# Synergistic Perception-Reasoning Governance: Grounding Medical MLLMs with Verifiable Anatomical Evidence

arXiv: https://arxiv.org/abs/2607.00060 · HTML: https://mlsanity.com/paper/2607.00060/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Hallucination detection and mitigation, one of 17 directions in LLM reasoning.
- Builds on 17 of its 26 references that are in the map.
- First posted on arXiv 30 Jun 2026.

## Placed in

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

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

- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [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)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [OPERA: Alleviating Hallucination in Multi-Modal Large Language Models via Over-Trust Penalty and Retrospection-Allocation](https://mlsanity.com/paper/2311.17911/) (2023)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [DoLa: Decoding by Contrasting Layers Improves Factuality in Large Language Models](https://mlsanity.com/paper/2309.03883/) (2023)
- [Multi-Modal Hallucination Control by Visual Information Grounding](https://mlsanity.com/paper/2403.14003/) (2024)
- [Paying More Attention to Image: A Training-Free Method for Alleviating Hallucination in LVLMs](https://mlsanity.com/paper/2407.21771/) (2024)
- [XrayGPT: Chest Radiographs Summarization using Medical Vision-Language Models](https://mlsanity.com/paper/2306.07971/) (2023)
- [LLM-CXR: Instruction-Finetuned LLM for CXR Image Understanding and Generation](https://mlsanity.com/paper/2305.11490/) (2023)
- [DAMRO: Dive into the Attention Mechanism of LVLM to Reduce Object Hallucination](https://mlsanity.com/paper/2410.04514/) (2024)
- [Don't Miss the Forest for the Trees: Attentional Vision Calibration for Large Vision Language Models](https://mlsanity.com/paper/2405.17820/) (2024)
- [Attention Reallocation: Towards Zero-cost and Controllable Hallucination Mitigation of MLLMs](https://mlsanity.com/paper/2503.08342/) (2025)
- [MedHEval: Benchmarking Hallucinations and Mitigation Strategies in Medical Large Vision-Language Models](https://mlsanity.com/paper/2503.02157/) (2025)

## Abstract (arXiv)

Multimodal large language models (MLLMs) show strong promise for clinical VQA and radiology report generation, yet inference-time hallucinations still undermine trustworthy use: models can produce fluent conclusions that conflict with imaging evidence. Existing mitigation strategies typically rely on additional training, external retrieval/knowledge bases, or multi-stage post-hoc verification, which increases cost and pipeline complexity and often generalizes poorly across models and tasks.To address this, we propose a holistic, training-free evidence-injection framework that systematically mitigates hallucinations through dual-side evidence injection. By leveraging ROI priors acquired using MedSAM in our implementation, we recalibrate the visual perception trajectory via ROI-guided activation modulation while anchoring the textual reasoning trajectory by mapping anatomical coordinates into discrete semantic tokens as verifiable external memory. Then we introduce a task-aware dynamic router to select modality-specific interventions based on task semantics, balancing perceptual grounding and linguistic fluency. We conduct systematic evaluations on 2 tasks and 5 datasets using textttLLaVA-1.5-7B, textttLLaVA-Med-1.5-7B, textttQwen3-VL-8B/32B, and textttInternVL-3.5-8B/38B. Controlled ablations and visualizations further validate the framework, which consistently outperforms baselines across medical benchmarks, improving close-ended accuracy by up to ~6%uparrow and reducing open-ended hallucinations by ~35%downarrow. The code has been made available on GitHub: hrefhttps://github.com/Henry991115/SPRGtextcolorbluehttps://github.com/Henry991115/SPRG.