# Iterative Multimodal Retrieval-Augmented Generation for Medical Question Answering

arXiv: https://arxiv.org/abs/2604.27724 · HTML: https://mlsanity.com/paper/2604.27724/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and biomedical RAG, one of 15 directions in Retrieval-augmented generation.
- Builds on 28 of its 32 references that are in the map.
- First posted on arXiv 30 Apr 2026.

## Placed in

- Retrieval-augmented generation / [Medical and biomedical RAG](https://mlsanity.com/rag/medical-and-biomedical-rag/)

## Builds on (most cited first, 28 of 28)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Survey of Hallucination in Natural Language Generation](https://mlsanity.com/paper/2202.03629/) (2022)
- [Self-RAG: Learning to Retrieve, Generate, and Critique through Self-Reflection](https://mlsanity.com/paper/2310.11511/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Interleaving Retrieval with Chain-of-Thought Reasoning for Knowledge-Intensive Multi-Step Questions](https://mlsanity.com/paper/2212.10509/) (2022)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [Active Retrieval Augmented Generation](https://mlsanity.com/paper/2305.06983/) (2023)
- [Search-o1: Agentic Search-Enhanced Large Reasoning Models](https://mlsanity.com/paper/2501.05366/) (2025)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [VisRAG: Vision-based Retrieval-augmented Generation on Multi-modality Documents](https://mlsanity.com/paper/2410.10594/) (2024)
- [M3DocRAG: Multi-modal Retrieval is What You Need for Multi-page Multi-document Understanding](https://mlsanity.com/paper/2411.04952/) (2024)
- [Unifying Multimodal Retrieval via Document Screenshot Embedding](https://mlsanity.com/paper/2406.11251/) (2024)
- [MMed-RAG: Versatile Multimodal RAG System for Medical Vision Language Models](https://mlsanity.com/paper/2410.13085/) (2024)
- [RULE: Reliable Multimodal RAG for Factuality in Medical Vision Language Models](https://mlsanity.com/paper/2407.05131/) (2024)
- [VDocRAG: Retrieval-Augmented Generation over Visually-Rich Documents](https://mlsanity.com/paper/2504.09795/) (2025)
- [Improving Retrieval-Augmented Generation in Medicine with Iterative Follow-up Questions](https://mlsanity.com/paper/2408.00727/) (2024)
- [Rationale-Guided Retrieval Augmented Generation for Medical Question Answering](https://mlsanity.com/paper/2411.00300/) (2024)
- [Improving Medical Reasoning through Retrieval and Self-Reflection with Retrieval-Augmented Large Language Models](https://mlsanity.com/paper/2401.15269/) (2024)
- [OpenMedLM: Prompt engineering can out-perform fine-tuning in medical question-answering with open-source large language models](https://mlsanity.com/paper/2402.19371/) (2024)

## Abstract (arXiv)

Medical retrieval-augmented generation (RAG) systems typically operate on text chunks extracted from biomedical literature, discarding the rich visual content (tables, figures, structured layouts) of original document pages. We propose MED-VRAG, an iterative multimodal RAG framework that retrieves and reasons over PMC document page images instead of OCR'd text. The system pairs ColQwen2.5 patch-level page embeddings with a sharded MapReduce LLM filter, scaling to ~350K pages while keeping Stage-1 retrieval under 30 ms via an offline coarse-to-fine index (C=8 centroids per page, ANN over centroids, exact two-way scoring on the top-R shortlist). A vision-language model (VLM) then iteratively refines its query and accumulates evidence in a memory bank across up to 3 reasoning rounds, with a single iteration costing ~15.9 s and the full three-round pipeline ~47.8 s on 4xA100. Across four medical QA benchmarks (MedQA, MedMCQA, PubMedQA, MMLU-Med), MEDVRAG reaches 78.6% average accuracy. Under controlled comparison with the same Qwen2.5-VL-32B backbone, retrieval contributes a +5.8 point gain over the no-retrieval baseline; we also note a +1.8 point edge over MedRAG + GPT-4 (76.8%), with the caveat that this is a cross-paper rather than head-to-head comparison. Ablations isolate +1.0 from page-image vs text-chunk retrieval, +1.5 from iteration, and +1.0 from the memory bank.