# MedVR: Annotation-Free Medical Visual Reasoning via Agentic Reinforcement Learning

arXiv: https://arxiv.org/abs/2604.08203 · HTML: https://mlsanity.com/paper/2604.08203/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 36 of its 52 references that are in the map.
- First posted on arXiv 9 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 30 of 36)

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [DAPO: An Open-Source LLM Reinforcement Learning System at Scale](https://mlsanity.com/paper/2503.14476/) (2025)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [MathVista: Evaluating Mathematical Reasoning of Foundation Models in Visual Contexts](https://mlsanity.com/paper/2310.02255/) (2023)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [Understanding R1-Zero-Like Training: A Critical Perspective](https://mlsanity.com/paper/2503.20783/) (2025)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [DeepEyes: Incentivizing "Thinking with Images" via Reinforcement Learning](https://mlsanity.com/paper/2505.14362/) (2025)
- [Inter-GPS: Interpretable Geometry Problem Solving with Formal Language and Symbolic Reasoning](https://mlsanity.com/paper/2105.04165/) (2021)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Pixel Reasoner: Incentivizing Pixel-Space Reasoning with Curiosity-Driven Reinforcement Learning](https://mlsanity.com/paper/2505.15966/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [Learning to Reason without External Rewards](https://mlsanity.com/paper/2505.19590/) (2025)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [Agentic Reinforced Policy Optimization](https://mlsanity.com/paper/2507.19849/) (2025)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [Right Question is Already Half the Answer: Fully Unsupervised LLM Reasoning Incentivization](https://mlsanity.com/paper/2504.05812/) (2025)
- [Adaptive Chain-of-Focus Reasoning via Dynamic Visual Search and Zooming for Efficient VLMs](https://mlsanity.com/paper/2505.15436/) (2025)
- [UniVG-R1: Reasoning Guided Universal Visual Grounding with Reinforcement Learning](https://mlsanity.com/paper/2505.14231/) (2025)
- [Grounded Reinforcement Learning for Visual Reasoning](https://mlsanity.com/paper/2505.23678/) (2025)
- [VGR: Visual Grounded Reasoning](https://mlsanity.com/paper/2506.11991/) (2025)
- [Visual Hallucinations of Multi-modal Large Language Models](https://mlsanity.com/paper/2402.14683/) (2024)
- [Baichuan-M2: Scaling Medical Capability with Large Verifier System](https://mlsanity.com/paper/2509.02208/) (2025)
- [QoQ-Med: Building Multimodal Clinical Foundation Models with Domain-Aware GRPO Training](https://mlsanity.com/paper/2506.00711/) (2025)
- [First SFT, Second RL, Third UPT: Continual Improving Multi-Modal LLM Reasoning via Unsupervised Post-Training](https://mlsanity.com/paper/2505.22453/) (2025)

## Built on by (most cited first, 5 of 5)

- [Test-time Scaling over Perception: Resolving the Grounding Paradox in Thinking with Images](https://mlsanity.com/paper/2604.11025/) (2026)
- [LiteMedCoT-VL: Parameter-Efficient Adaptation for Medical Visual Question Answering](https://mlsanity.com/paper/2605.09384/) (2026)
- [GeoVista: Visually Grounded Active Perception for Vision-Language Understanding of Ultra-High-Resolution Remote Sensing Images](https://mlsanity.com/paper/2605.14475/) (2026)
- [Volumetric Radiology AI in the Era of Multimodal Large Language Models](https://mlsanity.com/paper/2608.20549/) (2026)
- [From Given to Gathered Evidence: Agentic Learning for Longitudinal Medical Reasoning](https://mlsanity.com/paper/2609.39566/) (2026)

## Abstract (arXiv)

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.