# VIHD: Visual Intervention-based Hallucination Detection for Medical Visual Question Answering

arXiv: https://arxiv.org/abs/2605.20772 · HTML: https://mlsanity.com/paper/2605.20772/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Hallucination mitigation in LVLMs, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 24 of its 27 references that are in the map.
- First posted on arXiv 20 May 2026.

## Placed in

- Multimodal LLMs / vision-language models / [Hallucination mitigation in LVLMs](https://mlsanity.com/mllm/hallucination-mitigation-in-lvlms/)

## Builds on (most cited first, 24 of 24)

- [The Curious Case of Neural Text Degeneration](https://mlsanity.com/paper/1904.09751/) (2019)
- [DeBERTa: Decoding-enhanced BERT with Disentangled Attention](https://mlsanity.com/paper/2006.03654/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [MM-Vet: Evaluating Large Multimodal Models for Integrated Capabilities](https://mlsanity.com/paper/2308.02490/) (2023)
- [Hierarchical Neural Story Generation](https://mlsanity.com/paper/1805.04833/) (2018)
- [Semantic Uncertainty: Linguistic Invariances for Uncertainty Estimation in Natural Language Generation](https://mlsanity.com/paper/2302.09664/) (2023)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [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)
- [Detecting and Preventing Hallucinations in Large Vision Language Models](https://mlsanity.com/paper/2308.06394/) (2023)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [LM vs LM: Detecting Factual Errors via Cross Examination](https://mlsanity.com/paper/2305.13281/) (2023)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [Hulu-Med: A Transparent Generalist Model towards Holistic Medical Vision-Language Understanding](https://mlsanity.com/paper/2510.08668/) (2025)
- [ReDeEP: Detecting Hallucination in Retrieval-Augmented Generation via Mechanistic Interpretability](https://mlsanity.com/paper/2410.11414/) (2024)
- [Self-Introspective Decoding: Alleviating Hallucinations for Large Vision-Language Models](https://mlsanity.com/paper/2408.02032/) (2024)
- [SAC3: Reliable Hallucination Detection in Black-Box Language Models via Semantic-aware Cross-check Consistency](https://mlsanity.com/paper/2311.01740/) (2023)
- [Detecting and Mitigating Hallucination in Large Vision Language Models via Fine-Grained AI Feedback](https://mlsanity.com/paper/2404.14233/) (2024)
- [VL-Uncertainty: Detecting Hallucination in Large Vision-Language Model via Uncertainty Estimation](https://mlsanity.com/paper/2411.11919/) (2024)
- [Detecting and Evaluating Medical Hallucinations in Large Vision Language Models](https://mlsanity.com/paper/2406.10185/) (2024)
- [Logical Closed Loop: Uncovering Object Hallucinations in Large Vision-Language Models](https://mlsanity.com/paper/2402.11622/) (2024)
- [Estimating LLM Uncertainty with Evidence](https://mlsanity.com/paper/2502.00290/) (2025)
- [RadFlag: A Black-Box Hallucination Detection Method for Medical Vision Language Models](https://mlsanity.com/paper/2411.00299/) (2024)
- [V-Loop: Visual Logical Loop Verification for Hallucination Detection in Medical Visual Question Answering](https://mlsanity.com/paper/2601.18240/) (2026)

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

- [The Evidence Anchoring Boundary: Where Visual Interventions Matter and When They Help in Multimodal LLMs](https://mlsanity.com/paper/2610.12981/) (2026)

## Abstract (arXiv)

While medical Multimodal Large Language Models (MLLMs) have shown promise in assisting diagnosis, they still frequently generate hallucinated responses that appear linguistically plausible but lack visual evidence. Such hallucinations pose risks to clinical decision-making and necessitate effective detection. Existing introspective detection methods primarily perform uncertainty estimation or logical verification by analyzing model responses conditioned on original or perturbed inputs. However, such external perturbations are often heuristic and context-agnostic, which overlooks the internal cross-modal dependency between generated tokens and related visual tokens during decoding. To address this issue, we propose VIHD, a Visual Intervention-based Hallucination Detection method that leverages targeted visual token masking to calibrate semantic entropy for more effective hallucination detection. VIHD locates visually dominant decoder layers via Visual Dependency Probing (VDP), executes Visual Intervention Decoding (VID) via token masking to calibrate the semantic distribution, and quantifies the resulting Calibrated Semantic Entropy (CSE) as a reliable hallucination signal. Extensive experiments on three medical VQA benchmarks with two medical MLLMs demonstrate that VIHD consistently outperforms state-of-the-art methods, underscoring the importance of fine-grained visual dependency for hallucination detection. The code will be available at https://github.com/Jiayi-Chen-AU/VIHD