arXiv subjects

Chunzheng Zhu

Publications and source records attributed to Chunzheng Zhu.

11 recordsLinked to original sources

arXiv2026

CRAFT: Causal Responsibility and Failure Tracing in Medical Vision Language Models

As vision language models are increasingly deployed in clinical diagnosis, understanding how they internally resolve competing visual and textual signals becomes a safety imperative. Existing mechanistic analyses remain confined to unimodal text and offer no explanation for why a single misleading sentence can override a correct image based diagnosis, or why a model commits to a confident answer despite insufficient visual evidence. We find that these two safety risks, arbitration failure where textual context overrides visual grounding and brake failure where the model commits without adequate evidence, are mediated by spatially disjoint attention head populations: arbitration heads form a mid-to-deep wideband reflecting cross-layer evidence competition, while brake heads concentrate in a narrow middle-to-late layer band that regulates evidence sufficiency and abstention behavior. To ground these observations in causal circuitry, we introduce CRAFT, which localizes each failure mode to a minimal causal head set via dual criteria and verifies necessity and sufficiency through temporal probes and Tuned Lens trajectory analysis. Excising arbitration heads sharply reduces conflict following with negligible degradation on clean inputs, while excising brake heads restores appropriate abstention under degraded visual evidence. The two interventions target spatially disjoint head sets and produce distinct corrective effects, underscoring the mechanistic separability of the failure modes. Experiments across multiple medical VQA benchmarks and VLM architectures validate both the localization and interventions, demonstrating that the identified heads causally drive each failure mode and that targeted modulation generalises without retraining. The code is available at GitHub repository.

cs.CV↗

arXiv2026

The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy

The growing ability of large language models and vision-language models to jointly interpret and reason over images and text is reshaping medical imaging AI, moving it from task-specific predictors toward autonomous agents that perceive, reason, plan, remember, and act in clinical environments. This survey departs from the capability-first perspective of existing literature and instead begins from clinical deployment, asking what tasks, contamination-resistant benchmarks, and interactive training environments are required before medical agents can be trusted in practice. Medical agents are formalized as sequential decision-making systems under partial observability, together with a three-level autonomy taxonomy spanning assisted, cooperative, and fully autonomous operation. The field is organized along a unified scaling spine consisting of framework scaling, capability scaling, and environment scaling. Within this framework, clinical environment scaling, the integration of tools, data, and clinical gyms, is identified as the most actionable yet underexplored direction for agents operating in PACS, EHR, and FHIR ecosystems. Clinical self-evolution, where agents improve through interaction with their environments rather than parameter scaling alone, is further positioned as a key research frontier, drawing insights from self-improving agents, agent gyms, and test-time compute scaling. Applications across radiology, pathology, ophthalmology, and hospital workflows are examined together with deployment challenges including hallucination, cascading failures, and fairness. By consolidating more than 300 references, with particular emphasis on advances from 2025 to 2026, this survey provides a roadmap toward trustworthy, self-improving medical imaging systems for real clinical practice.

cs.AI↗

arXiv2026

MedSynapse-V: Bridging Visual Perception and Clinical Intuition via Latent Memory Evolution

High-precision medical diagnosis relies not only on static imaging features but also on the implicit diagnostic memory experts instantly invoke during image interpretation. We pinpoint a fundamental cognitive misalignment in medical VLMs caused by discrete tokenization, leading to quantization loss, long-range information dissipation, and missing case-adaptive expertise. To bridge this gap, we propose ours, a framework for latent diagnostic memory evolution that simulates the experiential invocation of clinicians by dynamically synthesizing implicit diagnostic memories within the model's hidden stream. Specifically, it begins with a Meta Query for Prior Memorization mechanism, where learnable probes retrieve structured priors from an anatomical prior encoder to generate condensed implicit memories. To ensure clinical fidelity, we introduce Causal Counterfactual Refinement (CCR), which leverages reinforcement learning and counterfactual rewards derived from region-level feature masking to quantify the causal contribution of each memory, thereby pruning redundancies and aligning latent representations with diagnostic logic. This evolutionary process culminates in Intrinsic Memory Transition (IMT), a privileged-autonomous dual-branch paradigm that internalizes teacher-branch diagnostic patterns into the student-branch via full-vocabulary divergence alignment. Comprehensive empirical evaluations across multiple datasets demonstrate that ours, by transferring external expertise into endogenous parameters, significantly outperforms existing state-of-the-art methods, particularly chain-of-thought paradigms, in diagnostic accuracy. The code is available at https://github.com/zhcz328/MedSynapse-V.

cs.CV↗

arXiv2026

Anatomy-Anchored Self-Supervision: Distilling Vision Foundation Models for Invariant Ultrasound Representation

Self-supervised pre-training paradigm has gained increasing prominence for learning transferable representations in medical imaging, yet existing methods for ultrasound (US) images operate at the image or frame level, overlooking the anatomical context for clinical-aligned representation learning. In this work, we propose an anatomy-anchored ultrasound self-supervision framework ANAUS that shifts representation learning from generic visual regions to clinically meaningful anatomical structures. Utilizing a learnable latent prompt engine alongside a one-time domain adaptation on existing public image-mask pairs, we empower the LP-SAM module to achieve annotation-free anatomy delineation at scale. Building upon this anatomical grounding, we propose a dual-policy self-supervised learning paradigm consisting of inter-view semantics-aware anatomy-separating alignment and contextual core-region prediction to enhance representation learning. Specifically, the former enforces feature invariance within identical anatomical regions while promoting discriminability across distinct structures; the latter compels the model to reconstruct corrupted regions, thereby capturing fine-grained structural details. Extensive evaluations on six public datasets demonstrate that ANAUS consistently outstrips current state-of-the-art methods while maintaining the computational efficiency essential for clinical deployment. Code is available at https://github.com/zhcz328/ANAUS.

cs.CV↗

arXiv2026

When Models Learn to Ask Why: Adaptive Causal Reasoning for Trustworthy Medical Vision-Language Models

Vision-Language Models (VLMs) have enabled interpretable medical diagnosis by integrating visual perception with linguistic reasoning. Yet, existing medical chain-of-thought (CoT) models lack explicit mechanisms to represent and enforce causal reasoning, leaving them vulnerable to spurious correlations and limiting their clinical reliability. We pinpoint three core challenges in medical CoT reasoning: how to adaptively trigger causal correction, construct high-quality causal-spurious contrastive samples, and maintain causal consistency across reasoning trajectories. To address these challenges, we propose MedCausalX, an end-to-end framework explicitly models causal reasoning chains in medical VLMs. We first introduce the CRMed dataset providing fine-grained anatomical annotations, structured causal reasoning chains, and counterfactual variants that guide the learning of causal relationships beyond superficial correlations. Building upon CRMed, MedCausalX employs a two-stage adaptive reflection architecture equipped with $\langle$causal$\rangle$ and $\langle$verify$\rangle$ tokens, enabling the model to autonomously determine when and how to perform causal analysis and verification. Finally, a trajectory-level causal correction objective optimized through error-attributed reinforcement learning refines the reasoning chain, allowing the model to distinguish genuine causal dependencies from shortcut associations. Extensive experiments on multiple benchmarks show that MedCausalX consistently outperforms state-of-the-art methods, improving diagnostic consistency by +5.4 points, reducing hallucination by over 10 points, and attaining top spatial grounding IoU, thereby setting a new standard for causally grounded medical reasoning. The code and dataset are available at https://github.com/zhcz328/MedCausalX.

cs.AI↗

arXiv2026

Subspace-Guided Semantic and Topological Invariant Registration for Annotation-Free Ultrasound Plane Quality Control

Reliable quality control (QC) of ultrasound images is essential for both real-time acquisition guidance and retrospective clinical audit, yet existing approaches rely heavily on per-plane annotations, or employ pseudo-labeling prone to systematic bias under spatial deformations inherent in clinical acquisition. We present STRIQ, a registration-driven framework that recasts annotation-free US plane quality control as a subspace-guided consistency measurement problem. Specifically, STRIQ introduces a Latent Registration Aligner (LRA) to establish hierarchical feature space correspondences between query images and variance-driven anchors, which are autonomously distilled from unlabeled data via a variance spectrum criterion to serve as structurally stable prototypes. To further disambiguate anatomical planes and mitigate negative knowledge transfer, we propose an Orthogonal Knowledge Subspace (OKS) module. The OKS decomposes plane-specific representations into mutually orthogonal subspaces, enabling fine-grained expert collaboration while preventing inter-plane interference, ensuring that the quality metric is grounded in principled subspace proximity. Extensive experiments on the in-house US4QA and public CAMUS datasets demonstrate that STRIQ achieves state-of-the-art correlation with clinical quality scores, establishing a new paradigm for annotation-free, real-time reliable ultrasound quality control. Our code is available at https://github.com/zhcz328/STRIQ.

cs.CV↗

arXiv2026

Difference Feedback: Generating Multimodal Process-Level Supervision for VLM Reinforcement Learning

Vision--language models (VLMs) are increasingly aligned via Group Relative Policy Optimization (GRPO)-style training. However, relying solely on terminal outcome rewards yields sparse credit assignment in multi-step reasoning, weakening the linkage between visual evidence and intermediate steps and often causing unstable optimization and visual hallucinations. We propose Differential Feedback, which automatically constructs token/step-level supervision masks by repairing erroneous reasoning trajectories, explicitly marking the key positions that require correction. Without costly large-scale step-by-step human annotations, our method enables process-level visual alignment and can be seamlessly integrated into existing GRPO-like frameworks. Experiments on multimodal reasoning benchmarks including MMMStar and MathVista show an average 3% improvement under matched compute budgets. Our approach offers an effective, low-cost solution for accurate vision--reasoning process alignment.

cs.CV↗

arXiv2026

MedEyes: Learning Dynamic Visual Focus for Medical Progressive Diagnosis

Accurate medical diagnosis often involves progressive visual focusing and iterative reasoning, characteristics commonly observed in clinical workflows. While recent vision-language models demonstrate promising chain-of-thought (CoT) reasoning capabilities via reinforcement learning with verifiable rewards (RLVR), their purely on-policy learning paradigm tends to reinforce superficially coherent but clinically inaccurate reasoning paths. We propose MedEyes, a novel reinforcement learning framework that dynamically models clinician-style diagnostic reasoning by progressively attending to and interpreting relevant medical image regions. By incorporating off-policy expert guidance, MedEyes converts expert visual search trajectories into structured external behavioral signals, guiding the model toward clinically aligned visual reasoning. We design the Gaze-guided Reasoning Navigator (GRN) to emulate the diagnostic process through a dual-mode exploration strategy, scanning for systematic abnormality localization and drilling for detailed regional analysis. To balance expert imitation and autonomous discovery, we introduce the Confidence Value Sampler (CVS), which employs nucleus sampling and adaptive termination to create diverse yet credible exploration paths. Finally, the dual-stream GRPO optimization framework decouples on-policy and off-policy learning signals, mitigating reward assimilation and entropy collapse. Experiments demonstrate that MedEyes achieves an average performance improvement of +8.5pp across multiple medical VQA benchmarks, validating MedEyes's potential in building trustworthy medical AI systems. Code is available at https://github.com/zhcz328/MedEyes.

cs.CV↗

arXiv2025

fMRI2GES: Co-speech Gesture Reconstruction from fMRI Signal with Dual Brain Decoding Alignment

Understanding how the brain responds to external stimuli and decoding this process has been a significant challenge in neuroscience. While previous studies typically concentrated on brain-to-image and brain-to-language reconstruction, our work strives to reconstruct gestures associated with speech stimuli perceived by brain. Unfortunately, the lack of paired \{brain, speech, gesture\} data hinders the deployment of deep learning models for this purpose. In this paper, we introduce a novel approach, \textbf{fMRI2GES}, that allows training of fMRI-to-gesture reconstruction networks on unpaired data using \textbf{Dual Brain Decoding Alignment}. This method relies on two key components: (i) observed texts that elicit brain responses, and (ii) textual descriptions associated with the gestures. Then, instead of training models in a completely supervised manner to find a mapping relationship among the three modalities, we harness an fMRI-to-text model, a text-to-gesture model with paired data and an fMRI-to-gesture model with unpaired data, establishing dual fMRI-to-gesture reconstruction patterns. Afterward, we explicitly align two outputs and train our model in a self-supervision way. We show that our proposed method can reconstruct expressive gestures directly from fMRI recordings. We also investigate fMRI signals from different ROIs in the cortex and how they affect generation results. Overall, we provide new insights into decoding co-speech gestures, thereby advancing our understanding of neuroscience and cognitive science.

cs.AI↗

arXiv2025

Pathology-Aware Prototype Evolution via LLM-Driven Semantic Disambiguation for Multicenter Diabetic Retinopathy Diagnosis

Diabetic retinopathy (DR) grading plays a critical role in early clinical intervention and vision preservation. Recent explorations predominantly focus on visual lesion feature extraction through data processing and domain decoupling strategies. However, they generally overlook domain-invariant pathological patterns and underutilize the rich contextual knowledge of foundation models, relying solely on visual information, which is insufficient for distinguishing subtle pathological variations. Therefore, we propose integrating fine-grained pathological descriptions to complement prototypes with additional context, thereby resolving ambiguities in borderline cases. Specifically, we propose a Hierarchical Anchor Prototype Modulation (HAPM) framework to facilitate DR grading. First, we introduce a variance spectrum-driven anchor prototype library that preserves domain-invariant pathological patterns. We further employ a hierarchical differential prompt gating mechanism, dynamically selecting discriminative semantic prompts from both LVLM and LLM sources to address semantic confusion between adjacent DR grades. Finally, we utilize a two-stage prototype modulation strategy that progressively integrates clinical knowledge into visual prototypes through a Pathological Semantic Injector (PSI) and a Discriminative Prototype Enhancer (DPE). Extensive experiments across eight public datasets demonstrate that our approach achieves pathology-guided prototype evolution while outperforming state-of-the-art methods. The code is available at https://github.com/zhcz328/HAPM.

cs.AI↗

arXiv2023

NTIRE 2023 Quality Assessment of Video Enhancement Challenge

This paper reports on the NTIRE 2023 Quality Assessment of Video Enhancement Challenge, which will be held in conjunction with the New Trends in Image Restoration and Enhancement Workshop (NTIRE) at CVPR 2023. This challenge is to address a major challenge in the field of video processing, namely, video quality assessment (VQA) for enhanced videos. The challenge uses the VQA Dataset for Perceptual Video Enhancement (VDPVE), which has a total of 1211 enhanced videos, including 600 videos with color, brightness, and contrast enhancements, 310 videos with deblurring, and 301 deshaked videos. The challenge has a total of 167 registered participants. 61 participating teams submitted their prediction results during the development phase, with a total of 3168 submissions. A total of 176 submissions were submitted by 37 participating teams during the final testing phase. Finally, 19 participating teams submitted their models and fact sheets, and detailed the methods they used. Some methods have achieved better results than baseline methods, and the winning methods have demonstrated superior prediction performance.

cs.CV↗