Shujian Gao
Publications
MedUP: Awakening Unified Understanding and Perception in Medical Vision-Language Models
Medical Vision-Language Models (Med-VLMs) excel at verbalizing visual content, yet precise visual perception, segmentation, and grounding remain challenging. Existing approaches either verbalize regions as coordinate strings or rely on external modules that decouple perception from understanding, creating representation gaps for region-language alignment. We present MedUP, a Med-VLM that natively unifies perception and understanding within a shared token space. At its core lies UniMedTok, a region tokenizer that encodes masks as discrete tokens in the LLM vocabulary, enabling the model to seamlessly interleave mask tokens with text. We curate UniMed-Train, a 1.84M-instance corpus spanning text-guided segmentation, region-grounded understanding, medical VQA and CoT-based segmentation, and introduce UniMed-Bench for unified evaluation. Extensive experiments show that MedUP outperforms native, agentic, and dual-decoder Med-VLMs across all tasks while remaining competitive with specialist segmentors, demonstrating the strong potential of unified understanding and perception modeling.
MedStreamBench: A Time-Aware Benchmark for Streaming and Proactive Medical Video Understanding
Existing medical video benchmarks primarily evaluate whether a model produces the correct answer, but rarely assess whether it answers at the right time. In real clinical settings, AI systems must decide not only what to predict, but also when to answer, defer judgment, or proactively raise alerts. This creates a critical gap between benchmark evaluation and deployment requirements. We present MedStreamBench, a benchmark for time-aware medical video understanding. MedStreamBench integrates 22 medical datasets and 5,419 QA instances across four temporal settings: retrospective, present, future, and proactive. Unlike conventional benchmarks that assume full-video access, MedStreamBench restricts models to temporally bounded evidence windows and supports both single-turn and streaming evaluation. We further introduce a proactive monitoring setting that requires models to determine whether and when clinically relevant alerts should be triggered. Beyond answer correctness, MedStreamBench evaluates temporal behavior through responsiveness and post-evidence stability. Experiments on leading general-purpose and medical vision-language models reveal a substantial gap between offline recognition and temporally grounded decision-making, with performance dropping markedly in streaming and proactive settings. Our benchmark is available at https://huggingface.co/datasets/Venn2024/MedStreamBench.
Thinking with Deltas: Incentivizing Reinforcement Learning via Differential Visual Reasoning Policy
Reinforcement Learning with Verifiable Rewards (RLVR) has significantly advanced reasoning capabilities in Large Language Models. However, adapting RLVR to multimodal domains suffers from a critical \textit{perception-reasoning decoupling}. Existing paradigms, driven by text-centric outcome rewards, reasoning in language medium, inadvertently encourage models to bypass visual perception. We empirically validate this through blind experiments: state-of-the-art policies maintain or surprisingly improve performance even when visual inputs are entirely removed. This reveals that these models degenerate into \textit{blind reasoners}, exploiting linguistic priors to generate plausible answers instead of attending to visual evidence. In response, we propose \textbf{Thinking with Deltas}, a framework driven by a \textbf{Differential Visual Reasoning Policy (DVRP)}. DVRP introduces intrinsic supervision via visual triplets, comprising original, masked, and perturbed inputs. It optimizes the model to maximize reasoning divergence from masked inputs (enforcing \textit{visual sensitivity}) while minimizing divergence from perturbed inputs (ensuring \textit{visual robustness}). By aligning reasoning variations strictly with the \textit{Delta} of visual information, DVRP inherently bolsters visual understanding capabilities and significantly outperforms state-of-the-art methods on both general and medical benchmarks, without requiring external annotations or auxiliary tools.