Artificial intelligence has advanced in Medical Visual Question Answering (Med-VQA), but prevalent research tends to focus on the accuracy of the answers, often overlooking the reasoning paths and interpretability, which are crucial in clinical settings. Besides, current Med-VQA algorithms, typically reliant on singular models, lack the robustness needed for real-world medical diagnostics which usually require collaborative expert evaluation. To address these shortcomings, this paper presents MedCoT, a novel hierarchical expert verification reasoning chain method designed to enhance interpretability and accuracy in biomedical imaging inquiries. MedCoT is predicated on two principles: The necessity for explicit reasoning paths in Med-VQA and the requirement for multi-expert review to formulate accurate conclusions. The methodology involves an Initial Specialist proposing diagnostic rationales, followed by a Follow-up Specialist who validates these rationales, and finally, a consensus is reached through a vote among a sparse Mixture of Experts within the locally deployed Diagnostic Specialist, which then provides the definitive diagnosis. Experimental evaluations on four standard Med-VQA datasets demonstrate that MedCoT surpasses existing state-of-the-art approaches, providing significant improvements in performance and interpretability.

Vision-language models like CLIP, utilizing class proxies derived from class name text features, have shown a notable capability in zero-shot medical image diagnosis which is vital in scenarios with limited disease databases or labeled samples. However, insufficient medical text precision and the modal disparity between text and vision spaces pose challenges for such paradigm. We show analytically and experimentally that enriching medical texts with detailed descriptions can markedly enhance the diagnosis performance, with the granularity and phrasing of these enhancements having a crucial impact on CLIP’s understanding of medical images; and learning proxies within the vision domain can effectively circumvent the modal gap issue. Based on our analysis, we propose a medical visual proxy learning framework comprising two key components: a text refinement module that create high quality medical text descriptions, and a stable Sinkhorn algorithm for an efficient generation of pseudo labels which further guide the visual proxy learning. Our method elevates the Vanilla CLIP inference by supplying meticulously crafted clues to leverage CLIP’s existing interpretive power and using the feature of refined texts to bridge the vision-text gap. The effectiveness and robustness of our method are clearly demonstrated through extensive experiments. Notably, our method outperforms the state-of-the-art zero-shot medical image diagnosis by a significant margin, ranging from 1.69% to 15.31% on five datasets covering various diseases, confirming its immense potential in zero-shot diagnosis across diverse medical applications.