Diagnostic Benchmark

Legends are fundamental to chart understanding, as reliable interpretation requires correctly binding legend entries to corresponding visual marks. While vision-language models (VLMs) are increasingly applied to chart understanding, their legend understanding is poorly diagnosed by aggregate accuracy, which can be satisfied by superficial shortcuts and confound legend-specific errors with other reasoning failures. To enable fine-grained diagnosis and controlled testing, we introduce LegendBench, a parametric benchmark and generation pipeline that produces targeted legend-centric test cases. LegendBench contributes (1) a capability-task taxonomy spanning legend parsing, legend grounding, legend-conditioned reasoning, and legend-aware abstention to localize failures, and (2) counterfactual group generation, where each base chart yields multiple variants under controlled legend interventions to probe model invariance and sensitivity. Using LegendBench, we evaluate both general-purpose VLMs and specialized chart models and generate their capability profiles, revealing persistent bottlenecks in reliable legend-to-mark binding and counterfactual consistency. We then use these capability profiles to guide targeted fine-tuning, demonstrating that bottleneck-specific interventions can effectively close the localized capability gaps and generalize to unseen data. We further leverage our counterfactual design to conduct fine-grained diagnostic experiments, analyzing encoding-channel effects, legend-order shortcuts, and abstention under varying visibility.

More than 300 million people worldwide are affected by one of over 7,000 known rare diseases, yet diagnosis remains difficult because patients initially present with incomplete and heterogeneous phenotypes. We present HPOQuest, a training-free framework for sequential phenotype acquisition in rare-disease diagnosis. Starting from a small set of observed patient phenotypes, HPOQuest maintains a probabilistic disease ranking and iteratively selects informative follow-up questions to support clinicians during patient assessment. Confirmed phenotypes update the disease ranking, while all responses update the candidate question set. Across four benchmark cohorts, HPOQuest substantially improves diagnosis from sparse initial phenotypes, with gains of up to 30% points at Recall@1 and 45% points at Recall@5. These results demonstrate that sequential phenotype acquisition can substantially improve rare-disease diagnosis from limited initial clinical evidence.

Full-duplex spoken dialogue systems must distinguish interruptions that require yielding the floor from backchannels that permit continued speaking. Existing benchmarks typically evaluate events independently and may therefore reward fixed action preferences rather than context-sensitive decisions. We introduce ECHO, a paired diagnostic benchmark for Chinese full-duplex turn-taking. ECHO pairs examples with the same overlap transcript but contrasting preceding multi-turn dialogue contexts, with one requiring Yield and the other Keep. It additionally includes off-talk examples for diagnosing unnecessary yielding. We introduce pair accuracy, which requires correct decisions on both members of a pair and assigns no credit to constant-action policies. Experiments on multiple full-duplex systems show that most exhibit a pronounced bias toward \textsc{Yield}, performing substantially better on interruptions than on backchannels, while another system remains comparatively balanced. These findings demonstrate that interruption-only evaluation can overestimate practical turn-taking reliability. ECHO and its metadata will be publicly released.

Medical benchmarks are dominated by single-turn, multiple-choice clinical cases that poorly reflect real consultations. Practically, clinicians elicit evidence interactively and patient communication varies widely. We introduce MedRoundsQA, a multi-turn diagnostic benchmark derived from 1,387 board-exam cases across 17 specialties. Each case is converted into a structured 24-slot clinical record, and then instantiated as controlled doctor-patient dual-agent dialogues under varying patient personas, with the underlying clinical content held fixed. We further classify cases by difficulty using model-based uncertainty to enable easy-to-hard analysis. Evaluations of fifteen LLM doctor agents show that (i) moving from a single-turn diagnosis on the standardized records to multi-turn consultations causes large degradations of roughly 13-39 points; (ii) more turns reliably improves question relevance, but diagnostic accuracy exhibits diminishing returns and typically plateaus after 6-12 turns; and (iii) patient persona differences can shift diagnosis accuracy by about 7-8 points (lowest to highest education), highlighting equity risks that single-turn benchmarks miss.

A medical claim's correctness often depends not on the claim alone, but on the clinical structure around it. A claim may require a lab reference range, a causal or conditional link, or patient-specific details to be judged correctly, and atom-level decomposition can fragment these dependencies, leaving the verifier with clinically incomplete claims. We reformulate medical fact-checking around snippet-level verification, where clause-grouped units preserve local clinical structure. We introduce MedSNIP-Bench, a human-annotated benchmark for snippet-level medical fact verification, and MedSNIP, an automatic snippet-generation pipeline. MedSNIP-Bench covers 276 consumer-health and clinical-vignette responses, segmented into 2,524 snippets with dual in-general and in-patient-context labels and six structural pattern codes. MedSNIP is evaluated against human snippet boundaries on MedSNIP-Bench and then used to generate snippet-level units for external corpora. Across MedSNIP-Bench, HealthFC, and MedHallu, snippet-level verification preserves or improves false-class F1, with gains concentrated where answers are long enough to fragment and where the verifier is strong enough to exploit the recovered structure. The largest merge-pattern gain is on causal-conditional clinical chains. It also reduces verifier calls by 24-73%, though the saving survives end-to-end only when decomposition is cheap, which an open-weight decomposer makes possible at no loss of chunking fidelity.

Clinical AI evaluation should encompass diagnosis and management after adaptive information gathering. We compared Doctorina, eight physicians and four standalone frontier language models in 150 synthetic Polish-language primary-care consultations. Doctorina achieved 82.0% Top-1 concordance versus 57.0% for physicians (difference, 25.0 percentage points; 95% confidence interval, 17.7-32.7) and 97.3% versus 85.0% primary-or-reference-differential concordance. Across 149 case pairs, normalized workup and treatment scores were 89.4 versus 66.9 and 83.7 versus 61.2. Doctorina had the highest diagnostic point estimates among all six groups; Kimi K3 ranked next, while Claude Opus 5 led the closely spaced management estimates of Opus, Doctorina and Kimi. A second Doctorina execution reproduced the advantages over physicians across all outcomes. Doctorina's advantage over physicians therefore extended from primary-diagnosis selection to higher-rated diagnostic workup and initial treatment after adaptive consultation.

Tracking depression from multi-session counseling dialogues requires estimating both current symptom severity and how it changes across sessions. Yet progress on this task is constrained by the scarcity of longitudinal counseling data with standardized session-level depression labels. Existing resources typically provide either multi-session conversations without depression labels or labeled interviews in a single session. Building such a benchmark poses three challenges: maintaining longitudinal consistency and diversity, grounding symptom progression in empirical patterns, and expressing controlled depression states naturally without exposing target labels. To address these challenges, we introduce LongCounsel-8, a benchmark suite of three independently generated datasets totaling 7,749 five-session counseling trajectories, grounded in real-world client profiles, depression trajectories, symptom compositions, and counseling patterns. We combine profile-grounded simulation, empirically informed state construction, and indirect behavioral realization to address these challenges. Across the benchmark, simulated self-reports closely recover the controlled states, supporting label fidelity. Experiments on existing depression tracking methods reveal three key findings: (1) lower single-session score error does not guarantee accurate identification of trend, i.e., improvement or worsening; (2) existing methods are consistently less reliable on worsening trajectories; and (3) additional session history may reduce the accuracy of trend prediction. Together, these findings establish LongCounsel-8 as a foundation for advancing depression assessment from static, single-session prediction toward reliable longitudinal tracking of mental-health change.

Although document OCR systems perform increasingly well on routine documents, complex formulas, structured text, and long-tail formats remain error-prone. OCR predictions may omit fine-grained content or hallucinate unsupported outputs, while equivalent encodings of the same visible content must be accommodated. Existing OCR evaluation methods mostly report aggregate metrics, offering limited support for analyzing case-level errors and improving OCR performance. We propose OCR-EDR (OCR Error Diagnosis and Repair), a rendering-aware framework that advances from fine-grained diagnosis to iterative repair. Given a source image, an editable OCR prediction, and its rendered image, OCR-EDR first jointly assesses whether the prediction and its rendering are consistent with the source, preserving valid predictions, including rendering-equivalent ones, while diagnosing and localizing genuine errors. It then applies executable edits and may request an updated rendering for iterative reassessment. We construct OCRErrBench from diverse real OCR predictions, covering text and formulas, exact and rendering-equivalent positives, and genuine errors, and develop the DocEDR model to execute the diagnosis--repair loop. On OCRErrBench, DocEDR achieves 94.78% diagnostic accuracy. It repairs 86.23% of erroneous inputs to visual consistency, raises formula Case-F1 by 30.99 percentage points over DOCR-Inspector-7B on DOCRcaseBench, and improves formula CDM by up to 4.62 percentage points on the identified Bad subsets of four OCR systems on UniMER-Test. These results show that OCR-EDR turns fine-grained OCR analysis into verified corrections and performance gains.

Sentence-level recognition of depression symptoms is challenging because similar expressions can differ in symptom relevance, and language-model inference is insufficiently grounded in diagnostic definitions. This study proposes a two-stage framework separating symptom-candidate generation from definition-grounded verification. A contrastively fine-tuned sentence encoder generates a symptom candidate per sentence, and a fine-tuned language model verifies whether the candidate is present or absent using the sentence, its context, and a candidate-specific diagnostic definition, checking its judgment against that definition before answering. Evaluated against encoder, inference-based, medical, and general LLM baselines and a matched single-stage supervised classifier, the proposed pipeline attains the best accuracy and F1 scores of all methods, with rationales matching expert-authored annotations. A preliminary clinical audit indicates moderate alignment with diagnostic definitions, with explanation quality strongly dependent on prediction correctness. The results support decomposing symptom recognition into candidate generation and definition-grounded verification, though performance remains limited for rare categories.

As AI systems are increasingly used to draft radiology reports, reliably evaluating their clinical quality remains a critical challenge. Large language model (LLM)-based metrics are now the best-correlated with radiologist judgment, yet they output a single opaque score that neither a clinician nor a model builder can easily interpret or audit. We introduce RadMatch, a multi-stage, LLM-based metric that decomposes report comparison into a structured finding-level matching with significance-aware scoring and error characterization across seven clinical attribute dimensions (status, location, severity, morphology, certainty, longitudinal comparison, and measurement). The main score is the actionable-error count, both interpretable and auditable. Candidate findings are graded correct, partial, or incorrect, and unmatched findings are counted as missed or hallucinated. Triage and actionable safety recall/precision and per-subset views add complementary, deployment-oriented lenses. Across two expert benchmarks, RadMatch is the most clinically aligned metric, matching inter-radiologist agreement on ReXVal and more than doubling the best prior metric on the harder RadEvalExpert. Relying only on few-shot prompting, it is designed to extend to other modalities and anatomies. We will release RadMatch as open-source code with an interactive dashboard for inspecting results.

Multimodal coding and editing systems must map a visible or semantic referent to the exact executable object that can be edited. A wrong reference may select a valid but incorrect DOM node, SVG element, graph endpoint, hierarchy member, or table cell, while final execution success alone does not reveal the source of the failure. ExBind isolates this visual-to-executable correspondence layer as a controlled diagnostic benchmark between semantic localization and action execution. It samples representation-independent latent binding instances and compiles them into SVG, DOM, canvas, tree, graph, and table cases with deterministic mappings to executable references. Models output only a strict reference; the evaluator maps predictions back to latent structure and scores structural constraints without requiring reasoning traces. The release contains a 250-case broad suite, a disjoint 240-case targeted suite, and 50 paired latent groups. Qwen2.5-VL-3B achieves 98.4% candidate validity but 76.4% exact accuracy, while Qwen3-VL-4B achieves 100.0% validity and 98.8% exact accuracy. In the targeted table suite, all Qwen2.5-VL-3B residual errors are valid correct-row/wrong-column selections. Candidate-order perturbations change case-level outcomes while preserving this error pattern. ExBind is designed for controlled diagnosis rather than population-scale ranking or end-to-end editing evaluation. Code and benchmark records are available at https://github.com/Daerwang2020/Exbind and https://huggingface.co/datasets/Ziqianwwww/ExBind.

The rapid advancement of vision-language models (VLMs) has accelerated progress in computational pathology; however, whole-slide image (WSI)-based pathology report generation remains limited by the scarcity of large-scale WSI--report datasets and the complexity of mapping spatially distributed visual patterns to structured clinical text. To address this, we introduce a clinically curated Pan-Asia WSI--report dataset of approximately 10,500 pairs from five institutions and establish the REG 2025 benchmark through a MICCAI challenge for systematic evaluation of multimodal models. We analyze submitted methods spanning pretrained VLMs, multiple-instance learning frameworks, hierarchical expert models, retrieval-augmented generation, and cross-modal Transformers. Rather than indicating that VLM use alone was sufficient for superior performance, the results suggest that top-performing methods benefited from structured report representations, hierarchical diagnostic decomposition, and effective multimodal grounding. We identify key limitations, including instability in quantitative attribute estimation (e.g., numeric hallucination) and a tendency toward diagnostic overspecification, with some errors resembling known diagnostic pitfalls in routine pathology. These findings establish REG 2025 as a benchmark for evaluating WSI-based structured report generation and vision-language understanding in computational pathology, providing insights for the design of clinically grounded multimodal pathology models.

Ambient AI scribes draft clinical notes, and published audits find their dominant error is omission: information the encounter established that the note fails to record. The standard check is an LLM judge: a second model reads the note against the transcript and flags problems. We ask whether judges detect omissions. Public corpora cannot supply the answer key: their clinician reference notes and transcripts are materially discrepant. Our benchmark has 500 single-error note pairs from audited fact sheets, 298 with a named fact certainly absent and 202 added-or-altered controls. Across eight judge designs, paired discrimination (the flawed note below its clean twin, 0.5 a coin flip) reads 0.79-0.94 on added or altered content and 0.50-0.63 on omissions. On single notes, no design flags omissions reliably more often than perfect notes. Wording changes, voting and GEPA prompt optimisation move the operating point without creating usable detection. Restructuring the task recovers it: list the facts the transcript establishes, then check the note for each. Two methods reach it independently and trade off: a per-fact pipeline, and a GEPA-evolved prompt doing the same in one call. The pipeline's flags name the missing fact and its severity at 2.7% false alarms. The single call detects more (36.9% against 24.6%, p=0.002) at 6.2% false alarms and a tenth of the cost per note. A physician author validated 70 items and, where the two routes disagree, sided with the pipeline on 10 of 10 (p=0.002). A second clinician, not an author, graded the severity rubric blind and agrees to within a grade. On real vendor notes from a companion census no benchmark threshold transfers, but the re-calibrated single call detects more than the best of the eight at half its false-alarm rate. Omissions whose fact is restated elsewhere defeat both routes. We release the benchmark, prompts and judgements.

Background and Objective: Quality control is a prerequisite for whole-slide image analysis, yet the benchmarks on which quality-control methods are compared share four properties that make their reported differences hard to interpret: few independent slides, annotation concentrated in a minority of them, pooled ratio metrics with no closed-form standard error, and a single inherited train/test partition. We propose a reliability protocol for such benchmarks. Methods: The protocol quantifies four sources of variability - test-set sampling, training stochasticity, partition composition, and undocumented preprocessing - a claim is reportable only if it survives all four; three of the four cost minutes of compute. We apply it to an independent reconstruction of a published diffusion-based artifact detector, evaluated on the original 24-slide partition and against a supervised baseline. Results: The method's central mechanism reproduces: the auxiliary contrastive term improves pooled F1 from 0.673 to 0.688 and replicates under a second seed (+0.0156, p = 0.031; +0.0190, p = 0.005), although it acts on pen marking rather than the artifact types cited to motivate it. Its comparative claims do not: differences between design variants, and against the supervised baseline, fall inside the uncertainty of the evaluation. Four of 24 slides carry 70% of scored annotated pixels, giving an effective sample size of 6.2, and the inherited partition sits at the 7th percentile. An unreported tissue-restriction step excludes 41.4% of out-of-focus annotation against 2.6% of air bubble; such a gate is confounded with blur by construction. Conclusions: Small-cohort benchmarks support far weaker conclusions than current reporting implies. The four checks are cheap enough to accompany any evaluation on such a resource and separate reproducible effects from differences the evaluation cannot resolve.

Recent efforts have aimed to automate scientific diagram generation from paper content (Lin et al., 2026; Zhu et al., 2026a). However, fully satisfying an author's visual and communicative preferences in a single turn is challenging: in our formative user study (N = 14), all participants requested further revisions after viewing an initial draft, and 86% of them rated the refined diagrams as more satisfactory. Despite the clear demand, the multi-turn workflow remains largely underexplored. To bridge this gap, we present MTPaperBananaBench, a benchmark for multi-turn diagram generation containing 292 images annotated with 3,518 user requirements. To reduce expensive human studies and enable scalable benchmarking, we construct a user simulator that, at each turn, identifies unsatisfied requirements and converts k of them into natural language feedback. Evaluating both requirement satisfaction and overall diagram quality reveals two key failure modes shared across baseline multiturn systems: (1) quality drift, where diagram quality progressively declines over turns, and (2) forgetting, where previously implemented features are lost in subsequent turns. To address these issues, we introduce PaperBanana-Interact, a multi-agent system that refines diagrams via an internal critique-and-refine loop. PaperBanana-Interact consistently improves rather than degrades diagram quality across turns, outperforming baselines by 11.9-18.6 points in quality score and reducing forgetting by 3.7-6.2 points.

We introduce a Polish-language medical visual question answering (VQA) benchmark, built from Polish Board Certification Examination questions for licensed physicians and dentists pursuing specialist certification. The benchmark comprises image-containing questions spanning diverse medical specialties and visual domains, together with a text-only question answering (QA) control set. We evaluate Polish-oriented, general-purpose open-weight, and commercial vision-language models. The task remains challenging: the best model achieves 79.0% accuracy on the full VQA set, and only GPT-5.6 surpasses the approximate human reference on the subset with available candidate responses; all other evaluated models perform worse than humans. To assess visual grounding, we compare complete inputs with configurations omitting the image, the question, or both, and categorize questions by image importance. Models derive more useful information from the question text than from the image and perform worse on image-dominant questions. Across both QA and VQA, they nevertheless achieve above-chance accuracy from the answer choices alone, showing that non-trivial performance can persist even when key task components are missing.

Multimodal Large Language Models (MLLMs) have been growing the capability for scientific writing and collaboration. For example, OpenAI Prism is a free workspace for scientific writing and collaboration. One important feature in Prism is turning scientific diagrams directly into LaTeX TikZ code. In this paper, we build a benchmark, Diagram-MMU, a multi-modal benchmark designed to assess MLLMs' ability for scientific diagram parsing and understanding. Diagram-MMU features 3.7k curated diagrams and 18.3k human-validated questions across six domains. It evaluates MLLMs on three tasks common in vibe writing workspaces: diagram-to-code parsing, diagram-to-code editing, and diagram question answering, alongside agentic settings per task. The evaluation of 12 MLLMs reveals that diagram-to-code tasks are more challenging than diagram question answering: models can reason well over diagrams but struggle to parse and edit them, underscoring the need for methods to enhance MLLMs' capability in diagram-to-code generation. Under agentic settings, most models improve parsing and editing performance but degrade on question answering, while Claude-4.6 Opus consistently improves across all three tasks. Project Page: https://vi-ocean.github.io/projects/diagram-mmu.

Professionals across medicine, engineering, finance, manufacturing, and the sciences often make consequential decisions from charts. Existing chart benchmarks do not sufficiently measure this ability: they are dominated by bar, line, and pie formats, rely on shorter reasoning chains, and are nearing saturation, with frontier models already scoring 80-90%. We introduce Chartography, a benchmark of 100 tasks that pair charts drawn from professional practice, in domain-specific formats that standard chart benchmarks rarely include, with questions written by professionals who read these charts for a living and independently verified by three additional experts. In an evaluation of 30 frontier-model configurations (20 scored trials per task), the best configuration reaches only 45.0% mean pass@1; the remainder span 9.0-39.5%. Failures concentrate in visual perception: models can miss nuanced features, misread values along sparsely labeled axes, mishandle projected 3D geometry, and violate domain conventions encoded in the chart. We release all tasks, images, provenance metadata, and evaluation code.

Transforming table-form documents into machine-processable records requires recovering not only their visible content but also the multilevel structure that organizes it. However, existing benchmarks evaluate either holistic document outputs or conventional table grids, and their aggregate scores provide little insight into where structural failures occur. We introduce FormStruct-Bench, a hierarchical and diagnostic benchmark that evaluates table-form document structure recognition at both the document level and progressively finer component levels, allowing aggregate performance to be traced back to specific structural failure modes. To construct auditable ground truth at scale, we annotate 70 reusable templates and expand them into 7,000 verified instances through a provenance-preserving Director--Artist--Verifier pipeline; all 1,100 instances in the template-disjoint test set additionally receive human review. Our evaluation protocol uses five primary metrics and three structure-specific diagnostics across page, schema, and component levels, together with slices over difficulty, structural constraints, and visual degradation. Across 14 API-hosted and locally deployable systems plus two SFT variants, the best document-level score reaches 83.85%, whereas the best reported fine-grained structural score remains below 18%. These results reveal a pronounced gap between reading document content and recovering the hierarchy and regional organization required for reliable table-form understanding.

Recent document parsers achieve table TEDS scores above 93 on OmniDocBench v1.6, yet community feedback and our audit reveal persistent failures on complex real-world tables. To quantify this gap, we introduce TableParseMap, a diagnostic benchmark of 916 real-world tables organized into five challenging scenarios and nine failure types. The strongest evaluated parser achieves only 85.03 TEDS, showing that aggregate benchmark scores conceal substantial weaknesses. Our analysis attributes these failures to three complementary limitations: large tables exceed the reliable processing scale of a single pass, weak or ambiguous visual cues hinder structure perception, and the reconstructed table may remain visually inconsistent with the image. We therefore propose DEC (Decompose--Enhance--Correct), a visual-consistency-guided agentic framework that improves frozen table parsers without retraining. DEC uses a general VLM as the controller: Decompose partitions large tables along structure-aware boundaries, Enhance exposes weak visual evidence and reparses transformed views, and Correct diagnoses and repairs residual errors. A Visual Consistency Gate (VC-Gate) selectively triggers intervention, while a Visual Consistency Ranker (VC-Ranker) verifies candidate updates and supports rollback without ground-truth HTML at inference time. We further derive a 1,977-table Consensus-Hard Set from 4,556 candidates through offline metrics and cross-model consensus. Across three frozen parsers, DEC improves TEDS by 1.57 points on average; on TableParseMap, gains reach 1.89 points overall, 2.62 on structural errors, and 5.66 on large tables.

Natural-language-driven "vibe coding" enables the one-shot generation of visually rich and interactive web applications, yet reliable assessment of their quality has not kept pace. Existing evaluations often score isolated artifacts or final task outcomes, offering limited evidence about which failures occur and why. We introduce VideoVIBE, a video-grounded benchmark that transforms human-operated webpage recordings into fine-grained diagnostic tasks. It contains approximately 1.7K diagnostic Video QA instances derived from 6,338 verified failures across generated webpages, spanning semantic-logical, visual-motion, structural-temporal, and functional failures. Diagnoses are grounded primarily in recorded presentation and behavior, with webpage source code used as complementary context. We further propose V2Lens, a training-free, evidence-grounded multi-agent system that challenges and selectively refines initial video-based diagnoses through targeted visual and source-code verification. Across thirteen closed-source and open-weight Video MLLMs, Gemini-2.5-Flash is the strongest standalone model with a score of 64.54, while V2Lens reaches 71.72, an improvement of 7.18 points. Together, our results show that video-grounded evaluation can move beyond isolated artifacts and aggregate outcomes toward a behaviorally faithful and diagnostically informative account of generated application quality.

KV-cache compression reduces long-context memory, but aggregate task scores reveal neither which correct executions fail nor why. We present KVDiagnosis, a diagnostic dataset and benchmark with three contributions. First, a 25-method taxonomy groups methods into five mechanism families and links them to eight verified implementations and their valid diagnostic measurements. Second, for every supported method setting, we evaluate all sources in each fixed split against a per-source FullCache control before selecting FullCache-correct/compressed-wrong (C-to-W) rows separately for each method-setting, so no compressor defines another's test set. Third, a common record format links paired outputs and run metadata to cache, likelihood, attention, and decoding measurements with explicit applicability states. On Qwen3-8B, four evidence-aware workloads yield 59 800 supported compressed runs over 2600 sources and 12 520 C-to-W rows. Under fixed diagnostic rules, 63.2% have low or partial measured/projected coverage. Only 19 rows (0.2%) combine high measured/projected coverage with strong likelihood drift; another 2,126 (17.0%) preserve structural position addressability, for which representation fidelity remains unknown, while showing the same drift. Against C-to-C success controls, all ten diagnostics separate failed from successful compression (stratified AUROC 0.684-0.871). Among 96 reproducible low-EAR failures, a controlled 4x evidence-attention boost repairs 29.2%, versus 6.3% under a count-matched sham intervention and 3.3% degradation on matched C-to-C controls. Code and data are available at https://github.com/ChosenQC/KVDiagnosis.

The generation of mathematically precise diagrams from tex- tual prompts has emerged as a critical yet underexplored capability of Large Language Models (LLMs). This has been of interest to researchers in the areas of curriculum preparation, automated ranking of problem sets, and scientific publishing. For LLMs to achieve this, it requires per- fect coordination between Spatial Reasoning, Mathematical Reasoning, and Rendering systems. While existing benchmarks such as MathVision, MathVista are built for Math Reasoning or DiagramGenBenchmark, Mer- maidSeqBench on general purpose diagram generation, no prior work provides a standardized set of prompt, image pairs that can be used to evaluate the LLMs specifically on math diagram generation. This includes fields that span both both text-to-code and text-to-image paradigms. We introduce Math-Vision Diagrams, the first benchmark specifically designed to evaluate LLMs on mathematical diagram generation, and the first to assess text-to-code and text-to-image generation paradigms together in a single unified setting, agnostic of the underlying coding lan- guage or model type. Building on the Math-Vision benchmark, we select a subset of 2920 images out of 3040 from high-quality competition problems with essential visual context. A novel pipeline combining an ensemble of LLMs with Subject Matter Expert (SME) curation is presented, together with a suite of evaluation metrics. Testing several leading models against this benchmark, we demonstrate that LLMs struggle with math diagram generation. All code, data, curation pipeline, and evaluation scripts will be fully open-sourced.

Imaging device downtime is a major barrier to healthcare delivery in low- and middle-income countries (LMICs), often driven by limited access to specialized biomedical engineering support. We present a multi-modality medical equipment maintenance question-answering (QA) framework and demonstrate the fine-tuning of a medical foundation model for specialized technical troubleshooting tasks. Guided by a multi-country survey across nine LMICs, we curated technical manuals from MRI and ultrasound systems to generate the INGENZI_DatasetV1, containing 10,294 high-quality, filtered QA-context pairs. Using QLoRA-based parameter-efficient fine-tuning, we adapted the MedGemma-4b-it model to interpret system error logs and generate step-by-step equipment repair instructions. Compared to the baseline model, the fine-tuned system achieved substantial improvements across metrics, including F1 score (0.22 to 0.38), ROUGE-2 (0.18 to 0.41), and BERTScore F1 (0.86 to 0.91). These metric gains demonstrate that the model generates significantly more precise and procedurally accurate technical responses to new troubleshooting queries. This work establishes a reliable foundation for AI-assisted diagnostic and maintenance tools in resource-constrained settings.

To address this gap, we introduce TomaMMU, a large-scale Tomato leaf disease MultiModal Understanding dataset, alongside TomaBench, a benchmark for evaluating VLMs on tomato disease understanding. TomaMMU comprises 28,808 high-quality images spanning 15 categories and 213,119 human-annotated visual question-answer pairs, generated through a three-stage pipeline comprising Data Collection, Human Annotation, and Question-Answer Generation. Building on this foundation, TomaBench organizes seven agricultural tasks into a hierarchical three-level taxonomy spanning Basic Perception, Pathology Understanding, and Expert Diagnosis, which together enable systematic evaluation from low-level visual recognition to high-level diagnostic reasoning. The tasks assess visual symptom recognition, taxonomic relationships, and diagnostic reasoning, offering a comprehensive view of how well models grasp plant pathology. Our results pronounced gaps in fine-grained recognition and factually grounded reasoning with 14 state-of-the-art VLMs, consistently underperforming on both challenging MCQs and open-ended questions. These results suggest that current VLMs struggle to translate visual perception into reliable diagnostic knowledge, motivating the need for targeted domain adaptation. Simple fine-tuning on TomaMMU substantially narrows this gap, boosting accuracy on challenging MCQs to 96.09%, outperforming recent VLMs, and pointing toward promising directions for future work. All data and code is available in https://huggingface.co/datasets/enalis/TomaMMU.

Reliable evaluation of tool routing is critical as Large Language Models increasingly operate as autonomous agents. Current benchmarks face three structural limitations: data distributions that follow a power law leave rare scenarios underrepresented; the absence of adversarial hard negatives obscures performance differences across models; and annotation pipelines depend on LLM judgments that have not been validated through execution. In this paper, we introduce PluginEval, a benchmark constructed through a two-stage framework that systematically mitigates these limitations. First, we formulate tool routing as a sequence of three decisions and separate generation from verification. LLMs propose candidate calls, while deterministic validation and real API execution provide reliable quality signals. Second, we decompose each plugin by capability, intent, and boundary to identify trigger and exclusion scenarios. We then generate queries at different difficulty levels to fill coverage gaps, including adversarial negatives targeting three failure modes, and return them to the first stage for annotation. This process creates a closed loop that iterates until coverage converges. For evaluation, we move beyond aggregate accuracy. An LLM judge anchored to gold annotations classifies failures as missed calls, spurious calls, or parameter errors, producing a detailed error profile for each model. We evaluate five model families, including proprietary models and models with open weights, analyze their performance across difficulty levels and error categories, and validate the judge through agreement with human annotations.

Large language models perform strongly on medical knowledge benchmarks, but reliable clinical deployment requires agents to conduct defensible investigations over heterogeneous, longitudinal records: determining what evidence is needed, retrieving and reconciling structured and free-text data, grounding conclusions in verifiable evidence, and deferring cases that cannot be resolved reliably. We introduce CliniCARE-Bench (Clinical Calibrated Audit of Medical Reasoning in EHR), a benchmark for retrospective clinical audit: 25 clinician-validated scenarios instantiated as 750 patient-specific cases over real-patient-derived MIMIC-IV data. Systems investigate each case through a governed, logged tool environment for record retrieval, computation, and policy access, and return one of four verdicts---Yes, No, Indeterminate: Lack of Data, or Indeterminate: Medically Ambiguous---the last two separating missing evidence from residual medical ambiguity. Beyond verdict accuracy, we score patient-evidence and policy grounding, process adherence, calibrated abstention, reliability, and efficiency against case-level reference verdicts produced by independent multi-model adjudication and calibrated against Clinical Board review. Every retrieval, computation, and report is replayable, so the investigation trace is inspectable and scorable. To our knowledge, CliniCARE-Bench is the first deployment-oriented clinical-agent benchmark to jointly evaluate real longitudinal EHR investigation, claim-level evidence grounding, governing-policy use, process adherence, and calibrated abstention within a common patient-level adjudication framework. Across 16 agentic systems, four-way accuracy spans 65.3-76.1%, but raw accuracy overstates investigation quality. Defect-free accuracy, which credits a verdict only when correct and free of prohibited shortcuts, is 4.8-14.8 points lower and reorders the leaderboard.

Radiology reporting is time-consuming and subject to inter-rater variability, making automated report generation an attractive clinical application for Vision-Language Models (VLMs). We benchmark state-of-the-art VLMs on lumbar spine MRI with a focus on diagnostic accuracy and demonstrate that standard lexical and semantic metrics poorly reflect clinical correctness: fluent, well-structured reports can score highly while containing clinically meaningful diagnostic errors. To address this failure mode, we propose an architecture-agnostic framework that augments VLM inputs with spatially localized, disc-level anomaly heatmaps generated by a semi-supervised U-Net++ model. These heatmaps both improve anatomical sensitivity through explicit visual grounding and provide an independent interpretability output for clinical oversight, moving us closer to diagnostically reliable, visually grounded VLMs for lumbar spine MRI interpretation.

Standard accuracy metrics for VLMs often mask significant reliability failures in sensitive domains. In this work, we utilize a histopathology-validated brain MRI dataset to systematically assess the diagnostic robustness of four VLM families under evidence-preserving perturbations. By reordering anatomical slices and swapping target label positions, we evaluate whether models maintain consistent predictions when clinical evidence remains invariant. Our results reveal significant vulnerabilities in presentation-order stability, with models exhibiting prediction flips in up to 48.9% of cases under simple sequence reversals. We further identify a textual selection bias, where label reordering triggers inconsistent diagnoses in up to 67.8% of cases despite identical visual inputs. Negative-control tests further reveal diagnostic overcommitment: models generate categorical diagnoses in up to 76.1% of cases after expert-annotated lesion slices are removed. These results demonstrate that high accuracy can overestimate clinical reliability, masking sensitivity to sequential presentation and textual framing that is not captured by aggregate accuracy. Our findings highlight the necessity of stability-based metrics for the deployment of VLMs in safety-critical clinical applications. Our evaluation data and code will be made public upon acceptance.

Background: Respiratory specialty care requires multimodal interpretation, longitudinal risk assessment, guideline-concordant intervention, and whole-course management, which are poorly represented by examination-oriented medical benchmarks. Objective: To develop RESPClinBench, a real-world scenario-based benchmark for respiratory clinical decision-making, and evaluate seven contemporary large language models across AECOPD-PIM and PNBIM. Methods: RESPClinBench cases were adapted from de-identified respiratory clinical data. Three attending-level respiratory physicians revised cases, reference answers, and atomic clinical-action points, while one senior respiratory specialist performed cross-review and final adjudication. AECOPD-PIM comprised 427 open-ended COPD cases, and PNBIM comprised 196 multimodal pulmonary nodule cases combining chest CT with structured clinical information. Seven models generated 4,361 responses through standardized API inference with temperature 0 and a maximum output length of 8192 tokens. An automated framework calculated the final score as the arithmetic mean of atomic-action recall and rubric-based LLM-as-a-Judge assessment. Results: Across 623 cases, the mean final score was 68.58. Qwen3.6-27B ranked first overall at 71.22, Qwen3.5-397B-A17B led PNBIM at 72.48, and Qwen3.6-27B led AECOPD-PIM at 71.11. Imaging hallucination and serious medical risk occurred in 31.85% and 8.16% of PNBIM responses; medication-safety risk and serious medical risk occurred in 26.93% and 1.44% of AECOPD-PIM responses. Conclusions: RESPClinBench identifies task-specific limitations in multimodal pulmonary nodule assessment and longitudinal COPD management. Combining explicit clinical-action coverage, holistic evaluation, and independent safety flags provides a clinically grounded basis for model selection and prospective validation.

Causal diagnostic models must explain how conclusions follow from evidence because diagnoses guide repairs and treatments. Yet serious cases are scarce, records rarely contain reasoning paths, and data transfer poorly across configurations, complicating local deployment. We present DiagLoop, a counterfactual data flywheel that converts codified physical relations or clinical guidelines, authored once per mechanism family, into training supervision beyond recorded cases. A training-only teacher proposes counterfactual worlds by varying causes, contexts, and observations, while an independent hybrid checker admits only valid worlds. The student reasons through symptom abstraction, causal-chain construction, and root-cause attribution. Stage-specific criteria identify its earliest failure. For nonterminal failures, a bounded repair probes downstream competence, and the resulting weakness profile guides subsequent data generation. Stage-localized reinforcement learning updates only the model-generated continuation, while replay and preservation reduce forgetting. The same criteria govern admission, attribution, reward, and regeneration through checks separate from the proposer. Using only synthesized scenarios and no case-level expert reasoning annotations, the resulting 8B model improves strict path correctness over the strongest conventional baseline. Gains are 11.6 points across eight industrial systems and 5.5 points across ten disease categories. Gains over a deranged-routing control are 3.9 and 2.3 points, respectively. The model also exceeds the evaluated proprietary references in both domains, even when they receive few-shot examples or the specification in context.

Large Language Model (LLM) agents offer a promising approach to attack chain reconstruction by retrieving and interpreting heterogeneous telemetry to infer ordered attacker actions. However, existing benchmarks mainly evaluate final outputs or aggregate accuracy, providing limited insight into how errors arise and propagate across intermediate reasoning stages. We present DiagChain, a diagnostic benchmark for evidence-grounded attack chain reconstruction that enables stage-wise evaluation of LLM agents. DiagChain includes MAIN-69, a suite of 69 scenarios spanning multiple operating systems, evidence noise levels, and chain lengths. It further introduces Evidence-Centric Retrieval-Augmented Generation (ECRAG), which couples evidence retrieval with an evolving structured representation of the reconstructed chain. Five complementary metrics are introduced to assess distinct stages of the reconstruction process and support systematic failure diagnosis. Based on evaluations using 6 LLMs, DiagChain reveals that even the strongest configuration succeeds on only 39.6% of the 849 reference steps in MAIN-69. Our analysis further shows that smaller models struggle with the more basic task of incorporating retrieved evidence into their outputs, whereas larger models can proceed to later steps, where correctly ordering that evidence becomes the main bottleneck. These results validate the importance of diagnostic evaluation beyond end-to-end accuracy and provide actionable insights for improving evidence-grounded cybersecurity agents.

Multiple sclerosis (MS) is diagnosed through clinical assessment, magnetic resonance imaging, laboratory evidence when appropriate, and exclusion of better explanations. Blood RNA expression data may contain disease associated immune signal, but a blood RNA classifier cannot be treated as a replacement for clinical diagnosis. This paper presents MS-MLB (Multiple Sclerosis Machine Learning Benchmark), a reproducible open benchmark for machine learning based MS research classification from whole blood RNA expression data. MS-MLB uses the public GSE17048 cohort, converts it into an MS versus healthy control task, and evaluates multiple algorithms under a shared, leakage controlled pipeline that a researcher can rerun without reconfiguring the evaluation. The evaluation includes nested cross-validation, an untouched stratified holdout set, bootstrap confidence intervals, ROC and precision recall analysis, calibration measurement, and an exploratory MS Research Score. In the final benchmark summary, Gradient Boosting ranked first by MS Research Score on the holdout set, with an MS Research Score of 93.83, AUC-ROC of 0.989, sensitivity of 0.950, specificity of 0.778, $F_{1}$ score of 0.927, and Brier score of 0.050. Prior studies have applied machine learning to MS blood transcriptomic data, including PBMC stage classification and whole blood diagnostic signature modeling. The contribution here is different and narrower. To our knowledge, MS-MLB is the first open benchmark focused on MS versus healthy control classification from GSE17048 whole blood RNA expression data with a documented external model submission pathway built into the framework. The score is intended for research comparison only and has not been clinically validated. The benchmark is accessible here: https://github.com/duckyquang/MS-MLB.

Multimodal large language models have demonstrated strong defect recognition capability in industrial anomaly detection. However, in lithography review, merely determining whether an image contains a defect is insufficient for engineering inspection; models must also understand defect morphology, spatial location, and the potential causes supported by visible evidence. To this end, this paper proposes LDU-Bench, a multi-task multimodal benchmark for lithography defect understanding. Constructed from real lithography and integrated-circuit review images, LDU-Bench decomposes the review workflow into four independent tasks: defect triage, morphology recognition, coarse localization, and image-conditioned cause analysis. It systematically evaluates models using task-level metrics, diagnostic readouts, and the Lithography Closure Score (LCS). Experimental results show that although existing MLLMs can perform defect triage relatively reliably, this ability does not stably transfer to downstream review stages. Morphology alignment, effective localization, and evidence-to-cause mapping remain the major bottlenecks. Further diagnostics indicate that this capability break is not a fluctuation of a single metric, but reflects insufficient structured understanding across semantic levels. Overall, LDU-Bench provides a quantifiable and diagnostic unified platform for evaluating the usability, failure points, and capability boundaries of industrial MLLMs in lithography review chains.

A natural language interface can be used to make cancer genomics databases easier to use, but even if a question is perfectly fluent, its scientific meaning can be ambiguous. We propose CLARA, a framework that represents a question as a typed scientific query specification, considers a few possible interpretations, executes them, and asks for clarification when the estimates diverge. CLARA was assessed on mutation-prevalence contrasts among eight TCGA PanCancer Atlas cohorts and a 30-gene panel. This benchmark consisted of 330 unique executable contrasts varying in mutation scope, assay denominator, and sample context; 115 contrasts were result-sensitive and 215 were result-stable, per the preregistered definition of relative divergence greater than 0.10 or absolute divergence greater than 5 percentage points. An independently implemented pandas execution engine perfectly replicated all 660 results from the SQLite engine. In a separate 120-question LLM-generated, manually vetted language stress test, CLARA recognized all 60 result-sensitive contrasts and needlessly clarified 13 of 60 stable contrasts (accuracy 89.2%, sensitivity/recall 100%, specificity 78.3%). Standalone machine learning had superior overall accuracy (97.5%) but missed one critical contrast. This demonstrates that downstream execution can distinguish consequential from inconsequential ambiguity and reveal an explicit trade-off between safety and burden.

Controllable video generation models are increasingly being developed as world models. Accordingly, evaluating them in this role extends beyond the apparent appearance of generated videos to the inherent reactivity of the worlds they depict: the ability to infer from the scene state how the world should react and to generate plausible consequences not explicitly described in the input. Yet existing benchmarks mainly assess visual quality or explicit instruction fulfillment by checking whether requested actions and interaction outcomes are realized, leaving inherent reactivity underexamined. We introduce WorldExam, a hierarchical diagnostic benchmark spanning four levels: Visual Quality, Control Adherence, Spatial Consistency, and World Reactivity. It comprises 1,474 cases across eight dedicated tasks and supports unified evaluation of camera-, action-, and language-driven model paradigms. The World Reactivity level evaluates scene-conditioned reactions and goal-directed behaviors beyond what is explicitly specified in the input. Evaluation of 20 representative models reveals a clear capability split. Camera-driven models excel at camera control, but their interfaces do not support dynamic interaction; action-driven models control subjects more precisely but often leave the world unresponsive; and language-driven models perform better on interaction but follow complex controls less faithfully. No model combines broad task coverage with consistently strong performance, showing that high visual quality and explicit instruction fulfillment do not guarantee inherent reactivity.

Recent audio-video generators can produce semantically plausible and apparently synchronized sound, yet may still violate the acoustic processes implied by visible events and environments. Existing benchmarks provide limited support for attributing such violations to particular acoustic processes and quantifying their severity. We introduce AcoustiTrace, a diagnostic benchmark that formalizes acoustic physical realism in audio-video generation. AcoustiTrace organizes text-to-audio-video (T2AV) and image-to-audio-video (I2AV) evaluation around the acoustic process, covering sound generation, propagation environment, and acoustic reception through eight dimensions grounded in measurable acoustic quantities. Based on these evaluation dimensions, we construct a large-scale dataset organized around acoustic mechanisms, comprising real-world audio-video recordings and acoustically annotated RGB-D observations, and use it to develop targeted prompt suites and validated evaluators. Experiments reveal that even leading generators still struggle with fundamental acoustic processes despite producing plausible sound events. Finally, we show that the diagnostics AcoustiTrace provides for specific acoustic relations can guide model refinement toward more physically faithful audio and open new directions for incorporating acoustic principles into training objectives, reward modeling, and candidate selection.

Identifying reliable Alzheimer's disease (AD) markers typically requires manual, labor-intensive transcription and expert analysis, limiting its scale. We introduce an automated pipeline that extracts qualitative knowledge about potential AD progression indicators directly from audio recordings of verbal fluency tests. Our method uses pretrained foundation models to process raw audio and extract clinically relevant variables to construct a Bayesian Network (BN); this BN is used to reason about the AD progression markers and infer their qualitative relationships. Our system successfully recovers known clinical knowledge and identifies novel relationships between linguistic markers.

Vision-language models (VLMs) are increasingly being evaluated for medical imaging, but many available benchmarks emphasize disease classification, report generation, or broad visual question answering rather than the spatial and anatomical reasoning required for radiology. We developed the Spatial Perception and Anatomical Reasoning in Clinical Radiology (SPARC-Rad) Benchmark, a manually curated multimodal benchmark dataset and evaluation pipeline for assessing these capabilities in radiology VLMs. SPARC-Rad includes 300 image-question pairs derived from healthy control imaging studies in The Cancer Imaging Archive (TCIA), spanning CT, MRI, and radiography across the abdomen, chest, breast, neuro, and musculoskeletal categories. Radiology trainees manually designed and annotated questions to evaluate anatomical identification, localization, laterality, regional recognition, device identification, and inter-structure spatial relationships. The evaluation pipeline supports standardized prompting, structured output collection, response normalization, LLM-as-judge grading, human quality review, binary correctness scoring, and subgroup analysis by modality, anatomy, and reasoning type. SPARC-Rad provides a reusable framework for evaluating whether VLMs can provide reasoning for radiologic anatomy as a spatial system, supporting future model development, failure-mode analysis, and pre-deployment assessment.

Clinical diagnosis at hospital admission must be made rapidly from limited, incomplete evidence. Existing diagnosis-prediction benchmarks are poorly suited to this setting: they restrict prediction to closed code sets, exclude free-text notes, and supervise with discharge diagnoses that incorporate the full inpatient course. We introduce EarlyDx, a large-scale benchmark for open-ended early diagnosis, built from 154,834 emergency department encounters in MIMIC-IV. Each encounter is restricted to records available at admission time $t_0$ and supervised by the diagnoses recorded during the ED encounter rather than at discharge. An LLM auditor further verifies every free-text label as supported, partially supported, or unsupported by that evidence; the primary evaluation scores only fully supported labels. Under a semantic LLM-as-judge protocol, no evaluated system --- frontier general, medical-specialized, or in-domain post-trained --- synthesizes admission-time evidence reliably. Zero-shot models score largely by extraction, recovering only 3-31% of diagnoses that must be inferred rather than read from the record; post-training raises inference-dependent recall to 56%, but a sizeable margin remains, and on time-critical conditions no system attains a clinician's balance of sensitivity and precision. We release the full construction and evaluation pipeline at here.

Accurate evaluation of multimodal large language models (MLLMs) in dental panoramic radiography (orthopantomogram, OPG) is limited by the lack of fine-grained, clinically reliable benchmarks that reflect expert interpretation. This work introduces PanDent, a large-scale, clinically grounded OPG benchmark built upon fine-grained, expert-validated tooth-level annotations. The dataset comprises 9,524 high-quality OPGs, each associated with comprehensive structured annotations produced by experienced dentists and further validated by an oral and maxillofacial radiologist, providing clinically reliable supervision for tooth-level diagnosis and reasoning. Clinically consistent radiology reports are constructed from expert-validated findings using clinician-defined reporting logic, establishing explicit correspondence between structured clinical evidence and free-text descriptions. This design enables evaluation of whether MLLMs generate reports that are not only linguistically coherent but also clinically consistent with expert-validated tooth-level findings. Experiments are conducted on diverse MLLMs, including state-of-the-art (SOTA) proprietary models, general-domain open-source models, and medical-specific models. Results show that current MLLMs can generate fluent reports, yet fail to produce clinically consistent descriptions, exhibiting substantial errors in fine-grained localization and tooth-level diagnosis. Fine-tuning on PanDent significantly improves structure-language consistency, substantially enhancing visual localization accuracy and diagnostic correctness, and bringing model outputs closer to expert dental interpretation. These results establish PanDent as a rigorous benchmark for evaluating tooth-level clinical reasoning in MLLMs and a valuable resource for clinically grounded dental AI.

Enzyme function prediction is a hierarchical, knowledge-intensive form of protein function classification. Existing benchmarks expose an anomaly: general LLMs often get the coarse first level right, yet once asked for a complete EC number their accuracy at levels two through four drops to almost zero, while specialized models and tools stay usable. We propose EC-Reason-Bench, a training-free, diagnostic evaluation protocol built to answer two questions: why general LLMs score close to nothing on EC number prediction, and how much of that loss can be recovered without updating a single weight. We break enzyme classification ability into four orthogonal levers that can each be measured on their own: output structure, external knowledge, reasoning structure, and reasoning robustness. We test each lever with an inference-time method against a shared zero-shot baseline reproducing previously reported near-zero performance. Experiments with several strong reasoning LLMs yield four main findings. First, external knowledge is decisive and must precede reasoning: uniformly low closed-book performance rises sharply with open-book access, narrowing model gaps. Second, in closed-book settings, whether cascading and chain-of-thought help or hurt depends on a model's tendency to abstain. Third, once evidence is available the aggregate score of the best LLM setting is indistinguishable from simply voting the EC numbers of the nearest retrieved neighbors; that tie is an artifact of averaging, and it hides a large gain on adversarial evidence set against an equally large loss on multi-functional enzymes. Reasoning over evidence therefore acts as an arbiter of conflicting neighbors rather than as a source of knowledge, and no single-number leaderboard can see it. Fourth, accuracy obeys a law of homology availability.

Clinical practice guidelines (CPGs) encode diagnostic criteria, but LLM systems typically retrieve guideline text or absorb it through training rather than execute its rules. We introduce GuideSkill, an external reasoning layer that compiles disease-specific criteria into executable functions returning ordinal diagnostic-support scores. GuideSkill-Zero is initialized from guidelines, while GuideSkill-Evo uses case--diagnosis pairs to refine covered skills and add missing diagnoses. At inference, an LLM proposes a differential diagnosis, grounds the features required by each matched skill, and fuses its ranking with the executed skill scores. Across four benchmarks and four backbones, GuideSkill-Zero improves macro-average accuracy over guideline RAG by 13.45% on average. GuideSkill-Evo achieves the highest macro-average for every backbone, improves over direct inference by 18.49% relatively, and increases gold-label skill coverage from 56.5% to 99.5%. On Qwen3.5-9B, it also exceeds the strongest parameter-update baseline by 11.16% without updating the backbone. Expert evaluation further indicates that GuideSkill produces clinically sound and broadly acceptable skills, suggesting that its initialized and evolved rules are reliable and practically meaningful. These results support executable skills as a model-agnostic mechanism for combining guideline-derived procedures with case-derived diagnostic patterns.

As LLMs increasingly shape the political information citizens rely on, no standard exists to assess whether they do so responsibly. We introduce Polistemics, a theory-grounded diagnostic benchmark for evaluating LLMs as mediators of political information in elections. Prior work has treated this task as reproduction rather than mediation, leaving its epistemic dimensions and interaction with imperfect information unaddressed. We ground the evaluation in Epistemic Modesty, a normative standard derived from citizens' epistemic agency, and test it across controlled settings that vary the clarity, noise, and consistency of the available evidence. Applying the benchmark to three state-of-the-art LLMs across the 2025 German and Dutch elections, we find that high aggregate scores mask systematic failures. Models mediate reliably under clear evidence but break down when it is absent, vague, or contradictory, while flattening the intensity of political language throughout. These failures point to party priors, shifting with party labels and output language. Reliable mediation appears achievable, but no model delivers it consistently.

Clinical diagnostic evaluation should not only assess whether models can provide correct diagnoses, but also reflect the realities of clinical practice, including progressive disclosure of multimodal information, dynamic updating of diagnostic hypotheses, and continuous refinement of clinical reasoning. However, existing evaluations of multimodal large language models (MLLMs) typically rely on single-turn or isolated tasks, making it difficult to fully capture the complexity of real-world clinical diagnosis. To bridge this gap, we developed ClinMM-Bench, the largest multi-turn multimodal clinical diagnostic evaluation benchmark to date. ClinMM-Bench contains 1,089 challenging real-world clinical cases and 3,760 medical images across eight specialties. We systematically evaluated 15 representative MLLMs using a two-level evaluation framework that assessed both diagnostic accuracy and diagnostic reasoning quality. Results showed that proprietary models achieved the highest overall diagnostic accuracy, but the proportion of completely correct diagnoses remained limited across all models. In terms of diagnostic reasoning quality, current models can identify plausible diagnostic directions but still have considerable limitations in generating reliable diagnostic reasoning. Error analysis further identified five representative failure modes: information synthesis failure, knowledge mapping error, perception error, premature closure, and visual hallucination.

Medical-imaging AI benchmarks combine datasets, DICOM rendering, prompts, provider APIs, automated labels, statistical code, manuscripts, and repository releases. Agreement across these artifacts is usually assumed rather than tested. We performed a retrospective forensic reproducibility audit of a preserved chest-radiograph vision-language model (VLM) pilot; no model was called again and no image or report was newly annotated. We traced prompt bindings, DICOM metadata, output completeness, label extraction, matched analyses, and release propagation. Of 300 planned model-prompt calls, 297 yielded nonempty reports. Sixty Claude calls labeled A/B were executed with the same C prompt. The 30 studies represented 28 patients. Four MONOCHROME1 images were rendered without required polarity inversion, dataset split membership was not retained, and the unvalidated extractor truncated five reports to 4000 characters. Reconstructing one common cohort of 369 complete case-finding blocks changed Cochran's Q from 154.73 to 182.29. Of 45 McNemar comparisons, 27 had unadjusted p < 0.05 and 20 remained below 0.05 after Holm adjustment. These values describe only the archived automated-label matrix; they do not recover the intended prompt comparison or establish clinical performance. We withdraw the original performance, ranking, prompt-effect, and clinical claims and specify machine-verifiable controls for cohort, DICOM rendering, prompt and model identity, call status, annotation provenance, keyed analysis, and derived artifacts.

Single-cell ribonucleic acid sequencing (scRNA-seq) is a foundational technology for precision-medicine workflows that contribute to United Nations Sustainable Development Goal 3 on Good Health and Well-being, and unsupervised clustering is the analytical step that turns raw expression matrices into interpretable cell populations. Practitioners therefore face a recurring engineering decision: is an additional deep representation stage worth its compute and tuning cost, or do classical principal component analysis (PCA) pipelines already suffice? We address this question with a diagnostic benchmark of nine clustering pipelines on ten real datasets (90-5,685 cells, 19,046-41,480 genes, 4-11 cell types), augmented by a partial scVI V2 specialized comparison on seven datasets. The protocol integrates Optuna hyperparameter search, repeated-run robustness, Friedman/Wilcoxon-Holm/TOST testing, and Sobol total-order sensitivity analysis. The contrastive autoencoder achieved the highest mean Adjusted Rand Index (0.7872), but Holm-corrected tests did not establish dominance over the strongest baselines. Per-dataset analysis reveals three reproducible regimes: probabilistic variational autoencoder (VAE) variants help on the smallest datasets, deep autoencoders win on mid-scale data with multi-batch or many-type structure, and classical PCA pipelines remain competitive when linear projection already captures the dominant variation. Sobol indices identify learning rate ($S_T=0.70$) and latent dimensionality ($S_T=0.56$) as the dominant variance contributors, indicating where limited tuning budgets should be allocated. The contribution is therefore a dataset-aware and compute-conscious decision framework for biomedical AI pipelines supporting sustainable healthcare analytics, rather than a universal superiority claim.

Entity-Relationship Diagrams (ERDs) are central to conceptual database design, yet they are typically available only as rendered images rather than machine-readable schemas, limiting AI-assisted database engineering. We introduce ERUnderstand, the first large-scale benchmark for structured understanding of ER diagrams, comprising 2,960 diagrams collected from curated educational sources, real-world schemas, and synthetically generated examples spanning diverse domains, notations, complexity levels, and Extended Entity-Relationship (EER) constructs. Each diagram is paired with a standardized machine-readable representation for fine-grained evaluation of schema elements. Evaluating state-of-the-art Vision-Language Models (VLMs), we find that while common ERD elements are recovered reliably (F1 > 0.74), performance drops sharply on weak entities (as low as 0.28 F1), multivalued attributes (0.14 F1), and N-ary relationships (0.07 F1). Reasoning-augmented models improve overall performance by 15-25% but remain sensitive to linguistic priors and increasing diagram complexity. ERUnderstand provides a standardized benchmark for evaluating multimodal understanding of conceptual database schemas. The benchmark, dataset, evaluation toolkit, and generation code are publicly available at https://github.com/salinaria/ERUnderstand.

Phenotype-driven diagnostic benchmarks usually report the rank of the reference disease, but they rarely reveal which plausible alternatives are ranked above it or what evidence a tool-using model examines before making its decision. We introduce GraphRareBench, a provenance-preserving benchmark containing 2,365 ontology-derived cases and 18,093 target-confounder pairs. Each case includes a coarsened HPO query, a fixed candidate pool, graph-defined hard confounders, and source-linked evidence records. On the 237-case gene-component-disjoint test split, supervised rankers using a shared 21-feature interface achieved MRRs ranging from 0.640 to 0.740 and case-averaged target-over-confounder accuracies ranging from 0.898 to 0.916. Agents instantiated with Agents-A1 and DeepSeek-V4-Flash achieved MRRs of 0.746 and 0.718, respectively. Their paired MRR difference was not statistically significant, whereas their target-evidence coverage differed by 0.561. Together with the observation that 22.1% to 43.7% of selected Hit@10 successes still ranked at least one graph-defined hard confounder above the target, these results indicate that full-pool retrieval, hard-confounder discrimination, and observable evidence access capture complementary aspects of model behavior. GraphRareBench therefore provides a foundation for more transparent and evidence-aware evaluation of phenotype-driven diagnostic systems. Code and data are available at https://github.com/GUI0609/GraphRareBench.

Large language models show strong promise for information extraction (IE), but existing reflection-based correction methods are often misaligned with structured extraction outputs. Free-form self-reflection can flag an error, yet it rarely identifies whether the failure is a missing span, wrong label, boundary mismatch, invalid relation type, or reversed argument order. We introduce LA-RL (Label-Aware Reflective Reinforcement Learning), an outcome-supervised framework that guides IE self-correction with task-grounded diagnostic labels. A single backbone first predicts an extraction, diagnoses task-specific error labels, and then revises its output conditioned on the diagnosis. Training starts from diagnostic data labeled by an annotation model for cold-start supervised fine-tuning and proceeds through two GRPO stages that reward final extraction quality, format validity, and first-pass correctness, without a process reward model. Experiments on named entity recognition, relation extraction, and event extraction show consistent same-backbone gains over SFT, including 6.83 average F1 on SciER relation extraction, about 20 F1 on out-of-distribution relation extraction, and 14.80 trigger F1 plus 17.50 argument F1 on DuEE1.0. Ablations show that reflection structure is task-sensitive: stronger constraints benefit relation extraction, whereas named entity recognition needs less restrictive correction under domain shift.

This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.

Knowledge-Intensive Visual Question Answering (KI-VQA) benchmarks evaluate Vision-Language Models (VLMs) as multimodal knowledge assistants by requiring external information beyond a provided image to answer questions. KI-VQA involves multiple sub-problems -referring expression understanding, visual grounding, object recognition, knowledge retrieval, and reasoning-yet existing benchmarks typically report only end-task accuracy, obscuring where failures arise. To analyze the full KI-VQA pipeline, we introduce CRAG-MM-Diagnostics, a diagnostic benchmark with stage-wise data annotations that isolate 1) language-based visual grounding, 2) object identification, and 3) knowledge retrieval and reasoning. We evaluate fully parametric and retrieval-augmented VLMs, providing fine-grained analyses using newly collected metadata, such as target ROIs, entity names, and visual complexity scores. Our results point to knowledge retrieval and reasoning as the primary bottleneck, but also highlight issues in the other parts of the KI-VQA pipeline, such as the fact that VLMs struggle with target object identification or that image retrievers struggle to integrate textual cues. These findings expose fundamental limitations in current KI-VQA systems and motivate stage-aware evaluation. We, lastly, leverage these findings to propose a grounded bimodal RAG pipeline that integrates a visual grounding module to crop targets before image retrieval, boosting GPT-5 and Qwen's respective accuracies by 13.3 and 8.5 percentage points.

Medical LLMs are often evaluated by whether they select the correct diagnosis, but diagnostic accuracy alone does not show whether the model used the case evidence appropriately. We present a behavioral audit of evidence use in medical diagnosis. For each case, we decompose patient information into evidence units, score candidate diagnoses under controlled evidence subsets, and mine low-order interactions in diagnostic margins. Because medical evidence is diagnosis-relative, the audit separates interaction discovery from failure assignment: large or negative interactions can reflect plausible differential diagnosis, while suspicious interactions require robustness checks and clinical review. We evaluate five open-weight LLMs on DDXPlus, CupCase, and MedCase. Across datasets, faithful support and differential conflict or cancellation account for most interaction strength, showing that many evidence interactions are clinically plausible rather than failures. In a DDXPlus-focused blinded five-reviewer 130-item enriched review sample, invalid or shortcut-like cases concentrate in negated or absent findings and clinically local evidence. These results show that accuracy can hide candidate evidence-use failures and motivate role-aware audits for medical LLM evaluation.

Concept Bottleneck Models provide interpretable-by-design predictions by mediating diagnosis through human-understandable concepts, but in medical imaging, their trustworthiness is often limited by the quality and granularity of available supervision. In particular, predicted concept activations can be driven by irrelevant regions, leading to spatially unfaithful explanations. We study a data-centric spatially grounded Concept Bottleneck Model (SG-CBM) that leverages coarse lesion delineations as weak supervision to encourage anatomically plausible concept evidence. For breast ultrasound, we derive two clinically motivated zones from each lesion mask: (i) an in-lesion region of interest for morphology-related concepts and (ii) a posterior acoustic band for posterior phenomena. We train concept maps using a grouped spatial grounding objective and preserve semantic faithfulness with a linear bottleneck classifier. Across five-fold stratified group cross-validation, the proposed SG-CBM improves diagnostic AUROC and concept macro-AUROC while markedly increasing spatial alignment of concept evidence. We also perform a Train-corrupt/Test-clean annotation-quality stress test to quantify the impact of supervision quality on diagnosis and spatial faithfulness. Overall, the results underscore the need for data-quality-aware supervision design and systematic trustworthiness validation for deployable healthcare AI systems.

The accurate diagnosis of spinal pathologies depends heavily on radiological interpretation, yet automated systems are hindered by the lack of diverse, high-quality benchmarks. In this study, we present PhenSPINE, a Magnetic Resonance Imaging dataset comprising 16,813 images from 250 patients, curated to facilitate advanced deep learning research. We propose a robust diagnostic benchmark that integrates state-of-theart convolutional backbones with a Positional Encoding mechanism to explicitly model the anatomical context of intervertebral discs. Evaluating across four standard MRI sequences, our experiments demonstrate that the Sagittal T2-weighted sequence offers the most robust diagnostic value, achieving a superior Macro F1-score of 50.31%. We find that multisequence fusion strategies yield inferior performance compared to this single-sequence baseline, as the images across sequences in our dataset are significantly compromised by noise interference from surrounding anatomical regions. This work establishes a robust baseline and offers critical insights into sequence selection for spine analysis.

Whole-slide image (WSI) diagnosis requires identifying diagnostically relevant regions, examining them across magnifications, and integrating multi-scale evidence. However, most existing pathology benchmarks evaluate models on pre-cropped patches or pre-extracted slide features, leaving their ability to acquire evidence directly from gigapixel WSIs largely untested. We introduce PathAgentBench, a benchmark for evaluating evidence-seeking vision-language models (VLMs) across four complementary capabilities: image-to-text matching for evidence interpretation, text-to-image retrieval for evidence verification, diagnostic-region localization for evidence acquisition, and multi-scale reasoning for evidence integration. The benchmark is organized as a diagnostic tree that links nested regions across magnifications with scale-specific findings and path-level diagnoses. It contains 1,822 TCGA WSIs and 17,135 diagnostic paths annotated by ten board-certified pathologists. An additional private cohort of 190 breast cancer WSIs with detailed annotations is used to evaluate autonomous whole-slide exploration. We evaluate 20 general-purpose, medical, and pathology-specialized models. Leading open-weight models achieve over 93% accuracy in multi-scale reasoning and over 50% accuracy in both cross-modal matching tasks. In contrast, diagnostic-region localization remains challenging: the best text-guided mean intersection-over-union is below 0.09, underperforming a simple center-based heuristic. During autonomous exploration, the unconditional hit rate decreases from 0.522 at low magnification to 0.185 at intermediate magnification and 0.020 at high magnification. These results reveal a pronounced gap between reasoning over curated evidence and acquiring that evidence directly from WSIs. PathAgentBench provides a unified framework for measuring and improving evidence-seeking pathology models.

Clinical NLP evaluation remains dominated by multiple-choice question answering (MCQA), which scores only final-answer accuracy and cannot detect when a model reaches the correct diagnosis while grounding it in irrelevant, absent, or contradictory evidence. We introduce MIRA-Ev, a clinical argument mining benchmark built on Spanish Médico Interno Residente (MIR) licensing-exam cases, re-annotated by expert clinicians with span-level premises, claims, and directed support/attack relations, and released in parallel Spanish (native), English, and Basque versions, the first clinical argumentation resource in Basque. MIRA-Ev organizes evaluation into a three-tier task hierarchy: evidence sentence retrieval, argumentative component extraction, and relation classification.

Pathology report generation from whole-slide images (WSIs) is a rapidly growing multimodal learning problem, yet progress is difficult to measure because existing studies use heterogeneous datasets, model settings, visual encoders, and evaluation protocols. Moreover, commonly used natural language generation metrics, including BLEU, ROUGE, and METEOR, primarily reward lexical similarity and often fail to detect clinically consequential errors such as omitted diagnoses, hallucinated findings, or discordant tumor attributes. We present a standardized benchmark and evaluation framework for pathology report generation. The benchmark evaluates four representative methods across three datasets (TCGA, HistAI, and REG 2025) using three pathology foundation encoders (CONCHv1.5, UNI2-h, and H-Optimus-1). Our framework standardizes preprocessing, feature extraction, training, decoding, and evaluation, enabling fair comparison across models while providing a modular platform for integrating new methods, datasets, and encoders. A central contribution is the Clinical Report Quality Score (CRQS), a clinically grounded metric for evaluating factual correctness. CRQS maps reference and generated reports into structured clinical attributes and measures four complementary dimensions: clinical fact coverage, key information recall, hallucination rate, and clinical discordance, producing both an overall score and interpretable sub-scores. Experiments demonstrate that conventional language-generation metrics are weakly aligned with clinical correctness and frequently overestimate report quality. In contrast, CRQS reveals clinically meaningful differences between models and encoders that lexical metrics fail to capture. Together, the benchmark, public plug-and-play framework, and CRQS establish a reproducible foundation for rigorous evaluation of pathology report generation.

Battery-free Internet of Things (IoT) requires iterative design of vibration energy harvesters (VEHs) under coupled physical constraints, while LLMs are emerging as interface layers for engineering workflows. However, existing engineering benchmarks primarily assess final artifact validity, offering limited insights into how LLMs behave across different stages of coupled physical design. We introduce VEHBench, an engineering-native diagnostic benchmark for LLM-assisted VEH design, featuring 763 literature-grounded tasks scored by an analytical physical oracle. VEHBench evaluates four design roles: specification triage, verifier-guided search, corrupted-state recovery, and policy-conditioned selection. Experimental results reveal that LLM capability is strongly stage-dependent: no single model consistently dominates the entire workflow, and response-control profiles expose distinct behavioral patterns across design roles. VEHBench thus provides a stage-aware foundation for evaluating, selecting, routing, and improving verifier-grounded engineering LLMs. The benchmark artifact is available at https://huggingface.co/datasets/AnonymousVehbench/vehbench

Structural fidelity is essential to scientific methodology diagrams. To communicate research logic, these diagrams must faithfully render components, directional relations, and textual annotations. Since a single error, such as a reversed arrow or an unreadable equation, can invalidate the entire figure, structural fidelity is inherently conjunctive: correctness on one axis cannot compensate for failure on another. Current open-source models fail to satisfy this criterion. Supervised fine-tuning (SFT) learns plausible layouts but cannot reliably ensure structural correctness, while scalar reward-based post-training obscures which structural dimension has failed. To address this, we introduce SciForma, a framework for the structure faithful generation of scientific methodology diagrams. Specifically, SciForma decomposes diagram quality into three structural axes: Component, Arrow, and Text, guided by a structural inventory. Built on this foundation, we curate SciFormaData-700K for structured training and SciFormaBench-2K for logic-verified evaluation. To close the gap left by SFT, we develop Multi-Dimensional Conjunctive Preference Optimization (M-DPO), which enforces simultaneous correctness across all axes and adaptively routes gradients to the most deficient dimension in post-training. The same structural inventory also enables iterative editing at inference time to correct residual errors. This combination allows SciForma-9B to exceed all open-source baselines and GPT-Image-1.5 on both SciFormaBench-2K and AIBench, bringing open scientific diagram generation close to proprietary-level structural fidelity. Our code and data will be available at: https://github.com/microsoft/SciForma.