Source-Dependent Deference in Medical Imaging Agents Under Falsified Findings: A Pilot Audit
Authors: Ridam Roy, Md Shahriar Rashid, Md. Rajib Mia
Organizations: Daffodil International University Savar, Dhaka, Bangladesh · Boise State University Boise, Idaho, USA
Abstract
Tool-using agents are being proposed for medical imaging, and their behaviour when a tool returns a false finding is largely unmeasured. We audit whether a ReAct-style tool-calling agent abandons an answer it has already given correctly once a falsified finding arrives, and whether that depends on how the finding is presented. On 20 VQA-RAD closed questions across four vendor-designated model tiers, the agent commits to an answer from the image alone; a negated finding is then delivered either as JSON from an analyze_image tool the agent invokes itself, or as quoted prose attributed to a radiologist. Our outcome is the commission-error rate over cases answered correctly without any tool. Deference is much higher under the prose-attributed claim: at the strongest tier the agent revised its correct answer in 10 of 13 cases against 1 of 13 under the tool (exact McNemar p=0.0039, Holm-adjusted 0.012). We do not claim this isolates the source label. Attribution travels with the delivery channel in our design, and exposure differs because the tool claim reaches the agent only when it calls the tool. The finding is a joint source-and-delivery asymmetry from a small-scale pilot whose pre-specified stopping rule was not met.
To make clinically grounded decisions, medical AI agents are expected to go beyond simple recognition and be capable of tool retrieval, evidence acquisition, and integration. Existing benchmarks largely evaluate isolated perception or single-turn question answering, and therefore provide limited visibility into failures of planning, tool recruitment, and rollout reliability. We introduce MedCTA, a benchmark for evaluating medical tool agents on clinician-validated, step-implicit tasks grounded in realistic multimodal clinical inputs, including radiology images, pathology slides, and reports. MedCTA comprises 107 real-world clinical tasks with clinician-verified executable trajectories over 5 deployed tools, and supports process-aware evaluation of tool selection, argument validity, execution stability, trajectory fidelity, and outcome quality. We benchmark 18 open- and closed-source multimodal models and find that even frontier systems remain brittle in multi-step clinical tool use: autonomous rollouts are dominated by protocol failures, premature stopping, and incorrect tool recruitment, while gold-standard tool routing yields large but still incomplete gains. These results show that strong backbone perception does not translate into reliable agentic behavior in clinical settings. MedCTA provides a rigorous testbed for auditing, diagnosing, and advancing trustworthy medical AI agents. The dataset and evaluation suite are available at https://ivul-kaust.github.io/MedCTA/
Tajamul Ashraf, Hyewon Jeong, Fida Mohammad Thoker +1
Tool-augmented language models are evaluated on whether they reach the right answer, not on whether they report honestly when a tool fails to supply one. We isolate this post-failure decision with a benchmark of 1,024 items spanning 16 internal-system domains and eight tool-failure types, in which a tool call is enforced and the returned payload is guaranteed to be unusable. Under a deployment-style system prompt, 14.10% of responses are dishonest: the model either asserts a value the payload cannot support or declines while citing a fabricated policy or capability limit. The rate is governed almost entirely by whether the failure is signalled. When the tool returns status:error, dishonesty is absent (0.0%); when it returns status:ok with a redacted, corrupted, stale, malformed, empty or truncated value, dishonesty reaches 45.3%. The behaviour is not an artefact of our prompts: it appears under a neutral prompt (10.17%) and under the shipped prompt of every production agent framework we evaluate, reaching 24.67% under CrewAI's, and none of the nine frameworks we audit specifies what the model should do when a tool fails. Comparing prompt-level defences, we find that the operative variable is not deference to tool output but the absence of a named failure state. Appending a single sentence that requires the model to emit retrieval_status: OK or FAILED before answering reduces dishonesty from 14.10% to 0.87%, with one item of 688 worsening against 92 improving, and transfers unchanged into three foreign agent scaffolds. The emitted flag is faithful in 99.7-99.9% of declarations, giving a runtime detector that needs only a regular expression.
Clinical decision support is moving toward committees of language-model agents deliberating on a shared workspace. We ask whether such committees can be gamed by shortcuts, cues a benchmark rewards but a clinician would ignore. Across seven cohorts on six public datasets spanning text (MedQA-USMLE, MedMCQA, MIMIC-CXR reports), imaging (NIH ChestX-ray14, MIMIC-CXR-JPG, CheXpert) and tabular ICU records (SUPPORT2), Gemini committees resist these cues in isolation (flip 5-16%), yet a socially plausible shortcut spreads: when two peers assert the same wrong answer, the holdout under test adopts it in 38% of cases, as does a false "pre-screen" system flag, on both capability tiers. Of three oversight agents, a gate cannot separate adoption from honest agreement (false-positive rate 100%); a same-lineage judge reading only the transcript flags adoption on text (precision 100%, recall 93%) but collapses onto the gate in imaging; a referee that privately re-queries the holdout transfers to imaging (77-88% precision, 13-21% false-positive rate). Tripling a cue's visual salience does not move contagion, whereas a second peer voice raises it by half again. Gaming a hidden rubric is near-silent: only 1/10 text and 1/134 imaging drifters name the rubric they moved toward. What games a committee is social plausibility, and only a referee independent of self-report catches it. Code: https://github.com/criticaldata/benchmaxxing