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

• URL: http://arxiv.org/abs/2607.00060v1
• Date: Tue, 30 Jun 2026 08:07:25 GMT
• Title: Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence
• Abstract summary: Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations undermine trustworthy use.<n>We propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection.<n>We conduct systematic evaluations on 2 tasks and 5 datasets using textttLLaVA-1.5-7B, texttLLaVA-Med-1.5-7B, texttQwen3-VL-8B/32B, and textttInternVL
• Score: 45.78409219344429
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations still undermine trustworthy use: models can produce fluent conclusions that conflict with imaging evidence. Existing mitigation strategies typically rely on additional training, external retrieval/knowledge bases, or multi-stage post-hoc verification, which increases cost and pipeline complexity and often generalizes poorly across models and tasks.To address this, we propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection. By leveraging ROI priors acquired using MedSAM in our implementation, we recalibrate the visual perception trajectory via ROI-guided activation modulation while anchoring the textual reasoning trajectory by mapping anatomical coordinates into discrete semantic tokens as verifiable external memory. Then we introduce a task-aware dynamic router to select modality-specific interventions based on task semantics, balancing perceptual grounding and linguistic fluency. We conduct systematic evaluations on 2 tasks and 5 datasets using \texttt{LLaVA-1.5-7B}, \texttt{LLaVA-Med-1.5-7B}, \texttt{Qwen3-VL-8B/32B}, and \texttt{InternVL-3.5-8B/38B}. Controlled ablations and visualizations further validate the framework, which consistently outperforms baselines across medical benchmarks, improving close-ended accuracy by up to $\sim\mathbf{6}\%\uparrow$ and reducing open-ended hallucinations by $\sim\mathbf{35}\%\downarrow$. The code has been made available on GitHub: \href{https://github.com/Henry991115/SPRG}{\textcolor{blue}{https://github.com/Henry991115/SPRG}}.

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