RationalRewards: Reasoning Rewards Scale Visual Generation Both Training and Test Time

Most reward models for visual generation reduce rich human judgments to a single unexplained score, discarding the reasoning that underlies preference. We show that teaching reward models to produce explicit, multi-dimensional critiques before scoring transforms them from passive evaluators into active optimization tools, improving generators in two complementary ways: at training time, structured rationales provide interpretable, fine-grained rewards for reinforcement learning; at test time, a Generate-Critique-Refine loop turns critiques into targeted prompt revisions that improve outputs without any parameter updates. To train such a reward model without costly rationale annotations, we introduce Preference-Anchored Rationalization (PARROT), a principled framework that recovers high-quality rationales from readily available preference data through anchored generation, consistency filtering, and distillation. The resulting model, RationalRewards (8B), achieves state-of-the-art preference prediction among open-source reward models, competitive with Gemini-2.5-Pro, while using 10-20x less training data than comparable baselines. As an RL reward, it consistently improves text-to-image and image-editing generators beyond scalar alternatives. Most strikingly, its test-time critique-and-refine loop matches or exceeds RL-based fine-tuning on several benchmarks, suggesting that structured reasoning can unlock latent capabilities in existing generators that suboptimal prompts fail to elicit.

A Reasoning-Enabled Vision-Language Foundation Model for Chest X-ray Interpretation

Chest X-rays (CXRs) are among the most frequently performed imaging examinations worldwide, yet rising imaging volumes increase radiologist workload and the risk of diagnostic errors. Although artificial intelligence (AI) systems have shown promise for CXR interpretation, most generate only final predictions, without making explicit how visual evidence is translated into radiographic findings and diagnostic predictions. We present CheXOne, a reasoning-enabled vision-language model for CXR interpretation. CheXOne jointly generates diagnostic predictions and explicit, clinically grounded reasoning traces that connect visual evidence, radiographic findings, and these predictions. The model is trained on 14.7 million instruction and reasoning samples curated from 30 public datasets spanning 36 CXR interpretation tasks, using a two-stage framework that combines instruction tuning with reinforcement learning to improve reasoning quality. We evaluate CheXOne in zero-shot settings across visual question answering, report generation, visual grounding and reasoning assessment, covering 17 evaluation settings. CheXOne outperforms existing medical and general-domain foundation models and achieves strong performance on independent public benchmarks. A clinical reader study demonstrates that CheXOne-drafted reports are comparable to or better than resident-written reports in 55% of cases, while effectively addressing clinical indications and enhancing both report writing and CXR interpretation efficiency. Further analyses involving radiologists reveal that the generated reasoning traces show high clinical factuality and provide causal support for the final predictions, offering a plausible explanation for the performance gains. These results suggest that explicit reasoning can improve model performance, interpretability and clinical utility in AI-assisted CXR interpretation.

The Geometry of Compromise: Unlocking Generative Capabilities via Controllable Modality Alignment

Vision-Language Models (VLMs) such as CLIP learn a shared embedding space for images and text, yet their representations remain geometrically separated, a phenomenon known as the modality gap. This gap limits tasks requiring cross-modal interchangeability, such as captioning and joint clustering. Existing post-processing approaches can partially improve cross-modal compatibility; however, we show through geometric analysis that they primarily reduce the global centroid offset while leaving the underlying distributional mismatch intact. We decompose the modality gap into a Centroid Gap and a Distribution Gap, and demonstrate that the Distribution Gap is the true predictor of cross-modal task quality ($R^2 = 0.986$), whereas the commonly used Raw Gap is misleading ($R^2 = 0.691$). Motivated by this observation, we propose TPC-CMA (Three-Phase Curriculum for Cross-Modal Alignment), a fine-tuning framework that explicitly reduces both components. The proposed CMA jointly mitigates centroid offsets and reshapes the distributional structure, while a three-phase curriculum with gradient-aware scheduling progressively introduces alignment during training to enable stable optimization. Experiments demonstrate that our method significantly improves cross-modal alignment. With $α_{\text{target}}{=}0.05$, the modality gap is reduced by 66.6\% with only 4.84\% accuracy drop. Under stronger alignment ($α_{\text{target}}{=}0.5$), the gap is reduced by 82.3\%, clustering ARI improves from 0.318 to 0.516, and captioning CIDEr increases by 57.1\% over the original model. Our code and pre-trained models will be made publicly available upon acceptance.

Activation Matters: Test-time Activated Negative Labels for OOD Detection with Vision-Language Models

Out-of-distribution (OOD) detection aims to identify samples that deviate from in-distribution (ID). One popular pipeline addresses this by introducing negative labels distant from ID classes and detecting OOD based on their distance to these labels. However, such labels may present poor activation on OOD samples, failing to capture the OOD characteristics. To address this, we propose \underline{T}est-time \underline{A}ctivated \underline{N}egative \underline{L}abels (TANL) by dynamically evaluating activation levels across the corpus dataset and mining candidate labels with high activation responses during the testing process. Specifically, TANL identifies high-confidence test images online and accumulates their assignment probabilities over the corpus to construct a label activation metric. Such a metric leverages historical test samples to adaptively align with the test distribution, enabling the selection of distribution-adaptive activated negative labels. By further exploring the activation information within the current testing batch, we introduce a more fine-grained, batch-adaptive variant. To fully utilize label activation knowledge, we propose an activation-aware score function that emphasizes negative labels with stronger activations, boosting performance and enhancing its robustness to the label number. Our TANL is training-free, test-efficient, and grounded in theoretical justification. Experiments on diverse backbones and wide task settings validate its effectiveness. Notably, on the large-scale ImageNet benchmark, TANL significantly reduces the FPR95 from 17.5\% to 9.8\%. Codes are available at \href{https://github.com/YBZh/OpenOOD-VLM}{YBZh/OpenOOD-VLM}.

Look Before Acting: Enhancing Vision Foundation Representations for Vision-Language-Action Models

Vision-Language-Action (VLA) models have recently emerged as a promising paradigm for robotic manipulation, in which reliable action prediction critically depends on accurately interpreting and integrating visual observations conditioned on language instructions. Although recent works have sought to enhance the visual capabilities of VLA models, most approaches treat the LLM backbone as a black box, providing limited insight into how visual information is grounded into action generation. Therefore, we perform a systematic analysis of multiple VLA models across different action-generation paradigms and observe that sensitivity to visual tokens progressively decreases in deeper layers during action generation. Motivated by this observation, we propose \textbf{DeepVision-VLA}, built on a \textbf{Vision-Language Mixture-of-Transformers (VL-MoT)} framework. This framework enables shared attention between the vision foundation model and the VLA backbone, injecting multi-level visual features from the vision expert into deeper layers of the VLA backbone to enhance visual representations for precise and complex manipulation. In addition, we introduce \textbf{Action-Guided Visual Pruning (AGVP)}, which leverages shallow-layer attention to prune irrelevant visual tokens while preserving task-relevant ones, reinforcing critical visual cues for manipulation with minimal computational overhead. DeepVision-VLA outperforms prior state-of-the-art methods by 9.0\% and 7.5\% on simulated and real-world tasks, respectively, providing new insights for the design of visually enhanced VLA models.

Unlocking the Latent Canvas: Eliciting and Benchmarking Symbolic Visual Expression in LLMs

Current multimodal approaches predominantly treat visual generation as an external process, relying on pixel rendering or code execution, thereby overlooking the native visual representation capabilities latent within Large Language Models (LLMs). In this work, we unlock this potential through ASCII art, a compact, efficient, and text-native visual format. We introduce SVE-ASCII, a unified framework designed to elicit and benchmark Symbolic Visual Expression directly within the pure text space. To address the scarcity of systematic resources, we construct ASCIIArt-7K, a high-quality dataset synthesized via a novel "Seed-and-Evolve" pipeline that augments human-curated anchors through in-context stylistic editing. We further implement a unified instruction-tuning strategy that jointly optimizes for both Generation (Text-to-ASCII) and Understanding (ASCII-to-Text). Crucially, our experiments reveal a critical phenomenon regarding task duality: while it is established that perception aids generation, we provide compelling evidence that generative training significantly enhances visual comprehension. This confirms a mutually reinforcing cycle in symbolic visual processing, a relationship previously hypothesized but rarely empirically demonstrated in the visual domain. We release our dataset, the ASCIIArt-Bench benchmark, and the SVE-ASCII model, establishing a robust baseline for native text-based visual intelligence.

Learning Generalizable 3D Medical Image Representations from Mask-Guided Self-Supervision

Foundation models have transformed vision and language by learning general-purpose representations from large-scale unlabeled data, yet 3D medical imaging lacks analogous approaches. Existing self-supervised methods rely on low-level reconstruction or contrastive objectives that fail to capture the anatomical semantics critical for medical image analysis, limiting transfer to downstream tasks. We present MASS (MAsk-guided Self-Supervised learning), which treats in-context segmentation as the pretext task for learning general-purpose medical imaging representations. MASS's key insight is that automatically generated class-agnostic masks provide sufficient structural supervision for learning semantically rich representations. By training on thousands of diverse mask proposals spanning anatomical structures and pathological findings, MASS learns what semantically defines medical structures: the holistic combination of appearance, shape, spatial context, and anatomical relationships. We demonstrate effectiveness across data regimes: from small-scale pretraining on individual datasets (20-200 scans) to large-scale multi-modal pretraining on 5K CT, MRI, and PET volumes, all without annotations. MASS demonstrates: (i) few-shot segmentation on novel structures, (ii) matching full supervision with only 20-40\% labeled data while outperforming self-supervised baselines by over 20 in Dice score in low-data regimes, and (iii) frozen-encoder classification on unseen pathologies that matches full supervised training with thousands of samples. Mask-guided self-supervised pretraining captures broadly generalizable knowledge, opening a path toward 3D medical imaging foundation models without expert annotations. Code is available: https://github.com/Stanford-AIMI/MASS.

A data- and compute-efficient chest X-ray foundation model beyond aggressive scaling

Foundation models for medical imaging are typically pretrained on increasingly large datasets, following a "scale-at-all-costs" paradigm. However, this strategy faces two critical challenges: large-scale medical datasets often contain substantial redundancy and severe class imbalance that bias representation learning toward over-represented patterns, and indiscriminate training regardless of heterogeneity in data quality incurs considerable computational inefficiency. Here we demonstrate that active, principled data curation during pretraining can serve as a viable, cost-effective alternative to brute-force dataset enlargement. We introduce CheXficient, a chest X-ray (CXR) foundation model that selectively prioritizes informative training samples. CheXficient is pretrained on only 22.7% of 1,235,004 paired CXR images and reports while consuming under 27.3% of the total compute budget, yet achieving comparable or superior performance to its full-data counterpart and other large-scale pretrained models. We assess CheXficient across 20 individual benchmarks spanning 5 task types, including non-adapted off-the-shelf evaluations (zero-shot findings classification and crossmodal retrieval) and adapted downstream tasks (disease prediction, semantic segmentation, and radiology report generation). Further analyses show that CheXficient systematically prioritizes under-represented training samples, improving generalizability on long-tailed or rare conditions. Overall, our work offers practical insights into the data and computation demands for efficient pretraining and downstream adaptation of medical vision-language foundation models.

Unpaired Image-to-Image Translation via a Self-Supervised Semantic Bridge

Adversarial diffusion and diffusion-inversion methods have advanced unpaired image-to-image translation, but each faces key limitations. Adversarial approaches require target-domain adversarial loss during training, which can limit generalization to unseen data, while diffusion-inversion methods often produce low-fidelity translations due to imperfect inversion into noise-latent representations. In this work, we propose the Self-Supervised Semantic Bridge (SSB), a versatile framework that integrates external semantic priors into diffusion bridge models to enable spatially faithful translation without cross-domain supervision. Our key idea is to leverage self-supervised visual encoders to learn representations that are invariant to appearance changes but capture geometric structure, forming a shared latent space that conditions the diffusion bridges. Extensive experiments show that SSB outperforms strong prior methods for challenging medical image synthesis in both in-domain and out-of-domain settings, and extends easily to high-quality text-guided editing.

In-Hospital Stroke Prediction from PPG-Derived Hemodynamic Features

The absence of pre-hospital physiological data in standard clinical datasets fundamentally constrains the early prediction of stroke, as patients typically present only after stroke has occurred, leaving the predictive value of continuous monitoring signals such as photoplethysmography (PPG) unvalidated. In this work, we overcome this limitation by focusing on a rare but clinically critical cohort - patients who suffered stroke during hospitalization while already under continuous monitoring - thereby enabling the first large-scale analysis of pre-stroke PPG waveforms aligned to verified onset times. Using MIMIC-III and MC-MED, we develop an LLM-assisted data mining pipeline to extract precise in-hospital stroke onset timestamps from unstructured clinical notes, followed by physician validation, identifying 176 patients (MIMIC) and 158 patients (MC-MED) with high-quality synchronized pre-onset PPG data, respectively. We then extract hemodynamic features from PPG and employ a ResNet-1D model to predict impending stroke across multiple early-warning horizons. The model achieves F1-scores of 0.7956, 0.8759, and 0.9406 at 4, 5, and 6 hours prior to onset on MIMIC-III, and, without re-tuning, reaches 0.9256, 0.9595, and 0.9888 on MC-MED for the same horizons. These results provide the first empirical evidence from real-world clinical data that PPG contains predictive signatures of stroke several hours before onset, demonstrating that passively acquired physiological signals can support reliable early warning, supporting a shift from post-event stroke recognition to proactive, physiology-based surveillance that may materially improve patient outcomes in routine clinical care.