# Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning

arXiv: https://arxiv.org/abs/2506.07044 · HTML: https://mlsanity.com/paper/2506.07044/

## Key facts

- Cited by 230 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 77 of its 117 references that are in the map.
- First posted on arXiv 8 Jun 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 77)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [MMMU: A Massive Multi-discipline Multimodal Understanding and Reasoning Benchmark for Expert AGI](https://mlsanity.com/paper/2311.16502/) (2023)
- [CIDEr: Consensus-based Image Description Evaluation](https://mlsanity.com/paper/1411.5726/) (2014)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-training](https://mlsanity.com/paper/2501.17161/) (2025)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [VideoLLaMA 3: Frontier Multimodal Foundation Models for Image and Video Understanding](https://mlsanity.com/paper/2501.13106/) (2025)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [VLMEvalKit: An Open-Source Toolkit for Evaluating Large Multi-Modality Models](https://mlsanity.com/paper/2407.11691/) (2024)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [LMMs-Eval: Reality Check on the Evaluation of Large Multimodal Models](https://mlsanity.com/paper/2407.12772/) (2024)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [Molmo and PixMo: Open Weights and Open Data for State-of-the-Art Vision-Language Models](https://mlsanity.com/paper/2409.17146/) (2024)
- [Demystifying Long Chain-of-Thought Reasoning in LLMs](https://mlsanity.com/paper/2502.03373/) (2025)

## Built on by (most cited first, 30 of 230)

- [Baichuan-M2: Scaling Medical Capability with Large Verifier System](https://mlsanity.com/paper/2509.02208/) (2025)
- [A Survey of Scientific Large Language Models: From Data Foundations to Agent Frontiers](https://mlsanity.com/paper/2508.21148/) (2025)
- [ReasonMed: A 370K Multi-Agent Generated Dataset for Advancing Medical Reasoning](https://mlsanity.com/paper/2506.09513/) (2025)
- [Pillar-0: A New Frontier for Radiology Foundation Models](https://mlsanity.com/paper/2511.17803/) (2025)
- [Entropy-Adaptive Fine-Tuning: Resolving Confident Conflicts to Mitigate Forgetting](https://mlsanity.com/paper/2601.02151/) (2026)
- [MedMO: Grounding and Understanding Multimodal Large Language Model for Medical Images](https://mlsanity.com/paper/2602.06965/) (2026)
- [Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning](https://mlsanity.com/paper/2512.00818/) (2025)
- [Think Twice to See More: Iterative Visual Reasoning in Medical VLMs](https://mlsanity.com/paper/2510.10052/) (2025)
- [UniMedVL: Unifying Medical Multimodal Understanding and Generation through Observation-Knowledge-Analysis](https://mlsanity.com/paper/2510.15710/) (2025)
- [Fleming-VL: Towards Universal Medical Visual Reasoning with Multimodal LLMs](https://mlsanity.com/paper/2511.00916/) (2025)
- [OralGPT-Omni: A Versatile Dental Multimodal Large Language Model](https://mlsanity.com/paper/2511.22055/) (2025)
- [Baichuan-M3: Modeling Clinical Inquiry for Reliable Medical Decision-Making](https://mlsanity.com/paper/2602.06570/) (2026)
- [MedReasoner: Reinforcement Learning Drives Reasoning Grounding from Clinical Thought to Pixel-Level Precision](https://mlsanity.com/paper/2508.08177/) (2025)
- [SaFeR-VLM: Toward Safety-aware Fine-grained Reasoning in Multimodal Models](https://mlsanity.com/paper/2510.06871/) (2025)
- [Beyond the Crowd: LLM-Augmented Community Notes for Governing Health Misinformation](https://mlsanity.com/paper/2510.11423/) (2025)
- [OctoMed: Data Recipes for State-of-the-Art Multimodal Medical Reasoning](https://mlsanity.com/paper/2511.23269/) (2025)
- [Ophiuchus: Incentivizing Tool-augmented "Think with Images" for Joint Medical Segmentation, Understanding and Reasoning](https://mlsanity.com/paper/2512.14157/) (2025)
- [IBISAgent: Reinforcing Pixel-Level Visual Reasoning in MLLMs for Universal Biomedical Object Referring and Segmentation](https://mlsanity.com/paper/2601.03054/) (2026)
- [OmniCT: Towards a Unified Slice-Volume LVLM for Comprehensive CT Analysis](https://mlsanity.com/paper/2602.16110/) (2026)
- [GeoPQA: Bridging the Visual Perception Gap in MLLMs for Geometric Reasoning](https://mlsanity.com/paper/2509.17437/) (2025)
- [Citrus-V: Advancing Medical Foundation Models with Unified Medical Image Grounding for Clinical Reasoning](https://mlsanity.com/paper/2509.19090/) (2025)
- [OmniBrainBench: A Comprehensive Multimodal Benchmark for Brain Imaging Analysis Across Multi-stage Clinical Tasks](https://mlsanity.com/paper/2511.00846/) (2025)
- [MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning](https://mlsanity.com/paper/2602.03320/) (2026)
- [PET2Rep: Towards Vision-Language Model-Drived Automated Radiology Report Generation for Positron Emission Tomography](https://mlsanity.com/paper/2508.04062/) (2025)
- [CXRAgent: Director-Orchestrated Multi-Stage Reasoning for Chest X-Ray Interpretation](https://mlsanity.com/paper/2510.21324/) (2025)
- [Bridging the Gap in Ophthalmic AI: MM-Retinal-Reason Dataset and OphthaReason Model toward Dynamic Multimodal Reasoning](https://mlsanity.com/paper/2508.16129/) (2025)
- [GGBench: A Geometric Generative Reasoning Benchmark for Unified Multimodal Models](https://mlsanity.com/paper/2511.11134/) (2025)
- [DentalGPT: Incentivizing Multimodal Complex Reasoning in Dentistry](https://mlsanity.com/paper/2512.11558/) (2025)
- [RadImageNet-VQA: A Large-Scale CT and MRI Dataset for Radiologic Visual Question Answering](https://mlsanity.com/paper/2512.17396/) (2025)
- [M3CoTBench: Benchmark Chain-of-Thought of MLLMs in Medical Image Understanding](https://mlsanity.com/paper/2601.08758/) (2026)

## Abstract (arXiv)

Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...