{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:16:18Z","timestamp":1783656978918,"version":"3.55.0"},"reference-count":61,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","award":["22120210543"],"award-info":[{"award-number":["22120210543"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["62071334"],"award-info":[{"award-number":["62071334"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["62301308"],"award-info":[{"award-number":["62301308"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["62371342"],"award-info":[{"award-number":["62371342"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["62305019"],"award-info":[{"award-number":["62305019"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012152","name":"National Postdoctoral Program for Innovative Talents","doi-asserted-by":"publisher","award":["BX20230223"],"award-info":[{"award-number":["BX20230223"]}],"id":[{"id":"10.13039\/501100012152","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","award":["2023M732262"],"award-info":[{"award-number":["2023M732262"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003399","name":"Science and Technology Commission of Shanghai Municipality","doi-asserted-by":"publisher","award":["19511132101"],"award-info":[{"award-number":["19511132101"]}],"id":[{"id":"10.13039\/501100003399","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003399","name":"Science and Technology Commission of Shanghai Municipality","doi-asserted-by":"publisher","award":["2021SHZDZX0100"],"award-info":[{"award-number":["2021SHZDZX0100"]}],"id":[{"id":"10.13039\/501100003399","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004750","name":"Aeronautical Science Foundation of China","doi-asserted-by":"publisher","award":["20230007038001"],"award-info":[{"award-number":["20230007038001"]}],"id":[{"id":"10.13039\/501100004750","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFA1004700"],"award-info":[{"award-number":["2022YFA1004700"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Knowledge-Based Systems"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.knosys.2026.116475","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:02:02Z","timestamp":1782802922000},"page":"116475","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Beyond textual rationales: Anatomy-grounded chain-of-thought for traceable radiology reasoning"],"prefix":"10.1016","volume":"350","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7215-3685","authenticated-orcid":false,"given":"Shengzhi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-0869","authenticated-orcid":false,"given":"Jun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingliang","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingqing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingwen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.knosys.2026.116475_b1","article-title":"Introducing openai o1-preview","author":"OpenAI","year":"2024","journal-title":"OpenAI Off. Website"},{"key":"10.1016\/j.knosys.2026.116475_b2","article-title":"Introducing-o3-and-o4-mini","author":"OpenAI","year":"2024","journal-title":"OpenAI Off. Website"},{"key":"10.1016\/j.knosys.2026.116475_b3","series-title":"Deepseek-r1: Incentivizing reasoning capability in llms via reinforcement learning","author":"Guo","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b4","series-title":"Deepseekmath: Pushing the limits of mathematical reasoning in open language models","author":"Shao","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b5","doi-asserted-by":"crossref","first-page":"24824","DOI":"10.52202\/068431-1800","article-title":"Chain-of-thought prompting elicits reasoning in large language models","volume":"35","author":"Wei","year":"2022","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b6","doi-asserted-by":"crossref","first-page":"27730","DOI":"10.52202\/068431-2011","article-title":"Training language models to follow instructions with human feedback","volume":"35","author":"Ouyang","year":"2022","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b7","series-title":"DeepEyes: Incentivizing\u201d thinking with images\u201d via reinforcement learning","author":"Zheng","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b8","series-title":"GRIT: Teaching MLLMs to think with images","author":"Fan","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b9","series-title":"Visual cot: Unleashing chain-of-thought reasoning in multi-modal language models","author":"Shao","year":"2024"},{"issue":"10","key":"10.1016\/j.knosys.2026.116475_b10","doi-asserted-by":"crossref","first-page":"900","DOI":"10.3348\/kjr.2025.0599","article-title":"Multimodal large language models in medical imaging: Current state and future directions","volume":"26","author":"Nam","year":"2025","journal-title":"Korean J. Radiol."},{"key":"10.1016\/j.knosys.2026.116475_b11","series-title":"A comprehensive survey on the trustworthiness of large language models in healthcare","author":"Aljohani","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b12","doi-asserted-by":"crossref","unstructured":"Y. Hu, T. Li, Q. Lu, W. Shao, J. He, Y. Qiao, P. Luo, Omnimedvqa: A new large-scale comprehensive evaluation benchmark for medical lvlm, in: Proceedings of the IEEE\/CVF Conference on Computer Vision and Pattern Recognition, 2024, pp. 22170\u201322183.","DOI":"10.1109\/CVPR52733.2024.02093"},{"key":"10.1016\/j.knosys.2026.116475_b13","first-page":"94327","article-title":"Gmai-mmbench: A comprehensive multimodal evaluation benchmark towards general medical ai","volume":"37","author":"Ye","year":"2024","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b14","doi-asserted-by":"crossref","unstructured":"B. Liu, K. Zou, L.-M. Zhan, Z. Lu, X. Dong, Y. Chen, C. Xie, J. Cao, X.-M. Wu, H. Fu, Gemex: A large-scale, groundable, and explainable medical vqa benchmark for chest x-ray diagnosis, in: Proceedings of the IEEE\/CVF International Conference on Computer Vision, 2025, pp. 21310\u201321320.","DOI":"10.1109\/ICCV51701.2025.01979"},{"key":"10.1016\/j.knosys.2026.116475_b15","series-title":"International Conference on Medical Image Computing and Computer-Assisted Intervention","first-page":"337","article-title":"Medvlm-r1: Incentivizing medical reasoning capability of vision-language models (vlms) via reinforcement learning","author":"Pan","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b16","series-title":"Noiseboost: Alleviating hallucination with noise perturbation for multimodal large language models","author":"Wu","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b17","series-title":"Ground-R1: Incentivizing grounded visual reasoning via reinforcement learning","author":"Cao","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.2147\/AMEP.S280941","article-title":"Teaching medical students how to interpret chest X-Rays: The design and development of an e-learning resource","volume":"12","author":"Sait","year":"2021","journal-title":"Adv. Med. Educ. Pr."},{"key":"10.1016\/j.knosys.2026.116475_b19","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-024-05879-0","article-title":"Radiology education for medical students: A qualitative exploration of educational topics, teaching methods and future strategies","volume":"24","author":"Harthoorn","year":"2024","journal-title":"BMC Med. Educ."},{"issue":"8","key":"10.1016\/j.knosys.2026.116475_b20","doi-asserted-by":"crossref","first-page":"818","DOI":"10.3390\/bioengineering12080818","article-title":"Large language models in medical image analysis: A systematic survey and future directions","volume":"12","author":"Urooj","year":"2025","journal-title":"Bioengineering"},{"key":"10.1016\/j.knosys.2026.116475_b21","series-title":"Multimodal chain-of-thought reasoning: A comprehensive survey","author":"Wang","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b22","series-title":"Medcot: Medical chain of thought via hierarchical expert","author":"Liu","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b23","series-title":"Mc-cot: A modular collaborative cot framework for zero-shot medical-vqa with llm and mllm integration","author":"Wei","year":"2024"},{"issue":"1","key":"10.1016\/j.knosys.2026.116475_b24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1055\/s-0045-1806783","article-title":"Competency-based medical education in radiology in Indian medical schools: A narrative review","volume":"04","author":"Rai","year":"2025","journal-title":"Indographics"},{"key":"10.1016\/j.knosys.2026.116475_b25","doi-asserted-by":"crossref","DOI":"10.1016\/j.knosys.2025.114433","article-title":"Structural chain of thoughts for radiology education","author":"Awasthi","year":"2025","journal-title":"Knowl.-Based Syst."},{"key":"10.1016\/j.knosys.2026.116475_b26","series-title":"Gemini pro","author":"Google DeepMind","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b27","doi-asserted-by":"crossref","first-page":"28541","DOI":"10.52202\/075280-1240","article-title":"Llava-med: Training a large language-and-vision assistant for biomedicine in one day","volume":"36","author":"Li","year":"2023","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b28","article-title":"Med-flamingo: a multimodal medical few-shot learner","author":"Wu","year":"2023","journal-title":"Mach. Learn. Health (ML4H)"},{"key":"10.1016\/j.knosys.2026.116475_b29","series-title":"Xraygpt: Chest radiographs summarization using medical vision-language models","author":"Thawkar","year":"2023"},{"key":"10.1016\/j.knosys.2026.116475_b30","series-title":"A foundation model for generalist medical artificial intelligence","author":"Chen","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b31","series-title":"CheXagent: Towards a foundation model for chest X-Ray interpretation","author":"Chen","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b32","series-title":"Medical hallucinations in foundation models and their impact on healthcare","author":"Kim","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b33","series-title":"Localizing before answering: A hallucination evaluation benchmark for grounded medical multimodal LLMs","author":"Nguyen","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b34","series-title":"Gmai-vl-r1: Harnessing reinforcement learning for multimodal medical reasoning","author":"Su","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b35","series-title":"Vocot: Unleashing visually grounded multi-step reasoning in large multi-modal models","author":"Li","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b36","series-title":"Latent visual reasoning","author":"Li","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b37","series-title":"Med-r1: Reinforcement learning for generalizable medical reasoning in vision-language models","author":"Lai","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b38","series-title":"Vision-r1: Incentivizing reasoning capability in multimodal large language models","author":"Huang","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b39","series-title":"R1-onevision: Advancing generalized multimodal reasoning through cross-modal formalization","author":"Yang","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b40","series-title":"Vlm-r1: A stable and generalizable r1-style large vision-language model","author":"Shen","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b41","series-title":"R1-v: Reinforcing super generalization ability in vision-language models with less than $3","author":"Chen","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b42","series-title":"Chain-of-spot: Interactive reasoning improves large vision-language models","author":"Liu","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b43","series-title":"MINT-cot: Enabling interleaved visual tokens in mathematical chain-of-thought reasoning","author":"Chen","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b44","series-title":"Chain of images for intuitively reasoning","author":"Meng","year":"2023"},{"key":"10.1016\/j.knosys.2026.116475_b45","doi-asserted-by":"crossref","first-page":"139348","DOI":"10.52202\/079017-4423","article-title":"Visual sketchpad: Sketching as a visual chain of thought for multimodal language models","volume":"37","author":"Hu","year":"2024","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b46","series-title":"Grounding chest X-Ray visual question answering with generated radiology reports","author":"Serra","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b47","doi-asserted-by":"crossref","unstructured":"B. Liu, X. Zhao, A. He, Y. Chen, H. Fu, X.-M. Wu, GEMeX-RMCoT: An Enhanced Med-VQA Dataset for Region-Aware Multimodal Chain-of-Thought Reasoning, in: Proceedings of the 33rd ACM International Conference on Multimedia, 2025, pp. 13213\u201313220.","DOI":"10.1145\/3746027.3758277"},{"key":"10.1016\/j.knosys.2026.116475_b48","series-title":"Chest imagenome dataset for clinical reasoning","author":"Wu","year":"2021"},{"key":"10.1016\/j.knosys.2026.116475_b49","doi-asserted-by":"crossref","first-page":"3867","DOI":"10.52202\/075280-0170","article-title":"Ehrxqa: A multi-modal question answering dataset for electronic health records with chest x-ray images","volume":"36","author":"Bae","year":"2023","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"10.1016\/j.knosys.2026.116475_b50","series-title":"LLM-as-a-judge in healthcare: A scoping analysis of applications, methods, and human alignment","author":"Li","year":"2026"},{"key":"10.1016\/j.knosys.2026.116475_b51","series-title":"Lingshu: A generalist foundation model for unified multimodal medical understanding and reasoning","author":"Xu","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b52","series-title":"Introducing GPT-5","author":"OpenAI","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b53","series-title":"GPT-4","author":"OpenAI","year":"2023"},{"key":"10.1016\/j.knosys.2026.116475_b54","series-title":"Hello GPT-4o","author":"OpenAI","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b55","series-title":"Improved baselines with visual instruction tuning","author":"Liu","year":"2023"},{"key":"10.1016\/j.knosys.2026.116475_b56","series-title":"Expanding performance boundaries of open-source multimodal models with model, data, and test-time scaling","author":"Chen","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b57","series-title":"Internvl3: Exploring advanced training and test-time recipes for open-source multimodal models","author":"Zhu","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b58","series-title":"Huatuogpt-vision, towards injecting medical visual knowledge into multimodal LLMs at scale","author":"Chen","year":"2024"},{"key":"10.1016\/j.knosys.2026.116475_b59","series-title":"Qwen2. 5-vl technical report","author":"Bai","year":"2025"},{"key":"10.1016\/j.knosys.2026.116475_b60","series-title":"2021 IEEE 18th International Symposium on Biomedical Imaging","first-page":"1650","article-title":"Slake: A semantically-labeled knowledge-enhanced dataset for medical visual question answering","author":"Liu","year":"2021"},{"key":"10.1016\/j.knosys.2026.116475_b61","series-title":"Pmc-vqa: Visual instruction tuning for medical visual question answering","author":"Zhang","year":"2023"}],"container-title":["Knowledge-Based Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0950705126012013?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0950705126012013?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:44:35Z","timestamp":1783655075000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0950705126012013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":61,"alternative-id":["S0950705126012013"],"URL":"https:\/\/doi.org\/10.1016\/j.knosys.2026.116475","relation":{},"ISSN":["0950-7051"],"issn-type":[{"value":"0950-7051","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Beyond textual rationales: Anatomy-grounded chain-of-thought for traceable radiology reasoning","name":"articletitle","label":"Article Title"},{"value":"Knowledge-Based Systems","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.knosys.2026.116475","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"116475"}}