RadSight: Towards Perceptually Reliable Multimodal Radiology Image Understanding

Medical multimodal large language models (MLLMs) are increasingly expected to perform complex image understanding tasks, yet their reliability is often compromised by frequent errors in visual interpretation. To systematically trace these failures, we traverse the hierarchy from high-level clinical tasks down to fundamental visual perception. We therefore introduce Perception-Bench, a large-scale benchmark comprising 1.13 million samples that assesses medical MLLMs across six dimensions: attribute judgment, spatial grounding, spatial understanding, disease prediction, anomaly detection, and report generation, spanning both 2D and 3D radiology images. Our analysis on Perception-Bench reveals that existing MLLMs lack the ability to capture even the most basic lesion attributes, such as location, size, and density. This inability to ground clinical outputs in primary visual evidence reveals that the models' diagnostic unreliability is rooted in a critical but overlooked bottleneck in low-level visual perception. Motivated by this, we propose RadSight, a perception-driven MLLM built upon a dual 2D/3D encoder architecture that preserves native imaging spatial structures. RadSight formulates medical image understanding as a four-stage progressive process: visual-language alignment, fine-grained visual perception, clinical diagnosis, and diagnostic interpretation. The model is trained on an 8.37 million perception-oriented corpus using progressive curriculum learning. On Perception-Bench, RadSight consistently outperforms existing MLLMs across all six evaluation dimensions, with particularly strong gains in spatial grounding and clinical diagnosis. It also achieves consistent improvements on public 2D and 3D medical benchmarks, further demonstrating that robust low-level visual perception is a critical foundation for reliable clinical understanding. Code and model will be publicly available.

Real-time Reconstruction of Human Visual Perception from fMRI

Real-time closed-loop neurofeedback based on functional magnetic resonance imaging (fMRI) has led to important scientific and clinical advances. However, the sophistication of the analysis methods used in real-time fMRI lags behind the state-of-the-art in fMRI decoding, largely due to computational factors: Most advanced decoding pipelines do not fit within the envelope of real-time processing, where the analysis needs to be conducted in a matter of seconds and without leveraging data acquired later in the session. Here, we present a real-time compatible adaptation of a computationally intensive state-of-the-art pipeline for reconstructing perceived natural images (MindEye2), and we demonstrate that reliable fine-grained decoding is still achievable in this setting. Using RT-Cloud, an open-source, scalable cloud-based platform, we performed a real-time scan where we decoded single-trial visual perception within seconds after an image was shown to the participant. Finally, we use simulated analyses to document the factors driving changes in performance from offline to real-time analysis. This work serves as a proof-of-concept that it is feasible to deploy these powerful fMRI decoding pipelines in real-time analysis, paving the way for their use in brain-computer interfaces for scientific discovery and clinical treatment.

Visual Semantic Decoding of Electrocorticography from Video Stimuli using End-to-End Deep Learning

ECoG-based visual semantic decoding enables inference of semantic interpretation of visual perception from complex, noisy brain activity. This study examines the feasibility of visual semantic decoding using an end-to-end deep learning framework using electrocorticography (ECoG). Specifically, the decoding task is to predict visual categories from video stimuli using time-series neural inputs. A previously collected ECoG dataset from participants ($n=17$) with drug-resistant epilepsy is used for analysis. With fewer than 50 training samples per visual category, this study evaluates multiple deep learning approaches, artificial neural network architectures, and frequency-band filtered inputs. The best-performing approach is analyzed to shed light on the discriminative information it relies on across spectral, temporal, and cortical dimensions. The selected decoding system uses mixup augmentation, a Transformer-based encoder, and high-gamma (80-150 Hz) inputs with a 900 ms post-stimulus window. Further analysis shows that early visual cortex (V2-V4), ventral stream visual cortex, MT+ complex with neighbouring visual areas, and lateral temporal cortex contributed substantially to decoding performance. This study demonstrates that an end-to-end deep learning framework can yield promising decoding performance from dynamic visual stimuli without handcrafted features, while the model behavior remains interpretable through spectral, temporal, and cortical dimensions, which are broadly consistent with established neuroscience knowledge.

MMBU: A Massive Multi-modal Biomedical Understanding Benchmark to Probe the Perception Capabilities of Vision-Language Models

Vision and language models (VLMs) hold immense promise to transform biomedical imaging workflows, from detecting lesions in chest X-rays to profiling cellular features in microscopy. Realizing this potential, however, requires robust and fine-grained visual perception. Models need to correctly interpret subtle features in images, and they must do so across diverse biomedical modalities, scales, and contexts. Nevertheless, current benchmarks remain limited. To address these gaps, we introduce the Massive Multimodal Biomedical Understanding (MMBU) benchmark. It is the largest biomedical vision and language benchmark to date, covering 35 submodalities with rich structured metadata. It includes both open and closed versions of ungrounded classification, grounded classification, and object detection, enabling systematic evaluation of model performance across biological scales, clinical settings, and imaging modalities. Evaluating 15 open-weight and 2 frontier VLMs, we find that while medical adaptation provides measurable gains for some models, the high accuracy often reported on established benchmarks can mask deficiencies in visual perception and domain generalization.