# Uncertainty-Driven Expert Control: Enhancing the Reliability of Medical Vision-Language Models

arXiv: https://arxiv.org/abs/2507.09209 · HTML: https://mlsanity.com/paper/2507.09209/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 49 of its 60 references that are in the map.
- First posted on arXiv 12 Jul 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 49)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Classifier-Free Diffusion Guidance](https://mlsanity.com/paper/2207.12598/) (2022)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [Billion-scale similarity search with GPUs](https://mlsanity.com/paper/1702.08734/) (2017)
- [Phi-3 Technical Report: A Highly Capable Language Model Locally on Your Phone](https://mlsanity.com/paper/2404.14219/) (2024)
- [Evaluating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2305.10355/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Just Ask for Calibration: Strategies for Eliciting Calibrated Confidence Scores from Language Models Fine-Tuned with Human Feedback](https://mlsanity.com/paper/2305.14975/) (2023)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [mPLUG-Owl2: Revolutionizing Multi-modal Large Language Model with Modality Collaboration](https://mlsanity.com/paper/2311.04257/) (2023)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [OPERA: Alleviating Hallucination in Multi-Modal Large Language Models via Over-Trust Penalty and Retrospection-Allocation](https://mlsanity.com/paper/2311.17911/) (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)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [A Survey on Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2402.00253/) (2024)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Analyzing and Mitigating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2310.00754/) (2023)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [M3D: Advancing 3D Medical Image Analysis with Multi-Modal Large Language Models](https://mlsanity.com/paper/2404.00578/) (2024)
- [Stay on topic with Classifier-Free Guidance](https://mlsanity.com/paper/2306.17806/) (2023)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [MMed-RAG: Versatile Multimodal RAG System for Medical Vision Language Models](https://mlsanity.com/paper/2410.13085/) (2024)
- [Negative Object Presence Evaluation (NOPE) to Measure Object Hallucination in Vision-Language Models](https://mlsanity.com/paper/2310.05338/) (2023)

## Built on by (most cited first, 4 of 4)

- [EDCO: Dynamic Curriculum Orchestration for Domain-specific Large Language Model Fine-tuning](https://mlsanity.com/paper/2601.03725/) (2026)
- [MedProbCLIP: Probabilistic Adaptation of Vision-Language Foundation Model for Reliable Radiograph-Report Retrieval](https://mlsanity.com/paper/2602.16019/) (2026)
- [Improving Few-Shot Change Detection Visual Question Answering via Decision-Ambiguity-guided Reinforcement Fine-Tuning](https://mlsanity.com/paper/2512.24591/) (2025)
- [Counterfactual Anatomy-guided Spatial-Temporal Decoding for Annotation-Free Hallucination Mitigation in Medical VLMs](https://mlsanity.com/paper/2608.17427/) (2026)

## Abstract (arXiv)

The rapid advancements in Vision Language Models (VLMs) have prompted the development of multi-modal medical assistant systems. Despite this progress, current models still have inherent probabilistic uncertainties, often producing erroneous or unverified responses-an issue with serious implications in medical applications. Existing methods aim to enhance the performance of Medical Vision Language Model (MedVLM) by adjusting model structure, fine-tuning with high-quality data, or through preference fine-tuning. However, these training-dependent strategies are costly and still lack sufficient alignment with clinical expertise. To address these issues, we propose an expert-in-the-loop framework named Expert-Controlled Classifier-Free Guidance (Expert-CFG) to align MedVLM with clinical expertise without additional training. This framework introduces an uncertainty estimation strategy to identify unreliable outputs. It then retrieves relevant references to assist experts in highlighting key terms and applies classifier-free guidance to refine the token embeddings of MedVLM, ensuring that the adjusted outputs are correct and align with expert highlights. Evaluations across three medical visual question answering benchmarks demonstrate that the proposed Expert-CFG, with 4.2B parameters and limited expert annotations, outperforms state-of-the-art models with 13B parameters. The results demonstrate the feasibility of deploying such a system in resource-limited settings for clinical use.