# DoubleTake: Contrastive Reasoning for Faithful Decision-Making in Medical Imaging

arXiv: https://arxiv.org/abs/2602.02894 · HTML: https://mlsanity.com/paper/2602.02894/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 23 references that are in the map.
- First posted on arXiv 2 Feb 2026.

## Builds on (most cited first, 16 of 16)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Billion-scale similarity search with GPUs](https://mlsanity.com/paper/1702.08734/) (2017)
- [VisualBERT: A Simple and Performant Baseline for Vision and Language](https://mlsanity.com/paper/1908.03557/) (2019)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [A Gentle Introduction to Conformal Prediction and Distribution-Free Uncertainty Quantification](https://mlsanity.com/paper/2107.07511/) (2021)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [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)
- [UniMed-CLIP: Towards a Unified Image-Text Pretraining Paradigm for Diverse Medical Imaging Modalities](https://mlsanity.com/paper/2412.10372/) (2024)
- [MediConfusion: Can you trust your AI radiologist? Probing the reliability of multimodal medical foundation models](https://mlsanity.com/paper/2409.15477/) (2024)

## Abstract (arXiv)

Accurate decision making in medical imaging requires reasoning over subtle visual differences between confusable conditions, yet most existing approaches rely on nearest neighbor retrieval that returns redundant evidence and reinforces a single hypothesis. We introduce a contrastive, document-aware reference selection framework that constructs compact evidence sets optimized for discrimination rather than similarity by explicitly balancing visual relevance, embedding diversity, and source-level provenance using ROCO embeddings and metadata. While ROCO provides large-scale image-caption pairs, it does not specify how references should be selected for contrastive reasoning, and naive retrieval frequently yields near-duplicate figures from the same document. To address this gap, we release a reproducible reference selection protocol and curated reference bank that enable a systematic study of contrastive retrieval in medical image reasoning. Building on these contrastive evidence sets, we propose Counterfactual-Contrastive Inference, a confidence-aware reasoning framework that performs structured pairwise visual comparisons and aggregates evidence using margin-based decision rules with faithful abstention. On the MediConfusion benchmark, our approach achieves state-of-the-art performance, improving set-level accuracy by nearly 15% relative to prior methods while reducing confusion and improving individual accuracy.