Daily Papers

Colonoscopy is currently one of the most sensitive screening methods for colorectal cancer. This study investigates the frontiers of intelligent colonoscopy techniques and their prospective implications for multimodal medical applications. With this goal, we begin by assessing the current data-centric and model-centric landscapes through four tasks for colonoscopic scene perception, including classification, detection, segmentation, and vision-language understanding. This assessment enables us to identify domain-specific challenges and reveals that multimodal research in colonoscopy remains open for further exploration. To embrace the coming multimodal era, we establish three foundational initiatives: a large-scale multimodal instruction tuning dataset ColonINST, a colonoscopy-designed multimodal language model ColonGPT, and a multimodal benchmark. To facilitate ongoing monitoring of this rapidly evolving field, we provide a public website for the latest updates: https://github.com/ai4colonoscopy/IntelliScope.

We present a radiology-specific multimodal model for the task for generating radiological reports from chest X-rays (CXRs). Our work builds on the idea that large language model(s) can be equipped with multimodal capabilities through alignment with pre-trained vision encoders. On natural images, this has been shown to allow multimodal models to gain image understanding and description capabilities. Our proposed model (MAIRA-1) leverages a CXR-specific image encoder in conjunction with a fine-tuned large language model based on Vicuna-7B, and text-based data augmentation, to produce reports with state-of-the-art quality. In particular, MAIRA-1 significantly improves on the radiologist-aligned RadCliQ metric and across all lexical metrics considered. Manual review of model outputs demonstrates promising fluency and accuracy of generated reports while uncovering failure modes not captured by existing evaluation practices. More information and resources can be found on the project website: https://aka.ms/maira.

The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed's large-scale, de-identified medical image-text pairs to address these limitations, they still fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an 'unblinded' capacity to denoise and reformat the data, resulting in the creation of the PubMedVision dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of current MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM HuatuoGPT-Vision, which shows superior performance in medical multimodal scenarios among open-source MLLMs.

Multimodal Large Language Models (MLLMs) have shown impressive abilities in interacting with visual content with myriad potential downstream tasks. However, even though a list of benchmarks has been proposed, the capabilities and limitations of MLLMs are still not comprehensively understood, due to a lack of a standardized and holistic evaluation framework. To this end, we present the first Comprehensive Evaluation Framework (ChEF) that can holistically profile each MLLM and fairly compare different MLLMs. First, we structure ChEF as four modular components, i.e., Scenario as scalable multimodal datasets, Instruction as flexible instruction retrieving formulae, Inferencer as reliable question answering strategies, and Metric as indicative task-specific score functions. Based on them, ChEF facilitates versatile evaluations in a standardized framework, and new evaluations can be built by designing new Recipes (systematic selection of these four components). Notably, current MLLM benchmarks can be readily summarized as recipes of ChEF. Second, we introduce 6 new recipes to quantify competent MLLMs' desired capabilities (or called desiderata, i.e., calibration, in-context learning, instruction following, language performance, hallucination, and robustness) as reliable agents that can perform real-world multimodal interactions. Third, we conduct a large-scale evaluation of 9 prominent MLLMs on 9 scenarios and 6 desiderata. Our evaluation summarized over 20 valuable observations concerning the generalizability of MLLMs across various scenarios and the composite capability of MLLMs required for multimodal interactions. We will publicly release all the detailed implementations for further analysis, as well as an easy-to-use modular toolkit for the integration of new recipes and models, so that ChEF can be a growing evaluation framework for the MLLM community.

Multimodal large language models (LLMs) have demonstrated impressive capabilities in generating high-quality images from textual instructions. However, their performance in generating scientific images--a critical application for accelerating scientific progress--remains underexplored. In this work, we address this gap by introducing ScImage, a benchmark designed to evaluate the multimodal capabilities of LLMs in generating scientific images from textual descriptions. ScImage assesses three key dimensions of understanding: spatial, numeric, and attribute comprehension, as well as their combinations, focusing on the relationships between scientific objects (e.g., squares, circles). We evaluate five models, GPT-4o, Llama, AutomaTikZ, Dall-E, and StableDiffusion, using two modes of output generation: code-based outputs (Python, TikZ) and direct raster image generation. Additionally, we examine four different input languages: English, German, Farsi, and Chinese. Our evaluation, conducted with 11 scientists across three criteria (correctness, relevance, and scientific accuracy), reveals that while GPT-4o produces outputs of decent quality for simpler prompts involving individual dimensions such as spatial, numeric, or attribute understanding in isolation, all models face challenges in this task, especially for more complex prompts.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

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.

Multimodal large language models (MLLMs) hold significant potential in the medical field, but their capabilities are often limited by insufficient data in certain medical domains, highlighting the need for understanding what kinds of images can be used by MLLMs for generalization. Current research suggests that multi-task training outperforms single-task as different tasks can benefit each other, but they often overlook the internal relationships within these tasks, providing limited guidance on selecting datasets to enhance specific tasks. To analyze this phenomenon, we attempted to employ compositional generalization (CG)-the ability of models to understand novel combinations by recombining learned elements-as a guiding framework. Since medical images can be precisely defined by Modality, Anatomical area, and Task, naturally providing an environment for exploring CG. Therefore, we assembled 106 medical datasets to create Med-MAT for comprehensive experiments. The experiments confirmed that MLLMs can use CG to understand unseen medical images and identified CG as one of the main drivers of the generalization observed in multi-task training. Additionally, further studies demonstrated that CG effectively supports datasets with limited data and delivers consistent performance across different backbones, highlighting its versatility and broad applicability. Med-MAT is publicly available at https://github.com/FreedomIntelligence/Med-MAT.

The remarkable multimodal capabilities and interactive experience of GPT-4o underscore their necessity in practical applications, yet open-source models rarely excel in both areas. In this paper, we introduce VITA, the first-ever open-source Multimodal Large Language Model (MLLM) adept at simultaneous processing and analysis of Video, Image, Text, and Audio modalities, and meanwhile has an advanced multimodal interactive experience. Starting from Mixtral 8x7B as a language foundation, we expand its Chinese vocabulary followed by bilingual instruction tuning. We further endow the language model with visual and audio capabilities through two-stage multi-task learning of multimodal alignment and instruction tuning. VITA demonstrates robust foundational capabilities of multilingual, vision, and audio understanding, as evidenced by its strong performance across a range of both unimodal and multimodal benchmarks. Beyond foundational capabilities, we have made considerable progress in enhancing the natural multimodal human-computer interaction experience. To the best of our knowledge, we are the first to exploit non-awakening interaction and audio interrupt in MLLM. VITA is the first step for the open-source community to explore the seamless integration of multimodal understanding and interaction. While there is still lots of work to be done on VITA to get close to close-source counterparts, we hope that its role as a pioneer can serve as a cornerstone for subsequent research. Project Page: https://vita-home.github.io.

Recent Multimodal Large Language Models (MLLMs) exhibit impressive abilities to perceive images and follow open-ended instructions. The capabilities of MLLMs depend on two crucial factors: the model architecture to facilitate the feature alignment of visual modules and large language models; the multimodal instruction tuning datasets for human instruction following. (i) For the model architecture, most existing models introduce an external bridge module to connect vision encoders with language models, which needs an additional feature-alignment pre-training. In this work, we discover that compact pre-trained vision language models can inherently serve as ``out-of-the-box'' bridges between vision and language. Based on this, we propose Muffin framework, which directly employs pre-trained vision-language models to act as providers of visual signals. (ii) For the multimodal instruction tuning datasets, existing methods omit the complementary relationship between different datasets and simply mix datasets from different tasks. Instead, we propose UniMM-Chat dataset which explores the complementarities of datasets to generate 1.1M high-quality and diverse multimodal instructions. We merge information describing the same image from diverse datasets and transforms it into more knowledge-intensive conversation data. Experimental results demonstrate the effectiveness of the Muffin framework and UniMM-Chat dataset. Muffin achieves state-of-the-art performance on a wide range of vision-language tasks, significantly surpassing state-of-the-art models like LLaVA and InstructBLIP. Our model and dataset are all accessible at https://github.com/thunlp/muffin.

We introduce a radiology-focused visual language model designed to generate radiology reports from chest X-rays. Building on previous findings that large language models (LLMs) can acquire multimodal capabilities when aligned with pretrained vision encoders, we demonstrate similar potential with chest X-ray images. This integration enhances the ability of model to understand and describe chest X-ray images. Our model combines an image encoder with a fine-tuned LLM based on the Vicuna-7B architecture, enabling it to generate different sections of a radiology report with notable accuracy. The training process involves a two-stage approach: (i) initial alignment of chest X-ray features with the LLM (ii) followed by fine-tuning for radiology report generation.

In this paper, we aim to develop an open-source, multilingual language model for medicine, that the benefits a wider, linguistically diverse audience from different regions. In general, we present the contribution from the following aspects: first, for multilingual medical-specific adaptation, we construct a new multilingual medical corpus, that contains approximately 25.5B tokens encompassing 6 main languages, termed as MMedC, that enables auto-regressive training for existing general LLMs. second, to monitor the development of multilingual LLMs in medicine, we propose a new multilingual medical multi-choice question-answering benchmark with rationale, termed as MMedBench; third, we have assessed a number of popular, opensource large language models (LLMs) on our benchmark, along with those further auto-regressive trained on MMedC, as a result, our final model, termed as MMedLM 2, with only 7B parameters, achieves superior performance compared to all other open-source models, even rivaling GPT-4 on MMedBench. We will make the resources publicly available, including code, model weights, and datasets.

Videos serve as a powerful medium to convey ideas, tell stories, and provide detailed instructions, especially through long-format tutorials. Such tutorials are valuable for learning new skills at one's own pace, yet they can be overwhelming due to their length and dense content. Viewers often seek specific information, like precise measurements or step-by-step execution details, making it essential to extract and summarize key segments efficiently. An intelligent, time-sensitive video assistant capable of summarizing and detecting highlights in long videos is highly sought after. Recent advancements in Multimodal Large Language Models offer promising solutions to develop such an assistant. Our research explores the use of multimodal models to enhance video summarization and step-by-step instruction generation within specific domains. These models need to understand temporal events and relationships among actions across video frames. Our approach focuses on fine-tuning TimeChat to improve its performance in specific domains: cooking and medical procedures. By training the model on domain-specific datasets like Tasty for cooking and MedVidQA for medical procedures, we aim to enhance its ability to generate concise, accurate summaries of instructional videos. We curate and restructure these datasets to create high-quality video-centric instruction data. Our findings indicate that when finetuned on domain-specific procedural data, TimeChat can significantly improve the extraction and summarization of key instructional steps in long-format videos. This research demonstrates the potential of specialized multimodal models to assist with practical tasks by providing personalized, step-by-step guidance tailored to the unique aspects of each domain.

In the field of multi-modal language models, the majority of methods are built on an architecture similar to LLaVA. These models use a single-layer ViT feature as a visual prompt, directly feeding it into the language models alongside textual tokens. However, when dealing with long sequences of visual signals or inputs such as videos, the self-attention mechanism of language models can lead to significant computational overhead. Additionally, using single-layer ViT features makes it challenging for large language models to perceive visual signals fully. This paper proposes an efficient multi-modal language model to minimize computational costs while enabling the model to perceive visual signals as comprehensively as possible. Our method primarily includes: (1) employing cross-attention to image-text interaction similar to Flamingo. (2) utilize hierarchical ViT features. (3) introduce the Mixture of Experts (MoE) mechanism to enhance model effectiveness. Our model achieves competitive scores on public multi-modal benchmarks and performs well in tasks such as image captioning and video captioning.

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

As advances in large language models (LLMs) and multimodal techniques continue to mature, the development of general-purpose multimodal large language models (MLLMs) has surged, offering significant applications in interpreting natural images. However, the field of pathology has largely remained untapped, particularly in gathering high-quality data and designing comprehensive model frameworks. To bridge the gap in pathology MLLMs, we present PathAsst, a multimodal generative foundation AI assistant to revolutionize diagnostic and predictive analytics in pathology. The development of PathAsst involves three pivotal steps: data acquisition, CLIP model adaptation, and the training of PathAsst's multimodal generative capabilities. Firstly, we collect over 207K high-quality pathology image-text pairs from authoritative sources. Leveraging the advanced power of ChatGPT, we generate over 180K instruction-following samples. Furthermore, we devise additional instruction-following data specifically tailored for invoking eight pathology-specific sub-models we prepared, allowing the PathAsst to effectively collaborate with these models, enhancing its diagnostic ability. Secondly, by leveraging the collected data, we construct PathCLIP, a pathology-dedicated CLIP, to enhance PathAsst's capabilities in interpreting pathology images. Finally, we integrate PathCLIP with the Vicuna-13b and utilize pathology-specific instruction-tuning data to enhance the multimodal generation capacity of PathAsst and bolster its synergistic interactions with sub-models. The experimental results of PathAsst show the potential of harnessing AI-powered generative foundation model to improve pathology diagnosis and treatment processes.

This paper introduces MedTrinity-25M, a comprehensive, large-scale multimodal dataset for medicine, covering over 25 million images across 10 modalities, with multigranular annotations for more than 65 diseases. These enriched annotations encompass both global textual information, such as disease/lesion type, modality, region-specific descriptions, and inter-regional relationships, as well as detailed local annotations for regions of interest (ROIs), including bounding boxes, segmentation masks. Unlike existing approach which is limited by the availability of image-text pairs, we have developed the first automated pipeline that scales up multimodal data by generating multigranular visual and texual annotations (in the form of image-ROI-description triplets) without the need for any paired text descriptions. Specifically, data from over 90 different sources have been collected, preprocessed, and grounded using domain-specific expert models to identify ROIs related to abnormal regions. We then build a comprehensive knowledge base and prompt multimodal large language models to perform retrieval-augmented generation with the identified ROIs as guidance, resulting in multigranular texual descriptions. Compared to existing datasets, MedTrinity-25M provides the most enriched annotations, supporting a comprehensive range of multimodal tasks such as captioning and report generation, as well as vision-centric tasks like classification and segmentation. Pretraining on MedTrinity-25M, our model achieves state-of-the-art performance on VQA-RAD and PathVQA, surpassing both multimodal large language models and other representative SoTA approaches. This dataset can also be utilized to support large-scale pre-training of multimodal medical AI models, contributing to the development of future foundation models in the medical domain.

Multimodal Large Language Models (MLLMs) have become increasingly important due to their state-of-the-art performance and ability to integrate multiple data modalities, such as text, images, and audio, to perform complex tasks with high accuracy. This paper presents a comprehensive survey on personalized multimodal large language models, focusing on their architecture, training methods, and applications. We propose an intuitive taxonomy for categorizing the techniques used to personalize MLLMs to individual users, and discuss the techniques accordingly. Furthermore, we discuss how such techniques can be combined or adapted when appropriate, highlighting their advantages and underlying rationale. We also provide a succinct summary of personalization tasks investigated in existing research, along with the evaluation metrics commonly used. Additionally, we summarize the datasets that are useful for benchmarking personalized MLLMs. Finally, we outline critical open challenges. This survey aims to serve as a valuable resource for researchers and practitioners seeking to understand and advance the development of personalized multimodal large language models.

In recent years, Multimodal Large Language Models (MLLM) have achieved notable advancements, demonstrating the feasibility of developing an intelligent biomedical assistant. However, current biomedical MLLMs predominantly focus on image-level understanding and restrict interactions to textual commands, thus limiting their capability boundaries and the flexibility of usage. In this paper, we introduce a novel end-to-end multimodal large language model for the biomedical domain, named MedPLIB, which possesses pixel-level understanding. Excitingly, it supports visual question answering (VQA), arbitrary pixel-level prompts (points, bounding boxes, and free-form shapes), and pixel-level grounding. We propose a novel Mixture-of-Experts (MoE) multi-stage training strategy, which divides MoE into separate training phases for a visual-language expert model and a pixel-grounding expert model, followed by fine-tuning using MoE. This strategy effectively coordinates multitask learning while maintaining the computational cost at inference equivalent to that of a single expert model. To advance the research of biomedical MLLMs, we introduce the Medical Complex Vision Question Answering Dataset (MeCoVQA), which comprises an array of 8 modalities for complex medical imaging question answering and image region understanding. Experimental results indicate that MedPLIB has achieved state-of-the-art outcomes across multiple medical visual language tasks. More importantly, in zero-shot evaluations for the pixel grounding task, MedPLIB leads the best small and large models by margins of 19.7 and 15.6 respectively on the mDice metric. The codes, data, and model checkpoints will be made publicly available at https://github.com/ShawnHuang497/MedPLIB.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

Connecting text and visual modalities plays an essential role in generative intelligence. For this reason, inspired by the success of large language models, significant research efforts are being devoted to the development of Multimodal Large Language Models (MLLMs). These models can seamlessly integrate visual and textual modalities, both as input and output, while providing a dialogue-based interface and instruction-following capabilities. In this paper, we provide a comprehensive review of recent visual-based MLLMs, analyzing their architectural choices, multimodal alignment strategies, and training techniques. We also conduct a detailed analysis of these models across a wide range of tasks, including visual grounding, image generation and editing, visual understanding, and domain-specific applications. Additionally, we compile and describe training datasets and evaluation benchmarks, conducting comparisons among existing models in terms of performance and computational requirements. Overall, this survey offers a comprehensive overview of the current state of the art, laying the groundwork for future MLLMs.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their capability to understand various medical instructions and reason through complex clinical scenarios. Notably, o1 surpasses the previous GPT-4 in accuracy by an average of 6.2% and 6.6% across 19 datasets and two newly created complex QA scenarios. But meanwhile, we identify several weaknesses in both the model capability and the existing evaluation protocols, including hallucination, inconsistent multilingual ability, and discrepant metrics for evaluation. We release our raw data and model outputs at https://ucsc-vlaa.github.io/o1_medicine/ for future research.

Large Language Models (LLMs) constitute a breakthrough state-of-the-art Artificial Intelligence (AI) technology which is rapidly evolving and promises to aid in medical diagnosis either by assisting doctors or by simulating a doctor's workflow in more advanced and complex implementations. In this technical paper, we outline Cognitive Network Evaluation Toolkit for Medical Domains (COGNET-MD), which constitutes a novel benchmark for LLM evaluation in the medical domain. Specifically, we propose a scoring-framework with increased difficulty to assess the ability of LLMs in interpreting medical text. The proposed framework is accompanied with a database of Multiple Choice Quizzes (MCQs). To ensure alignment with current medical trends and enhance safety, usefulness, and applicability, these MCQs have been constructed in collaboration with several associated medical experts in various medical domains and are characterized by varying degrees of difficulty. The current (first) version of the database includes the medical domains of Psychiatry, Dentistry, Pulmonology, Dermatology and Endocrinology, but it will be continuously extended and expanded to include additional medical domains.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

Existing open-source multimodal large language models (MLLMs) generally follow a training process involving pre-training and supervised fine-tuning. However, these models suffer from distribution shifts, which limit their multimodal reasoning, particularly in the Chain-of-Thought (CoT) performance. To address this, we introduce a preference optimization (PO) process to enhance the multimodal reasoning capabilities of MLLMs. Specifically, (1) on the data side, we design an automated preference data construction pipeline to create MMPR, a high-quality, large-scale multimodal reasoning preference dataset. and (2) on the model side, we explore integrating PO with MLLMs, developing a simple yet effective method, termed Mixed Preference Optimization (MPO), which boosts multimodal CoT performance. Our approach demonstrates improved performance across multiple benchmarks, particularly in multimodal reasoning tasks. Notably, our model, InternVL2-8B-MPO, achieves an accuracy of 67.0 on MathVista, outperforming InternVL2-8B by 8.7 points and achieving performance comparable to the 10x larger InternVL2-76B. We hope this study could inspire further advancements in MLLMs. Code, data, and model shall be publicly released.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Recent researches of large language models(LLM), which is pre-trained on massive general-purpose corpora, have achieved breakthroughs in responding human queries. However, these methods face challenges including limited data insufficiency to support extensive pre-training and can not align responses with users' instructions. To address these issues, we introduce a medical instruction dataset, CMedINS, containing six medical instructions derived from actual medical tasks, which effectively fine-tunes LLM in conjunction with other data. Subsequently, We launch our medical model, IIMedGPT, employing an efficient preference alignment method, Direct preference Optimization(DPO). The results show that our final model outperforms existing medical models in medical dialogue.Datsets, Code and model checkpoints will be released upon acceptance.

Despite the success of Large Language Models (LLMs) in general image tasks, a gap persists in the medical field for a multimodal large model adept at handling the nuanced diversity of medical images. Addressing this, we propose MedXChat, a unified multimodal large model designed for seamless interactions between medical assistants and users. MedXChat encompasses three key functionalities: CXR(Chest X-ray)-to-Report generation, CXR-based visual question-answering (VQA), and Text-to-CXR synthesis. Our contributions are as follows. Firstly, our model showcases exceptional cross-task adaptability, displaying adeptness across all three defined tasks and outperforming the benchmark models on the MIMIC dataset in medical multimodal applications. Secondly, we introduce an innovative Text-to-CXR synthesis approach that utilizes instruction-following capabilities within the Stable Diffusion (SD) architecture. This technique integrates smoothly with the existing model framework, requiring no extra parameters, thereby maintaining the SD's generative strength while also bestowing upon it the capacity to render fine-grained medical images with high fidelity. Comprehensive experiments validate MedXChat's synergistic enhancement across all tasks. Our instruction data and model will be open-sourced.

In the past year, MultiModal Large Language Models (MM-LLMs) have undergone substantial advancements, augmenting off-the-shelf LLMs to support MM inputs or outputs via cost-effective training strategies. The resulting models not only preserve the inherent reasoning and decision-making capabilities of LLMs but also empower a diverse range of MM tasks. In this paper, we provide a comprehensive survey aimed at facilitating further research of MM-LLMs. Specifically, we first outline general design formulations for model architecture and training pipeline. Subsequently, we provide brief introductions of 26 existing MM-LLMs, each characterized by its specific formulations. Additionally, we review the performance of MM-LLMs on mainstream benchmarks and summarize key training recipes to enhance the potency of MM-LLMs. Lastly, we explore promising directions for MM-LLMs while concurrently maintaining a real-time tracking website for the latest developments in the field. We hope that this survey contributes to the ongoing advancement of the MM-LLMs domain.

Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs to predict free-form answers as a generative task to solve medical visual question answering (Med-VQA) tasks. In this paper, we propose a parameter efficient framework for fine-tuning MLLM specifically tailored to Med-VQA applications, and empirically validate it on a public benchmark dataset. To accurately measure the performance, we employ human evaluation and the results reveal that our model achieves an overall accuracy of 81.9%, and outperforms the GPT-4v model by a significant margin of 26% absolute accuracy on closed-ended questions. The code will be available here: https://github.com/jinlHe/PeFoMed.

Large models have recently played a dominant role in natural language processing and multimodal vision-language learning. It remains less explored about their efficacy in text-related visual tasks. We conducted a comprehensive study of existing publicly available multimodal models, evaluating their performance in text recognition (document text, artistic text, handwritten text, scene text), text-based visual question answering (document text, scene text, and bilingual text), key information extraction (receipts, documents, and nutrition facts) and handwritten mathematical expression recognition. Our findings reveal strengths and weaknesses in these models, which primarily rely on semantic understanding for word recognition and exhibit inferior perception of individual character shapes. They also display indifference towards text length and have limited capabilities in detecting finegrained features in images. Consequently, these results demonstrate that even the current most powerful large multimodal models cannot match domain-specific methods in traditional text tasks and face greater challenges in more complex tasks. Most importantly, the baseline results showcased in this study could provide a foundational framework for the conception and assessment of innovative strategies targeted at enhancing zero-shot multimodal techniques. Evaluation pipeline is available at https://github.com/Yuliang-Liu/MultimodalOCR.

A big convergence of language, multimodal perception, action, and world modeling is a key step toward artificial general intelligence. In this work, we introduce Kosmos-1, a Multimodal Large Language Model (MLLM) that can perceive general modalities, learn in context (i.e., few-shot), and follow instructions (i.e., zero-shot). Specifically, we train Kosmos-1 from scratch on web-scale multimodal corpora, including arbitrarily interleaved text and images, image-caption pairs, and text data. We evaluate various settings, including zero-shot, few-shot, and multimodal chain-of-thought prompting, on a wide range of tasks without any gradient updates or finetuning. Experimental results show that Kosmos-1 achieves impressive performance on (i) language understanding, generation, and even OCR-free NLP (directly fed with document images), (ii) perception-language tasks, including multimodal dialogue, image captioning, visual question answering, and (iii) vision tasks, such as image recognition with descriptions (specifying classification via text instructions). We also show that MLLMs can benefit from cross-modal transfer, i.e., transfer knowledge from language to multimodal, and from multimodal to language. In addition, we introduce a dataset of Raven IQ test, which diagnoses the nonverbal reasoning capability of MLLMs.

We introduce Phi-4-Mini and Phi-4-Multimodal, compact yet highly capable language and multimodal models. Phi-4-Mini is a 3.8-billion-parameter language model trained on high-quality web and synthetic data, significantly outperforming recent open-source models of similar size and matching the performance of models twice its size on math and coding tasks requiring complex reasoning. This achievement is driven by a carefully curated synthetic data recipe emphasizing high-quality math and coding datasets. Compared to its predecessor, Phi-3.5-Mini, Phi-4-Mini features an expanded vocabulary size of 200K tokens to better support multilingual applications, as well as group query attention for more efficient long-sequence generation. Phi-4-Multimodal is a multimodal model that integrates text, vision, and speech/audio input modalities into a single model. Its novel modality extension approach leverages LoRA adapters and modality-specific routers to allow multiple inference modes combining various modalities without interference. For example, it now ranks first in the OpenASR leaderboard to date, although the LoRA component of the speech/audio modality has just 460 million parameters. Phi-4-Multimodal supports scenarios involving (vision + language), (vision + speech), and (speech/audio) inputs, outperforming larger vision-language and speech-language models on a wide range of tasks. Additionally, we experiment to further train Phi-4-Mini to enhance its reasoning capabilities. Despite its compact 3.8-billion-parameter size, this experimental version achieves reasoning performance on par with or surpassing significantly larger models, including DeepSeek-R1-Distill-Qwen-7B and DeepSeek-R1-Distill-Llama-8B.

Sifting through vast textual data and summarizing key information imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown immense promise in natural language processing (NLP) tasks, their efficacy across diverse clinical summarization tasks has not yet been rigorously examined. In this work, we employ domain adaptation methods on eight LLMs, spanning six datasets and four distinct summarization tasks: radiology reports, patient questions, progress notes, and doctor-patient dialogue. Our thorough quantitative assessment reveals trade-offs between models and adaptation methods in addition to instances where recent advances in LLMs may not lead to improved results. Further, in a clinical reader study with six physicians, we depict that summaries from the best adapted LLM are preferable to human summaries in terms of completeness and correctness. Our ensuing qualitative analysis delineates mutual challenges faced by both LLMs and human experts. Lastly, we correlate traditional quantitative NLP metrics with reader study scores to enhance our understanding of how these metrics align with physician preferences. Our research marks the first evidence of LLMs outperforming human experts in clinical text summarization across multiple tasks. This implies that integrating LLMs into clinical workflows could alleviate documentation burden, empowering clinicians to focus more on personalized patient care and other irreplaceable human aspects of medicine.

Open-source, multilingual medical large language models (LLMs) have the potential to serve linguistically diverse populations across different regions. Adapting generic LLMs for healthcare often requires continual pretraining, but this approach is computationally expensive and sometimes impractical. Instruction fine-tuning on a specific task may not always guarantee optimal performance due to the lack of broader domain knowledge that the model needs to understand and reason effectively in diverse scenarios. To address these challenges, we introduce two multilingual instruction fine-tuning datasets, MMed-IFT and MMed-IFT-MC, containing over 200k high-quality medical samples in six languages. We propose a two-stage training paradigm: the first stage injects general medical knowledge using MMed-IFT, while the second stage fine-tunes task-specific multiple-choice questions with MMed-IFT-MC. Our method achieves competitive results on both English and multilingual benchmarks, striking a balance between computational efficiency and performance. We plan to make our dataset and model weights public at https://github.com/SpassMed/Med-Llama3 in the future.

Large Language Models (LLMs) like ChatGPT demonstrate significant potential in the medical field, often evaluated using multiple-choice questions (MCQs) similar to those found on the USMLE. Despite their prevalence in medical education, MCQs have limitations that might be exacerbated when assessing LLMs. To evaluate the effectiveness of MCQs in assessing the performance of LLMs, we developed a fictional medical benchmark focused on a non-existent gland, the Glianorex. This approach allowed us to isolate the knowledge of the LLM from its test-taking abilities. We used GPT-4 to generate a comprehensive textbook on the Glianorex in both English and French and developed corresponding multiple-choice questions in both languages. We evaluated various open-source, proprietary, and domain-specific LLMs using these questions in a zero-shot setting. The models achieved average scores around 67%, with minor performance differences between larger and smaller models. Performance was slightly higher in English than in French. Fine-tuned medical models showed some improvement over their base versions in English but not in French. The uniformly high performance across models suggests that traditional MCQ-based benchmarks may not accurately measure LLMs' clinical knowledge and reasoning abilities, instead highlighting their pattern recognition skills. This study underscores the need for more robust evaluation methods to better assess the true capabilities of LLMs in medical contexts.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

Vision-Language Models (VLMs), such as GPT-4V and Llama 3.2 vision, have garnered significant research attention for their ability to leverage Large Language Models (LLMs) in multimodal tasks. However, their potential is constrained by inherent challenges, including proprietary restrictions, substantial computational demands, and limited accessibility. Smaller models, such as GIT and BLIP, exhibit marked limitations, often failing to generate coherent and consistent text beyond a few tokens, even with extensive training. This underscores a pivotal inquiry: how small can a VLM be and still produce fluent and consistent text? Drawing inspiration from the exceptional learning process of 3-4 year old children, who rely heavily on visual cues for understanding and communication, we introduce two novel datasets: ShortDesc (featuring concise image descriptions) and LongDesc (containing more detailed image descriptions). These datasets consist of image-text pairs where the text is restricted to the simple vocabulary and syntax typically used by young children, generated with a scaled- down model, GPT-4o. Using these datasets, we demonstrate that it is possible to train VLMs that are significantly smaller, up to 10 times smaller than state of the art(SOTA) small VLMs while maintaining architectural simplicity. To evaluate the outputs, we leverage GPT-4o to grade the text, as if stories written by students, on creativity, meaningfulness, and consistency, assigning scores out of 10. This method addresses limitations of standard benchmarks by accommodating unstructured outputs and providing a multidimensional evaluation of the model capabilities. Our findings contribute to the development of lightweight, accessible multimodal models for resource constrained environments.

In this study, we aimed to determine if fine-tuned large language models (LLMs) can generate accurate, personalized impressions for whole-body PET reports. Twelve language models were trained on a corpus of PET reports using the teacher-forcing algorithm, with the report findings as input and the clinical impressions as reference. An extra input token encodes the reading physician's identity, allowing models to learn physician-specific reporting styles. Our corpus comprised 37,370 retrospective PET reports collected from our institution between 2010 and 2022. To identify the best LLM, 30 evaluation metrics were benchmarked against quality scores from two nuclear medicine (NM) physicians, with the most aligned metrics selecting the model for expert evaluation. In a subset of data, model-generated impressions and original clinical impressions were assessed by three NM physicians according to 6 quality dimensions (3-point scale) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. Bootstrap resampling was used for statistical analysis. Of all evaluation metrics, domain-adapted BARTScore and PEGASUSScore showed the highest Spearman's rank correlations (0.568 and 0.563) with physician preferences. Based on these metrics, the fine-tuned PEGASUS model was selected as the top LLM. When physicians reviewed PEGASUS-generated impressions in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08 out of 5. Physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P=0.41). In conclusion, personalized impressions generated by PEGASUS were clinically useful, highlighting its potential to expedite PET reporting.

Multimodal large language models (MLLMs), building upon the foundation of powerful large language models (LLMs), have recently demonstrated exceptional capabilities in generating not only texts but also images given interleaved multimodal inputs (acting like a combination of GPT-4V and DALL-E 3). However, existing MLLM benchmarks remain limited to assessing only models' comprehension ability of single image-text inputs, failing to keep up with the strides made in MLLMs. A comprehensive benchmark is imperative for investigating the progress and uncovering the limitations of current MLLMs. In this work, we categorize the capabilities of MLLMs into hierarchical levels from L_0 to L_4 based on the modalities they can accept and generate, and propose SEED-Bench-2, a comprehensive benchmark that evaluates the hierarchical capabilities of MLLMs. Specifically, SEED-Bench-2 comprises 24K multiple-choice questions with accurate human annotations, which spans 27 dimensions, including the evaluation of both text and image generation. Multiple-choice questions with groundtruth options derived from human annotation enables an objective and efficient assessment of model performance, eliminating the need for human or GPT intervention during evaluation. We further evaluate the performance of 23 prominent open-source MLLMs and summarize valuable observations. By revealing the limitations of existing MLLMs through extensive evaluations, we aim for SEED-Bench-2 to provide insights that will motivate future research towards the goal of General Artificial Intelligence. Dataset and evaluation code are available at https://github.com/AILab-CVC/SEED-Bench

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI. Project Page: https://uni-medical.github.io/GMAI-MMBench.github.io/

Multimodal Large Language Model (MLLMs) leverages Large Language Models as a cognitive framework for diverse visual-language tasks. Recent efforts have been made to equip MLLMs with visual perceiving and grounding capabilities. However, there still remains a gap in providing fine-grained pixel-level perceptions and extending interactions beyond text-specific inputs. In this work, we propose {AnyRef}, a general MLLM model that can generate pixel-wise object perceptions and natural language descriptions from multi-modality references, such as texts, boxes, images, or audio. This innovation empowers users with greater flexibility to engage with the model beyond textual and regional prompts, without modality-specific designs. Through our proposed refocusing mechanism, the generated grounding output is guided to better focus on the referenced object, implicitly incorporating additional pixel-level supervision. This simple modification utilizes attention scores generated during the inference of LLM, eliminating the need for extra computations while exhibiting performance enhancements in both grounding masks and referring expressions. With only publicly available training data, our model achieves state-of-the-art results across multiple benchmarks, including diverse modality referring segmentation and region-level referring expression generation.

Pathology plays a critical role in diagnosing a wide range of diseases, yet existing approaches often rely heavily on task-specific models trained on extensive, well-labeled datasets. These methods face sustainability challenges due to the diversity of pathologies and the labor-intensive nature of data collection. To address these limitations, we highlight the need for universal multimodal embeddings that can support multiple downstream tasks. Previous approaches often involve fine-tuning CLIP-based models, which handle images and text separately, limiting their ability to capture complex multimodal relationships. Additionally, these models are evaluated across diverse datasets without a unified benchmark for assessing multimodal embeddings in pathology. To address these challenges, we propose MLLM4PUE, a novel framework that leverages Multimodal Large Language Models (MLLMs) to generate Pathology Universal Embeddings. The MLLM4PUE framework not only facilitates robust integration of images and text but also enhances understanding and fusion capabilities across various tasks. We further introduce the Pathology Multimodal Embedding Benchmark (PMEB), a comprehensive benchmark designed to assess the quality of pathology multimodal embeddings. PMEB comprises 15 original tasks drawn from 14 datasets, organized into three meta-tasks: retrieval, classification, and composed retrieval. Experimental results demonstrate the superiority of MLLM4PUE, illustrating MLLM-based models can effectively support a wide range of downstream tasks and unify the research direction for foundation models in pathology.

With the rise of multimodal applications, instruction data has become critical for training multimodal language models capable of understanding complex image-based queries. Existing practices rely on powerful but costly large language models (LLMs) or multimodal language models (MLMs) to produce instruction data. These are often prone to hallucinations, licensing issues and the generation process is often hard to scale and interpret. In this work, we present a programmatic approach that employs scene graphs as symbolic representations of images and human-written programs to systematically synthesize vision-centric instruction data. Our approach ensures the interpretability and controllability of the data generation process and scales efficiently while maintaining factual accuracy. By implementing a suite of 24 single-image, 14 multi-image instruction generators, and a scene graph generation pipeline, we build a scalable, cost-effective system: ProVision which produces diverse question-answer pairs concerning objects, attributes, relations, depth, etc., for any given image. Applied to Visual Genome and DataComp datasets, we generate over 10 million instruction data points, ProVision-10M, and leverage them in both pretraining and instruction tuning stages of MLMs. When adopted in the instruction tuning stage, our single-image instruction data yields up to a 7% improvement on the 2D split and 8% on the 3D split of CVBench, along with a 3% increase in performance on QBench2, RealWorldQA, and MMMU. Our multi-image instruction data leads to an 8% improvement on Mantis-Eval. Incorporation of our data in both pre-training and fine-tuning stages of xGen-MM-4B leads to an averaged improvement of 1.6% across 11 benchmarks.

Multimodal Large Language Models (MLLMs) have showcased impressive skills in tasks related to visual understanding and reasoning. Yet, their widespread application faces obstacles due to the high computational demands during both the training and inference phases, restricting their use to a limited audience within the research and user communities. In this paper, we investigate the design aspects of Multimodal Small Language Models (MSLMs) and propose an efficient multimodal assistant named Mipha, which is designed to create synergy among various aspects: visual representation, language models, and optimization strategies. We show that without increasing the volume of training data, our Mipha-3B outperforms the state-of-the-art large MLLMs, especially LLaVA-1.5-13B, on multiple benchmarks. Through detailed discussion, we provide insights and guidelines for developing strong MSLMs that rival the capabilities of MLLMs. Our code is available at https://github.com/zhuyiche/llava-phi.

Large Language Models (LLMs) have demonstrated significant enhancements in instruction-following abilities through instruction tuning, achieving notable performances across various tasks. Previous research has focused on fine-tuning medical domain-specific LLMs using an extensive array of medical-specific data, incorporating millions of pieces of biomedical literature to augment their medical capabilities. However, existing medical instruction-tuned LLMs have been constrained by the limited scope of tasks and instructions available, restricting the efficacy of instruction tuning and adversely affecting performance in the general domain. In this paper, we fine-tune LLaMA-series models using 52k diverse, machine-generated, medical instruction-following data, MedInstruct-52k, resulting in the model AlpaCare. Comprehensive experimental results on both general and medical-specific domain free-form instruction evaluations showcase AlpaCare's strong medical proficiency and generalizability compared to previous instruction-tuned models in both medical and general domains. We provide public access to our MedInstruct-52k dataset and a clinician-crafted free-form instruction test set, MedInstruct-test, along with our codebase, to foster further research and development. Our project page is available at https://github.com/XZhang97666/AlpaCare.

The increasing interest in developing Artificial Intelligence applications in the medical domain, suffers from the lack of high-quality dataset, mainly due to privacy-related issues. Moreover, the recent rising of Multimodal Large Language Models (MLLM) leads to a need for multimodal medical datasets, where clinical reports and findings are attached to the corresponding CT or MR scans. This paper illustrates the entire workflow for building the data set MedPix 2.0. Starting from the well-known multimodal dataset MedPix\textregistered, mainly used by physicians, nurses and healthcare students for Continuing Medical Education purposes, a semi-automatic pipeline was developed to extract visual and textual data followed by a manual curing procedure where noisy samples were removed, thus creating a MongoDB database. Along with the dataset, we developed a GUI aimed at navigating efficiently the MongoDB instance, and obtaining the raw data that can be easily used for training and/or fine-tuning MLLMs. To enforce this point, we also propose a CLIP-based model trained on MedPix 2.0 for scan classification tasks.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

The popularity of multimodal large language models (MLLMs) has triggered a recent surge in research efforts dedicated to evaluating these models. Nevertheless, existing evaluation studies of MLLMs primarily focus on the comprehension and reasoning of unimodal (vision) content, neglecting performance evaluations in the domain of multimodal (vision-language) content understanding. Beyond multimodal reasoning, tasks related to multimodal content comprehension necessitate a profound understanding of multimodal contexts, achieved through the multimodal interaction to obtain a final answer. In this paper, we introduce a comprehensive assessment framework called MM-BigBench, which incorporates a diverse range of metrics to offer an extensive evaluation of the performance of various models and instructions across a wide spectrum of diverse multimodal content comprehension tasks. Consequently, our work complements research on the performance of MLLMs in multimodal comprehension tasks, achieving a more comprehensive and holistic evaluation of MLLMs. To begin, we employ the Best Performance metric to ascertain each model's performance upper bound on different datasets. Subsequently, the Mean Relative Gain metric offers an assessment of the overall performance of various models and instructions, while the Stability metric measures their sensitivity. Furthermore, previous research centers on evaluating models independently or solely assessing instructions, neglecting the adaptability between models and instructions. We propose the Adaptability metric to quantify the adaptability between models and instructions. Our paper evaluates a total of 20 language models (14 MLLMs) on 14 multimodal datasets spanning 6 tasks, with 10 instructions for each task, and derives novel insights. Our code will be released at https://github.com/declare-lab/MM-BigBench.

This study evaluates the performance of large language models (LLMs) as medical agents in Portuguese, aiming to develop a reliable and relevant virtual assistant for healthcare professionals. The HealthCareMagic-100k-en and MedQuAD datasets, translated from English using GPT-3.5, were used to fine-tune the ChatBode-7B model using the PEFT-QLoRA method. The InternLM2 model, with initial training on medical data, presented the best overall performance, with high precision and adequacy in metrics such as accuracy, completeness and safety. However, DrBode models, derived from ChatBode, exhibited a phenomenon of catastrophic forgetting of acquired medical knowledge. Despite this, these models performed frequently or even better in aspects such as grammaticality and coherence. A significant challenge was low inter-rater agreement, highlighting the need for more robust assessment protocols. This work paves the way for future research, such as evaluating multilingual models specific to the medical field, improving the quality of training data, and developing more consistent evaluation methodologies for the medical field.

Multimodal large language models (MLLMs) have shown promising advancements in general visual and language understanding. However, the representation of multimodal information using MLLMs remains largely unexplored. In this work, we introduce a new framework, E5-V, designed to adapt MLLMs for achieving universal multimodal embeddings. Our findings highlight the significant potential of MLLMs in representing multimodal inputs compared to previous approaches. By leveraging MLLMs with prompts, E5-V effectively bridges the modality gap between different types of inputs, demonstrating strong performance in multimodal embeddings even without fine-tuning. We propose a single modality training approach for E5-V, where the model is trained exclusively on text pairs. This method demonstrates significant improvements over traditional multimodal training on image-text pairs, while reducing training costs by approximately 95%. Additionally, this approach eliminates the need for costly multimodal training data collection. Extensive experiments across four types of tasks demonstrate the effectiveness of E5-V. As a universal multimodal model, E5-V not only achieves but often surpasses state-of-the-art performance in each task, despite being trained on a single modality.

With the rapid advancement of multimodal large language models (MLLMs), their evaluation has become increasingly comprehensive. However, understanding long multimodal content, as a foundational ability for real-world applications, remains underexplored. In this work, we present Needle In A Multimodal Haystack (MM-NIAH), the first benchmark specifically designed to systematically evaluate the capability of existing MLLMs to comprehend long multimodal documents. Our benchmark includes three types of evaluation tasks: multimodal retrieval, counting, and reasoning. In each task, the model is required to answer the questions according to different key information scattered throughout the given multimodal document. Evaluating the leading MLLMs on MM-NIAH, we observe that existing models still have significant room for improvement on these tasks, especially on vision-centric evaluation. We hope this work can provide a platform for further research on long multimodal document comprehension and contribute to the advancement of MLLMs. Code and benchmark are released at https://github.com/OpenGVLab/MM-NIAH.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Since the emergence of the Transformer architecture, language model development has increased, driven by their promising potential. However, releasing these models into production requires properly understanding their behavior, particularly in sensitive domains such as medicine. Despite this need, the medical literature still lacks technical assessments of pre-trained language models, which are especially valuable in resource-constrained settings in terms of computational power or limited budget. To address this gap, we provide a comprehensive survey of language models in the medical domain. In addition, we selected a subset of these models for thorough evaluation, focusing on classification and text generation tasks. Our subset encompasses 53 models, ranging from 110 million to 13 billion parameters, spanning the three families of Transformer-based models and from diverse knowledge domains. This study employs a series of approaches for text classification together with zero-shot prompting instead of model training or fine-tuning, which closely resembles the limited resource setting in which many users of language models find themselves. Encouragingly, our findings reveal remarkable performance across various tasks and datasets, underscoring the latent potential of certain models to contain medical knowledge, even without domain specialization. Consequently, our study advocates for further exploration of model applications in medical contexts, particularly in resource-constrained settings. The code is available on https://github.com/anpoc/Language-models-in-medicine.

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.

Curated datasets for healthcare are often limited due to the need of human annotations from experts. In this paper, we present MedEval, a multi-level, multi-task, and multi-domain medical benchmark to facilitate the development of language models for healthcare. MedEval is comprehensive and consists of data from several healthcare systems and spans 35 human body regions from 8 examination modalities. With 22,779 collected sentences and 21,228 reports, we provide expert annotations at multiple levels, offering a granular potential usage of the data and supporting a wide range of tasks. Moreover, we systematically evaluated 10 generic and domain-specific language models under zero-shot and finetuning settings, from domain-adapted baselines in healthcare to general-purposed state-of-the-art large language models (e.g., ChatGPT). Our evaluations reveal varying effectiveness of the two categories of language models across different tasks, from which we notice the importance of instruction tuning for few-shot usage of large language models. Our investigation paves the way toward benchmarking language models for healthcare and provides valuable insights into the strengths and limitations of adopting large language models in medical domains, informing their practical applications and future advancements.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

Multimodal Large Language Models (MLLMs) have shown significant promise in various applications, leading to broad interest from researchers and practitioners alike. However, a comprehensive evaluation of their long-context capabilities remains underexplored. To address these gaps, we introduce the MultiModal Needle-in-a-haystack (MMNeedle) benchmark, specifically designed to assess the long-context capabilities of MLLMs. Besides multi-image input, we employ image stitching to further increase the input context length, and develop a protocol to automatically generate labels for sub-image level retrieval. Essentially, MMNeedle evaluates MLLMs by stress-testing their capability to locate a target sub-image (needle) within a set of images (haystack) based on textual instructions and descriptions of image contents. This setup necessitates an advanced understanding of extensive visual contexts and effective information retrieval within long-context image inputs. With this benchmark, we evaluate state-of-the-art MLLMs, encompassing both API-based and open-source models. The findings reveal that GPT-4o consistently surpasses other models in long-context scenarios, but suffers from hallucination problems in negative samples, i.e., when needles are not in the haystacks. Our comprehensive long-context evaluation of MLLMs also sheds lights on the considerable performance gap between API-based and open-source models. All the code, data, and instructions required to reproduce the main results are available at https://github.com/Wang-ML-Lab/multimodal-needle-in-a-haystack.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

Although instruction-tuned large language models (LLMs) have exhibited remarkable capabilities across various NLP tasks, their effectiveness on other data modalities beyond text has not been fully studied. In this work, we propose Macaw-LLM, a novel multi-modal LLM that seamlessly integrates visual, audio, and textual information. Macaw-LLM consists of three main components: a modality module for encoding multi-modal data, a cognitive module for harnessing pretrained LLMs, and an alignment module for harmonizing diverse representations. Our novel alignment module seamlessly bridges multi-modal features to textual features, simplifying the adaptation process from the modality modules to the cognitive module. In addition, we construct a large-scale multi-modal instruction dataset in terms of multi-turn dialogue, including 69K image instances and 50K video instances. We have made our data, code and model publicly available, which we hope can pave the way for future research in multi-modal LLMs and expand the capabilities of LLMs to handle diverse data modalities and address complex real-world scenarios.

We introduce Kvasir-VQA, an extended dataset derived from the HyperKvasir and Kvasir-Instrument datasets, augmented with question-and-answer annotations to facilitate advanced machine learning tasks in Gastrointestinal (GI) diagnostics. This dataset comprises 6,500 annotated images spanning various GI tract conditions and surgical instruments, and it supports multiple question types including yes/no, choice, location, and numerical count. The dataset is intended for applications such as image captioning, Visual Question Answering (VQA), text-based generation of synthetic medical images, object detection, and classification. Our experiments demonstrate the dataset's effectiveness in training models for three selected tasks, showcasing significant applications in medical image analysis and diagnostics. We also present evaluation metrics for each task, highlighting the usability and versatility of our dataset. The dataset and supporting artifacts are available at https://datasets.simula.no/kvasir-vqa.

Rapid progress in multimodal large language models (MLLMs) highlights the need to introduce challenging yet realistic benchmarks to the academic community, while existing benchmarks primarily focus on understanding simple natural images and short context. In this paper, we present MULTI as a cutting-edge benchmark for evaluating MLLMs on understanding complex tables and images, and reasoning with long context. MULTI provides multimodal inputs and requires responses that are either precise or open-ended, reflecting real-life examination styles. MULTI includes over 18,000 questions and challenges MLLMs with a variety of tasks, ranging from formula derivation to image detail analysis and cross-modality reasoning. We also introduce MULTI-Elite, a 500-question selected hard subset, and MULTI-Extend, with more than 4,500 external knowledge context pieces. Our evaluation indicates significant potential for MLLM advancement, with GPT-4V achieving a 63.7% accuracy rate on MULTI, in contrast to other MLLMs scoring between 28.5% and 55.3%. MULTI serves not only as a robust evaluation platform but also paves the way for the development of expert-level AI.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

The rapid evolution of Multimodal Large Language Models (MLLMs) has brought substantial advancements in artificial intelligence, significantly enhancing the capability to understand and generate multimodal content. While prior studies have largely concentrated on model architectures and training methodologies, a thorough analysis of the benchmarks used for evaluating these models remains underexplored. This survey addresses this gap by systematically reviewing 211 benchmarks that assess MLLMs across four core domains: understanding, reasoning, generation, and application. We provide a detailed analysis of task designs, evaluation metrics, and dataset constructions, across diverse modalities. We hope that this survey will contribute to the ongoing advancement of MLLM research by offering a comprehensive overview of benchmarking practices and identifying promising directions for future work. An associated GitHub repository collecting the latest papers is available.

Large language models (LLMs) can potentially democratize access to medical knowledge. While many efforts have been made to harness and improve LLMs' medical knowledge and reasoning capacities, the resulting models are either closed-source (e.g., PaLM, GPT-4) or limited in scale (<= 13B parameters), which restricts their abilities. In this work, we improve access to large-scale medical LLMs by releasing MEDITRON: a suite of open-source LLMs with 7B and 70B parameters adapted to the medical domain. MEDITRON builds on Llama-2 (through our adaptation of Nvidia's Megatron-LM distributed trainer), and extends pretraining on a comprehensively curated medical corpus, including selected PubMed articles, abstracts, and internationally-recognized medical guidelines. Evaluations using four major medical benchmarks show significant performance gains over several state-of-the-art baselines before and after task-specific finetuning. Overall, MEDITRON achieves a 6% absolute performance gain over the best public baseline in its parameter class and 3% over the strongest baseline we finetuned from Llama-2. Compared to closed-source LLMs, MEDITRON-70B outperforms GPT-3.5 and Med-PaLM and is within 5% of GPT-4 and 10% of Med-PaLM-2. We release our code for curating the medical pretraining corpus and the MEDITRON model weights to drive open-source development of more capable medical LLMs.

Predicting multiple real-world tasks in a single model often requires a particularly diverse feature space. Multimodal (MM) models aim to extract the synergistic predictive potential of multiple data types to create a shared feature space with aligned semantic meaning across inputs of drastically varying sizes (i.e. images, text, sound). Most current MM architectures fuse these representations in parallel, which not only limits their interpretability but also creates a dependency on modality availability. We present MultiModN, a multimodal, modular network that fuses latent representations in a sequence of any number, combination, or type of modality while providing granular real-time predictive feedback on any number or combination of predictive tasks. MultiModN's composable pipeline is interpretable-by-design, as well as innately multi-task and robust to the fundamental issue of biased missingness. We perform four experiments on several benchmark MM datasets across 10 real-world tasks (predicting medical diagnoses, academic performance, and weather), and show that MultiModN's sequential MM fusion does not compromise performance compared with a baseline of parallel fusion. By simulating the challenging bias of missing not-at-random (MNAR), this work shows that, contrary to MultiModN, parallel fusion baselines erroneously learn MNAR and suffer catastrophic failure when faced with different patterns of MNAR at inference. To the best of our knowledge, this is the first inherently MNAR-resistant approach to MM modeling. In conclusion, MultiModN provides granular insights, robustness, and flexibility without compromising performance.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

The development of large language models (LLMs) has significantly advanced the emergence of large multimodal models (LMMs). While LMMs have achieved tremendous success by promoting the synergy between multimodal comprehension and creation, they often face challenges when confronted with out-of-distribution data. This is primarily due to their reliance on image encoders trained to encode images into task-relevant features, which may lead them to disregard irrelevant details. Delving into the modeling capabilities of diffusion models for images naturally prompts the question: Can diffusion models serve as the eyes of large language models for image perception? In this paper, we propose DEEM, a simple and effective approach that utilizes the generative feedback of diffusion models to align the semantic distributions of the image encoder. This addresses the drawbacks of previous methods that solely relied on image encoders like ViT, thereby enhancing the model's resilience against out-of-distribution samples and reducing visual hallucinations. Importantly, this is achieved without requiring additional training modules and with fewer training parameters. We extensively evaluated DEEM on both our newly constructed RobustVQA benchmark and another well-known benchmark, POPE, for object hallucination. Compared to the state-of-the-art interleaved content generation models, DEEM exhibits enhanced robustness and a superior capacity to alleviate model hallucinations while utilizing fewer trainable parameters, less pre-training data (10%), and a smaller base model size.

The remarkable multimodal capabilities demonstrated by OpenAI's GPT-4 have sparked significant interest in the development of multimodal Large Language Models (LLMs). A primary research objective of such models is to align visual and textual modalities effectively while comprehending human instructions. Current methodologies often rely on annotations derived from benchmark datasets to construct image-dialogue datasets for training purposes, akin to instruction tuning in LLMs. However, these datasets often exhibit domain bias, potentially constraining the generative capabilities of the models. In an effort to mitigate these limitations, we propose a novel data collection methodology that synchronously synthesizes images and dialogues for visual instruction tuning. This approach harnesses the power of generative models, marrying the abilities of ChatGPT and text-to-image generative models to yield a diverse and controllable dataset with varied image content. This not only provides greater flexibility compared to existing methodologies but also significantly enhances several model capabilities. Our research includes comprehensive experiments conducted on various datasets using the open-source LLAVA model as a testbed for our proposed pipeline. Our results underscore marked enhancements across more than ten commonly assessed capabilities,

This paper aims to efficiently enable Large Language Models (LLMs) to use multimodal tools. Advanced proprietary LLMs, such as ChatGPT and GPT-4, have shown great potential for tool usage through sophisticated prompt engineering. Nevertheless, these models typically rely on prohibitive computational costs and publicly inaccessible data. To address these challenges, we propose the GPT4Tools based on self-instruct to enable open-source LLMs, such as LLaMA and OPT, to use tools. It generates an instruction-following dataset by prompting an advanced teacher with various multi-modal contexts. By using the Low-Rank Adaptation (LoRA) optimization, our approach facilitates the open-source LLMs to solve a range of visual problems, including visual comprehension and image generation. Moreover, we provide a benchmark to evaluate the ability of LLMs to use tools, which is performed in both zero-shot and fine-tuning ways. Extensive experiments demonstrate the effectiveness of our method on various language models, which not only significantly improves the accuracy of invoking seen tools, but also enables the zero-shot capacity for unseen tools. The code and demo are available at https://github.com/StevenGrove/GPT4Tools.

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

In this work, we introduce Multiple Embedding Model for EHR (MEME), an approach that views Electronic Health Records (EHR) as multimodal data. This approach incorporates "pseudo-notes", textual representations of tabular EHR concepts such as diagnoses and medications, and allows us to effectively employ Large Language Models (LLMs) for EHR representation. This framework also adopts a multimodal approach, embedding each EHR modality separately. We demonstrate the effectiveness of MEME by applying it to several tasks within the Emergency Department across multiple hospital systems. Our findings show that MEME surpasses the performance of both single modality embedding methods and traditional machine learning approaches. However, we also observe notable limitations in generalizability across hospital institutions for all tested models.

In this paper, we introduce MIO, a novel foundation model built on multimodal tokens, capable of understanding and generating speech, text, images, and videos in an end-to-end, autoregressive manner. While the emergence of large language models (LLMs) and multimodal large language models (MM-LLMs) propels advancements in artificial general intelligence through their versatile capabilities, they still lack true any-to-any understanding and generation. Recently, the release of GPT-4o has showcased the remarkable potential of any-to-any LLMs for complex real-world tasks, enabling omnidirectional input and output across images, speech, and text. However, it is closed-source and does not support the generation of multimodal interleaved sequences. To address this gap, we present MIO, which is trained on a mixture of discrete tokens across four modalities using causal multimodal modeling. MIO undergoes a four-stage training process: (1) alignment pre-training, (2) interleaved pre-training, (3) speech-enhanced pre-training, and (4) comprehensive supervised fine-tuning on diverse textual, visual, and speech tasks. Our experimental results indicate that MIO exhibits competitive, and in some cases superior, performance compared to previous dual-modal baselines, any-to-any model baselines, and even modality-specific baselines. Moreover, MIO demonstrates advanced capabilities inherent to its any-to-any feature, such as interleaved video-text generation, chain-of-visual-thought reasoning, visual guideline generation, instructional image editing, etc.

Research on language technology for the development of medical applications is currently a hot topic in Natural Language Understanding and Generation. Thus, a number of large language models (LLMs) have recently been adapted to the medical domain, so that they can be used as a tool for mediating in human-AI interaction. While these LLMs display competitive performance on automated medical texts benchmarks, they have been pre-trained and evaluated with a focus on a single language (English mostly). This is particularly true of text-to-text models, which typically require large amounts of domain-specific pre-training data, often not easily accessible for many languages. In this paper, we address these shortcomings by compiling, to the best of our knowledge, the largest multilingual corpus for the medical domain in four languages, namely English, French, Italian and Spanish. This new corpus has been used to train Medical mT5, the first open-source text-to-text multilingual model for the medical domain. Additionally, we present two new evaluation benchmarks for all four languages with the aim of facilitating multilingual research in this domain. A comprehensive evaluation shows that Medical mT5 outperforms both encoders and similarly sized text-to-text models for the Spanish, French, and Italian benchmarks, while being competitive with current state-of-the-art LLMs in English.

Recent advancements in artificial intelligence (AI) have precipitated significant breakthroughs in healthcare, particularly in refining diagnostic procedures. However, previous studies have often been constrained to limited functionalities. This study introduces MiniGPT-Med, a vision-language model derived from large-scale language models and tailored for medical applications. MiniGPT-Med demonstrates remarkable versatility across various imaging modalities, including X-rays, CT scans, and MRIs, enhancing its utility. The model is capable of performing tasks such as medical report generation, visual question answering (VQA), and disease identification within medical imagery. Its integrated processing of both image and textual clinical data markedly improves diagnostic accuracy. Our empirical assessments confirm MiniGPT-Med's superior performance in disease grounding, medical report generation, and VQA benchmarks, representing a significant step towards reducing the gap in assisting radiology practice. Furthermore, it achieves state-of-the-art performance on medical report generation, higher than the previous best model by 19\% accuracy. MiniGPT-Med promises to become a general interface for radiology diagnoses, enhancing diagnostic efficiency across a wide range of medical imaging applications.

Recent studies have demonstrated Large Language Models (LLMs) can extend their zero-shot generalization capabilities to multimodal learning through instruction tuning. As more modalities and downstream tasks are introduced, negative conflicts and interference may have a worse impact on performance. While this phenomenon has been overlooked in previous work, we propose a novel and extensible framework, called Octavius, for comprehensive studies and experimentation on multimodal learning with Multimodal Large Language Models (MLLMs). Specifically, we combine the well-known Mixture-of-Experts (MoE) and one of the representative PEFT techniques, i.e., LoRA, designing a novel LLM-based decoder, called LoRA-MoE, for multimodal learning. To the best of our knowledge, we are one of the pioneering efforts to introduce MoE into MLLMs to address this problem. The experimental results (about 20% improvement) have shown the effectiveness and versatility of our design in various 2D and 3D downstream tasks. Code and datasets are available at https://openlamm.github.io/paper_list/Octavius.

The integration of Large Language Models (LLMs) into healthcare promises to transform medical diagnostics, research, and patient care. Yet, the progression of medical LLMs faces obstacles such as complex training requirements, rigorous evaluation demands, and the dominance of proprietary models that restrict academic exploration. Transparent, comprehensive access to LLM resources is essential for advancing the field, fostering reproducibility, and encouraging innovation in healthcare AI. We present Hippocrates, an open-source LLM framework specifically developed for the medical domain. In stark contrast to previous efforts, it offers unrestricted access to its training datasets, codebase, checkpoints, and evaluation protocols. This open approach is designed to stimulate collaborative research, allowing the community to build upon, refine, and rigorously evaluate medical LLMs within a transparent ecosystem. Also, we introduce Hippo, a family of 7B models tailored for the medical domain, fine-tuned from Mistral and LLaMA2 through continual pre-training, instruction tuning, and reinforcement learning from human and AI feedback. Our models outperform existing open medical LLMs models by a large-margin, even surpassing models with 70B parameters. Through Hippocrates, we aspire to unlock the full potential of LLMs not just to advance medical knowledge and patient care but also to democratize the benefits of AI research in healthcare, making them available across the globe.

Multimodal Large Language Model (MLLM) relies on the powerful LLM to perform multimodal tasks, showing amazing emergent abilities in recent studies, such as writing poems based on an image. However, it is difficult for these case studies to fully reflect the performance of MLLM, lacking a comprehensive evaluation. In this paper, we fill in this blank, presenting the first MLLM Evaluation benchmark MME. It measures both perception and cognition abilities on a total of 14 subtasks. In order to avoid data leakage that may arise from direct use of public datasets for evaluation, the annotations of instruction-answer pairs are all manually designed. The concise instruction design allows us to fairly compare MLLMs, instead of struggling in prompt engineering. Besides, with such an instruction, we can also easily carry out quantitative statistics. A total of 12 advanced MLLMs are comprehensively evaluated on our MME, which not only suggests that existing MLLMs still have a large room for improvement, but also reveals the potential directions for the subsequent model optimization.

Menu system design is a challenging task involving many design options and various human factors. For example, one crucial factor that designers need to consider is the semantic and systematic relation of menu commands. However, capturing these relations can be challenging due to limited available resources. With the advancement of neural language models, large language models can utilize their vast pre-existing knowledge in designing and refining menu systems. In this paper, we propose MenuCraft, an AI-assisted designer for menu design that enables collaboration between the designer and a dialogue system to design menus. MenuCraft offers an interactive language-based menu design tool that simplifies the menu design process and enables easy customization of design options. MenuCraft supports a variety of interactions through dialog that allows performing few-shot learning.

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Large Language Models (LLMs) have garnered significant attention for their advancements in natural language processing, demonstrating unparalleled prowess in text comprehension and generation. Yet, the simultaneous generation of images with coherent textual narratives remains an evolving frontier. In response, we introduce an innovative interleaved vision-and-language generation technique anchored by the concept of "generative vokens," acting as the bridge for harmonized image-text outputs. Our approach is characterized by a distinctive two-staged training strategy focusing on description-free multimodal generation, where the training requires no comprehensive descriptions of images. To bolster model integrity, classifier-free guidance is incorporated, enhancing the effectiveness of vokens on image generation. Our model, MiniGPT-5, exhibits substantial improvement over the baseline Divter model on the MMDialog dataset and consistently delivers superior or comparable multimodal outputs in human evaluations on the VIST dataset, highlighting its efficacy across diverse benchmarks.

This study explores the capabilities of multimodal large language models (LLMs) in handling challenging multistep tasks that integrate language and vision, focusing on model steerability, composability, and the application of long-term memory and context understanding. The problem addressed is the LLM's ability (Nov 2023 GPT-4 Vision Preview) to manage tasks that require synthesizing visual and textual information, especially where stepwise instructions and sequential logic are paramount. The research presents a series of 14 creatively and constructively diverse tasks, ranging from AI Lego Designing to AI Satellite Image Analysis, designed to test the limits of current LLMs in contexts that previously proved difficult without extensive memory and contextual understanding. Key findings from evaluating 800 guided dialogs include notable disparities in task completion difficulty. For instance, 'Image to Ingredient AI Bartender' (Low difficulty) contrasted sharply with 'AI Game Self-Player' (High difficulty), highlighting the LLM's varying proficiency in processing complex visual data and generating coherent instructions. Tasks such as 'AI Genetic Programmer' and 'AI Negotiator' showed high completion difficulty, emphasizing challenges in maintaining context over multiple steps. The results underscore the importance of developing LLMs that combine long-term memory and contextual awareness to mimic human-like thought processes in complex problem-solving scenarios.

With the rapid development of large language models (LLMs) and their integration into large multimodal models (LMMs), there has been impressive progress in zero-shot completion of user-oriented vision-language tasks. However, a gap remains in the domain of chart image understanding due to the distinct abstract components in charts. To address this, we introduce a large-scale MultiModal Chart Instruction (MMC-Instruction) dataset comprising 600k instances supporting diverse tasks and chart types. Leveraging this data, we develop MultiModal Chart Assistant (MMCA), an LMM that achieves state-of-the-art performance on existing chart QA benchmarks. Recognizing the need for a comprehensive evaluation of LMM chart understanding, we also propose a MultiModal Chart Benchmark (MMC-Benchmark), a comprehensive human-annotated benchmark with 9 distinct tasks evaluating reasoning capabilities over charts. Extensive experiments on MMC-Benchmark reveal the limitations of existing LMMs on correctly interpreting charts, even for the most recent GPT-4V model. Our work provides an instruction-tuning methodology and benchmark to advance multimodal understanding of charts.

Large language models like ChatGPT have shown substantial progress in natural language understanding and generation, proving valuable across various disciplines, including the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks which often require multi-task learning capabilities. Previous approaches, although beneficial, fall short in real-world applications because they necessitate task-specific annotations at inference time, limiting broader generalization. This paper introduces MING-MOE, a novel Mixture-of-Expert~(MOE)-based medical large language model designed to manage diverse and complex medical tasks without requiring task-specific annotations, thus enhancing its usability across extensive datasets. MING-MOE employs a Mixture of Low-Rank Adaptation (MoLoRA) technique, allowing for efficient parameter usage by maintaining base model parameters static while adapting through a minimal set of trainable parameters. We demonstrate that MING-MOE achieves state-of-the-art (SOTA) performance on over 20 medical tasks, illustrating a significant improvement over existing models. This approach not only extends the capabilities of medical language models but also improves inference efficiency.

Recent developments in Multimodal Large Language Models (MLLMs) have shown rapid progress, moving towards the goal of creating versatile MLLMs that understand inputs from various modalities. However, existing methods typically rely on joint training with paired multimodal instruction data, which is resource-intensive and challenging to extend to new modalities. In this paper, we propose a new paradigm through the model composition of existing MLLMs to create a new model that retains the modal understanding capabilities of each original model. Our basic implementation, NaiveMC, demonstrates the effectiveness of this paradigm by reusing modality encoders and merging LLM parameters. Furthermore, we introduce DAMC to address parameter interference and mismatch issues during the merging process, thereby enhancing the model performance. To facilitate research in this area, we propose MCUB, a benchmark for assessing ability of MLLMs to understand inputs from diverse modalities. Experiments on this benchmark and four other multimodal understanding tasks show significant improvements over baselines, proving that model composition can create a versatile model capable of processing inputs from multiple modalities.

Assessing the capabilities of large multimodal models (LMMs) often requires the creation of ad-hoc evaluations. Currently, building new benchmarks requires tremendous amounts of manual work for each specific analysis. This makes the evaluation process tedious and costly. In this paper, we present APEx, Automatic Programming of Experiments, the first framework for automatic benchmarking of LMMs. Given a research question expressed in natural language, APEx leverages a large language model (LLM) and a library of pre-specified tools to generate a set of experiments for the model at hand, and progressively compile a scientific report. The report drives the testing procedure: based on the current status of the investigation, APEx chooses which experiments to perform and whether the results are sufficient to draw conclusions. Finally, the LLM refines the report, presenting the results to the user in natural language. Thanks to its modularity, our framework is flexible and extensible as new tools become available. Empirically, APEx reproduces the findings of existing studies while allowing for arbitrary analyses and hypothesis testing.

Open-source multimodal large language models (MLLMs) have shown significant potential in a broad range of multimodal tasks. However, their reasoning capabilities remain constrained by existing instruction-tuning datasets, which were predominately repurposed from academic datasets such as VQA, AI2D, and ChartQA. These datasets target simplistic tasks, and only provide phrase-level answers without any intermediate rationales. To address these challenges, we introduce a scalable and cost-effective method to construct a large-scale multimodal instruction-tuning dataset with rich intermediate rationales designed to elicit CoT reasoning. Using only open models, we create a dataset containing 12M instruction-response pairs to cover diverse, reasoning-intensive tasks with detailed and faithful rationales. Experiments demonstrate that training MLLMs on this dataset significantly improves reasoning capabilities, achieving state-of-the-art performance on benchmarks such as MathVerse (+8.1%), MMMU-Pro (+7%), and MuirBench (+13.3%). Additionally, the model demonstrates notable improvements of up to 4% on non-reasoning-based benchmarks. Ablation studies further highlight the importance of key components, such as rewriting and self-filtering, in the dataset construction process.

Research on food image understanding using recipe data has been a long-standing focus due to the diversity and complexity of the data. Moreover, food is inextricably linked to people's lives, making it a vital research area for practical applications such as dietary management. Recent advancements in Multimodal Large Language Models (MLLMs) have demonstrated remarkable capabilities, not only in their vast knowledge but also in their ability to handle languages naturally. While English is predominantly used, they can also support multiple languages including Japanese. This suggests that MLLMs are expected to significantly improve performance in food image understanding tasks. We fine-tuned open MLLMs LLaVA-1.5 and Phi-3 Vision on a Japanese recipe dataset and benchmarked their performance against the closed model GPT-4o. We then evaluated the content of generated recipes, including ingredients and cooking procedures, using 5,000 evaluation samples that comprehensively cover Japanese food culture. Our evaluation demonstrates that the open models trained on recipe data outperform GPT-4o, the current state-of-the-art model, in ingredient generation. Our model achieved F1 score of 0.531, surpassing GPT-4o's F1 score of 0.481, indicating a higher level of accuracy. Furthermore, our model exhibited comparable performance to GPT-4o in generating cooking procedure text.

Multimodal Vision-Language Models (VLMs) enable powerful applications from their fused understanding of images and language, but many perform poorly on UI tasks due to the lack of UI training data. In this paper, we adapt a recipe for generating paired text-image training data for VLMs to the UI domain by combining existing pixel-based methods with a Large Language Model (LLM). Unlike prior art, our method requires no human-provided annotations, and it can be applied to any dataset of UI screenshots. We generate a dataset of 335K conversational examples paired with UIs that cover Q&A, UI descriptions, and planning, and use it to fine-tune a conversational VLM for UI tasks. To assess the performance of our model, we benchmark it on UI element detection tasks, evaluate response quality, and showcase its applicability to multi-step UI navigation and planning.

Large Language Models (LLMs) have demonstrated exceptional text understanding. Existing works explore their application in text embedding tasks. However, there are few works utilizing LLMs to assist multimodal representation tasks. In this work, we investigate the potential of LLMs to enhance multimodal representation in multimodal item-to-item (I2I) recommendations. One feasible method is the transfer of Multimodal Large Language Models (MLLMs) for representation tasks. However, pre-training MLLMs usually requires collecting high-quality, web-scale multimodal data, resulting in complex training procedures and high costs. This leads the community to rely heavily on open-source MLLMs, hindering customized training for representation scenarios. Therefore, we aim to design an end-to-end training method that customizes the integration of any existing LLMs and vision encoders to construct efficient multimodal representation models. Preliminary experiments show that fine-tuned LLMs in this end-to-end method tend to overlook image content. To overcome this challenge, we propose a novel training framework, NoteLLM-2, specifically designed for multimodal representation. We propose two ways to enhance the focus on visual information. The first method is based on the prompt viewpoint, which separates multimodal content into visual content and textual content. NoteLLM-2 adopts the multimodal In-Content Learning method to teach LLMs to focus on both modalities and aggregate key information. The second method is from the model architecture, utilizing a late fusion mechanism to directly fuse visual information into textual information. Extensive experiments have been conducted to validate the effectiveness of our method.

Multimodal large language models (MLLMs) have shown remarkable capabilities across a broad range of tasks but their knowledge and abilities in the geographic and geospatial domains are yet to be explored, despite potential wide-ranging benefits to navigation, environmental research, urban development, and disaster response. We conduct a series of experiments exploring various vision capabilities of MLLMs within these domains, particularly focusing on the frontier model GPT-4V, and benchmark its performance against open-source counterparts. Our methodology involves challenging these models with a small-scale geographic benchmark consisting of a suite of visual tasks, testing their abilities across a spectrum of complexity. The analysis uncovers not only where such models excel, including instances where they outperform humans, but also where they falter, providing a balanced view of their capabilities in the geographic domain. To enable the comparison and evaluation of future models, our benchmark will be publicly released.

Multimodal Large Language Models (MLLMs) excel in generating responses based on visual inputs. However, they often suffer from a bias towards generating responses similar to their pretraining corpus, overshadowing the importance of visual information. We treat this bias as a "preference" for pretraining statistics, which hinders the model's grounding in visual input. To mitigate this issue, we propose Bootstrapped Preference Optimization (BPO), which conducts preference learning with datasets containing negative responses bootstrapped from the model itself. Specifically, we propose the following two strategies: 1) using distorted image inputs to the MLLM for eliciting responses that contain signified pretraining bias; 2) leveraging text-based LLM to explicitly inject erroneous but common elements into the original response. Those undesirable responses are paired with original annotated responses from the datasets to construct the preference dataset, which is subsequently utilized to perform preference learning. Our approach effectively suppresses pretrained LLM bias, enabling enhanced grounding in visual inputs. Extensive experimentation demonstrates significant performance improvements across multiple benchmarks, advancing the state-of-the-art in multimodal conversational systems.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

We introduce InternVL 2.5, an advanced multimodal large language model (MLLM) series that builds upon InternVL 2.0, maintaining its core model architecture while introducing significant enhancements in training and testing strategies as well as data quality. In this work, we delve into the relationship between model scaling and performance, systematically exploring the performance trends in vision encoders, language models, dataset sizes, and test-time configurations. Through extensive evaluations on a wide range of benchmarks, including multi-discipline reasoning, document understanding, multi-image / video understanding, real-world comprehension, multimodal hallucination detection, visual grounding, multilingual capabilities, and pure language processing, InternVL 2.5 exhibits competitive performance, rivaling leading commercial models such as GPT-4o and Claude-3.5-Sonnet. Notably, our model is the first open-source MLLMs to surpass 70% on the MMMU benchmark, achieving a 3.7-point improvement through Chain-of-Thought (CoT) reasoning and showcasing strong potential for test-time scaling. We hope this model contributes to the open-source community by setting new standards for developing and applying multimodal AI systems. HuggingFace demo see https://huggingface.co/spaces/OpenGVLab/InternVL

Recent Multimodal Large Language Models (MLLMs) have demonstrated significant progress in perceiving and reasoning over multimodal inquiries, ushering in a new research era for foundation models. However, vision-language misalignment in MLLMs has emerged as a critical challenge, where the textual responses generated by these models are not factually aligned with the given text-image inputs. Existing efforts to address vision-language misalignment have focused on developing specialized vision-language connectors or leveraging visual instruction tuning from diverse domains. In this paper, we tackle this issue from a fundamental yet unexplored perspective by revisiting the core architecture of MLLMs. Most MLLMs are typically built on decoder-only LLMs consisting of a causal attention mechanism, which limits the ability of earlier modalities (e.g., images) to incorporate information from later modalities (e.g., text). To address this problem, we propose AKI, a novel MLLM that unlocks causal attention into modality-mutual attention (MMA) to enable image tokens to attend to text tokens. This simple yet effective design allows AKI to achieve superior performance in 12 multimodal understanding benchmarks (+7.2% on average) without introducing additional parameters and increasing training time. Our MMA design is intended to be generic, allowing for application across various modalities, and scalable to accommodate diverse multimodal scenarios. The code is publicly available at https://github.com/sony/aki, and we will release our AKI-4B model to encourage further advancements in MLLMs across various directions.

In recent years, advances in the large-scale pretraining of language and text-to-image models have revolutionized the field of machine learning. Yet, integrating these two modalities into a single, robust model capable of generating seamless multimodal outputs remains a significant challenge. To address this gap, we present the Joint Autoregressive Mixture (JAM) framework, a modular approach that systematically fuses existing text and image generation models. We also introduce a specialized, data-efficient instruction-tuning strategy, tailored for mixed-modal generation tasks. Our final instruct-tuned model demonstrates unparalleled performance in generating high-quality multimodal outputs and represents the first model explicitly designed for this purpose.

This paper investigates the challenges of developing large language models (LLMs) proficient in both multilingual understanding and medical knowledge. We demonstrate that simply translating medical data does not guarantee strong performance on clinical tasks in the target language. Our experiments reveal that the optimal language mix in training data varies significantly across different medical tasks. We find that larger models with carefully calibrated language ratios achieve superior performance on native-language clinical tasks. Furthermore, our results suggest that relying solely on fine-tuning may not be the most effective approach for incorporating new language knowledge into LLMs. Instead, data and computationally intensive pretraining methods may still be necessary to achieve optimal performance in multilingual medical settings. These findings provide valuable guidance for building effective and inclusive medical AI systems for diverse linguistic communities.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

While recently Multimodal Large Language Models (MM-LLMs) have made exciting strides, they mostly fall prey to the limitation of only input-side multimodal understanding, without the ability to produce content in multiple modalities. As we humans always perceive the world and communicate with people through various modalities, developing any-to-any MM-LLMs capable of accepting and delivering content in any modality becomes essential to human-level AI. To fill the gap, we present an end-to-end general-purpose any-to-any MM-LLM system, NExT-GPT. We connect an LLM with multimodal adaptors and different diffusion decoders, enabling NExT-GPT to perceive inputs and generate outputs in arbitrary combinations of text, images, videos, and audio. By leveraging the existing well-trained highly-performing encoders and decoders, NExT-GPT is tuned with only a small amount of parameter (1%) of certain projection layers, which not only benefits low-cost training and also facilitates convenient expansion to more potential modalities. Moreover, we introduce a modality-switching instruction tuning (MosIT) and manually curate a high-quality dataset for MosIT, based on which NExT-GPT is empowered with complex cross-modal semantic understanding and content generation. Overall, our research showcases the promising possibility of building an AI agent capable of modeling universal modalities, paving the way for more human-like AI research in the community.

Since the release of ChatGPT, the field of Natural Language Processing has experienced rapid advancements, particularly in Large Language Models (LLMs) and their multimodal counterparts, Large Multimodal Models (LMMs). Despite their impressive capabilities, LLMs often exhibit significant performance disparities across different languages and cultural contexts, as demonstrated by various text-only benchmarks. However, current research lacks such benchmarks for multimodal visio-linguistic settings. This work fills this gap by introducing M5, the first comprehensive benchmark designed to evaluate LMMs on diverse vision-language tasks within a multilingual and multicultural context. M5 includes eight datasets covering five tasks and 41 languages, with a focus on underrepresented languages and culturally diverse images. Furthermore, we introduce two novel datasets, M5-VGR and M5-VLOD, including a new Visio-Linguistic Outlier Detection task, in which all evaluated open-source models fail to significantly surpass the random baseline. Through extensive evaluation and analyses, we highlight substantial task-agnostic performance disparities between high- and low-resource languages. Moreover, we show that larger models do not necessarily outperform smaller ones in a multilingual setting.

In the era of modern healthcare, swiftly generating medical question summaries is crucial for informed and timely patient care. Despite the increasing complexity and volume of medical data, existing studies have focused solely on text-based summarization, neglecting the integration of visual information. Recognizing the untapped potential of combining textual queries with visual representations of medical conditions, we introduce the Multimodal Medical Question Summarization (MMQS) Dataset. This dataset, a major contribution to our work, pairs medical queries with visual aids, facilitating a richer and more nuanced understanding of patient needs. We also propose a framework, utilizing the power of Contrastive Language Image Pretraining(CLIP) and Large Language Models(LLMs), consisting of four modules that identify medical disorders, generate relevant context, filter medical concepts, and craft visually aware summaries. Our comprehensive framework harnesses the power of CLIP, a multimodal foundation model, and various general-purpose LLMs, comprising four main modules: the medical disorder identification module, the relevant context generation module, the context filtration module for distilling relevant medical concepts and knowledge, and finally, a general-purpose LLM to generate visually aware medical question summaries. Leveraging our MMQS dataset, we showcase how visual cues from images enhance the generation of medically nuanced summaries. This multimodal approach not only enhances the decision-making process in healthcare but also fosters a more nuanced understanding of patient queries, laying the groundwork for future research in personalized and responsive medical care

We introduce NVLM 1.0, a family of frontier-class multimodal large language models (LLMs) that achieve state-of-the-art results on vision-language tasks, rivaling the leading proprietary models (e.g., GPT-4o) and open-access models (e.g., Llama 3-V 405B and InternVL 2). Remarkably, NVLM 1.0 shows improved text-only performance over its LLM backbone after multimodal training. In terms of model design, we perform a comprehensive comparison between decoder-only multimodal LLMs (e.g., LLaVA) and cross-attention-based models (e.g., Flamingo). Based on the strengths and weaknesses of both approaches, we propose a novel architecture that enhances both training efficiency and multimodal reasoning capabilities. Furthermore, we introduce a 1-D tile-tagging design for tile-based dynamic high-resolution images, which significantly boosts performance on multimodal reasoning and OCR-related tasks. Regarding training data, we meticulously curate and provide detailed information on our multimodal pretraining and supervised fine-tuning datasets. Our findings indicate that dataset quality and task diversity are more important than scale, even during the pretraining phase, across all architectures. Notably, we develop production-grade multimodality for the NVLM-1.0 models, enabling them to excel in vision-language tasks while maintaining and even improving text-only performance compared to their LLM backbones. To achieve this, we craft and integrate a high-quality text-only dataset into multimodal training, alongside a substantial amount of multimodal math and reasoning data, leading to enhanced math and coding capabilities across modalities. To advance research in the field, we are releasing the model weights and will open-source the code for the community: https://nvlm-project.github.io/.

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

Lately, researchers in artificial intelligence have been really interested in how language and vision come together, giving rise to the development of multimodal models that aim to seamlessly integrate textual and visual information. Multimodal models, an extension of Large Language Models (LLMs), have exhibited remarkable capabilities in addressing a diverse array of tasks, ranging from image captioning and visual question answering (VQA) to visual grounding. While these models have showcased significant advancements, challenges persist in accurately interpreting images and answering the question, a common occurrence in real-world scenarios. This paper introduces a novel approach to enhance the multimodal capabilities of existing models. In response to the limitations observed in current Vision Language Models (VLMs) and Multimodal Large Language Models (MLLMs), our proposed model Veagle, incorporates a unique mechanism inspired by the successes and insights of previous works. Veagle leverages a dynamic mechanism to project encoded visual information directly into the language model. This dynamic approach allows for a more nuanced understanding of intricate details present in visual contexts. To validate the effectiveness of Veagle, we conduct comprehensive experiments on benchmark datasets, emphasizing tasks such as visual question answering and image understanding. Our results indicate a improvement of 5-6 \% in performance, with Veagle outperforming existing models by a notable margin. The outcomes underscore the model's versatility and applicability beyond traditional benchmarks.

Despite the progress made by multimodal large language models (MLLMs) in computational pathology, they remain limited by a predominant focus on patch-level analysis, missing essential contextual information at the whole-slide level. The lack of large-scale instruction datasets and the gigapixel scale of whole slide images (WSIs) pose significant developmental challenges. In this paper, we present SlideChat, the first vision-language assistant capable of understanding gigapixel whole-slide images, exhibiting excellent multimodal conversational capability and response complex instruction across diverse pathology scenarios. To support its development, we created SlideInstruction, the largest instruction-following dataset for WSIs consisting of 4.2K WSI captions and 176K VQA pairs with multiple categories. Furthermore, we propose SlideBench, a multimodal benchmark that incorporates captioning and VQA tasks to assess SlideChat's capabilities in varied clinical settings such as microscopy, diagnosis. Compared to both general and specialized MLLMs, SlideChat exhibits exceptional capabilities achieving state-of-the-art performance on 18 of 22 tasks. For example, it achieved an overall accuracy of 81.17% on SlideBench-VQA (TCGA), and 54.15% on SlideBench-VQA (BCNB). We will fully release SlideChat, SlideInstruction and SlideBench as open-source resources to facilitate research and development in computational pathology.

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 have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Radiology report generation (RRG) is a challenging task, as it requires a thorough understanding of medical images, integration of multiple temporal inputs, and accurate report generation. Effective interpretation of medical images, such as chest X-rays (CXRs), demands sophisticated visual-language reasoning to map visual findings to structured reports. Recent studies have shown that multimodal large language models (MLLMs) can acquire multimodal capabilities by aligning with pre-trained vision encoders. However, current approaches predominantly focus on single-image analysis or utilise rule-based symbolic processing to handle multiple images, thereby overlooking the essential temporal information derived from comparing current images with prior ones. To overcome this critical limitation, we introduce Libra, a temporal-aware MLLM tailored for CXR report generation using temporal images. Libra integrates a radiology-specific image encoder with a MLLM and utilises a novel Temporal Alignment Connector to capture and synthesise temporal information of images across different time points with unprecedented precision. Extensive experiments show that Libra achieves new state-of-the-art performance among the same parameter scale MLLMs for RRG tasks on the MIMIC-CXR. Specifically, Libra improves the RadCliQ metric by 12.9% and makes substantial gains across all lexical metrics compared to previous models.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

The rapid advancement of Large Language Models (LLMs) has led to an influx of efforts to extend their capabilities to multimodal tasks. Among them, growing attention has been focused on monolithic Multimodal Large Language Models (MLLMs) that integrate visual encoding and language decoding into a single LLM. Despite the structural simplicity and deployment-friendliness, training a monolithic MLLM with promising performance still remains challenging. In particular, the popular approaches adopt continuous pre-training to extend a pre-trained LLM to a monolithic MLLM, which suffers from catastrophic forgetting and leads to performance degeneration. In this paper, we aim to overcome this limitation from the perspective of delta tuning. Specifically, our core idea is to embed visual parameters into a pre-trained LLM, thereby incrementally learning visual knowledge from massive data via delta tuning, i.e., freezing the LLM when optimizing the visual parameters. Based on this principle, we present Mono-InternVL, a novel monolithic MLLM that seamlessly integrates a set of visual experts via a multimodal mixture-of-experts structure. Moreover, we propose an innovative pre-training strategy to maximize the visual capability of Mono-InternVL, namely Endogenous Visual Pre-training (EViP). In particular, EViP is designed as a progressive learning process for visual experts, which aims to fully exploit the visual knowledge from noisy data to high-quality data. To validate our approach, we conduct extensive experiments on 16 benchmarks. Experimental results not only validate the superior performance of Mono-InternVL compared to the state-of-the-art MLLM on 6 multimodal benchmarks, e.g., +113 points over InternVL-1.5 on OCRBench, but also confirm its better deployment efficiency, with first token latency reduced by up to 67%.

In this work, we discuss building performant Multimodal Large Language Models (MLLMs). In particular, we study the importance of various architecture components and data choices. Through careful and comprehensive ablations of the image encoder, the vision language connector, and various pre-training data choices, we identified several crucial design lessons. For example, we demonstrate that for large-scale multimodal pre-training using a careful mix of image-caption, interleaved image-text, and text-only data is crucial for achieving state-of-the-art (SOTA) few-shot results across multiple benchmarks, compared to other published pre-training results. Further, we show that the image encoder together with image resolution and the image token count has substantial impact, while the vision-language connector design is of comparatively negligible importance. By scaling up the presented recipe, we build MM1, a family of multimodal models up to 30B parameters, consisting of both dense models and mixture-of-experts (MoE) variants, that are SOTA in pre-training metrics and achieve competitive performance after supervised fine-tuning on a range of established multimodal benchmarks. Thanks to large-scale pre-training, MM1 enjoys appealing properties such as enhanced in-context learning, and multi-image reasoning, enabling few-shot chain-of-thought prompting.

Recent years have witnessed the rapid development of general multimodal large language models (MLLMs). However, adapting general MLLMs to specific domains, such as scientific fields and industrial applications, remains less explored. This paper systematically investigates domain adaptation of MLLMs through post-training, focusing on data synthesis, training pipelines, and task evaluation. (1) Data Synthesis: Using open-source models, we develop a visual instruction synthesizer that effectively generates diverse visual instruction tasks from domain-specific image-caption pairs. Our synthetic tasks surpass those generated by manual rules, GPT-4, and GPT-4V in enhancing the domain-specific performance of MLLMs. (2) Training Pipeline: While the two-stage training--initially on image-caption pairs followed by visual instruction tasks--is commonly adopted for developing general MLLMs, we apply a single-stage training pipeline to enhance task diversity for domain-specific post-training. (3) Task Evaluation: We conduct experiments in two domains, biomedicine and food, by post-training MLLMs of different sources and scales (e.g., Qwen2-VL-2B, LLaVA-v1.6-8B, Llama-3.2-11B), and then evaluating MLLM performance on various domain-specific tasks. To support further research in MLLM domain adaptation, we will open-source our implementations.

Multimodal large language models (MLLMs) can simultaneously process visual, textual, and auditory data, capturing insights that complement human analysis. However, existing video question-answering (VidQA) benchmarks and datasets often exhibit a bias toward a single modality, despite the goal of requiring advanced reasoning skills that integrate diverse modalities to answer the queries. In this work, we introduce the modality importance score (MIS) to identify such bias. It is designed to assess which modality embeds the necessary information to answer the question. Additionally, we propose an innovative method using state-of-the-art MLLMs to estimate the modality importance, which can serve as a proxy for human judgments of modality perception. With this MIS, we demonstrate the presence of unimodal bias and the scarcity of genuinely multimodal questions in existing datasets. We further validate the modality importance score with multiple ablation studies to evaluate the performance of MLLMs on permuted feature sets. Our results indicate that current models do not effectively integrate information due to modality imbalance in existing datasets. Our proposed MLLM-derived MIS can guide the curation of modality-balanced datasets that advance multimodal learning and enhance MLLMs' capabilities to understand and utilize synergistic relations across modalities.

Large Language Models (LLMs), primarily trained on text-based datasets, exhibit exceptional proficiencies in understanding and executing complex linguistic instructions via text outputs. However, they falter when requests to generate non-text ones. Concurrently, modality conversion models, such as text-to-image, despite generating high-quality images, suffer from a lack of extensive textual pretraining. As a result, these models are only capable of accommodating specific image descriptions rather than comprehending more complex instructions. To bridge this gap, we propose a novel approach, \methodname, from a modality conversion perspective that evolves a text-based LLM into a multi-modal one. We specifically employ a minimal dataset to instruct LLMs to recognize the intended output modality as directed by the instructions. Consequently, the adapted LLM can effectively summon various off-the-shelf modality conversion models from the model zoos to generate non-text responses. This circumvents the necessity for complicated pretraining that typically requires immense quantities of paired multi-modal data, while simultaneously inheriting the extensive knowledge of LLMs and the ability of high-quality generative models. To evaluate and compare the adapted multi-modal LLM with its traditional counterparts, we have constructed a multi-modal instruction benchmark that solicits diverse modality outputs. The experiment results reveal that, with minimal training, LLMs can be conveniently adapted to comprehend requests for non-text responses, thus achieving higher flexibility in multi-modal scenarios. Code and data will be made available at https://github.com/xinke-wang/SwitchGPT.

Multimodal Large Language Models (MLLMs) are widely regarded as crucial in the exploration of Artificial General Intelligence (AGI). The core of MLLMs lies in their capability to achieve cross-modal alignment. To attain this goal, current MLLMs typically follow a two-phase training paradigm: the pre-training phase and the instruction-tuning phase. Despite their success, there are shortcomings in the modeling of alignment capabilities within these models. Firstly, during the pre-training phase, the model usually assumes that all image-text pairs are uniformly aligned, but in fact the degree of alignment between different image-text pairs is inconsistent. Secondly, the instructions currently used for finetuning incorporate a variety of tasks, different tasks's instructions usually require different levels of alignment capabilities, but previous MLLMs overlook these differentiated alignment needs. To tackle these issues, we propose a new multimodal large language model AlignGPT. In the pre-training stage, instead of treating all image-text pairs equally, we assign different levels of alignment capabilities to different image-text pairs. Then, in the instruction-tuning phase, we adaptively combine these different levels of alignment capabilities to meet the dynamic alignment needs of different instructions. Extensive experimental results show that our model achieves competitive performance on 12 benchmarks.

Recent advancements in text-to-image (T2I) and vision-language-to-image (VL2I) generation have made significant strides. However, the generation from generalized vision-language inputs, especially involving multiple images, remains under-explored. This paper presents Kosmos-G, a model that leverages the advanced perception capabilities of Multimodal Large Language Models (MLLMs) to tackle the aforementioned challenge. Our approach aligns the output space of MLLM with CLIP using the textual modality as an anchor and performs compositional instruction tuning on curated data. Kosmos-G demonstrates a unique capability of zero-shot multi-entity subject-driven generation. Notably, the score distillation instruction tuning requires no modifications to the image decoder. This allows for a seamless substitution of CLIP and effortless integration with a myriad of U-Net techniques ranging from fine-grained controls to personalized image decoder variants. We posit Kosmos-G as an initial attempt towards the goal of "image as a foreign language in image generation."

Medical vision-and-language pre-training (Med-VLP) has shown promising improvements on many downstream medical tasks owing to its applicability to extracting generic representations from medical images and texts. Practically, there exist two typical types, i.e., the fusion-encoder type and the dual-encoder type, depending on whether a heavy fusion module is used. The former is superior at multi-modal tasks owing to the sufficient interaction between modalities; the latter is good at uni-modal and cross-modal tasks due to the single-modality encoding ability. To take advantage of these two types, we propose an effective yet straightforward scheme named PTUnifier to unify the two types. We first unify the input format by introducing visual and textual prompts, which serve as a feature bank that stores the most representative images/texts. By doing so, a single model could serve as a foundation model that processes various tasks adopting different input formats (i.e., image-only, text-only, and image-text-pair). Furthermore, we construct a prompt pool (instead of static ones) to improve diversity and scalability. Experimental results show that our approach achieves state-of-the-art results on a broad range of tasks, spanning uni-modal tasks (i.e., image/text classification and text summarization), cross-modal tasks (i.e., image-to-text generation and image-text/text-image retrieval), and multi-modal tasks (i.e., visual question answering), demonstrating the effectiveness of our approach. Note that the adoption of prompts is orthogonal to most existing Med-VLP approaches and could be a beneficial and complementary extension to these approaches.

Recent advancements in large language models (LLMs) have shown promise in medical applications such as disease diagnosis and treatment planning. However, most existing medical LLMs struggle with the advanced reasoning required for complex clinical scenarios, such as differential diagnosis or personalized treatment suggestions. We proposed FineMedLM-o1, which leverages high-quality synthetic medical data and long-form reasoning data for Supervised Fine-Tuning (SFT) and Direct Preference Optimization (DPO), enabling advanced dialogue and deep reasoning capabilities. Additionally, we introduced Test-Time Training (TTT) in the medical domain for the first time, facilitating domain adaptation and ensuring reliable, accurate reasoning. Experimental results demonstrate that FineMedLM-o1 achieves a 23% average performance improvement over prior models on key medical benchmarks. Furthermore, the introduction of TTT provides an additional 14% performance boost, highlighting its effectiveness in enhancing medical reasoning capabilities. To support this process, we also proposed a novel method for synthesizing medical dialogue. Compared to other open-source datasets, our dataset stands out as superior in both quality and complexity. The project and data will be released on GitHub.

Multimodal Large Language Models (MLLMs) demonstrate remarkable image-language capabilities, but their widespread use faces challenges in cost-effective training and adaptation. Existing approaches often necessitate expensive language model retraining and limited adaptability. Additionally, the current focus on zero-shot performance improvements offers insufficient guidance for task-specific tuning. We propose CROME, an efficient vision-language instruction tuning framework. It features a novel gated cross-modal adapter that effectively combines visual and textual representations prior to input into a frozen LLM. This lightweight adapter, trained with minimal parameters, enables efficient cross-modal understanding. Notably, CROME demonstrates superior zero-shot performance on standard visual question answering and instruction-following benchmarks. Moreover, it yields fine-tuning with exceptional parameter efficiency, competing with task-specific specialist state-of-the-art methods. CROME demonstrates the potential of pre-LM alignment for building scalable, adaptable, and parameter-efficient multimodal models.

We present Kosmos-2.5, a multimodal literate model for machine reading of text-intensive images. Pre-trained on large-scale text-intensive images, Kosmos-2.5 excels in two distinct yet cooperative transcription tasks: (1) generating spatially-aware text blocks, where each block of text is assigned its spatial coordinates within the image, and (2) producing structured text output that captures styles and structures into the markdown format. This unified multimodal literate capability is achieved through a shared Transformer architecture, task-specific prompts, and flexible text representations. We evaluate Kosmos-2.5 on end-to-end document-level text recognition and image-to-markdown text generation. Furthermore, the model can be readily adapted for any text-intensive image understanding task with different prompts through supervised fine-tuning, making it a general-purpose tool for real-world applications involving text-rich images. This work also paves the way for the future scaling of multimodal large language models.

Instruction-based image editing improves the controllability and flexibility of image manipulation via natural commands without elaborate descriptions or regional masks. However, human instructions are sometimes too brief for current methods to capture and follow. Multimodal large language models (MLLMs) show promising capabilities in cross-modal understanding and visual-aware response generation via LMs. We investigate how MLLMs facilitate edit instructions and present MLLM-Guided Image Editing (MGIE). MGIE learns to derive expressive instructions and provides explicit guidance. The editing model jointly captures this visual imagination and performs manipulation through end-to-end training. We evaluate various aspects of Photoshop-style modification, global photo optimization, and local editing. Extensive experimental results demonstrate that expressive instructions are crucial to instruction-based image editing, and our MGIE can lead to a notable improvement in automatic metrics and human evaluation while maintaining competitive inference efficiency.

Multimodal large language models (MLLMs) have gained significant attention due to their strong multimodal understanding capability. However, existing works rely heavily on modality-specific encoders, which usually differ in architecture and are limited to common modalities. In this paper, we present OneLLM, an MLLM that aligns eight modalities to language using a unified framework. We achieve this through a unified multimodal encoder and a progressive multimodal alignment pipeline. In detail, we first train an image projection module to connect a vision encoder with LLM. Then, we build a universal projection module (UPM) by mixing multiple image projection modules and dynamic routing. Finally, we progressively align more modalities to LLM with the UPM. To fully leverage the potential of OneLLM in following instructions, we also curated a comprehensive multimodal instruction dataset, including 2M items from image, audio, video, point cloud, depth/normal map, IMU and fMRI brain activity. OneLLM is evaluated on 25 diverse benchmarks, encompassing tasks such as multimodal captioning, question answering and reasoning, where it delivers excellent performance. Code, data, model and online demo are available at https://github.com/csuhan/OneLLM

Objective: The reading level of health educational materials significantly influences the understandability and accessibility of the information, particularly for minoritized populations. Many patient educational resources surpass the reading level and complexity of widely accepted standards. There is a critical need for high-performing text simplification models in health information to enhance dissemination and literacy. This need is particularly acute in cancer education, where effective prevention and screening education can substantially reduce morbidity and mortality. Methods: We introduce Simplified Digestive Cancer (SimpleDC), a parallel corpus of cancer education materials tailored for health text simplification research, comprising educational content from the American Cancer Society, Centers for Disease Control and Prevention, and National Cancer Institute. Utilizing SimpleDC alongside the existing Med-EASi corpus, we explore Large Language Model (LLM)-based simplification methods, including fine-tuning, reinforcement learning (RL), reinforcement learning with human feedback (RLHF), domain adaptation, and prompt-based approaches. Our experimentation encompasses Llama 2 and GPT-4. A novel RLHF reward function is introduced, featuring a lightweight model adept at distinguishing between original and simplified texts, thereby enhancing the model's effectiveness with unlabeled data. Results: Fine-tuned Llama 2 models demonstrated high performance across various metrics. Our innovative RLHF reward function surpassed existing RL text simplification reward functions in effectiveness. The results underscore that RL/RLHF can augment fine-tuning, facilitating model training on unlabeled text and improving performance.

Large pretrained (e.g., "foundation") models exhibit distinct capabilities depending on the domain of data they are trained on. While these domains are generic, they may only barely overlap. For example, visual-language models (VLMs) are trained on Internet-scale image captions, but large language models (LMs) are further trained on Internet-scale text with no images (e.g., spreadsheets, SAT questions, code). As a result, these models store different forms of commonsense knowledge across different domains. In this work, we show that this diversity is symbiotic, and can be leveraged through Socratic Models (SMs): a modular framework in which multiple pretrained models may be composed zero-shot i.e., via multimodal-informed prompting, to exchange information with each other and capture new multimodal capabilities, without requiring finetuning. With minimal engineering, SMs are not only competitive with state-of-the-art zero-shot image captioning and video-to-text retrieval, but also enable new applications such as (i) answering free-form questions about egocentric video, (ii) engaging in multimodal assistive dialogue with people (e.g., for cooking recipes) by interfacing with external APIs and databases (e.g., web search), and (iii) robot perception and planning.

Advances in large language models (LLMs) have empowered a variety of applications. However, there is still a significant gap in research when it comes to understanding and enhancing the capabilities of LLMs in the field of mental health. In this work, we present the first comprehensive evaluation of multiple LLMs, including Alpaca, Alpaca-LoRA, FLAN-T5, GPT-3.5, and GPT-4, on various mental health prediction tasks via online text data. We conduct a broad range of experiments, covering zero-shot prompting, few-shot prompting, and instruction fine-tuning. The results indicate a promising yet limited performance of LLMs with zero-shot and few-shot prompt designs for the mental health tasks. More importantly, our experiments show that instruction finetuning can significantly boost the performance of LLMs for all tasks simultaneously. Our best-finetuned models, Mental-Alpaca and Mental-FLAN-T5, outperform the best prompt design of GPT-3.5 (25 and 15 times bigger) by 10.9% on balanced accuracy and the best of GPT-4 (250 and 150 times bigger) by 4.8%. They further perform on par with the state-of-the-art task-specific language model. We also conduct an exploratory case study on LLMs' capability on the mental health reasoning tasks, illustrating the promising capability of certain models such as GPT-4. We summarize our findings into a set of action guidelines for potential methods to enhance LLMs' capability for mental health tasks. Meanwhile, we also emphasize the important limitations before achieving deployability in real-world mental health settings, such as known racial and gender bias. We highlight the important ethical risks accompanying this line of research.

Large-scale language models (LLMs), such as ChatGPT, are capable of generating human-like responses for various downstream tasks, such as task-oriented dialogues and question answering. However, applying LLMs to medical domains remains challenging due to their inability to leverage domain-specific knowledge. In this study, we present the Large-scale Language Models Augmented with Medical Textbooks (LLM-AMT), which integrates authoritative medical textbooks as the cornerstone of its design, enhancing its proficiency in the specialized domain through plug-and-play modules, comprised of a Hybrid Textbook Retriever, supplemented by the Query Augmenter and the LLM Reader. Experimental evaluation on three open-domain medical question-answering tasks reveals a substantial enhancement in both the professionalism and accuracy of the LLM responses when utilizing LLM-AMT, exhibiting an improvement ranging from 11.4% to 13.2%. Despite being 100 times smaller, we found that medical textbooks as the retrieval corpus serves as a more valuable external knowledge source than Wikipedia in the medical domain. Our experiments show that textbook augmentation results in a performance improvement ranging from 9.7% to 12.2% over Wikipedia augmentation.

Recently, slow-thinking reasoning systems, built upon large language models (LLMs), have garnered widespread attention by scaling the thinking time during inference. There is also growing interest in adapting this capability to multimodal large language models (MLLMs). Given that MLLMs handle more complex data semantics across different modalities, it is intuitively more challenging to implement multimodal slow-thinking systems. To address this issue, in this paper, we explore a straightforward approach by fine-tuning a capable MLLM with a small amount of textual long-form thought data, resulting in a multimodal slow-thinking system, Virgo (Visual reasoning with long thought). We find that these long-form reasoning processes, expressed in natural language, can be effectively transferred to MLLMs. Moreover, it seems that such textual reasoning data can be even more effective than visual reasoning data in eliciting the slow-thinking capacities of MLLMs. While this work is preliminary, it demonstrates that slow-thinking capacities are fundamentally associated with the language model component, which can be transferred across modalities or domains. This finding can be leveraged to guide the development of more powerful slow-thinking reasoning systems. We release our resources at https://github.com/RUCAIBox/Virgo.

Large Language Models (LLMs), despite their remarkable progress across various general domains, encounter significant barriers in medicine and healthcare. This field faces unique challenges such as domain-specific terminologies and the reasoning over specialized knowledge. To address these obstinate issues, we propose a novel Multi-disciplinary Collaboration (MC) framework for the medical domain that leverages role-playing LLM-based agents who participate in a collaborative multi-round discussion, thereby enhancing LLM proficiency and reasoning capabilities. This training-free and interpretable framework encompasses five critical steps: gathering domain experts, proposing individual analyses, summarising these analyses into a report, iterating over discussions until a consensus is reached, and ultimately making a decision. Our work particularly focuses on the zero-shot scenario, our results on nine data sets (MedQA, MedMCQA, PubMedQA, and six subtasks from MMLU) establish that our proposed MC framework excels at mining and harnessing the medical expertise in LLMs, as well as extending its reasoning abilities. Based on these outcomes, we further conduct a human evaluation to pinpoint and categorize common errors within our method, as well as ablation studies aimed at understanding the impact of various factors on overall performance. Our code can be found at https://github.com/gersteinlab/MedAgents.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

The development of vision-language models (VLMs) is driven by large-scale and diverse multimodal datasets. However, progress toward generalist biomedical VLMs is limited by the lack of annotated, publicly accessible datasets across biology and medicine. Existing efforts are restricted to narrow domains, missing the full diversity of biomedical knowledge encoded in scientific literature. To address this gap, we introduce BIOMEDICA, a scalable, open-source framework to extract, annotate, and serialize the entirety of the PubMed Central Open Access subset into an easy-to-use, publicly accessible dataset.Our framework produces a comprehensive archive with over 24 million unique image-text pairs from over 6 million articles. Metadata and expert-guided annotations are also provided. We demonstrate the utility and accessibility of our resource by releasing BMCA-CLIP, a suite of CLIP-style models continuously pre-trained on the BIOMEDICA dataset via streaming, eliminating the need to download 27 TB of data locally.On average, our models achieve state-of-the-art performance across 40 tasks - spanning pathology, radiology, ophthalmology, dermatology, surgery, molecular biology, parasitology, and cell biology - excelling in zero-shot classification with a 6.56% average improvement (as high as 29.8% and 17.5% in dermatology and ophthalmology, respectively), and stronger image-text retrieval, all while using 10x less compute. To foster reproducibility and collaboration, we release our codebase and dataset for the broader research community.

Text-rich images, where text serves as the central visual element guiding the overall understanding, are prevalent in real-world applications, such as presentation slides, scanned documents, and webpage snapshots. Tasks involving multiple text-rich images are especially challenging, as they require not only understanding the content of individual images but reasoning about inter-relationships and logical flows across multiple visual inputs. Despite the importance of these scenarios, current multimodal large language models (MLLMs) struggle to handle such tasks due to two key challenges: (1) the scarcity of high-quality instruction tuning datasets for text-rich multi-image scenarios, and (2) the difficulty in balancing image resolution with visual feature sequence length. To address these challenges, we propose \OurMethod, a MLLM designed specifically for handling vision-language tasks involving multiple text-rich images. First, we curated about one million high-quality multimodal instruction-tuning data, tailored to text-rich, multi-image scenarios. Second, we developed an adaptive high-resolution multi-image encoding module to dynamically optimize the allocation of visual sequence length based on the original aspect ratios and resolutions of the input images. Experiments across a wide range of benchmarks demonstrate our model's superior capabilities in text-rich, multi-image evaluations and competitive performance in general domain evaluations.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Projecting visual features into word embedding space has become a significant fusion strategy adopted by Multimodal Large Language Models (MLLMs). However, its internal mechanisms have yet to be explored. Inspired by multilingual research, we identify domain-specific neurons in multimodal large language models. Specifically, we investigate the distribution of domain-specific neurons and the mechanism of how MLLMs process features from diverse domains. Furthermore, we propose a three-stage framework for language model modules in MLLMs when handling projected image features, and verify this hypothesis using logit lens. Extensive experiments indicate that while current MLLMs exhibit Visual Question Answering (VQA) capability, they may not fully utilize domain-specific information. Manipulating domain-specific neurons properly will result in a 10\% change of accuracy at most, shedding light on the development of cross-domain, all-encompassing MLLMs in the future. Our code will be released upon paper notification.

Multilingual multimodal reasoning is a core component in achieving human-level intelligence. However, most existing benchmarks for multilingual multimodal reasoning struggle to differentiate between models of varying performance; even language models without visual capabilities can easily achieve high scores. This leaves a comprehensive evaluation of leading multilingual multimodal models largely unexplored. In this work, we introduce M4U, a novel and challenging benchmark for assessing the capability of multi-discipline multilingual multimodal understanding and reasoning. M4U contains 8,931 samples covering 64 disciplines across 16 subfields in Science, Engineering, and Healthcare in Chinese, English, and German. Using M4U, we conduct extensive evaluations of 21 leading Large Multimodal Models (LMMs) and Large Language Models (LLMs) with external tools. The evaluation results show that the state-of-the-art model, GPT-4o, achieves only 47.6% average accuracy on M4U. Additionally, we observe that the leading LMMs exhibit significant language preferences. Our in-depth analysis indicates that leading LMMs, including GPT-4o, suffer performance degradation when prompted with cross-lingual multimodal questions, such as images with key textual information in Chinese while the question is in German. We believe that M4U can serve as a crucial tool for systematically evaluating LMMs based on their multilingual multimodal reasoning capabilities and monitoring their development. The homepage, codes and data are public available.

Multimodal large language models (MLLMs) have significantly advanced tasks like caption generation and visual question answering by integrating visual and textual data. However, they sometimes produce misleading or hallucinate content due to discrepancies between their pre-training data and real user prompts. Existing approaches using Direct Preference Optimization (DPO) in vision-language tasks often rely on strong models like GPT-4 or CLIP to determine positive and negative responses. Here, we propose a new framework in generating synthetic data using a reward model as a proxy of human preference for effective multimodal alignment with DPO training. The resulting DPO dataset ranges from 2K to 9K image-text pairs, was evaluated on LLaVA-v1.5-7B, where our approach demonstrated substantial improvements in both the trustworthiness and reasoning capabilities of the base model across multiple hallucination and vision-language benchmark. The experiment results indicate that integrating selected synthetic data, such as from generative and rewards models can effectively reduce reliance on human-annotated data while enhancing MLLMs' alignment capability, offering a scalable solution for safer deployment.

In the healthcare domain, summarizing medical questions posed by patients is critical for improving doctor-patient interactions and medical decision-making. Although medical data has grown in complexity and quantity, the current body of research in this domain has primarily concentrated on text-based methods, overlooking the integration of visual cues. Also prior works in the area of medical question summarisation have been limited to the English language. This work introduces the task of multimodal medical question summarization for codemixed input in a low-resource setting. To address this gap, we introduce the Multimodal Medical Codemixed Question Summarization MMCQS dataset, which combines Hindi-English codemixed medical queries with visual aids. This integration enriches the representation of a patient's medical condition, providing a more comprehensive perspective. We also propose a framework named MedSumm that leverages the power of LLMs and VLMs for this task. By utilizing our MMCQS dataset, we demonstrate the value of integrating visual information from images to improve the creation of medically detailed summaries. This multimodal strategy not only improves healthcare decision-making but also promotes a deeper comprehension of patient queries, paving the way for future exploration in personalized and responsive medical care. Our dataset, code, and pre-trained models will be made publicly available.

Large language models (LLMs), such as GPT-4, PaLM, and LLaMa, have been shown to achieve remarkable performance across a variety of natural language tasks. Recent advancements in instruction tuning bring LLMs with ability in following user's instructions and producing human-like responses. However, the high costs associated with training and implementing LLMs pose challenges to academic research. Furthermore, the availability of pretrained LLMs and instruction-tune datasets for Vietnamese language is limited. To tackle these concerns, we leverage large-scale instruction-following datasets from open-source projects, namely Alpaca, GPT4All, and Chat-Doctor, which cover general domain and specific medical domain. To the best of our knowledge, these are the first instructional dataset for Vietnamese. Subsequently, we utilize parameter-efficient tuning through Low-Rank Adaptation (LoRA) on two open LLMs: Bloomz (Multilingual) and GPTJ-6B (Vietnamese), resulting four models: Bloomz-Chat, Bloomz-Doctor, GPTJ-Chat, GPTJ-Doctor.Finally, we assess the effectiveness of our methodology on a per-sample basis, taking into consideration the helpfulness, relevance, accuracy, level of detail in their responses. This evaluation process entails the utilization of GPT-4 as an automated scoring mechanism. Despite utilizing a low-cost setup, our method demonstrates about 20-30\% improvement over the original models in our evaluation tasks.

Large language models (LLMs) have demonstrated remarkable language abilities. GPT-4, based on advanced LLMs, exhibits extraordinary multimodal capabilities beyond previous visual language models. We attribute this to the use of more advanced LLMs compared with previous multimodal models. Unfortunately, the model architecture and training strategies of GPT-4 are unknown. To endow LLMs with multimodal capabilities, we propose X-LLM, which converts Multi-modalities (images, speech, videos) into foreign languages using X2L interfaces and inputs them into a large Language model (ChatGLM). Specifically, X-LLM aligns multiple frozen single-modal encoders and a frozen LLM using X2L interfaces, where ``X'' denotes multi-modalities such as image, speech, and videos, and ``L'' denotes languages. X-LLM's training consists of three stages: (1) Converting Multimodal Information: The first stage trains each X2L interface to align with its respective single-modal encoder separately to convert multimodal information into languages. (2) Aligning X2L representations with the LLM: single-modal encoders are aligned with the LLM through X2L interfaces independently. (3) Integrating multiple modalities: all single-modal encoders are aligned with the LLM through X2L interfaces to integrate multimodal capabilities into the LLM. Our experiments show that X-LLM demonstrates impressive multimodel chat abilities, sometimes exhibiting the behaviors of multimodal GPT-4 on unseen images/instructions, and yields a 84.5\% relative score compared with GPT-4 on a synthetic multimodal instruction-following dataset. And we also conduct quantitative tests on using LLM for ASR and multimodal ASR, hoping to promote the era of LLM-based speech recognition.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Current multimodal language models (MLMs) evaluation and training approaches overlook the influence of instruction format, presenting an elephant-in-the-room problem. Previous research deals with this problem by manually crafting instructions, failing to yield significant insights due to limitations in diversity and scalability. In this work, we propose a programmatic instruction template generator capable of producing over 39B unique template combinations by filling randomly sampled positional synonyms into weighted sampled meta templates, enabling us to comprehensively examine the MLM's performance across diverse instruction templates. Our experiments across eight common MLMs on five benchmark datasets reveal that MLMs have high template sensitivities with at most 29% performance gaps between different templates. We further augment the instruction tuning dataset of LLaVA-1.5 with our template generator and perform instruction tuning on LLaVA-1.5-7B and LLaVA-1.5-13B. Models tuned on our augmented dataset achieve the best overall performance when compared with the same scale MLMs tuned on at most 75 times the scale of our augmented dataset, highlighting the importance of instruction templates in MLM training. The code is available at https://github.com/shijian2001/TemplateMatters .

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.

Multimodal large language models (MLLMs) have shown impressive capabilities across various domains, excelling in processing and understanding information from multiple modalities. Despite the rapid progress made previously, insufficient OCR ability hinders MLLMs from excelling in text-related tasks. In this paper, we present Ocean-OCR, a 3B MLLM with state-of-the-art performance on various OCR scenarios and comparable understanding ability on general tasks. We employ Native Resolution ViT to enable variable resolution input and utilize a substantial collection of high-quality OCR datasets to enhance the model performance. We demonstrate the superiority of Ocean-OCR through comprehensive experiments on open-source OCR benchmarks and across various OCR scenarios. These scenarios encompass document understanding, scene text recognition, and handwritten recognition, highlighting the robust OCR capabilities of Ocean-OCR. Note that Ocean-OCR is the first MLLM to outperform professional OCR models such as TextIn and PaddleOCR.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

Recent large language models (LLMs) in the general domain, such as ChatGPT, have shown remarkable success in following instructions and producing human-like responses. However, such language models have not been learned individually and carefully for the medical domain, resulting in poor diagnostic accuracy and inability to give correct recommendations for medical diagnosis, medications, etc. To address this issue, we collected more than 700 diseases and their corresponding symptoms, recommended medications, and required medical tests, and then generated 5K doctor-patient conversations. By fine-tuning models of doctor-patient conversations, these models emerge with great potential to understand patients' needs, provide informed advice, and offer valuable assistance in a variety of medical-related fields. The integration of these advanced language models into healthcare can revolutionize the way healthcare professionals and patients communicate, ultimately improving the overall quality of care and patient outcomes. In addition, we will open all source code, datasets and model weights to advance the further development of dialogue models in the medical field. In addition, the training data, code, and weights of this project are available at: https://github.com/Kent0n-Li/ChatDoctor.

We present MM1.5, a new family of multimodal large language models (MLLMs) designed to enhance capabilities in text-rich image understanding, visual referring and grounding, and multi-image reasoning. Building upon the MM1 architecture, MM1.5 adopts a data-centric approach to model training, systematically exploring the impact of diverse data mixtures across the entire model training lifecycle. This includes high-quality OCR data and synthetic captions for continual pre-training, as well as an optimized visual instruction-tuning data mixture for supervised fine-tuning. Our models range from 1B to 30B parameters, encompassing both dense and mixture-of-experts (MoE) variants, and demonstrate that careful data curation and training strategies can yield strong performance even at small scales (1B and 3B). Additionally, we introduce two specialized variants: MM1.5-Video, designed for video understanding, and MM1.5-UI, tailored for mobile UI understanding. Through extensive empirical studies and ablations, we provide detailed insights into the training processes and decisions that inform our final designs, offering valuable guidance for future research in MLLM development.

The success of Large Language Models (LLM) has led researchers to explore Multimodal Large Language Models (MLLM) for unified visual and linguistic understanding. However, the increasing model size and computational complexity of MLLM limit their use in resource-constrained environments. Small-scale MLLM (s-MLLM) aims to retain the capabilities of the large-scale model (l-MLLM) while reducing computational demands, but resulting in a significant decline in performance. To address the aforementioned issues, we propose a novel LLaVA-KD framework to transfer knowledge from l-MLLM to s-MLLM. Specifically, we introduce Multimodal Distillation (MDist) to minimize the divergence between the visual-textual output distributions of l-MLLM and s-MLLM, and Relation Distillation (RDist) to transfer l-MLLM's ability to model correlations between visual features. Additionally, we propose a three-stage training scheme to fully exploit the potential of s-MLLM: 1) Distilled Pre-Training to align visual-textual representations, 2) Supervised Fine-Tuning to equip the model with multimodal understanding, and 3) Distilled Fine-Tuning to further transfer l-MLLM capabilities. Our approach significantly improves performance without altering the small model's architecture. Extensive experiments and ablation studies validate the effectiveness of each proposed component. Code will be available at https://github.com/caiyuxuan1120/LLaVA-KD.

This research tests the role of Large Language Models (LLMs) as formal second opinion tools in professional decision-making, particularly focusing on complex medical cases where even experienced physicians seek peer consultation. The work analyzed 183 challenging medical cases from Medscape over a 20-month period, testing multiple LLMs' performance against crowd-sourced physician responses. A key finding was the high overall score possible in the latest foundational models (>80% accuracy compared to consensus opinion), which exceeds most human metrics reported on the same clinical cases (450 pages of patient profiles, test results). The study rates the LLMs' performance disparity between straightforward cases (>81% accuracy) and complex scenarios (43% accuracy), particularly in these cases generating substantial debate among human physicians. The research demonstrates that LLMs may be valuable as generators of comprehensive differential diagnoses rather than as primary diagnostic tools, potentially helping to counter cognitive biases in clinical decision-making, reduce cognitive loads, and thus remove some sources of medical error. The inclusion of a second comparative legal dataset (Supreme Court cases, N=21) provides added empirical context to the AI use to foster second opinions, though these legal challenges proved considerably easier for LLMs to analyze. In addition to the original contributions of empirical evidence for LLM accuracy, the research aggregated a novel benchmark for others to score highly contested question and answer reliability between both LLMs and disagreeing human practitioners. These results suggest that the optimal deployment of LLMs in professional settings may differ substantially from current approaches that emphasize automation of routine tasks.

We present CoDi-2, a versatile and interactive Multimodal Large Language Model (MLLM) that can follow complex multimodal interleaved instructions, conduct in-context learning (ICL), reason, chat, edit, etc., in an any-to-any input-output modality paradigm. By aligning modalities with language for both encoding and generation, CoDi-2 empowers Large Language Models (LLMs) to not only understand complex modality-interleaved instructions and in-context examples, but also autoregressively generate grounded and coherent multimodal outputs in the continuous feature space. To train CoDi-2, we build a large-scale generation dataset encompassing in-context multimodal instructions across text, vision, and audio. CoDi-2 demonstrates a wide range of zero-shot capabilities for multimodal generation, such as in-context learning, reasoning, and compositionality of any-to-any modality generation through multi-round interactive conversation. CoDi-2 surpasses previous domain-specific models on tasks such as subject-driven image generation, vision transformation, and audio editing. CoDi-2 signifies a substantial breakthrough in developing a comprehensive multimodal foundation model adept at interpreting in-context language-vision-audio interleaved instructions and producing multimodal outputs.

GPT-4o, an all-encompassing model, represents a milestone in the development of large multi-modal language models. It can understand visual, auditory, and textual modalities, directly output audio, and support flexible duplex interaction. Models from the open-source community often achieve some functionalities of GPT-4o, such as visual understanding and voice chat. Nevertheless, training a unified model that incorporates all modalities is challenging due to the complexities of multi-modal data, intricate model architectures, and training processes. In this paper, we introduce Mini-Omni2, a visual-audio assistant capable of providing real-time, end-to-end voice responses to visoin and audio queries. By integrating pretrained visual and auditory encoders, Mini-Omni2 maintains performance in individual modalities. We propose a three-stage training process to align modalities, allowing the language model to handle multi-modal inputs and outputs after training on a limited dataset. For interaction, we introduce a command-based interruption mechanism, enabling more flexible interaction with users. To the best of our knowledge, Mini-Omni2 is one of the closest reproductions of GPT-4o, which have similar form of functionality, and we hope it can offer valuable insights for subsequent research.

Large language models (LLMs) have demonstrated remarkable prediction performance for a growing array of tasks. However, their rapid proliferation and increasing opaqueness have created a growing need for interpretability. Here, we ask whether we can automatically obtain natural language explanations for black box text modules. A "text module" is any function that maps text to a scalar continuous value, such as a submodule within an LLM or a fitted model of a brain region. "Black box" indicates that we only have access to the module's inputs/outputs. We introduce Summarize and Score (SASC), a method that takes in a text module and returns a natural language explanation of the module's selectivity along with a score for how reliable the explanation is. We study SASC in 3 contexts. First, we evaluate SASC on synthetic modules and find that it often recovers ground truth explanations. Second, we use SASC to explain modules found within a pre-trained BERT model, enabling inspection of the model's internals. Finally, we show that SASC can generate explanations for the response of individual fMRI voxels to language stimuli, with potential applications to fine-grained brain mapping. All code for using SASC and reproducing results is made available on Github.

Large Language Models (LLMs) have shown the potential to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs address healthcare-specific challenges, including privacy demands and computational constraints. However, evaluation of these models has primarily been limited to non-clinical tasks, which do not reflect the complexity of practical clinical applications. Additionally, there has been no thorough comparison between biomedical and general-domain LLMs for clinical tasks. To fill this gap, we present the Clinical Language Understanding Evaluation (CLUE), a benchmark tailored to evaluate LLMs on real-world clinical tasks. CLUE includes two novel datasets derived from MIMIC IV discharge letters and four existing tasks designed to test the practical applicability of LLMs in healthcare settings. Our evaluation covers several biomedical and general domain LLMs, providing insights into their clinical performance and applicability. CLUE represents a step towards a standardized approach to evaluating and developing LLMs in healthcare to align future model development with the real-world needs of clinical application. We publish our evaluation and data generation scripts: https://github.com/dadaamin/CLUE

Large language models (LLMs) have shown impressive performance on complex reasoning by leveraging chain-of-thought (CoT) prompting to generate intermediate reasoning chains as the rationale to infer the answer. However, existing CoT studies have focused on the language modality. We propose Multimodal-CoT that incorporates language (text) and vision (images) modalities into a two-stage framework that separates rationale generation and answer inference. In this way, answer inference can leverage better generated rationales that are based on multimodal information. With Multimodal-CoT, our model under 1 billion parameters outperforms the previous state-of-the-art LLM (GPT-3.5) by 16 percentage points (75.17%->91.68% accuracy) on the ScienceQA benchmark and even surpasses human performance. Code is publicly available available at https://github.com/amazon-science/mm-cot.

Embodied agents have achieved prominent performance in following human instructions to complete tasks. However, the potential of providing instructions informed by texts and images to assist humans in completing tasks remains underexplored. To uncover this capability, we present the multimodal procedural planning (MPP) task, in which models are given a high-level goal and generate plans of paired text-image steps, providing more complementary and informative guidance than unimodal plans. The key challenges of MPP are to ensure the informativeness, temporal coherence,and accuracy of plans across modalities. To tackle this, we propose Text-Image Prompting (TIP), a dual-modality prompting method that jointly leverages zero-shot reasoning ability in large language models (LLMs) and compelling text-to-image generation ability from diffusion-based models. TIP improves the interaction in the dual modalities using Text-to-Image Bridge and Image-to-Text Bridge, allowing LLMs to guide the textual-grounded image plan generation and leveraging the descriptions of image plans to ground the textual plan reversely. To address the lack of relevant datasets, we collect WIKIPLAN and RECIPEPLAN as a testbed for MPP. Our results show compelling human preferences and automatic scores against unimodal and multimodal baselines on WIKIPLAN and RECIPEPLAN in terms of informativeness, temporal coherence, and plan accuracy. Our code and data: https://github.com/YujieLu10/MPP.

The development of Multimodal Large Language Models (MLLMs) has seen significant advancements. However, the quantity and quality of multimodal instruction data have emerged as significant bottlenecks in their progress. Manually creating multimodal instruction data is both time-consuming and inefficient, posing challenges in producing instructions of high complexity. Moreover, distilling instruction data from black-box commercial models (e.g., GPT-4o, GPT-4V) often results in simplistic instruction data, which constrains performance to that of these models. The challenge of curating diverse and complex instruction data remains substantial. We propose MMEvol, a novel multimodal instruction data evolution framework that combines fine-grained perception evolution, cognitive reasoning evolution, and interaction evolution. This iterative approach breaks through data quality bottlenecks to generate a complex and diverse image-text instruction dataset, thereby empowering MLLMs with enhanced capabilities. Beginning with an initial set of instructions, SEED-163K, we utilize MMEvol to systematically broadens the diversity of instruction types, integrates reasoning steps to enhance cognitive capabilities, and extracts detailed information from images to improve visual understanding and robustness. To comprehensively evaluate the effectiveness of our data, we train LLaVA-NeXT using the evolved data and conduct experiments across 13 vision-language tasks. Compared to the baseline trained with seed data, our approach achieves an average accuracy improvement of 3.1 points and reaches state-of-the-art (SOTA) performance on 9 of these tasks.

This paper introduces BiMediX2, a bilingual (Arabic-English) Bio-Medical EXpert Large Multimodal Model (LMM) with a unified architecture that integrates text and visual modalities, enabling advanced image understanding and medical applications. BiMediX2 leverages the Llama3.1 architecture and integrates text and visual capabilities to facilitate seamless interactions in both English and Arabic, supporting text-based inputs and multi-turn conversations involving medical images. The model is trained on an extensive bilingual healthcare dataset consisting of 1.6M samples of diverse medical interactions for both text and image modalities, mixed in Arabic and English. We also propose the first bilingual GPT-4o based medical LMM benchmark named BiMed-MBench. BiMediX2 is benchmarked on both text-based and image-based tasks, achieving state-of-the-art performance across several medical benchmarks. It outperforms recent state-of-the-art models in medical LLM evaluation benchmarks. Our model also sets a new benchmark in multimodal medical evaluations with over 9% improvement in English and over 20% in Arabic evaluations. Additionally, it surpasses GPT-4 by around 9% in UPHILL factual accuracy evaluations and excels in various medical Visual Question Answering, Report Generation, and Report Summarization tasks. The project page including source code and the trained model, is available at https://github.com/mbzuai-oryx/BiMediX2.

Multi-modal Large Language Models (MLLMs) have demonstrated impressive instruction abilities across various open-ended tasks. However, previous methods primarily focus on enhancing multi-modal capabilities. In this work, we introduce a versatile multi-modal large language model, mPLUG-Owl2, which effectively leverages modality collaboration to improve performance in both text and multi-modal tasks. mPLUG-Owl2 utilizes a modularized network design, with the language decoder acting as a universal interface for managing different modalities. Specifically, mPLUG-Owl2 incorporates shared functional modules to facilitate modality collaboration and introduces a modality-adaptive module that preserves modality-specific features. Extensive experiments reveal that mPLUG-Owl2 is capable of generalizing both text tasks and multi-modal tasks and achieving state-of-the-art performances with a single generic model. Notably, mPLUG-Owl2 is the first MLLM model that demonstrates the modality collaboration phenomenon in both pure-text and multi-modal scenarios, setting a pioneering path in the development of future multi-modal foundation models.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,562 real-world case reports from BMC, including diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

Reasoning about images with rich text, such as charts and documents, is a critical application of vision-language models (VLMs). However, VLMs often struggle in these domains due to the scarcity of diverse text-rich vision-language data. To address this challenge, we present CoSyn, a framework that leverages the coding capabilities of text-only large language models (LLMs) to automatically create synthetic text-rich multimodal data. Given input text describing a target domain (e.g., "nutrition fact labels"), CoSyn prompts an LLM to generate code (Python, HTML, LaTeX, etc.) for rendering synthetic images. With the underlying code as textual representations of the synthetic images, CoSyn can generate high-quality instruction-tuning data, again relying on a text-only LLM. Using CoSyn, we constructed a dataset comprising 400K images and 2.7M rows of vision-language instruction-tuning data. Comprehensive experiments on seven benchmarks demonstrate that models trained on our synthetic data achieve state-of-the-art performance among competitive open-source models, including Llama 3.2, and surpass proprietary models such as GPT-4V and Gemini 1.5 Flash. Furthermore, CoSyn can produce synthetic pointing data, enabling VLMs to ground information within input images, showcasing its potential for developing multimodal agents capable of acting in real-world environments.

Recent advancements in Multimodal Large Language Models (LLMs) have focused primarily on scaling by increasing text-image pair data and enhancing LLMs to improve performance on multimodal tasks. However, these scaling approaches are computationally expensive and overlook the significance of improving model capabilities from the vision side. Inspired by the successful applications of Mixture-of-Experts (MoE) in LLMs, which improves model scalability during training while keeping inference costs similar to those of smaller models, we propose CuMo. CuMo incorporates Co-upcycled Top-K sparsely-gated Mixture-of-experts blocks into both the vision encoder and the MLP connector, thereby enhancing the multimodal LLMs with minimal additional activated parameters during inference. CuMo first pre-trains the MLP blocks and then initializes each expert in the MoE block from the pre-trained MLP block during the visual instruction tuning stage. Auxiliary losses are used to ensure a balanced loading of experts. CuMo outperforms state-of-the-art multimodal LLMs across various VQA and visual-instruction-following benchmarks using models within each model size group, all while training exclusively on open-sourced datasets. The code and model weights for CuMo are open-sourced at https://github.com/SHI-Labs/CuMo.

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

Over the past few years, the advancement of Multimodal Large Language Models (MLLMs) has captured the wide interest of researchers, leading to numerous innovations to enhance MLLMs' comprehension. In this paper, we present AdaptVision, a multimodal large language model specifically designed to dynamically process input images at varying resolutions. We hypothesize that the requisite number of visual tokens for the model is contingent upon both the resolution and content of the input image. Generally, natural images with a lower information density can be effectively interpreted by the model using fewer visual tokens at reduced resolutions. In contrast, images containing textual content, such as documents with rich text, necessitate a higher number of visual tokens for accurate text interpretation due to their higher information density. Building on this insight, we devise a dynamic image partitioning module that adjusts the number of visual tokens according to the size and aspect ratio of images. This method mitigates distortion effects that arise from resizing images to a uniform resolution and dynamically optimizing the visual tokens input to the LLMs. Our model is capable of processing images with resolutions up to 1008times 1008. Extensive experiments across various datasets demonstrate that our method achieves impressive performance in handling vision-language tasks in both natural and text-related scenes. The source code and dataset are now publicly available at https://github.com/harrytea/AdaptVision.

Recently, many versatile Multi-modal Large Language Models (MLLMs) have emerged continuously. However, their capacity to query information depicted in visual charts and engage in reasoning based on the queried contents remains under-explored. In this paper, to comprehensively and rigorously benchmark the ability of the off-the-shelf MLLMs in the chart domain, we construct ChartX, a multi-modal evaluation set covering 18 chart types, 7 chart tasks, 22 disciplinary topics, and high-quality chart data. Besides, we develop ChartVLM to offer a new perspective on handling multi-modal tasks that strongly depend on interpretable patterns, such as reasoning tasks in the field of charts or geometric images. We evaluate the chart-related ability of mainstream MLLMs and our ChartVLM on the proposed ChartX evaluation set. Extensive experiments demonstrate that ChartVLM surpasses both versatile and chart-related large models, achieving results comparable to GPT-4V. We believe that our study can pave the way for further exploration in creating a more comprehensive chart evaluation set and developing more interpretable multi-modal models. Both ChartX and ChartVLM are available at: https://github.com/UniModal4Reasoning/ChartVLM

Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s). LLaVA-Med exhibits excellent multimodal conversational capability and can follow open-ended instruction to assist with inquiries about a biomedical image. On three standard biomedical visual question answering datasets, LLaVA-Med outperforms previous supervised state-of-the-art on certain metrics. To facilitate biomedical multimodal research, we will release our instruction-following data and the LLaVA-Med model.

In this position paper, we argue that human evaluation of generative large language models (LLMs) should be a multidisciplinary undertaking that draws upon insights from disciplines such as user experience research and human behavioral psychology to ensure that the experimental design and results are reliable. The conclusions from these evaluations, thus, must consider factors such as usability, aesthetics, and cognitive biases. We highlight how cognitive biases can conflate fluent information and truthfulness, and how cognitive uncertainty affects the reliability of rating scores such as Likert. Furthermore, the evaluation should differentiate the capabilities and weaknesses of increasingly powerful large language models -- which requires effective test sets. The scalability of human evaluation is also crucial to wider adoption. Hence, to design an effective human evaluation system in the age of generative NLP, we propose the ConSiDERS-The-Human evaluation framework consisting of 6 pillars -- Consistency, Scoring Criteria, Differentiating, User Experience, Responsible, and Scalability.

As language models continue to scale, Large Language Models (LLMs) have exhibited emerging capabilities in In-Context Learning (ICL), enabling them to solve language tasks by prefixing a few in-context demonstrations (ICDs) as context. Inspired by these advancements, researchers have extended these techniques to develop Large Multimodal Models (LMMs) with ICL capabilities. However, existing LMMs face a critical issue: they often fail to effectively leverage the visual context in multimodal demonstrations and instead simply follow textual patterns. This indicates that LMMs do not achieve effective alignment between multimodal demonstrations and model outputs. To address this problem, we propose Symbol Demonstration Direct Preference Optimization (SymDPO). Specifically, SymDPO aims to break the traditional paradigm of constructing multimodal demonstrations by using random symbols to replace text answers within instances. This forces the model to carefully understand the demonstration images and establish a relationship between the images and the symbols to answer questions correctly. We validate the effectiveness of this method on multiple benchmarks, demonstrating that with SymDPO, LMMs can more effectively understand the multimodal context within examples and utilize this knowledge to answer questions better.

This tutorial note summarizes the presentation on ``Large Multimodal Models: Towards Building and Surpassing Multimodal GPT-4'', a part of CVPR 2023 tutorial on ``Recent Advances in Vision Foundation Models''. The tutorial consists of three parts. We first introduce the background on recent GPT-like large models for vision-and-language modeling to motivate the research in instruction-tuned large multimodal models (LMMs). As a pre-requisite, we describe the basics of instruction-tuning in large language models, which is further extended to the multimodal space. Lastly, we illustrate how to build the minimum prototype of multimodal GPT-4 like models with the open-source resource, and review the recently emerged topics.

Existing Multimodal Large Language Models (MLLMs) increasingly emphasize complex understanding of various visual elements, including multiple objects, text information, and spatial relations. Their development for comprehensive visual perception hinges on the availability of high-quality image-text datasets that offer diverse visual elements and throughout image descriptions. However, the scarcity of such hyper-detailed datasets currently hinders progress within the MLLM community. The bottleneck stems from the limited perceptual capabilities of current caption engines, which fall short in providing complete and accurate annotations. To facilitate the cutting-edge research of MLLMs on comprehensive vision perception, we thereby propose Perceptual Fusion, using a low-budget but highly effective caption engine for complete and accurate image descriptions. Specifically, Perceptual Fusion integrates diverse perception experts as image priors to provide explicit information on visual elements and adopts an efficient MLLM as a centric pivot to mimic advanced MLLMs' perception abilities. We carefully select 1M highly representative images from uncurated LAION dataset and generate dense descriptions using our engine, dubbed DenseFusion-1M. Extensive experiments validate that our engine outperforms its counterparts, where the resulting dataset significantly improves the perception and cognition abilities of existing MLLMs across diverse vision-language benchmarks, especially with high-resolution images as inputs. The dataset and code are publicly available at https://github.com/baaivision/DenseFusion.

In production, multi-modal large language models (MLLMs) are expected to support multi-turn queries of interchanging image and text modalities. However, the current MLLMs trained with visual-question-answering (VQA) datasets could suffer from degradation, as VQA datasets lack the diversity and complexity of the original text instruction datasets which the underlying language model had been trained with. To address this challenging degradation, we first collect a lightweight (6k entries) VQA preference dataset where answers were annotated by Gemini for 5 quality metrics in a granular fashion, and investigate standard Supervised Fine-tuning, rejection sampling, Direct Preference Optimization (DPO), and SteerLM. Our findings indicate that the with DPO we are able to surpass instruction-following capabilities of the language model, achieving a 6.73 score on MT-Bench, compared to Vicuna's 6.57 and LLaVA's 5.99 despite small data scale. This enhancement in textual instruction proficiency correlates with boosted visual instruction performance (+4.9\% on MM-Vet, +6\% on LLaVA-Bench), with minimal alignment tax on visual knowledge benchmarks compared to previous RLHF approach. In conclusion, we propose a distillation-based multi-modal alignment model with fine-grained annotations on a small dataset that reconciles the textual and visual performance of MLLMs, restoring and boosting language capability after visual instruction tuning.

Multimodal large language models (MLLMs) like LLaVA and GPT-4(V) enable general-purpose conversations about images with the language modality. As off-the-shelf MLLMs may have limited capabilities on images from domains like dermatology and agriculture, they must be fine-tuned to unlock domain-specific applications. The prevalent architecture of current open-source MLLMs comprises two major modules: an image-language (cross-modal) projection network and a large language model. It is desirable to understand the roles of these two modules in modeling domain-specific visual attributes to inform the design of future models and streamline the interpretability efforts on the current models. To this end, via experiments on 4 datasets and under 2 fine-tuning settings, we find that as the MLLM is fine-tuned, it indeed gains domain-specific visual capabilities, but the updates do not lead to the projection extracting relevant domain-specific visual attributes. Our results indicate that the domain-specific visual attributes are modeled by the LLM, even when only the projection is fine-tuned. Through this study, we offer a potential reinterpretation of the role of cross-modal projections in MLLM architectures. Projection webpage: https://claws-lab.github.io/projection-in-MLLMs/

Recently, several multi-modal models have been developed for joint image and language understanding, which have demonstrated impressive chat abilities by utilizing advanced large language models (LLMs). The process of developing such models is straightforward yet effective. It involves pre-training an adaptation module to align the semantics of the vision encoder and language model, followed by fine-tuning on the instruction-following data. However, despite the success of this pipeline in image and language understanding, its effectiveness in joint video and language understanding has not been widely explored. In this paper, we aim to develop a novel multi-modal foundation model capable of perceiving video, image, and language within a general framework. To achieve this goal, we introduce Valley: Video Assistant with Large Language model Enhanced ability. Specifically, our proposed Valley model is designed with a simple projection module that bridges video, image, and language modalities, and is further unified with a multi-lingual LLM. We also collect multi-source vision-text pairs and adopt a spatio-temporal pooling strategy to obtain a unified vision encoding of video and image input for pre-training. Furthermore, we generate multi-task instruction-following video data, including multi-shot captions, long video descriptions, action recognition, causal relationship inference, etc. To obtain the instruction-following data, we design diverse rounds of task-oriented conversations between humans and videos, facilitated by ChatGPT. Qualitative examples demonstrate that our proposed model has the potential to function as a highly effective multilingual video assistant that can make complex video understanding scenarios easy. Code, data, and models will be available at https://github.com/RupertLuo/Valley.

Large language models (LLMs) are transforming the ways the general public accesses and consumes information. Their influence is particularly pronounced in pivotal sectors like healthcare, where lay individuals are increasingly appropriating LLMs as conversational agents for everyday queries. While LLMs demonstrate impressive language understanding and generation proficiencies, concerns regarding their safety remain paramount in these high-stake domains. Moreover, the development of LLMs is disproportionately focused on English. It remains unclear how these LLMs perform in the context of non-English languages, a gap that is critical for ensuring equity in the real-world use of these systems.This paper provides a framework to investigate the effectiveness of LLMs as multi-lingual dialogue systems for healthcare queries. Our empirically-derived framework XlingEval focuses on three fundamental criteria for evaluating LLM responses to naturalistic human-authored health-related questions: correctness, consistency, and verifiability. Through extensive experiments on four major global languages, including English, Spanish, Chinese, and Hindi, spanning three expert-annotated large health Q&A datasets, and through an amalgamation of algorithmic and human-evaluation strategies, we found a pronounced disparity in LLM responses across these languages, indicating a need for enhanced cross-lingual capabilities. We further propose XlingHealth, a cross-lingual benchmark for examining the multilingual capabilities of LLMs in the healthcare context. Our findings underscore the pressing need to bolster the cross-lingual capacities of these models, and to provide an equitable information ecosystem accessible to all.

Visual embedding models excel at zero-shot tasks like visual retrieval and classification. However, these models cannot be used for tasks that contain ambiguity or require user instruction. These tasks necessitate a multimodal embedding model, which outputs embeddings that combine visual and natural language input. Existing CLIP-based approaches embed images and text independently, and fuse the result. We find that this results in weak interactions between modalities, and poor user control over the representation. We introduce ABC, an open-source multimodal embedding model that uses a vision-language model backbone to deeply integrate image features with natural language instructions. ABC achieves bestfor-size performance on MSCOCO image-to-text retrieval and is the top performing model on classification and VQA tasks in the Massive Multimodal Embedding Benchmark. With a strongly unified vision-language representation, ABC can use natural language to solve subtle and potentially ambiguous visual retrieval problems. To evaluate this capability, we design CtrlBench, a benchmark that requires interleaving textual instructions with image content for correct retrieval. ABC advances the state of multimodal embeddings by offering high-quality representations and flexible natural language control. Our model and datasets are available at our project page.

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

The recent advancements in auto-regressive multimodal large language models (MLLMs) have demonstrated promising progress for vision-language tasks. While there exists a variety of studies investigating the processing of linguistic information within large language models, little is currently known about the inner working mechanism of MLLMs and how linguistic and visual information interact within these models. In this study, we aim to fill this gap by examining the information flow between different modalities -- language and vision -- in MLLMs, focusing on visual question answering. Specifically, given an image-question pair as input, we investigate where in the model and how the visual and linguistic information are combined to generate the final prediction. Conducting experiments with a series of models from the LLaVA series, we find that there are two distinct stages in the process of integration of the two modalities. In the lower layers, the model first transfers the more general visual features of the whole image into the representations of (linguistic) question tokens. In the middle layers, it once again transfers visual information about specific objects relevant to the question to the respective token positions of the question. Finally, in the higher layers, the resulting multimodal representation is propagated to the last position of the input sequence for the final prediction. Overall, our findings provide a new and comprehensive perspective on the spatial and functional aspects of image and language processing in the MLLMs, thereby facilitating future research into multimodal information localization and editing.

We propose a method to fuse frozen text-only large language models (LLMs) with pre-trained image encoder and decoder models, by mapping between their embedding spaces. Our model demonstrates a wide suite of multimodal capabilities: image retrieval, novel image generation, and multimodal dialogue. Ours is the first approach capable of conditioning on arbitrarily interleaved image and text inputs to generate coherent image (and text) outputs. To achieve strong performance on image generation, we propose an efficient mapping network to ground the LLM to an off-the-shelf text-to-image generation model. This mapping network translates hidden representations of text into the embedding space of the visual models, enabling us to leverage the strong text representations of the LLM for visual outputs. Our approach outperforms baseline generation models on tasks with longer and more complex language. In addition to novel image generation, our model is also capable of image retrieval from a prespecified dataset, and decides whether to retrieve or generate at inference time. This is done with a learnt decision module which conditions on the hidden representations of the LLM. Our model exhibits a wider range of capabilities compared to prior multimodal language models. It can process image-and-text inputs, and produce retrieved images, generated images, and generated text -- outperforming non-LLM based generation models across several text-to-image tasks that measure context dependence.

Multi-modal data abounds in biomedicine, such as radiology images and reports. Interpreting this data at scale is essential for improving clinical care and accelerating clinical research. Biomedical text with its complex semantics poses additional challenges in vision--language modelling compared to the general domain, and previous work has used insufficiently adapted models that lack domain-specific language understanding. In this paper, we show that principled textual semantic modelling can substantially improve contrastive learning in self-supervised vision--language processing. We release a language model that achieves state-of-the-art results in radiology natural language inference through its improved vocabulary and novel language pretraining objective leveraging semantics and discourse characteristics in radiology reports. Further, we propose a self-supervised joint vision--language approach with a focus on better text modelling. It establishes new state of the art results on a wide range of publicly available benchmarks, in part by leveraging our new domain-specific language model. We release a new dataset with locally-aligned phrase grounding annotations by radiologists to facilitate the study of complex semantic modelling in biomedical vision--language processing. A broad evaluation, including on this new dataset, shows that our contrastive learning approach, aided by textual-semantic modelling, outperforms prior methods in segmentation tasks, despite only using a global-alignment objective.

Multimodal large language models (MLLMs) have shown great potential in perception and interpretation tasks, but their capabilities in predictive reasoning remain under-explored. To address this gap, we introduce a novel benchmark that assesses the predictive reasoning capabilities of MLLMs across diverse scenarios. Our benchmark targets three important domains: abstract pattern reasoning, human activity prediction, and physical interaction prediction. We further develop three evaluation methods powered by large language model to robustly quantify a model's performance in predicting and reasoning the future based on multi-visual context. Empirical experiments confirm the soundness of the proposed benchmark and evaluation methods via rigorous testing and reveal pros and cons of current popular MLLMs in the task of predictive reasoning. Lastly, our proposed benchmark provides a standardized evaluation framework for MLLMs and can facilitate the development of more advanced models that can reason and predict over complex long sequence of multimodal input.

In this paper, we critically evaluate the capabilities of the state-of-the-art multimodal large language model, i.e., GPT-4 with Vision (GPT-4V), on Visual Question Answering (VQA) task. Our experiments thoroughly assess GPT-4V's proficiency in answering questions paired with images using both pathology and radiology datasets from 11 modalities (e.g. Microscopy, Dermoscopy, X-ray, CT, etc.) and fifteen objects of interests (brain, liver, lung, etc.). Our datasets encompass a comprehensive range of medical inquiries, including sixteen distinct question types. Throughout our evaluations, we devised textual prompts for GPT-4V, directing it to synergize visual and textual information. The experiments with accuracy score conclude that the current version of GPT-4V is not recommended for real-world diagnostics due to its unreliable and suboptimal accuracy in responding to diagnostic medical questions. In addition, we delineate seven unique facets of GPT-4V's behavior in medical VQA, highlighting its constraints within this complex arena. The complete details of our evaluation cases are accessible at https://github.com/ZhilingYan/GPT4V-Medical-Report.

The impressive development of large language models (LLMs) is expanding into the realm of large multimodal models (LMMs), which incorporate multiple types of data beyond text. However, the nature of multimodal models leads to significant expenses in the creation of training data. Furthermore, constructing multilingual data for LMMs presents its own set of challenges due to language diversity and complexity. Therefore, in this study, we propose two cost-effective methods to solve this problem: (1) vocabulary expansion and pretraining of multilingual LLM for specific languages, and (2) automatic and elaborate construction of multimodal datasets using GPT4-V. Based on015 these methods, we constructed a 91K English-Korean-Chinese multilingual, multimodal training dataset. Additionally, we developed a bilingual multimodal model that exhibits excellent performance in both Korean and English, surpassing existing approaches.

Recent advancements in Multimodal Large Language Models (MLLMs) underscore the significance of scalable models and data to boost performance, yet this often incurs substantial computational costs. Although the Mixture of Experts (MoE) architecture has been employed to efficiently scale large language and image-text models, these efforts typically involve fewer experts and limited modalities. To address this, our work presents the pioneering attempt to develop a unified MLLM with the MoE architecture, named Uni-MoE that can handle a wide array of modalities. Specifically, it features modality-specific encoders with connectors for a unified multimodal representation. We also implement a sparse MoE architecture within the LLMs to enable efficient training and inference through modality-level data parallelism and expert-level model parallelism. To enhance the multi-expert collaboration and generalization, we present a progressive training strategy: 1) Cross-modality alignment using various connectors with different cross-modality data, 2) Training modality-specific experts with cross-modality instruction data to activate experts' preferences, and 3) Tuning the Uni-MoE framework utilizing Low-Rank Adaptation (LoRA) on mixed multimodal instruction data. We evaluate the instruction-tuned Uni-MoE on a comprehensive set of multimodal datasets. The extensive experimental results demonstrate Uni-MoE's principal advantage of significantly reducing performance bias in handling mixed multimodal datasets, alongside improved multi-expert collaboration and generalization. Our findings highlight the substantial potential of MoE frameworks in advancing MLLMs and the code is available at https://github.com/HITsz-TMG/UMOE-Scaling-Unified-Multimodal-LLMs.

Vision Language Models (VLMs) like CLIP have attracted substantial attention in pathology, serving as backbones for applications such as zero-shot image classification and Whole Slide Image (WSI) analysis. Additionally, they can function as vision encoders when combined with large language models (LLMs) to support broader capabilities. Current efforts to train pathology VLMs rely on pathology image-text pairs from platforms like PubMed, YouTube, and Twitter, which provide limited, unscalable data with generally suboptimal image quality. In this work, we leverage large-scale WSI datasets like TCGA to extract numerous high-quality image patches. We then train a large multimodal model to generate captions for these images, creating PathGen-1.6M, a dataset containing 1.6 million high-quality image-caption pairs. Our approach involves multiple agent models collaborating to extract representative WSI patches, generating and refining captions to obtain high-quality image-text pairs. Extensive experiments show that integrating these generated pairs with existing datasets to train a pathology-specific CLIP model, PathGen-CLIP, significantly enhances its ability to analyze pathological images, with substantial improvements across nine pathology-related zero-shot image classification tasks and three whole-slide image tasks. Furthermore, we construct 200K instruction-tuning data based on PathGen-1.6M and integrate PathGen-CLIP with the Vicuna LLM to create more powerful multimodal models through instruction tuning. Overall, we provide a scalable pathway for high-quality data generation in pathology, paving the way for next-generation general pathology models.

Existing text-to-image diffusion models primarily generate images from text prompts. However, the inherent conciseness of textual descriptions poses challenges in faithfully synthesizing images with intricate details, such as specific entities or scenes. This paper presents UNIMO-G, a simple multimodal conditional diffusion framework that operates on multimodal prompts with interleaved textual and visual inputs, which demonstrates a unified ability for both text-driven and subject-driven image generation. UNIMO-G comprises two core components: a Multimodal Large Language Model (MLLM) for encoding multimodal prompts, and a conditional denoising diffusion network for generating images based on the encoded multimodal input. We leverage a two-stage training strategy to effectively train the framework: firstly pre-training on large-scale text-image pairs to develop conditional image generation capabilities, and then instruction tuning with multimodal prompts to achieve unified image generation proficiency. A well-designed data processing pipeline involving language grounding and image segmentation is employed to construct multi-modal prompts. UNIMO-G excels in both text-to-image generation and zero-shot subject-driven synthesis, and is notably effective in generating high-fidelity images from complex multimodal prompts involving multiple image entities.

Multimodal large language models (MLLMs), such as GPT-4o, Gemini, LLaVA, and Flamingo, have made significant progress in integrating visual and textual modalities, excelling in tasks like visual question answering (VQA), image captioning, and content retrieval. They can generate coherent and contextually relevant descriptions of images. However, they still face challenges in accurately identifying and counting objects and determining their spatial locations, particularly in complex scenes with overlapping or small objects. To address these limitations, we propose a novel framework based on multimodal retrieval-augmented generation (RAG), which introduces structured scene graphs to enhance object recognition, relationship identification, and spatial understanding within images. Our framework improves the MLLM's capacity to handle tasks requiring precise visual descriptions, especially in scenarios with challenging perspectives, such as aerial views or scenes with dense object arrangements. Finally, we conduct extensive experiments on the VG-150 dataset that focuses on first-person visual understanding and the AUG dataset that involves aerial imagery. The results show that our approach consistently outperforms existing MLLMs in VQA tasks, which stands out in recognizing, localizing, and quantifying objects in different spatial contexts and provides more accurate visual descriptions.

Recent advancements in multimodal large language models (MLLMs) have achieved significant multimodal generation capabilities, akin to GPT-4. These models predominantly map visual information into language representation space, leveraging the vast knowledge and powerful text generation abilities of LLMs to produce multimodal instruction-following responses. We could term this method as LLMs for Vision because of its employing LLMs for visual-language understanding, yet observe that these MLLMs neglect the potential of harnessing visual knowledge to enhance overall capabilities of LLMs, which could be regraded as Vision Enhancing LLMs. In this paper, we propose an approach called MKS2, aimed at enhancing LLMs through empowering Multimodal Knowledge Storage and Sharing in LLMs. Specifically, we introduce the Modular Visual Memory, a component integrated into the internal blocks of LLMs, designed to store open-world visual information efficiently. Additionally, we present a soft Mixtures-of-Multimodal Experts architecture in LLMs to invoke multimodal knowledge collaboration during generation. Our comprehensive experiments demonstrate that MKS2 substantially augments the reasoning capabilities of LLMs in contexts necessitating physical or commonsense knowledge. It also delivers competitive results on multimodal benchmarks.

Large multimodal models (LMMs) extend large language models (LLMs) with multi-sensory skills, such as visual understanding, to achieve stronger generic intelligence. In this paper, we analyze the latest model, GPT-4V(ision), to deepen the understanding of LMMs. The analysis focuses on the intriguing tasks that GPT-4V can perform, containing test samples to probe the quality and genericity of GPT-4V's capabilities, its supported inputs and working modes, and the effective ways to prompt the model. In our approach to exploring GPT-4V, we curate and organize a collection of carefully designed qualitative samples spanning a variety of domains and tasks. Observations from these samples demonstrate that GPT-4V's unprecedented ability in processing arbitrarily interleaved multimodal inputs and the genericity of its capabilities together make GPT-4V a powerful multimodal generalist system. Furthermore, GPT-4V's unique capability of understanding visual markers drawn on input images can give rise to new human-computer interaction methods such as visual referring prompting. We conclude the report with in-depth discussions on the emerging application scenarios and the future research directions for GPT-4V-based systems. We hope that this preliminary exploration will inspire future research on the next-generation multimodal task formulation, new ways to exploit and enhance LMMs to solve real-world problems, and gaining better understanding of multimodal foundation models.

The rise in popularity of ChatGPT and GPT-4 has significantly accelerated the development of large models, leading to the creation of numerous impressive large language models(LLMs) and multimodal large language models (MLLMs). These cutting-edge models owe their remarkable performance to high-quality data. However, the details of the training data used in leading paradigms are often kept confidential. This lack of transparency, coupled with the scarcity of open-source data, impedes further developments within the community. As a response, this paper presents "Wan Juan", a large-scale multimodal dataset composed of both Chinese and English data, collected from a wide range of web sources. The dataset incorporates text, image-text, and video modalities, with a total volume exceeding 2TB. It was utilized in the training of InternLM, a model that demonstrated significant advantages in multi-dimensional evaluations when compared to models of a similar scale. All data can be accessed at https://opendatalab.org.cn/WanJuan1.0.

Due to the remarkable capabilities of powerful Large Language Models (LLMs) in effectively following instructions, there has been a growing number of assistants in the community to assist humans. Recently, significant progress has been made in the development of Vision Language Models (VLMs), expanding the capabilities of LLMs and enabling them to execute more diverse instructions. However, it is foreseeable that models will likely need to handle tasks involving additional modalities such as speech, video, and others. This poses a particularly prominent challenge of dealing with the complexity of mixed modalities. To address this, we introduce a novel architecture called PILL: Plug Into LLM with adapter expert and attention gate to better decouple these complex modalities and leverage efficient fine-tuning. We introduce two modules: Firstly, utilizing Mixture-of-Modality-Adapter-Expert to independently handle different modalities, enabling better adaptation to downstream tasks while preserving the expressive capability of the original model. Secondly, by introducing Modality-Attention-Gating, which enables adaptive control of the contribution of modality tokens to the overall representation. In addition, we have made improvements to the Adapter to enhance its learning and expressive capabilities. Experimental results demonstrate that our approach exhibits competitive performance compared to other mainstream methods for modality fusion. For researchers interested in our work, we provide free access to the code and models at https://github.com/DsaltYfish/PILL.

Recent Multimodal Large Language Models (MLLMs) have typically focused on integrating visual and textual modalities, with less emphasis placed on the role of speech in enhancing interaction. However, speech plays a crucial role in multimodal dialogue systems, and implementing high-performance in both vision and speech tasks remains a significant challenge due to the fundamental modality differences. In this paper, we propose a carefully designed multi-stage training methodology that progressively trains LLM to understand both visual and speech information, ultimately enabling fluent vision and speech interaction. Our approach not only preserves strong vision-language capacity, but also enables efficient speech-to-speech dialogue capabilities without separate ASR and TTS modules, significantly accelerating multimodal end-to-end response speed. By comparing our method against state-of-the-art counterparts across benchmarks for image, video, and speech tasks, we demonstrate that our model is equipped with both strong visual and speech capabilities, making near real-time vision and speech interaction.

Multimodal vision language models (VLMs) have made significant progress with the support of continuously increasing model sizes and data volumes. Running VLMs on edge devices has become a challenge for their widespread application. There are several efficient VLM efforts, but they often sacrifice linguistic capabilities to enhance multimodal abilities, or require extensive training. To address this quandary,we introduce the innovative framework of Efficient Vision Language Models with Elastic Visual Experts (Eve). By strategically incorporating adaptable visual expertise at multiple stages of training, Eve strikes a balance between preserving linguistic abilities and augmenting multimodal capabilities. This balanced approach results in a versatile model with only 1.8B parameters that delivers significant improvements in both multimodal and linguistic tasks. Notably, in configurations below 3B parameters, Eve distinctly outperforms in language benchmarks and achieves state-of-the-art results 68.87% in VLM Benchmarks. Additionally, its multimodal accuracy outstrips that of the larger 7B LLaVA-1.5 model. Our code is available at https://github.com/rangmiao/Eve.

Medical vision-and-language pre-training (Med-VLP) has received considerable attention owing to its applicability to extracting generic vision-and-language representations from medical images and texts. Most existing methods mainly contain three elements: uni-modal encoders (i.e., a vision encoder and a language encoder), a multi-modal fusion module, and pretext tasks, with few studies considering the importance of medical domain expert knowledge and explicitly exploiting such knowledge to facilitate Med-VLP. Although there exist knowledge-enhanced vision-and-language pre-training (VLP) methods in the general domain, most require off-the-shelf toolkits (e.g., object detectors and scene graph parsers), which are unavailable in the medical domain. In this paper, we propose a systematic and effective approach to enhance Med-VLP by structured medical knowledge from three perspectives. First, considering knowledge can be regarded as the intermediate medium between vision and language, we align the representations of the vision encoder and the language encoder through knowledge. Second, we inject knowledge into the multi-modal fusion model to enable the model to perform reasoning using knowledge as the supplementation of the input image and text. Third, we guide the model to put emphasis on the most critical information in images and texts by designing knowledge-induced pretext tasks. To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results illustrate the effectiveness of our approach, where state-of-the-art performance is achieved on all downstream tasks. Further analyses explore the effects of different components of our approach and various settings of pre-training.