# MedLVR: Latent Visual Reasoning for Reliable Medical Visual Question Answering

arXiv: https://arxiv.org/abs/2604.09757 · HTML: https://mlsanity.com/paper/2604.09757/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 45 of its 55 references that are in the map.
- First posted on arXiv 10 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 30 of 45)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [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)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [LLaVA-OneVision: Easy Visual Task Transfer](https://mlsanity.com/paper/2408.03326/) (2024)
- [MMMU: A Massive Multi-discipline Multimodal Understanding and Reasoning Benchmark for Expert AGI](https://mlsanity.com/paper/2311.16502/) (2023)
- [InternVL3.5: Advancing Open-Source Multimodal Models in Versatility, Reasoning, and Efficiency](https://mlsanity.com/paper/2508.18265/) (2025)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Chameleon: Mixed-Modal Early-Fusion Foundation Models](https://mlsanity.com/paper/2405.09818/) (2024)
- [Training Large Language Models to Reason in a Continuous Latent Space](https://mlsanity.com/paper/2412.06769/) (2024)
- [Multimodal Chain-of-Thought Reasoning in Language Models](https://mlsanity.com/paper/2302.00923/) (2023)
- [Eyes Wide Shut? Exploring the Visual Shortcomings of Multimodal LLMs](https://mlsanity.com/paper/2401.06209/) (2024)
- [ViperGPT: Visual Inference via Python Execution for Reasoning](https://mlsanity.com/paper/2303.08128/) (2023)
- [BLINK: Multimodal Large Language Models Can See but Not Perceive](https://mlsanity.com/paper/2404.12390/) (2024)
- [OPERA: Alleviating Hallucination in Multi-Modal Large Language Models via Over-Trust Penalty and Retrospection-Allocation](https://mlsanity.com/paper/2311.17911/) (2023)
- [LLaVA-CoT: Let Vision Language Models Reason Step-by-Step](https://mlsanity.com/paper/2411.10440/) (2024)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Scaling up Test-Time Compute with Latent Reasoning: A Recurrent Depth Approach](https://mlsanity.com/paper/2502.05171/) (2025)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [R1-Onevision: Advancing Generalized Multimodal Reasoning through Cross-Modal Formalization](https://mlsanity.com/paper/2503.10615/) (2025)
- [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)
- [Visual Sketchpad: Sketching as a Visual Chain of Thought for Multimodal Language Models](https://mlsanity.com/paper/2406.09403/) (2024)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [CODI: Compressing Chain-of-Thought into Continuous Space via Self-Distillation](https://mlsanity.com/paper/2502.21074/) (2025)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)

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

- [VITAL: Visual-Semantic Dual Supervision for Enhanced and Interpretable Latent Reasoning in Medical MLLMs](https://mlsanity.com/paper/2605.28422/) (2026)

## Abstract (arXiv)

Medical vision--language models (VLMs) have shown strong potential for medical visual question answering (VQA), yet their reasoning remains largely text-centric: images are encoded once as static context, and subsequent inference is dominated by language. This paradigm is fundamentally limited in clinical scenarios, where accurate answers often depend on subtle, localized visual evidence that cannot be reliably preserved in static embeddings. We propose textscMedLVR, a latent visual reasoning framework that introduces an explicit visual evidence state into autoregressive decoding. Instead of relying solely on text-based intermediate reasoning, textscMedLVR interleaves a short latent reasoning segment within the decoder by reusing hidden states as continuous latent steps, enabling iterative preservation and refinement of query-relevant visual evidence before answer generation. To support effective visual supervision, we adopt a two-stage training strategy: region of interest (ROI)-supervised fine-tuning aligns latent states with clinically relevant image evidence, and Visual-Latent Policy Optimization (VLPO) further optimizes latent reasoning and answer generation under outcome-level rewards. Experiments on OmniMedVQA and five external medical VQA benchmarks show that textscMedLVR consistently outperforms recent reasoning baselines and improves the average score over the Qwen2.5-VL-7B backbone from 48.3% to 53.4%. These results show that latent visual reasoning provides an effective mechanism for preserving diagnostically relevant visual evidence and improving the reliability of medical VQA.