLLM provides various observations of medical images based on instructions of the LLM. Our experiments on datasets such as SLAKE, VQA-RAD, and PATH-VQA show that MC-CoT surpasses standalone MLLMs and various multimodality CoT frameworks in recall rate and accuracy. These findings highlight the importance of incorporating background information and detailed guidance in addressing complex zero-shot Med-VQA tasks.

Chain of Thought (CoT) of multi-step benefits from the logical structure of the reasoning steps and task-specific actions, significantly enhancing the mathematical reasoning capabilities of large language models. As the prevalence of long CoT, the number of reasoning steps exceeds manageable token limits and leads to higher computational demands. Inspired by the fundamental logic of human cognition, ``derive, then reduce'', we conceptualize the standard multi-step CoT as a novel Markov Chain of Thought (MCoT). In this study, we consider the mathematical reasoning task, defining each reasoning step as text accompanied by a Python code snippet. To facilitate a longer reasoning path, self-correction is enabled through interactions with the code interpreter. Our MCoT aims to compress previous reasoning steps into a simplified question, enabling efficient next-step inference without relying on a lengthy KV cache. In our experiments, we curate the MCoTInstruct dataset, and the empirical results indicate that MCoT not only significantly enhances efficiency but also maintains comparable accuracy. While much remains to be explored, this work paves the way for exploring the long CoT reasoning abilities of LLMs.

Language models traditionally used for cross-domain generalization have recently demonstrated task-specific reasoning. However, their top-down training approach on general corpora is insufficient for acquiring abstractions needed for deep domain expertise. This may require a bottom-up approach that acquires expertise by learning to compose simple domain concepts into more complex ones. A knowledge graph (KG) provides this compositional structure, where domain primitives are represented as head-relation-tail edges and their paths encode higher-level concepts. We present a task generation pipeline that synthesizes tasks directly from KG primitives, enabling models to acquire and compose them for reasoning. We fine-tune language models on the resultant KG-grounded curriculum to demonstrate domain-specific superintelligence. While broadly applicable, we validate our approach in medicine, where reliable KGs exist. Using a medical KG, we curate 24,000 reasoning tasks paired with thinking traces derived from diverse medical primitives. We fine-tune the QwQ-32B model on this curriculum to obtain QwQ-Med-3 that takes a step towards medical superintelligence. We also introduce ICD-Bench, an evaluation suite to quantify reasoning abilities across 15 medical domains. Our experiments demonstrate that QwQ-Med-3 significantly outperforms state-of-the-art reasoning models on ICD-Bench categories. Further analysis reveals that QwQ-Med-3 utilizes acquired primitives to widen the performance gap on the hardest tasks of ICD-Bench. Finally, evaluation on medical question-answer benchmarks shows that QwQ-Med-3 transfers acquired expertise to enhance the base model's performance. While the industry's approach to artificial general intelligence (AGI) emphasizes broad expertise, we envision a future in which AGI emerges from the composable interaction of efficient domain-specific superintelligent agents.

Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the first quantitative evidence of the chasm between visually convincing mimicry and causal understanding in surgical AI. Our findings from SurgVeo and the SPP establish a crucial foundation and roadmap for developing future models capable of navigating the complexities of specialized, real-world healthcare domains.

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

While there have been extensive studies in code generation by large language models (LLM), where benchmarks like HumanEval have been surpassed with an impressive 96.3% success rate, these benchmarks predominantly judge a model's performance on basic function-level code generation and lack the critical thinking and concept of scope required of real-world scenarios such as solving GitHub issues. This research introduces the application of the Tree of Thoughts (ToT) language model reasoning framework for enhancing the decision-making and problem-solving abilities of LLMs for this complex task. Compared to traditional input-output (IO) prompting and Retrieval Augmented Generation (RAG) techniques, ToT is designed to improve performance by facilitating a structured exploration of multiple reasoning trajectories and enabling self-assessment of potential solutions. We experimentally deploy ToT in tackling a Github issue contained within an instance of the SWE-bench. However, our results reveal that the ToT framework alone is not enough to give LLMs the critical reasoning capabilities to outperform existing methods. In this paper we analyze the potential causes of these shortcomings and identify key areas for improvement such as deepening the thought process and introducing agentic capabilities. The insights of this research are aimed at informing future directions for refining the application of ToT and better harnessing the potential of LLMs in real-world problem-solving scenarios.

Large Language Models (LLMs) have demonstrated potential in predicting mental health outcomes from online text, yet traditional classification methods often lack interpretability and robustness. This study evaluates structured reasoning techniques-Chain-of-Thought (CoT), Self-Consistency (SC-CoT), and Tree-of-Thought (ToT)-to improve classification accuracy across multiple mental health datasets sourced from Reddit. We analyze reasoning-driven prompting strategies, including Zero-shot CoT and Few-shot CoT, using key performance metrics such as Balanced Accuracy, F1 score, and Sensitivity/Specificity. Our findings indicate that reasoning-enhanced techniques improve classification performance over direct prediction, particularly in complex cases. Compared to baselines such as Zero Shot non-CoT Prompting, and fine-tuned pre-trained transformers such as BERT and Mental-RoBerta, and fine-tuned Open Source LLMs such as Mental Alpaca and Mental-Flan-T5, reasoning-driven LLMs yield notable gains on datasets like Dreaddit (+0.52\% over M-LLM, +0.82\% over BERT) and SDCNL (+4.67\% over M-LLM, +2.17\% over BERT). However, performance declines in Depression Severity, and CSSRS predictions suggest dataset-specific limitations, likely due to our using a more extensive test set. Among prompting strategies, Few-shot CoT consistently outperforms others, reinforcing the effectiveness of reasoning-driven LLMs. Nonetheless, dataset variability highlights challenges in model reliability and interpretability. This study provides a comprehensive benchmark of reasoning-based LLM techniques for mental health text classification. It offers insights into their potential for scalable clinical applications while identifying key challenges for future improvements.

Current vision-language models (VLMs) in medicine are primarily designed for categorical question answering (e.g., "Is this normal or abnormal?") or qualitative descriptive tasks. However, clinical decision-making often relies on quantitative assessments, such as measuring the size of a tumor or the angle of a joint, from which physicians draw their own diagnostic conclusions. This quantitative reasoning capability remains underexplored and poorly supported in existing VLMs. In this work, we introduce MedVision, a large-scale dataset and benchmark specifically designed to evaluate and improve VLMs on quantitative medical image analysis. MedVision spans 22 public datasets covering diverse anatomies and modalities, with 30.8 million image-annotation pairs. We focus on three representative quantitative tasks: (1) detection of anatomical structures and abnormalities, (2) tumor/lesion (T/L) size estimation, and (3) angle/distance (A/D) measurement. Our benchmarks show that current off-the-shelf VLMs perform poorly on these tasks. However, with supervised fine-tuning on MedVision, we significantly enhance their performance across detection, T/L estimation, and A/D measurement, demonstrating reduced error rates and improved precision. This work provides a foundation for developing VLMs with robust quantitative reasoning capabilities in medical imaging. Code and data are available at https://medvision-vlm.github.io.

Large language models (LLMs) have been routinely used to solve various tasks using step-by-step reasoning. However, the structure of intermediate reasoning steps, or thoughts, is rigid and unidirectional, such as chains, trees, or acyclic-directed graphs. Consequently, the resulting inflexible and forward-only reasoning may not address challenging tasks and fail when the LLM frequently gives false responses, i.e., ``hallucinations''. This paper proposes a new reasoning framework, called Thought Rollback (TR), allowing LLMs to adaptively build thought structure while maintaining effective reasoning toward problem-solving under ``hallucinations''. The core mechanism of TR is rolling back thoughts, which allows LLMs to perform error analysis on thoughts, and thus roll back to any previously mistaken thought for revision. Subsequently, by including such trial-and-error in the prompt to guide the LLM, each rollback leads to one more reliable reasoning path. Therefore, starting with a simple prompt without human annotations, LLM with TR adaptively and gradually explores thoughts for a correct solution. Comprehensive experiments on mathematical problems and multi-task reasoning demonstrate the state-of-the-art performance of TR in terms of problem-solving rate and interaction cost. For instance, the solving rate of GPT-4 with TR outperforms the current best by 9% on the MATH dataset.

Equipped with Chain-of-Thought (CoT), Large language models (LLMs) have shown impressive reasoning ability in various downstream tasks. Even so, suffering from hallucinations and the inability to access external knowledge, LLMs often come with incorrect or unfaithful intermediate reasoning steps, especially in the context of answering knowledge-intensive tasks such as KBQA. To alleviate this issue, we propose a framework called Knowledge-Driven Chain-of-Thought (KD-CoT) to verify and modify reasoning traces in CoT via interaction with external knowledge, and thus overcome the hallucinations and error propagation. Concretely, we formulate the CoT rationale process of LLMs into a structured multi-round QA format. In each round, LLMs interact with a QA system that retrieves external knowledge and produce faithful reasoning traces based on retrieved precise answers. The structured CoT reasoning of LLMs is facilitated by our developed KBQA CoT collection, which serves as in-context learning demonstrations and can also be utilized as feedback augmentation to train a robust retriever. Extensive experiments on WebQSP and ComplexWebQuestion datasets demonstrate the effectiveness of proposed KD-CoT in task-solving reasoning generation, which outperforms the vanilla CoT ICL with an absolute success rate of 8.0% and 5.1%. Furthermore, our proposed feedback-augmented retriever outperforms the state-of-the-art baselines for retrieving knowledge, achieving significant improvement in Hit performance.

Integrating Large Language Models (LLMs) in healthcare diagnosis demands systematic frameworks that can handle complex medical scenarios while maintaining specialized expertise. We present KG4Diagnosis, a novel hierarchical multi-agent framework that combines LLMs with automated knowledge graph construction, encompassing 362 common diseases across medical specialties. Our framework mirrors real-world medical systems through a two-tier architecture: a general practitioner (GP) agent for initial assessment and triage, coordinating with specialized agents for in-depth diagnosis in specific domains. The core innovation lies in our end-to-end knowledge graph generation methodology, incorporating: (1) semantic-driven entity and relation extraction optimized for medical terminology, (2) multi-dimensional decision relationship reconstruction from unstructured medical texts, and (3) human-guided reasoning for knowledge expansion. KG4Diagnosis serves as an extensible foundation for specialized medical diagnosis systems, with capabilities to incorporate new diseases and medical knowledge. The framework's modular design enables seamless integration of domain-specific enhancements, making it valuable for developing targeted medical diagnosis systems. We provide architectural guidelines and protocols to facilitate adoption across medical contexts.

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

With the advancement of telemedicine, both researchers and medical practitioners are working hand-in-hand to develop various techniques to automate various medical operations, such as diagnosis report generation. In this paper, we first present a multi-modal clinical conversation summary generation task that takes a clinician-patient interaction (both textual and visual information) and generates a succinct synopsis of the conversation. We propose a knowledge-infused, multi-modal, multi-tasking medical domain identification and clinical conversation summary generation (MM-CliConSummation) framework. It leverages an adapter to infuse knowledge and visual features and unify the fused feature vector using a gated mechanism. Furthermore, we developed a multi-modal, multi-intent clinical conversation summarization corpus annotated with intent, symptom, and summary. The extensive set of experiments, both quantitatively and qualitatively, led to the following findings: (a) critical significance of visuals, (b) more precise and medical entity preserving summary with additional knowledge infusion, and (c) a correlation between medical department identification and clinical synopsis generation. Furthermore, the dataset and source code are available at https://github.com/NLP-RL/MM-CliConSummation.

We present MedHal, a novel large-scale dataset specifically designed to evaluate if models can detect hallucinations in medical texts. Current hallucination detection methods face significant limitations when applied to specialized domains like medicine, where they can have disastrous consequences. Existing medical datasets are either too small, containing only a few hundred samples, or focus on a single task like Question Answering or Natural Language Inference. MedHal addresses these gaps by: (1) incorporating diverse medical text sources and tasks; (2) providing a substantial volume of annotated samples suitable for training medical hallucination detection models; and (3) including explanations for factual inconsistencies to guide model learning. We demonstrate MedHal's utility by training and evaluating a baseline medical hallucination detection model, showing improvements over general-purpose hallucination detection approaches. This resource enables more efficient evaluation of medical text generation systems while reducing reliance on costly expert review, potentially accelerating the development of medical AI research.

While deep learning models have become the predominant method for medical image segmentation, they are typically not capable of generalizing to unseen segmentation tasks involving new anatomies, image modalities, or labels. Given a new segmentation task, researchers generally have to train or fine-tune models, which is time-consuming and poses a substantial barrier for clinical researchers, who often lack the resources and expertise to train neural networks. We present UniverSeg, a method for solving unseen medical segmentation tasks without additional training. Given a query image and example set of image-label pairs that define a new segmentation task, UniverSeg employs a new Cross-Block mechanism to produce accurate segmentation maps without the need for additional training. To achieve generalization to new tasks, we have gathered and standardized a collection of 53 open-access medical segmentation datasets with over 22,000 scans, which we refer to as MegaMedical. We used this collection to train UniverSeg on a diverse set of anatomies and imaging modalities. We demonstrate that UniverSeg substantially outperforms several related methods on unseen tasks, and thoroughly analyze and draw insights about important aspects of the proposed system. The UniverSeg source code and model weights are freely available at https://universeg.csail.mit.edu

When presented with questions involving visual thinking, humans naturally switch reasoning modalities, often forming mental images or drawing visual aids. Large language models have shown promising results in arithmetic and symbolic reasoning by expressing intermediate reasoning in text as a chain of thought, yet struggle to extend this capability to answer text queries that are easily solved by visual reasoning, even with extensive multimodal pretraining. We introduce a simple method, whiteboard-of-thought prompting, to unlock the visual reasoning capabilities of multimodal large language models across modalities. Whiteboard-of-thought prompting provides multimodal large language models with a metaphorical `whiteboard' to draw out reasoning steps as images, then returns these images back to the model for further processing. We find this can be accomplished with no demonstrations or specialized modules, instead leveraging models' existing ability to write code with libraries such as Matplotlib and Turtle. This simple approach shows state-of-the-art results on four difficult natural language tasks that involve visual and spatial reasoning. We identify multiple settings where GPT-4o using chain-of-thought fails dramatically, including more than one where it achieves 0% accuracy, while whiteboard-of-thought enables up to 92% accuracy in these same settings. We present a detailed exploration of where the technique succeeds as well as its sources of error.

Chain-of-Thought (CoT) prompting enhances the reasoning of large language models (LLMs) by decomposing problems into sequential steps, mimicking human logic and reducing errors. However, complex tasks with vast solution spaces and vague constraints often exceed the capacity of a single reasoning chain. Inspired by Minimal Free Resolution (MFR) in commutative algebra and algebraic geometry, we propose Syzygy of Thoughts (SoT)-a novel framework that extends CoT by introducing auxiliary, interrelated reasoning paths. SoT captures deeper logical dependencies, enabling more robust and structured problem-solving. MFR decomposes a module into a sequence of free modules with minimal rank, providing a structured analytical approach to complex systems. This method introduces the concepts of "Module", "Betti numbers","Freeness", "Mapping", "Exactness" and "Minimality", enabling the systematic decomposition of the original complex problem into logically complete minimal subproblems while preserving key problem features and reducing reasoning length. We tested SoT across diverse datasets (e.g., GSM8K, MATH) and models (e.g., GPT-4o-mini, Qwen2.5), achieving inference accuracy that matches or surpasses mainstream CoTs standards. Additionally, by aligning the sampling process with algebraic constraints, our approach enhances the scalability of inference time in LLMs, ensuring both transparent reasoning and high performance. Our code will be publicly available at https://github.com/dlMARiA/Syzygy-of-thoughts.

In this paper, we introduce the Tree-of-Thought (ToT) framework, a novel approach aimed at improving the problem-solving capabilities of auto-regressive large language models (LLMs). The ToT technique is inspired by the human mind's approach for solving complex reasoning tasks through trial and error. In this process, the human mind explores the solution space through a tree-like thought process, allowing for backtracking when necessary. To implement ToT as a software system, we augment an LLM with additional modules including a prompter agent, a checker module, a memory module, and a ToT controller. In order to solve a given problem, these modules engage in a multi-round conversation with the LLM. The memory module records the conversation and state history of the problem solving process, which allows the system to backtrack to the previous steps of the thought-process and explore other directions from there. To verify the effectiveness of the proposed technique, we implemented a ToT-based solver for the Sudoku Puzzle. Experimental results show that the ToT framework can significantly increase the success rate of Sudoku puzzle solving. Our implementation of the ToT-based Sudoku solver is available on GitHub: https://github.com/jieyilong/tree-of-thought-puzzle-solver.

Image editing with natural language has gained significant popularity, yet existing methods struggle with intricate object intersections and fine-grained spatial relationships due to the lack of an explicit reasoning process. While Chain-of-Thought (CoT) has been explored to enhance reasoning, purely textual CoT or CoT augmented with coordinate information is fundamentally limited in its ability to represent intricate visual layouts and lacks the necessary visual cues to guide the generation of fine-grained, pixel-level details. To address these challenges, we propose Multimodal Reasoning Edit (MURE), a novel framework that shifts the visual editing process from purely text-based reasoning to a series of interleaved textual and visual rationales. Our framework performs image editing using a natively multimodal, interleaved text-image CoT. This approach generates a step-by-step chain of reasoning where a textual description is followed by a corresponding visual cue, such as a positional mask that defined intended edited regions or a representation of new content. Furthermore, to mitigate the hallucination phenomenon of large language models, we introduce Multimodal Deep Confidence (MMDC) reasoning paradigm. This paradigm explores a tree of visual reasoning paths at each step. By pruning low-quality branches using a deep confidence score from a reward model, it ensures the model consistently follows a high-quality trajectory towards the final edited result. The proposed method decomposes complex editing tasks into interdependent sub-tasks, achieving greater precision at each stage and yielding high-fidelity edited results. We define the formulation for interleaved text-image chains and release the first CoT-Edit-14K dataset, comprising 14K high-quality editing examples. Extensive experiments show that our method yields significant improvements across three image editing benchmarks.

Large language models (LLMs) now achieve near-human performance on standard math word problem benchmarks (e.g., GSM8K), yet their true reasoning ability remains disputed. A key concern is that models often produce confident, yet unfounded, answers to unanswerable problems. We introduce TreeCut, a synthetic dataset that systematically generates infinite unanswerable math word problems and their answerable counterparts, by representing each question as a tree and removing chosen necessary conditions. Experiments show TreeCut effectively induce hallucinations in large language models, including GPT-4o and o3-mini, with rates of 64% and 44% in their respective worst-case scenarios under zero-shot setting. Further analysis highlights that deeper or more complex trees, composite item names, and removing necessary condition near the middle of a path all increase the likelihood of hallucinations, underscoring the persistent challenges LLMs face in identifying unanswerable math problems. The dataset generation code and sample data are available at https://github.com/j-bagel/treecut-math.

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

Human cognition typically involves thinking through abstract, fluid concepts rather than strictly using discrete linguistic tokens. Current reasoning models, however, are constrained to reasoning within the boundaries of human language, processing discrete token embeddings that represent fixed points in the semantic space. This discrete constraint restricts the expressive power and upper potential of such reasoning models, often causing incomplete exploration of reasoning paths, as standard Chain-of-Thought (CoT) methods rely on sampling one token per step. In this work, we introduce Soft Thinking, a training-free method that emulates human-like "soft" reasoning by generating soft, abstract concept tokens in a continuous concept space. These concept tokens are created by the probability-weighted mixture of token embeddings, which form the continuous concept space, enabling smooth transitions and richer representations that transcend traditional discrete boundaries. In essence, each generated concept token encapsulates multiple meanings from related discrete tokens, implicitly exploring various reasoning paths to converge effectively toward the correct answer. Empirical evaluations on diverse mathematical and coding benchmarks consistently demonstrate the effectiveness and efficiency of Soft Thinking, improving pass@1 accuracy by up to 2.48 points while simultaneously reducing token usage by up to 22.4% compared to standard CoT. Qualitative analysis further reveals that Soft Thinking outputs remain highly interpretable and readable, highlighting the potential of Soft Thinking to break the inherent bottleneck of discrete language-based reasoning. Code is available at https://github.com/eric-ai-lab/Soft-Thinking.

Compressing long chain-of-thought (CoT) from large language models (LLMs) is an emerging strategy to improve the reasoning efficiency of LLMs. Despite its promising benefits, existing studies equally compress all thoughts within a long CoT, hindering more concise and effective reasoning. To this end, we first investigate the importance of different thoughts by examining their effectiveness and efficiency in contributing to reasoning through automatic long CoT chunking and Monte Carlo rollouts. Building upon the insights, we propose a theoretically bounded metric to jointly measure the effectiveness and efficiency of different thoughts. We then propose LongotimesShort, an efficient reasoning framework that enables two LLMs to collaboratively solve the problem: a long-thought LLM for more effectively generating important thoughts, while a short-thought LLM for efficiently generating remaining thoughts. Specifically, we begin by synthesizing a small amount of cold-start data to fine-tune LLMs for long-thought and short-thought reasoning styles, respectively. Furthermore, we propose a synergizing-oriented multi-turn reinforcement learning, focusing on the model self-evolution and collaboration between long-thought and short-thought LLMs. Experimental results show that our method enables Qwen2.5-7B and Llama3.1-8B to achieve comparable performance compared to DeepSeek-R1-Distill-Qwen-7B and DeepSeek-R1-Distill-Llama-8B, while reducing token length by over 80% across the MATH500, AIME24/25, AMC23, and GPQA Diamond benchmarks. Our data and code are available at https://github.com/yasNing/Long-otimes-Short/.

Medical Vision-Language Models (VLMs) are prone to hallucinations, compromising clinical reliability. While reinforcement learning methods like Group Relative Policy Optimization (GRPO) offer a low-cost alignment solution, their reliance on sparse, outcome-based rewards inadvertently encourages models to "overthink" -- generating verbose, convoluted, and unverifiable Chain-of-Thought reasoning to justify answers. This focus on outcomes obscures factual errors and poses significant safety risks. To address this, we propose CheXPO-v2, a novel alignment framework that shifts from outcome to process supervision. Our core innovation is a Knowledge Graph Consistency Reward mechanism driven by Entity-Relation Matching. By explicitly parsing reasoning steps into structured "Disease, Relation, Anatomy" triplets, we provide fine-grained supervision that penalizes incoherent logic and hallucinations at the atomic level. Integrating this with a hard-example mining strategy, our approach significantly outperforms GRPO and state-of-the-art models on benchmarks like MIMIC-CXR-VQA. Crucially, CheXPO-v2 achieves new state-of-the-art accuracy using only 5k samples, demonstrating exceptional data efficiency while producing clinically sound and verifiable reasoning. The project source code is publicly available at: https://github.com/ecoxial2007/CheX-Phi4MM.

Accurate classification of brain tumors from MRI scans is critical for effective treatment planning. This study presents a Hybrid Quantum Convolutional Neural Network (HQCNN) that integrates quantum feature-encoding circuits with depth-wise separable convolutional layers to analyze images from a publicly available brain tumor dataset. Evaluated on this dataset, the HQCNN achieved 99.16% training accuracy and 91.47% validation accuracy, demonstrating robust performance across varied imaging conditions. The quantum layers capture complex, non-linear relationships, while separable convolutions ensure computational efficiency. By reducing both parameter count and circuit depth, the architecture is compatible with near-term quantum hardware and resource-constrained clinical environments. These results establish a foundation for integrating quantum-enhanced models into medical-imaging workflows with minimal changes to existing software platforms. Future work will extend evaluation to multi-center cohorts, assess real-time inference on quantum simulators and hardware, and explore integration with surgical-planning systems.

Medical image segmentation plays a crucial role in assisting healthcare professionals with accurate diagnoses and enabling automated diagnostic processes. Traditional convolutional neural networks (CNNs) often struggle with capturing long-range dependencies, while transformer-based architectures, despite their effectiveness, come with increased computational complexity. Recent efforts have focused on combining CNNs and transformers to balance performance and efficiency, but existing approaches still face challenges in achieving high segmentation accuracy while maintaining low computational costs. Furthermore, many methods underutilize the CNN encoder's capability to capture local spatial information, concentrating primarily on mitigating long-range dependency issues. To address these limitations, we propose QTSeg, a novel architecture for medical image segmentation that effectively integrates local and global information. QTSeg features a dual-mix attention decoder designed to enhance segmentation performance through: (1) a cross-attention mechanism for improved feature alignment, (2) a spatial attention module to capture long-range dependencies, and (3) a channel attention block to learn inter-channel relationships. Additionally, we introduce a multi-level feature distribution module, which adaptively balances feature propagation between the encoder and decoder, further boosting performance. Extensive experiments on five publicly available datasets covering diverse segmentation tasks, including lesion, polyp, breast cancer, cell, and retinal vessel segmentation, demonstrate that QTSeg outperforms state-of-the-art methods across multiple evaluation metrics while maintaining lower computational costs. Our implementation can be found at: https://github.com/tpnam0901/QTSeg (v1.0.0)

The "thinking with images" paradigm represents a pivotal shift in the reasoning of Vision Language Models (VLMs), moving from text-dominant chain-of-thought to image-interactive reasoning. By invoking visual tools or generating intermediate visual representations, VLMs can iteratively attend to fine-grained regions, enabling deeper image understanding and more faithful multimodal reasoning. As an emerging paradigm, however, it still leaves substantial room for exploration in data construction accuracy, structural design, and broader application scenarios, which offer rich opportunities for advancing multimodal reasoning. To further advance this line of work, we present DeepSketcher, a comprehensive suite comprising both an image-text interleaved dataset and a self-contained model. The dataset contains 31k chain-of-thought (CoT) reasoning trajectories with diverse tool calls and resulting edited images, covering a wide range of data types and manipulation instructions with high annotation accuracy. Building on this resource, we design a model that performs interleaved image-text reasoning and natively generates "visual thoughts" by operating directly in the visual embedding space, rather than invoking external tools and repeatedly re-encoding generated images. This design enables tool-free and more flexible "thinking with images". Extensive experiments on multimodal reasoning benchmarks demonstrate strong performance, validating both the utility of the dataset and the effectiveness of the model design.

Medical Visual Question Answering (Med-VQA) answers clinical questions using medical images, aiding diagnosis. Designing the MedVQA system holds profound importance in assisting clinical diagnosis and enhancing diagnostic accuracy. Building upon this foundation, Hierarchical Medical VQA extends Medical VQA by organizing medical questions into a hierarchical structure and making level-specific predictions to handle fine-grained distinctions. Recently, many studies have proposed hierarchical MedVQA tasks and established datasets, However, several issues still remain: (1) imperfect hierarchical modeling leads to poor differentiation between question levels causing semantic fragmentation across hierarchies. (2) Excessive reliance on implicit learning in Transformer-based cross-modal self-attention fusion methods, which obscures crucial local semantic correlations in medical scenarios. To address these issues, this study proposes a HiCA-VQA method, including two modules: Hierarchical Prompting for fine-grained medical questions and Hierarchical Answer Decoders. The hierarchical prompting module pre-aligns hierarchical text prompts with image features to guide the model in focusing on specific image regions according to question types, while the hierarchical decoder performs separate predictions for questions at different levels to improve accuracy across granularities. The framework also incorporates a cross-attention fusion module where images serve as queries and text as key-value pairs. Experiments on the Rad-Restruct benchmark demonstrate that the HiCA-VQA framework better outperforms existing state-of-the-art methods in answering hierarchical fine-grained questions. This study provides an effective pathway for hierarchical visual question answering systems, advancing medical image understanding.

Speculative decoding and quantization effectively accelerate memory-bound inference of large language models. Speculative decoding mitigates the memory bandwidth bottleneck by verifying multiple tokens within a single forward pass, which increases computational effort. Quantization achieves this optimization by compressing weights and activations into lower bit-widths and also reduces computations via low-bit matrix multiplications. To further leverage their strengths, we investigate the integration of these two techniques. Surprisingly, experiments applying the advanced speculative decoding method EAGLE-2 to various quantized models reveal that the memory benefits from 4-bit weight quantization are diminished by the computational load from speculative decoding. Specifically, verifying a tree-style draft incurs significantly more time overhead than a single-token forward pass on 4-bit weight quantized models. This finding led to our new speculative decoding design: a hierarchical framework that employs a small model as an intermediate stage to turn tree-style drafts into sequence drafts, leveraging the memory access benefits of the target quantized model. Experimental results show that our hierarchical approach achieves a 2.78times speedup across various tasks for the 4-bit weight Llama-3-70B model on an A100 GPU, outperforming EAGLE-2 by 1.31times. Code available at https://github.com/AI9Stars/SpecMQuant.

Counterfactual medical image generation enables clinicians to explore clinical hypotheses, such as predicting disease progression, facilitating their decision-making. While existing methods can generate visually plausible images from disease progression prompts, they produce silent predictions that lack interpretation to verify how the generation reflects the hypothesized progression -- a critical gap for medical applications that require traceable reasoning. In this paper, we propose Interpretable Counterfactual Generation (ICG), a novel task requiring the joint generation of counterfactual images that reflect the clinical hypothesis and interpretation texts that outline the visual changes induced by the hypothesis. To enable ICG, we present ICG-CXR, the first dataset pairing longitudinal medical images with hypothetical progression prompts and textual interpretations. We further introduce ProgEmu, an autoregressive model that unifies the generation of counterfactual images and textual interpretations. We demonstrate the superiority of ProgEmu in generating progression-aligned counterfactuals and interpretations, showing significant potential in enhancing clinical decision support and medical education. Project page: https://progemu.github.io.

Large language models (LLMs) have shown promise in medical question answering but often struggle with hallucinations and shallow reasoning, particularly in tasks requiring nuanced clinical understanding. Retrieval-augmented generation (RAG) offers a practical and privacy-preserving way to enhance LLMs with external medical knowledge. However, most existing approaches rely on surface-level semantic retrieval and lack the structured reasoning needed for clinical decision support. We introduce MedCoT-RAG, a domain-specific framework that combines causal-aware document retrieval with structured chain-of-thought prompting tailored to medical workflows. This design enables models to retrieve evidence aligned with diagnostic logic and generate step-by-step causal reasoning reflective of real-world clinical practice. Experiments on three diverse medical QA benchmarks show that MedCoT-RAG outperforms strong baselines by up to 10.3% over vanilla RAG and 6.4% over advanced domain-adapted methods, improving accuracy, interpretability, and consistency in complex medical tasks.

We propose MedicalNarratives, a dataset curated from medical pedagogical videos similar in nature to data collected in Think-Aloud studies and inspired by Localized Narratives, which collects grounded image-text data by curating instructors' speech and mouse cursor movements synchronized in time. MedicalNarratives enables pretraining of both semantic and dense objectives, alleviating the need to train medical semantic and dense tasks disparately due to the lack of reasonably sized datasets. Our dataset contains 4.7M image-text pairs from videos and articles, with 1M samples containing dense annotations in the form of traces and bounding boxes. To evaluate the utility of MedicalNarratives, we train GenMedClip based on the CLIP architecture using our dataset spanning 12 medical domains and demonstrate that it outperforms previous state-of-the-art models on a newly constructed medical imaging benchmark that comprehensively evaluates performance across all modalities. Data, demo, code and models available at https://medical-narratives.github.io

Depression poses significant challenges to patients and healthcare organizations, necessitating efficient assessment methods. Existing paradigms typically focus on a patient-doctor way that overlooks multi-role interactions, such as family involvement in the evaluation and caregiving process. Moreover, current automatic depression detection (ADD) methods usually model depression detection as a classification or regression task, lacking interpretability for the decision-making process. To address these issues, we developed InterMind, a doctor-patient-family interactive depression assessment system empowered by large language models (LLMs). Our system enables patients and families to contribute descriptions, generates assistive diagnostic reports for doctors, and provides actionable insights, improving diagnostic precision and efficiency. To enhance LLMs' performance in psychological counseling and diagnostic interpretability, we integrate retrieval-augmented generation (RAG) and chain-of-thoughts (CoT) techniques for data augmentation, which mitigates the hallucination issue of LLMs in specific scenarios after instruction fine-tuning. Quantitative experiments and professional assessments by clinicians validate the effectiveness of our system.

Chain-of-Thought (CoT) has been a widely adopted prompting method, eliciting impressive reasoning abilities of Large Language Models (LLMs). Inspired by the sequential thought structure of CoT, a number of Chain-of-X (CoX) methods have been developed to address various challenges across diverse domains and tasks involving LLMs. In this paper, we provide a comprehensive survey of Chain-of-X methods for LLMs in different contexts. Specifically, we categorize them by taxonomies of nodes, i.e., the X in CoX, and application tasks. We also discuss the findings and implications of existing CoX methods, as well as potential future directions. Our survey aims to serve as a detailed and up-to-date resource for researchers seeking to apply the idea of CoT to broader scenarios.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

We propose Quantum-informed Tensor Adaptation (QuanTA), a novel, easy-to-implement, fine-tuning method with no inference overhead for large-scale pre-trained language models. By leveraging quantum-inspired methods derived from quantum circuit structures, QuanTA enables efficient high-rank fine-tuning, surpassing the limitations of Low-Rank Adaptation (LoRA)--low-rank approximation may fail for complicated downstream tasks. Our approach is theoretically supported by the universality theorem and the rank representation theorem to achieve efficient high-rank adaptations. Experiments demonstrate that QuanTA significantly enhances commonsense reasoning, arithmetic reasoning, and scalability compared to traditional methods. Furthermore, QuanTA shows superior performance with fewer trainable parameters compared to other approaches and can be designed to integrate with existing fine-tuning algorithms for further improvement, providing a scalable and efficient solution for fine-tuning large language models and advancing state-of-the-art in natural language processing.

Human problem-solving is never the repetition of a single mindset, by which we mean a distinct mode of cognitive processing. When tackling a specific task, we do not rely on a single mindset; instead, we integrate multiple mindsets within the single solution process. However, existing LLM reasoning methods fall into a common trap: they apply the same fixed mindset across all steps, overlooking that different stages of solving the same problem require fundamentally different mindsets. This single-minded assumption prevents models from reaching the next level of intelligence. To address this limitation, we propose Chain of Mindset (CoM), a training-free agentic framework that enables step-level adaptive mindset orchestration. CoM decomposes reasoning into four functionally heterogeneous mindsets: Spatial, Convergent, Divergent, and Algorithmic. A Meta-Agent dynamically selects the optimal mindset based on the evolving reasoning state, while a bidirectional Context Gate filters cross-module information flow to maintain effectiveness and efficiency. Experiments across six challenging benchmarks spanning mathematics, code generation, scientific QA, and spatial reasoning demonstrate that CoM achieves state-of-the-art performance, outperforming the strongest baseline by 4.96\% and 4.72\% in overall accuracy on Qwen3-VL-32B-Instruct and Gemini-2.0-Flash, while balancing reasoning efficiency. Our code is publicly available at https://github.com/QuantaAlpha/chain-of-mindset{https://github.com/QuantaAlpha/chain-of-mindset}.