# Concept-Grounded Reasoning with Prompt-Driven Localization for Interpretable Structured Report Generation

arXiv: https://arxiv.org/abs/2609.15334 · HTML: https://mlsanity.com/paper/2609.15334/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 11 of its 30 references that are in the map.
- First posted on arXiv 14 Sep 2026.

## Placed in

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

## Builds on (most cited first, 11 of 11)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [OpenAI GPT-5 System Card](https://mlsanity.com/paper/2601.03267/) (2025)
- [Gemini: A Family of Highly Capable Multimodal Models](https://mlsanity.com/paper/2312.11805/) (2023)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [LISA++: An Improved Baseline for Reasoning Segmentation with Large Language Model](https://mlsanity.com/paper/2312.17240/) (2023)
- [Medical SAM3: A Foundation Model for Universal Prompt-Driven Medical Image Segmentation](https://mlsanity.com/paper/2601.10880/) (2026)
- [Interpretable Bilingual Multimodal Large Language Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2410.18387/) (2024)
- [Sim4Seg: Boosting Multimodal Multi-disease Medical Diagnosis Segmentation with Region-Aware Vision-Language Similarity Masks](https://mlsanity.com/paper/2511.06665/) (2025)

## Abstract (arXiv)

Medical imaging modalities such as ultrasound and X-ray are widely used in clinical practice, where diagnosis follows a structured, evidence-driven workflow aligned with standardized criteria. While multimodal large language models (MLLMs) show promise for automated medical report generation, most existing systems rely on end-to-end multimodal fusion without modeling clinically defined intermediate attributes, leading to limited grounding and interpretability. To address this issue, we propose CORAL (COncept-grounded ReAsoning with Localization), a multimodal framework that integrates spatial grounding and concept-level supervision into a unified reasoning process. CORAL employs a prompt-driven medical segmentation model to localize lesions and predicts multi-class clinical attributes through a Concept Bottleneck module. The resulting textual concept tokens are combined with mask-modulated visual features within an MLLM to enable structured report generation and diagnostic prediction. Experiments on BUS-CoT and IU X-ray datasets demonstrate consistent improvements in diagnostic accuracy, concept consistency, and report quality over strong general-purpose and medical MLLMs, indicating that concept-grounded reasoning better aligns generation with clinical decision processes.