Although large multimodal models (LMMs) have demonstrated remarkable capabilities in visual scene interpretation and reasoning, their capacity for complex and precise 3-dimensional spatial reasoning remains uncertain. Existing benchmarks focus predominantly on 2D spatial understanding and lack a framework to comprehensively evaluate 6D spatial reasoning across varying complexities. To address this limitation, we present Spatial457, a scalable and unbiased synthetic dataset designed with 4 key capability for spatial reasoning: multi-object recognition, 2D location, 3D location, and 3D orientation. We develop a cascading evaluation structure, constructing 7 question types across 5 difficulty levels that range from basic single object recognition to our new proposed complex 6D spatial reasoning tasks. We evaluated various large multimodal models (LMMs) on Spatial457, observing a general decline in performance as task complexity increases, particularly in 3D reasoning and 6D spatial tasks. To quantify these challenges, we introduce the Relative Performance Dropping Rate (RPDR), highlighting key weaknesses in 3D reasoning capabilities. Leveraging the unbiased attribute design of our dataset, we also uncover prediction biases across different attributes, with similar patterns observed in real-world image settings.1The code is released in https://github.com/XingruiWang/Spatial457.

Building state-of-the-art Vision-Language Models (VLMs) with strong captioning capabilities typically necessitates training on billions of high-quality image-text pairs, requiring millions of GPU hours. This paper introduces the Vision-Language-Vision **(VLV)** auto-encoder framework, which strategically leverages key pretrained components: a vision encoder, the decoder of a Text-to-Image (T2I) diffusion model, and subsequently, a Large Language Model (LLM). Specifically, we establish an information bottleneck by regularizing the language representation space, achieved through freezing the pretrained T2I diffusion decoder. Our VLV pipeline effectively distills knowledge from the text-conditioned diffusion model using continuous embeddings, demonstrating comprehensive semantic understanding via high-quality reconstructions. Furthermore, by fine-tuning a pretrained LLM to decode the intermediate language representations into detailed descriptions, we construct a state-of-the-art (SoTA) captioner comparable to leading models like GPT-4o and Gemini 2.0 Flash. Our method demonstrates exceptional cost-efficiency and significantly reduces data requirements; by primarily utilizing single-modal images for training and maximizing the utility of existing pretrained models (image encoder, T2I diffusion model, and LLM), it circumvents the need for massive paired image-text datasets, keeping the total training expenditure under $1,000 USD.

Annotating medical images, particularly for organ segmentation, is laborious and time-consuming. For example, annotating an abdominal organ requires an estimated rate of 30-60 minutes per CT volume based on the expertise of an annotator and the size, visibility, and complexity of the organ. Therefore, publicly available datasets for multi-organ segmentation are often limited in data size and organ diversity. This paper proposes an active learning procedure to expedite the annotation process for organ segmentation and creates the largest multi-organ dataset (by far) with the spleen, liver, kidneys, stomach, gallbladder, pancreas, aorta, and IVC annotated in 8,448 CT volumes, equating to 3.2 million slices. The conventional annotation methods would take an experienced annotator up to 1,600 weeks (or roughly 30.8 years) to complete this task. In contrast, our annotation procedure has accomplished this task in three weeks (based on an 8-hour workday, five days a week) while maintaining a similar or even better annotation quality. This achievement is attributed to three unique properties of our method: (1) label bias reduction using multiple pre-trained segmentation models, (2) effective error detection in the model predictions, and (3) attention guidance for annotators to make corrections on the most salient errors. Furthermore, we summarize the taxonomy of common errors made by AI algorithms and annotators. This allows for continuous improvement of AI and annotations, significantly reducing the annotation costs required to create large-scale datasets for a wider variety of medical imaging tasks. Code and dataset are available at https://github.com/MrGiovanni/AbdomenAtlas