# MedXplain-VQA: Multi-Component Explainable Medical Visual Question Answering

arXiv: https://arxiv.org/abs/2510.22803 · HTML: https://mlsanity.com/paper/2510.22803/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 23 of its 38 references that are in the map.
- First posted on arXiv 26 Oct 2025.

## Builds on (most cited first, 23 of 23)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [Large Language Models are Zero-Shot Reasoners](https://mlsanity.com/paper/2205.11916/) (2022)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [VQA: Visual Question Answering](https://mlsanity.com/paper/1505.00468/) (2015)
- [CIDEr: Consensus-based Image Description Evaluation](https://mlsanity.com/paper/1411.5726/) (2014)
- [Show, Attend and Tell: Neural Image Caption Generation with Visual Attention](https://mlsanity.com/paper/1502.03044/) (2015)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [Multimodal Chain-of-Thought Reasoning in Language Models](https://mlsanity.com/paper/2302.00923/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [Medical Visual Question Answering: A Survey](https://mlsanity.com/paper/2111.10056/) (2021)
- [Overcoming Data Limitation in Medical Visual Question Answering](https://mlsanity.com/paper/1909.11867/) (2019)
- [MMBERT: Multimodal BERT Pretraining for Improved Medical VQA](https://mlsanity.com/paper/2104.01394/) (2021)
- [Measuring Faithful and Plausible Visual Grounding in VQA](https://mlsanity.com/paper/2305.15015/) (2023)

## Built on by (most cited first, 1 of 1)

- [VinDr-CXR-VQA: A Visual Question Answering Dataset for Explainable Chest X-Ray Analysis with Multi-Task Learning](https://mlsanity.com/paper/2511.00504/) (2025)

## Abstract (arXiv)

Explainability is critical for the clinical adoption of medical visual question answering (VQA) systems, as physicians require transparent reasoning to trust AI-generated diagnoses. We present MedXplain-VQA, a comprehensive framework integrating five explainable AI components to deliver interpretable medical image analysis. The framework leverages a fine-tuned BLIP-2 backbone, medical query reformulation, enhanced Grad-CAM attention, precise region extraction, and structured chain-of-thought reasoning via multi-modal language models. To evaluate the system, we introduce a medical-domain-specific framework replacing traditional NLP metrics with clinically relevant assessments, including terminology coverage, clinical structure quality, and attention region relevance. Experiments on 500 PathVQA histopathology samples demonstrate substantial improvements, with the enhanced system achieving a composite score of 0.683 compared to 0.378 for baseline methods, while maintaining high reasoning confidence (0.890). Our system identifies 3-5 diagnostically relevant regions per sample and generates structured explanations averaging 57 words with appropriate clinical terminology. Ablation studies reveal that query reformulation provides the most significant initial improvement, while chain-of-thought reasoning enables systematic diagnostic processes. These findings underscore the potential of MedXplain-VQA as a robust, explainable medical VQA system. Future work will focus on validation with medical experts and large-scale clinical datasets to ensure clinical readiness.