MedAlign: A Synergistic Framework of Multimodal Preference Optimization and Federated Meta-Cognitive Reasoning

• URL: http://arxiv.org/abs/2510.21093v1
• Date: Fri, 24 Oct 2025 02:11:05 GMT
• Title: MedAlign: A Synergistic Framework of Multimodal Preference Optimization and Federated Meta-Cognitive Reasoning
• Authors: Siyong Chen, Jinbo Wen, Jiawen Kang, Tenghui Huang, Xumin Huang, Yuanjia Su, Hudan Pan, Zishao Zhong, Dusit Niyato, Shengli Xie, Dong In Kim,
• Abstract summary: We develop MedAlign, a framework to ensure visually accurate LVLM responses for Medical Visual Question Answering (Med-VQA)<n>We first propose a multimodal Direct Preference Optimization (mDPO) objective to align preference learning with visual context.<n>We then design a Retrieval-Aware Mixture-of-Experts (RA-MoE) architecture that utilizes image and text similarity to route queries to a specialized and context-augmented LVLM.
• Score: 52.064286116035134
• License: http://arxiv.org/licenses/nonexclusive-distrib/1.0/
• Abstract: Recently, large models have shown significant potential for smart healthcare. However, the deployment of Large Vision-Language Models (LVLMs) for clinical services is currently hindered by three critical challenges: a tendency to hallucinate answers not grounded in visual evidence, the inefficiency of fixed-depth reasoning, and the difficulty of multi-institutional collaboration. To address these challenges, in this paper, we develop MedAlign, a novel framework to ensure visually accurate LVLM responses for Medical Visual Question Answering (Med-VQA). Specifically, we first propose a multimodal Direct Preference Optimization (mDPO) objective to explicitly align preference learning with visual context. We then design a Retrieval-Aware Mixture-of-Experts (RA-MoE) architecture that utilizes image and text similarity to route queries to a specialized and context-augmented LVLM (i.e., an expert), thereby mitigating hallucinations in LVLMs. To achieve adaptive reasoning and facilitate multi-institutional collaboration, we propose a federated governance mechanism, where the selected expert, fine-tuned on clinical datasets based on mDPO, locally performs iterative Chain-of-Thought (CoT) reasoning via the local meta-cognitive uncertainty estimator. Extensive experiments on three representative Med-VQA datasets demonstrate that MedAlign achieves state-of-the-art performance, outperforming strong retrieval-augmented baselines by up to $11.85\%$ in F1-score, and simultaneously reducing the average reasoning length by $51.60\%$ compared with fixed-depth CoT approaches.

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