Daily Papers

Medical Visual Question Answering (Med-VQA) holds significant potential for clinical decision support, yet existing efforts primarily focus on 2D imaging with limited task diversity. This paper presents 3D-RAD, a large-scale dataset designed to advance 3D Med-VQA using radiology CT scans. The 3D-RAD dataset encompasses six diverse VQA tasks: anomaly detection, image observation, medical computation, existence detection, static temporal diagnosis, and longitudinal temporal diagnosis. It supports both open- and closed-ended questions while introducing complex reasoning challenges, including computational tasks and multi-stage temporal analysis, to enable comprehensive benchmarking. Extensive evaluations demonstrate that existing vision-language models (VLMs), especially medical VLMs exhibit limited generalization, particularly in multi-temporal tasks, underscoring the challenges of real-world 3D diagnostic reasoning. To drive future advancements, we release a high-quality training set 3D-RAD-T of 136,195 expert-aligned samples, showing that fine-tuning on this dataset could significantly enhance model performance. Our dataset and code, aiming to catalyze multimodal medical AI research and establish a robust foundation for 3D medical visual understanding, are publicly available at https://github.com/Tang-xiaoxiao/3D-RAD.

Recent progress in Large Vision-Language Models (LVLMs) has enabled promising applications in medical tasks, such as report generation and visual question answering. However, existing benchmarks focus mainly on the final diagnostic answer, offering limited insight into whether models engage in clinically meaningful reasoning. To address this, we present CheXStruct and CXReasonBench, a structured pipeline and benchmark built on the publicly available MIMIC-CXR-JPG dataset. CheXStruct automatically derives a sequence of intermediate reasoning steps directly from chest X-rays, such as segmenting anatomical regions, deriving anatomical landmarks and diagnostic measurements, computing diagnostic indices, and applying clinical thresholds. CXReasonBench leverages this pipeline to evaluate whether models can perform clinically valid reasoning steps and to what extent they can learn from structured guidance, enabling fine-grained and transparent assessment of diagnostic reasoning. The benchmark comprises 18,988 QA pairs across 12 diagnostic tasks and 1,200 cases, each paired with up to 4 visual inputs, and supports multi-path, multi-stage evaluation including visual grounding via anatomical region selection and diagnostic measurements. Even the strongest of 10 evaluated LVLMs struggle with structured reasoning and generalization, often failing to link abstract knowledge with anatomically grounded visual interpretation. The code is available at https://github.com/ttumyche/CXReasonBench

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.

Cardiac biosignals, such as electrocardiograms (ECG) and photoplethysmograms (PPG), are of paramount importance for the diagnosis, prevention, and management of cardiovascular diseases, and have been extensively used in a variety of clinical tasks. Conventional deep learning approaches for analyzing these signals typically rely on homogeneous datasets and static bespoke models, limiting their robustness and generalizability across diverse clinical settings and acquisition protocols. In this study, we present a cardiac sensing foundation model (CSFM) that leverages advanced transformer architectures and a generative, masked pretraining strategy to learn unified representations from vast, heterogeneous health records. Our model is pretrained on an innovative multi-modal integration of data from multiple large-scale datasets (including MIMIC-III-WDB, MIMIC-IV-ECG, and CODE), comprising cardiac signals and the corresponding clinical or machine-generated text reports from approximately 1.7 million individuals. We demonstrate that the embeddings derived from our CSFM not only serve as effective feature extractors across diverse cardiac sensing scenarios, but also enable seamless transfer learning across varying input configurations and sensor modalities. Extensive evaluations across diagnostic tasks, demographic information recognition, vital sign measurement, clinical outcome prediction, and ECG question answering reveal that CSFM consistently outperforms traditional one-modal-one-task approaches. Notably, CSFM exhibits robust performance across multiple ECG lead configurations from standard 12-lead systems to single-lead setups, and in scenarios where only ECG, only PPG, or a combination thereof is available. These findings highlight the potential of CSFM as a versatile and scalable solution, for comprehensive cardiac monitoring.

We explore different ways to utilize position-based cross-attention in seq2seq networks to enable length generalization in algorithmic tasks. We show that a simple approach of interpolating the original and reversed encoded representations combined with relative attention allows near-perfect length generalization for both forward and reverse lookup tasks or copy tasks that had been generally hard to tackle. We also devise harder diagnostic tasks where the relative distance of the ideal attention position varies with timestep. In such settings, the simple interpolation trick with relative attention is not sufficient. We introduce novel variants of location attention building on top of Dubois et al. (2020) to address the new diagnostic tasks. We also show the benefits of our approaches for length generalization in SCAN (Lake & Baroni, 2018) and CFQ (Keysers et al., 2020). Our code is available on GitHub.

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.

Multimodal alignment of histopathology encoders with transcriptomic and genomic data has been shown to significantly improve performance in downstream diagnostic tasks. Hematological cytology is unique in that visual single-cell evaluation is often paired with cytogenetics and molecular genetics for blood cancer diagnosis. In this study, we present a framework to align single white blood cell images with chromosomal aberrations (karyotype) and somatic mutations from targeted gene panels. Our training strategy follows a two-stage approach: (i) self-supervised, vision-only pretraining of a transformer aggregator using an iBOT head on a cohort of over 1500 patients, and (ii) genetic alignment via supervised contrastive loss on acute myeloid leukemia patients. Our genetically aligned patient encoder improves hematological diagnostic tasks, outperforming slide-level histopathology foundation models. Additionally, the model provides off-the-shelf retrieval capabilities for diseases and genetic alterations. Incorporating genetic data into patient encoders increases the quality of patient representations, providing a framework that aligns with clinical diagnostic workflows and paves the way for future multimodal hematology-specific AI. The code and model weights are available at https://github.com/marrlab/GenBloom.

Reasoning in language models is difficult to evaluate: natural-language traces are unverifiable, symbolic datasets are too small, and most benchmarks conflate heuristics with inference. We present FOL-Traces, the first large-scale dataset of programmatically verified reasoning traces, enabling rigorous evaluation of structured logical inference. We also propose two challenging and comprehensive diagnostic tasks-masked operation prediction and step completion-that directly probe syntactic awareness and process fidelity. FOL-Traces serves as a scalable testbed for rigorously studying how models perform structured logical inference. Systematic experiments with 5 reasoning LLMs show that the dataset remains challenging: models only reach around 45.7% accuracy on masked operation prediction and around 27% on two-step completion.

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.

Electrocardiogram (ECG) interpretation requires specialized expertise, often involving synthesizing insights from ECG signals with complex clinical queries posed in natural language. The scarcity of labeled ECG data coupled with the diverse nature of clinical inquiries presents a significant challenge for developing robust and adaptable ECG diagnostic systems. This work introduces a novel multimodal meta-learning method for few-shot ECG question answering, addressing the challenge of limited labeled data while leveraging the rich knowledge encoded within large language models (LLMs). Our LLM-agnostic approach integrates a pre-trained ECG encoder with a frozen LLM (e.g., LLaMA and Gemma) via a trainable fusion module, enabling the language model to reason about ECG data and generate clinically meaningful answers. Extensive experiments demonstrate superior generalization to unseen diagnostic tasks compared to supervised baselines, achieving notable performance even with limited ECG leads. For instance, in a 5-way 5-shot setting, our method using LLaMA-3.1-8B achieves accuracy of 84.6%, 77.3%, and 69.6% on single verify, choose and query question types, respectively. These results highlight the potential of our method to enhance clinical ECG interpretation by combining signal processing with the nuanced language understanding capabilities of LLMs, particularly in data-constrained scenarios.

LLM agents excel when environments are mostly static and the needed information fits in a model's context window, but they often fail in open-ended investigations where explanations must be constructed by iteratively mining evidence from massive, heterogeneous operational data. These investigations exhibit hidden dependency structure: entities interact, signals co-vary, and the importance of a fact may only become clear after other evidence is discovered. Because the context window is bounded, agents must summarize intermediate findings before their significance is known, increasing the risk of discarding key evidence. ReAct-style agents are especially brittle in this regime. Their retrieve-summarize-reason loop makes conclusions sensitive to exploration order and introduces run-to-run non-determinism, producing a reliability gap where Pass-at-k may be high but Majority-at-k remains low. Simply sampling more rollouts or generating longer reasoning traces does not reliably stabilize results, since hypotheses cannot be autonomously checked as new evidence arrives and there is no explicit mechanism for belief bookkeeping and revision. In addition, ReAct entangles semantic reasoning with controller duties such as tool orchestration and state tracking, so execution errors and plan drift degrade reasoning while consuming scarce context. We address these issues by formulating investigation as abductive reasoning over a dependency graph and proposing EoG (Explanations over Graphs), a disaggregated framework in which an LLM performs bounded local evidence mining and labeling (cause vs symptom) while a deterministic controller manages traversal, state, and belief propagation to compute a minimal explanatory frontier. On a representative ITBench diagnostics task, EoG improves both accuracy and run-to-run consistency over ReAct baselines, including a 7x average gain in Majority-at-k entity F1.

Large language models have shown promise in clinical decision making, but current approaches struggle to localize and correct errors at specific steps of the reasoning process. This limitation is critical in medicine, where identifying and addressing reasoning errors is essential for accurate diagnosis and effective patient care. We introduce Med-PRM, a process reward modeling framework that leverages retrieval-augmented generation to verify each reasoning step against established medical knowledge bases. By verifying intermediate reasoning steps with evidence retrieved from clinical guidelines and literature, our model can precisely assess the reasoning quality in a fine-grained manner. Evaluations on five medical QA benchmarks and two open-ended diagnostic tasks demonstrate that Med-PRM achieves state-of-the-art performance, with improving the performance of base models by up to 13.50% using Med-PRM. Moreover, we demonstrate the generality of Med-PRM by integrating it in a plug-and-play fashion with strong policy models such as Meerkat, achieving over 80\% accuracy on MedQA for the first time using small-scale models of 8 billion parameters. Our code and data are available at: https://med-prm.github.io/

Cardiac magnetic resonance (CMR) is a cornerstone for diagnosing cardiovascular disease. However, it remains underutilized due to complex, time-consuming interpretation across multi-sequences, phases, quantitative measures that heavily reliant on specialized expertise. Here, we present BAAI Cardiac Agent, a multimodal intelligent system designed for end-to-end CMR interpretation. The agent integrates specialized cardiac expert models to perform automated segmentation of cardiac structures, functional quantification, tissue characterization and disease diagnosis, and generates structured clinical reports within a unified workflow. Evaluated on CMR datasets from two hospitals (2413 patients) spanning 7-types of major cardiovascular diseases, the agent achieved an area under the receiver-operating-characteristic curve exceeding 0.93 internally and 0.81 externally. In the task of estimating left ventricular function indices, the results generated by this system for core parameters such as ejection fraction, stroke volume, and left ventricular mass are highly consistent with clinical reports, with Pearson correlation coefficients all exceeding 0.90. The agent outperformed state-of-the-art models in segmentation and diagnostic tasks, and generated clinical reports showing high concordance with expert radiologists (six readers across three experience levels). By dynamically orchestrating expert models for coordinated multimodal analysis, this agent framework enables accurate, efficient CMR interpretation and highlights its potentials for complex clinical imaging workflows. Code is available at https://github.com/plantain-herb/Cardiac-Agent.

Recent advances in reasoning with large language models (LLMs)has shown remarkable reasoning capabilities in domains such as mathematics and coding, yet their application to clinical diagnosis remains underexplored. Here, we introduce ClinicalGPT-R1, a reasoning enhanced generalist large language model for disease diagnosis. Trained on a dataset of 20,000 real-world clinical records, ClinicalGPT-R1 leverages diverse training strategies to enhance diagnostic reasoning. To benchmark performance, we curated MedBench-Hard, a challenging dataset spanning seven major medical specialties and representative diseases. Experimental results demonstrate that ClinicalGPT-R1 outperforms GPT-4o in Chinese diagnostic tasks and achieves comparable performance to GPT-4 in English settings. This comparative study effectively validates the superior performance of ClinicalGPT-R1 in disease diagnosis tasks. Resources are available at https://github.com/medfound/medfound.

The rapid progress of multimodal large language models (MLLMs) has led to increasing interest in agent-based systems. While most prior work in medical imaging concentrates on automating routine clinical workflows, we study an underexplored yet clinically significant setting: distinguishing visually hard-to-separate diseases in a zero-shot setting. We benchmark representative agents on two imaging-only proxy diagnostic tasks, (1) melanoma vs. atypical nevus and (2) pulmonary edema vs. pneumonia, where visual features are highly confounded despite substantial differences in clinical management. We introduce a multi-agent framework based on contrastive adjudication. Experimental results show improved diagnostic performance (an 11-percentage-point gain in accuracy on dermoscopy data) and reduced unsupported claims on qualitative samples, although overall performance remains insufficient for clinical deployment. We acknowledge the inherent uncertainty in human annotations and the absence of clinical context, which further limit the translation to real-world settings. Within this controlled setting, this pilot study provides preliminary insights into zero-shot agent performance in visually confounded scenarios.

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.

Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

Diagnosing and managing oral diseases necessitate advanced visual interpretation across diverse imaging modalities and integrated information synthesis. While current AI models excel at isolated tasks, they often fall short in addressing the complex, multimodal requirements of comprehensive clinical dental practice. Here we introduce DentVLM, a multimodal vision-language model engineered for expert-level oral disease diagnosis. DentVLM was developed using a comprehensive, large-scale, bilingual dataset of 110,447 images and 2.46 million visual question-answering (VQA) pairs. The model is capable of interpreting seven 2D oral imaging modalities across 36 diagnostic tasks, significantly outperforming leading proprietary and open-source models by 19.6% higher accuracy for oral diseases and 27.9% for malocclusions. In a clinical study involving 25 dentists, evaluating 1,946 patients and encompassing 3,105 QA pairs, DentVLM surpassed the diagnostic performance of 13 junior dentists on 21 of 36 tasks and exceeded that of 12 senior dentists on 12 of 36 tasks. When integrated into a collaborative workflow, DentVLM elevated junior dentists' performance to senior levels and reduced diagnostic time for all practitioners by 15-22%. Furthermore, DentVLM exhibited promising performance across three practical utility scenarios, including home-based dental health management, hospital-based intelligent diagnosis and multi-agent collaborative interaction. These findings establish DentVLM as a robust clinical decision support tool, poised to enhance primary dental care, mitigate provider-patient imbalances, and democratize access to specialized medical expertise within the field of dentistry.

Medical Large Vision-Language Models (Med-LVLMs) have shown strong potential in multimodal diagnostic tasks. However, existing single-agent models struggle to generalize across diverse medical specialties, limiting their performance. Recent efforts introduce multi-agent collaboration frameworks inspired by clinical workflows, where general practitioners (GPs) and specialists interact in a fixed sequence. Despite improvements, these static pipelines lack flexibility and adaptability in reasoning. To address this, we propose MMedAgent-RL, a reinforcement learning (RL)-based multi-agent framework that enables dynamic, optimized collaboration among medical agents. Specifically, we train two GP agents based on Qwen2.5-VL via RL: the triage doctor learns to assign patients to appropriate specialties, while the attending physician integrates the judgments from multi-specialists and its own knowledge to make final decisions. To address the inconsistency in specialist outputs, we introduce a curriculum learning (CL)-guided RL strategy that progressively teaches the attending physician to balance between imitating specialists and correcting their mistakes. Experiments on five medical VQA benchmarks demonstrate that MMedAgent-RL not only outperforms both open-source and proprietary Med-LVLMs, but also exhibits human-like reasoning patterns. Notably, it achieves an average performance gain of 20.7% over supervised fine-tuning baselines.

Intraoperative pathology is pivotal to precision surgery, yet its clinical impact is constrained by diagnostic complexity and the limited availability of high-quality frozen-section data. While computational pathology has made significant strides, the lack of large-scale, prospective validation has impeded its routine adoption in surgical workflows. Here, we introduce CRISP, a clinical-grade foundation model developed on over 100,000 frozen sections from eight medical centers, specifically designed to provide Clinical-grade Robust Intraoperative Support for Pathology (CRISP). CRISP was comprehensively evaluated on more than 15,000 intraoperative slides across nearly 100 retrospective diagnostic tasks, including benign-malignant discrimination, key intraoperative decision-making, and pan-cancer detection, etc. The model demonstrated robust generalization across diverse institutions, tumor types, and anatomical sites-including previously unseen sites and rare cancers. In a prospective cohort of over 2,000 patients, CRISP sustained high diagnostic accuracy under real-world conditions, directly informing surgical decisions in 92.6% of cases. Human-AI collaboration further reduced diagnostic workload by 35%, avoided 105 ancillary tests and enhanced detection of micrometastases with 87.5% accuracy. Together, these findings position CRISP as a clinical-grade paradigm for AI-driven intraoperative pathology, bridging computational advances with surgical precision and accelerating the translation of artificial intelligence into routine clinical practice.

With the rapid development of computational pathology, many AI-assisted diagnostic tasks have emerged. Cellular nuclei segmentation can segment various types of cells for downstream analysis, but it relies on predefined categories and lacks flexibility. Moreover, pathology visual question answering can perform image-level understanding but lacks region-level detection capability. To address this, we propose a new benchmark called Pathology Visual Grounding (PathVG), which aims to detect regions based on expressions with different attributes. To evaluate PathVG, we create a new dataset named RefPath which contains 27,610 images with 33,500 language-grounded boxes. Compared to visual grounding in other domains, PathVG presents pathological images at multi-scale and contains expressions with pathological knowledge. In the experimental study, we found that the biggest challenge was the implicit information underlying the pathological expressions. Based on this, we proposed Pathology Knowledge-enhanced Network (PKNet) as the baseline model for PathVG. PKNet leverages the knowledge-enhancement capabilities of Large Language Models (LLMs) to convert pathological terms with implicit information into explicit visual features, and fuses knowledge features with expression features through the designed Knowledge Fusion Module (KFM). The proposed method achieves state-of-the-art performance on the PathVG benchmark.

We present ECG-Expert-QA, a comprehensive multimodal dataset for evaluating diagnostic capabilities in electrocardiogram (ECG) interpretation. It combines real-world clinical ECG data with systematically generated synthetic cases, covering 12 essential diagnostic tasks and totaling 47,211 expert-validated QA pairs. These encompass diverse clinical scenarios, from basic rhythm recognition to complex diagnoses involving rare conditions and temporal changes. A key innovation is the support for multi-turn dialogues, enabling the development of conversational medical AI systems that emulate clinician-patient or interprofessional interactions. This allows for more realistic assessment of AI models' clinical reasoning, diagnostic accuracy, and knowledge integration. Constructed through a knowledge-guided framework with strict quality control, ECG-Expert-QA ensures linguistic and clinical consistency, making it a high-quality resource for advancing AI-assisted ECG interpretation. It challenges models with tasks like identifying subtle ischemic changes and interpreting complex arrhythmias in context-rich scenarios. To promote research transparency and collaboration, the dataset, accompanying code, and prompts are publicly released at https://github.com/Zaozzz/ECG-Expert-QA

In medical applications, deep learning methods are built to automate diagnostic tasks. However, a clinically relevant question that practitioners usually face, is how to predict the future trajectory of a disease (prognosis). Current methods for such a problem often require domain knowledge, and are complicated to apply. In this paper, we formulate the prognosis prediction problem as a one-to-many forecasting problem from multimodal data. Inspired by a clinical decision-making process with two agents -- a radiologist and a general practitioner, we model a prognosis prediction problem with two transformer-based components that share information between each other. The first block in this model aims to analyze the imaging data, and the second block leverages the internal representations of the first one as inputs, also fusing them with auxiliary patient data. We show the effectiveness of our method in predicting the development of structural knee osteoarthritis changes over time. Our results show that the proposed method outperforms the state-of-the-art baselines in terms of various performance metrics. In addition, we empirically show that the existence of the multi-agent transformers with depths of 2 is sufficient to achieve good performances. Our code is publicly available at https://github.com/MIPT-Oulu/CLIMAT.

Anatomical structure labels for chest radiographs are essential for medical image segmentation and a broad range of downstream diagnostic tasks. However, annotating anatomy directly on 2D chest radiographs is labor-intensive and intrinsically ambiguous, as 3D anatomical structures are projected onto a single 2D plane where boundaries may overlap, be occluded, or appear only partially visible. Consequently, existing anatomy-labeled chest radiograph datasets remain limited in scale, anatomy coverage, and label reliability. To address these limitations, we introduce RadGenome-Anatomy, the largest anatomy-labeled chest radiograph dataset, containing over 10 million segmentation masks across 210 anatomical structures in 25,692 studies. It is constructed by projecting large-scale 3D anatomical masks from CT volumes into 2D radiographic space through canonical radiographic geometry. This shifts annotation from directly tracing uncertain 2D boundaries to defining anatomy in volumetric space, where structures that overlap or become partially invisible in radiographs remain spatially separable. As a result, each 2D mask represents the physically grounded projected footprint of a volumetrically defined structure. The scale and broad anatomical coverage of RadGenome-Anatomy, including structures that are overlapping, partially visible, or difficult to delineate directly, enable research on geometric measurements as explicit evidence for chest radiograph interpretation. We demonstrate this by training XAnatomy to predict structure-specific masks and derive clinically relevant measurements, achieving diagnostic accuracies of 96.4%, 95.6%, and 89.2% for cardiomegaly, kyphosis, and scoliosis, respectively.

Pathology Foundation Models (FMs) have shown strong performance across a wide range of pathology image representation and diagnostic tasks. However, FMs do not exhibit the expected performance advantage over traditional specialized models in Nuclei Detection and Classification (NDC). In this work, we reveal that jointly optimizing nuclei detection and classification leads to severe representation degradation in FMs. Moreover, we identify that the substantial intrinsic disparity in task difficulty between nuclei detection and nuclei classification renders joint NDC optimization unnecessarily computationally burdensome for the detection stage. To address these challenges, we propose DeNuC, a simple yet effective method designed to break through existing bottlenecks by Decoupling Nuclei detection and Classification. DeNuC employs a lightweight model for accurate nuclei localization, subsequently leveraging a pathology FM to encode input images and query nucleus-specific features based on the detected coordinates for classification. Extensive experiments on three widely used benchmarks demonstrate that DeNuC effectively unlocks the representational potential of FMs for NDC and significantly outperforms state-of-the-art methods. Notably, DeNuC improves F1 scores by 4.2% and 3.6% (or higher) on the BRCAM2C and PUMA datasets, respectively, while using only 16% (or fewer) trainable parameters compared to other methods. Code is available at https://github.com/ZijiangY1116/DeNuC.

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.

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.

Large Language Models (LLMs) have shown remarkable success in supporting a wide range of knowledge-intensive tasks. In specialized domains, there is growing interest in leveraging LLMs to assist subject matter experts with domain-specific challenges. However, deploying LLMs as SaaS solutions raises data privacy concerns, while many open-source models demand significant computational resources for effective domain adaptation and deployment. A promising alternative is to develop smaller, domain-specialized LLMs, though this approach is often constrained by the lack of high-quality domain-specific training data. In this work, we address these limitations by presenting a cost-efficient and scalable training pipeline that combines guided synthetic data generation from a small seed corpus with bottom-up domain data curation. Our pipeline integrates Domain-Adaptive Pretraining (DAPT), Domain-specific Supervised Fine-tuning (DSFT), and Direct Preference Optimization (DPO) to train effective small-scale models for specialized use cases. We demonstrate this approach through DiagnosticSLM, a 3B-parameter domain-specific model tailored for fault diagnosis, root cause analysis, and repair recommendation in industrial settings. To evaluate model performance, we introduce four domain-specific benchmarks: multiple-choice questions (DiagnosticMCQ), question answering (DiagnosticQA), sentence completion (DiagnosticComp), and summarization (DiagnosticSum). DiagnosticSLM achieves up to 25% accuracy improvement over open-source models of comparable or larger size (2B-9B) on the MCQ task, while also outperforming or matching them in other tasks, demonstrating effective domain-specific reasoning and generalization capabilities.

Achieving human-like perception and reasoning in Multimodal Large Language Models (MLLMs) remains a central challenge in artificial intelligence. While recent research has primarily focused on enhancing reasoning capabilities in MLLMs, a fundamental question persists: Can Multimodal Large Language Models truly perceive the world as humans do? This paper shifts focus from reasoning to perception. Rather than constructing benchmarks specifically for reasoning, we introduce the Turing Eye Test (TET), a challenging perception-oriented benchmark comprising four diagnostic tasks that evaluate MLLMs' performance on synthetic images that humans process intuitively. Our findings reveal that state-of-the-art MLLMs exhibit catastrophic failures on our perceptual tasks trivial for humans. Both in-context learning and training on language backbone-effective for previous benchmarks-fail to improve performance on our tasks, while fine-tuning the vision tower enables rapid adaptation, suggesting that our benchmark poses challenges for vision tower generalization rather than for the knowledge and reasoning capabilities of the language backbone-a key gap between current MLLMs and human perception. We release a representative subset of TET tasks in this version, and will introduce more diverse tasks and methods to enhance visual generalization in future work.

Multimodal large language models (MLLMs) have shown remarkable potential in various domains, yet their application in the medical field is hindered by several challenges. General-purpose MLLMs often lack the specialized knowledge required for medical tasks, leading to uncertain or hallucinatory responses. Knowledge distillation from advanced models struggles to capture domain-specific expertise in radiology and pharmacology. Additionally, the computational cost of continual pretraining with large-scale medical data poses significant efficiency challenges. To address these issues, we propose InfiMed-Foundation-1.7B and InfiMed-Foundation-4B, two medical-specific MLLMs designed to deliver state-of-the-art performance in medical applications. We combined high-quality general-purpose and medical multimodal data and proposed a novel five-dimensional quality assessment framework to curate high-quality multimodal medical datasets. We employ low-to-high image resolution and multimodal sequence packing to enhance training efficiency, enabling the integration of extensive medical data. Furthermore, a three-stage supervised fine-tuning process ensures effective knowledge extraction for complex medical tasks. Evaluated on the MedEvalKit framework, InfiMed-Foundation-1.7B outperforms Qwen2.5VL-3B, while InfiMed-Foundation-4B surpasses HuatuoGPT-V-7B and MedGemma-27B-IT, demonstrating superior performance in medical visual question answering and diagnostic tasks. By addressing key challenges in data quality, training efficiency, and domain-specific knowledge extraction, our work paves the way for more reliable and effective AI-driven solutions in healthcare. InfiMed-Foundation-4B model is available at https://huggingface.co/InfiX-ai/InfiMed-Foundation-4B{InfiMed-Foundation-4B}.

Content generation modeling has emerged as a promising direction in computational pathology, offering capabilities such as data-efficient learning, synthetic data augmentation, and task-oriented generation across diverse diagnostic tasks. This review provides a comprehensive synthesis of recent progress in the field, organized into four key domains: image generation, text generation, molecular profile-morphology generation, and other specialized generation applications. By analyzing over 150 representative studies, we trace the evolution of content generation architectures -- from early generative adversarial networks to recent advances in diffusion models and generative vision-language models. We further examine the datasets and evaluation protocols commonly used in this domain and highlight ongoing limitations, including challenges in generating high-fidelity whole slide images, clinical interpretability, and concerns related to the ethical and legal implications of synthetic data. The review concludes with a discussion of open challenges and prospective research directions, with an emphasis on developing integrated and clinically deployable generation systems. This work aims to provide a foundational reference for researchers and practitioners developing content generation models in computational pathology.

Deep learning has enabled the development of highly robust foundation models for various pathological tasks across diverse diseases and patient cohorts. Among these models, vision-language pre-training, which leverages large-scale paired data to align pathology image and text embedding spaces, and provides a novel zero-shot paradigm for downstream tasks. However, existing models have been primarily data-driven and lack the incorporation of domain-specific knowledge, which limits their performance in cancer diagnosis, especially for rare tumor subtypes. To address this limitation, we establish a Knowledge-enhanced Pathology (KEEP) foundation model that harnesses disease knowledge to facilitate vision-language pre-training. Specifically, we first construct a disease knowledge graph (KG) that covers 11,454 human diseases with 139,143 disease attributes, including synonyms, definitions, and hypernym relations. We then systematically reorganize the millions of publicly available noisy pathology image-text pairs, into 143K well-structured semantic groups linked through the hierarchical relations of the disease KG. To derive more nuanced image and text representations, we propose a novel knowledge-enhanced vision-language pre-training approach that integrates disease knowledge into the alignment within hierarchical semantic groups instead of unstructured image-text pairs. Validated on 18 diverse benchmarks with more than 14,000 whole slide images (WSIs), KEEP achieves state-of-the-art performance in zero-shot cancer diagnostic tasks. Notably, for cancer detection, KEEP demonstrates an average sensitivity of 89.8% at a specificity of 95.0% across 7 cancer types. For cancer subtyping, KEEP achieves a median balanced accuracy of 0.456 in subtyping 30 rare brain cancers, indicating strong generalizability for diagnosing rare tumors.

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

Pre-trained audio models excel at detecting acoustic patterns in auscultation sounds but often fail to grasp their clinical significance, limiting their use and performance in diagnostic tasks. To bridge this gap, we introduce AcuLa (Audio-Clinical Understanding via Language Alignment), a lightweight post-training framework that instills semantic understanding into any audio encoder by aligning it with a medical language model, which acts as a "semantic teacher." To enable alignment at scale, we construct a large-scale dataset by leveraging off-the-shelf large language models to translate the rich, structured metadata accompanying existing audio recordings into coherent clinical reports. Our alignment strategy combines a representation-level contrastive objective with a self-supervised modeling, ensuring that the model learns clinical semantics while preserving fine-grained temporal cues. AcuLa achieves state-of-the-art results across 18 diverse cardio-respiratory tasks from 10 different datasets, improving the mean AUROC on classification benchmarks from 0.68 to 0.79 and, on the most challenging COVID-19 cough detection task, boosting the AUROC from 0.55 to 0.89. Our work demonstrates that this audio-language alignment transforms purely acoustic models into clinically-aware diagnostic tools, establishing a novel paradigm for enhancing physiological understanding in audio-based health monitoring.

Deep learning has shown strong performance in musculoskeletal imaging, but prior work has largely targeted conditions where diagnosis is relatively straightforward. More challenging problems remain underexplored, such as detecting Bankart lesions (anterior-inferior glenoid labral tears) on standard MRIs. These lesions are difficult to diagnose due to subtle imaging features, often necessitating invasive MRI arthrograms (MRAs). We introduce ScopeMRI, the first publicly available, expert-annotated dataset for shoulder pathologies, and present a deep learning framework for Bankart lesion detection on both standard MRIs and MRAs. ScopeMRI contains shoulder MRIs from patients who underwent arthroscopy, providing ground-truth labels from intraoperative findings, the diagnostic gold standard. Separate models were trained for MRIs and MRAs using CNN- and transformer-based architectures, with predictions ensembled across multiple imaging planes. Our models achieved radiologist-level performance, with accuracy on standard MRIs surpassing radiologists interpreting MRAs. External validation on independent hospital data demonstrated initial generalizability across imaging protocols. By releasing ScopeMRI and a modular codebase for training and evaluation, we aim to accelerate research in musculoskeletal imaging and foster development of datasets and models that address clinically challenging diagnostic tasks.

Medical audio signals, such as heart and lung sounds, play a crucial role in clinical diagnosis. However, analyzing these signals remains challenging: traditional methods rely on handcrafted features or supervised deep learning models that demand extensive labeled datasets, limiting their scalability and applicability. To address these issues, we propose CaReAQA, an audio-language model that integrates a foundation audio model with the reasoning capabilities of large language models, enabling clinically relevant, open-ended diagnostic responses. Alongside CaReAQA, we introduce CaReSound, a benchmark dataset of annotated medical audio recordings enriched with metadata and paired question-answer examples, intended to drive progress in diagnostic reasoning research. Evaluation results show that CaReAQA achieves 86.2% accuracy on open-ended diagnostic reasoning tasks, outperforming baseline models. It also generalizes well to closed-ended classification tasks, achieving an average accuracy of 56.9% on unseen datasets. Our findings show how audio-language integration and reasoning advances medical diagnostics, enabling efficient AI systems for clinical decision support.

Accurate diagnostic coding of medical notes is crucial for enhancing patient care, medical research, and error-free billing in healthcare organizations. Manual coding is a time-consuming task for providers, and diagnostic codes often exhibit low sensitivity and specificity, whereas the free text in medical notes can be a more precise description of a patients status. Thus, accurate automated diagnostic coding of medical notes has become critical for a learning healthcare system. Recent developments in long-document transformer architectures have enabled attention-based deep-learning models to adjudicate medical notes. In addition, contrastive loss functions have been used to jointly pre-train large language and image models with noisy labels. To further improve the automated adjudication of medical notes, we developed an approach based on i) models for ICD-10 diagnostic code sequences using a large real-world data set, ii) large language models for medical notes, and iii) contrastive pre-training to build an integrated model of both ICD-10 diagnostic codes and corresponding medical text. We demonstrate that a contrastive approach for pre-training improves performance over prior state-of-the-art models for the MIMIC-III-50, MIMIC-III-rare50, and MIMIC-III-full diagnostic coding tasks.

This large scale study focuses on quantifying what X-rays diagnostic prediction tasks generalize well across multiple different datasets. We present evidence that the issue of generalization is not due to a shift in the images but instead a shift in the labels. We study the cross-domain performance, agreement between models, and model representations. We find interesting discrepancies between performance and agreement where models which both achieve good performance disagree in their predictions as well as models which agree yet achieve poor performance. We also test for concept similarity by regularizing a network to group tasks across multiple datasets together and observe variation across the tasks. All code is made available online and data is publicly available: https://github.com/mlmed/torchxrayvision

As large language models (LLMs) are increasingly applied to real-world legal tasks, evaluating the reliability of their open-ended legal responses has become essential. These tasks require context-sensitive answers and allow little room for error, motivating fine-grained and diagnostic evaluation that can identify specific sources of response quality failures. We introduce LexRubric, a rubric-based benchmark for evaluating open-ended Chinese legal tasks. LexRubric contains 649 instances from legal consultation and judicial examination, which reflect both everyday legal needs and professional legal reasoning and cover 14 legal scenarios. It further includes 12,337 expert-written atomic scoring criteria organized under a unified six-dimensional framework, enabling accurate evaluation and diagnostic analysis across tasks and evaluation dimensions. To validate the reliability of the evaluation, we test multiple judge models and compare model-based judgments with human judgments. We further evaluate 18 recent general and legal-domain LLMs on LexRubric. Results show that different models exhibit distinct capability profiles, and that open-ended legal question remains challenging for current LLMs. Data is available at: https://github.com/foggpoy/LexRubric.

Image segmentation plays an essential role in medicine for both diagnostic and interventional tasks. Segmentation approaches are either manual, semi-automated or fully-automated. Manual segmentation offers full control over the quality of the results, but is tedious, time consuming and prone to operator bias. Fully automated methods require no human effort, but often deliver sub-optimal results without providing users with the means to make corrections. Semi-automated approaches keep users in control of the results by providing means for interaction, but the main challenge is to offer a good trade-off between precision and required interaction. In this paper we present a deep learning (DL) based semi-automated segmentation approach that aims to be a "smart" interactive tool for region of interest delineation in medical images. We demonstrate its use for segmenting multiple organs on computed tomography (CT) of the abdomen. Our approach solves some of the most pressing clinical challenges: (i) it requires only one to a few user clicks to deliver excellent 2D segmentations in a fast and reliable fashion; (ii) it can generalize to previously unseen structures and "corner cases"; (iii) it delivers results that can be corrected quickly in a smart and intuitive way up to an arbitrary degree of precision chosen by the user and (iv) ensures high accuracy. We present our approach and compare it to other techniques and previous work to show the advantages brought by our method.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Collective insights from a group of experts have always proven to outperform an individual's best diagnostic for clinical tasks. For the task of medical image segmentation, existing research on AI-based alternatives focuses more on developing models that can imitate the best individual rather than harnessing the power of expert groups. In this paper, we introduce a single diffusion model-based approach that produces multiple plausible outputs by learning a distribution over group insights. Our proposed model generates a distribution of segmentation masks by leveraging the inherent stochastic sampling process of diffusion using only minimal additional learning. We demonstrate on three different medical image modalities- CT, ultrasound, and MRI that our model is capable of producing several possible variants while capturing the frequencies of their occurrences. Comprehensive results show that our proposed approach outperforms existing state-of-the-art ambiguous segmentation networks in terms of accuracy while preserving naturally occurring variation. We also propose a new metric to evaluate the diversity as well as the accuracy of segmentation predictions that aligns with the interest of clinical practice of collective insights.

Recent advances in Large Vision-Language Models (LVLMs) have shown strong potential for multi-modal radiological reasoning, particularly in tasks like diagnostic visual question answering (VQA) and radiology report generation. However, most existing approaches for 3D CT analysis largely rely on static, single-pass inference. In practice, clinical interpretation is a dynamic, tool-mediated workflow where radiologists iteratively review slices and use measurement, radiomics, and segmentation tools to refine findings. To bridge this gap, we propose CT-Flow, an agentic framework designed for interoperable volumetric interpretation. By leveraging the Model Context Protocol (MCP), CT-Flow shifts from closed-box inference to an open, tool-aware paradigm. We curate CT-FlowBench, the first large-scale instruction-tuning benchmark tailored for 3D CT tool-use and multi-step reasoning. Built upon this, CT-Flow functions as a clinical orchestrator capable of decomposing complex natural language queries into automated tool-use sequences. Experimental evaluations on CT-FlowBench and standard 3D VQA datasets demonstrate that CT-Flow achieves state-of-the-art performance, surpassing baseline models by 41% in diagnostic accuracy and achieving a 95% success rate in autonomous tool invocation. This work provides a scalable foundation for integrating autonomous, agentic intelligence into real-world clinical radiology.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

A recent trend in vision-language models (VLMs) has been to enhance their spatial cognition for embodied domains. Despite progress, existing evaluations have been limited both in paradigm and in coverage, hindering rapid, iterative model development. To address these limitations, we propose ESPIRE, a diagnostic benchmark for embodied spatial reasoning. ESPIRE offers a simulated world that physically grounds VLMs and evaluates them on spatial-reasoning-centric robotic tasks, thus narrowing the gap between evaluation and real-world deployment. To adapt VLMs to robotic tasks, we decompose each task into localization and execution, and frame both as generative problems, in stark contrast to predominant discriminative evaluations (e.g., via visual-question answering) that rely on distractors and discard execution. This decomposition further enables a fine-grained analysis beyond passive spatial reasoning toward reasoning to act. We systematically design ESPIRE both at the instruction level and at the environment level, ensuring broad coverage of spatial reasoning scenarios. We use ESPIRE to diagnose a range of frontier VLMs and provide in-depth analysis of their spatial reasoning behaviors.

We propose a novel multimodal video benchmark - the Perception Test - to evaluate the perception and reasoning skills of pre-trained multimodal models (e.g. Flamingo, BEiT-3, or GPT-4). Compared to existing benchmarks that focus on computational tasks (e.g. classification, detection or tracking), the Perception Test focuses on skills (Memory, Abstraction, Physics, Semantics) and types of reasoning (descriptive, explanatory, predictive, counterfactual) across video, audio, and text modalities, to provide a comprehensive and efficient evaluation tool. The benchmark probes pre-trained models for their transfer capabilities, in a zero-shot / few-shot or limited finetuning regime. For these purposes, the Perception Test introduces 11.6k real-world videos, 23s average length, designed to show perceptually interesting situations, filmed by around 100 participants worldwide. The videos are densely annotated with six types of labels (multiple-choice and grounded video question-answers, object and point tracks, temporal action and sound segments), enabling both language and non-language evaluations. The fine-tuning and validation splits of the benchmark are publicly available (CC-BY license), in addition to a challenge server with a held-out test split. Human baseline results compared to state-of-the-art video QA models show a significant gap in performance (91.4% vs 43.6%), suggesting that there is significant room for improvement in multimodal video understanding. Dataset, baselines code, and challenge server are available at https://github.com/deepmind/perception_test

Reasoning benchmarks have played a crucial role in the progress of language models. Yet rigorous evaluation remains a significant challenge as static question-answer pairs provide only a snapshot of performance, compressing complex behavior into a single accuracy metric. This limitation is especially true in complex, rule-bound domains such as law, where existing benchmarks are costly to build and ill suited for isolating specific failure modes. To address this, we introduce OpenExempt, a framework and benchmark for diagnostic evaluation of legal reasoning. The OpenExempt Framework uses expert-crafted symbolic representations of U.S. Bankruptcy Code statutes to dynamically generate a large space of natural language reasoning tasks and their machine-computable solutions on demand. This gives users fine-grained control over task complexity and scope, allowing individual reasoning skills to be probed in isolation. Using this system, we construct the OpenExempt Benchmark, a diagnostic benchmark for legal reasoning with 9,765 samples across nine evaluation suites designed to carefully probe model capabilities. Experiments on 13 diverse language models reveal sharp performance cliffs that emerge only under longer reasoning paths and in the presence of obfuscating statements. We release the framework and benchmark publicly to support research aimed at understanding and improving the next generation of reasoning systems.

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.

Despite the successes of recent developments in visual AI, different shortcomings still exist; from missing exact logical reasoning, to abstract generalization abilities, to understanding complex and noisy scenes. Unfortunately, existing benchmarks, were not designed to capture more than a few of these aspects. Whereas deep learning datasets focus on visually complex data but simple visual reasoning tasks, inductive logic datasets involve complex logical learning tasks, however, lack the visual component. To address this, we propose the visual logical learning dataset, V-LoL, that seamlessly combines visual and logical challenges. Notably, we introduce the first instantiation of V-LoL, V-LoL-Trains, -- a visual rendition of a classic benchmark in symbolic AI, the Michalski train problem. By incorporating intricate visual scenes and flexible logical reasoning tasks within a versatile framework, V-LoL-Trains provides a platform for investigating a wide range of visual logical learning challenges. We evaluate a variety of AI systems including traditional symbolic AI, neural AI, as well as neuro-symbolic AI. Our evaluations demonstrate that even state-of-the-art AI faces difficulties in dealing with visual logical learning challenges, highlighting unique advantages and limitations specific to each methodology. Overall, V-LoL opens up new avenues for understanding and enhancing current abilities in visual logical learning for AI systems.

Recent advancements in Large Vision-Language Models (LVLMs) have demonstrated remarkable multimodal perception and reasoning capabilities. While numerous benchmarks have evaluated LVLMs from holistic or task-specific perspectives, their capabilities on fine-grained image tasks-fundamental to computer vision-remain insufficiently understood. To address this gap, we introduce FG-BMK, a comprehensive fine-grained evaluation benchmark containing 1.01 million questions and 0.28 million images, covering diverse scenarios from common object-centric domains to specialized domains. FG-BMK jointly evaluates dialogue-level fine-grained semantic recognition and feature-level visual discriminability through human-oriented and machine-oriented paradigms, enabling diagnostic analysis of whether LVLM failures arise from insufficient visual representations, weak visual-to-semantic grounding, or limited fine-grained knowledge. Through extensive experiments on a diverse set of representative LVLMs/VLMs, we find that current LVLMs remain inadequate fine-grained recognizers, with failures arising from intertwined bottlenecks in visual representations, semantic grounding, modality alignment, and category-level knowledge. We further analyze training design factors for improving fine-grained capabilities and examine how visual and linguistic perturbations affect LVLM predictions. These findings provide diagnostic insights into the limitations of current LVLMs and offer guidance for future data construction and model design in developing more reliable LVLMs for fine-grained visual tasks. Our code is open-source and available at https://fg-bmk.github.io/.

Dynamic graph learning methods have recently emerged as powerful tools for modelling relational data evolving through time. However, despite extensive benchmarking efforts, it remains unclear whether current Temporal Graph Neural Networks (TGNNs) effectively capture core temporal patterns such as periodicity, cause-and-effect, and long-range dependencies. In this work, we introduce the Temporal Graph Reasoning Benchmark (T-GRAB), a comprehensive set of synthetic tasks designed to systematically probe the capabilities of TGNNs to reason across time. T-GRAB provides controlled, interpretable tasks that isolate key temporal skills: counting/memorizing periodic repetitions, inferring delayed causal effects, and capturing long-range dependencies over both spatial and temporal dimensions. We evaluate 11 temporal graph learning methods on these tasks, revealing fundamental shortcomings in their ability to generalize temporal patterns. Our findings offer actionable insights into the limitations of current models, highlight challenges hidden by traditional real-world benchmarks, and motivate the development of architectures with stronger temporal reasoning abilities. The code for T-GRAB can be found at: https://github.com/alirezadizaji/T-GRAB.

With the rapid advancement of deep learning, particularly in the field of medical image analysis, an increasing number of Vision-Language Models (VLMs) are being widely applied to solve complex health and biomedical challenges. However, existing research has primarily focused on specific tasks or single modalities, which limits their applicability and generalization across diverse medical scenarios. To address this challenge, we propose UMIT, a unified multi-modal, multi-task VLM designed specifically for medical imaging tasks. UMIT is able to solve various tasks, including visual question answering, disease detection, and medical report generation. In addition, it is applicable to multiple imaging modalities (e.g., X-ray, CT and PET), covering a wide range of applications from basic diagnostics to complex lesion analysis. Moreover, UMIT supports both English and Chinese, expanding its applicability globally and ensuring accessibility to healthcare services in different linguistic contexts. To enhance the model's adaptability and task-handling capability, we design a unique two-stage training strategy and fine-tune UMIT with designed instruction templates. Through extensive empirical evaluation, UMIT outperforms previous methods in five tasks across multiple datasets. The performance of UMIT indicates that it can significantly enhance diagnostic accuracy and workflow efficiency, thus providing effective solutions for medical imaging applications.

Multimodal large language models (MLLMs) are proficient in perception and instruction-following, but they still struggle with spatial reasoning: the ability to mentally track and manipulate objects across multiple views and over time. Spatial reasoning is a key component of human intelligence, but most existing benchmarks focus on static images or final outputs, failing to account for the sequential and viewpoint-dependent nature of this skill. To close this gap, we introduce GamiBench, a benchmark designed to evaluate spatial reasoning and 2D-to-3D planning in MLLMs through origami-inspired folding tasks. GamiBench includes 186 regular and 186 impossible 2D crease patterns paired with their corresponding 3D folded shapes, produced from six distinct viewpoints across three visual question-answering (VQA) tasks: predicting 3D fold configurations, distinguishing valid viewpoints, and detecting impossible patterns. Unlike previous benchmarks that assess only final predictions, GamiBench holistically evaluates the entire reasoning process--measuring cross-view consistency, physical feasibility through impossible-fold detection, and interpretation of intermediate folding steps. It further introduces new diagnostic metrics--viewpoint consistency (VC) and impossible fold selection rate (IFSR)--to measure how well models handle folds of varying complexity. Our experiments show that even leading models such as GPT-5 and Gemini-2.5-Pro struggle on single-step spatial understanding. These contributions establish a standardized framework for evaluating geometric understanding and spatial reasoning in MLLMs. Dataset and code: https://github.com/stvngo/GamiBench.

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.

Electrocardiography plays a central role in cardiovascular diagnostics, yet existing automated approaches often struggle to generalize across clinical tasks and offer limited support for open-ended reasoning. We present DiagECG, a novel framework that integrates time-series and language modeling by enabling large language models to process 12-lead ECG signals for clinical text generation tasks. Our approach discretizes continuous ECG embeddings into symbolic tokens using a lead-independent encoder and quantization module. These tokens are then used to extend the vocabulary of LLM, allowing the model to handle both ECG and natural language inputs in a unified manner. To bridge the modality gap, we pretrain the model on an autoregressive ECG forecasting task, enabling the LLM to model temporal dynamics using its native language modeling capabilities. Finally, we perform instruction tuning on both ECG question answering and diagnostic report generation. Without modifying the core model, DiagECG achieves strong performance across tasks while maintaining generalization to out-of-distribution settings. Extensive experiments demonstrate the effectiveness of each component and highlight the potential of integrating symbolic ECG representations into LLMs for medical reasoning.

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.

Large language model-based web agents have demonstrated strong performance on realistic web interaction tasks. However, existing evaluations are predominantly conducted under relatively stable and well-behaved interaction conditions, which may overestimate agent robustness. High task success in such idealized settings does not necessarily reflect performance under realistic web interaction. To address this limitation, we introduce a diagnostic stress-testing benchmark for web agents. We first construct realistic and controllable web environments that provide clean and stable interaction workflows as reference baselines. We then introduce structured and controlled perturbations that emulate interaction variability, including shifting layouts, altered interaction semantics, and execution disruptions. By comparing agent behavior between clean and perturbed settings, our framework enables systematic diagnosis of robustness under what-if interaction scenarios. Through extensive evaluation of state-of-the-art multimodal web agents, we show that stress-based evaluation exposes failure modes and substantial robustness gaps that remain hidden under clean benchmark conditions.

Search-augmented large language models (LLMs) have advanced information-seeking tasks by integrating retrieval into generation, reducing users' cognitive burden compared to traditional search systems. Yet they remain insufficient for fully addressing diverse user needs, which requires recognizing how the same query can reflect different intents across users and delivering information in preferred forms. While recent systems such as ChatGPT and Gemini attempt personalization by leveraging user histories, systematic evaluation of such personalization is under-explored. To address this gap, we propose BESPOKE, the realistic benchmark for evaluating personalization in search-augmented LLMs. BESPOKE is designed to be both realistic, by collecting authentic chat and search histories directly from humans, and diagnostic, by pairing responses with fine-grained preference scores and feedback. The benchmark is constructed through long-term, deeply engaged human annotation, where human annotators contributed their own histories, authored queries with detailed information needs, and evaluated responses with scores and diagnostic feedback. Leveraging BESPOKE, we conduct systematic analyses that reveal key requirements for effective personalization in information-seeking tasks, providing a foundation for fine-grained evaluation of personalized search-augmented LLMs. Our code and data are available at https://augustinlib.github.io/BESPOKE/.

Object orientation understanding represents a fundamental challenge in visual perception critical for applications like robotic manipulation and augmented reality. Current vision-language benchmarks fail to isolate this capability, often conflating it with positional relationships and general scene understanding. We introduce DORI (Discriminative Orientation Reasoning Intelligence), a comprehensive benchmark establishing object orientation perception as a primary evaluation target. DORI assesses four dimensions of orientation comprehension: frontal alignment, rotational transformations, relative directional relationships, and canonical orientation understanding. Through carefully curated tasks from 11 datasets spanning 67 object categories across synthetic and real-world scenarios, DORI provides insights on how multi-modal systems understand object orientations. Our evaluation of 15 state-of-the-art vision-language models reveals critical limitations: even the best models achieve only 54.2% accuracy on coarse tasks and 33.0% on granular orientation judgments, with performance deteriorating for tasks requiring reference frame shifts or compound rotations. These findings demonstrate the need for dedicated orientation representation mechanisms, as models show systematic inability to perform precise angular estimations, track orientation changes across viewpoints, and understand compound rotations - suggesting limitations in their internal 3D spatial representations. As the first diagnostic framework specifically designed for orientation awareness in multimodal systems, DORI offers implications for improving robotic control, 3D scene reconstruction, and human-AI interaction in physical environments. DORI data: https://huggingface.co/datasets/appledora/DORI-Benchmark

Understanding uncertainty in chain-of-thought reasoning is critical for reliable deployment of large language models. In this work, we propose a simple yet effective diagnostic approach based on trajectory shape rather than scalar magnitude. We show that this signal is practical, interpretable, and inexpensive to obtain in black-box settings, while remaining robust across models and datasets. Through extensive ablations and cross-domain replications, we demonstrate its utility for selective prediction and triage. Our findings offer a generalizable insight into uncertainty dynamics in reasoning tasks, with particular focus on numeric and discrete-answer settings.

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.

Large Language Models (LLMs) have not only exhibited exceptional performance across various tasks, but also demonstrated sparks of intelligence. Recent studies have focused on assessing their capabilities on human exams and revealed their impressive competence in different domains. However, cognitive research on the overall knowledge structure of LLMs is still lacking. In this paper, based on educational diagnostic assessment method, we conduct an evaluation using MoocRadar, a meticulously annotated human test dataset based on Bloom Taxonomy. We aim to reveal the knowledge structures of LLMs and gain insights of their cognitive capabilities. This research emphasizes the significance of investigating LLMs' knowledge and understanding the disparate cognitive patterns of LLMs. By shedding light on models' knowledge, researchers can advance development and utilization of LLMs in a more informed and effective manner.

Advances in diffusion, autoregressive, and hybrid models have enabled high-quality image synthesis for tasks such as text-to-image, editing, and reference-guided composition. Yet, existing benchmarks remain limited, either focus on isolated tasks, cover only narrow domains, or provide opaque scores without explaining failure modes. We introduce ImagenWorld, a benchmark of 3.6K condition sets spanning six core tasks (generation and editing, with single or multiple references) and six topical domains (artworks, photorealistic images, information graphics, textual graphics, computer graphics, and screenshots). The benchmark is supported by 20K fine-grained human annotations and an explainable evaluation schema that tags localized object-level and segment-level errors, complementing automated VLM-based metrics. Our large-scale evaluation of 14 models yields several insights: (1) models typically struggle more in editing tasks than in generation tasks, especially in local edits. (2) models excel in artistic and photorealistic settings but struggle with symbolic and text-heavy domains such as screenshots and information graphics. (3) closed-source systems lead overall, while targeted data curation (e.g., Qwen-Image) narrows the gap in text-heavy cases. (4) modern VLM-based metrics achieve Kendall accuracies up to 0.79, approximating human ranking, but fall short of fine-grained, explainable error attribution. ImagenWorld provides both a rigorous benchmark and a diagnostic tool to advance robust image generation.

We introduce PRISM-Bench, a benchmark of puzzle-based visual challenges designed to evaluate not only whether models can solve problems, but how their reasoning unfolds. Unlike prior evaluations that measure only final-answer accuracy, PRISM-Bench introduces a diagnostic task: given a visual puzzle and a step-by-step chain-of-thought (CoT) containing exactly one error, models must identify the first incorrect step. This setting enables fine-grained assessment of logical consistency, error detection, and visual reasoning. The puzzles in PRISM-Bench require multi-step symbolic, geometric, and analogical reasoning, resisting shortcuts based on superficial pattern matching. Evaluations across state-of-the-art MLLMs reveal a persistent gap between fluent generation and faithful reasoning: models that produce plausible CoTs often fail to locate simple logical faults. By disentangling answer generation from reasoning verification, PRISM-Bench offers a sharper lens on multimodal reasoning competence and underscores the need for diagnostic evaluation protocols in the development of trustworthy MLLMs.

Recent advances in generative foundational models, often termed "world models," have propelled interest in applying them to critical tasks like robotic planning and autonomous system training. For reliable deployment, these models must exhibit high physical fidelity, accurately simulating real-world dynamics. Existing physics-based video benchmarks, however, suffer from entanglement, where a single test simultaneously evaluates multiple physical laws and concepts, fundamentally limiting their diagnostic capability. We introduce WorldBench, a novel video-based benchmark specifically designed for concept-specific, disentangled evaluation, allowing us to rigorously isolate and assess understanding of a single physical concept or law at a time. To make WorldBench comprehensive, we design benchmarks at two different levels: 1) an evaluation of intuitive physical understanding with concepts such as object permanence or scale/perspective, and 2) an evaluation of low-level physical constants and material properties such as friction coefficients or fluid viscosity. When SOTA video-based world models are evaluated on WorldBench, we find specific patterns of failure in particular physics concepts, with all tested models lacking the physical consistency required to generate reliable real-world interactions. Through its concept-specific evaluation, WorldBench offers a more nuanced and scalable framework for rigorously evaluating the physical reasoning capabilities of video generation and world models, paving the way for more robust and generalizable world-model-driven learning.

Recent text-to-image generation models have demonstrated remarkable capabilities in synthesizing highly realistic images from text inputs alone. Although existing benchmarks can evaluate the generation capabilities of various models to some extent, they struggle to comprehensively and accurately measure performance across multiple dimensions, often failing to reveal the inherent deficiencies of models in specific categories. To address these limitations, we propose WeGenBench, a novel benchmark designed for the comprehensive, multi-perspective evaluation of text-to-image generation capabilities. Our benchmark comprises a total of 4,000 test prompts across two primary categories, meticulously balanced between Chinese and English to evaluate bilingual and cross-cultural generation capabilities. Beyond macroscopic scene classification, we annotate each prompt with multi-dimensional tags tailored to the distinct content and challenges of each language, thereby refining the generation tasks into more specific sub-categories. Through a cross-dimensional evaluation mechanism leveraging both scene classifications and multi-dimensional tags, WeGenBench can precisely pinpoint model shortcomings in specific generation categories. Furthermore, to measure generation quality more accurately, we design and validate several novel evaluation metrics by integrating Vision-Language Models (VLMs), which assess model performance on domain-specific tasks from three core aspects. Crucially, our approach yields both the assessment outcomes and the detailed reasoning trajectories, facilitating a rigorous verification of the accuracy and soundness of the evaluation results. Finally, we conduct systematic benchmarking on current state-of-the-art methods and provide an in-depth analysis of the limitations present in existing models.

Nucleotide sequences constitute the fundamental genetic basis of biological systems, rendering viral genomic analysis critical for biomedical advancement. Despite progress in biological foundation models, specifically nucleotide foundation models (NFMs), the field lacks a unified standard for viral genomics to facilitate community development and enforce biosecurity constraints. To address this, we introduce ViroBench, the first comprehensive and large-scale benchmark specifically designed for NFMs in viral settings. ViroBench evaluates models across two critical dimensions: biological understanding and latent biosecurity risk, covering 18 diverse scenarios within 4 task types. Extensive evaluation of 66 NFMs across diverse architectures yields three critical conclusions. Firstly, NFMs exhibit a performance degradation in biological understanding under phylogenetic and temporal shifts, indicating weak extrapolation capabilities. Secondly, generation tasks reveal a decoupling between statistical likelihood and biological functional validity, posing latent biosecurity risks. Thirdly, controlled ablation studies reveal that taxonomic diversity in pretraining data outweighs parameter scale. Specifically, a lightweight baseline trained on diverse data achieves a 67.5% performance gain over its original model. Overall, ViroBench provides interpretable, diagnostic evaluations and a reproducible measurement framework for future research on viral nucleotide foundation models. The datasets and code are publicly available at https://github.com/QIANJINYDX/ViroBench.

We introduce EgoSchema, a very long-form video question-answering dataset, and benchmark to evaluate long video understanding capabilities of modern vision and language systems. Derived from Ego4D, EgoSchema consists of over 5000 human curated multiple choice question answer pairs, spanning over 250 hours of real video data, covering a very broad range of natural human activity and behavior. For each question, EgoSchema requires the correct answer to be selected between five given options based on a three-minute-long video clip. While some prior works have proposed video datasets with long clip lengths, we posit that merely the length of the video clip does not truly capture the temporal difficulty of the video task that is being considered. To remedy this, we introduce temporal certificate sets, a general notion for capturing the intrinsic temporal understanding length associated with a broad range of video understanding tasks & datasets. Based on this metric, we find EgoSchema to have intrinsic temporal lengths over 5.7x longer than the second closest dataset and 10x to 100x longer than any other video understanding dataset. Further, our evaluation of several current state-of-the-art video and language models shows them to be severely lacking in long-term video understanding capabilities. Even models with several billions of parameters achieve QA accuracy less than 33% (random is 20%) on the EgoSchema multi-choice question answering task, while humans achieve about 76% accuracy. We posit that {}, with its long intrinsic temporal structures and diverse complexity, would serve as a valuable evaluation probe for developing effective long-term video understanding systems in the future. Data and Zero-shot model evaluation code are open-sourced for both public and commercial use under the Ego4D license at http://egoschema.github.io

Understanding human tasks through video observations is an essential capability of intelligent agents. The challenges of such capability lie in the difficulty of generating a detailed understanding of situated actions, their effects on object states (i.e., state changes), and their causal dependencies. These challenges are further aggravated by the natural parallelism from multi-tasking and partial observations in multi-agent collaboration. Most prior works leverage action localization or future prediction as an indirect metric for evaluating such task understanding from videos. To make a direct evaluation, we introduce the EgoTaskQA benchmark that provides a single home for the crucial dimensions of task understanding through question-answering on real-world egocentric videos. We meticulously design questions that target the understanding of (1) action dependencies and effects, (2) intents and goals, and (3) agents' beliefs about others. These questions are divided into four types, including descriptive (what status?), predictive (what will?), explanatory (what caused?), and counterfactual (what if?) to provide diagnostic analyses on spatial, temporal, and causal understandings of goal-oriented tasks. We evaluate state-of-the-art video reasoning models on our benchmark and show their significant gaps between humans in understanding complex goal-oriented egocentric videos. We hope this effort will drive the vision community to move onward with goal-oriented video understanding and reasoning.

Although large multimodal models (LMMs) have demonstrated remarkable capabilities in visual scene interpretation and reasoning, their capacity for complex and precise 3-dimensional spatial reasoning remains uncertain. Existing benchmarks focus predominantly on 2D spatial understanding and lack a framework to comprehensively evaluate 6D spatial reasoning across varying complexities. To address this limitation, we present PulseCheck457, a scalable and unbiased synthetic dataset designed with 4 key capability for spatial reasoning: multi-object recognition, 2D location, 3D location, and 3D orientation. We develop a cascading evaluation structure, constructing 7 question types across 5 difficulty levels that range from basic single object recognition to our new proposed complex 6D spatial reasoning tasks. We evaluated various large multimodal models (LMMs) on PulseCheck457, observing a general decline in performance as task complexity increases, particularly in 3D reasoning and 6D spatial tasks. To quantify these challenges, we introduce the Relative Performance Dropping Rate (RPDR), highlighting key weaknesses in 3D reasoning capabilities. Leveraging the unbiased attribute design of our dataset, we also uncover prediction biases across different attributes, with similar patterns observed in real-world image settings.

State-of-the-art visual grounding models can achieve high detection accuracy, but they are not designed to distinguish between all objects versus only certain objects of interest. In natural language, in order to specify a particular object or set of objects of interest, humans use determiners such as "my", "either" and "those". Determiners, as an important word class, are a type of schema in natural language about the reference or quantity of the noun. Existing grounded referencing datasets place much less emphasis on determiners, compared to other word classes such as nouns, verbs and adjectives. This makes it difficult to develop models that understand the full variety and complexity of object referencing. Thus, we have developed and released the DetermiNet dataset , which comprises 250,000 synthetically generated images and captions based on 25 determiners. The task is to predict bounding boxes to identify objects of interest, constrained by the semantics of the given determiner. We find that current state-of-the-art visual grounding models do not perform well on the dataset, highlighting the limitations of existing models on reference and quantification tasks.

Retrieval-augmented generation (RAG) has proven effective for knowledge-intensive tasks, but is widely believed to offer limited benefit for reasoning-intensive problems such as math and code generation. We challenge this assumption by showing that the limitation lies not in RAG itself, but in the choice of corpus. Instead of retrieving documents, we propose retrieving thinking traces, i.e., intermediate thinking trajectories generated during problem solving attempts. We show that thinking traces are already a strong retrieval source, and further introduce T3, an offline method that transforms them into structured, retrieval-friendly representations, to improve usability. Using these traces as a corpus, a simple retrieve-then-generate pipeline consistently improves reasoning performance across strong models and benchmarks such as AIME 2025--2026, LiveCodeBench, and GPQA-Diamond, outperforming both non-RAG baselines and retrieval over standard web corpora. For instance, on AIME, RAG with traces generated by Gemini-2-thinking achieves relative gains of +56.3%, +8.6%, and +7.6% for Gemini-2.5-Flash, GPT-OSS-120B, and GPT-5, respectively, even though these are more recent models. Interestingly, RAG on T3 also incurs little or no extra inference cost, and can even reduce inference cost by up to 15%. Overall, our results suggest that thinking traces are an effective retrieval corpus for reasoning tasks, and transforming them into structured, compact, or diagnostic representations unlocks even stronger gains. Code available at https://github.com/Narabzad/t3.

Research in AI4Science has shown promise in many science applications, including polymer design. However, current LLMs prove ineffective on this problem space because: (i) most models lack polymer-specific knowledge (ii) existing aligned models lack coverage of knowledge and capabilities relevant to polymer design. Addressing this, we introduce PolyBench, a large scale training and test benchmark dataset of more than 125K polymer design related tasks, leveraging a knowledge base of 13M+ data points obtained from experimental and synthetic sources to ensure broad coverage of polymers and their properties. For effective alignment using PolyBench, we introduce a knowledge-augmented reasoning distillation method that augments this dataset with structured CoT. Furthermore, tasks in PolyBench are organized from simple to complex analytical reasoning problems, enabling generalization tests and diagnostic probes across the problem space. Experiments show that small language models (SLMs), of 7B to 14B parameters, trained on PolyBench data outperform similar sized models, and even closed source frontier LLMs on PolyBench test dataset while demonstrating gains on other polymer benchmarks as well.

Image captioning, situated at the intersection of computer vision and natural language processing, requires a sophisticated understanding of both visual scenes and linguistic structure. While modern approaches are dominated by large-scale Transformer architectures, this paper documents a systematic, iterative development of foundational image captioning models, progressing from a simple CNN-LSTM encoder-decoder to a competitive attention-based system. This paper presents a series of five models, beginning with Genesis and concluding with Nexus, an advanced model featuring an EfficientNetV2B3 backbone and a dynamic attention mechanism. The experiments chart the impact of architectural enhancements and demonstrate a key finding within the classic CNN-LSTM paradigm: merely upgrading the visual backbone without a corresponding attention mechanism can degrade performance, as the single-vector bottleneck cannot transmit the richer visual detail. This insight validates the architectural shift to attention. Trained on the MS COCO 2017 dataset, the final model, Nexus, achieves a BLEU-4 score of 31.4, surpassing several foundational benchmarks and validating the iterative design process. This work provides a clear, replicable blueprint for understanding the core architectural principles that underpin modern vision-language tasks.

It is unclear whether strong forecasting performance reflects genuine temporal understanding or the ability to reason under contextual and event-driven conditions. We introduce TemporalBench, a multi-domain benchmark designed to evaluate temporal reasoning behavior under progressively richer informational settings. TemporalBench adopts a four-tier task taxonomy that examines historical structure interpretation, context-free forecasting, contextual temporal reasoning, and event-conditioned prediction across four real-world domains: retail, healthcare, energy, and physical systems. By controlling access to future targets and contextual information, the benchmark enables a diagnostic analysis of whether models can correctly interpret temporal patterns, align them with external context, and adapt predictions when conditions change. Extensive baseline experiments show that strong numerical forecasting accuracy does not reliably translate into robust contextual or event-aware temporal reasoning; instead, existing agent frameworks exhibit fragmented strengths and systematic failure modes that remain largely hidden under forecasting-only benchmarks. The TemporalBench dataset is publicly available at https://huggingface.co/datasets/Melady/TemporalBench, and we additionally provide a public leaderboard at https://huggingface.co/spaces/Melady/TemporalBench_Leaderboard.

Feature vectors provided by pre-trained deep artificial neural networks have become a dominant source for image representation in recent literature. Their contribution to the performance of image analysis can be improved through finetuning. As an ultimate solution, one might even train a deep network from scratch with the domain-relevant images, a highly desirable option which is generally impeded in pathology by lack of labeled images and the computational expense. In this study, we propose a new network, namely KimiaNet, that employs the topology of the DenseNet with four dense blocks, fine-tuned and trained with histopathology images in different configurations. We used more than 240,000 image patches with 1000x1000 pixels acquired at 20x magnification through our proposed "highcellularity mosaic" approach to enable the usage of weak labels of 7,126 whole slide images of formalin-fixed paraffin-embedded human pathology samples publicly available through the The Cancer Genome Atlas (TCGA) repository. We tested KimiaNet using three public datasets, namely TCGA, endometrial cancer images, and colorectal cancer images by evaluating the performance of search and classification when corresponding features of different networks are used for image representation. As well, we designed and trained multiple convolutional batch-normalized ReLU (CBR) networks. The results show that KimiaNet provides superior results compared to the original DenseNet and smaller CBR networks when used as feature extractor to represent histopathology images.

In this paper, we introduce a novel Multi-Modal Contrastive Pre-training Framework that synergistically combines X-rays, electrocardiograms (ECGs), and radiology/cardiology reports. Our approach leverages transformers to encode these diverse modalities into a unified representation space, aiming to enhance diagnostic accuracy and facilitate comprehensive patient assessments. We utilize LoRA-Peft to significantly reduce trainable parameters in the LLM and incorporate recent linear attention dropping strategy in the Vision Transformer(ViT) for smoother attention. Furthermore, we provide novel multimodal attention explanations and retrieval for our model. To the best of our knowledge, we are the first to propose an integrated model that combines X-ray, ECG, and Radiology/Cardiology Report with this approach. By utilizing contrastive loss, MoRE effectively aligns modality-specific features into a coherent embedding, which supports various downstream tasks such as zero-shot classification and multimodal retrieval. Employing our proposed methodology, we achieve state-of-the-art (SOTA) on the Mimic-IV, CheXpert, Edema Severity, and PtbXl downstream datasets, surpassing existing multimodal approaches. Our proposed framework shows significant improvements in capturing intricate inter-modal relationships and its robustness in medical diagnosis that establishes a framework for future research in multimodal learning in the healthcare sector.

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

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.

Transformer-based speech language models (SLMs) have significantly improved neural speech recognition and understanding. While existing research has examined how well SLMs encode shallow acoustic and phonetic features, the extent to which SLMs encode nuanced syntactic and conceptual features remains unclear. By drawing parallels with linguistic competence assessments for large language models, this study is the first to systematically evaluate the presence of contextual syntactic and semantic features across SLMs for self-supervised learning (S3M), automatic speech recognition (ASR), speech compression (codec), and as the encoder for auditory large language models (AudioLLMs). Through minimal pair designs and diagnostic feature analysis across 71 tasks spanning diverse linguistic levels, our layer-wise and time-resolved analysis uncovers that 1) all speech encode grammatical features more robustly than conceptual ones.

Spoken Language Understanding (SLU) is moving from task-specific pipelines toward large audio language models (LALMs) that generate natural-language responses. However, existing speech benchmarks mainly focus on single-speaker settings or isolated subtasks, leaving speaker-centric understanding in realistic multi-speaker conversations insufficiently evaluated. We introduce MSU-Bench, a diagnostic benchmark for multi-speaker conversational understanding, covering 16 speaker-centric tasks and 2,300 QA instances in a two-tier framework from speaker grounding to dialogue reasoning. We build a Gemini-assisted annotation and QA generation pipeline with human-in-the-loop verification, achieving high QA validity and strong agreement between human answers and verified labels. We further analyze speaker-referencing schemes and diagnostic error types to reveal bottlenecks in speaker grounding and reasoning. Experiments reveal clear gaps across model families, with closed-source systems leading overall but all models still facing challenges in complex speaker grounding and multi-speaker reasoning. The benchmark annotations, metadata, and evaluation scripts will be available at the GitHub repository: https://github.com/ASLP-lab/MSU-Bench.

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.

Software engineering agents (SWE) are improving rapidly, with recent gains largely driven by reinforcement learning (RL). However, RL training is constrained by the scarcity of large-scale task collections with reproducible execution environments and reliable test suites. Although a growing number of benchmarks have emerged, datasets suitable for training remain limited in scale and diversity or often target a limited set of high-resource language ecosystems. We introduce SWE-rebench V2, a language-agnostic automated pipeline for harvesting executable real-world SWE tasks and constructing RL training environments at scale. The pipeline synthesizes repository-specific installation and test procedures via an interactive setup agent, and filters unsound instances using an ensemble of LLM judges, validated against human-verified SWE-bench annotations. Using this pipeline, we construct a dataset of 32,000+ tasks spanning 20 languages and 3,600+ repositories, with pre-built images for reproducible execution. To further scale training data, we additionally release 120,000+ tasks with installation instructions, fail-to-pass tests and rich metadata, where the problem statement is generated based on the original pull request description. We validate the collected instances through a diagnostic study that covers a subset of tasks in five programming languages across seven popular models, and provide instance-level metadata that flags common confounders such as overly restrictive tests and underspecified descriptions. We release the datasets, the collection and execution code, and associated artifacts to enable large-scale training of SWE agents across diverse languages and repositories.

Reinforcement learning from verifiable rewards (RLVR) suffers from sparse outcome signals, creating severe exploration bottlenecks on complex reasoning tasks. Recent on-policy self-distillation methods attempt to address this by utilizing language feedback to generate dense, token-level supervision. However, these approaches rely on a fixed, passive teacher to interpret the feedback. As the student policy improves, the teacher's zero-shot assessment capabilities plateau, ultimately halting further learning. To overcome this, we propose Variational Policy Distillation (VPD), a framework that formalizes learning from language feedback as a Variational Expectation-Maximization (EM) problem. VPD co-evolves both policies: in the E-step, the teacher is actively refined on trajectory outcomes via an adaptive trust-region update, translating textual feedback into a dynamically improved target token distribution. In the M-step, the student internalizes this dense distributional guidance on its own on-policy rollouts. By continuously improving the teacher's ability to extract actionable signals from textual critique, VPD overcomes the limitations of passive distillation. Evaluated across diverse sources of diagnostic feedback on scientific reasoning and code generation tasks, VPD consistently outperforms both standard RLVR and existing self-distillation baselines. Finally, by stress-testing our framework on rigid mathematical reasoning and cold-start regimes, we illuminate the fundamental bounds of feedback-driven self-distillation compared to pure environment-driven RL.

Long-form multimodal video understanding requires integrating vision, speech, and ambient audio with coherent long-range reasoning. Existing benchmarks emphasize either temporal length or multimodal richness, but rarely both and while some incorporate open-ended questions and advanced metrics, they mostly rely on single-score accuracy, obscuring failure modes. We introduce LongShOTBench, a diagnostic benchmark with open-ended, intent-driven questions; single- and multi-turn dialogues; and tasks requiring multimodal reasoning and agentic tool use across video, audio, and speech. Each item includes a reference answer and graded rubric for interpretable, and traceable evaluation. LongShOTBench is produced via a scalable, human-validated pipeline to ensure coverage and reproducibility. All samples in our LongShOTBench are human-verified and corrected. Furthermore, we present LongShOTAgent, an agentic system that analyzes long videos via preprocessing, search, and iterative refinement. On LongShOTBench, state-of-the-art MLLMs show large gaps: Gemini-2.5-Flash achieves 52.95%, open-source models remain below 30%, and LongShOTAgent attains 44.66%. These results underscore the difficulty of real-world long-form video understanding. LongShOTBench provides a practical, reproducible foundation for evaluating and improving MLLMs. All resources are available on GitHub: https://github.com/mbzuai-oryx/longshot.

We introduce Continual Learning via Neural Pruning (CLNP), a new method aimed at lifelong learning in fixed capacity models based on neuronal model sparsification. In this method, subsequent tasks are trained using the inactive neurons and filters of the sparsified network and cause zero deterioration to the performance of previous tasks. In order to deal with the possible compromise between model sparsity and performance, we formalize and incorporate the concept of graceful forgetting: the idea that it is preferable to suffer a small amount of forgetting in a controlled manner if it helps regain network capacity and prevents uncontrolled loss of performance during the training of future tasks. CLNP also provides simple continual learning diagnostic tools in terms of the number of free neurons left for the training of future tasks as well as the number of neurons that are being reused. In particular, we see in experiments that CLNP verifies and automatically takes advantage of the fact that the features of earlier layers are more transferable. We show empirically that CLNP leads to significantly improved results over current weight elasticity based methods.

Understanding scientific papers requires more than answering isolated questions or summarizing content. It involves an integrated reasoning process that grounds textual and visual information, interprets experimental evidence, synthesizes information across sources, and critically evaluates scientific claims. However, existing benchmarks typically assess these abilities in isolation, making it difficult to evaluate scientific paper understanding as a unified set of interacting cognitive abilities. In this work, we introduce PAPERMIND, a benchmark designed to evaluate integrated and agent-oriented scientific reasoning over research papers. PAPERMIND is constructed from real scientific papers across seven domains, including agriculture, biology, chemistry, computer science, medicine, physics, and economics. It comprises four complementary task families that collectively operationalize distinct cognitive facets of scientific paper reasoning, including multimodal grounding, experimental interpretation, cross-source evidence reasoning, and critical assessment. By analyzing model behavior across multiple tasks, PAPERMIND enables a diagnostic evaluation of integrated scientific reasoning behaviors that are difficult to assess through isolated task evaluations. Extensive experiments on both opensource and closed-source multimodal LLMs reveal consistent performance gaps across tasks, highlighting persistent challenges in integrated scientific reasoning and critique. Our benchmark and dataset are available at https:// github.com/Yanjun-Zhao/PaperMind.

Japanese scene text poses challenges that multilingual benchmarks often fail to capture, including mixed scripts, frequent vertical writing, and a character inventory far larger than the Latin alphabet. Although Japanese is included in several multilingual benchmarks, these resources do not adequately capture the language-specific complexities. Meanwhile, existing Japanese visual text datasets have primarily focused on scanned documents, leaving in-the-wild scene text underexplored. To fill this gap, we introduce JaWildText, a diagnostic benchmark for evaluating vision-language models (VLMs) on Japanese scene text understanding. JaWildText contains 3,241 instances from 2,961 images newly captured in Japan, with 1.12 million annotated characters spanning 3,643 unique character types. It comprises three complementary tasks that vary in visual organization, output format, and writing style: (i) Dense Scene Text Visual Question Answering (STVQA), which requires reasoning over multiple pieces of visual text evidence; (ii) Receipt Key Information Extraction (KIE), which tests layout-aware structured extraction from mobile-captured receipts; and (iii) Handwriting OCR, which evaluates page-level transcription across various media and writing directions. We evaluate 14 open-weight VLMs and find that the best model achieves an average score of 0.64 across the three tasks. Error analyses show recognition remains the dominant bottleneck, especially for kanji. JaWildText enables fine-grained, script-aware diagnosis of Japanese scene text capabilities, and will be released with evaluation code.

Ultrasound is crucial in modern medicine but faces challenges like operator dependence, image noise, and real-time scanning, hindering AI integration. While large multimodal models excel in other medical imaging areas, they struggle with ultrasound's complexities. To address this, we introduce Dolphin v1.0 (V1) and its reasoning-augmented version, Dolphin R1-the first large-scale multimodal ultrasound foundation models unifying diverse clinical tasks in a single vision-language framework.To tackle ultrasound variability and noise, we curated a 2-million-scale multimodal dataset, combining textbook knowledge, public data, synthetic samples, and general corpora. This ensures robust perception, generalization, and clinical adaptability.The Dolphin series employs a three-stage training strategy: domain-specialized pretraining, instruction-driven alignment, and reinforcement-based refinement. Dolphin v1.0 delivers reliable performance in classification, detection, regression, and report generation. Dolphin R1 enhances diagnostic inference, reasoning transparency, and interpretability through reinforcement learning with ultrasound-specific rewards.Evaluated on U2-Bench across eight ultrasound tasks, Dolphin R1 achieves a U2-score of 0.5835-over twice the second-best model (0.2968) setting a new state of the art. Dolphin v1.0 also performs competitively, validating the unified framework. Comparisons show reasoning-enhanced training significantly improves diagnostic accuracy, consistency, and interpretability, highlighting its importance for high-stakes medical AI.

Large Language Model (LLM)-based agents have demonstrated strong capabilities across a wide range of tasks, and their application in the medical domain holds particular promise due to the demand for high generalizability and reliance on interdisciplinary knowledge. However, existing medical agent systems often rely on static, manually crafted workflows that lack the flexibility to accommodate diverse diagnostic requirements and adapt to emerging clinical scenarios. Motivated by the success of automated machine learning (AutoML), this paper introduces a novel framework for the automated design of medical agent architectures. Specifically, we define a hierarchical and expressive agent search space that enables dynamic workflow adaptation through structured modifications at the node, structural, and framework levels. Our framework conceptualizes medical agents as graph-based architectures composed of diverse, functional node types and supports iterative self-improvement guided by diagnostic feedback. Experimental results on skin disease diagnosis tasks demonstrate that the proposed method effectively evolves workflow structures and significantly enhances diagnostic accuracy over time. This work represents the first fully automated framework for medical agent architecture design and offers a scalable, adaptable foundation for deploying intelligent agents in real-world clinical environments.

This paper presents factorized linear projection (FLiP) models for understanding pretrained sentence embedding spaces. We train FLiP models to recover the lexical content from multilingual (LaBSE), multimodal (SONAR) and API-based (Gemini) sentence embedding spaces in several high- and mid-resource languages. We show that FLiP can recall more than 75% of lexical content from the embeddings, significantly outperforming existing non-factorized baselines. Using this as a diagnostic tool, we uncover the modality and language biases across the selected sentence encoders and provide practitioners with intrinsic insights about the encoders without relying on conventional downstream evaluation tasks. Our implementation is public https://github.com/BUTSpeechFIT/FLiP.

Pretrained Multimodal Large Language Models (MLLMs) are increasingly deployed in medical AI systems for clinical reasoning, diagnosis support, and report generation. However, their training on sensitive patient data raises critical privacy and compliance challenges under regulations such as HIPAA and GDPR, which enforce the "right to be forgotten". Unlearning, the process of tuning models to selectively remove the influence of specific training data points, offers a potential solution, yet its effectiveness in complex medical settings remains underexplored. To systematically study this, we introduce MedForget, a Hierarchy-Aware Multimodal Unlearning Testbed with explicit retain and forget splits and evaluation sets containing rephrased variants. MedForget models hospital data as a nested hierarchy (Institution -> Patient -> Study -> Section), enabling fine-grained assessment across eight organizational levels. The benchmark contains 3840 multimodal (image, question, answer) instances, each hierarchy level having a dedicated unlearning target, reflecting distinct unlearning challenges. Experiments with four SOTA unlearning methods on three tasks (generation, classification, cloze) show that existing methods struggle to achieve complete, hierarchy-aware forgetting without reducing diagnostic performance. To test whether unlearning truly deletes hierarchical pathways, we introduce a reconstruction attack that progressively adds hierarchical level context to prompts. Models unlearned at a coarse granularity show strong resistance, while fine-grained unlearning leaves models vulnerable to such reconstruction. MedForget provides a practical, HIPAA-aligned testbed for building compliant medical AI systems.

Test-time compute has empowered multimodal large language models to generate extended reasoning chains, yielding strong performance on tasks such as multimodal math reasoning. However, this improved reasoning ability often comes with increased hallucination: as generations become longer, models tend to drift away from image-grounded content and rely more heavily on language priors. Attention analysis shows that longer reasoning chains lead to reduced focus on visual inputs, which contributes to hallucination. To systematically study this phenomenon, we introduce RH-AUC, a metric that quantifies how a model's perception accuracy changes with reasoning length, allowing us to evaluate whether the model preserves visual grounding during reasoning. We also release RH-Bench, a diagnostic benchmark that spans a variety of multimodal tasks, designed to assess the trade-off between reasoning ability and hallucination. Our analysis reveals that (i) larger models typically achieve a better balance between reasoning and perception, and (ii) this balance is influenced more by the types and domains of training data than by its overall volume. These findings underscore the importance of evaluation frameworks that jointly consider both reasoning quality and perceptual fidelity.

Linguistic expressions of emotions such as depression, anxiety, and trauma-related states are pervasive in clinical notes, counseling dialogues, and online mental health communities, and accurate recognition of these emotions is essential for clinical triage, risk assessment, and timely intervention. Although large language models (LLMs) have demonstrated strong generalization ability in emotion analysis tasks, their diagnostic reliability in high-stakes, context-intensive medical settings remains highly sensitive to prompt design. Moreover, existing methods face two key challenges: emotional comorbidity, in which multiple intertwined emotional states complicate prediction, and inefficient exploration of clinically relevant cues. To address these challenges, we propose APOLO (Automated Prompt Optimization for Linguistic Emotion Diagnosis), a framework that systematically explores a broader and finer-grained prompt space to improve diagnostic efficiency and robustness. APOLO formulates instruction refinement as a Partially Observable Markov Decision Process and adopts a multi-agent collaboration mechanism involving Planner, Teacher, Critic, Student, and Target roles. Within this closed-loop framework, the Planner defines an optimization trajectory, while the Teacher-Critic-Student agents iteratively refine prompts to enhance reasoning stability and effectiveness, and the Target agent determines whether to continue optimization based on performance evaluation. Experimental results show that APOLO consistently improves diagnostic accuracy and robustness across domain-specific and stratified benchmarks, demonstrating a scalable and generalizable paradigm for trustworthy LLM applications in mental healthcare.

The non-invasive assessment of increasingly incidentally discovered renal masses is a critical challenge in urologic oncology, where diagnostic uncertainty frequently leads to the overtreatment of benign or indolent tumors. In this study, we developed and validated RenalCLIP using a dataset of 27,866 CT scans from 8,809 patients across nine Chinese medical centers and the public TCIA cohort, a visual-language foundation model for characterization, diagnosis and prognosis of renal mass. The model was developed via a two-stage pre-training strategy that first enhances the image and text encoders with domain-specific knowledge before aligning them through a contrastive learning objective, to create robust representations for superior generalization and diagnostic precision. RenalCLIP achieved better performance and superior generalizability across 10 core tasks spanning the full clinical workflow of kidney cancer, including anatomical assessment, diagnostic classification, and survival prediction, compared with other state-of-the-art general-purpose CT foundation models. Especially, for complicated task like recurrence-free survival prediction in the TCIA cohort, RenalCLIP achieved a C-index of 0.726, representing a substantial improvement of approximately 20% over the leading baselines. Furthermore, RenalCLIP's pre-training imparted remarkable data efficiency; in the diagnostic classification task, it only needs 20% training data to achieve the peak performance of all baseline models even after they were fully fine-tuned on 100% of the data. Additionally, it achieved superior performance in report generation, image-text retrieval and zero-shot diagnosis tasks. Our findings establish that RenalCLIP provides a robust tool with the potential to enhance diagnostic accuracy, refine prognostic stratification, and personalize the management of patients with kidney cancer.

The widespread use of chest X-rays (CXRs), coupled with a shortage of radiologists, has driven growing interest in automated CXR analysis and AI-assisted reporting. While existing vision-language models (VLMs) show promise in specific tasks such as report generation or abnormality detection, they often lack support for interactive diagnostic capabilities. In this work we present RadVLM, a compact, multitask conversational foundation model designed for CXR interpretation. To this end, we curate a large-scale instruction dataset comprising over 1 million image-instruction pairs containing both single-turn tasks -- such as report generation, abnormality classification, and visual grounding -- and multi-turn, multi-task conversational interactions. After fine-tuning RadVLM on this instruction dataset, we evaluate it across different tasks along with re-implemented baseline VLMs. Our results show that RadVLM achieves state-of-the-art performance in conversational capabilities and visual grounding while remaining competitive in other radiology tasks. Ablation studies further highlight the benefit of joint training across multiple tasks, particularly for scenarios with limited annotated data. Together, these findings highlight the potential of RadVLM as a clinically relevant AI assistant, providing structured CXR interpretation and conversational capabilities to support more effective and accessible diagnostic workflows.

Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.

The rapid development of Large Language Models (LLMs) and the emergence of novel abilities with scale have necessitated the construction of holistic, diverse and challenging benchmarks such as HELM and BIG-bench. However, at the moment, most of these benchmarks focus only on performance in English and evaluations that include Southeast Asian (SEA) languages are few in number. We therefore propose BHASA, a holistic linguistic and cultural evaluation suite for LLMs in SEA languages. It comprises three components: (1) a NLP benchmark covering eight tasks across Natural Language Understanding (NLU), Generation (NLG) and Reasoning (NLR) tasks, (2) LINDSEA, a linguistic diagnostic toolkit that spans the gamut of linguistic phenomena including syntax, semantics and pragmatics, and (3) a cultural diagnostics dataset that probes for both cultural representation and sensitivity. For this preliminary effort, we implement the NLP benchmark only for Indonesian, Vietnamese, Thai and Tamil, and we only include Indonesian and Tamil for LINDSEA and the cultural diagnostics dataset. As GPT-4 is purportedly one of the best-performing multilingual LLMs at the moment, we use it as a yardstick to gauge the capabilities of LLMs in the context of SEA languages. Our initial experiments on GPT-4 with BHASA find it lacking in various aspects of linguistic capabilities, cultural representation and sensitivity in the targeted SEA languages. BHASA is a work in progress and will continue to be improved and expanded in the future. The repository for this paper can be found at: https://github.com/aisingapore/BHASA

While Instruction-based Image Editing (IIE) has achieved significant progress, existing benchmarks pursue task breadth via mixed evaluations. This paradigm obscures a critical failure mode crucial in professional applications: the inconsistent performance of models across tasks of varying semantic scales. To address this gap, we introduce Omni IIE Bench, a high-quality, human-annotated benchmark specifically designed to diagnose the editing consistency of IIE models in practical application scenarios. Omni IIE Bench features an innovative dual-track diagnostic design: (1) Single-turn Consistency, comprising shared-context task pairs of attribute modification and entity replacement; and (2) Multi-turn Coordination, involving continuous dialogue tasks that traverse semantic scales. The benchmark is constructed via an exceptionally rigorous multi-stage human filtering process, incorporating a quality standard enforced by computer vision graduate students and an industry relevance review conducted by professional designers. We perform a comprehensive evaluation of 8 mainstream IIE models using Omni IIE Bench. Our analysis quantifies, for the first time, a prevalent performance gap: nearly all models exhibit a significant performance degradation when transitioning from low-semantic-scale to high-semantic-scale tasks. Omni IIE Bench provides critical diagnostic tools and insights for the development of next-generation, more reliable, and stable IIE models.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

Progress in genomic foundation models is difficult to assess due to fragmented benchmarks, incompatible evaluation protocols, and task-specific reporting. As a result, claims of superiority or generality across models are often not directly comparable. We introduce GENEB, a large-scale diagnostic benchmark that evaluates frozen representations from 40 genomic foundation models across 100 tasks spanning 13 functional categories under a unified probing-based protocol, including few-shot regimes. GENEB enables controlled comparison across model scale, architecture, tokenization, and pretraining data while explicitly exposing task-level trade-offs. Our analysis shows that aggregate leaderboards are unstable: model rankings vary sharply across task categories, scale provides only modest and inconsistent gains, and architectural and pretraining alignment frequently outweigh parameter count. These results highlight limitations of current evaluation practices and position GENEB as a reference framework for principled comparison and category-aware model selection in genomic machine learning.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

Despite the advancements and impressive performance of Multimodal Large Language Models (MLLMs) on benchmarks, their effectiveness in real-world, long-context, and multi-image tasks is unclear due to the benchmarks' limited scope. Existing benchmarks often focus on single-image and short-text samples, and when assessing multi-image tasks, they either limit the image count or focus on specific task (e.g time-series captioning), potentially obscuring the performance challenges of MLLMs. To address these limitations, we introduce MileBench, a pioneering benchmark designed to test the MultImodal Long-contExt capabilities of MLLMs. This benchmark comprises not only multimodal long contexts, but also multiple tasks requiring both comprehension and generation. We establish two distinct evaluation sets, diagnostic and realistic, to systematically assess MLLMs' long-context adaptation capacity and their ability to complete tasks in long-context scenarios. Our experimental results, obtained from testing 20 models, revealed that while the closed-source GPT-4(Vision) and Gemini 1.5 outperform others, most open-source MLLMs struggle in long-context situations. Interestingly, the performance gap tends to widen with an increase in the number of images. We strongly encourage an intensification of research efforts towards enhancing MLLMs' long-context capabilities, especially in scenarios involving multiple images.

As data-science agents shift from co-pilots to auto-pilots, silent misframing becomes a critical failure mode. Agents quietly commit to plausible but unintended task framings, producing clean, executable artifacts that hide their incorrect assessment of the task. Existing benchmarks score whether the pipeline runs, ignoring whether the agent recognized the task was underspecified. We introduce Ambig-DS, two diagnostic suites: one for prediction-target ambiguity (Ambig-DS-Target, 51 tasks built on DSBench, a tabular modeling benchmark) and one for evaluation-objective ambiguity (Ambig-DS-Objective, 61 tasks built on MLE-bench, a Kaggle-style ML competition benchmark), constructed so that scoring uses each source benchmark's original evaluator. For every task we pair the original, fully specified version with an ambiguous variant produced by controlled edits; a human-and-LLM verification pipeline confirms each variant admits multiple plausible interpretations with decision-relevant consequences. The suites are analyzed independently and ambiguity lowers performance in both. Across five agents spanning efficient to frontier-class models, we find in our controlled diagnostic setting: (i) failures are silent commitments: wrong-target submissions on Target, wrong-metric or non-committal baseline submissions on Objective, rather than execution errors; (ii) allowing the agent to ask one clarifying question recovers much of the loss under idealized conditions, suggesting missing framing information drives a substantial part of the observed degradation; but (iii) agents cannot reliably tell when to use it: permissive prompts induce over-asking on clear tasks, while conservative prompts induce silent defaulting on ambiguous ones. Recognizing target and objective underspecification, not pipeline execution, is the bottleneck missing from standard DS-agent evaluations.

Healthcare automation is shaped by local procedures and organizational constraints, so agent capabilities rarely transfer unchanged across settings. Agent skills, self-contained directories that package reusable procedures for AI agents, are emerging as a procedural layer for adapting healthcare agents across diverse healthcare settings. We present the first empirical analysis of healthcare agent skills, drawing on 557 healthcare-related skills filtered from 58,159 public skills on ClawHub and annotated along ten dimensions covering function, deployment context, autonomy, and safety. We find that public healthcare skills emphasize patient-facing workflow automation and monitoring rather than the diagnostic and treatment-oriented tasks foregrounded in healthcare-agent research; coverage of the healthcare lifecycle and specialized clinical inputs remains uneven; and general technical risk does not reliably capture clinical risk. These findings position healthcare skills as a procedural layer not yet addressed by current benchmarks and risk frameworks.

Universal image restoration (UIR) aims to recover clean images from diverse and unknown degradations using a unified model. Existing UIR methods primarily focus on pixel reconstruction and often lack explicit diagnostic reasoning over degradation composition, severity, and scene semantics prior to restoration. We propose Reason and Restore (R\&R), a novel framework that integrates structured Chain-of-Thought (CoT) reasoning into the image restoration pipeline. R\&R introduces an explicit reasoner, implemented by fine-tuning Qwen3-VL, to diagnose degradation types, quantify degradation severity, infer key degradation-related factors, and describe relevant scene and object semantics. The resulting structured reasoning provides interpretable and fine-grained diagnostic priors for the restorer. To further improve restoration quality, the quantified degradation severity produced by the reasoner is leveraged as reinforcement learning (RL) signals to guide and strengthen the restorer. Unlike existing multimodal LLM-based agentic systems that decouple reasoning from low-level vision tasks, R\&R tightly couples semantic diagnostic reasoning with pixel-level restoration in a unified framework. Extensive experiments across diverse UIR benchmarks demonstrate that R\&R achieves state-of-the-art performance while offering unique interpretability into the restoration process.

Equipping large language models with explicit skills has emerged as a promising paradigm for enabling autonomous agents to solve complex tasks. Agent skills can be inherently divided into general skills for broad cognitive transfer and task-specific skills for dynamic execution. However, existing skill-based reinforcement learning (RL) methods typically force a rigid choice between full externalization, which incurs prohibitive context overhead, and full internalization, which risks overfitting and knowledge conflicts. To address this dilemma, we propose Skill0.5, a novel agentic RL framework that explicitly differentiates skill treatments by combining general skill internalization with task-specific skill utilization. Driven by a dynamic, difficulty-aware router, Skill0.5 streams tasks into distinct mastery tiers to apply tailored optimization strategies: it internalizes general skills via privileged distillation to build a cognitive foundation for hard tasks, while using diagnostic probing on easy tasks to penalize shortcuts and enforce specific skill utilization. Experiments on ALFWorld and WebShop demonstrate that Skill0.5 outperforms both memory-based and skill-based RL baselines, yielding performance improvements across both in-distribution and out-of-distribution scenarios.

Memory remains a critical bottleneck for long-horizon robotic manipulation, as standard Vision-Language-Action (VLA) policies often fail when task-relevant cues become occluded or unobservable over time. While existing memory-augmented methods utilize historical context, they either suffer from severe information bottlenecks, incur high latency via decoupled dual systems, or rely on unselective buffers that accumulate massive visual redundancies. To address these limitations, we introduce EventVLA, an end-to-end framework founded on the concept of sparse visual evidence memory that comprises two core components: foundational visual anchors to retain initial and short-term contexts, and a dynamic Keyframe Evidence Memory (KEM) module. Specifically, KEM directly predicts future keyframe probabilities from the VLA's latent embeddings to autonomously capture and store sparse, task-critical visual events. This foresight-driven mechanism empowers the policy to dynamically evaluate the future causal utility of current observations, preserving transient visual evidence before it becomes unobservable. Furthermore, we propose RoboTwin-MeM, a diagnostic benchmark specifically designed to evaluate non-Markovian manipulation tasks with interactive visual evidence. Extensive evaluations show that across 17 memory-requiring simulation tasks and 4 real-world bimanual tasks, EventVLA achieves an average success rate improvement of +40% over state-of-the-art memory-augmented VLAs.

As Large Language Models shift the programming toward human-guided ''vibe coding'', agentic coding tools increasingly rely on models to self-diagnose and repair their own subtle faults -- a capability central to autonomous software engineering yet never systematically evaluated. We present , the first empirical decomposition that jointly evaluates two coupled tasks: Fault-Triggering Test Generation (FT-Test) constructing a discriminative witness that exposes a latent bug, and Fault-targeted Program Repair (FPR), repairing it under varying diagnostic conditions. pairs competitive programming problems with LLM-generated solutions that pass partial test suites but fail on semantic edge cases, enabling controlled identification of where the diagnostic chain breaks down. Evaluating 12 frontier LLMs, we find that fault-targeted reasoning does not scale with general coding ability. Models produce syntactically valid test inputs at near-ceiling rates yet collapse on discriminative generation, with fault hypothesis generation -- not output validation -- as the dominant bottleneck. Test-guided repair reveals a complementary insight: when self-generated tests successfully witness a fault, the resulting repair matches or outperforms repair guided by externally provided tests, but tests that fail to witness the fault actively degrade repair below unguided baselines. Together, these results reframe the challenge of autonomous debugging: the binding bottleneck is not code synthesis or test validity but fault-target reasoning, a capability that remains deficient across all frontier models. As Large Language Models shift the programming toward human-guided ''vibe coding'', agentic coding tools increasingly rely on models to self-diagnose and repair their own subtle faults -- a capability central to autonomous software engineering yet never systematically evaluated.

Small object-centric spatial understanding in indoor videos remains a significant challenge for multimodal large language models (MLLMs), despite its practical value for object search and assistive applications. Although existing benchmarks have advanced video spatial intelligence, embodied reasoning, and diagnostic perception, no existing benchmark directly evaluates whether a model can localize a target object in video and express its position with sufficient precision for downstream use. In this work, we introduce PinpointQA, the first dataset and benchmark for small object-centric spatial understanding in indoor videos. Built from ScanNet++ and ScanNet200, PinpointQA comprises 1,024 scenes and 10,094 QA pairs organized into four progressively challenging tasks: Target Presence Verification (TPV), Nearest Reference Identification (NRI), Fine-Grained Spatial Description (FSD), and Structured Spatial Prediction (SSP). The dataset is built from intermediate spatial representations, with QA pairs generated automatically and further refined through quality control. Experiments on representative MLLMs reveal a consistent capability gap along the progressive chain, with SSP remaining particularly difficult. Supervised fine-tuning on PinpointQA yields substantial gains, especially on the harder tasks, demonstrating that PinpointQA serves as both a diagnostic benchmark and an effective training dataset. The dataset and project page are available at https://rainchowz.github.io/PinpointQA.

Clinical image interpretation is inherently multi-step and tool-centric: clinicians iteratively combine visual evidence with patient context, quantify findings, and refine their decisions through a sequence of specialized procedures. While LLM-based agents promise to orchestrate such heterogeneous medical tools, existing systems treat tool sets and invocation strategies as static after deployment. This design is brittle under real-world domain shifts, across tasks, and evolving diagnostic requirements, where predefined tool chains frequently degrade and demand costly manual re-design. We propose MACRO, a self-evolving, experience-augmented medical agent that shifts from static tool composition to experience-driven tool discovery. From verified execution trajectories, the agent autonomously identifies recurring effective multi-step tool sequences, synthesizes them into reusable composite tools, and registers these as new high-level primitives that continuously expand its behavioral repertoire. A lightweight image-feature memory grounds tool selection in a visual-clinical context, while a GRPO-like training loop reinforces reliable invocation of discovered composites, enabling closed-loop self-improvement with minimal supervision. Extensive experiments across diverse medical imaging datasets and tasks demonstrate that autonomous composite tool discovery consistently improves multi-step orchestration accuracy and cross-domain generalization over strong baselines and recent state-of-the-art agentic methods, bridging the gap between brittle static tool use and adaptive, context-aware clinical AI assistance. Code will be available upon acceptance.

Automated interpretation of electrocardiograms (ECG) has garnered significant attention with the advancements in machine learning methodologies. Despite the growing interest, most current studies focus solely on classification or regression tasks, which overlook a crucial aspect of clinical cardio-disease diagnosis: the diagnostic report generated by experienced human clinicians. In this paper, we introduce a novel approach to ECG interpretation, leveraging recent breakthroughs in Large Language Models (LLMs) and Vision-Transformer (ViT) models. Rather than treating ECG diagnosis as a classification or regression task, we propose an alternative method of automatically identifying the most similar clinical cases based on the input ECG data. Also, since interpreting ECG as images is more affordable and accessible, we process ECG as encoded images and adopt a vision-language learning paradigm to jointly learn vision-language alignment between encoded ECG images and ECG diagnosis reports. Encoding ECG into images can result in an efficient ECG retrieval system, which will be highly practical and useful in clinical applications. More importantly, our findings could serve as a crucial resource for providing diagnostic services in underdeveloped regions.

Recent advancements in Multimodal Large Language Models (MLLMs) have demonstrated impressive performance on standard visual reasoning benchmarks. However, there is growing concern that these models rely excessively on linguistic shortcuts rather than genuine visual grounding, a phenomenon we term Text Bias. In this paper, we investigate the fundamental tension between visual perception and linguistic priors. We decouple the sources of this bias into two dimensions: Internal Corpus Bias, stemming from statistical correlations in pretraining, and External Instruction Bias, arising from the alignment-induced tendency toward sycophancy. To quantify this effect, we introduce V-FAT (Visual Fidelity Against Text-bias), a diagnostic benchmark comprising 4,026 VQA instances across six semantic domains. V-FAT employs a Three-Level Evaluation Framework that systematically increases the conflict between visual evidence and textual information: (L1) internal bias from atypical images, (L2) external bias from misleading instructions, and (L3) synergistic bias where both coincide. We introduce the Visual Robustness Score (VRS), a metric designed to penalize "lucky" linguistic guesses and reward true visual fidelity. Our evaluation of 12 frontier MLLMs reveals that while models excel in existing benchmarks, they experience significant visual collapse under high linguistic dominance.

Recent rapid progress in the field of computational pathology has been enabled by foundation models. These models are beginning to move beyond encoding image patches towards whole-slide understanding but their clinical utility remains limited. In this work, we present PRISM2, a multimodal slide-level foundation model trained on data from 700,000 diagnostic specimen-report pairs, the largest vision (2.3 million whole slide images) and language (14M question-answer pairs) histopathology dataset to date. By learning through clinical-dialogue supervision, PRISM2 aligns histomorphologic features with the language of diagnostic reasoning, producing slide-level representations that support both direct diagnostic question-answering and transferable embeddings for downstream tasks. Without additional training, PRISM2 matches or exceeds the cancer-detection performance of clinical-grade products. This is observed without loss of generality on other tasks, where PRISM2 achieves top performance. Finally, using survival prediction as the example, we show that task-specific finetuning with a large dataset can outperform task-specific models, further improving performance. These results demonstrate how language-supervised pretraining provides a scalable, clinically grounded signal for learning generalizable pathology representations, bridging human diagnostic reasoning and foundation-model performance.

The integration of visual understanding and generation into unified multimodal models represents a significant stride toward general-purpose AI. However, a fundamental question remains unanswered by existing benchmarks: does this architectural unification actually enable synergetic interaction between the constituent capabilities? Existing evaluation paradigms, which primarily assess understanding and generation in isolation, are insufficient for determining whether a unified model can leverage its understanding to enhance its generation, or use generative simulation to facilitate deeper comprehension. To address this critical gap, we introduce RealUnify, a benchmark specifically designed to evaluate bidirectional capability synergy. RealUnify comprises 1,000 meticulously human-annotated instances spanning 10 categories and 32 subtasks. It is structured around two core axes: 1) Understanding Enhances Generation, which requires reasoning (e.g., commonsense, logic) to guide image generation, and 2) Generation Enhances Understanding, which necessitates mental simulation or reconstruction (e.g., of transformed or disordered visual inputs) to solve reasoning tasks. A key contribution is our dual-evaluation protocol, which combines direct end-to-end assessment with a diagnostic stepwise evaluation that decomposes tasks into distinct understanding and generation phases. This protocol allows us to precisely discern whether performance bottlenecks stem from deficiencies in core abilities or from a failure to integrate them. Through large-scale evaluations of 12 leading unified models and 6 specialized baselines, we find that current unified models still struggle to achieve effective synergy, indicating that architectural unification alone is insufficient. These results highlight the need for new training strategies and inductive biases to fully unlock the potential of unified modeling.

Recent advancements in diffusion probabilistic models (DPMs) have revolutionized image processing, demonstrating significant potential in medical applications. Accurate segmentation of the left ventricle (LV) in echocardiograms is crucial for diagnostic procedures and necessary treatments. However, ultrasound images are notoriously noisy with low contrast and ambiguous LV boundaries, thereby complicating the segmentation process. To address these challenges, this paper introduces Echo-DND, a novel dual-noise diffusion model specifically designed for this task. Echo-DND leverages a unique combination of Gaussian and Bernoulli noises. It also incorporates a multi-scale fusion conditioning module to improve segmentation precision. Furthermore, it utilizes spatial coherence calibration to maintain spatial integrity in segmentation masks. The model's performance was rigorously validated on the CAMUS and EchoNet-Dynamic datasets. Extensive evaluations demonstrate that the proposed framework outperforms existing SOTA models. It achieves high Dice scores of 0.962 and 0.939 on these datasets, respectively. The proposed Echo-DND model establishes a new standard in echocardiogram segmentation, and its architecture holds promise for broader applicability in other medical imaging tasks, potentially improving diagnostic accuracy across various medical domains. Project page: https://abdur75648.github.io/Echo-DND

Large language models (LLMs), particularly those with reasoning capabilities, have rapidly advanced in recent years, demonstrating significant potential across a wide range of applications. However, their deployment in healthcare, especially in disease reasoning tasks, is hindered by the challenge of acquiring expert-level cognitive data. In this paper, we introduce Citrus, a medical language model that bridges the gap between clinical expertise and AI reasoning by emulating the cognitive processes of medical experts. The model is trained on a large corpus of simulated expert disease reasoning data, synthesized using a novel approach that accurately captures the decision-making pathways of clinicians. This approach enables Citrus to better simulate the complex reasoning processes involved in diagnosing and treating medical conditions.To further address the lack of publicly available datasets for medical reasoning tasks, we release the last-stage training data, including a custom-built medical diagnostic dialogue dataset. This open-source contribution aims to support further research and development in the field. Evaluations using authoritative benchmarks such as MedQA, covering tasks in medical reasoning and language understanding, show that Citrus achieves superior performance compared to other models of similar size. These results highlight Citrus potential to significantly enhance medical decision support systems, providing a more accurate and efficient tool for clinical decision-making.

Diagnosing and treating skin diseases require advanced visual skills across domains and the ability to synthesize information from multiple imaging modalities. While current deep learning models excel at specific tasks like skin cancer diagnosis from dermoscopic images, they struggle to meet the complex, multimodal requirements of clinical practice. Here, we introduce PanDerm, a multimodal dermatology foundation model pretrained through self-supervised learning on over 2 million real-world skin disease images from 11 clinical institutions across 4 imaging modalities. We evaluated PanDerm on 28 diverse benchmarks, including skin cancer screening, risk stratification, differential diagnosis of common and rare skin conditions, lesion segmentation, longitudinal monitoring, and metastasis prediction and prognosis. PanDerm achieved state-of-the-art performance across all evaluated tasks, often outperforming existing models when using only 10% of labeled data. We conducted three reader studies to assess PanDerm's potential clinical utility. PanDerm outperformed clinicians by 10.2% in early-stage melanoma detection through longitudinal analysis, improved clinicians' skin cancer diagnostic accuracy by 11% on dermoscopy images, and enhanced non-dermatologist healthcare providers' differential diagnosis by 16.5% across 128 skin conditions on clinical photographs. These results demonstrate PanDerm's potential to improve patient care across diverse clinical scenarios and serve as a model for developing multimodal foundation models in other medical specialties, potentially accelerating the integration of AI support in healthcare. The code can be found at https://github.com/SiyuanYan1/PanDerm.

Tissue phenotyping is a fundamental computational pathology (CPath) task in learning objective characterizations of histopathologic biomarkers in anatomic pathology. However, whole-slide imaging (WSI) poses a complex computer vision problem in which the large-scale image resolutions of WSIs and the enormous diversity of morphological phenotypes preclude large-scale data annotation. Current efforts have proposed using pretrained image encoders with either transfer learning from natural image datasets or self-supervised pretraining on publicly-available histopathology datasets, but have not been extensively developed and evaluated across diverse tissue types at scale. We introduce UNI, a general-purpose self-supervised model for pathology, pretrained using over 100 million tissue patches from over 100,000 diagnostic haematoxylin and eosin-stained WSIs across 20 major tissue types, and evaluated on 33 representative CPath clinical tasks in CPath of varying diagnostic difficulties. In addition to outperforming previous state-of-the-art models, we demonstrate new modeling capabilities in CPath such as resolution-agnostic tissue classification, slide classification using few-shot class prototypes, and disease subtyping generalization in classifying up to 108 cancer types in the OncoTree code classification system. UNI advances unsupervised representation learning at scale in CPath in terms of both pretraining data and downstream evaluation, enabling data-efficient AI models that can generalize and transfer to a gamut of diagnostically-challenging tasks and clinical workflows in anatomic pathology.

Recent breakthroughs in large language models (LLMs) offer unprecedented natural language understanding and generation capabilities. However, existing surveys on LLMs in biomedicine often focus on specific applications or model architectures, lacking a comprehensive analysis that integrates the latest advancements across various biomedical domains. This review, based on an analysis of 484 publications sourced from databases including PubMed, Web of Science, and arXiv, provides an in-depth examination of the current landscape, applications, challenges, and prospects of LLMs in biomedicine, distinguishing itself by focusing on the practical implications of these models in real-world biomedical contexts. Firstly, we explore the capabilities of LLMs in zero-shot learning across a broad spectrum of biomedical tasks, including diagnostic assistance, drug discovery, and personalized medicine, among others, with insights drawn from 137 key studies. Then, we discuss adaptation strategies of LLMs, including fine-tuning methods for both uni-modal and multi-modal LLMs to enhance their performance in specialized biomedical contexts where zero-shot fails to achieve, such as medical question answering and efficient processing of biomedical literature. Finally, we discuss the challenges that LLMs face in the biomedicine domain including data privacy concerns, limited model interpretability, issues with dataset quality, and ethics due to the sensitive nature of biomedical data, the need for highly reliable model outputs, and the ethical implications of deploying AI in healthcare. To address these challenges, we also identify future research directions of LLM in biomedicine including federated learning methods to preserve data privacy and integrating explainable AI methodologies to enhance the transparency of LLMs.