# MedQ-Engine: A Closed-Loop Data Engine for Evolving MLLMs in Medical Image Quality Assessment

arXiv: https://arxiv.org/abs/2603.19863 · HTML: https://mlsanity.com/paper/2603.19863/

## 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 17 of its 30 references that are in the map.
- First posted on arXiv 20 Mar 2026.

## Placed in

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

## Builds on (most cited first, 17 of 17)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [fastMRI: An Open Dataset and Benchmarks for Accelerated MRI](https://mlsanity.com/paper/1811.08839/) (2018)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [The Unreasonable Effectiveness of Entropy Minimization in LLM Reasoning](https://mlsanity.com/paper/2505.15134/) (2025)
- [Depicting Beyond Scores: Advancing Image Quality Assessment through Multi-modal Language Models](https://mlsanity.com/paper/2312.08962/) (2023)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [Evaluation of Retinal Image Quality Assessment Networks in Different Color-spaces](https://mlsanity.com/paper/1907.05345/) (2019)
- [BiMediX2: Bio-Medical EXpert LMM for Diverse Medical Modalities](https://mlsanity.com/paper/2412.07769/) (2024)
- [IQAGPT: Image Quality Assessment with Vision-language and ChatGPT Models](https://mlsanity.com/paper/2312.15663/) (2023)
- [MedQ-Bench: Evaluating and Exploring Medical Image Quality Assessment Abilities in MLLMs](https://mlsanity.com/paper/2510.01691/) (2025)
- [MedIQA: A Scalable Foundation Model for Prompt-Driven Medical Image Quality Assessment](https://mlsanity.com/paper/2507.19004/) (2025)

## Abstract (arXiv)

Medical image quality assessment (Med-IQA) is a prerequisite for clinical AI deployment, yet multimodal large language models (MLLMs) still fall substantially short of human experts, particularly when required to provide descriptive assessments with clinical reasoning beyond simple quality scores. However, improving them is hindered by the high cost of acquiring descriptive annotations and by the inability of one-time data collection to adapt to the model's evolving weaknesses. To address these challenges, we propose MedQ-Engine, a closed-loop data engine that iteratively evaluates the model to discover failure prototypes via data-driven clustering, explores a million-scale image pool using these prototypes as retrieval anchors with progressive human-in-the-loop annotation, and evolves through quality-assured fine-tuning, forming a self-improving cycle. Models are evaluated on complementary perception and description tasks. An entropy-guided routing mechanism triages annotations to minimize labeling cost. Experiments across five medical imaging modalities show that MedQ-Engine elevates an 8B-parameter model to surpass GPT-4o by over 13% and narrow the gap with human experts to only 4.34%, using only 10K annotations with more than 4x sample efficiency over random sampling.