# Med-VCD: Mitigating Hallucination for Medical Large Vision Language Models through Visual Contrastive Decoding

arXiv: https://arxiv.org/abs/2512.01922 · HTML: https://mlsanity.com/paper/2512.01922/

## Key facts

- Cited by 6 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 59 of its 76 references that are in the map.
- First posted on arXiv 1 Dec 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 59)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Sequence to Sequence Learning with Neural Networks](https://mlsanity.com/paper/1409.3215/) (2014)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [HuggingFace's Transformers: State-of-the-art Natural Language Processing](https://mlsanity.com/paper/1910.03771/) (2019)
- [PaLM-E: An Embodied Multimodal Language Model](https://mlsanity.com/paper/2303.03378/) (2023)
- [Evaluating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2305.10355/) (2023)
- [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)
- [PaLM 2 Technical Report](https://mlsanity.com/paper/2305.10403/) (2023)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [OPERA: Alleviating Hallucination in Multi-Modal Large Language Models via Over-Trust Penalty and Retrospection-Allocation](https://mlsanity.com/paper/2311.17911/) (2023)
- [Mitigating Hallucination in Large Multi-Modal Models via Robust Instruction Tuning](https://mlsanity.com/paper/2306.14565/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [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)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [Analyzing and Mitigating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2310.00754/) (2023)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [Detecting and Preventing Hallucinations in Large Vision Language Models](https://mlsanity.com/paper/2308.06394/) (2023)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Multi-Modal Hallucination Control by Visual Information Grounding](https://mlsanity.com/paper/2403.14003/) (2024)
- [Mitigating Hallucinations in Large Vision-Language Models with Instruction Contrastive Decoding](https://mlsanity.com/paper/2403.18715/) (2024)

## Built on by (most cited first, 6 of 6)

- [Decoding by Perturbation: Mitigating MLLM Hallucinations via Dynamic Textual Perturbation](https://mlsanity.com/paper/2604.12424/) (2026)
- [Dialectic-Med: Mitigating Diagnostic Hallucinations via Counterfactual Adversarial Multi-Agent Debate](https://mlsanity.com/paper/2604.11258/) (2026)
- [The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy](https://mlsanity.com/paper/2607.11175/) (2026)
- [RadSight: Towards Perceptually Reliable Multimodal Radiology Image Understanding](https://mlsanity.com/paper/2607.22293/) (2026)
- [Countering the Over-Reliance Trap: Mitigating Object Hallucination for LVLMs via a Self-Validation Framework](https://mlsanity.com/paper/2601.22451/) (2026)
- [Concept-Enhanced Multimodal RAG: Towards Interpretable and Accurate Radiology Report Generation](https://mlsanity.com/paper/2602.15650/) (2026)

## Abstract (arXiv)

Large vision-language models (LVLMs) are now central to healthcare applications such as medical visual question answering and imaging report generation. Yet, these models remain vulnerable to hallucination outputs that appear plausible but are in fact incorrect. In the natural image domain, several decoding strategies have been proposed to mitigate hallucinations by reinforcing visual evidence, but most rely on secondary decoding or rollback procedures that substantially slow inference. Moreover, existing solutions are often domain-specific and may introduce misalignment between modalities or between generated and ground-truth content. We introduce Med-VCD, a sparse visual-contrastive decoding method that mitigates hallucinations in medical LVLMs without the time overhead of secondary decoding. Med-VCD incorporates a novel token-sparsification strategy that selects visually informed tokens on the fly, trimming redundancy while retaining critical visual context and thus balancing efficiency with reliability. Evaluations on eight medical datasets, spanning ophthalmology, radiology, and pathology tasks in visual question answering, report generation, and dedicated hallucination benchmarks, show that Med-VCD raises factual accuracy by an average of 13% and improves hallucination accuracy by 6% relative to baseline medical LVLMs.