Daily Papers

Hybrid language models combine softmax attention with linear-time sequence mechanisms such as state-space or linear-attention layers, but the functional contribution of each component type remains insufficiently characterized. We study component-level ablation in two sub-1B hybrid language models, Qwen3.5-0.8B and Falcon-H1-0.5B, using likelihood-based evaluation, downstream benchmarks, layer-wise interventions, random controls, and representation-level diagnostics. Across the tested models, removing either attention or the alternative sequence-processing pathway substantially degrades performance, indicating that both component types contribute to model behavior. Likelihood metrics are especially sensitive to the linear-attention or state-space pathway, while downstream benchmark degradation depends on task and architecture. Layer-wise ablations show that component importance is position-dependent, with the strongest effects concentrated in early or mid-network components rather than uniformly across depth. Random-removal controls further show that hybrid architectures and same-family Transformer baselines degrade differently under structural perturbation. These results suggest that component ablation is a useful diagnostic for understanding hybrid language model architectures. The findings provide evidence relevant to efficient model design, compression, robustness analysis, and deployment decisions in architectures that combine attention with alternative sequence-processing mechanisms.

Bug reports serve as task specifications for repository-level automated program repair (APR) agents, but they often describe only the observed failure and omit repair-relevant information such as the failure-inducing behavior, behavioral requirement, and implementation scope. As a result, a repair agent may inspect irrelevant code, infer an incorrect requirement, or generate a patch that addresses the reported symptom without restoring the intended repository behavior. We present TrajSpec, a trajectory-guided approach for repository-supported bug report specification refinement. Given an original report and a pre-fix repository, TrajSpec runs a trajectory-collection agent and uses the resulting unverified trajectory as a source of trajectory-derived specification evidence. It organizes this evidence into a three-level representation consisting of a high-level interpretation of the issue, diagnostic findings supporting that interpretation, and concrete repository observations. TrajSpec then generates a draft refined report and applies repository-based review to remove unsupported claims, revise uncertain claims, and add repository-supported details. We evaluate TrajSpec on all 300 SWE-Bench Lite instances using Mini-SWE-Agent V2. TrajSpec's refined reports improve Pass@1 from 41.00% to 59.67% with GPT-5-mini and from 54.67% to 64.33% with MiniMax M2.5. On a stratified sample of 100 instances, TrajSpec's refined reports also improve Pass@1 from 41.00% to 71.00% with Agentless and from 47.00% to 72.00% with AutoCodeRover. Ablation results show that removing repository-based review or the hierarchical evidence representation reduces Pass@1 from 59.67% to 48.00% and 47.67%, respectively. Overall, TrajSpec provides actionable repository-supported context that consistently improves repair performance.

Assessing scientific claims requires identifying, extracting, and reasoning with multimodal data expressed in information-rich figures in scientific literature. Despite the large body of work in scientific QA, figure captioning, and other multimodal reasoning tasks over chart-based data, there are no readily usable multimodal benchmarks that directly test claim verification abilities. To remedy this gap, we introduce a new benchmark MuSciClaims accompanied by diagnostics tasks. We automatically extract supported claims from scientific articles, which we manually perturb to produce contradicted claims. The perturbations are designed to test for a specific set of claim verification capabilities. We also introduce a suite of diagnostic tasks that help understand model failures. Our results show most vision-language models are poor (~0.3-0.5 F1), with even the best model only achieving 0.72 F1. They are also biased towards judging claims as supported, likely misunderstanding nuanced perturbations within the claims. Our diagnostics show models are bad at localizing correct evidence within figures, struggle with aggregating information across modalities, and often fail to understand basic components of the figure.

Fine-grained visual representations are essential for medical image analysis, particularly when diagnostically relevant evidence is subtle and spatially localized. Modern transformer-based medical vision encoders must therefore learn patch-level representations that are both clinically meaningful and spatially consistent. Without these properties, large vision-language models (LVLMs) operate on an ambiguous visual foundation, limiting their ability to generate clinically reliable and spatially grounded responses. However, existing training strategies for medical vision encoders rarely achieve both objectives. Image-text alignment provides clinically meaningful supervision primarily at the image level, leaving the spatial localization of diagnostic evidence weakly constrained. In contrast, self-supervised learning promotes spatial consistency but lacks the semantic supervision needed to distinguish visually similar yet clinically distinct regions. To address this gap, we present LoFi, a medical vision foundation model built on location-aware fine-grained representation learning. LoFi trains a vision encoder with a lightweight large language model under grounding and grounded captioning objectives. Because these objectives require predicting location from clinical text and vice versa, spatial consistency emerges without any explicit patch-level regularization. To enable training at scale, we construct MedG, a large-scale medical grounding dataset of 4.48M image-text-box triplets curated from 84 datasets spanning 7 modalities. Across phrase grounding, visual question answering, and region-based organ classification under perturbations, LoFi consistently outperforms general-purpose and medical vision foundation models as well as state-of-the-art LVLMs. Code is available at https://github.com/myeongkyunkang/lofi-medg.

Retinal foundation models have significantly advanced retinal image analysis by leveraging self-supervised learning to reduce dependence on labeled data while achieving strong generalization. Many recent approaches enhance retinal image understanding using report supervision, but obtaining clinical reports is often costly and challenging. In contrast, metadata (e.g., age, gender) is widely available and serves as a valuable resource for analyzing disease progression. To effectively incorporate patient-specific information, we propose PRETI, a retinal foundation model that integrates metadata-aware learning with robust self-supervised representation learning. We introduce Learnable Metadata Embedding (LME), which dynamically refines metadata representations. Additionally, we construct patient-level data pairs, associating images from the same individual to improve robustness against non-clinical variations. To further optimize retinal image representation, we propose Retina-Aware Adaptive Masking (RAAM), a strategy that selectively applies masking within the retinal region and dynamically adjusts the masking ratio during training. PRETI captures both global structures and fine-grained pathological details, resulting in superior diagnostic performance. Extensive experiments demonstrate that PRETI achieves state-of-the-art results across diverse diseases and biomarker predictions using in-house and public data, indicating the importance of metadata-guided foundation models in retinal disease analysis. Our code and pretrained model are available at https://github.com/MICV-yonsei/PRETI

Autoregressive (AR) visual generators model images as sequences of discrete tokens and are trained with a next-token likelihood objective. This strict causal supervision optimizes each step based only on the immediate next token, which can weaken global coherence and slow convergence. We investigate whether foresight, training signals that originate from later tokens, can improve autoregressive visual generation. We conduct a series of controlled diagnostics along the injection level, foresight layout, and foresight source axes, revealing a key insight: aligning foresight with AR models' internal representations on the 2D image grid improves causal modeling. We formulate this insight with Mirai (meaning "future" in Japanese), a general framework that injects future information into AR training with no architecture change and no extra inference overhead: Mirai-E uses explicit foresight from multiple future positions of unidirectional representations, whereas Mirai-I leverages implicit foresight from matched bidirectional representations. Extensive experiments show that Mirai significantly accelerates convergence and improves generation quality. For instance, Mirai can speed up LlamaGen-B's convergence by up to 10times and reduce the generation FID from 5.34 to 4.34 on the ImageNet class-condition image generation benchmark. Our study highlights that visual autoregressive models need foresight.

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

Neurophysiological recordings such as electroencephalography (EEG) offer accessible and minimally invasive means of estimating physiological activity for applications in healthcare, diagnostic screening, and even immersive entertainment. However, these recordings yield high-dimensional, noisy time-series data that typically require extensive pre-processing and handcrafted feature extraction to reveal meaningful information. Recently, there has been a surge of interest in applying representation learning techniques from large pre-trained (foundation) models to effectively decode and interpret biosignals. We discuss the challenges posed for incorporating such methods and introduce BioCodec, an alternative representation learning framework inspired by neural codecs to capture low-level signal characteristics in the form of discrete tokens. Pre-trained on thousands of EEG hours, BioCodec shows efficacy across multiple downstream tasks, ranging from clinical diagnostic tasks and sleep physiology to decoding speech and motor imagery, particularly in low-resource settings. Additionally, we provide a qualitative analysis of codebook usage and estimate the spatial coherence of codebook embeddings from EEG connectivity. Notably, we also document the suitability of our method to other biosignal data, i.e., electromyographic (EMG) signals. Overall, the proposed approach provides a versatile solution for biosignal tokenization that performs competitively with state-of-the-art models. The source code and model checkpoints are shared.

Radiology reporting generative AI holds significant potential to alleviate clinical workloads and streamline medical care. However, achieving high clinical accuracy is challenging, as radiological images often feature subtle lesions and intricate structures. Existing systems often fall short, largely due to their reliance on fixed size, patch-level image features and insufficient incorporation of pathological information. This can result in the neglect of such subtle patterns and inconsistent descriptions of crucial pathologies. To address these challenges, we propose an innovative approach that leverages pathology-aware regional prompts to explicitly integrate anatomical and pathological information of various scales, significantly enhancing the precision and clinical relevance of generated reports. We develop an anatomical region detector that extracts features from distinct anatomical areas, coupled with a novel multi-label lesion detector that identifies global pathologies. Our approach emulates the diagnostic process of radiologists, producing clinically accurate reports with comprehensive diagnostic capabilities. Experimental results show that our model outperforms previous state-of-the-art methods on most natural language generation and clinical efficacy metrics, with formal expert evaluations affirming its potential to enhance radiology practice.

As the global burden of Alzheimer's disease (AD) continues to grow, early and accurate detection has become increasingly critical, especially in regions with limited access to advanced diagnostic tools. We propose BRAINS (Biomedical Retrieval-Augmented Intelligence for Neurodegeneration Screening) to address this challenge. This novel system harnesses the powerful reasoning capabilities of Large Language Models (LLMs) for Alzheimer's detection and monitoring. BRAINS features a dual-module architecture: a cognitive diagnostic module and a case-retrieval module. The Diagnostic Module utilizes LLMs fine-tuned on cognitive and neuroimaging datasets -- including MMSE, CDR scores, and brain volume metrics -- to perform structured assessments of Alzheimer's risk. Meanwhile, the Case Retrieval Module encodes patient profiles into latent representations and retrieves similar cases from a curated knowledge base. These auxiliary cases are fused with the input profile via a Case Fusion Layer to enhance contextual understanding. The combined representation is then processed with clinical prompts for inference. Evaluations on real-world datasets demonstrate BRAINS effectiveness in classifying disease severity and identifying early signs of cognitive decline. This system not only shows strong potential as an assistive tool for scalable, explainable, and early-stage Alzheimer's disease detection, but also offers hope for future applications in the field.

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

Recently computer-aided diagnosis has demonstrated promising performance, effectively alleviating the workload of clinicians. However, the inherent sample imbalance among different diseases leads algorithms biased to the majority categories, leading to poor performance for rare categories. Existing works formulated this challenge as a long-tailed problem and attempted to tackle it by decoupling the feature representation and classification. Yet, due to the imbalanced distribution and limited samples from tail classes, these works are prone to biased representation learning and insufficient classifier calibration. To tackle these problems, we propose a new Long-tailed Medical Diagnosis (LMD) framework for balanced medical image classification on long-tailed datasets. In the initial stage, we develop a Relation-aware Representation Learning (RRL) scheme to boost the representation ability by encouraging the encoder to capture intrinsic semantic features through different data augmentations. In the subsequent stage, we propose an Iterative Classifier Calibration (ICC) scheme to calibrate the classifier iteratively. This is achieved by generating a large number of balanced virtual features and fine-tuning the encoder using an Expectation-Maximization manner. The proposed ICC compensates for minority categories to facilitate unbiased classifier optimization while maintaining the diagnostic knowledge in majority classes. Comprehensive experiments on three public long-tailed medical datasets demonstrate that our LMD framework significantly surpasses state-of-the-art approaches. The source code can be accessed at https://github.com/peterlipan/LMD.

Pre-trained neural language models give high performance on natural language inference (NLI) tasks. But whether they actually understand the meaning of the processed sequences remains unclear. We propose a new diagnostics test suite which allows to assess whether a dataset constitutes a good testbed for evaluating the models' meaning understanding capabilities. We specifically apply controlled corruption transformations to widely used benchmarks (MNLI and ANLI), which involve removing entire word classes and often lead to non-sensical sentence pairs. If model accuracy on the corrupted data remains high, then the dataset is likely to contain statistical biases and artefacts that guide prediction. Inversely, a large decrease in model accuracy indicates that the original dataset provides a proper challenge to the models' reasoning capabilities. Hence, our proposed controls can serve as a crash test for developing high quality data for NLI tasks.

Current evaluation protocols for Vision-Language Models (VLMs) in Radiology Report Generation (RRG) rely on report-level metrics that measure lexical overlap or aggregate clinical correctness. However, such metrics do not test whether individual diagnostic statements stem from the actual pathological evidence visible in the image. This allows models to achieve competitive scores by exploiting learned priors or spurious correlations, a failure mode we refer to as vision shortcut. We introduce SHOVIR, a benchmark for evaluating vision shortcut behavior in RRG. SHOVIR extends two spatially annotated chest X-ray datasets, MIMIC-CXR and PadChest-GR, with per-box CheXpert labels, and defines image-level and disease-level occlusion experiments that contrast baseline performance on clean images against localized, region-specific perturbations. Comparing predictions across these conditions isolates two failure modes at the disease-class level: direct shortcuts, where a finding persists after its visual evidence is removed, and contextual shortcuts, where detection degrades once co-occurring pathologies are occluded despite the target region remaining intact. Benchmarking eight state-of-the-art VLMs, we find that shortcut behavior varies substantially across architectures and datasets. Models achieving the highest baseline report quality do not necessarily rank highest in spatial grounding, revealing that clinically fluent generation can coexist with shallow reliance on visual evidence. These findings expose a blind spot in current RRG evaluation and motivate region-aware assessment protocols.

LLMs for clinical decision support often fail under small but clinically meaningful input shifts such as masking a symptom or negating a finding, despite high performance on static benchmarks. These reasoning failures frequently go undetected by standard NLP metrics, which are insensitive to latent representation shifts that drive diagnosis instability. We propose a geometry-aware evaluation framework, LAPD (Latent Agentic Perturbation Diagnostics), which systematically probes the latent robustness of clinical LLMs under structured adversarial edits. Within this framework, we introduce Latent Diagnosis Flip Rate (LDFR), a model-agnostic diagnostic signal that captures representational instability when embeddings cross decision boundaries in PCA-reduced latent space. Clinical notes are generated using a structured prompting pipeline grounded in diagnostic reasoning, then perturbed along four axes: masking, negation, synonym replacement, and numeric variation to simulate common ambiguities and omissions. We compute LDFR across both foundation and clinical LLMs, finding that latent fragility emerges even under minimal surface-level changes. Finally, we validate our findings on 90 real clinical notes from the DiReCT benchmark (MIMIC-IV), confirming the generalizability of LDFR beyond synthetic settings. Our results reveal a persistent gap between surface robustness and semantic stability, underscoring the importance of geometry-aware auditing in safety-critical clinical AI.

Clinical diagnosis prediction models, when provided with a patient's medical history, aim to detect potential diseases early, facilitating timely intervention and improving prognostic outcomes. However, the inherent scarcity of patient data and large disease candidate space often pose challenges in developing satisfactory models for this intricate task. The exploration of leveraging Large Language Models (LLMs) for encapsulating clinical decision processes has been limited. We introduce MERA, a clinical diagnosis prediction model that bridges pertaining natural language knowledge with medical practice. We apply hierarchical contrastive learning on a disease candidate ranking list to alleviate the large decision space issue. With concept memorization through fine-tuning, we bridge the natural language clinical knowledge with medical codes. Experimental results on MIMIC-III and IV datasets show that MERA achieves the state-of-the-art diagnosis prediction performance and dramatically elevates the diagnosis prediction capabilities of generative LMs.

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available.

The recent surge of foundation models in computer vision and natural language processing opens up perspectives in utilizing multi-modal clinical data to train large models with strong generalizability. Yet pathological image datasets often lack biomedical text annotation and enrichment. Guiding data-efficient image diagnosis from the use of biomedical text knowledge becomes a substantial interest. In this paper, we propose to Connect Image and Text Embeddings (CITE) to enhance pathological image classification. CITE injects text insights gained from language models pre-trained with a broad range of biomedical texts, leading to adapt foundation models towards pathological image understanding. Through extensive experiments on the PatchGastric stomach tumor pathological image dataset, we demonstrate that CITE achieves leading performance compared with various baselines especially when training data is scarce. CITE offers insights into leveraging in-domain text knowledge to reinforce data-efficient pathological image classification. Code is available at https://github.com/Yunkun-Zhang/CITE.

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

Fine-grained steering of language model outputs is essential for safety and reliability. Prompting and finetuning are widely used to achieve these goals, but interpretability researchers have proposed a variety of representation-based techniques as well, including sparse autoencoders (SAEs), linear artificial tomography, supervised steering vectors, linear probes, and representation finetuning. At present, there is no benchmark for making direct comparisons between these proposals. Therefore, we introduce AxBench, a large-scale benchmark for steering and concept detection, and report experiments on Gemma-2-2B and 9B. For steering, we find that prompting outperforms all existing methods, followed by finetuning. For concept detection, representation-based methods such as difference-in-means, perform the best. On both evaluations, SAEs are not competitive. We introduce a novel weakly-supervised representational method (Rank-1 Representation Finetuning; ReFT-r1), which is competitive on both tasks while providing the interpretability advantages that prompting lacks. Along with AxBench, we train and publicly release SAE-scale feature dictionaries for ReFT-r1 and DiffMean.

In computational pathology, understanding and generation have evolved along disparate paths: advanced understanding models already exhibit diagnostic-level competence, whereas generative models largely simulate pixels. Progress remains hindered by three coupled factors: the scarcity of large, high-quality image-text corpora; the lack of precise, fine-grained semantic control, which forces reliance on non-semantic cues; and terminological heterogeneity, where diverse phrasings for the same diagnostic concept impede reliable text conditioning. We introduce UniPath, a semantics-driven pathology image generation framework that leverages mature diagnostic understanding to enable controllable generation. UniPath implements Multi-Stream Control: a Raw-Text stream; a High-Level Semantics stream that uses learnable queries to a frozen pathology MLLM to distill paraphrase-robust Diagnostic Semantic Tokens and to expand prompts into diagnosis-aware attribute bundles; and a Prototype stream that affords component-level morphological control via a prototype bank. On the data front, we curate a 2.65M image-text corpus and a finely annotated, high-quality 68K subset to alleviate data scarcity. For a comprehensive assessment, we establish a four-tier evaluation hierarchy tailored to pathology. Extensive experiments demonstrate UniPath's SOTA performance, including a Patho-FID of 80.9 (51% better than the second-best) and fine-grained semantic control achieving 98.7% of the real-image. The meticulously curated datasets, complete source code, and pre-trained model weights developed in this study will be made openly accessible to the public.

Representation learning has been a critical topic in machine learning. In Click-through Rate Prediction, most features are represented as embedding vectors and learned simultaneously with other parameters in the model. With the development of CTR models, feature representation learning has become a trending topic and has been extensively studied by both industrial and academic researchers in recent years. This survey aims at summarizing the feature representation learning in a broader picture and pave the way for future research. To achieve such a goal, we first present a taxonomy of current research methods on feature representation learning following two main issues: (i) which feature to represent and (ii) how to represent these features. Then we give a detailed description of each method regarding these two issues. Finally, the review concludes with a discussion on the future directions of this field.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Tool-augmented large language models (LLMs) are rapidly being integrated into real-world applications. Due to the lack of benchmarks, the community still needs to fully understand the hallucination issues within these models. To address this challenge, we introduce a comprehensive diagnostic benchmark, ToolBH. Specifically, we assess the LLM's hallucinations through two perspectives: depth and breadth. In terms of depth, we propose a multi-level diagnostic process, including (1) solvability detection, (2) solution planning, and (3) missing-tool analysis. For breadth, we consider three scenarios based on the characteristics of the toolset: missing necessary tools, potential tools, and limited functionality tools. Furthermore, we developed seven tasks and collected 700 evaluation samples through multiple rounds of manual annotation. The results show the significant challenges presented by the ToolBH benchmark. The current advanced models Gemini-1.5-Pro and GPT-4o only achieve a total score of 45.3 and 37.0, respectively, on a scale of 100. In this benchmark, larger model parameters do not guarantee better performance; the training data and response strategies also play a crucial role in tool-enhanced LLM scenarios. Our diagnostic analysis indicates that the primary reason for model errors lies in assessing task solvability. Additionally, open-weight models suffer from performance drops with verbose replies, whereas proprietary models excel with longer reasoning.

Accurate brain tumor diagnosis requires models to not only detect lesions but also generate clinically interpretable reasoning grounded in imaging manifestations, yet existing public datasets remain limited in annotation richness and diagnostic semantics. To bridge this gap, we introduce MM-NeuroOnco, a large-scale multimodal benchmark and instruction-tuning dataset for brain tumor MRI understanding, consisting of 24,726 MRI slices from 20 data sources paired with approximately 200,000 semantically enriched multimodal instructions spanning diverse tumor subtypes and imaging modalities. To mitigate the scarcity and high cost of diagnostic semantic annotations, we develop a multi-model collaborative pipeline for automated medical information completion and quality control, enabling the generation of diagnosis-related semantics beyond mask-only annotations. Building upon this dataset, we further construct MM-NeuroOnco-Bench, a manually annotated evaluation benchmark with a rejection-aware setting to reduce biases inherent in closed-ended question formats. Evaluation across ten representative models shows that even the strongest baseline, Gemini 3 Flash, achieves only 41.88% accuracy on diagnosis-related questions, highlighting the substantial challenges of multimodal brain tumor diagnostic understanding. Leveraging MM-NeuroOnco, we further propose NeuroOnco-GPT, which achieves a 27% absolute accuracy improvement on diagnostic questions following fine-tuning. This result demonstrates the effectiveness of our dataset and benchmark in advancing clinically grounded multimodal diagnostic reasoning. Code and dataset are publicly available at: https://github.com/gfnnnb/MM-NeuroOnco

We introduce MentalBench, a benchmark for evaluating psychiatric diagnostic decision-making in large language models (LLMs). Existing mental health benchmarks largely rely on social media data, limiting their ability to assess DSM-grounded diagnostic judgments. At the core of MentalBench is MentalKG, a psychiatrist-built and validated knowledge graph encoding DSM-5 diagnostic criteria and differential diagnostic rules for 23 psychiatric disorders. Using MentalKG as a golden-standard logical backbone, we generate 24,750 synthetic clinical cases that systematically vary in information completeness and diagnostic complexity, enabling low-noise and interpretable evaluation. Our experiments show that while state-of-the-art LLMs perform well on structured queries probing DSM-5 knowledge, they struggle to calibrate confidence in diagnostic decision-making when distinguishing between clinically overlapping disorders. These findings reveal evaluation gaps not captured by existing benchmarks.

We present a method for diagnosing interpretation in neural networks by identifying an input subspace where a proposed interpretation is highly faithful. Our method is particularly useful for causal-abstraction-style interpretability, where a high-level causal hypothesis is evaluated by interchange interventions. Rather than treating interchange intervention accuracy as a single global summary, we refine this framework by partitioning the input space into well-interpreted and under-interpreted regions according to pairwise interchange-intervention behavior. This turns causal abstraction from a purely global evaluation into a more diagnostic tool: it not only measures whether an interpretation works, but also reveals where it works, where it fails, and what distinguishes the two cases. This diagnostic view also provides practical heuristics for improving interpretations. By analyzing the structure of the well-interpreted and under-interpreted regions, we can identify missing distinctions in a high-level hypothesis, discover previously unmodeled intermediate variables, and combine complementary partial interpretations into a stronger one. We instantiate this idea as a simple four-step recipe and show that it yields informative error analyses across multiple causal abstraction settings. In a toy logic task, recursively applying the recipe recovers a high-level hypothesis from scratch. More broadly, our results suggest that partitioning the input space is a useful step toward more precise, constructive, and scalable mechanistic interpretability.

Medical imaging is widely used in clinical practice for diagnosis and treatment. Report-writing can be error-prone for unexperienced physicians, and time- consuming and tedious for experienced physicians. To address these issues, we study the automatic generation of medical imaging reports. This task presents several challenges. First, a complete report contains multiple heterogeneous forms of information, including findings and tags. Second, abnormal regions in medical images are difficult to identify. Third, the re- ports are typically long, containing multiple sentences. To cope with these challenges, we (1) build a multi-task learning framework which jointly performs the pre- diction of tags and the generation of para- graphs, (2) propose a co-attention mechanism to localize regions containing abnormalities and generate narrations for them, (3) develop a hierarchical LSTM model to generate long paragraphs. We demonstrate the effectiveness of the proposed methods on two publicly available datasets.

Rare diseases collectively affect over 300 million individuals worldwide, yet timely and accurate diagnosis remains a pervasive challenge. This is largely due to their clinical heterogeneity, low individual prevalence, and the limited familiarity most clinicians have with rare conditions. Here, we introduce DeepRare, the first rare disease diagnosis agentic system powered by a large language model (LLM), capable of processing heterogeneous clinical inputs. The system generates ranked diagnostic hypotheses for rare diseases, each accompanied by a transparent chain of reasoning that links intermediate analytic steps to verifiable medical evidence. DeepRare comprises three key components: a central host with a long-term memory module; specialized agent servers responsible for domain-specific analytical tasks integrating over 40 specialized tools and web-scale, up-to-date medical knowledge sources, ensuring access to the most current clinical information. This modular and scalable design enables complex diagnostic reasoning while maintaining traceability and adaptability. We evaluate DeepRare on eight datasets. The system demonstrates exceptional diagnostic performance among 2,919 diseases, achieving 100% accuracy for 1013 diseases. In HPO-based evaluations, DeepRare significantly outperforms other 15 methods, like traditional bioinformatics diagnostic tools, LLMs, and other agentic systems, achieving an average Recall@1 score of 57.18% and surpassing the second-best method (Reasoning LLM) by a substantial margin of 23.79 percentage points. For multi-modal input scenarios, DeepRare achieves 70.60% at Recall@1 compared to Exomiser's 53.20% in 109 cases. Manual verification of reasoning chains by clinical experts achieves 95.40% agreements. Furthermore, the DeepRare system has been implemented as a user-friendly web application http://raredx.cn/doctor.

We study how large language models recall relational knowledge during text generation, with a focus on identifying latent representations suitable for relation classification via linear probes. Prior work shows how attention heads and MLPs interact to resolve subject, predicate, and object, but it remains unclear which representations support faithful linear relation classification and why some relation types are easier to capture linearly than others. We systematically evaluate different latent representations derived from attention head and MLP contributions, showing that per-head attention contributions to the residual stream are comparatively strong features for linear relation classification. Feature attribution analyses of the trained probes, as well as characteristics of the different relation types, reveal clear correlations between probe accuracy and relation specificity, entity connectedness, and how distributed the signal on which the probe relies is across attention heads. Finally, we show how token-level feature attribution of probe predictions can be used to reveal probe behavior in further detail.

Accurate disease interpretation from radiology remains challenging due to imaging heterogeneity. Achieving expert-level diagnostic decisions requires integration of subtle image features with clinical knowledge. Yet major vision-language models (VLMs) treat images as holistic entities and overlook fine-grained image details that are vital for disease diagnosis. Clinicians analyze images by utilizing their prior medical knowledge and identify anatomical structures as important region of interests (ROIs). Inspired from this human-centric workflow, we introduce Anatomy-VLM, a fine-grained, vision-language model that incorporates multi-scale information. First, we design a model encoder to localize key anatomical features from entire medical images. Second, these regions are enriched with structured knowledge for contextually-aware interpretation. Finally, the model encoder aligns multi-scale medical information to generate clinically-interpretable disease prediction. Anatomy-VLM achieves outstanding performance on both in- and out-of-distribution datasets. We also validate the performance of Anatomy-VLM on downstream image segmentation tasks, suggesting that its fine-grained alignment captures anatomical and pathology-related knowledge. Furthermore, the Anatomy-VLM's encoder facilitates zero-shot anatomy-wise interpretation, providing its strong expert-level clinical interpretation capabilities.

Vision-language models in pathology enable multimodal case retrieval and automated report generation. Many of the models developed so far, however, have been trained on pathology reports that include information which cannot be inferred from paired whole slide images (e.g., patient history), potentially leading to hallucinated sentences in generated reports. To this end, we investigate how the selection of information from pathology reports for vision-language modeling affects the quality of the multimodal representations and generated reports. More concretely, we compare a model trained on full reports against a model trained on preprocessed reports that only include sentences describing the cell and tissue appearances based on the H&E-stained slides. For the experiments, we built upon the BLIP-2 framework and used a cutaneous melanocytic lesion dataset of 42,433 H&E-stained whole slide images and 19,636 corresponding pathology reports. Model performance was assessed using image-to-text and text-to-image retrieval, as well as qualitative evaluation of the generated reports by an expert pathologist. Our results demonstrate that text preprocessing prevents hallucination in report generation. Despite the improvement in the quality of the generated reports, training the vision-language model on full reports showed better cross-modal retrieval performance.

An effective method for combining frozen large language models (LLM) and visual encoders involves a resampler module that creates a `visual prompt' which is provided to the LLM, along with the textual prompt. While this approach has enabled impressive performance across many coarse-grained tasks like image captioning and visual question answering, more fine-grained tasks that require spatial understanding have not been thoroughly examined. In this paper, we use diagnostic classifiers to measure the extent to which the visual prompt produced by the resampler encodes spatial information. Our results show that this information is largely absent from the resampler output when kept frozen during training of the classifiers. However, when the resampler and classifier are trained jointly, we observe a significant performance boost. This shows that the compression achieved by the resamplers can in principle encode the requisite spatial information, but that more object-aware objectives are needed at the pretraining stage to facilitate this capability

Medical diagnostic applications require models that can process multimodal medical inputs (images, patient histories, lab results) and generate diverse outputs including both textual reports and visual content (annotations, segmentation masks, and images). Despite this need, existing medical AI systems disrupt this unified process: medical image understanding models interpret images but cannot generate visual outputs, while medical image generation models synthesize images but cannot provide textual explanations. This leads to gaps in data representation, feature integration, and task-level multimodal capabilities. To this end, we propose a multi-level framework that draws inspiration from diagnostic workflows through the Observation-Knowledge-Analysis (OKA) paradigm. Specifically, at the observation level, we construct UniMed-5M, a dataset comprising over 5.6M samples that reformat diverse unimodal data into multimodal pairs for foundational observation. At the knowledge level, we propose Progressive Curriculum Learning that systematically introduces medical multimodal knowledge. At the analysis level, we introduce UniMedVL, the first medical unified multimodal model for the simultaneous analysis of image understanding and generation tasks within a single architecture. UniMedVL achieves superior performance on five medical image understanding benchmarks, while matching specialized models in generation quality across eight medical imaging modalities. Crucially, our unified architecture enables bidirectional knowledge sharing: generation tasks enhance visual understanding features, demonstrating that integrating traditionally separate capabilities within a single medical framework unlocks improvements across diverse medical vision-language tasks. Code is available at https://github.com/uni-medical/UniMedVL.

Robust benchmarks are crucial for evaluating Multimodal Large Language Models (MLLMs). Yet we find that models can ace many multimodal benchmarks without strong visual understanding, instead exploiting biases, linguistic priors, and superficial patterns. This is especially problematic for vision-centric benchmarks that are meant to require visual inputs. We adopt a diagnostic principle for benchmark design: if a benchmark can be gamed, it will be. Designers should therefore try to ``game'' their own benchmarks first, using diagnostic and debiasing procedures to systematically identify and mitigate non-visual biases. Effective diagnosis requires directly ``training on the test set'' -- probing the released test set for its intrinsic, exploitable patterns. We operationalize this standard with two components. First, we diagnose benchmark susceptibility using a ``Test-set Stress-Test'' (TsT) methodology. Our primary diagnostic tool involves fine-tuning a powerful Large Language Model via k-fold cross-validation on exclusively the non-visual, textual inputs of the test set to reveal shortcut performance and assign each sample a bias score s(x). We complement this with a lightweight Random Forest-based diagnostic operating on hand-crafted features for fast, interpretable auditing. Second, we debias benchmarks by filtering high-bias samples using an ``Iterative Bias Pruning'' (IBP) procedure. Applying this framework to four benchmarks -- VSI-Bench, CV-Bench, MMMU, and VideoMME -- we uncover pervasive non-visual biases. As a case study, we apply our full framework to create VSI-Bench-Debiased, demonstrating reduced non-visual solvability and a wider vision-blind performance gap than the original.

In this work, we study the challenge of providing human-understandable descriptions for failure modes in trained image classification models. Existing works address this problem by first identifying clusters (or directions) of incorrectly classified samples in a latent space and then aiming to provide human-understandable text descriptions for them. We observe that in some cases, describing text does not match well with identified failure modes, partially owing to the fact that shared interpretable attributes of failure modes may not be captured using clustering in the feature space. To improve on these shortcomings, we propose a novel approach that prioritizes interpretability in this problem: we start by obtaining human-understandable concepts (tags) of images in the dataset and then analyze the model's behavior based on the presence or absence of combinations of these tags. Our method also ensures that the tags describing a failure mode form a minimal set, avoiding redundant and noisy descriptions. Through several experiments on different datasets, we show that our method successfully identifies failure modes and generates high-quality text descriptions associated with them. These results highlight the importance of prioritizing interpretability in understanding model failures.

Recent advancements in Large Language Models (LLMs) have demonstrated significant promise in clinical diagnosis. However, current models struggle to emulate the iterative, diagnostic hypothesis-driven reasoning of real clinical scenarios. Specifically, current LLMs suffer from three critical limitations: (1) generating hallucinated medical content due to weak grounding in verified knowledge, (2) asking redundant or inefficient questions rather than discriminative ones that hinder diagnostic progress, and (3) losing coherence over multi-turn dialogues, leading to contradictory or inconsistent conclusions. To address these challenges, we propose MedKGI, a diagnostic framework grounded in clinical practices. MedKGI integrates a medical knowledge graph (KG) to constrain reasoning to validated medical ontologies, selects questions based on information gain to maximize diagnostic efficiency, and adopts an OSCE-format structured state to maintain consistent evidence tracking across turns. Experiments on clinical benchmarks show that MedKGI outperforms strong LLM baselines in both diagnostic accuracy and inquiry efficiency, improving dialogue efficiency by 30% on average while maintaining state-of-the-art accuracy.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Traditionally, AI research in medical diagnosis has largely centered on image analysis. While this has led to notable advancements, the absence of patient-reported symptoms continues to hinder diagnostic accuracy. To address this, we propose a Pre-Consultation Dialogue Framework (PCDF) that mimics real-world diagnostic procedures, where doctors iteratively query patients before reaching a conclusion. Specifically, we simulate diagnostic dialogues between two vision-language models (VLMs): a DocVLM, which generates follow-up questions based on the image and dialogue history, and a PatientVLM, which responds using a symptom profile derived from the ground-truth diagnosis. We additionally conducted a small-scale clinical validation of the synthetic symptoms generated by our framework, with licensed clinicians confirming their clinical relevance, symptom coverage, and overall realism. These findings indicate that the resulting DocVLM-PatientVLM interactions form coherent, multi-turn consultations paired with images and diagnoses, which we then use to fine-tune the DocVLM. This dialogue-based supervision leads to substantial gains over image-only training, highlighting the value of realistic symptom elicitation for diagnosis.

We introduce an axiomatic evaluation framework for latent thought representations in LLMs, comprising metrics that are independent of downstream benchmark scores and reveal representational failures that benchmark accuracy masks. Existing evaluations conflate representation quality with model capacity. Therefore, failures cannot be attributed to the representation rather than to the model that processes it. We formalize four functional axioms (Causality, Minimality, Separability, and Stability) and define a quantitative measure for each, computed directly on the representation independently of downstream accuracy. We audit open-weight LLMs across 23 reasoning tasks (e.g., Spatial Reasoning, Factual QA). We find that no candidate satisfies all four axioms simultaneously, that the representations distinguish task type reliably but cannot distinguish between two questions within the same task, and that the representations encode little information beyond what is already present in the input embedding. The failure is consistent across dense, reasoning-distilled, and RL-trained model families, indicating that the gap is structural rather than a property of model size or training procedure.

Radiology report evaluation is essential for advancing automated report generation. Natural language generation metrics have limited clinical relevance. Clinical efficacy (CE) metrics evaluate important medical findings, but focus mainly on presence and cover only a limited set of entities. Due to heavy reliance on manual annotations, it is difficult for CE metrics to extend clinical entities or attributes. In clinical practice, radiology reports serve as a medium for information transfer. Clinicians use them to perform downstream diagnostic tasks without directly inspecting images. Based on this insight, we propose ReportQA, a clinical-related and flexible radiology report evaluation framework, supporting detailed quantitative analysis of radiology report generation systems. We first collect datasets covering multiple imaging modalities and anatomical regions. We then construct knowledge trees of clinical entities and attributes with radiologist guidance, and use large language models (LLMs) to extract structured information from raw reports. Next, we generate QA pairs from predefined templates and apply quality control through self-filtering and report-based filtering. During evaluation, the report is treated as context, and an LLM acts as a judge model to answer the QA pairs. Based on the resulting QA accuracy, we introduce QAScore metric. Compared with existing metrics, QAScore shows better alignment with radiologist judgments. Experiments on multiple state-of-the-art vision-language models reveal that current report-based inference paradigms struggle to learn fine-grained clinical representations and exhibit strong negative prior biases. In contrast, question-driven inference provides a more effective alternative. For reproducibility and extensibility, we release the knowledge trees, structured reports, and QA pairs, along with the pipeline code for QA construction and evaluation.

Pathology plays a critical role in diagnosing a wide range of diseases, yet existing approaches often rely heavily on task-specific models trained on extensive, well-labeled datasets. These methods face sustainability challenges due to the diversity of pathologies and the labor-intensive nature of data collection. To address these limitations, we highlight the need for universal multimodal embeddings that can support multiple downstream tasks. Previous approaches often involve fine-tuning CLIP-based models, which handle images and text separately, limiting their ability to capture complex multimodal relationships. Additionally, these models are evaluated across diverse datasets without a unified benchmark for assessing multimodal embeddings in pathology. To address these challenges, we propose MLLM4PUE, a novel framework that leverages Multimodal Large Language Models (MLLMs) to generate Pathology Universal Embeddings. The MLLM4PUE framework not only facilitates robust integration of images and text but also enhances understanding and fusion capabilities across various tasks. We further introduce the Pathology Multimodal Embedding Benchmark (PMEB), a comprehensive benchmark designed to assess the quality of pathology multimodal embeddings. PMEB comprises 15 original tasks drawn from 14 datasets, organized into three meta-tasks: retrieval, classification, and composed retrieval. Experimental results demonstrate the superiority of MLLM4PUE, illustrating MLLM-based models can effectively support a wide range of downstream tasks and unify the research direction for foundation models in pathology.

Rare diseases, including Inborn Errors of Metabolism (IEM), pose significant diagnostic challenges. Case reports serve as key but computationally underutilized resources to inform diagnosis. Clinical dense information extraction refers to organizing medical information into structured predefined categories. Large Language Models (LLMs) may enable scalable information extraction from case reports but are rarely evaluated for this task. We introduce CaseReportBench, an expert-annotated dataset for dense information extraction of case reports, focusing on IEMs. Using this dataset, we assess various models and prompting strategies, introducing novel approaches such as category-specific prompting and subheading-filtered data integration. Zero-shot chain-of-thought prompting offers little advantage over standard zero-shot prompting. Category-specific prompting improves alignment with the benchmark. The open-source model Qwen2.5-7B outperforms GPT-4o for this task. Our clinician evaluations show that LLMs can extract clinically relevant details from case reports, supporting rare disease diagnosis and management. We also highlight areas for improvement, such as LLMs' limitations in recognizing negative findings important for differential diagnosis. This work advances LLM-driven clinical natural language processing and paves the way for scalable medical AI applications.

Large Language Models (LLMs) have demonstrated impressive generative capabilities across diverse tasks but remain susceptible to hallucinations, confidently generated yet factually incorrect outputs. We introduce a reference-free, token-level hallucination detection framework that leverages the variance in token log-probabilities across multiple stochastic generations. Unlike prior methods that require ground-truth references or sentence-level verification, our approach is model-agnostic, interpretable, and suited for real-time or post-hoc analysis. We evaluate our method on unanswerable question prompts from the SQuAD v2 dataset and benchmark across three autoregressive models of varying scales: GPT-Neo 125M, Falcon 1B, and Mistral 7B. Through both quantitative metrics and visual diagnostics, we show that token-level variance reliably highlights instability in model outputs and correlates with hallucination patterns. Our framework is lightweight, reproducible, and adaptable to multiple domains, offering a valuable diagnostic tool for analyzing generative reliability in LLMs.

When building artificial intelligence systems that can reason and answer questions about visual data, we need diagnostic tests to analyze our progress and discover shortcomings. Existing benchmarks for visual question answering can help, but have strong biases that models can exploit to correctly answer questions without reasoning. They also conflate multiple sources of error, making it hard to pinpoint model weaknesses. We present a diagnostic dataset that tests a range of visual reasoning abilities. It contains minimal biases and has detailed annotations describing the kind of reasoning each question requires. We use this dataset to analyze a variety of modern visual reasoning systems, providing novel insights into their abilities and limitations.

Conventional imaging diagnostics frequently encounter bottlenecks due to manual inspection, which can lead to delays and inconsistencies. Although deep learning offers a pathway to automation and enhanced accuracy, foundational models in computer vision often emphasize global context at the expense of local details, which are vital for medical imaging diagnostics. To address this, we harness the Swin Transformer's capacity to discern extended spatial dependencies within images through the hierarchical framework. Our novel contribution lies in refining local feature representations, orienting them specifically toward the final distribution of the classifier. This method ensures that local features are not only preserved but are also enriched with task-specific information, enhancing their relevance and detail at every hierarchical level. By implementing this strategy, our model demonstrates significant robustness and precision, as evidenced by extensive validation of two established benchmarks for Knee OsteoArthritis (KOA) grade classification. These results highlight our approach's effectiveness and its promising implications for the future of medical imaging diagnostics. Our implementation is available on https://github.com/mtliba/KOA_NLCS2024

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

Few shot classification aims to learn to recognize novel categories using only limited samples per category. Most current few shot methods use a base dataset rich in labeled examples to train an encoder that is used for obtaining representations of support instances for novel classes. Since the test instances are from a distribution different to the base distribution, their feature representations are of poor quality, degrading performance. In this paper we propose to make use of the well-trained feature representations of the base dataset that are closest to each support instance to improve its representation during meta-test time. To this end, we propose BaseTransformers, that attends to the most relevant regions of the base dataset feature space and improves support instance representations. Experiments on three benchmark data sets show that our method works well for several backbones and achieves state-of-the-art results in the inductive one shot setting. Code is available at github.com/mayug/BaseTransformers

Zero-shot medical detection can further improve detection performance without relying on annotated medical images even upon the fine-tuned model, showing great clinical value. Recent studies leverage grounded vision-language models (GLIP) to achieve this by using detailed disease descriptions as prompts for the target disease name during the inference phase. However, these methods typically treat prompts as equivalent context to the target name, making it difficult to assign specific disease knowledge based on visual information, leading to a coarse alignment between images and target descriptions. In this paper, we propose StructuralGLIP, which introduces an auxiliary branch to encode prompts into a latent knowledge bank layer-by-layer, enabling more context-aware and fine-grained alignment. Specifically, in each layer, we select highly similar features from both the image representation and the knowledge bank, forming structural representations that capture nuanced relationships between image patches and target descriptions. These features are then fused across modalities to further enhance detection performance. Extensive experiments demonstrate that StructuralGLIP achieves a +4.1\% AP improvement over prior state-of-the-art methods across seven zero-shot medical detection benchmarks, and consistently improves fine-tuned models by +3.2\% AP on endoscopy image datasets.

Radiology reports contain rich clinical information that can be used to train imaging models without relying on costly manual annotation. However, existing approaches face critical limitations: rule-based methods struggle with linguistic variability, supervised models require large annotated datasets, and recent LLM-based systems depend on closed-source or resource-intensive models that are unsuitable for clinical use. Moreover, current solutions are largely restricted to English and single-modality, single-taxonomy datasets. We introduce MOSAIC, a multilingual, taxonomy-agnostic, and computationally efficient approach for radiological report classification. Built on a compact open-access language model (MedGemma-4B), MOSAIC supports both zero-/few-shot prompting and lightweight fine-tuning, enabling deployment on consumer-grade GPUs. We evaluate MOSAIC across seven datasets in English, Spanish, French, and Danish, spanning multiple imaging modalities and label taxonomies. The model achieves a mean macro F1 score of 88 across five chest X-ray datasets, approaching or exceeding expert-level performance, while requiring only 24 GB of GPU memory. With data augmentation, as few as 80 annotated samples are sufficient to reach a weighted F1 score of 82 on Danish reports, compared to 86 with the full 1600-sample training set. MOSAIC offers a practical alternative to large or proprietary LLMs in clinical settings. Code and models are open-source. We invite the community to evaluate and extend MOSAIC on new languages, taxonomies, and modalities.

Recent advances in multimodal large language models enable new possibilities for image-based decision support. However, their reliability and operational trade-offs in neuroimaging remain insufficiently understood. We present a comprehensive benchmarking study of vision-enabled large language models for 2D neuroimaging using curated MRI and CT datasets covering multiple sclerosis, stroke, brain tumors, other abnormalities, and normal controls. Models are required to generate multiple outputs simultaneously, including diagnosis, diagnosis subtype, imaging modality, specialized sequence, and anatomical plane. Performance is evaluated across four directions: discriminative classification with abstention, calibration, structured-output validity, and computational efficiency. A multi-phase framework ensures fair comparison while controlling for selection bias. Across twenty frontier multimodal models, the results show that technical imaging attributes such as modality and plane are nearly solved, whereas diagnostic reasoning, especially subtype prediction, remains challenging. Tumor classification emerges as the most reliable task, stroke is moderately solvable, while multiple sclerosis and rare abnormalities remain difficult. Few-shot prompting improves performance for several models but increases token usage, latency, and cost. Gemini-2.5-Pro and GPT-5-Chat achieve the strongest overall diagnostic performance, while Gemini-2.5-Flash offers the best efficiency-performance trade-off. Among open-weight architectures, MedGemma-1.5-4B demonstrates the most promising results, as under few-shot prompting, it approaches the zero-shot performance of several proprietary models, while maintaining perfect structured output. These findings provide practical insights into performance, reliability, and efficiency trade-offs, supporting standardized evaluation of multimodal LLMs in neuroimaging.

Interpreting chest X-rays is inherently challenging due to the overlap between anatomical structures and the subtle presentation of many clinically significant pathologies, making accurate diagnosis time-consuming even for experienced radiologists. Recent radiology-focused foundation models, such as LLaVA-Rad and Maira-2, have positioned multi-modal large language models (MLLMs) at the forefront of automated radiology report generation (RRG). However, despite these advances, current foundation models generate reports in a single forward pass. This decoding strategy diminishes attention to visual tokens and increases reliance on language priors as generation proceeds, which in turn introduces spurious pathology co-occurrences in the generated reports. To mitigate these limitations, we propose Category-Wise Contrastive Decoding (CWCD), a novel and modular framework designed to enhance structured radiology report generation (SRRG). Our approach introduces category-specific parameterization and generates category-wise reports by contrasting normal X-rays with masked X-rays using category-specific visual prompts. Experimental results demonstrate that CWCD consistently outperforms baseline methods across both clinical efficacy and natural language generation metrics. An ablation study further elucidates the contribution of each architectural component to overall performance.

Deep learning based automated pathological diagnosis has markedly improved diagnostic efficiency and reduced variability between observers, yet its clinical adoption remains limited by opaque model decisions and a lack of traceable rationale. To address this, recent multimodal visual reasoning architectures provide a unified framework that generates segmentation masks at the pixel level alongside semantically aligned textual explanations. By localizing lesion regions and producing expert style diagnostic narratives, these models deliver the transparent and interpretable insights necessary for dependable AI assisted pathology. Building on these advancements, we propose PathMR, a cell-level Multimodal visual Reasoning framework for Pathological image analysis. Given a pathological image and a textual query, PathMR generates expert-level diagnostic explanations while simultaneously predicting cell distribution patterns. To benchmark its performance, we evaluated our approach on the publicly available PathGen dataset as well as on our newly developed GADVR dataset. Extensive experiments on these two datasets demonstrate that PathMR consistently outperforms state-of-the-art visual reasoning methods in text generation quality, segmentation accuracy, and cross-modal alignment. These results highlight the potential of PathMR for improving interpretability in AI-driven pathological diagnosis. The code will be publicly available in https://github.com/zhangye-zoe/PathMR.

Training loss and throughput can hide distinct internal representation in language-model training. To examine these hidden mechanics, we use spectral measurements as practical and operational diagnostics. Using a controlled family of decoder-only models adapted from the modded NanoGPT codebase, we introduce an empirical protocol based on activation covariance and per-sample gradient SVD spectra. This dual-view reveals three empirical findings and one mechanistic explanation. First, batch size acts as a latent determinant of representation geometry: runs that reach equal loss settle into systematically distinct activation spectra. Second, the activation covariance tail measured early in training reliably forecasts downstream token efficiency. Third, movement of the activation spectrum head (leading modes), together with gradient spectra, characterizes underlying learning-dynamics changes, separating learning-side architectural improvements from primarily execution-side gains. These predictive and diagnostic signals persist across the 12-, 36-, and 48-layer model tiers. Finally, a mechanistic model proves the main observations and explains how activation covariance spectra correlate with task-aligned feature learning.

Depression is a common mental disorder. Automatic depression detection tools using speech, enabled by machine learning, help early screening of depression. This paper addresses two limitations that may hinder the clinical implementations of such tools: noise resulting from segment-level labelling and a lack of model interpretability. We propose a bi-modal speech-level transformer to avoid segment-level labelling and introduce a hierarchical interpretation approach to provide both speech-level and sentence-level interpretations, based on gradient-weighted attention maps derived from all attention layers to track interactions between input features. We show that the proposed model outperforms a model that learns at a segment level (p=0.854, r=0.947, F1=0.947 compared to p=0.732, r=0.808, F1=0.768). For model interpretation, using one true positive sample, we show which sentences within a given speech are most relevant to depression detection; and which text tokens and Mel-spectrogram regions within these sentences are most relevant to depression detection. These interpretations allow clinicians to verify the validity of predictions made by depression detection tools, promoting their clinical implementations.

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

The application of large vision-language models to computational pathology holds great promise for diagnostic assistants but faces a critical computational bottleneck: the gigapixel scale of Whole Slide Images (WSIs). A single WSI typically contains over 105 patches, creating sequence lengths that exceed the constraints of standard Transformer architectures. Existing solutions often resort to spatial sampling, which risks discarding diagnostically critical evidence. To address this, we propose TC-SSA (Token Compression via Semantic Slot Aggregation), a learnable token compression framework that aggregates patch features into a fixed number of semantic slots. A gated routing module assigns patches to slots using sparse Top-2 routing, followed by weighted aggregation, enabling global slide coverage under a strict token budget. The resulting representation retains diagnostically relevant information while reducing the number of visual tokens to 1.7% of the original sequence. On the SlideBench(TCGA), our model achieves 78.34% overall accuracy and 77.14% on the diagnosis subset, outperforming sampling-based baselines under comparable token budgets. The method also generalizes to MIL classification, reaching AUC of 95.83% on TCGA-BRCA, 98.27% on TCGA-NSCLC and 79.80% on PANDA. These results suggest that learnable semantic aggregation provides an effective trade-off between efficiency and diagnostic performance for gigapixel pathology reasoning.

Chest X-ray plays a central role in thoracic diagnosis, and its interpretation inherently requires multi-step, evidence-grounded reasoning. However, large vision-language models (LVLMs) often generate plausible responses that are not faithfully grounded in diagnostic evidence and provide limited visual evidence for verification, while also requiring costly retraining to support new diagnostic tasks, limiting their reliability and adaptability in clinical settings. To address these limitations, we present CXReasonAgent, a diagnostic agent that integrates a large language model (LLM) with clinically grounded diagnostic tools to perform evidence-grounded diagnostic reasoning using image-derived diagnostic and visual evidence. To evaluate these capabilities, we introduce CXReasonDial, a multi-turn dialogue benchmark with 1,946 dialogues across 12 diagnostic tasks, and show that CXReasonAgent produces faithfully grounded responses, enabling more reliable and verifiable diagnostic reasoning than LVLMs. These findings highlight the importance of integrating clinically grounded diagnostic tools, particularly in safety-critical clinical settings.

Medical decision-making requires integrating diverse medical information, from imaging to clinical narratives. These medical modalities are often acquired in a many-to-many manner. However, current medical vision-language pretraining models (Med-VLPMs) fail to directly account for this many-to-many mapping in their model training and embeddings. To address this, we present Probabilistic Modality-Enhanced Diagnosis (ProbMED), a multimodal Med-VLPM that employs probabilistic contrastive learning to model distributions over embeddings rather than deterministic estimates. ProbMED aligns four distinct modalities -- chest X-rays, electrocardiograms, echocardiograms, and clinical text -- into a unified probabilistic embedding space. We use InfoNCE loss with Hellinger distance to integrate inter-modality distributions. We introduce a probabilistic synthetic sampling loss that captures modality-specific mean and variance to improve intra-modality binding. Extensive experiments across 13 medical datasets demonstrate that our model outperforms current Med-VLPMs in cross-modality retrieval, zero-shot, and few-shot classification. We also demonstrate the robust integration of multiple modalities for prognostication, showing improved intra- and inter-medical modality binding.

Rare diseases affect hundreds of millions worldwide, yet diagnosis often spans years. Convectional pipelines decouple noisy evidence extraction from downstream inferential diagnosis, and general/medical large language models (LLMs) face scarce real world electronic health records (EHRs), stale domain knowledge, and hallucinations. We assemble a large, domain specialized clinical corpus and a clinician validated reasoning set, and develop RareSeek R1 via staged instruction tuning, chain of thought learning, and graph grounded retrieval. Across multicenter EHR narratives and public benchmarks, RareSeek R1 attains state of the art accuracy, robust generalization, and stability under noisy or overlapping phenotypes. Augmented retrieval yields the largest gains when narratives pair with prioritized variants by resolving ambiguity and aligning candidates to mechanisms. Human studies show performance on par with experienced physicians and consistent gains in assistive use. Notably, transparent reasoning highlights decisive non phenotypic evidence (median 23.1%, such as imaging, interventions, functional tests) underpinning many correct diagnoses. This work advances a narrative first, knowledge integrated reasoning paradigm that shortens the diagnostic odyssey and enables auditable, clinically translatable decision support.

Understanding what defines a good representation in large language models (LLMs) is fundamental to both theoretical understanding and practical applications. In this paper, we investigate the quality of intermediate representations in various LLM architectures, including Transformers and State Space Models (SSMs). We find that intermediate layers often yield more informative representations for downstream tasks than the final layers. To measure the representation quality, we adapt and apply a suite of metrics - such as prompt entropy, curvature, and augmentation-invariance - originally proposed in other contexts. Our empirical study reveals significant architectural differences, how representations evolve throughout training, and how factors like input randomness and prompt length affect each layer. Notably, we observe a bimodal pattern in the entropy of some intermediate layers and consider potential explanations tied to training data. Overall, our results illuminate the internal mechanics of LLMs and guide strategies for architectural optimization and training.

Large language models (LLMs) have recently showcased remarkable capabilities, spanning a wide range of tasks and applications, including those in the medical domain. Models like GPT-4 excel in medical question answering but may face challenges in the lack of interpretability when handling complex tasks in real clinical settings. We thus introduce the diagnostic reasoning dataset for clinical notes (DiReCT), aiming at evaluating the reasoning ability and interpretability of LLMs compared to human doctors. It contains 511 clinical notes, each meticulously annotated by physicians, detailing the diagnostic reasoning process from observations in a clinical note to the final diagnosis. Additionally, a diagnostic knowledge graph is provided to offer essential knowledge for reasoning, which may not be covered in the training data of existing LLMs. Evaluations of leading LLMs on DiReCT bring out a significant gap between their reasoning ability and that of human doctors, highlighting the critical need for models that can reason effectively in real-world clinical scenarios.

Visual document retrieval has become essential for accessing information in visually rich documents. Existing approaches fall into two camps. Late-interaction retrievers achieve strong quality through fine-grained token-level matching but store hundreds of vectors per page, incurring large index footprints and high serving costs. By contrast, dense single-vector retrievers retain storage and latency advantages but consistently lag in quality because they compress all information into a single final-layer embedding. In this work, we first conduct a layerwise diagnostic on single-vector retrievers, revealing that retrieval-relevant signal resides in internal representations. Motivated by these findings, we propose MINER (Mining Multimodal Internal RepreseNtation for Efficient Retrieval), a lightweight plug-in module that probes and fuses internal signals across transformer layers into a single compact embedding without modifying the backbone or sacrificing single-vector efficiency. The first Retrieval-Aligned Layer Probing stage attaches a lightweight probe at each layer, surfacing which dimensions carry retrieval-relevant information. The subsequent Adaptive Sparse Multi-Layer Fusion stage applies performance-adaptive neuron-level masking to the selected layers and fuses the surviving signals into the final dense vector. Across ViDoRe V1/V2/V3, MINER outperforms existing dense single-vector retrievers on the majority of benchmarks, with up to 4.5% nDCG@5 improvement over its corresponding backbone. Compared to strong late-interaction baselines, in some settings MINER substantially narrows the nDCG@5 gap to 0.2 while preserving the storage and serving advantages of dense retrieval.

Microscopic interpretation of histopathology images underlies many important diagnostic and treatment decisions. While advances in vision-language modeling raise new opportunities for analysis of such images, the gigapixel-scale size of whole slide images (WSIs) introduces unique challenges. Additionally, pathology reports simultaneously highlight key findings from small regions while also aggregating interpretation across multiple slides, often making it difficult to create robust image-text pairs. As such, pathology reports remain a largely untapped source of supervision in computational pathology, with most efforts relying on region-of-interest annotations or self-supervision at the patch-level. In this work, we develop a vision-language model based on the BLIP-2 framework using WSIs paired with curated text from pathology reports. This enables applications utilizing a shared image-text embedding space, such as text or image retrieval for finding cases of interest, as well as integration of the WSI encoder with a frozen large language model (LLM) for WSI-based generative text capabilities such as report generation or AI-in-the-loop interactions. We utilize a de-identified dataset of over 350,000 WSIs and diagnostic text pairs, spanning a wide range of diagnoses, procedure types, and tissue types. We present pathologist evaluation of text generation and text retrieval using WSI embeddings, as well as results for WSI classification and workflow prioritization (slide-level triaging). Model-generated text for WSIs was rated by pathologists as accurate, without clinically significant error or omission, for 78% of WSIs on average. This work demonstrates exciting potential capabilities for language-aligned WSI embeddings.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

In this study, we introduce FEET, a standardized protocol designed to guide the development and benchmarking of foundation models. While numerous benchmark datasets exist for evaluating these models, we propose a structured evaluation protocol across three distinct scenarios to gain a comprehensive understanding of their practical performance. We define three primary use cases: frozen embeddings, few-shot embeddings, and fully fine-tuned embeddings. Each scenario is detailed and illustrated through two case studies: one in sentiment analysis and another in the medical domain, demonstrating how these evaluations provide a thorough assessment of foundation models' effectiveness in research applications. We recommend this protocol as a standard for future research aimed at advancing representation learning models.

Most of the recent works on probing representations have focused on BERT, with the presumption that the findings might be similar to the other models. In this work, we extend the probing studies to two other models in the family, namely ELECTRA and XLNet, showing that variations in the pre-training objectives or architectural choices can result in different behaviors in encoding linguistic information in the representations. Most notably, we observe that ELECTRA tends to encode linguistic knowledge in the deeper layers, whereas XLNet instead concentrates that in the earlier layers. Also, the former model undergoes a slight change during fine-tuning, whereas the latter experiences significant adjustments. Moreover, we show that drawing conclusions based on the weight mixing evaluation strategy -- which is widely used in the context of layer-wise probing -- can be misleading given the norm disparity of the representations across different layers. Instead, we adopt an alternative information-theoretic probing with minimum description length, which has recently been proven to provide more reliable and informative results.

In many real-world applications, deployed models encounter inputs that differ from the data seen during training. Out-of-distribution detection identifies whether an input stems from an unseen distribution, while open-world recognition flags such inputs to ensure the system remains robust as ever-emerging, previously unknown categories appear and must be addressed without retraining. Foundation and vision-language models are pre-trained on large and diverse datasets with the expectation of broad generalization across domains, including medical imaging. However, benchmarking these models on test sets with only a few common outlier types silently collapses the evaluation back to a closed-set problem, masking failures on rare or truly novel conditions encountered in clinical use. We therefore present NOVA, a challenging, real-life evaluation-only benchmark of sim900 brain MRI scans that span 281 rare pathologies and heterogeneous acquisition protocols. Each case includes rich clinical narratives and double-blinded expert bounding-box annotations. Together, these enable joint assessment of anomaly localisation, visual captioning, and diagnostic reasoning. Because NOVA is never used for training, it serves as an extreme stress-test of out-of-distribution generalisation: models must bridge a distribution gap both in sample appearance and in semantic space. Baseline results with leading vision-language models (GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B) reveal substantial performance drops across all tasks, establishing NOVA as a rigorous testbed for advancing models that can detect, localize, and reason about truly unknown anomalies.

The recent success of general-domain large language models (LLMs) has significantly changed the natural language processing paradigm towards a unified foundation model across domains and applications. In this paper, we focus on assessing the performance of GPT-4, the most capable LLM so far, on the text-based applications for radiology reports, comparing against state-of-the-art (SOTA) radiology-specific models. Exploring various prompting strategies, we evaluated GPT-4 on a diverse range of common radiology tasks and we found GPT-4 either outperforms or is on par with current SOTA radiology models. With zero-shot prompting, GPT-4 already obtains substantial gains (approx 10% absolute improvement) over radiology models in temporal sentence similarity classification (accuracy) and natural language inference (F_1). For tasks that require learning dataset-specific style or schema (e.g. findings summarisation), GPT-4 improves with example-based prompting and matches supervised SOTA. Our extensive error analysis with a board-certified radiologist shows GPT-4 has a sufficient level of radiology knowledge with only occasional errors in complex context that require nuanced domain knowledge. For findings summarisation, GPT-4 outputs are found to be overall comparable with existing manually-written impressions.

Creating a large-scale dataset of abnormality annotation on medical images is a labor-intensive and costly task. Leveraging weak supervision from readily available data such as radiology reports can compensate lack of large-scale data for anomaly detection methods. However, most of the current methods only use image-level pathological observations, failing to utilize the relevant anatomy mentions in reports. Furthermore, Natural Language Processing (NLP)-mined weak labels are noisy due to label sparsity and linguistic ambiguity. We propose an Anatomy-Guided chest X-ray Network (AGXNet) to address these issues of weak annotation. Our framework consists of a cascade of two networks, one responsible for identifying anatomical abnormalities and the second responsible for pathological observations. The critical component in our framework is an anatomy-guided attention module that aids the downstream observation network in focusing on the relevant anatomical regions generated by the anatomy network. We use Positive Unlabeled (PU) learning to account for the fact that lack of mention does not necessarily mean a negative label. Our quantitative and qualitative results on the MIMIC-CXR dataset demonstrate the effectiveness of AGXNet in disease and anatomical abnormality localization. Experiments on the NIH Chest X-ray dataset show that the learned feature representations are transferable and can achieve the state-of-the-art performances in disease classification and competitive disease localization results. Our code is available at https://github.com/batmanlab/AGXNet

Despite rapid adoption and deployment of large language models (LLMs), the internal computations of these models remain opaque and poorly understood. In this work, we seek to understand how high-level human-interpretable features are represented within the internal neuron activations of LLMs. We train k-sparse linear classifiers (probes) on these internal activations to predict the presence of features in the input; by varying the value of k we study the sparsity of learned representations and how this varies with model scale. With k=1, we localize individual neurons which are highly relevant for a particular feature, and perform a number of case studies to illustrate general properties of LLMs. In particular, we show that early layers make use of sparse combinations of neurons to represent many features in superposition, that middle layers have seemingly dedicated neurons to represent higher-level contextual features, and that increasing scale causes representational sparsity to increase on average, but there are multiple types of scaling dynamics. In all, we probe for over 100 unique features comprising 10 different categories in 7 different models spanning 70 million to 6.9 billion parameters.

We develop techniques to quantify the degree to which a given (training or testing) example is an outlier in the underlying distribution. We evaluate five methods to score examples in a dataset by how well-represented the examples are, for different plausible definitions of "well-represented", and apply these to four common datasets: MNIST, Fashion-MNIST, CIFAR-10, and ImageNet. Despite being independent approaches, we find all five are highly correlated, suggesting that the notion of being well-represented can be quantified. Among other uses, we find these methods can be combined to identify (a) prototypical examples (that match human expectations); (b) memorized training examples; and, (c) uncommon submodes of the dataset. Further, we show how we can utilize our metrics to determine an improved ordering for curriculum learning, and impact adversarial robustness. We release all metric values on training and test sets we studied.

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

Context-grounded hallucinations are cases where model outputs contain information not verifiable against the source text. We study the applicability of LLMs for localizing such hallucinations, as a more practical alternative to existing complex evaluation pipelines. In the absence of established benchmarks for meta-evaluation of hallucinations localization, we construct one tailored to LLMs, involving a challenging human annotation of over 1,000 examples. We complement the benchmark with an LLM-based evaluation protocol, verifying its quality in a human evaluation. Since existing representations of hallucinations limit the types of errors that can be expressed, we propose a new representation based on free-form textual descriptions, capturing the full range of possible errors. We conduct a comprehensive study, evaluating four large-scale LLMs, which highlights the benchmark's difficulty, as the best model achieves an F1 score of only 0.67. Through careful analysis, we offer insights into optimal prompting strategies for the task and identify the main factors that make it challenging for LLMs: (1) a tendency to incorrectly flag missing details as inconsistent, despite being instructed to check only facts in the output; and (2) difficulty with outputs containing factually correct information absent from the source - and thus not verifiable - due to alignment with the model's parametric knowledge.

Automated clinical diagnosis remains a core challenge in medical AI, which usually requires models to integrate multi-modal data and reason across complex, case-specific contexts. Although recent methods have advanced medical report generation (MRG) and visual question answering (VQA) with medical vision-language models (VLMs), these methods, however, predominantly operate under a sample-isolated inference paradigm, as such processing cases independently without access to longitudinal electronic health records (EHRs) or structurally related patient examples. This paradigm limits reasoning to image-derived information alone, which ignores external complementary medical evidence for potentially more accurate diagnosis. To overcome this limitation, we propose HyperWalker, a Deep Diagnosis framework that reformulates clinical reasoning via dynamic hypergraphs and test-time training. First, we construct a dynamic hypergraph, termed iBrochure, to model the structural heterogeneity of EHR data and implicit high-order associations among multimodal clinical information. Within this hypergraph, a reinforcement learning agent, Walker, navigates to and identifies optimal diagnostic paths. To ensure comprehensive coverage of diverse clinical characteristics in test samples, we incorporate a linger mechanism, a multi-hop orthogonal retrieval strategy that iteratively selects clinically complementary neighborhood cases reflecting distinct clinical attributes. Experiments on MRG with MIMIC and medical VQA on EHRXQA demonstrate that HyperWalker achieves state-of-the-art performance. Code is available at: https://github.com/Bean-Young/HyperWalker

Multimodal large language models (MLLMs) are increasingly deployed in open-ended, real-world environments where inputs are messy, underspecified, and not always trustworthy. Unlike curated benchmarks, these settings frequently involve instructions that refer to missing objects or contradictory facts, rely on ambiguous references, or request infeasible actions. In such cases, success hinges not on task execution alone, but on a model's ability to detect when something is silently wrong. This paper presents a systematic analysis of how current MLLMs handle such implicit reasoning scenarios: cases where the flaw is not explicitly stated but must be inferred from context. Using a curated diagnostic suite spanning four categories of real-world failure modes, we evaluate six MLLMs, including o3 and GPT-4o, and find that models frequently fail to surface hidden issues, even when they possess the necessary perceptual and reasoning skills. Explicit prompting reveals that the underlying capabilities exist but are often suppressed in favor of user compliance. We further show that simple inference-time interventions, such as cautious persona prompting and, in particular, requiring a clarifying question, can dramatically recover performance. Our findings highlight a persistent gap between reasoning competence and behavioral compliance in current MLLMs and suggest practical strategies for making these models more trustworthy in underconstrained environments.

Breast cancer is a major global health concern, and mammography screening plays a central role in early detection. The large volume of screening examinations creates a substantial workload for radiologists, making accurate and consistent report generation a critical clinical challenge. Existing automated mammography report generation methods primarily focus on direct visual-to-text mapping, while overlooking the structured clinical reasoning process followed by radiologists in real-world practice. To address this limitation, we propose MammoRG, a mammography report generation framework that explicitly simulates the clinical reporting workflow by following the BI-RADS guideline and incorporating prior clinical knowledge to produce diagnostic reports. Specifically, MammoRG adopts a two-stage training framework. In the first stage, the model learns to integrate clinically relevant prior knowledge from a patient's four-view mammograms through classification-based supervision. In the second stage, a terminology-aware supervised fine-tuning strategy is introduced to model mammography-specific clinical terms as atomic semantic units, enabling the generation of high-quality reports with improved clinical consistency. To facilitate clinical efficacy evaluation of generated reports, we further develop MammoRGTool, a dedicated mammography report parsing tool that extracts structured clinical information from free-text reports. Extensive experiments demonstrate that MammoRG consistently outperforms existing methods across multiple clinical efficacy metrics, particularly in diagnosis-related BI-RADS F1, where it surpasses the second-best model by 2.73%, 2.04%, 1.90%, and 3.27% on the internal, external 1, external 2, and VinDr-Mammo datasets, respectively.

The success of pre-trained contextualized representations has prompted researchers to analyze them for the presence of linguistic information. Indeed, it is natural to assume that these pre-trained representations do encode some level of linguistic knowledge as they have brought about large empirical improvements on a wide variety of NLP tasks, which suggests they are learning true linguistic generalization. In this work, we focus on intrinsic probing, an analysis technique where the goal is not only to identify whether a representation encodes a linguistic attribute but also to pinpoint where this attribute is encoded. We propose a novel latent-variable formulation for constructing intrinsic probes and derive a tractable variational approximation to the log-likelihood. Our results show that our model is versatile and yields tighter mutual information estimates than two intrinsic probes previously proposed in the literature. Finally, we find empirical evidence that pre-trained representations develop a cross-lingually entangled notion of morphosyntax.

Accurate diagnosis with medical large language models is hindered by knowledge gaps and hallucinations. Retrieval and tool-augmented methods help, but their impact is limited by weak use of external knowledge and poor feedback-reasoning traceability. To address these challenges, We introduce Deep-DxSearch, an agentic RAG system trained end-to-end with reinforcement learning (RL) that enables steer tracebale retrieval-augmented reasoning for medical diagnosis. In Deep-DxSearch, we first construct a large-scale medical retrieval corpus comprising patient records and reliable medical knowledge sources to support retrieval-aware reasoning across diagnostic scenarios. More crutially, we frame the LLM as the core agent and the retrieval corpus as its environment, using tailored rewards on format, retrieval, reasoning structure, and diagnostic accuracy, thereby evolving the agentic RAG policy from large-scale data through RL. Experiments demonstrate that our end-to-end agentic RL training framework consistently outperforms prompt-engineering and training-free RAG approaches across multiple data centers. After training, Deep-DxSearch achieves substantial gains in diagnostic accuracy, surpassing strong diagnostic baselines such as GPT-4o, DeepSeek-R1, and other medical-specific frameworks for both common and rare disease diagnosis under in-distribution and out-of-distribution settings. Moreover, ablation studies on reward design and retrieval corpus components confirm their critical roles, underscoring the uniqueness and effectiveness of our approach compared with traditional implementations. Finally, case studies and interpretability analyses highlight improvements in Deep-DxSearch's diagnostic policy, providing deeper insight into its performance gains and supporting clinicians in delivering more reliable and precise preliminary diagnoses. See https://github.com/MAGIC-AI4Med/Deep-DxSearch.

Generating clinically useful pathology reports for pathology cases from whole-slide images (WSIs) is challenging due to gigapixel resolution, long visual-token sequences, and the complexity of case-level reasoning, where a single case may contain multiple WSIs with heterogeneous tissues and ambiguous findings. We present a simple token-efficient vision--language model for case-level synoptic report generation that remains practical under constrained GPU memory. Our architecture follows a minimal three-component design: a frozen pathology patch encoder, a lightweight two-layer MLP vision-language aligner, and a large language model decoder, with an explicit WSI marker token to separate slides within a case. Training proceeds in two supervised stages: (1) aligner-only WSI captioning using heterogeneous WSI-text pairs, and (2) case-level supervised fine-tuning on case-report pairs for structured report generation. To reduce sequence length, we represent each slide using 512 times 512 patches at 5times magnification, which reduces the average sequence length by up to 64times times compared to the commonly used 20times patches. Combined with efficient training techniques, we enable practical training with only half a NVIDIA H100 GPU. Across both training stages, our approach achieves high ROUGE-L/METEOR/BLEU-4 scores while being substantially more efficient in memory and runtime. In AI-based evaluations, our model is consistently preferred over strong baselines. Extensive ablations characterize performance-efficiency trade-offs and identify simple choices that improve robustness in multi-WSI settings. Overall, this work provides a strong, reproducible baseline for efficient pathology report generation, lowering the barrier to multi-WSI VLM research under limited compute.

Language models excel at diagnostic assessments on currated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.47, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

In this paper, we identify and characterize the emerging area of representation engineering (RepE), an approach to enhancing the transparency of AI systems that draws on insights from cognitive neuroscience. RepE places population-level representations, rather than neurons or circuits, at the center of analysis, equipping us with novel methods for monitoring and manipulating high-level cognitive phenomena in deep neural networks (DNNs). We provide baselines and an initial analysis of RepE techniques, showing that they offer simple yet effective solutions for improving our understanding and control of large language models. We showcase how these methods can provide traction on a wide range of safety-relevant problems, including honesty, harmlessness, power-seeking, and more, demonstrating the promise of top-down transparency research. We hope that this work catalyzes further exploration of RepE and fosters advancements in the transparency and safety of AI systems.

Recent work has proposed the linear representation hypothesis: that language models perform computation by manipulating one-dimensional representations of concepts ("features") in activation space. In contrast, we explore whether some language model representations may be inherently multi-dimensional. We begin by developing a rigorous definition of irreducible multi-dimensional features based on whether they can be decomposed into either independent or non-co-occurring lower-dimensional features. Motivated by these definitions, we design a scalable method that uses sparse autoencoders to automatically find multi-dimensional features in GPT-2 and Mistral 7B. These auto-discovered features include strikingly interpretable examples, e.g. circular features representing days of the week and months of the year. We identify tasks where these exact circles are used to solve computational problems involving modular arithmetic in days of the week and months of the year. Finally, we provide evidence that these circular features are indeed the fundamental unit of computation in these tasks with intervention experiments on Mistral 7B and Llama 3 8B, and we find further circular representations by breaking down the hidden states for these tasks into interpretable components.

Generating accurate and clinically meaningful radiology reports from chest X-ray images remains a significant challenge in medical AI. While recent vision-language models achieve strong results in general radiology report generation, they often fail to adequately describe rare but clinically important pathologies like fractures. This work addresses this gap by developing specialized models for fracture pathology detection and description. We train fracture-specific vision-language models with encoders from MAIRA-2 and CheXagent, demonstrating significant improvements over general-purpose models in generating accurate fracture descriptions. Analysis of model outputs by fracture type, location, and age reveals distinct strengths and limitations of current vision-language model architectures. We publicly release our best-performing fracture-reporting model, facilitating future research in accurate reporting of rare pathologies.

Healthcare data now span EHRs, medical imaging, genomics, and wearable sensors, but most diagnostic models still process these modalities in isolation. This limits their ability to capture early, cross-modal disease signatures. This paper introduces a multimodal foundation model built on a transformer architecture that integrates heterogeneous clinical data through modality-specific encoders and cross-modal attention. Each modality is mapped into a shared latent space and fused using multi-head attention with residual normalization. We implement the framework using a multimodal dataset that simulates early-stage disease patterns across EHR sequences, imaging patches, genomic profiles, and wearable signals, including missing-modality scenarios and label noise. The model is trained using supervised classification together with self-supervised reconstruction and contrastive alignment to improve robustness. Experimental evaluation demonstrates strong performance in early-detection settings, with stable classification metrics, reliable uncertainty estimates, and interpretable attention patterns. The approach moves toward a flexible, pretrain-and-fine-tune foundation model that supports precision diagnostics, handles incomplete inputs, and improves early disease detection across oncology, cardiology, and neurology applications.

Despite their capabilities, Large Language Models (LLMs) remain opaque with limited understanding of their internal representations. Current interpretability methods, such as direct logit attribution (DLA) and sparse autoencoders (SAEs), provide restricted insight due to limitations such as the model's output vocabulary or unclear feature names. This work introduces Hyperdimensional Probe, a novel paradigm for decoding information from the LLM vector space. It combines ideas from symbolic representations and neural probing to project the model's residual stream into interpretable concepts via Vector Symbolic Architectures (VSAs). This probe combines the strengths of SAEs and conventional probes while overcoming their key limitations. We validate our decoding paradigm with controlled input-completion tasks, probing the model's final state before next-token prediction on inputs spanning syntactic pattern recognition, key-value associations, and abstract inference. We further assess it in a question-answering setting, examining the state of the model both before and after text generation. Our experiments show that our probe reliably extracts meaningful concepts across varied LLMs, embedding sizes, and input domains, also helping identify LLM failures. Our work advances information decoding in LLM vector space, enabling extracting more informative, interpretable, and structured features from neural representations.

Electronic health records (EHR) contain narrative notes that provide extensive details on the medical condition and management of patients. Natural language processing (NLP) of clinical notes can use observed frequencies of clinical terms as predictive features for downstream applications such as clinical decision making and patient trajectory prediction. However, due to the vast number of highly similar and related clinical concepts, a more effective modeling strategy is to represent clinical terms as semantic embeddings via representation learning and use the low dimensional embeddings as feature vectors for predictive modeling. To achieve efficient representation, fine-tuning pretrained language models with biomedical knowledge graphs may generate better embeddings for biomedical terms than those from standard language models alone. These embeddings can effectively discriminate synonymous pairs of from those that are unrelated. However, they often fail to capture different degrees of similarity or relatedness for concepts that are hierarchical in nature. To overcome this limitation, we propose HiPrBERT, a novel biomedical term representation model trained on additionally complied data that contains hierarchical structures for various biomedical terms. We modify an existing contrastive loss function to extract information from these hierarchies. Our numerical experiments demonstrate that HiPrBERT effectively learns the pair-wise distance from hierarchical information, resulting in a substantially more informative embeddings for further biomedical applications

Due to the unsupervised nature of anomaly detection, the key to fueling deep models is finding supervisory signals. Different from current reconstruction-guided generative models and transformation-based contrastive models, we devise novel data-driven supervision for tabular data by introducing a characteristic -- scale -- as data labels. By representing varied sub-vectors of data instances, we define scale as the relationship between the dimensionality of original sub-vectors and that of representations. Scales serve as labels attached to transformed representations, thus offering ample labeled data for neural network training. This paper further proposes a scale learning-based anomaly detection method. Supervised by the learning objective of scale distribution alignment, our approach learns the ranking of representations converted from varied subspaces of each data instance. Through this proxy task, our approach models inherent regularities and patterns within data, which well describes data "normality". Abnormal degrees of testing instances are obtained by measuring whether they fit these learned patterns. Extensive experiments show that our approach leads to significant improvement over state-of-the-art generative/contrastive anomaly detection methods.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

Medical phrase grounding is crucial for identifying relevant regions in medical images based on phrase queries, facilitating accurate image analysis and diagnosis. However, current methods rely on manual extraction of key phrases from medical reports, reducing efficiency and increasing the workload for clinicians. Additionally, the lack of model confidence estimation limits clinical trust and usability. In this paper, we introduce a novel task called Medical Report Grounding (MRG), which aims to directly identify diagnostic phrases and their corresponding grounding boxes from medical reports in an end-to-end manner. To address this challenge, we propose uMedGround, a robust and reliable framework that leverages a multimodal large language model to predict diagnostic phrases by embedding a unique token, <BOX>, into the vocabulary to enhance detection capabilities. A vision encoder-decoder processes the embedded token and input image to generate grounding boxes. Critically, uMedGround incorporates an uncertainty-aware prediction model, significantly improving the robustness and reliability of grounding predictions. Experimental results demonstrate that uMedGround outperforms state-of-the-art medical phrase grounding methods and fine-tuned large visual-language models, validating its effectiveness and reliability. This study represents a pioneering exploration of the MRG task, marking the first-ever endeavor in this domain. Additionally, we demonstrate the applicability of uMedGround in medical visual question answering and class-based localization tasks, where it highlights visual evidence aligned with key diagnostic phrases, supporting clinicians in interpreting various types of textual inputs, including free-text reports, visual question answering queries, and class labels.

Scientific knowledge is growing rapidly, making it challenging to track progress and high-level conceptual links across broad disciplines. While existing tools like citation networks and search engines make it easy to access a few related papers, they fundamentally lack the flexible abstraction needed to represent the density of activity in various scientific subfields. We motivate SCIENCE HIERARCHOGRAPHY, the goal of organizing scientific literature into a high-quality hierarchical structure that allows for the categorization of scientific work across varying levels of abstraction, from very broad fields to very specific studies. Such a representation can provide insights into which fields are well-explored and which are under-explored. To achieve the goals of SCIENCE HIERARCHOGRAPHY, we develop a range of algorithms. Our primary approach combines fast embedding-based clustering with LLM-based prompting to balance the computational efficiency of embedding methods with the semantic precision offered by LLM prompting. We demonstrate that this approach offers the best trade-off between quality and speed compared to methods that heavily rely on LLM prompting, such as iterative tree construction with LLMs. To better reflect the interdisciplinary and multifaceted nature of research papers, our hierarchy captures multiple dimensions of categorization beyond simple topic labels. We evaluate the utility of our framework by assessing how effectively an LLM-based agent can locate target papers using the hierarchy. Results show that this structured approach enhances interpretability, supports trend discovery, and offers an alternative pathway for exploring scientific literature beyond traditional search methods. Code, data and demo: https://github.com/JHU-CLSP/science-hierarchography{https://github.com/JHU-CLSP/science-hierarchography}

Pathological diagnosis remains the definitive standard for identifying tumors. The rise of multimodal large models has simplified the process of integrating image analysis with textual descriptions. Despite this advancement, the substantial costs associated with training and deploying these complex multimodal models, together with a scarcity of high-quality training datasets, create a significant divide between cutting-edge technology and its application in the clinical setting. We had meticulously compiled a dataset of approximately 45,000 cases, covering over 6 different tasks, including the classification of organ tissues, generating pathology report descriptions, and addressing pathology-related questions and answers. We have fine-tuned multimodal large models, specifically LLaVA, Qwen-VL, InternLM, with this dataset to enhance instruction-based performance. We conducted a qualitative assessment of the capabilities of the base model and the fine-tuned model in performing image captioning and classification tasks on the specific dataset. The evaluation results demonstrate that the fine-tuned model exhibits proficiency in addressing typical pathological questions. We hope that by making both our models and datasets publicly available, they can be valuable to the medical and research communities.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Individual neurons participate in the representation of multiple high-level concepts. To what extent can different interpretability methods successfully disentangle these roles? To help address this question, we introduce RAVEL (Resolving Attribute-Value Entanglements in Language Models), a dataset that enables tightly controlled, quantitative comparisons between a variety of existing interpretability methods. We use the resulting conceptual framework to define the new method of Multi-task Distributed Alignment Search (MDAS), which allows us to find distributed representations satisfying multiple causal criteria. With Llama2-7B as the target language model, MDAS achieves state-of-the-art results on RAVEL, demonstrating the importance of going beyond neuron-level analyses to identify features distributed across activations. We release our benchmark at https://github.com/explanare/ravel.

The public often attributes human-like qualities to large language models (LLMs), assuming that they "know" certain things. In reality, LLMs encode information retained during training as internal probabilistic knowledge. This study examines existing methods for probing the veracity of that knowledge and identifies three flawed underlying assumptions. To address these flaws, we introduce sAwMIL (Sparse-Aware Multiple-Instance Learning), a multiclass probing framework that combines multiple-instance learning with conformal prediction. sAwMIL leverages LLMs' internal representations to classify statements as true, false, or neither. We evaluate sAwMIL across 16 open-source LLMs, including default and chat-based variants, using three new curated datasets. Our results show that (1) common probing methods fail to provide a reliable and transferable veracity direction and, in some settings, perform worse than zero-shot prompting; (2) truth and falsehood are not encoded symmetrically; and (3) LLMs encode a third type of signal that is distinct from both true and false.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Automated radiology report generation holds immense potential to alleviate the heavy workload of radiologists. Despite the formidable vision-language capabilities of recent Multimodal Large Language Models (MLLMs), their clinical deployment is severely constrained by inherent limitations: their "black-box" decision-making renders the generated reports untraceable due to the lack of explicit visual evidence to support the diagnosis, and they struggle to access external domain knowledge. To address these challenges, we propose the Evidence-driven Radiology Report Generation Agent (EviAgent). Unlike opaque end-to-end paradigms, EviAgent coordinates a transparent reasoning trajectory by breaking down the complex generation process into granular operational units. We integrate multi-dimensional visual experts and retrieval mechanisms as external support modules, endowing the system with explicit visual evidence and high-quality clinical priors. Extensive experiments on MIMIC-CXR, CheXpert Plus, and IU-Xray datasets demonstrate that EviAgent outperforms both large-scale generalist models and specialized medical models, providing a robust and trustworthy solution for automated radiology report generation.

Whole Slide Images (WSIs) exhibit hierarchical structure, where diagnostic information emerges from cellular morphology, regional tissue organization, and global context. Existing Computational Pathology (CPath) Multimodal Large Language Models (MLLMs) typically compress an entire WSI into a single embedding, which hinders fine-grained grounding and ignores how pathologists synthesize evidence across different scales. We introduce MLLM-HWSI, a Hierarchical WSI-level MLLM that aligns visual features with pathology language at four distinct scales, cell as word, patch as phrase, region as sentence, and WSI as paragraph to support interpretable evidence-grounded reasoning. MLLM-HWSI decomposes each WSI into multi-scale embeddings with scale-specific projectors and jointly enforces (i) a hierarchical contrastive objective and (ii) a cross-scale consistency loss, preserving semantic coherence from cells to the WSI. We compute diagnostically relevant patches and aggregate segmented cell embeddings into a compact cellular token per-patch using a lightweight Cell-Cell Attention Fusion (CCAF) transformer. The projected multi-scale tokens are fused with text tokens and fed to an instruction-tuned LLM for open-ended reasoning, VQA, report, and caption generation tasks. Trained in three stages, MLLM-HWSI achieves new SOTA results on 13 WSI-level benchmarks across six CPath tasks. By aligning language with multi-scale visual evidence, MLLM-HWSI provides accurate, interpretable outputs that mirror diagnostic workflows and advance holistic WSI understanding. Code is available at: https://github.com/BasitAlawode/HWSI-MLLM{GitHub}.

Large Vision-Language Models (LVLMs) are increasingly being explored for applications in telemedicine, yet their ability to engage with diverse patient behaviors remains underexplored. We introduce 3MDBench (Medical Multimodal Multi-agent Dialogue Benchmark), an open-source evaluation framework designed to assess LLM-driven medical consultations. Unlike existing benchmarks, 3MDBench simulates real-world patient variability by incorporating four temperament-driven Patient Agents and an Assessor Agent that evaluates diagnostic accuracy and dialogue quality. The benchmark integrates textual and image-based patient data across 34 common diagnoses, mirroring real-world telemedicine interactions. Under different diagnostic strategies, we evaluate state-of-the-art LVLMs. Our findings demonstrate that incorporating dialogue improves the F1 score from 50.4 to 54.2 compared to non-dialogue settings, underscoring the value of context-driven, information-seeking questioning. Additionally, we demonstrate that multimodal inputs enhance diagnostic efficiency. Image-supported models outperform text-only counterparts by raising the diagnostic F1 score from 52.8 to 54.2 in a similar dialogue setting. Finally, we suggest an approach that improves the diagnostic F1-score to 70.3 by training the CNN model on the diagnosis prediction task and incorporating its top-3 predictions into the LVLM context. 3MDBench provides a reproducible and extendable evaluation framework for AI-driven medical assistants. It offers insights into how patient temperament, dialogue strategies, and multimodal reasoning influence diagnosis quality. By addressing real-world complexities in telemedicine, our benchmark paves the way for more empathetic, reliable, and context-aware AI-driven healthcare solutions. The source code of our benchmark is publicly available: https://github.com/univanxx/3mdbench

Scientific research based on multimodal clinical data (including medical imaging) requires coordinating clinical, radiological, programming, and biostatistical expertise, a fragmented process that bottlenecks discovery. We present VERITAS (Verifiable Epistemic Reasoning for Image-Derived Hypothesis Testing via Agentic Systems), a clinical co-scientist: a multi-agent system that autonomously tests natural-language hypotheses and produces a fully auditable evidence trail, tracing every conclusion through executable outputs from analysis plan to segmentation masks to statistical code to final verdict. Unlike prior AI-scientist systems, which mainly operate on tabular or text data, VERITAS grounds autonomous discovery directly in medical images. It decomposes the workflow into four phases handled by role-specialized agents, and introduces an epistemic evidence label framework that mechanically classifies outcomes as Supported, Refuted, Underpowered, or Invalid by jointly evaluating significance, effect direction, and study power. This distinction is critical in medical imaging, where non-significant results often reflect insufficient sample size rather than absent effects. We construct a tiered benchmark of 64 hypotheses spanning six complexity levels across cardiac and brain glioma MRI datasets. VERITAS reaches 81.4% verdict accuracy with frontier models and 71.2% with locally-hosted open-weight models (8-30B), outperforming all single-model baselines in both classes. It also produces the highest rate of independently verifiable statistical outputs (86.6%), so even its failures remain diagnosable through artifact inspection. Structured multi-agent decomposition thus substitutes for model scale while preserving the verifiability that scientific discovery demands. We release code, hypothesis bank, and evaluation pipeline at https://github.com/LucZot/veritas.

Large language models can solve substantially harder reasoning problems with more inference-time compute. The term "test-time scaling," however, now covers diverse inference algorithms that extend deliberation along a single trajectory, sample completed candidates and aggregate them through voting or verification, or search over unfinished partial states. These algorithms differ in their statistical structure, compute accounting, and failure modes. Treating these procedures as interchangeable under a single scalar "budget," or reporting accuracy without the inference protocol that produced it, makes results difficult to compare across studies. We develop a systematic account of test-time scaling along three axes. First, we formalize test-time scaling as budgeted inference over the implicit prefix tree of an autoregressive model and distinguish three structural regimes: single-trajectory sequential scaling, leaf-level scaling with terminal reduction, and prefix-level scaling. Second, we treat the evaluated object as the entire inference system and develop evaluation principles that separate end-to-end system performance from candidate-bank diagnostics. We introduce an evaluation profile whose coordinates and simple functionals recover or bound common repeated-sampling metrics, and prescribe protocol-matched reporting of compute and uncertainty. Third, we specify reproducibility requirements for inference protocols, distinguishing exact replay from distributional reproducibility and identifying the artifacts needed to support each. We also organize the open-weight reasoning ecosystem by model-side and interface mechanisms, apply these principles to broad-knowledge, symbolic-reasoning, and competition-mathematics benchmarks, and assemble over 2 billion full reasoning traces for release with progressively richer verifier and token-level signals.

With the increasing numbers of publicly available models, there are probably pretrained, online models for most tasks users require. However, current model search methods are rudimentary, essentially a text-based search in the documentation, thus users cannot find the relevant models. This paper presents ProbeLog, a method for retrieving classification models that can recognize a target concept, such as "Dog", without access to model metadata or training data. Differently from previous probing methods, ProbeLog computes a descriptor for each output dimension (logit) of each model, by observing its responses on a fixed set of inputs (probes). Our method supports both logit-based retrieval ("find more logits like this") and zero-shot, text-based retrieval ("find all logits corresponding to dogs"). As probing-based representations require multiple costly feedforward passes through the model, we develop a method, based on collaborative filtering, that reduces the cost of encoding repositories by 3x. We demonstrate that ProbeLog achieves high retrieval accuracy, both in real-world and fine-grained search tasks and is scalable to full-size repositories.

Hypothesis generation is a fundamental step in scientific discovery, yet it is increasingly challenged by information overload and disciplinary fragmentation. Recent advances in Large Language Models (LLMs) have sparked growing interest in their potential to enhance and automate this process. This paper presents a comprehensive survey of hypothesis generation with LLMs by (i) reviewing existing methods, from simple prompting techniques to more complex frameworks, and proposing a taxonomy that categorizes these approaches; (ii) analyzing techniques for improving hypothesis quality, such as novelty boosting and structured reasoning; (iii) providing an overview of evaluation strategies; and (iv) discussing key challenges and future directions, including multimodal integration and human-AI collaboration. Our survey aims to serve as a reference for researchers exploring LLMs for hypothesis generation.

Recent accelerations in multi-modal applications have been made possible with the plethora of image and text data available online. However, the scarcity of analogous data in the medical field, specifically in histopathology, has halted comparable progress. To enable similar representation learning for histopathology, we turn to YouTube, an untapped resource of videos, offering 1,087 hours of valuable educational histopathology videos from expert clinicians. From YouTube, we curate Quilt: a large-scale vision-language dataset consisting of 768,826 image and text pairs. Quilt was automatically curated using a mixture of models, including large language models, handcrafted algorithms, human knowledge databases, and automatic speech recognition. In comparison, the most comprehensive datasets curated for histopathology amass only around 200K samples. We combine Quilt with datasets from other sources, including Twitter, research papers, and the internet in general, to create an even larger dataset: Quilt-1M, with 1M paired image-text samples, marking it as the largest vision-language histopathology dataset to date. We demonstrate the value of Quilt-1M by fine-tuning a pre-trained CLIP model. Our model outperforms state-of-the-art models on both zero-shot and linear probing tasks for classifying new histopathology images across 13 diverse patch-level datasets of 8 different sub-pathologies and cross-modal retrieval tasks.

The field of medical diagnosis has undergone a significant transformation with the advent of large language models (LLMs), yet the challenges of interpretability within these models remain largely unaddressed. This study introduces Chain-of-Diagnosis (CoD) to enhance the interpretability of LLM-based medical diagnostics. CoD transforms the diagnostic process into a diagnostic chain that mirrors a physician's thought process, providing a transparent reasoning pathway. Additionally, CoD outputs the disease confidence distribution to ensure transparency in decision-making. This interpretability makes model diagnostics controllable and aids in identifying critical symptoms for inquiry through the entropy reduction of confidences. With CoD, we developed DiagnosisGPT, capable of diagnosing 9604 diseases. Experimental results demonstrate that DiagnosisGPT outperforms other LLMs on diagnostic benchmarks. Moreover, DiagnosisGPT provides interpretability while ensuring controllability in diagnostic rigor.

Despite generating increasingly photorealistic images, text-to-image (T2I) models still exhibit localized, subtle, and structurally complex failures. Diagnosing these failures requires instance-level feedback that answers where a defect occurs, what type it is, why it is defective, and its importance to overall image quality. While recent dense-feedback methods move beyond scalar supervision, their heatmap-centric representations still formulate diagnosis as pixel-field regression, making it difficult to localize variable-cardinality defects and bind semantic reasons to individual failures. To address this representation bottleneck, we propose Structured Defect Grounding (SDG), which casts T2I diagnosis as structured set prediction by modeling each defect as a (location, type, reason, importance) tuple. To make this formulation trainable and measurable, we introduce SDG-30K, a 30K-image dataset with box-grounded annotations across four modern T2I generators, together with a dedicated evaluation protocol, SDG-Eval. Building on this structured representation, we further present a diagnosis-to-alignment framework in which a Vision-Language Model (VLM) serves as the SDG detector, and BoxFlow-GRPO converts predicted defect sets into box-derived, importance-weighted spatial rewards for diffusion model alignment. Extensive experiments show that our SDG detector outperforms leading proprietary VLMs on structured defect grounding, while SDG-guided rewards consistently improve T2I alignment and support localized image refinement. These results establish SDG as a unified, instance-level interface for diagnosing, evaluating, and enhancing modern generative models.

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

Medical image classification is a critical problem for healthcare, with the potential to alleviate the workload of doctors and facilitate diagnoses of patients. However, two challenges arise when deploying deep learning models to real-world healthcare applications. First, neural models tend to learn spurious correlations instead of desired features, which could fall short when generalizing to new domains (e.g., patients with different ages). Second, these black-box models lack interpretability. When making diagnostic predictions, it is important to understand why a model makes a decision for trustworthy and safety considerations. In this paper, to address these two limitations, we propose a new paradigm to build robust and interpretable medical image classifiers with natural language concepts. Specifically, we first query clinical concepts from GPT-4, then transform latent image features into explicit concepts with a vision-language model. We systematically evaluate our method on eight medical image classification datasets to verify its effectiveness. On challenging datasets with strong confounding factors, our method can mitigate spurious correlations thus substantially outperform standard visual encoders and other baselines. Finally, we show how classification with a small number of concepts brings a level of interpretability for understanding model decisions through case studies in real medical data.

Large language models (LLMs) show promise in medical diagnosis, but real-world deployment remains challenging due to high-stakes clinical decisions and imperfect reasoning reliability. As a result, careful inspection of model behavior is essential for assessing whether diagnostic reasoning is reliable and clinically grounded. However, debugging medical LLMs remains difficult. First, developers often lack sufficient medical domain expertise to interpret model errors in clinically meaningful terms. Second, models can fail across a large and diverse set of instances involving different input types, tasks, and reasoning steps, making it challenging for developers to prioritize which errors deserve focused inspection. Third, developers struggle to identify recurring error patterns across cases, as existing debugging practices are largely instance-centric and rely on manual inspection of isolated failures. To address these challenges, we present VeriLLMed, a visual analytics system that integrates external biomedical knowledge to audit and debug medical LLM diagnostic reasoning. VeriLLMed transforms model outputs into comparable reasoning paths, constructs knowledge graph-grounded reference paths, and identifies three recurring classes of diagnosis errors: relation errors, branch errors, and missing errors. Case studies and expert evaluation demonstrate that VeriLLMed helps developers identify clinically implausible reasoning and generate actionable insights that can inform the improvement of medical LLMs.

We propose a novel approach to conformal prediction for generative language models (LMs). Standard conformal prediction produces prediction sets -- in place of single predictions -- that have rigorous, statistical performance guarantees. LM responses are typically sampled from the model's predicted distribution over the large, combinatorial output space of natural language. Translating this process to conformal prediction, we calibrate a stopping rule for sampling different outputs from the LM that get added to a growing set of candidates until we are confident that the output set is sufficient. Since some samples may be low-quality, we also simultaneously calibrate and apply a rejection rule for removing candidates from the output set to reduce noise. Similar to conformal prediction, we prove that the sampled set returned by our procedure contains at least one acceptable answer with high probability, while still being empirically precise (i.e., small) on average. Furthermore, within this set of candidate responses, we show that we can also accurately identify subsets of individual components -- such as phrases or sentences -- that are each independently correct (e.g., that are not "hallucinations"), again with statistical guarantees. We demonstrate the promise of our approach on multiple tasks in open-domain question answering, text summarization, and radiology report generation using different LM variants.

Vision Language Models (VLMs) are increasingly used for tasks like medical report generation and visual question answering. However, fluent diagnostic text does not guarantee safe visual understanding. In clinical practice, interpretation begins with pre-diagnostic sanity checks: verifying that the input is valid to read (correct modality and anatomy, plausible viewpoint and orientation, and no obvious integrity violations). Existing benchmarks largely assume this step is solved, and therefore miss a critical failure mode: a model can produce plausible narratives even when the input is inconsistent or invalid. We introduce MedObvious, a 1,880-task benchmark that isolates input validation as a set-level consistency capability over small multi-panel image sets: the model must identify whether any panel violates expected coherence. MedObvious spans five progressive tiers, from basic orientation/modality mismatches to clinically motivated anatomy/viewpoint verification and triage-style cues, and includes five evaluation formats to test robustness across interfaces. Evaluating 17 different VLMs, we find that sanity checking remains unreliable: several models hallucinate anomalies on normal (negative-control) inputs, performance degrades when scaling to larger image sets, and measured accuracy varies substantially between multiple-choice and open-ended settings. These results show that pre-diagnostic verification remains unsolved for medical VLMs and should be treated as a distinct, safety-critical capability before deployment.

While Multimodal Large Language Models (MLLMs) excel on benchmarks, their processing paradigm differs from the human ability to integrate visual information. Unlike humans who naturally bridge details and high-level concepts, models tend to treat these elements in isolation. Prevailing evaluation protocols often decouple low-level perception from high-level reasoning, overlooking their semantic and causal dependencies, which yields non-diagnostic results and obscures performance bottlenecks. We present VCU-Bridge, a framework that operationalizes a human-like hierarchy of visual connotation understanding: multi-level reasoning that advances from foundational perception through semantic bridging to abstract connotation, with an explicit evidence-to-inference trace from concrete cues to abstract conclusions. Building on this framework, we construct HVCU-Bench, a benchmark for hierarchical visual connotation understanding with explicit, level-wise diagnostics. Comprehensive experiments demonstrate a consistent decline in performance as reasoning progresses to higher levels. We further develop a data generation pipeline for instruction tuning guided by Monte Carlo Tree Search (MCTS) and show that strengthening low-level capabilities yields measurable gains at higher levels. Interestingly, it not only improves on HVCU-Bench but also brings benefits on general benchmarks (average +2.53%), especially with substantial gains on MMStar (+7.26%), demonstrating the significance of the hierarchical thinking pattern and its effectiveness in enhancing MLLM capabilities. The project page is at https://vcu-bridge.github.io .

As the field of artificial intelligence progresses, assistive technologies are becoming more widely used across all industries. The healthcare industry is no different, with numerous studies being done to develop assistive tools for healthcare professionals. Automatic diagnostic systems are one such beneficial tool that can assist with a variety of tasks, including collecting patient information, analyzing test results, and diagnosing patients. However, the idea of developing systems that can provide a differential diagnosis has been largely overlooked in most of these research studies. In this study, we propose a transformer-based approach for providing differential diagnoses based on a patient's age, sex, medical history, and symptoms. We use the DDXPlus dataset, which provides differential diagnosis information for patients based on 49 disease types. Firstly, we propose a method to process the tabular patient data from the dataset and engineer them into patient reports to make them suitable for our research. In addition, we introduce two data modification modules to diversify the training data and consequently improve the robustness of the models. We approach the task as a multi-label classification problem and conduct extensive experiments using four transformer models. All the models displayed promising results by achieving over 97% F1 score on the held-out test set. Moreover, we design additional behavioral tests to get a broader understanding of the models. In particular, for one of our test cases, we prepared a custom test set of 100 samples with the assistance of a doctor. The results on the custom set showed that our proposed data modification modules improved the model's generalization capabilities. We hope our findings will provide future researchers with valuable insights and inspire them to develop reliable systems for automatic differential diagnosis.

Despite the growing scale of medical Vision-Language datasets, the impact of dataset quality on model performance remains under-explored. We introduce Open-PMC, a high-quality medical dataset from PubMed Central, containing 2.2 million image-text pairs, enriched with image modality annotations, subfigures, and summarized in-text references. Notably, the in-text references provide richer medical context, extending beyond the abstract information typically found in captions. Through extensive experiments, we benchmark Open-PMC against larger datasets across retrieval and zero-shot classification tasks. Our results show that dataset quality-not just size-drives significant performance gains. We complement our benchmark with an in-depth analysis of feature representation. Our findings highlight the crucial role of data curation quality in advancing multimodal medical AI. We release Open-PMC, along with the trained models and our codebase.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Humans can approach complex visual problems by mentally simulating intermediate visual steps, rather than reasoning through language alone. Inspired by this, several works on Vision-Language Models have recently explored chain-of-thought reasoning with continuous latent tokens as intermediate visual imagination steps. In this work, we investigate how recent models leverage such latent tokens. Surprisingly, we find that model accuracy is unaffected when latent tokens are replaced by uninformative dummy tokens. This indicates that latent tokens play a minimal causal role in the model's final prediction. To better understand this phenomenon, we analyze both the training signal provided by oracle latent representations and the quality of the latent tokens generated at inference time. Our experiments reveal two crucial issues holding back latent visual reasoning: First, in most existing datasets, oracle latent tokens provide limited additional information beyond the original image and do not substantially simplify the task, leading models to ignore them during training and effectively bypassing them at inference time. When fine-tuned on a diagnostic dataset, in which latent tokens provide sufficient support for the final prediction, we show that models can causally rely on them. Second, the latent tokens produced at inference time deviate from their corresponding oracle representations, collapsing to a narrow region and preventing benefits even when the model relies on them. Overall, our findings suggest that future progress in latent visual reasoning depends on two key pillars: high-quality datasets with informative intermediate steps and more precise latent token prediction.

We introduce a radiology-focused visual language model designed to generate radiology reports from chest X-rays. Building on previous findings that large language models (LLMs) can acquire multimodal capabilities when aligned with pretrained vision encoders, we demonstrate similar potential with chest X-ray images. This integration enhances the ability of model to understand and describe chest X-ray images. Our model combines an image encoder with a fine-tuned LLM based on the Vicuna-7B architecture, enabling it to generate different sections of a radiology report with notable accuracy. The training process involves a two-stage approach: (i) initial alignment of chest X-ray features with the LLM (ii) followed by fine-tuning for radiology report generation.

As Retrieval-Augmented Generation (RAG) shifts toward diverse portfolio generation, it is stymied by two critical bottlenecks: flawed measurement of evidence utilization, and suboptimal context budget allocation. We resolve both sequentially. To resolve measurement, we expose a pervasive ``diagnostic illusion'': standard relevance proxies fail catastrophically on hard negatives. We replace them with an efficient causal leave-one-out probe that accurately isolates generative reliance and formally calibrates the structural dilution of LLM attention. To resolve allocation, we deploy this causal probe in a deconfounded factorial grid. We prove that the prevailing strategy of monolithic context widening is an architectural trap penalized by relevance decay. Instead, allocating compute iteratively across multiple sequential generations drives transformative portfolio recall gains of 16.7--20.5 absolute percentage points, scaling robustly up to 32B models. Finally, we unify these solutions into a deployable closed-loop submodular scheduler. Augmented by an attribution-steered contrastive decoder to override LLM attention inertia, our architecture systematically forces fresh evidence integration. By dominating classical open-loop baselines, we establish sequential, feedback-driven orchestration as the definitive paradigm for generative search. Our code, data, and causal measurement instruments are available at https://github.com/PeiYangLiu/ascp.