# Adapting and Evaluating Multimodal Large Language Models for Adolescent Idiopathic Scoliosis Self-Management: A Divide and Conquer Framework

arXiv: https://arxiv.org/abs/2509.11645 · HTML: https://mlsanity.com/paper/2509.11645/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 12 of its 27 references that are in the map.
- First posted on arXiv 15 Sep 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, 12 of 12)

- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Gemini 1.5: Unlocking multimodal understanding across millions of tokens of context](https://mlsanity.com/paper/2403.05530/) (2024)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [ChestX-Reasoner: Advancing Radiology Foundation Models with Reasoning through Step-by-Step Verification](https://mlsanity.com/paper/2504.20930/) (2025)
- [Enhancing Human-Computer Interaction in Chest X-ray Analysis using Vision and Language Model with Eye Gaze Patterns](https://mlsanity.com/paper/2404.02370/) (2024)
- [AOR: Anatomical Ontology-Guided Reasoning for Medical Large Multimodal Model in Chest X-Ray Interpretation](https://mlsanity.com/paper/2505.02830/) (2025)
- [Knowledge-Augmented Language Models Interpreting Structured Chest X-Ray Findings](https://mlsanity.com/paper/2505.01711/) (2025)

## Abstract (arXiv)

This study presents the first comprehensive evaluation of Multimodal Large Language Models (MLLMs) for Adolescent Idiopathic Scoliosis (AIS) self-management. We constructed a database of approximately 3,000 anteroposterior X-rays with diagnostic texts and evaluated five MLLMs through a `Divide and Conquer' framework consisting of a visual question-answering task, a domain knowledge assessment task, and a patient education counseling assessment task. Our investigation revealed limitations of MLLMs' ability in interpreting complex spinal radiographs and comprehending AIS care knowledge. To address these, we pioneered enhancing MLLMs with spinal keypoint prompting and compiled an AIS knowledge base for retrieval augmented generation (RAG), respectively. Results showed varying effectiveness of visual prompting across different architectures, while RAG substantially improved models' performances on the knowledge assessment task. Our findings indicate current MLLMs are far from capable in realizing personalized assistant in AIS care. The greatest challenge lies in their abilities to obtain accurate detections of spinal deformity locations (best accuracy: 0.55) and directions (best accuracy: 0.13).