Wasserstein-Aligned Localisation for VLM-Based Distributional OOD Detection in Medical Imaging
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arXiv
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| Format: | Preprint |
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2026
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| _version_ | 1866911653079023616 |
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| author | Kainz, Bernhard Mueller, Johanna P Baugh, Matthew Bercea, Cosmin |
| author_facet | Kainz, Bernhard Mueller, Johanna P Baugh, Matthew Bercea, Cosmin |
| contents | Zero-shot anomaly localisation via vision-language models (VLMs) offers a compelling approach for rare pathology detection, yet its performance is fundamentally limited by the absence of healthy anatomical context. We reformulate zero-shot localisation as a comparative inference problem in which anomalies are identified through structured comparison against reference distributions of normal anatomy. We introduce WALDO, a training-free framework grounded in optimal transport theory that enables comparative reasoning through: (i) entropy-weighted Sliced Wasserstein distances for anatomically-aware reference selection from DINOv2 patch distributions, (ii) Goldilocks zone sampling exploiting the non-monotonic relationship between reference similarity and localisation accuracy, and (iii) self-consistency aggregation via weighted non-maximum suppression. We theoretically analyse the Goldilocks effect through distributional divergence, and show that references with moderate similarity minimize a bias-variance trade-off in comparative visual reasoning. On the NOVA brain MRI benchmark, WALDO with Qwen2.5-VL-72B achieves $43.5_{\pm1.6}\%$ mAP@30 (95\% CI: [40.4, 46.7]), representing a 19\% relative improvement over zero-shot baselines. Cross-model evaluation shows consistent gains: GPT-4o achieves $32.0_{\pm6.5}\%$ and Qwen3-VL-32B achieves $32.0_{\pm6.6}\%$ mAP@30. Paired McNemar tests confirm statistical significance ($p<0.01$). Source code is available at https://github.com/bkainz/WALDO_MICCAI26_demo . |
| format | Preprint |
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arxiv_https___arxiv_org_abs_2605_05161 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | Wasserstein-Aligned Localisation for VLM-Based Distributional OOD Detection in Medical Imaging Kainz, Bernhard Mueller, Johanna P Baugh, Matthew Bercea, Cosmin Computer Vision and Pattern Recognition Zero-shot anomaly localisation via vision-language models (VLMs) offers a compelling approach for rare pathology detection, yet its performance is fundamentally limited by the absence of healthy anatomical context. We reformulate zero-shot localisation as a comparative inference problem in which anomalies are identified through structured comparison against reference distributions of normal anatomy. We introduce WALDO, a training-free framework grounded in optimal transport theory that enables comparative reasoning through: (i) entropy-weighted Sliced Wasserstein distances for anatomically-aware reference selection from DINOv2 patch distributions, (ii) Goldilocks zone sampling exploiting the non-monotonic relationship between reference similarity and localisation accuracy, and (iii) self-consistency aggregation via weighted non-maximum suppression. We theoretically analyse the Goldilocks effect through distributional divergence, and show that references with moderate similarity minimize a bias-variance trade-off in comparative visual reasoning. On the NOVA brain MRI benchmark, WALDO with Qwen2.5-VL-72B achieves $43.5_{\pm1.6}\%$ mAP@30 (95\% CI: [40.4, 46.7]), representing a 19\% relative improvement over zero-shot baselines. Cross-model evaluation shows consistent gains: GPT-4o achieves $32.0_{\pm6.5}\%$ and Qwen3-VL-32B achieves $32.0_{\pm6.6}\%$ mAP@30. Paired McNemar tests confirm statistical significance ($p<0.01$). Source code is available at https://github.com/bkainz/WALDO_MICCAI26_demo . |
| title | Wasserstein-Aligned Localisation for VLM-Based Distributional OOD Detection in Medical Imaging |
| topic | Computer Vision and Pattern Recognition |
| url | https://arxiv.org/abs/2605.05161 |