Text-guided image editors can now manipulate authentic medical scans with high fidelity, enabling lesion implantation/removal that threatens clinical trust and safety. Existing defenses are inadequate for healthcare. Medical detectors are largely black-box, while MLLM-based explainers are typically post-hoc, lack medical expertise, and may hallucinate evidence on ambiguous cases. We present MedForge, a data-and-method solution for pre-hoc, evidence-grounded medical forgery detection. We introduce MedForge-90K, a large-scale benchmark of realistic lesion edits across 19 pathologies with expert-guided reasoning supervision via doctor inspection guidelines and gold edit locations. Building on it, MedForge-Reasoner performs localize-then-analyze reasoning, predicting suspicious regions before producing a verdict, and is further aligned with Forgery-aware GSPO to strengthen grounding and reduce hallucinations. Experiments demonstrate state-of-the-art detection accuracy and trustworthy, expert-aligned explanations.

Large Language Models (LLMs) have achieved impressive performance on reasoning-intensive tasks, yet optimizing their reasoning efficiency remains an open challenge. While Test-Time Scaling (TTS) improves reasoning quality, it often leads to overthinking—wasting tokens on redundant computations. This work investigates how to efficiently and adaptively guide LLM TTS without additional training. Inspired by the concept of momentum in physics, we propose Momentum Uncertainty-guided Reasoning (MUR), which dynamically allocates thinking budgets to critical reasoning steps by tracking and aggregating step-wise uncertainty over time. To support flexible inference-time control, we introduce -control, a simple mechanism that tunes the reasoning budget via a single hyperparameter. We provide in-depth theoretical proof to support the superiority of MUR in terms of stability and biases. MUR is comprehensively evaluated against various TTS methods across four challenging benchmarks (MATH-500, AIME24, AIME25, and GPQA-diamond) using different sizes of recent Qwen3 models (1.7B, 4B, and 8B). Results demonstrate that MUR reduces computation by over 45% on average while improving accuracy by 0.33–3.46%.