# UniVRSE: Unified Vision-conditioned Response Semantic Entropy for Hallucination Detection in Medical Vision-Language Models

arXiv: https://arxiv.org/abs/2503.20504 · HTML: https://mlsanity.com/paper/2503.20504/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Placed in Hallucination mitigation in LVLMs, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 48 of its 64 references that are in the map.
- First posted on arXiv 26 Mar 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Hallucination mitigation in LVLMs](https://mlsanity.com/mllm/hallucination-mitigation-in-lvlms/)

## Builds on (most cited first, 30 of 48)

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [DeBERTa: Decoding-enhanced BERT with Disentangled Attention](https://mlsanity.com/paper/2006.03654/) (2020)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [FActScore: Fine-grained Atomic Evaluation of Factual Precision in Long Form Text Generation](https://mlsanity.com/paper/2305.14251/) (2023)
- [Semantic Uncertainty: Linguistic Invariances for Uncertainty Estimation in Natural Language Generation](https://mlsanity.com/paper/2302.09664/) (2023)
- [SelfCheckGPT: Zero-Resource Black-Box Hallucination Detection for Generative Large Language Models](https://mlsanity.com/paper/2303.08896/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [A Survey on Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2402.00253/) (2024)
- [INSIDE: LLMs' Internal States Retain the Power of Hallucination Detection](https://mlsanity.com/paper/2402.03744/) (2024)
- [Semantic Entropy Probes: Robust and Cheap Hallucination Detection in LLMs](https://mlsanity.com/paper/2406.15927/) (2024)
- [Detecting and Preventing Hallucinations in Large Vision Language Models](https://mlsanity.com/paper/2308.06394/) (2023)
- [Woodpecker: Hallucination Correction for Multimodal Large Language Models](https://mlsanity.com/paper/2310.16045/) (2023)
- [A Stitch in Time Saves Nine: Detecting and Mitigating Hallucinations of LLMs by Validating Low-Confidence Generation](https://mlsanity.com/paper/2307.03987/) (2023)
- [Mitigating Hallucinations in Large Vision-Language Models with Instruction Contrastive Decoding](https://mlsanity.com/paper/2403.18715/) (2024)
- [LM vs LM: Detecting Factual Errors via Cross Examination](https://mlsanity.com/paper/2305.13281/) (2023)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [HalluciDoctor: Mitigating Hallucinatory Toxicity in Visual Instruction Data](https://mlsanity.com/paper/2311.13614/) (2023)
- [Vision-Language Models for Medical Report Generation and Visual Question Answering: A Review](https://mlsanity.com/paper/2403.02469/) (2024)
- [Hallucination Augmented Contrastive Learning for Multimodal Large Language Model](https://mlsanity.com/paper/2312.06968/) (2023)
- [Do Language Models Know When They're Hallucinating References?](https://mlsanity.com/paper/2305.18248/) (2023)
- [Complex Claim Verification with Evidence Retrieved in the Wild](https://mlsanity.com/paper/2305.11859/) (2023)
- [CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats](https://mlsanity.com/paper/2405.19538/) (2024)
- [ReDeEP: Detecting Hallucination in Retrieval-Augmented Generation via Mechanistic Interpretability](https://mlsanity.com/paper/2410.11414/) (2024)
- [SAC3: Reliable Hallucination Detection in Black-Box Language Models via Semantic-aware Cross-check Consistency](https://mlsanity.com/paper/2311.01740/) (2023)
- [Detecting and Mitigating Hallucination in Large Vision Language Models via Fine-Grained AI Feedback](https://mlsanity.com/paper/2404.14233/) (2024)
- [Unified Hallucination Detection for Multimodal Large Language Models](https://mlsanity.com/paper/2402.03190/) (2024)
- [VL-Uncertainty: Detecting Hallucination in Large Vision-Language Model via Uncertainty Estimation](https://mlsanity.com/paper/2411.11919/) (2024)

## Built on by (most cited first, 5 of 5)

- [V-Loop: Visual Logical Loop Verification for Hallucination Detection in Medical Visual Question Answering](https://mlsanity.com/paper/2601.18240/) (2026)
- [Verification Mirage: Mapping the Reliability Boundary of Self-Verification in Medical VQA](https://mlsanity.com/paper/2605.10850/) (2026)
- [Suppressing VLM Hallucinations with Spectral Representation Filtering](https://mlsanity.com/paper/2511.12220/) (2025)
- [FaithSCAN: Model-Driven Single-Pass Hallucination Detection for Faithful Visual Question Answering](https://mlsanity.com/paper/2601.00269/) (2026)
- [Detecting Clinical Hallucinations in LVLMs via Counterfactual Visual Grounding Uncertainty](https://mlsanity.com/paper/2606.28520/) (2026)

## Abstract (arXiv)

Vision-language models (VLMs) have great potential for medical image understanding, particularly in Visual Report Generation (VRG) and Visual Question Answering (VQA), but they may generate hallucinated responses that contradict visual evidence, limiting clinical deployment. Although uncertainty-based hallucination detection methods are intuitive and effective, they are limited in medical VLMs. Specifically, Semantic Entropy (SE), effective in text-only LLMs, becomes less reliable in medical VLMs due to their overconfidence from strong language priors. To address this challenge, we propose UniVRSE, a Unified Vision-conditioned Response Semantic Entropy framework for hallucination detection in medical VLMs. UniVRSE strengthens visual guidance during uncertainty estimation by contrasting the semantic predictive distributions derived from an original image-text pair and a visually distorted counterpart, with higher entropy indicating hallucination risk. For VQA, UniVRSE works on the image-question pair, while for VRG, it decomposes the report into claims, generates verification questions, and applies vision-conditioned entropy estimation at the claim level. To evaluate hallucination detection, we propose a unified pipeline that generates responses on medical datasets and derives hallucination labels via factual consistency assessment. However, current evaluation methods rely on subjective criteria or modality-specific rules. To improve reliability, we introduce Alignment Ratio of Atomic Facts (ALFA), a novel method that quantifies fine-grained factual consistency. ALFA-derived labels provide ground truth for robust benchmarking. Experiments on six medical VQA/VRG datasets and three VLMs show UniVRSE significantly outperforms existing methods with strong cross-modal generalization.