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Bodong Du, Bowen Liu, Yang Yu, Xinpeng Ding, Zhiheng Wu, Shuning Wang, Shuo Nie, Naiming Liu, Qifeng Chen, Yangqiu Song, Xiaomeng Li
Medical multimodal large language models (MLLMs) have advanced image understanding and short-video analysis, but real clinical review often requires full-procedure video understanding. Unlike general long videos, medical procedures contain highly redundant anatomical views, while decisive evidence is temporally sparse, spatially subtle, and context dependent. Existing benchmarks often assume this evidence has already been localized through images, short clips, or pre-segmented videos, leaving the retrieval-before-reasoning problem under-tested. We introduce MedHorizon, an in-the-wild benchmark for long-context medical video understanding. MedHorizon preserves 759 hours of full-length clinical procedures and provides 1,253 evidence-grounded multiple-choice questionsthat jointly evaluate sparse evidence understanding and multi-hop clinical reasoning. Its evidence is extremely sparse, with only 0.166% evidence frames on average, requiring models to search noisy procedural streams before interpreting and aggregating findings. We evaluate representative general-domain, medical-domain, and long-video MLLMs. The best model reaches only 41.1% accuracy, showing that current systems remain far from robust full-procedure understanding. Further analysis yields four key findings: performance does not scale reliably with more frames, evidence retrieval and clinical interpretation remain primary bottlenecks; these bottlenecks are rooted in weak procedural reasoning and attention drift under redundancy, and generic sampling methods only partially balances local detail with global coverage. MedHorizon provides a rigorous testbed for MLLMs that retrieve sparse evidence and reason over complete clinical workflows.
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@article{du2026medhorizon,
title = {MedHorizon: Towards Long-context Medical Video Understanding in the Wild},
author = {Bodong Du and Bowen Liu and Yang Yu and Xinpeng Ding and Zhiheng Wu and Shuning Wang and Shuo Nie and Naiming Liu and Qifeng Chen and Yangqiu Song and Xiaomeng Li},
year = {2026},
abstract = {Medical multimodal large language models (MLLMs) have advanced image understanding and short-video analysis, but real clinical review often requires full-procedure video understanding. Unlike general long videos, medical procedures contain highly redundant anatomical views, while decisive evidence is temporally sparse, spatially subtle, and context dependent. Existing benchmarks often assume this evidence has already been localized through images, short clips, or pre-segmented videos, leaving th},
url = {https://arxiv.org/abs/2605.06537},
keywords = {cs.CV},
eprint = {2605.06537},
archiveprefix = {arXiv},
}
{}