Clinical AI in EHR

In previous work, we integrated large language models (LLMs) into the lesion segmentation model based on the ULS23 DeepLesion dataset, using short-form findings from the reports. In this study, we developed a unified 2D lesion analysis framework that integrates LLM-based reasoning, lesion bounding box detection, segmentation, and radiology report generation from the original DeepLesion dataset. In the testing phase, we achieved relatively high lesion bounding box detection accuracy with mAP50 of 70.1%, mAP50-95 of 46.4%; Lesion segmentation performance with a Dice score of 62.6%; short report generation accuracy with BLEU_1 score of 64.3%, BLEU_4 score of 49.6%, METEOR of 34.7%, and ROUGE_L of 60.1%. In this work, we address the challenging issue of segmentation in the original DeepLesion dataset and achieve a 28.5% Dice score improvement over the nnUNet lesion segmentation model. We also integrated spatial and anatomical context into the DeepLesion short report generation. We released the implementation, dataset, and models on Github. https://github.com/ruida/2D_DeepLesion_Foundation

Vision-language models (VLMs), including medical specialists, are increasingly proposed for medical imaging, yet their stated confidence is rarely evaluated separately from correctness. We use brain MRI as a controlled, high-stakes testbed for a broader failure mode in frontier multimodal systems: models can appear competent while lacking reliable self-knowledge. We present an automatically graded behavioral audit and pilot study of six instruction-tuned VLMs (five general-purpose and one medical specialist) on 4,102 images (4,032 axial/coronal/sagittal MRI slices from 250 subjects plus 70 non-brain/noise controls), with labels derived from public metadata and released expert segmentation masks rather than new human annotation. Across models, answer coverage is near-complete, but verbalized-confidence calibration is poor: ECE ranges from 0.27 to 0.40, mean confidence on incorrect answers ranges from 0.82 to 0.97, and 33-46% of answered items are high-confidence errors. The most accurate model is also the most confident on its errors, while a base/specialist family contrast suggests that medical adaptation improves tumor-presence detection without improving confidence reliability. Open-ended diagnostics further show that hallucination and abstention vary separately from multiple-choice accuracy. These findings argue that medical-image VLM evaluation should report verbalized-confidence reliability, confident error, hallucination, and abstention alongside accuracy.

The rapid spread of false and misleading health information through digital platforms has become a major public health challenge, particularly during infectious disease outbreaks where delayed verification can influence public behaviour and hinder effective disease control. Although recent advances in automated health misinformation detection have shown encouraging results, most existing approaches rely heavily on global biomedical resources and often fail to capture the local context needed to verify claims in developing countries. This study presents a retrieval-augmented transformer framework designed to verify health-related claims using trusted evidence from the World Health Organization and the Nigeria Centre for Disease Control and Prevention. The framework combines semantic evidence retrieval with transformer-based classification to determine whether a claim is true, false, or misleading. To evaluate the proposed approach, a manually annotated dataset of 67 verified health claims covering coronavirus disease, Lassa fever, cholera, measles, and monkeypox was compiled from Nigerian fact-checking sources. Three transformer models and a retrieval-augmented configuration were evaluated. The Bidirectional Encoder Representations from Transformers model achieved the best performance, with an accuracy of 71% and a weighted F1-score of 0.66. Although retrieval augmentation did not improve classification performance because the current evidence repository was limited in size and coverage, the findings highlight the importance of comprehensive and authoritative knowledge sources for reliable health misinformation verification. The proposed framework provides a practical foundation for developing context-aware and evidence-driven health misinformation verification systems for Nigeria and other resource-constrained settings.

Ensuring trust in AI systems is essential for the safe and ethical integration of machine learning systems into high-stakes domains such as digital health. Key dimensions, including robustness, explainability, fairness, accountability, and privacy, need to be addressed throughout the AI lifecycle, from problem formulation and data collection to model deployment and human interaction. While various contributions address different aspects of trustworthy AI, a focused synthesis on robustness and explainability, especially tailored to the healthcare context, remains limited. This review addresses that need by organizing recent advancements into an accessible framework, highlighting both technical and practical considerations. We present a structured overview of methods, challenges, and solutions, aiming to support researchers and practitioners in developing reliable and explainable AI solutions for digital health. This review article is organized into three main parts. First, we introduce the pillars of trustworthy AI and discuss the technical and ethical challenges, particularly in the context of digital health. Second, we explore application-specific trust considerations across domains such as intensive care, neonatal health, and metabolic health, highlighting how robustness and explainability support trust. Lastly, we present recent advancements in techniques aimed at improving robustness under data scarcity and distributional shifts, as well as explainable AI methods ranging from feature attribution to gradient-based interpretations and counterfactual explanations. This paper is further enriched with detailed discussions of the contributions toward robustness and explainability in digital health, the development of trustworthy AI systems in the era of LLMs, and various evaluation metrics for measuring trust and related parameters such as validity, fidelity, and diversity.

Access to holistic, multimodal data improves the performance of Artificial Intelligence (AI) in medical classification tasks compared to utilizing single modalities or data sources. However, the inherent heterogeneity and complexity of clinical real-world data pose significant challenges to structured data analysis and AI application. This heterogeneity includes missing values, multiple time points, diverse modalities, and inconsistent formats and semantics. Data harmonization prior to data integration tackles this challenge but remains resource-intensive and error-prone, limiting the scalability and reproducibility of holistic, AI-driven decision support on clinical real-world data. We therefore propose PatTree, a graph-based, holistic representation of patients that can be derived from real-world clinical data through the automated structuring of multimodal clinical data. PatTree enables early-stage data integration without relying on pre-standardized inputs. While representing heterogeneous clinical data within a unified knowledge graph, PatTree preserves the semantic relationships between data elements across modalities and data sources, facilitating interoperability and machine-interpretable data access. Using a subset of the ADNI-1 cohort (n = 763), we demonstrate that classification of patients is directly feasible on PatTree reaching state-of-the-art classification performance. In the three-class classification task distinguishing Alzheimer's disease, mild cognitive impairment, and cognitively normal individuals, we achieve a balanced accuracy of 98.5% and an F$_1$ score of 0.987 on the held-out test set. Our results show that assumption-free, automated structuring of multimodal medical data can serve as a scalable foundation for clinical AI pipelines bypassing tedious data preparation and standardization.

Deep learning models for medical image analysis typically apply a fixed amount of computation to every input, regardless of case difficulty. Anatomy-guided dual-stream architectures have been shown to improve diagnostic performance, but they evaluate both streams unconditionally, even on cases a single stream could already resolve confidently. We propose SecondOpinion, a framework in which a fast primary stream processes every case, while a second, anatomy-guided stream is invoked only when GateKeeper, a gating mechanism trained explicitly as a binary correctness classifier, judges that the primary stream's prediction needs additional scrutiny, much as a clinician might seek a second opinion on a difficult case. When activated, the two streams are combined through a lightweight cross-attention fusion module. We evaluate SecondOpinion on a unified five-class chest X-ray dataset and a pelvic fracture dataset, the latter including a held-out, harder subset of fractures that are invisible on X-ray but confirmed via CT. SecondOpinion matches or exceeds prior state-of-the-art performance on both tasks, while activating its anatomy-guided stream on only 9.23% of chest X-ray cases, rising to 24.12% on visible fractures and 45.71% on invisible fractures, an activation rate that tracks task difficulty directly. These results suggest that supervising a gating signal toward correctness, rather than relying on unsupervised confidence, allows a model to allocate anatomical reasoning where it is actually needed.

In recent years, generative AI has attracted significant public attention, and its use has been rapidly expanding across a wide range of domains. From creative tasks such as text summarization, idea generation, and source code generation, to the streamlining of medical support tasks like diagnostic report generation and summarization, AI is now deeply involved in many areas. Today's breadth of AI applications is clearly distinct from what was seen before generative AI gained widespread recognition. Representative generative AI services include DALL-E 3 (OpenAI, California, USA) and Stable Diffusion (Stability AI, London, England, UK) for image generation, ChatGPT (OpenAI, California, USA), and Gemini (Google, California, USA) for text generation. The rise of generative AI has been influenced by advances in deep learning models and the scaling up of data, models, and computational resources based on the scaling laws. Moreover, the emergence of foundation models, which are trained on large-scale datasets and possess general-purpose knowledge applicable to various downstream tasks, is creating a new paradigm in AI development. These shifts brought about by generative AI and foundation models also profoundly impact medical image processing, fundamentally changing the framework for AI development in healthcare. This paper provides an overview of diffusion models used in image generation AI and large language models (LLMs) used in text generation AI, and introduces their applications in medical support. This paper also discusses foundation models, which are gaining attention alongside generative AI, including their construction methods and applications in the medical field. Finally, the paper explores how to develop foundation models and high-performance AI for medical support by fully utilizing national data and computational resources.

Clinic notes and structured electronic health record (EHR) medication history often contain different medication information. Same-visit disagreement between these sources may result from note-side normalization errors, differences in terminology or timing, or actual differences in documentation. We developed a note-grounded approach that uses large language model (LLM) assisted reference construction, targeted and random human review, deterministic medication normalization, and semantic and temporal comparisons with structured medication history. We evaluated all normalization results on a patient-level held-out test set to limit adaptation to the study cohort. On 5,403 held-out mention rows, exact canonical agreement improved from 0.7226 with surface-exact matching to 0.8429 after lexical cleanup and curated alias mapping. In a random audit of previously unaudited rows, canonical-label agreement was 0.9210 among evaluable valid medication mentions, whereas treatment-action attribution was lower at 0.5326. In the full-cohort characterization analysis, only 16.44% of note-derived rows had same-visit exact overlap with structured medication history, but 55.17% had same-visit semantic overlap, 90.34% had same-visit or +/-30-day overlap, and only 3.97% remained in the strict no-structured-overlap bucket under broad project-level mapping. An ontology-backed sensitivity analysis further showed that held-out strict Observational Medical Outcomes Partnership (OMOP)-backed no-overlap fell from 43.99% to 36.68% after a development-derived alias supplement. These results show that note-to-structured-medication mismatch can arise from normalization errors, differences in terminology, and differences in documentation timing.

This work presents DS@GT ARC BioASQ team's work for a biomedical question answering pipeline, integrating multi-source query expansion, neural reranking, retrieval refinement, and OpenBioLLM-assisted answer generation. The system combines PubMed retrieval with fine-tuned MiniLM-based semantic reranking, Reciprocal Rank Fusion (RRF), and feature-based relevance scoring to improve document ranking quality. To address challenging queries with weak retrieval performance, we introduce a conditional weak-question recovery strategy that applies semantic expansion, relationship-aware augmentation, and selective result merging. A post-retrieval pruning stage further removes redundant or low-relevance snippets while preserving evidence coverage for downstream answer generation. Experimental results on BioASQ evaluation batches demonstrate that the proposed recovery and cleanup strategies substantially improve retrieval robustness and MAP@10 performance on difficult question sets. The final system also incorporates output validation and post-processing steps to ensure formatting consistency and submission reliability across BioASQ phases.

Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.

Safe deployment of AI methods in medicine requires robust guardrails that detect when input data deviate from the training distribution to ensure that models provide predictions only within their scope of expertise and abstain otherwise. Out-of-distribution (OOD) detection can provide such safeguards and is extensively studied in general computer vision. Yet, it remains underdeveloped in computational pathology, where gigapixel whole-slide images (WSIs), subtle differences between disease subtypes, and variability in tissue preparation pose unique challenges for conventional OOD methods. We propose ZIO, a training-free, multimodal OOD detector for pathology WSIs that leverages vision--language pathology foundation models (FMs). ZIO constructs text and visual prototypes of in-distribution classes and integrates their complementary information through a prototype shrinkage mechanism to derive OOD scores. We provide the ZIO formulation for both slide- and patch-level FMs. We evaluate ZIO across diverse clinically relevant domain shifts, including rare diseases and near-OOD settings. Extensive evaluation of over 14,700 WSIs from five independent consortia shows that ZIO consistently outperforms both unimodal prototypes and 40 state-of-the-art OOD methods. These results demonstrate the benefits of multimodal representation for OOD detection and pave the way towards safer AI deployment in clinical practice.

Pathology foundation models (PFMs) provide strong tile-level representations via self-supervised pre-training on large-scale pathology images. Yet, PFMs are developed under diverse and often opaque data, architecture, and objective choices, inducing latent representational biases that limit robustness and obscure what each model specialises in. We present AdaFusion, a lightweight adaptive fusion framework that integrates complementary signals from multiple frozen PFMs through (1) low-dimensional feature compression and (2) a sample-conditioned gating module that reweights model-wise (and optionally channel-wise) contributions. Beyond improving predictive accuracy, AdaFusion provides contribution-driven interpretation that offers evidence consistent with model-specific preferences and synergistic interactions across tissue phenotypes. We evaluate AdaFusion on three public benchmarks spanning treatment response prediction, prostate cancer grading, and spatial gene expression inference. AdaFusion consistently outperforms individual PFMs and other fusion baselines, while providing interpretable tissue visualisation which aligns model preferences with morphological patterns. Code is available at: https://github.com/xyx-98/PathoOracle.

We introduce PlainMedScale, a topic-aligned medical corpus spanning four levels of comprehensibility in German and English, drawn from MSD (professional and consumer), Gesund.Bund, Apotheken Umschau Einfache Sprache, and the NHS. The four tiers correspond to distinct communicative functions --- reference, explanation, decision support, and access --- and move beyond the binary expert--lay contrast of prior corpora. In two pilot studies enabled by the alignments, we show that many readability metrics established on two registers fail to generalize across the full gradient, and that a SOTA open-weight LLM prompted for Plain Language still partially preserves the difficulty of its input. Code (https://github.com/GS-Uni-Heidelberg/PlainMedScale) and data (https://doi.org/10.5281/zenodo.21728290) are made available.

Uncommon and off-guideline cases are difficult for clinical decision support, because physicians must make a series of management decisions under diagnostic uncertainty and rarely see the full case at once. Most large language model (LLM) benchmarks for medicine score only the final diagnosis, yet much of clinical care turns on the next appropriate action: the next test to order, the imaging study to obtain, the specialist to involve, or the differential to pursue. We introduce MedUPSQA, a dataset of 21,874 mid-stream clinical decision points built from 5,535 real case reports, and MedUPS, an alignment framework that supervises models on these intermediate decisions as they unfold along a patient's trajectory. We segment free-text case presentations into chronologically ordered, accumulating clinical chunks and align models to predict the next step with reinforcement learning (GRPO), using an external LLM-as-a-Judge reward. This objective mirrors how clinicians actually meet patients, reasoning forward from accumulating evidence toward the next decision, rather than committing to a final label. Across three backbones, mid-stream alignment raises next-step accuracy from 55.2 to 66.7 for Qwen3.6-27B, from 47.2 to 57.8 for Qwen3.5-9B, and from 37.8 to 44.4 for HuatuoGPT-3-8B, with 95% CI. In several model scales we test the objective improves accuracy more than scale, with smaller models surpassing larger, frontier models we evaluate. We further train supervised fine-tuning (SFT) baselines on the mid-stream task, SFT improves all backbones above base, indicating the target framwork carries signal independently of the optimizer. We release the dataset, code, and aligned checkpoints.

Electronic Health Records (EHRs) are widely used for clinical risk prediction using machine learning. International Classification of Diseases (ICD) codes provide structured information about patient diagnoses, but representing them effectively remains challenging. Existing approaches often face a trade-off between predictive performance and interpretability: grouping-based representations are interpretable but may lose information, while embedding-based representations achieve strong predictive performance but are difficult to interpret. We propose Explainable Representation of Multiple ICD Codes (xMICD), a method for constructing low-dimensional patient representations from sets of ICD codes. xMICD combines clinically meaningful diagnostic groupings with similarity in a pre-trained ICD embedding space. Instead of using binary group membership, the method assigns codes to groups via similarity-based relative assignments, yielding features that reflect how closely a patient's diagnoses align with each clinical group. Experiments on large-scale EHR datasets demonstrate that xMICD achieves predictive performance comparable to embedding-based representations such as ICD2Vec across multiple clinical prediction tasks. At the same time, the resulting features remain clinically interpretable because each dimension corresponds to a recognizable diagnostic group. xMICD therefore provides a practical way to integrate embedding-based semantic relationships into interpretable clinical feature spaces for machine learning models.

The integration of artificial intelligence into medical question-answering systems has advanced rapidly; however, research remains predominantly focused on English, leaving low resource languages like Persian significantly underserved. To address this gap, this paper introduces Gaokerena, a novel family of compact Persian medical language models optimized for deployment on consumer grade hardware. As a foundational step toward localized digital healthcare, we first present Gaokerena-V, developed by training a baseline model on a newly curated 90-million-token Persian medical corpus and 20,000 expert-vetted physician Q&A pairs, which improved performance on a translated medical MMLU benchmark from 46.28% to 49.31%. Second, recognizing the critical demands of clinical reasoning, we developed Gaokerena-R by integrating a Chain-of-Thought approach with two novel Reinforcement Learning with AI Feedback (RLAIF) frameworks to optimize preference-based reasoning. Despite utilizing the same baseline architecture and a smaller dataset than Gaokerena-V, Gaokerena-R achieved a superior benchmark score of 52.98%. Furthermore, both models are equipped with custom-developed uncertainty heads that predict the model's confidence in its responses based solely on internal hidden states. While these results demonstrate significant progress in Persian medical language modeling and proactive safety estimation, current performance levels remain insufficient for direct clinical application, highlighting the necessity for further research into robust knowledge acquisition and rigorous safety verification prior to real world deployment.

Internet of Medical Things (IoMT) networks are hard to protect: devices are heterogeneous, computing resources are scarce, and traffic must be analyzed in real time. We present an intrusion detection system that addresses these constraints through feature selection. A Pearson correlation filter first removes redundant attributes; a hybrid strategy then combines model-based feature importance with SHAP attribution to pick a compact subset, on which we train Random Forest and LightGBM classifiers. SHAP and LIME explain what each retained feature contributes to the decisions. On CIC-IoMT 2024 and CIC-IDS 2017, the method cuts the feature space by up to 88% - from 40 to as few as 5 features - and accuracy and F1-score stay within a few points of models trained on all features. Compact, interpretable detectors of this kind are practical candidates for deployment on resource-limited medical networks.

Accurate ICU mortality prediction requires modeling irregular clinical observations across heterogeneous entity types. Existing sequence models handle irregular sampling but ignore typed relational structure; existing graph models assume fixed-interval inputs. We introduce the Continuous-Time Heterogeneous EHR Graph (CT-HEG) schema and evaluate which architectural choices drive predictive performance. CT-HEG encodes each ICU stay as a typed, timestamped graph with three node types (visit, vital, lab_event) and 2D edge attributes (t_hours/48, value_norm) encoding timing and value without imputation. We instantiate CT-HEG as CHIRP-Net, a four-layer heterogeneous GATv2Conv network, evaluated on MIMIC-IV v3.1 (31,142 ICU stays, LOS>=48h, 13.4% mortality) with five seeds and bootstrapped confidence intervals, against logistic regression, mTAND, a Transformer, and GRU-D, plus an ablation study. CHIRP-Net achieved 5-seed mean AUROC 0.8449+/-0.0071 (AUPRC 0.4958+/-0.0209); the ensemble achieved AUROC 0.8618 (95% CI: 0.8485-0.8745). Removing reverse edges disconnected observation nodes from the visit readout, cutting AUROC by 0.1968+/-0.0073. Time-attentive edge features contributed 0.0247+/-0.0093 AUROC. Collapsing heterogeneous edge types into one relation (7x fewer parameters) outperformed the full model on all seeds. Post-calibration ECE was 0.0307. Temporal and demographic subgroup analyses were explored but not reported here, pending follow-up work. Bidirectional connectivity was necessary for the model to use its inputs at all, and CT-HEG was reasonably well calibrated after validation-fitted temperature scaling. These results support CT-HEG for irregular EHR data, while external validation, a pre-specified temporal evaluation, and a demographic fairness audit remain necessary before any claim of robustness. Code: https://github.com/nasiruddinstudents-ctrl/chirp-net-mimic-iv.

Retrieval-augmented large language models (LLMs) promise source-linked clinical support, but their value depends on whether displayed evidence guides rather than distorts physician reliance. We developed CORA, an agentic retrieval-augmented LLM, to investigate how source-linked assistance affects physician decision-making. CORA maintained benchmark performance and achieved larger gains on cases published after the models' training-data cutoffs. In a study of 46 physicians, accuracy increased from 70.8% unaided to 82.6% with CORA. Supporting citations predicted correct answers (87.7% vs 65.5%), but citations created an important asymmetry: perceived support increased adoption of correct advice from 34% to 76.9% but when an incorrect LLM answer appeared citation-supported, physician resistance to it fell from 92% to 34.8%. These findings show that source-linked LLM assistance can improve physician accuracy while introducing a grounding-dependent safety risk.

Vision-language models return structured chest-radiograph findings through interfaces exposing no confidence score, so a receiving institution cannot read off how far to trust an individual judgment. Whether agreement with an institution's reference standard transfers across sites, findings, prediction directions and question formats is largely unmeasured. We evaluated three generative vision-language models on three institutional chest-radiograph corpora and six findings under two elicitation protocols, comprising more than 345,000 finding-level predictions, and estimated finding-by-direction reference agreement at a receiving institution from a small budget of local labels. Estimation strategies were then stress-tested under repeated strict institution-held-out evaluation. Under evaluation excluding the receiving institution from development entirely, adaptive selection among the seven estimators that design admits did not improve on simple fixed alternatives: it achieved a mean Brier score of 0.1083, against 0.0853 for always using a Beta-Binomial empirical-Bayes estimator and 0.0855 for a target-only logistic model. Those two differ by 0.0003, less than this family's own sensitivity to a change of solver version, and each leads in about half the settings, so no default can be recommended. Their advantage over estimators pooling across institutions was concentrated at one site and not confirmatory once clustered by institution, and a plug-in empirical-Bayes posterior-predictive count interval at a nominal 95% level covered 87.0%, less at the hardest institution. Reference agreement therefore has to be re-evaluated per site and per interface; these results concern agreement with institutional labels, not clinical correctness.

Modern machine learning pipelines increasingly rely on reusing pretrained and foundation models across downstream tasks. These pretrained models can differ not only in performance but also in how they can be used: some only provide black-box predictions, while others may permit white-box access to internal representations that can be probed or fine-tuned. When deployed to the target domain in the presence of distribution shift, no single strategy, including zero-shot application, fine-tuning, or directly training a target-specific model, is uniformly the best. In this work, we propose Frontier Learning, a framework that treats a library of candidate models spanning different training histories and access regimes as complementary sources of information rather than mutually exclusive alternatives. Frontier Learning constructs a unified target-domain feature by concatenating internal representations from white-box candidates as well as prediction outputs from black-box candidates, then fits a lightweight, regularized supervised learner on this concatenated representation using labeled target data. Because the resulting hypothesis class contains predictors obtained by zero-shot reuse, fine-tuning, and direct training as special cases, empirical risk minimization over the frontier learner is guaranteed to be no worse, on the training sample, than any individual baseline. We evaluate the framework in simulations spanning varying degrees of source-target compatibility and in two real-world distribution-shift settings: visual domain adaptation on DomainNet/VisDA and clinical mortality prediction across intensive care unit domains using MIMIC-IV-Notes. Across all settings, Frontier Learning matches or outperforms the strongest individual reuse strategy, with the largest gains arising precisely when no single baseline is reliable across the range of shift considered.

Recent radiology-adapted vision-language models have achieved strong performance on standard report generation benchmarks, yet their robustness and generalization remain constrained by imperfect alignment and correlation between visual and textual features. Existing methods connect image and text either implicitly through autoregressive report supervision or explicitly through contrastive learning. However, autoregressive supervision alone is insufficient to establish reliable image-text alignment, while contrastive learning can push apart unpaired reports that describe related pathologies simply because they are not paired with the same image. This is problematic in radiology, where different reports may share compatible pathology semantics rather than being true negatives. As a result, the learned representation may fail to organize images and reports around shared pathology concepts, causing the decoder to rely on pretrained language priors and generate clinically plausible reports that are not fully supported by radiographic evidence. To address this issue, we propose PALM, a pathology-aware alignment framework for radiology report generation. Instead of directly matching each image-report pair while separating all others, PALM aligns visual and textual features through shared pathology prototypes. These prototypes provide a clinically meaningful bridge between radiographic evidence and textual findings, allowing cases with similar pathology semantics to move toward common concepts without separating compatible cases. In addition, we introduce Masked Evidence Modeling to strengthen the image encoder sensitivity to local radiographic evidence by learning semantic changes caused by masked image regions. Experiments on MIMIC-CXR, IU X-Ray, and MIMIC-ABN show that PALM consistently improves both report generation and abnormality-focused robustness.

Vision-language pretraining learns rich medical image representations from radiology reports, but previous model variants commonly operate within a single shared embedding space, so concept-level structure and interpretability must be recovered post hoc, limiting model transparency and, hence, clinical utility. We introduce RadPRISM, which makes a clinician-defined radiology schema a designated stratification axis: an on-premise large language model extracts per-concept text spans from free-text reports, and each clinical concept is aligned in its own dedicated visual subspace, turning concept stratification into direct, top-level alignment supervision. Instantiated on chest radiographs with a 19-concept schema over $203{,}602$ examinations from an internal multi-year archive, RadPRISM improved internal dataset zero-shot classification from $0.717$ (95% CI, $0.710-0.723$) to $0.868$ (95% CI, $0.863-0.872$) macro AUROC over a matched global-alignment baseline, performed on par with the purpose-built CARZero reference in external zero-shot classification while substantially outperforming it (up to 4.3-fold) in pointing-game visual grounding. In addition, a radiologist reader study demonstrated concept-stratified retrieval ability ($0.78$ macro retrieval correctness rate within rank 3), surfacing disentangled descriptive findings that report-level retrieval and fixed-label vocabularies cannot express. RadPRISM yields discriminative, spatially faithful, natively concept-stratified representations shaped by and transparently inspectable by clinicians.

Computed tomography angiography (CTA) is crucial for preprocedural TAVI planning, providing the anatomical information required for prosthesis sizing and vascular access assessment. As the volume of TAVI procedure increases, improving efficiency and standardizing annotations is becoming essential in clinical practice. This study presents TAVI-TEC, a fully automated artificial intelligence-based framework integrated into a web based DICOM viewer for routine preoperative TAVI planning. Pre-procedural CTA scans from patients undergoing TAVI with SAPIEN 3 Ultra (S3U) prostheses were processed using a fully automated pipeline. Deep learning-based segmentation of cardiovascular structures, calcification detection, centerline extraction, landmark identification, and annular plane definition was implemented to quantify key annular and aortic root measurements and color-coded maps of lumen reduction and vessel diameter for vascular access. A multilayer perceptron classifier was trained to predict prosthesis size prior to the TAVI procedure. Results revealed that TAVI-TEC enabled pre-procedural measurements in approximately 2-6 min. Strong agreement with clinician-derived measurements was observed for annular area (coefficient of concordance, CCC = 0.934; interclass correlation coefficient, ICC = 0.935; R^2 = 0.881) and perimeter (CCC = 0.909; ICC = 0.909; R^2 = 0.854). The valve-size prediction model achieved 82% overall accuracy, with most misclassifications occurring between adjacent prosthesis sizes. Though further multicenter validation and extension to additional measurements and valve platforms are required, the TAVI-TEC methodology may reduce operator variability in pre-TAVI measurements and streamline the preoperative workflows of the Heart Team for decision-making.

Transcranial focused ultrasound (tFUS) is a non-invasive technique that delivers focused acoustic energy through the skull for neuromodulation and therapeutic applications. However, the heterogeneous structure of the skull induces complex, patient-specific phase and amplitude aberrations that distort the acoustic focus and deviate it from the intended target, compromising therapeutic efficacy and safety. Conventional time-reversal (TR) simulations can correct these aberrations but rely on computationally expensive full-wave solvers, making them impractical for real-time use and iterative treatment planning. We propose a few-shot deep surrogate framework that predicts per-element phase and amplitude corrections for a 96-element 3D phased-array transducer from patient CT images. A geometry-aware encoder extracts skull-path features shared across dedicated phase classification and amplitude regression branches, where phase periodicity is handled via circular expectation decoding. The framework is pretrained on diverse skull geometries and fine-tuned with only ten target points, enabling rapid adaptation to unseen patients without full patient-specific simulation. Evaluated via leave-one-out cross-validation across 12 skulls, it achieves a mean phase CMAE of 0.155 rad and amplitude rMAE of 9.089%, a focal centroid error of 0.467 mm, Dice score of 94.422%, and peak pressure ratio of 92.332%, with an approximately 2,535 times speedup over TR simulation. The code is available at https://github.com/Minju-Seol/fewshot-tfus-correction.

Postoperative adverse events, including mortality and morbidity, remain a major global burden, many of which are preventable through early identification of high-risk patients and targeted perioperative care. Accurate risk stratification is therefore essential. With the growing availability of large-scale electronic health records (EHRs), machine learning (ML) provides a data-driven approach to model complex clinical patterns. However, existing studies vary widely in design, and methodological practices remain fragmented. This scoping review characterizes ML pipelines for surgical risk stratification and outcome prediction using EHR data. We reviewed 190 studies covering the ML workflow, including data preprocessing, algorithm selection, model evaluation, and explainability. Most studies relied on single-center private datasets with limited data modalities, while the scarcity of open-access surgical datasets constrained reproducibility and generalizability. Reporting of key preprocessing steps, including missing data handling, feature selection, and class imbalance, was often incomplete. Conventional ML models and simple neural networks predominated, whereas deep learning and multimodal approaches remained uncommon. Benchmark datasets and standardized evaluation protocols were largely absent, hindering cross-study comparisons. Only about one-third of studies incorporated explainability methods. This review identifies methodological gaps limiting clinically robust postoperative ML tools and provides a structured reference to support more rigorous, reproducible, and clinically meaningful ML development for perioperative care.

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.

Medical image fusion aims to integrate complementary information from diverse imaging modalities to support clinical diagnosis. Existing methods typically apply uniform fusion rules globally, lacking a deep understanding of diagnostic intents and pathological structures. To address these limitations, we propose MIND, a Multimodal Intent-Driven Network via Diffusion Transformers (DiTs) for medical image fusion. Specifically, we utilize BioMedGPT to generate intent-driven fusion texts from source images, guiding the fusion process with pathology-aware diagnostic intents. To combat the loss of 2D spatial continuity caused by 1D sequence flattening in DiTs, we design a Multi-scale Latent Adapter. This module explicitly extracts source image features before serialization, injecting them into the network via strict dimensional alignment to effectively supplement image features. To resolve the semantic shift caused by decoupling image outputs from diagnostic intents, we design a medical semantic consistency loss. This loss ensures deep semantic locking between fused images and fusion texts while maintaining the stability of the underlying physical manifold reconstruction. Comprehensive experiments on the Harvard, BraTS, and GFP datasets reveal that MIND delivers superior fusion quality, significantly improves downstream brain tumor segmentation accuracy, and enables flexible interactive fusion, holding significant promise for intent-driven intelligent clinical decision support systems.

Early detection of mental health disorders is often limited by the lack of specialized resources in Spanish and the difficulty of analyzing long histories of social media posts. This paper addresses these challenges through three main contributions. First, we introduce three Spanish foundational models specifically adapted to the mental health domain through domain-specific pre-training. Second, we propose Incremental Context Expansion (ICE), an automatic relabeling methodology designed for early detection. ICE identifies the point at which cumulative messages provide enough evidence of a disorder, generating more informative training samples. Third, we provide a set of fine-tuned models using the samples generated with the ICE methodology for early risk detection tasks. Our results on three Spanish benchmarks show that combining these specialized models with ICE improves the state-of-the-art, reducing detection latency while maintaining high performance. All models are publicly available.

Vision-language models remain underused in colonoscopy despite the rich expert descriptions recorded in routine reports. These reports document lesion appearance, size and location but summarise entire procedures rather than caption individual frames, leaving clinical findings only weakly linked to the corresponding images. Here we develop EndoCLIP, a colonoscopy vision-language foundation model trained on 125,756 lesion-level image-text pairs progressively recovered from 280,476 routine colonoscopy records. Across lesion-level image-text retrieval, structured report generation and six multi-centre clinical classification tasks, EndoCLIP outperforms general-purpose and biomedical vision-language encoders in both zero-shot and linear-probe settings. On benign-versus-malignant classification, its linear probe approaches the performance of expert readers in a blinded study involving 12 endoscopists. These results suggest that recovering finding-to-frame correspondence can transform routine documentation into scalable supervision, enabling clinical targets to be specified in language rather than separately annotated for each task.

Multimodal large language models (MLLMs) are increasingly used to analyze pathology images. However, dominant multimodal benchmarks in pathology mainly score final diagnostic answers, captions, or reports. These evaluations provide limited insight into whether a model understands the multiscale visual content needed for pathology reasoning and decision-making. We introduce PathVU, a vision-anchored benchmark for fine-grained and multiscale visual understanding in computational pathology. Built from 23 public pathology imaging datasets with human-supervised labels and spatial annotations, PathVU evaluates MLLM understanding in two fields of view: Region FOV for high-resolution local regions and Slide FOV for macro whole-slide views. By converting raw annotations into deterministic task targets, PathVU enables programmatic scoring of region localization, visual recognition, quantity estimation, spatial reasoning, and insufficient-context judgment. The benchmark contains 14 VQA-style tasks, 61,673 images, and 308,070 samples across 28 organs and 7,253,526 annotations. Evaluating 18 representative general-purpose, medical-domain, and pathology-oriented MLLMs, we observe substantial limitations even in advanced models on fine-grained visual tasks across multiscale pathology images. PathVU provides a reproducible basis for developing and evaluating pathology MLLMs with explicit multiscale visual understanding.

Federated learning enables multiple institutions to collaboratively train a shared model without exchanging their raw data. However, individual model updates are data-dependent and may reveal information about clients' local training data. This paper presents a privacy-preserving federated learning framework for clinical EEG data that uses masking-based secure aggregation as its core protection mechanism. The framework combines graph-based communication, threshold secret sharing, dropout recovery, local update clipping, an optional Bloom filter-based privacy-preserving record-linkage initialization module, and auxiliary-notary-based verifiability. It supports semi-honest and malicious aggregation settings and is implemented using the Flower federated learning framework. The secure aggregation variants are evaluated in a simulated cross-silo healthcare setting using TUH EEG-derived data under different client configurations. Under the stated assumptions, the secure variants hide individual updates from the aggregation server. The results show that these variants remain compatible with federated model training, although malicious-setting safeguards and lightweight consistency-checking mechanisms introduce additional computation, communication, and round-duration overhead. Among the proposed secure configurations, the base semi-honest variant incurs the lowest overhead; the malicious-server variants add protocol-consistency and authenticity safeguards, and the auxiliary-notary variants add lightweight aggregate-consistency checking.

Depression is a major mental disorder for which diagnosis relies primarily on clinical assessments. Automated methods to support its detection via the psychiatric MADRS scale are getting more and more attention. While existing solutions primarily focus on detecting the disorder from different text sources (e.g., online text, social media), there is still limited support for clinical trials, where clinical assessments are conducted through structured interviews based on standard guidelines such as SIGMA. In this work, we develop a LLM pipeline specifically designed to support clinicians in supporting the assessment of depression in patients enrolled in clinical trials. Our pipeline converts audio interviews into transcripts, maps them into the ten MADRS symptom items, estimates their severity, and identify problematic clinical ratings associated with them. Evaluation on real clinical interviews shows a strong overall correlation of 0.867 with expert ratings, providing interpretable support for future assessments in clinical trials.

Numerous unsupervised domain adaptation (UDA) algori-thms exist, but for clinical practice, selecting the best-suited one along with proper hyperparameters often remains unclear, as the unlabeled deployment (target) domain prevents direct evaluation. We propose a label-free criterion that jointly selects the algorithm and hyperparameters for UDA. Given a pool of candidate models from multiple algorithms trained with different hyperparameters, our approach scores each candidate against an agreement reference, and selects the one with the highest score. The agreement reference is constructed in two levels without using target labels. First, we leverage multiple label-free selection signals, using each to nominate a model within every algorithm. Second, the nominated models are aggregated across algorithms to form a reference prediction for each unlabeled target sample. The candidate whose predictions agree most with this reference is then selected for deployment. Experimental results on four brain MRI and four chest X-ray datasets across seven clinically relevant transfer scenarios show that our method achieves better selection performance than other methods and remains effective across different algorithm pools. Our approach takes a step towards practical, label-free algorithm selection for clinical deployment of UDA.

Mental health understanding in long-form videos requires nuanced reasoning over observable behavior, interpersonal context, and latent psychological states. Existing benchmarks largely reduce this task to coarse-grained classification, providing limited insight into whether models truly understand psychological phenomena or rely on superficial correlations. To address this limitation, we introduce MMHBench, a comprehensive multimodal benchmark for multi-perspective mental health understanding, comprising 268 long-form videos and 2,184 carefully curated questions. MMHBench organizes the evaluation into two complementary settings: (1) third-person assessment, consisting of 605 questions that focus on the interpretation of observable behaviors and multimodal evidence, and (2) first-person perspective-taking, comprising 1,579 questions that require perspective-conditioned reasoning to identify the interpretation of the mental state supported by the available multimodal evidence. We propose a Multi-Agent Question Generation (MAQG) framework that simulates diverse social roles to synthesize questions from multiple perspectives. The generated questions are refined through multi-role feedback and iterative optimization, followed by expert-guided verification to ensure quality and validity. Extensive evaluation of 22 representative multimodal large language models (MLLMs), spanning both open-source and leading closed-source models, demonstrates that long-form video mental health understanding remains highly challenging.

In clinical practice, patients often undergo multiple imaging examinations over successive visits, yielding longitudinal data. Modeling such temporal information is crucial for reliable assessment of disease progression and treatment response. However, despite the rapid advancement of multimodal large language models (MLLMs), longitudinal medical visual reasoning remains largely underexplored. To fill this gap, we propose LoMeVQA, a comprehensive benchmark consisting of 206K longitudinal visual question answering (VQA) pairs for temporal medical image analysis. LoMeVQA covers five tasks: progress classification, progress description, progress report generation, differential region grounding, and differential region description. To construct the dataset, we develop an automated pipeline that (1) organizes patient records chronologically, (2) extracts clinically meaningful entities via a medical knowledge graph, and (3) models their temporal evolution to guide large language models in generating high-quality longitudinal VQA pairs. Extensive evaluations demonstrate that both general-purpose and medical-domain MLLMs perform poorly on LoMeVQA, revealing substantial limitations in temporal reasoning. To address these limitations, we introduce MedLong-8B, which achieves state-of-the-art performance across all tasks. Beyond benchmarking, we conduct detailed analyses that uncover key failure modes and shed light on how to improve longitudinal medical visual reasoning. Our data is available at: https://github.com/pepperbubble/LoMeVQA

Large chest radiography archives are difficult to search because most studies are paired only with free-text reports rather than structured clinical annotations. Vision-language models offer a natural interface for text-to-image retrieval, but current biomedical models are primarily optimized for report-to-image matching rather than for satisfying short clinical search queries. This creates an objective mismatch: a model may retrieve images related to words in the query while failing to satisfy the full clinical constraint, especially for conjunctions and negations such as ``atelectasis and no pneumonia.'' We introduce CXR-Retrieve, a structured benchmark for compositional chest X-ray text-to-image retrieval. The benchmark contains 5,159 test images from the official test-split of MIMIC-CXR-JPG and 145 textual queries spanning single and conjunction findings, both positive and negative. Relevance is defined by whether a retrieved image satisfies all asserted pathology constraints, rather than by whether it matches a paired report. We further propose a label-aware contrastive fine-tuning objective for clinical retrieval. Our method attracts image-text pairs with compatible asserted pathology constraints, including shared confirmed absences, while explicitly repelling contradictory pairs. Starting from the in-domain CXR-CLIP checkpoint, our method improves Precision@5 over CXR-CLIP by 8.5 percentage points on two-pathology conjunctions and by 22.0 percentage points on negation queries. These results show that reliable chest X-ray retrieval requires training objectives that model not only which findings are mentioned, but also how they are clinically asserted.

Brain tumor diagnosis is a time-sensitive process in which patients may wait weeks for a finalized pathology report. This problem motivates automated systems that classify tumor subtype from multimodal inputs. This paper details the DS@GT ARC team's work for ImageCLEFmed MEDIQA-CORE 2026 Task~1, Brain Tumor Subtype Classification. The task evaluates three glioma classification problems: Level-1 Molecular Type, LGG vs HGG, and WHO Grade. We combine pre-extracted MRI (NeuroVFM) and histopathology (Prov-GigaPath) embeddings with free-text radiology reports. Our team explored two trimodal fusion architectures, two report encoders (RadBERT and Llama-3.1-8B-Instruct), and a biologically motivated post-processing stage. We achieve a mean macro-F1 of 0.801 under the Fully Multimodal condition, exceeding the organizers' baseline of 0.796 and ranking second among the teams whose code passed verification. Additional evaluation across modality-dropping conditions shows that this advantage depends heavily on the availability of the histopathology modality, and that our system falls behind the baseline when modalities are missing. Our code is available on GitHub at https://github.com/dsgt-arc/imageclef-mediqacore-2026.

Detecting anomalies in longitudinal clinical profiles is clinically important but difficult: abnormal evidence is often sparse, patient histories have unequal length, and expert explanations are costly. We propose INCLAIR, a framework that scores each observation against multiple historical contexts, aggregates evidence at the profile level, and generates grounded natural-language explanations under limited expert supervision. Under stated within-profile exchangeability assumptions, the complete mean subsequence score takes an order-$l$ U-statistic form, yielding a variance decomposition and an incomplete-subset approximation that controls combinatorial inference cost independently of profile length. The same analysis shows that mean aggregation attenuates localized anomalies by a factor set by the anomaly support and profile length, motivating validation-selected top-$k$ pooling. Across three clinical datasets, INCLAIR consistently outperforms state-of-the-art baselines. We further validate practical relevance through a case study on longitudinal steroid profiles, comparing INCLAIR's predictions and explanations against domain-expert assessments supported by DNA analysis. The results show that INCLAIR enables clinically actionable anomaly detection under limited expert supervision.

Medical imaging has served as primary proving ground for clinical artificial intelligence (AI), yet a decade of intense research has not translated into proportionate bedside impact. We argue that this gap is not primarily a product of insufficient algorithmic performance, inadequate regulation, or limited explainability. Rather, it reflects a structural misalignment, between how AI systems are designed and evaluated, and how clinical decisions are made. This Perspective identifies six interconnected dimensions of this misalignment: the dominance of pixel-only models in a multimodal clinical world; the erosion of physician trust through opaque and inflexible systems; the unfulfilled promise of foundation models in data-sparse medical domains; the persistent bottleneck of non-shareable, under-curated datasets; the gap between validated algorithms and deployable clinical platforms; and the failure of prediction-centric AI to generate actionable clinical guidance. For each dimension, we reframe the problem and propose a path forward, culminating in a vision of agentic, physician-aligned AI that extends, rather than replaces, clinical judgment.

Existing benchmarks for electrocardiogram foundation models primarily evaluate downstream predictive performance, providing limited insight into whether their internal representations can be faithfully decomposed, clinically interpreted, or reproduced across independent analyses. We introduce ECG-InterpBench, a benchmark designed to systematically evaluate the interpretability of ECG foundation-model representations. ECG-InterpBench uses sparse autoencoders as standardized measurement instruments and matches their capacity across models to enable controlled comparisons. We evaluate six frozen ECG foundation models across five standardized encoder depths, five matched dictionary widths, and three random seeds, producing a 450-cell interpretability atlas comprising 75 exactly matched six-model comparison blocks. The benchmark evaluates complementary dimensions of representation interpretability, including sparse reconstruction fidelity, single-feature accessibility and coverage of 49 clinically meaningful ECG measurements, and cross-seed feature reproducibility. The evaluation further quantifies patient-sampling uncertainty, depth- and seed-dependent variation, and sensitivity to the sparsity parameterization. The benchmark reveals that ECG foundation models exhibit distinct interpretability profiles. A matched replication on MIMIC-IV-ECG confirms that reconstruction fidelity and clinical accessibility identify different leading models. The benchmark is accompanied by executable evaluation code, standardized manifests, cell-level metrics, and reproducibility audits. ECG-InterpBench complements performance-centered ECG benchmarks by providing a capacity-controlled and reproducible framework for comparing ECG foundation models across distinct dimensions of representation interpretability.

Large language models used for clinical diagnostic reasoning are sensitive to sociolinguistic register, not just clinical content. We term this failure mode Narrative Anchoring: identical clinical facts expressed in different registers cause diagnostic outputs to diverge. Unlike prior demographic-bias work, which manipulates explicit identity tokens such as race or income, our benchmark isolates register as the sole channel of variation, with no demographic marker present in any form. We construct a dataset of 1,000 USMLE clinical vignettes, each rewritten into three sociolinguistically distinct personas under an independently audited fact-preservation guarantee, verified by a separate model that never sees the generation prompt. Across seven language models spanning three architecture families and scales, Narrative Anchoring is statistically significant under direct prompting in every model tested, with a Narrative Anchoring Gap of 0.064 to 0.151. Chain-of-thought reasoning and explicit debiasing instructions reduce the bias only partially, and their apparent gains are frequently confounded by accuracy collapse. We introduce NarrativeShield, a three-agent pipeline that structurally extracts and verifies clinical facts before diagnostic reasoning begins, reducing the Narrative Anchoring Gap to near-zero ($-0.004$ to $0.037$) and achieving the lowest rate of severely unstable decisions (DSS $<$ 0.8) of any method across all models, at a modest and mechanistically expected accuracy cost for most models. A stress test using a non-instruction-tuned base model shows that executing a debiasing intervention at all is gated by zero-shot instruction-following ability, not prompt content alone. We release our dataset, human-validated for fact preservation, as a standalone resource for studying register-based clinical bias.

Cross-modal knowledge distillation can transfer diagnostic knowledge from a strong but costly teacher modality to a cheaper and more deployable student modality. In medical image analysis, however, the two modalities are often unpaired: they are collected from different patient cohorts and occupy geometrically incompatible feature spaces. This makes instance-level distillation invalid and direct feature matching unreliable. To address these challenges, we propose Shared Semantic Codebook Distillation (SSCD), which compares teacher and student representations through a shared discrete codebook. Each image is represented as a distribution over a common, modality-agnostic vocabulary, and knowledge is transferred by aligning these distributions across modalities, both globally and class-conditionally, without requiring paired samples or directly comparable raw features. The codebook is evolved online by exponential moving average and kept diverse through entropy regularization and dead-code restart. At inference, all teacher-side and codebook modules are discarded, leaving only the student encoder and classifier. On two heterogeneous unpaired settings, OCT-to-fundus retinal disease classification and CT-to-chest-X-ray pneumonia classification, SSCD improves the student from 64.5 to 70.2 macro-F1 and from 73.8 to 76.3 macro-F1, respectively, outperforming all evaluated distillation baselines on both settings. Code and pretrained models are available at https://github.com/DillanImans/SSCD-unpaired-distillation

Medical vision-language models (VLMs) generate chain-of-thought (CoT) reasoning before answering clinical questions, but whether this reasoning causally influences predictions remains unclear. We present CoT-Mediate, a behavioral framework that perturbs a single clinically meaningful attribute within a model's own generated reasoning and measures whether the resulting prediction follows the edited reasoning. Our framework combines a dual-arm protocol comparing re-prompted evidence with prefix-forced continuation, together with a provenance-controlled intervention that varies only the attributed source of identical reasoning to disentangle reasoning mediation from sycophancy. We evaluate LLaVA-Med and MedGemma on 1,000 VQA-RAD samples each. Prefix-forced continuation consistently yields higher mediation faithfulness than re-prompting, while the provenance analysis reveals distinct model-specific deference behaviors. Across both models, removing visual evidence increases reliance on injected reasoning, whereas laterality is the least faithfully tracked clinical attribute. These results show that the mechanism used to inject reasoning substantially affects measured faithfulness and that contextual position, rather than stated provenance, is the primary determinant of whether medical VLMs use their generated reasoning.

Automated classification of pulmonary disease from chest radiographs is a widely studied application of machine learning in medical imaging. This paper presents a pilot study evaluating classical texture- and gradient-based feature representations for distinguishing COVID-19 from other forms of pneumonia using the publicly available COVID-19 Image Data Collection (668 posteroanterior/anteroposterior radiographs from 408 patients). Using histogram of oriented gradients (HOG) and gray-level co-occurrence matrix (GLCM) texture descriptors with classical classifiers (logistic regression, random forest, and support vector machine), evaluated under patient-level 5-fold stratified cross-validation to prevent data leakage, we obtain a best mean accuracy of 75.4% and AUC of 0.755, modestly exceeding the 71.6% majority-class baseline. We report these results transparently, including their limitations, and use them to motivate and scope a proposed multi-modal deep learning architecture -- combining convolutional and transformer-based encoders across imaging modalities -- as a direction for future work requiring access to larger, multi-institutional, ethically sourced datasets.

Vision-language pre-training (VLP) serves as a cornerstone for medical multimodal representation learning. However, existing medical VLP frameworks are often constrained by the limited context windows and shallow representational capacities of lightweight text encoders when processing lengthy, terminology-dense clinical reports. While integrating medical large language models (LLMs) offers unprecedented clinical reasoning capabilities, it introduces three major bottlenecks: (i) the anisotropic representational collapse of generative LLMs under standard contrastive objectives, (ii) the prohibitive memory overhead of joint end-to-end training with large batch sizes, and (iii) the medical hallucinations induced by vanilla contrastive losses that ignore fine-grained anatomical laterality and negation modifiers. To address these challenges, we propose \textbf{SCALPEL}, a \textbf{S}emantic \textbf{C}ross-modal \textbf{A}lignment framework via \textbf{L}LM-\textbf{P}owered \textbf{E}ncoder \textbf{L}earning. First, Clinical Report Contrastive fine-tuning converts a generative LLM into an isotropic encoder via domain-specific clinical text adaptation. Second, an asymmetric alignment strategy leverages offline feature caching to enable efficient training. Critically, we formulate an Anatomy-Negation Aware Objective that explicitly penalizes mismatched image-text pairs involving laterality confusion or false negations. Extensive experiments across MIMIC-CXR, CheXpert, and IU X-Ray benchmarks demonstrate that SCALPEL achieves state-of-the-art performance in cross-modal retrieval, zero-shot disease classification and medical visual question answering.

Most benchmarks for causal inference over time series are observational, small, or domain-specific, leaving interventional and counterfactual estimation under-served exactly where it matters most, such as in healthcare, policy evaluation, and climate science. We introduce \textbf{DoTime}, an open, scalable, and theoretically grounded generator of multivariate temporal structural causal models (TSCMs) with interventions, released as the \code{dotime} PyPI package together with four frozen evaluation suites. Beyond existing work, it adds capabilities absent from prior generators: continuous-time intervention \emph{windows}, counterfactual sampling modes with a positivity guard, regime-switching SCMs as a strict generalization of interrupted time series, non-stationary dynamics by construction with switching SCM parameters, and deterministic ramp and sinusoidal intervention profiles that place trends and structural breaks \emph{inside} the evaluation window. Moreover, it demonstrates the suitability of the generator as a prior for a causal foundation model reference implementation. The released suites span a training-scale snapshot of $100{,}000$ trajectories and eight named identification structures, each with exact ground truth: paired interventional trajectories from the same SCM throughout, and shared-noise counterfactuals in the continuous-time suite. We ship reference baseline implementations with an evaluation harness, and pose a falsifiable claim: interventional training buys a measurable direction-accuracy advantage over an observational model of identical capacity. It is tested across three training seeds per arm. Under structure-matched evaluation on held-out episodes, the interventional prior-fitted network's (PFN) gap is positive in every structure, trajectory length, and seed tested.

Integrating 3D medical images with vision-language models (VLMs) holds substantial promise for computer-aided diagnosis. However, volumetric images generate prohibitively long visual-token sequences with considerable spatial and inter-slice redundancy. Existing token compression methods typically apply uniform reduction or rely on a single importance signal, increasing the risk of removing regions that are clinically relevant to the query or structurally distinctive. To address this limitation, we propose MedARC, a unified, training-free framework for Adaptive Redundancy Compression of visual tokens in 3D medical VLMs. MedARC estimates token importance by integrating three complementary cues: self-attention from the VLM vision encoder, which reflects the model's intrinsic visual focus; similarity between projected visual tokens and text embeddings, which identifies query-relevant regions; and deviations of local visual foundation model features from the volume-level feature center, which highlight structurally distinctive anatomy. The resulting importance distribution guides a saliency-aware merging strategy that preserves informative tokens while consolidating redundant ones rather than simply discarding them. Experiments on CT-RATE and MR-RATE show that MedARC reduces visual-token overhead and inference time while preserving or improving diagnostic performance. Its multi-cue scoring cost is outweighed by the savings from processing fewer tokens, with greater benefits expected for larger language models.

Chest X-ray (CXR) machine learning relies heavily on automated evaluation using reference standards that aim to approximate clinical judgment. However, commonly used report-derived labels for pathology classification or generic image quality metrics for reconstruction may not reliably reflect clinical judgment. We systematically investigate how evaluation-reference choices affect model performance and ranking in both pathology classification and image quality assessment (IQA). To enable controlled comparison across evaluation references, we collected paired expert image- and report-derived labels for thoracic findings from a clinical cohort at Cambridge University Hospitals (CUH) and curated a subset of the public MIMIC-CXR dataset, along with expert ratings of diagnostic image quality. We show that for supervised image classifiers (ResNet, DenseNet), several zero-shot and fine-tuned vision-language models (e.g., MedKLIP, GLoRIA, and ConVIRT), changing the label source leads to substantial differences not only in performance estimates but also in model rankings. In parallel, alignment of IQA measures with expert judgment depends heavily on the choice of measure, and commonly used IQA metrics such as SSIM and PSNR often fail to align with expert assessments of diagnostic usability. Our results demonstrate that evaluation choices are crucial: they can determine which models and methods appear best and are therefore selected for further development or deployment. The selection of evaluation references should therefore be treated as a central component of clinical validity in CXR machine learning, and justified with respect to the pathology, imaging task, and intended downstream clinical use.

We built and evaluated a self-serve entity resolution (ER) system on six benchmarks spanning 864 to 5M records, and three lessons emerged that are absent from existing ER literature. (1) No single matching algorithm wins everywhere - a self-serve pipeline cannot predict its next dataset, so we recommend training several algorithm families per dataset and letting an automatic bake-off pick the winner. (2) Precision and recall need separate fixes, not a shared threshold - precision needs hard rule-based vetoes, recall needs more diverse candidate retrieval. (3) One false-positive link can silently merge unrelated entities - assuming "A matches B" and "B matches C" implies "A matches C" lets a single bad link chain hundreds of records together, so every cross-group merge must be actively re-verified. We hope these lessons save practitioners the months of dead-end experiments that led us to them.

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.

Clinical data-science agents must transform heterogeneous longitudinal records into auditable analyses, yet existing benchmarks largely isolate medical question answering, structured-table reasoning, or generic scientific repositories. We introduce CLINLENS, a benchmark of 200 executable tasks over five linked MIMIC resources spanning structured electronic health records, notes, electrocardiograms, chest radiographs, and echocardiograms. A 4 x 5 taxonomy crosses four patient-time scopes with five analysis capabilities. Program-first reverse synthesis pairs each bounded semi-raw package with an evaluator-private reference workflow and checks required artifacts, cohort and temporal semantics, and the final answer. On a fixed 126-task suite, the strongest of 24 standardized model-scaffold configurations achieves 56.3% scope-macro STRICTPASS despite 100% EXECSUCCESS. For reference, a separately configured coding agent solves 83 of 126 tasks, while five biomedical systems adapted to GPT-4o-mini reach at most 2.9% scope-macro STRICTPASS. These results expose a substantial gap between runnable submissions and correct clinical analyses.

We present VetClaw, an edge-cloud multimodal agentic system for early veterinary disease screening. VetClaw uses a camera module as an edge sensing device and sends captured images, together with optional symptom descriptions, to a server-hosted vision-language model for zero-shot disease classification. The system separates agent interaction from workflow orchestration: OpenClaw provides scheduling, tool access, user interaction, and notification services on the edge device, while LangGraph manages the stateful screening workflow, including input validation, image transmission, model invocation, safety checks, conditional routing, failure handling, and structured logging. This design moves beyond static image classification by enabling the system to collect visual evidence, invoke external models, apply deterministic safety rules, and generate diagnostic-support alerts. Results show that image-only VLM prediction remains limited, whereas symptom-guided and multimodal inputs improve zero-shot classification performance. Thus, VetClaw transforms a static prediction model into a coordinated, safety-aware system that can use tools, manage workflows, handle failures, and escalate uncertain cases.

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.

Many time-series forecasts depend not only on prior observations but also on actions specified during the forecast period. In intensive care units (ICUs), future vital signs and laboratory values are influenced by treatments such as vasopressors. However, models that predict the full future sequence all at once make little use of these treatments, whereas autoregressive models can accumulate errors. We introduce DRIFT, a hybrid framework in which a direct model produces the primary forecast and a recursive, action-conditioned model contributes constrained corrections. We evaluate DRIFT on 6,046 admissions from MIMIC-IV and 8,345 admissions from eICU-CRD. Averaged across the 8-, 24-, and 48-hour forecast endpoints, DRIFT reduces mean absolute error for mean arterial pressure (MAP) by 0.673% relative to an action-conditioned Temporal Fusion Transformer (TFT-action) on MIMIC-IV and achieves the lowest corresponding error among the compared models on eICU-CRD. Although the overall accuracy improvement is modest, a MIMIC-IV audit restricted to windows in which the supplied treatment sequence was altered showed that DRIFT achieved lower observed-target MAP error than TFT-action at 8 and 24 hours. Treatment-sequence alteration increased DRIFT's MAP error by 0.21-0.26 mmHg more than it increased TFT-action's error, with prediction changes occurring primarily after the supplied paths diverged. In a separate robustness experiment, the MAP advantage persisted under three shared checkpoint-selection rules emphasizing overall endpoint error, MAP error, or both equally.

Objective: Concept bottleneck models route prediction through interpretable intermediate variables, and their validity is normally judged by how accurately those variables are predicted. We ask whether that judgement is sufficient, using left ventricular volumes as the concepts underlying ejection fraction estimation from echocardiographic video. Methods: A video transformer encoder was trained on a publicly available echocardiography dataset. End-systolic and end-diastolic volumes formed a concept layer from which ejection fraction was computed analytically, with no residual path to the output. We compared training under an ejection fraction objective alone against training with additional supervision of the volumes in millilitres, and evaluated both on 1276 held-out studies. Results: The concept bottleneck did not increase ejection fraction error relative to direct regression, at 6.89 against 7.13 mean absolute error. Without volume supervision, however, the spread of predicted volumes collapsed to 0.1 millilitres against reference spreads of 35.7 and 45.7 millilitres, while correlation was partly preserved. We show that this follows from an invariance property of the objective: ejection fraction is a ratio and is unchanged when both volumes are rescaled, so the loss determines the concept layer only up to scale. Supervision in absolute units reduced volume error from 89.8 to 25.8 millilitres at a cost of 0.4 in ejection fraction error. Conclusion: Concept accuracy alone can conceal a concept layer that carries no physical scale. Significance: Interpretable intermediate variables in clinical models should be validated against the invariance structure of the training objective, not only against prediction accuracy.

Multimodal behavioral analysis offers a scalable approach to assessing depression, anxiety, and stress, yet generic fusion models often ignore the psychometric structure of questionnaire labels. In DASS-21, risk labels are derived from ordered symptom items through fixed item-to-subscale mappings. We propose \textbf{DynaBridge}, a dynamic summary-guided cross-task multimodal framework for DASS-structured mental health assessment. DynaBridge encodes acoustic, visual, and textual cues across multiple sessions and augments them with frozen-LLM-generated DASS-aware summaries as participant-level semantic evidence. It predicts ordinal item distributions, reconstructs depression, anxiety, and stress risk evidence from item-level soft scores, and fuses this evidence with direct multimodal risk predictions. A confidence-aware refinement strategy further incorporates high-confidence semantic cues conservatively. On the official AdoDAS validation split, DynaBridge outperforms the official baseline and representative multimodal methods, achieving 0.5012 mean F1 for D/A/S risk prediction and 0.3216 mean QWK for DASS-21 item prediction. These results show the value of bridging multimodal cues, semantic summaries, and DASS-21 psychometric structure.

Psychotherapists need repeated training and supervision by experts; however, scalability is problematic. Here we present MyMentorLLM, a multimodal voice- and text-based simulation environment for deliberate practice, used to generate 2,100 complete Cognitive Behavioural Therapy (CBT) training sessions. Each session links a DSM-5-TR-grounded patient (with major depressive, generalised anxiety or borderline personality disorder), a therapist-in-training and an expert supervisor. As an initial implementation, we adopted CBT because its structured procedures and competency-based supervision facilitate standardised simulation and evaluation. Sessions were analysed for emotional dynamics, therapeutic competence and diagnostic accuracy. Simulated patients expressed disorder-congruent emotional profiles, which trainee therapists mirrored as in real human counselling. The quality of supervision differed across LLMs: while most models overestimated trainees' competences, native speech-to-speech was closest to human scores. Supervisors' feedback led to better diagnoses in simulated psychotherapists in 5 out of 7 LLMs, and symptom identification accuracy increased with model size. This work shows that simulation of deliberate practice is possible for CBT training, although patient fidelity, calibration of supervisors, and harmful feedback should be evaluated together.

Understanding disease trajectories from longitudinal clinical data remains challenging due to complex temporal dynamics and heterogeneous patient cohorts. Here, we present a contrastive representation learning framework that models multivariate disease trajectories as temporal graphs and learns representations using contrastive graph neural networks. Nodes represent patient observations over time, while edges capture temporal continuity and structural similarity between trajectories. Structure-aware random walks guide contrastive learning to generate embeddings that preserve temporal context and trajectory topology. The resulting representations enable robust clustering of patients with similar disease progression patterns and reveal latent structure in longitudinal data.

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.