Daily Papers

Recent Audio Multimodal Large Language Models (Audio MLLMs) demonstrate impressive performance on speech benchmarks, yet it remains unclear whether these models genuinely process acoustic signals or rely on text-based semantic inference. To systematically study this question, we introduce DEAF (Diagnostic Evaluation of Acoustic Faithfulness), a benchmark of over 2,700 conflict stimuli spanning three acoustic dimensions: emotional prosody, background sounds, and speaker identity. Then, we design a controlled multi-level evaluation framework that progressively increases textual influence, ranging from semantic conflicts in the content to misleading prompts and their combination, allowing us to disentangle content-driven bias from prompt-induced sycophancy. We further introduce diagnostic metrics to quantify model reliance on textual cues over acoustic signals. Our evaluation of seven Audio MLLMs reveals a consistent pattern of text dominance: models are sensitive to acoustic variations, yet predictions are predominantly driven by textual inputs, revealing a gap between high performance on standard speech benchmarks and genuine acoustic understanding.

Zero-Shot Compositional Action Recognition (ZS-CAR) requires recognizing novel verb-object combinations composed of previously observed primitives. In this work, we tackle a key failure mode: models predict verbs via object-driven shortcuts (i.e., relying on the labeled object class) rather than temporal evidence. We argue that sparse compositional supervision and verb-object learning asymmetry can promote object-driven shortcut learning. Our analysis with proposed diagnostic metrics shows that existing methods overfit to training co-occurrence patterns and underuse temporal verb cues, resulting in weak generalization to unseen compositions. To address object-driven shortcuts, we propose Robust COmpositional REpresentations (RCORE) with two components. Co-occurrence Prior Regularization (CPR) adds explicit supervision for unseen compositions and regularizes the model against frequent co-occurrence priors by treating them as hard negatives. Temporal Order Regularization for Composition (TORC) enforces temporal-order sensitivity to learn temporally grounded verb representations. Across Sth-com and EK100-com, RCORE reduces shortcut diagnostics and consequently improves compositional generalization.

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.

Deep research (DR) systems are increasingly used for complex information-seeking tasks, but existing works mainly focus on generating reports and summaries. In contrast, many enterprise tasks instead require an agent to identify concrete workflows which is a sequence of action-steps. For example, rather than summarizing budgeting policies, an agent should be able to determine the steps needed to answer a question such as: "How do I request new headcount given a fixed budget?". Therefore, we introduce DRFLOW, a benchmark for evaluating personalized workflows predicted by agents from heterogeneous sources. Each task requires the agent to identify relevant evidence from scattered sources, then use that evidence to predict the correct action-step sequence for the user's task. DRFLOW contains 100 tasks across five domains, with 1,246 reference workflow steps grounded in more than 3,900 sources. We define seven diagnostic metrics covering factual grounding, step recovery, structural ordering, condition resolution, and personalization. We further present DRFLOW-Agent (DRFA), a workflow-oriented reference agent to predict personalized workflow. We show that although DRFA improves over strong baseline agents (upto 10.02% average F1 score), there is substantial room for improvement remains across these workflow metrics, indicating that predicting complete and correct personalized workflows remains a challenging frontier for deep research.

Large language models (LLMs) often exhibit unexpected errors or unintended behavior, even at scale. While recent work reveals the discrepancy between LLMs and humans in skill compositions, the learning dynamics of skill compositions and the underlying cause of non-human behavior remain elusive. In this study, we investigate the mechanism of learning dynamics by training transformers on synthetic arithmetic tasks. Through extensive ablations and fine-grained diagnostic metrics, we discover that transformers do not reliably build skill compositions according to human-like sequential rules. Instead, they often acquire skills in reverse order or in parallel, which leads to unexpected mixing errors especially under distribution shifts--a phenomenon we refer to as shattered compositionality. To explain these behaviors, we provide evidence that correlational matching to the training data, rather than causal or procedural composition, shapes learning dynamics. We further show that shattered compositionality persists in modern LLMs and is not mitigated by pure model scaling or scratchpad-based reasoning. Our results reveal a fundamental mismatch between a model's learning behavior and desired skill compositions, with implications for reasoning reliability, out-of-distribution robustness, and alignment.

Pre-trained Transformers often exhibit over-confidence in source patterns and difficulty in forming new target-domain patterns during fine-tuning. We formalize the mechanism of output saturation leading to gradient suppression through standard cross-entropy and softmax analysis, showing that gradient suppression at inflection layers confines adaptation to high-level recombination of existing features while preventing low-level reconstruction. We introduce a set of layer-wise diagnostic metrics -- attention entropy (saturation proxy), activation gradient norm, parameter gradient norm, and Delta-CKA under a shared PCA basis -- to identify inflection layers characterized by both low attention entropy and steep gradient decay. Building on these findings, we propose a diagnose-first, inject-light fine-tuning strategy: selectively inserting LoRA adapters at inflection layers to restore suppressed backward signals with minimal parameter overhead. Experiments on BERT-base transfer from SST-2 to Rotten Tomatoes under under-trained and over-trained source regimes reveal that over-trained initialization benefits from inflection-layer LoRA injection, while under-trained initialization suffers performance degradation. When base features are strong, unblocking inflection layers facilitates high-level compositional adaptation; when base features are weak, full-pathway unblocking is required for low-level reconstruction, as supported by joint analysis of layer-wise activation gradients and Delta-CKA dynamics.

Reasoning over dynamic visual content remains a central challenge for multimodal large language models. Recent thinking models generate explicit reasoning traces for interpretability; however, their reasoning often appears convincing while being logically inconsistent or weakly grounded in visual evidence. We identify and formalize these issues through two diagnostic metrics: Think Answer Consistency (TAC), which measures the alignment between reasoning and answers, and Video Attention Score (VAS), which captures the extent to which reasoning depends on visual versus textual cues. Analysis across 11 video reasoning benchmarks shows that current models rely heavily on linguistic priors rather than visual content. To address this, we propose a reinforcement learning approach that enhances both temporal precision and reasoning consistency. Our approach combines timestamp aware supervised fine tuning with Group Relative Policy Optimization (GRPO) guided by a novel Temporal Alignment Reward (TAR). This dual step post training stage encourages temporally aligned and causally coherent video reasoning. The resulting model, Video R2, achieves consistently higher TAC, VAS, and accuracy across multiple benchmarks, demonstrating that improvements in temporal alignment and reasoning coherence lead to more accurate and trustworthy video understanding. Code: https://github.com/mbzuai-oryx/Video-R2

A personalized LLM should remember user facts, apply them correctly, and adapt over time to provide responses that the user prefers. Existing LLM personalization benchmarks are largely centered on two axes: accurately recalling user information and accurately applying remembered information in downstream tasks. We argue that a third axis, likability, is both subjective and central to user experience, yet under-measured by current benchmarks. To measure likability holistically, we introduce LikeBench, a multi-session, dynamic evaluation framework that measures likability across multiple dimensions by how much an LLM can adapt over time to a user's preferences to provide more likable responses. In LikeBench, the LLMs engage in conversation with a simulated user and learn preferences only from the ongoing dialogue. As the interaction unfolds, models try to adapt to responses, and after each turn, they are evaluated for likability across seven dimensions by the same simulated user. To the best of our knowledge, we are the first to decompose likability into multiple diagnostic metrics: emotional adaptation, formality matching, knowledge adaptation, reference understanding, conversation length fit, humor fit, and callback, which makes it easier to pinpoint where a model falls short. To make the simulated user more realistic and discriminative, LikeBench uses fine-grained, psychologically grounded descriptive personas rather than the coarse high/low trait rating based personas used in prior work. Our benchmark shows that strong memory performance does not guarantee high likability: DeepSeek R1, with lower memory accuracy (86%, 17 facts/profile), outperformed Qwen3 by 28% on likability score despite Qwen3's higher memory accuracy (93%, 43 facts/profile). Even SOTA models like GPT-5 adapt well in short exchanges but show only limited robustness in longer, noisier interactions.

Despite Retrieval-Augmented Generation (RAG) has shown promising capability in leveraging external knowledge, a comprehensive evaluation of RAG systems is still challenging due to the modular nature of RAG, evaluation of long-form responses and reliability of measurements. In this paper, we propose a fine-grained evaluation framework, RAGChecker, that incorporates a suite of diagnostic metrics for both the retrieval and generation modules. Meta evaluation verifies that RAGChecker has significantly better correlations with human judgments than other evaluation metrics. Using RAGChecker, we evaluate 8 RAG systems and conduct an in-depth analysis of their performance, revealing insightful patterns and trade-offs in the design choices of RAG architectures. The metrics of RAGChecker can guide researchers and practitioners in developing more effective RAG systems.

Existing research on Domain Robustness (DR) suffers from disparate setups, lack of evaluation task variety, and reliance on challenge sets. In this paper, we pose a fundamental question: What is the state of affairs of the DR challenge in the era of Large Language Models (LLMs)? To this end, we construct a DR benchmark comprising diverse NLP tasks, including sentence and token-level classification, QA, and generation, each task consists of several domains. We explore the DR challenge of fine-tuned and few-shot learning models in natural domain shift settings and devise two diagnostic metrics of Out-of-Distribution (OOD) performance degradation: The commonly used Source Drop (SD) and the overlooked Target Drop (TD). Our findings reveal important insights: First, despite their capabilities, zero-to-few shot LLMs and fine-tuning approaches still fail to meet satisfactory performance in the OOD context; Second, TD approximates better than SD the average OOD degradation; Third, in a significant proportion of domain shifts, either SD or TD is positive, but not both, and therefore disregarding one can lead to incorrect DR conclusions.

Interpreting computed tomography (CT) requires review of hundreds of volumetric slices and remains time-intensive and expertise-dependent. Automated CT report generation offers a promising route to improving clinical efficiency, yet the field still lacks a generalizable CT report generation foundation model that supports multi-region reporting and remains robust across external real-world cohorts. Intrinsic inconsistencies in reporting style and diagnostic terminology across cohorts make naive joint training difficult. Here we present Astra, a generalizable CT report generation foundation model developed on 90,678 thoracoabdominal CT-report pairs collected from five sites worldwide (CTRgDB), comprising 353,671 abnormalities spanning eight organ systems. By harmonizing report style and further refining diagnostic consistency via reinforcement learning, Astra achieves style-consistent and diagnostically accurate report generation across diverse anatomical regions and institutions. Evaluated on CTRgDB and six external cohorts, Astra achieves state-of-the-art performance with a 38.4% average improvement in fine-grained diagnostic metrics (P<0.001). Deployed at external clinical sites without any site-specific fine-tuning, Astra accelerated chest report drafting by 29.6% and improved abdominal report completeness by 11.3% among junior and mid-level radiologists (P<0.001). Furthermore, Astra demonstrates broad utility as a foundation for CT AI development, improving downstream diagnostic performance and scaling vision-language pretrain through high-quality report synthesis. Overall, Astra serves as a broadly accessible clinical assistant and a pivotal infrastructure for the next generation of AI-powered healthcare. The code for Astra is publicly available at https://github.com/zh-Wang-Med/Astra.

The robustness of machine learning models can be compromised by spurious correlations between non-causal features in the input data and target labels. A common way to test for such correlations is to train on data where the label is strongly tied to some non-causal cue, then evaluate on examples where that tie no longer holds. This idea is well established for classification tasks, but for semantic segmentation the specific failure modes are not well understood. We show that a model may achieve reasonable overlap while assigning the wrong semantic label, swapping one plausible foreground class for another, even when object boundaries are largely correct. We focus on this semantic label-flip behaviour and quantify it with a simple diagnostic (Flip) that counts how often ground truth foreground pixels are assigned the wrong foreground identity while remaining predicted as foreground. In a setting where category and scene are correlated during training, increasing the correlation consistently widens the gap between common and rare test conditions and increases these within-object label swaps on counterfactual groups. Overall, our results motivate assessing segmentation robustness under distribution shift beyond overlap by decomposing foreground errors into correct pixels, flipped-identity pixels, and missed-to-background pixels. We also propose an entropy-based, ground truth label-free `flip-risk' score, which is computed from foreground identity uncertainty, and show that it can flag flip-prone cases at inference time. Code is available at https://github.com/acharaakshit/label-flips.

Navigation Instruction Generation (NIG) aims to produce step-by-step natural language instructions for navigation guidance. Existing studies primarily treat NIG as an auxiliary task for vision-andlanguage navigation (VLN), focusing on data augmentation or multi-task learning. However, generating navigation instructions from compact environmental priors requires meticulous spatial reasoning, especially when the target route does not simply follow the demonstrated tour, and remains challenging for current multimodal models. In this work, we introduce VideoNIG, a goal-oriented video-grounded NIG task that generates navigation instructions from ego-centric tour videos, an initial observation, and a textual or visual goal, without relying on intermediate representations such as graphs and maps. We instantiate VideoNIG in a controlled simulator benchmark with 60K tour videos across continuous indoor environments and 37K multimodal prompts with progressive difficulty levels. We further introduce a diagnostic evaluation protocol that combines text similarity, choice-based spatial consistency tests, and downstream navigation execution. To address this task, we propose a two-stage Curriculum Learning framework that decomposes the learning into foundational motion perception and long-horizon navigation reasoning. Specifically, we first employ Action Warmup for spatial action-view alignment, followed by Complexity Progression using trajectories with increasing exploratory difficulty. Extensive experiments show that existing MLLMs struggle with VideoNIG, while our approach significantly improves instruction quality across complementary diagnostic metrics. Finally, integrating VideoNIG-generated instructions with a VLN agent demonstrates the executability of this task formulation for end-to-end navigation.

The emergence of "vibe coding" platforms, where users describe applications in natural language and AI agents autonomously generate full-stack software, has created a need for rigorous evaluation beyond code-level benchmarks. In order to assess them as virtual software development agencies on understanding business requirements, making architectural decisions, writing production code, handling iterative modifications, and maintaining business readiness, we introduce SWE-WebDev Bench, a 68-metric evaluation framework spanning 25 primary and 43 diagnostic metrics across seven groups, organized along three dimensions: Interaction Mode (App Creation Request (ACR) vs. App Modification Request (AMR)), Agency Angle (Product Manager (PM), Engineering, Ops), and Complexity Tier (T4 multi-role SaaS, T5 AI-native). Our evaluation (six platforms, three domains, 18 evaluation cells) reveals four recurring shortcomings in the current generation of AI app builders: (1) A specification bottleneck, where platforms compress rich business requirements into oversimplified technical plans, (2) A pervasive frontend-backend decoupling, where visually polished UIs mask absent or broken backend infrastructure, (3) A steep production-readiness cliff, where no platform scores above 60% on engineering quality and post-generation human effort varies substantially across platforms and (4) Widespread security and infrastructure failures, with no platform exceeding 65% Security Score against a 90% target and concurrency handling as low as 6%. These observations are descriptive of our sample and require larger-scale replication to establish generality. We release SWE-WebDev Bench as a community benchmark to enable such replication and help platform builders identify and address these gaps. Code and benchmark resources are available at: https://github.com/snowmountainAi/webdevbench and https://webdevbench.com/.

Vision-Language-Action (VLA) models achieve strong performance in robotic manipulation by leveraging pre-trained vision-language backbones. However, in downstream robotic settings, they are typically fine-tuned with limited data, leading to overfitting to specific instruction formulations and leaving robustness to paraphrased instructions underexplored. To study this gap, we introduce LIBERO-Para, a controlled benchmark that independently varies action expressions and object references for fine-grained analysis of linguistic generalization. Across seven VLA configurations (0.6B-7.5B), we observe consistent performance degradation of 22-52 pp under paraphrasing. This degradation is primarily driven by object-level lexical variation: even simple synonym substitutions cause large drops, indicating reliance on surface-level matching rather than semantic grounding. Moreover, 80-96% of failures arise from planning-level trajectory divergence rather than execution errors, showing that paraphrasing disrupts task identification. Binary success rate treats all paraphrases equally, obscuring whether models perform consistently across difficulty levels or rely on easier cases. To address this, we propose PRIDE, a metric that quantifies paraphrase difficulty using semantic and syntactic factors. Our benchmark and corresponding code are available at: https://github.com/cau-hai-lab/LIBERO-Para

Egocentric AI assistants in real-world settings must process multi-modal inputs (video, audio, text), respond in real time, and retain evolving long-term memory. However, existing benchmarks typically evaluate these abilities in isolation, lack realistic streaming scenarios, or support only short-term tasks. We introduce TeleEgo, a long-duration, streaming, omni-modal benchmark for evaluating egocentric AI assistants in realistic daily contexts. The dataset features over 14 hours per participant of synchronized egocentric video, audio, and text across four domains: work \& study, lifestyle \& routines, social activities, and outings \& culture. All data is aligned on a unified global timeline and includes high-quality visual narrations and speech transcripts, curated through human refinement.TeleEgo defines 12 diagnostic subtasks across three core capabilities: Memory (recalling past events), Understanding (interpreting the current moment), and Cross-Memory Reasoning (linking distant events). It contains 3,291 human-verified QA items spanning multiple question formats (single-choice, binary, multi-choice, and open-ended), evaluated strictly in a streaming setting. We propose two key metrics -- Real-Time Accuracy and Memory Persistence Time -- to jointly assess correctness, temporal responsiveness, and long-term retention. TeleEgo provides a realistic and comprehensive evaluation to advance the development of practical AI assistants.

The evaluation of generated reports remains a critical challenge in Computed Tomography (CT) report generation, due to the large volume of text, the diversity and complexity of findings, and the presence of fine-grained, disease-oriented attributes. Conventional evaluation metrics offer only coarse measures of lexical overlap or entity matching and fail to reflect the granular diagnostic accuracy required for clinical use. To address this gap, we propose CT-FineBench, a benchmark built from CT-RATE and Merlin to evaluate the fine-grained factual consistency of CT reports, constructed from CT-RATE and Merlin. Our benchmark is constructed through a meticulous, Question-Answering (QA) based process: first, we identify and structure key, finding-specific clinical attributes (like location, size, margin). Second, we systematically transform these attributes into a QA dataset, where questions probe for specific clinical details grounded in gold-standard reports. The evaluation protocol for CT-FineBench involves using this QA dataset to query a machine-generated report and scoring the correctness of the answers. This allows for a comprehensive, interpretable, and clinically-relevant assessment, moving beyond superficial lexical overlap to pinpoint specific clinical errors. Experiments show that CT-FineBench correlates better with expert clinical assessment and is substantially more sensitive to fine-grained factual errors than prior metrics.

LLM-as-judge evaluation has become the de facto standard for scaling model assessment, but the practice is statistically unsound: uncalibrated scores can invert preferences, naive confidence intervals on uncalibrated scores achieve near-0% coverage, and importance-weighted estimators collapse under limited overlap despite high effective sample size (ESS). We introduce Causal Judge Evaluation (CJE), a framework that fixes all three failures. On n=4,961 Chatbot Arena prompts (after filtering from 5k), CJE achieves 99% pairwise ranking accuracy at full sample size (94% averaged across configurations), matching oracle quality, at 14x lower cost (for ranking 5 policies) by calibrating a 16x cheaper judge on just 5% oracle labels (~250 labels). CJE combines three components: (i) AutoCal-R, reward calibration via mean-preserving isotonic regression; (ii) SIMCal-W, weight stabilization via stacking of S-monotone candidates; and (iii) Oracle-Uncertainty Aware (OUA) inference that propagates calibration uncertainty into confidence intervals. We formalize the Coverage-Limited Efficiency (CLE) diagnostic, which explains why IPS-style estimators fail even when ESS exceeds 90%: the logger rarely visits regions where target policies concentrate. Key findings: SNIPS inverts rankings even with reward calibration (38% pairwise, negative Kendall's tau) due to weight instability; calibrated IPS remains near-random (47%) despite weight stabilization, consistent with CLE; OUA improves coverage from near-0% to ~86% (Direct) and ~96% (stacked-DR), where naive intervals severely under-cover.

In this paper, we propose an approach to support the diagnosis of urinary tract diseases, with a focus on bladder cancer, using SHAP (SHapley Additive exPlanations)-based feature selection to enhance the transparency and effectiveness of predictive models. Six binary classification scenarios were developed to distinguish bladder cancer from other urological and oncological conditions. The algorithms XGBoost, LightGBM, and CatBoost were employed, with hyperparameter optimization performed using Optuna and class balancing with the SMOTE technique. The selection of predictive variables was guided by importance values through SHAP-based feature selection while maintaining or even improving performance metrics such as balanced accuracy, precision, and specificity. The use of explainability techniques (SHAP) for feature selection proved to be an effective approach. The proposed methodology may contribute to the development of more transparent, reliable, and efficient clinical decision support systems, optimizing screening and early diagnosis of urinary tract diseases.

RAG (Retrieval-Augmented Generation) systems and web agents are increasingly evaluated on multi-hop deep search tasks, yet current practice suffers from two major limitations. First, most benchmarks leak the reasoning path in the question text, allowing models to follow surface cues rather than discover reasoning chains autonomously. Second, evaluation is typically reduced to a single pass rate, which collapses diverse behaviours into one score and obscures whether failures stem from inadequate search, poor knowledge use, or inappropriate refusal. To address these issues, we present WebDetective, a benchmark of hint-free multi-hop questions paired with a controlled Wikipedia sandbox that ensures full traceability of model actions, and a holistic evaluation framework that separates search sufficiency, knowledge utilisation, and refusal behaviour. Our evaluation of 25 state-of-the-art models reveals systematic weaknesses across all architectures: models struggle with knowledge utilisation despite having sufficient evidence and demonstrate near-absent appropriate refusal when evidence is lacking. These patterns expose a fundamental gap: today's systems excel at executing given reasoning paths but fail when required to discover them. We develop an agentic workflow, EvidenceLoop, that explicitly targets the challenges our benchmark identifies, incorporating verification loops and systematic evidence tracking that improve both search and synthesis capabilities. This baseline demonstrates that WebDetective's diagnostic framework can guide concrete architectural improvements, establishing our benchmark as a critical tool for developing genuinely autonomous reasoning systems rather than pattern-following agents.

Recent advances in autonomous LLM agents demonstrate their ability to improve performance through iterative interaction with the environment. We define this paradigm as Test-Time Improvement (TTI). However, the mechanisms under how and why TTI succeed or fail remain poorly understood, and existing evaluation metrics fail to capture their task optimization efficiency, behavior adaptation after erroneous actions, and the specific utility of working memory for task completion. To address these gaps, we propose Test-time Improvement Diagnostic Evaluation (TIDE), an agent-agnostic and environment-agnostic framework that decomposes TTI into three comprehensive and interconnected dimensions. The framework measures (1) the overall temporal dynamics of task completion and (2) identifies whether performance is primarily constrained by recursive looping behaviors or (3) by burdensome accumulated memory. Through extensive experiments across diverse agents and environments, TIDE highlights that improving agent performance requires more than scaling internal reasoning, calling for explicitly optimizing the interaction dynamics between the agent and the environment.

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.

Planning is central to LLM agents: before acting, an agent must decompose goals, select tools, reason over constraints, and decide when a task is infeasible. Yet existing agent evaluations often report only end-to-end success, making it difficult to determine whether failures stem from planning or execution. We introduce Agent Planning Benchmark (APB), a planning-specific diagnostic benchmark with 4,209 multimodal cases across 22 domains and five settings, covering holistic planning, feedback-conditioned step-wise planning, and robustness under extraneous tools, broken tools, and unsolvable tasks. Across 12 MLLMs, APB reveals systematic weaknesses in long-horizon planning, tool-noise robustness, calibrated refusal, and inference-time refinement. We further validate APB on 200 ToolSandbox tasks and 200 τ^2-bench tasks, where APB-guided refinement consistently improves plan correctness, plan grade, and downstream execution metrics across three representative models. APB thus serves as an upstream diagnostic complement to execution benchmarks. The APB benchmark and code are available in https://github.com/Mikivishy/AgentPlanningBenchmark{this URL}.

LLM-based agents are becoming central to software engineering tasks, yet evaluating them remains fragmented and largely model-centric. Existing studies overlook how architectural components, such as planners, memory, and tool routers, shape agent behavior, limiting diagnostic power. We propose a lightweight, architecture-informed approach that links agent components to their observable behaviors and to the metrics capable of evaluating them. Our method clarifies what to measure and why, and we illustrate its application through real world agents, enabling more targeted, transparent, and actionable evaluation of LLM-based agents.

Mixture-of-Experts (MoE) language models are universally sensitive to demographic content at the routing level, yet exploiting this sensitivity for fairness control is structurally limited. We introduce Fairness-Aware Routing Equilibrium (FARE), a diagnostic framework designed to probe the limits of routing-level stereotype intervention across diverse MoE architectures. FARE reveals that routing-level preference shifts are either unachievable (Mixtral, Qwen1.5, Qwen3), statistically non-robust (DeepSeekMoE), or accompanied by substantial utility cost (OLMoE, -4.4%p CrowS-Pairs at -6.3%p TQA). Critically, even where log-likelihood preference shifts are robust, they do not transfer to decoded generation: expanded evaluations on both non-null models yield null results across all generation metrics. Group-level expert masking reveals why: bias and core knowledge are deeply entangled within expert groups. These findings indicate that routing sensitivity is necessary but insufficient for stereotype control, and identify specific architectural conditions that can inform the design of more controllable future MoE systems.

Jaguar re-identification (re-ID) from citizen-science imagery can look strong on standard retrieval metrics while still relying on the wrong evidence, such as background context or silhouette shape, instead of the coat pattern that defines identity. We introduce a diagnostic framework for wildlife re-ID with two axes: a leakage-controlled context ratio, background/foreground, computed from inpainted background-only versus foreground-only images, and a laterality diagnostic based on cross-flank retrieval and mirror self-similarity. To make these diagnostics measurable, we curate a Pantanal jaguar benchmark with per-pixel segmentation masks and an identity-balanced evaluation protocol. We then use representative mitigation families, ArcFace fine-tuning, anti-symmetry regularization, and Lorentz hyperbolic embeddings, as case studies under the same evaluation lens. The goal is not only to ask which model ranks best, but also what visual evidence it uses to do so.

Alignment is no longer a luxury, it is a necessity. As large language models (LLMs) enter high-stakes domains like education, healthcare, governance, and law, their behavior must reliably reflect human-aligned values and safety constraints. Yet current evaluations rely heavily on behavioral proxies such as refusal rates, G-Eval scores, and toxicity classifiers, all of which have critical blind spots. Aligned models are often vulnerable to jailbreaking, stochasticity of generation, and alignment faking. To address this issue, we introduce the Alignment Quality Index (AQI). This novel geometric and prompt-invariant metric empirically assesses LLM alignment by analyzing the separation of safe and unsafe activations in latent space. By combining measures such as the Davies-Bouldin Score (DBS), Dunn Index (DI), Xie-Beni Index (XBI), and Calinski-Harabasz Index (CHI) across various formulations, AQI captures clustering quality to detect hidden misalignments and jailbreak risks, even when outputs appear compliant. AQI also serves as an early warning signal for alignment faking, offering a robust, decoding invariant tool for behavior agnostic safety auditing. Additionally, we propose the LITMUS dataset to facilitate robust evaluation under these challenging conditions. Empirical tests on LITMUS across different models trained under DPO, GRPO, and RLHF conditions demonstrate AQI's correlation with external judges and ability to reveal vulnerabilities missed by refusal metrics. We make our implementation publicly available to foster future research in this area.

Eye-tracking analysis plays a vital role in medical imaging, providing key insights into how radiologists visually interpret and diagnose clinical cases. In this work, we first analyze radiologists' attention and agreement by measuring the distribution of various eye-movement patterns, including saccades direction, amplitude, and their joint distribution. These metrics help uncover patterns in attention allocation and diagnostic strategies. Furthermore, we investigate whether and how doctors' gaze behavior shifts when viewing authentic (Real) versus deep-learning-generated (Fake) images. To achieve this, we examine fixation bias maps, focusing on first, last, short, and longest fixations independently, along with detailed saccades patterns, to quantify differences in gaze distribution and visual saliency between authentic and synthetic images.

Traditional metrics for Medical Report Generation (MRG) predominantly rely on surface-level n-gram overlap, which fails to capture clinical factual accuracy and often overlooks catastrophic diagnostic errors. We address this fundamental limitation by proposing AtomiMed, a universal, modality-agnostic evaluation framework that decomposes complex medical narratives into a standardized, multi-level hierarchy of Atomic Clinical Facts, encompassing Disease-level entities and Attribute-level descriptors, including location, morphology, and severity. By implementing an Agentic Cross-Verification loop between ground-truth and predicted reports, AtomiMed simulates a multi-radiologist peer-review process to verify clinical consistency, thus enabling the decoupled assessment of diagnostic detection and descriptive accuracy. To facilitate standardized evaluation, we introduce MRGEvalKit, an open-source toolkit for automated hierarchical extraction, and curate OmniMRG-Bench, a comprehensive multi-modal benchmark covering X-ray, CT, MRI, and Ultrasound. Extensive experiments on multiple expert-annotated reader studies demonstrate that AtomiMed achieves significantly higher correlation with human radiologist judgment compared to traditional and model-based metrics. Our code are release at https://github.com/Venn2336/MRGEvalkit

This paper presents MathBode, a dynamic diagnostic for mathematical reasoning in large language models (LLMs). Instead of one-shot accuracy, MathBode treats each parametric problem as a system: we drive a single parameter sinusoidally and fit first-harmonic responses of model outputs and exact solutions. This yields interpretable, frequency-resolved metrics -- gain (amplitude tracking) and phase (lag) -- that form Bode-style fingerprints. Across five closed-form families (linear solve, ratio/saturation, compound interest, 2x2 linear systems, similar triangles), the diagnostic surfaces systematic low-pass behavior and growing phase lag that accuracy alone obscures. We compare several models against a symbolic baseline that calibrates the instrument (G approx 1, phi approx 0). Results separate frontier from mid-tier models on dynamics, providing a compact, reproducible protocol that complements standard benchmarks with actionable measurements of reasoning fidelity and consistency. We open-source the dataset and code to enable further research and adoption.

Recent work has proposed a methodology for the systematic evaluation of "Situated Language Understanding Agents"-agents that operate in rich linguistic and non-linguistic contexts-through testing them in carefully constructed interactive settings. Other recent work has argued that Large Language Models (LLMs), if suitably set up, can be understood as (simulators of) such agents. A connection suggests itself, which this paper explores: Can LLMs be evaluated meaningfully by exposing them to constrained game-like settings that are built to challenge specific capabilities? As a proof of concept, this paper investigates five interaction settings, showing that current chat-optimised LLMs are, to an extent, capable to follow game-play instructions. Both this capability and the quality of the game play, measured by how well the objectives of the different games are met, follows the development cycle, with newer models performing better. The metrics even for the comparatively simple example games are far from being saturated, suggesting that the proposed instrument will remain to have diagnostic value. Our general framework for implementing and evaluating games with LLMs is available at https://github.com/clp-research/clembench.

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

Earth Observation (EO) forecasting aims to predict future Earth surface dynamics from satellite observations under changing meteorological conditions. In this paper, we view this task as a partially observed, weather-driven world modeling problem, in which weather acts as a conditioning signal, while forecasting remains uncertain due to sparse observations and unobserved land-surface states. However, existing methods do not fully capture this setting: deterministic models collapse uncertainty into a single future prediction, while diffusion-based methods typically treat weather variables as undifferentiated conditioning signals, and existing benchmarks focus mainly on reconstruction accuracy rather than whether forecasts respond correctly to changed weather forcing.We introduce EO-WM, a video diffusion transformer for multispectral EO forecasting. EO-WM incorporates a physically informed conditioning framework that represents meteorological forcing through a climatological baseline, weather anomalies, and cumulative physical stress signals. Specifically, it separates baseline and anomaly through distinct conditioning pathways, and accumulates anomalous forcing over time to capture sustained heat and drought stress. To evaluate weather-response behavior beyond standard metrics, we introduce two diagnostic benchmarks: an Extreme Summer Benchmark for severity-aware prediction of vegetation degradation under extreme weather, and a Seasonal Matched-Pair Benchmark for testing response fidelity under changed weather forcing. Experiments show that EO-WM reduces the error in predicted Normalized Difference Vegetation Index (NDVI) decline amplitude by a relative 5.63% and improves directional hit rate by a relative 7.80%, while remaining competitive on standard pixel-level metrics. The benchmarks and model will be made open-source at https://github.com/Luo-Z13/EO-WM.

Multi-step symbolic reasoning is essential for robust financial analysis, yet most benchmarks neglect intermediate reasoning steps. FINCHAIN introduced verifiable Chain-of-Thought (CoT) evaluation but is limited to English. FINESSE-Bench includes a Russian block but relies on multiple-choice questions without step-level supervision. We present RusFinChain, the first Russian-language symbolic benchmark for verifiable CoT reasoning in finance. It spans 17 domains, 172 topics, and comprises 5,280 parameterized examples from executable Python templates, ensuring contamination-free evaluation. Each example includes a gold-standard reasoning chain with intermediate numeric values for automatic verification. We also introduce enhanced metrics: Fuzzy Numeric Alignment and Soft-Attention Alignment. We evaluate 8 open-weight LLMs on a stratified sample, generating 8,100 responses. Results reveal a substantial reasoning gap: models achieve Hard F1 of ~0.65 for step alignment, but only ~29% of final answers are correct. Our fuzzy and soft metrics show stronger correlation with final-answer correctness (Spearman rho approx 0.48) than the original ChainEval (rho approx 0.38-0.46), demonstrating superior diagnostic power. We release dataset, code, and evaluation framework to foster verifiable financial AI for the Russian-speaking community.

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

We introduce SciTaRC, an expert-authored benchmark for question answering over scientific tables that targets composite, multi-step reasoning. To enable fine-grained diagnostic analysis beyond end-task accuracy, SciTaRC pairs each question with a manually constructed reasoning plan and explicit complexity metrics. State-of-the-art models fail on at least 23% of these questions, while highly capable open-weight models like Llama-3.3-70B collapse on 65.5% of the benchmark. Error analysis shows that, in zero-shot settings, failures are driven primarily by question comprehension, where models misinterpret the scientific query and derive the wrong reasoning objective. To determine whether overcoming this gap is sufficient, we use the structured plans to decouple strategy formulation from execution. Surprisingly, providing oracle step-by-step plans yields only limited gains and fails to eliminate the performance gap. This reveals a substantial execution bottleneck: both natural language and code-based methods struggle to reliably carry out long-horizon computational chains over structured data. Ultimately, SciTaRC serves as a rigorous diagnostic testbed for studying both planning and execution in scientific table reasoning.

While prior research on text-to-image generation has predominantly focused on biases in human depictions, demographic bias in generated objects remains relatively underexplored. We introduce SODA (Stereotyped Object Diagnostic Audit), a novel framework for systematically measuring these biases through automated attribute discovery and three standardized metrics: Base vs. Demographic Divergence (BDS), Cross-Demographic Disparity (CDS), and Visual Attribute Concentration (VAC). Applying SODA to 8,000 images across five state-of-the-art models and eight object categories (e.g., cars), we find that "neutral" prompts produce outputs most visually similar to middle-aged and White people, suggesting these groups are implicitly over-represented in model defaults. Furthermore, demographic cues trigger highly skewed stereotypical outputs: 26.6% of object-model-demographic combinations produce results where all 20 generated images share the exact same attribute value (e.g., rose gold laptops for women). Finally, prompt-level debiasing reduces inter-group disparity but paradoxically collapses within-group diversity, replacing one stereotype with another. SODA offers a practical pipeline for making these implicit associations measurable, serving as a step toward more responsible AI development.

Despite significant progress in generative modelling, existing diffusion models often struggle to produce anatomically precise female pelvic images, limiting their application in gynaecological imaging, where data scarcity and patient privacy concerns are critical. To overcome these barriers, we introduce a novel diffusion-based framework for uterine MRI synthesis, integrating both unconditional and conditioned Denoising Diffusion Probabilistic Models (DDPMs) and Latent Diffusion Models (LDMs) in 2D and 3D. Our approach generates anatomically coherent, high fidelity synthetic images that closely mimic real scans and provide valuable resources for training robust diagnostic models. We evaluate generative quality using advanced perceptual and distributional metrics, benchmarking against standard reconstruction methods, and demonstrate substantial gains in diagnostic accuracy on a key classification task. A blinded expert evaluation further validates the clinical realism of our synthetic images. We release our models with privacy safeguards and a comprehensive synthetic uterine MRI dataset to support reproducible research and advance equitable AI in gynaecology.

We present PosterIQ, a design-driven benchmark for poster understanding and generation, annotated across composition structure, typographic hierarchy, and semantic intent. It includes 7,765 image-annotation instances and 822 generation prompts spanning real, professional, and synthetic cases. To bridge visual design cognition and generative modeling, we define tasks for layout parsing, text-image correspondence, typography/readability and font perception, design quality assessment, and controllable, composition-aware generation with metaphor. We evaluate state-of-the-art MLLMs and diffusion-based generators, finding persistent gaps in visual hierarchy, typographic semantics, saliency control, and intention communication; commercial models lead on high-level reasoning but act as insensitive automatic raters, while generators render text well yet struggle with composition-aware synthesis. Extensive analyses show PosterIQ is both a quantitative benchmark and a diagnostic tool for design reasoning, offering reproducible, task-specific metrics. We aim to catalyze models' creativity and integrate human-centred design principles into generative vision-language systems.

Most vehicle predictive maintenance systems rely exclusively on internal diagnostic signals and are validated on deterministic synthetic data, limiting the credibility of reported metrics. This paper presents a simulation-validated proof-of-concept framework for V2X-augmented predictive maintenance, integrating on-board sensor streams with external contextual signals -- road quality, weather, traffic density, and driver behaviour -- acquired via V2X communication and third-party APIs, with inference at the vehicle edge. Field validation on instrumented vehicles is identified as the required next step. Three experiments address common shortcomings of prior work. A feature group ablation study shows that V2X contextual features contribute a 2.6-point F1 gain, with full context removal reducing macro F1 from 0.855 to 0.807. On the AI4I 2020 real-world industrial failure dataset (10,000 samples, five failure modes), LightGBM achieves AUC-ROC of 0.973 under 5-fold stratified CV with SMOTE confined to training folds. A noise sensitivity analysis shows macro F1 remains above 0.88 under low noise and degrades to 0.74 under very high noise. SHAP analysis confirms that V2X and engineered interaction features rank among the top 15 predictors. Edge inference is estimated to reduce latency from 3.5s to under 1.0s versus cloud-only processing.

Real-world video benchmarks provide broad coverage, but their fixed clips entangle event count, rate, duration, and visual complexity, making failure modes hard to isolate. While existing programmatic benchmarks offer better control, they score only the final answer rather than auditing reported events against executable ground truth. To bridge this gap, we introduce trace-grounded parametric profiling for event counting in three controlled video tasks: bouncing-ball wall contacts, visual blinks, and categorical state transitions. Across 2,190 videos, we vary event count N and frequency F while holding rendering fixed. Each video includes an executable event trace for capability-surface estimation and timestamp-level evaluation. Our results reveal a staged temporal failure. At an 80% reliability threshold, Gemini 3.6 Flash reliably counts persistent state transitions up to 12 events at 0.5 and 1.0 Hz, yet demonstrates no reliable positive-count region for transient blinking events. Thus, event representation dictates whether a model initially accesses evidence -- a limitation that compounds as count and frequency increase. In the high-count, high-frequency regime, only 0.2% of final counts are correct and the model recovers just 18.1% of true events. To test if visual access is the primary bottleneck, we increase sampling rate. Although this boosts Bounce Ball accuracy from 19.6% to 29.3%, the reported sequence agrees with ground truth only 3.7% of the time. Extra frames can therefore inflate final scores without producing faithful event recovery. Different prompting strategies yield similarly limited gains, and real-world video evaluations show the same concentration of success at low event counts. Ultimately, trace-grounded profiling shifts video evaluation from aggregate accuracy metrics to a detailed diagnostic of where temporal reasoning fails.

Existing 4D-driven video diffusion models primarily target plausible generation, but faithful 4D editing requires preserving source-observed regions while synthesizing disoccluded or out-of-view content. We identify Evidence-Role Mismatch: reliable source-backed evidence, unreliable rendered cues, and unsupported regions are entangled in a single conditioning signal, causing preservation drift, ghosting, and unstable extrapolation. We propose PREX (Preserve, Reveal, Expand), a region-aware framework that decomposes the target spatiotemporal volume into Preserve, Reveal, and Expand roles according to observation support and scene extent. PREX builds observation-backed appearance cues with calibrated confidence and injects them into a frozen video diffusion backbone through a region-aware adapter, trained with proxy tasks without requiring paired edited videos. We further introduce PREBench, a diagnostic benchmark with curated edits, region-role masks, and human-aligned metrics that complement global video-quality and 4D-control evaluations. Experiments show that PREX reduces region-structured failures while maintaining strong visual quality and 4D edit control capability. Project Page: https://ricepastem.github.io/PREX-Open

Music editing plays a vital role in modern music production, with applications in film, broadcasting, and game development. Recent advances in music editing systems have enabled diverse editing tasks such as timbre transfer, instrument substitution, and genre transformation. However, many existing works overlook evaluating their ability to preserve musical facets that should remain unchanged during editing, which we define as Music Context Preservation (MuseCP). While some studies do consider MuseCP, their evaluation protocols and metrics are not comprehensive. To address this, we introduce the first MuseCP evaluation framework, MuseCPEval, that covers four categories of music facets with fine-grained and well-tailored metrics to capture nuanced changes in music attributes. Objective validation and a human study demonstrate the effectiveness of these metrics. Moreover, the case studies on diverse music editing systems illustrate the practical utility of these metrics as a testbed and diagnostic tool, providing insights into the strengths and limitations of existing systems. We hope our metrics and findings can offer practical guidance for developing more effective and reliable music editing strategies with strong MuseCP capability

Data-parallel (DP) training with synchronous all-reduce is a dominant paradigm for full-parameter fine-tuning of large language models (LLMs). While parameter synchronization guarantees numerical equivalence of model weights after each iteration, it does not necessarily imply alignment of worker-level optimization dynamics before gradient aggregation. This paper identifies and studies this latent mismatch, termed silent inconsistency, where cross-worker divergence in losses and gradients can remain invisible under conventional aggregated monitoring signals. We propose a lightweight, model-agnostic diagnostic framework that quantifies worker-level consistency using training signals readily available in standard pipelines. Specifically, we introduce three complementary metrics: loss dispersion, gradient-norm dispersion, and gradient-direction consistency measured by inter-worker cosine similarity. The proposed metrics incur negligible overhead and require no modification to model architecture, synchronization mechanisms, or optimization algorithms. We validate the framework by fully fine-tuning the 1B-parameter openPangu-Embedded-1B-V1.1 model on the tatsu-lab/alpaca dataset using an 8-NPU DP setup, under controlled perturbations of cross-rank stochasticity. Experimental results show that progressively desynchronized data shuffling and random seeds lead to substantial increases in loss/gradient dispersion and reduced directional alignment, despite smooth globally averaged loss curves. These findings demonstrate that the proposed indicators provide actionable visibility into hidden instability modes in large-scale DP fine-tuning, enabling more reliable diagnosis and configuration assessment.

Developing models with robust group fairness properties is paramount, particularly in ethically sensitive domains such as medical diagnosis. Recent approaches to achieving fairness in machine learning require a substantial amount of training data and depend on model retraining, which may not be practical in real-world scenarios. To mitigate these challenges, we propose Bias-based Weight Masking Fine-Tuning (BMFT), a novel post-processing method that enhances the fairness of a trained model in significantly fewer epochs without requiring access to the original training data. BMFT produces a mask over model parameters, which efficiently identifies the weights contributing the most towards biased predictions. Furthermore, we propose a two-step debiasing strategy, wherein the feature extractor undergoes initial fine-tuning on the identified bias-influenced weights, succeeded by a fine-tuning phase on a reinitialised classification layer to uphold discriminative performance. Extensive experiments across four dermatological datasets and two sensitive attributes demonstrate that BMFT outperforms existing state-of-the-art (SOTA) techniques in both diagnostic accuracy and fairness metrics. Our findings underscore the efficacy and robustness of BMFT in advancing fairness across various out-of-distribution (OOD) settings. Our code is available at: https://github.com/vios-s/BMFT

Benchmarks within the OpenClaw ecosystem have thus far evaluated exclusively assistant-level tasks, leaving the academic-level capabilities of OpenClaw largely unexamined. We introduce AcademiClaw, a bilingual benchmark of 80 complex, long-horizon tasks sourced directly from university students' real academic workflows -- homework, research projects, competitions, and personal projects -- that they found current AI agents unable to solve effectively. Curated from 230 student-submitted candidates through rigorous expert review, the final task set spans 25+ professional domains, ranging from olympiad-level mathematics and linguistics problems to GPU-intensive reinforcement learning and full-stack system debugging, with 16 tasks requiring CUDA GPU execution. Each task executes in an isolated Docker sandbox and is scored on task completion by multi-dimensional rubrics combining six complementary techniques, with an independent five-category safety audit providing additional behavioral analysis. Experiments on six frontier models show that even the best achieves only a 55\% pass rate. Further analysis uncovers sharp capability boundaries across task domains, divergent behavioral strategies among models, and a disconnect between token consumption and output quality, providing fine-grained diagnostic signals beyond what aggregate metrics reveal. We hope that AcademiClaw and its open-sourced data and code can serve as a useful resource for the OpenClaw community, driving progress toward agents that are more capable and versatile across the full breadth of real-world academic demands. All data and code are available at https://github.com/GAIR-NLP/AcademiClaw.

Video generation models aspire to simulate dynamic environments, and several benchmarks now evaluate memory consistency across frames. However, most assess consistency only while the target remains in view, and the few that force objects out of view evaluate static scenes where nothing changes during occlusion. To bridge this gap, we introduce MemoBench, a diagnostic benchmark built around the disappear-and-reappear paradigm in dynamically changing environments: a target object undergoes a physical process, disappears from view, and must be correctly recovered in its updated state upon reappearance. We curate 360 ground-truth clips spanning synthetic and real-world scenes, and design an evaluation suite combining automated metrics with VQA-based assessment across four diagnostic pillars. Evaluation of eight state-of-the-art models reveals key insights and open challenges regarding memory consistency under the disappear-and-reappear paradigm.

Generative video models are increasingly studied as implicit world models, yet evaluating whether they produce physically plausible 3D structure and motion remains challenging. Most existing video evaluation pipelines rely heavily on human judgment or learned graders, which can be subjective and weakly diagnostic for geometric failures. We introduce PDI-Bench (Perspective Distortion Index), a quantitative framework for auditing geometric coherence in generated videos. Given a generated clip, we obtain object-centric observations via segmentation and point tracking (e.g., SAM 2, MegaSaM, and CoTracker3), lift them to 3D world-space coordinates via monocular reconstruction, and compute a set of projective-geometry residuals capturing three failure dimensions: scale-depth alignment, 3D motion consistency, and 3D structural rigidity. To support systematic evaluation, we build PDI-Dataset, covering diverse scenarios designed to stress these geometric constraints. Across state-of-the-art video generators, PDI reveals consistent geometry-specific failure modes that are not captured by common perceptual metrics, and provides a diagnostic signal for progress toward physically grounded video generation and physical world model. Our code and dataset can be found at https://pdi-bench.github.io/.

Humans exhibit remarkable abilities to coordinate in groups. As large language models (LLMs) become more capable, it remains an open question whether they can demonstrate comparable adaptive coordination and whether they use the same strategies as humans. To investigate this, we compare LLM and human performance on a common-interest game with imperfect monitoring: Group Binary Search. In this n-player game, participants need to coordinate their actions to achieve a common objective. Players independently submit numerical values in an effort to collectively sum to a randomly assigned target number. Without direct communication, they rely on group feedback to iteratively adjust their submissions until they reach the target number. Our findings show that, unlike humans who adapt and stabilize their behavior over time, LLMs often fail to improve across games and exhibit excessive switching, which impairs group convergence. Moreover, richer feedback (e.g., numerical error magnitude) benefits humans substantially but has small effects on LLMs. Taken together, by grounding the analysis in human baselines and mechanism-level metrics, including reactivity scaling, switching dynamics, and learning across games, we point to differences in human and LLM groups and provide a behaviorally grounded diagnostic for closing the coordination gap.

While Large Language Models (LLMs) show remarkable capabilities, their unreliability remains a critical barrier to deployment in high-stakes domains. This survey charts a functional evolution in addressing this challenge: the evolution of uncertainty from a passive diagnostic metric to an active control signal guiding real-time model behavior. We demonstrate how uncertainty is leveraged as an active control signal across three frontiers: in advanced reasoning to optimize computation and trigger self-correction; in autonomous agents to govern metacognitive decisions about tool use and information seeking; and in reinforcement learning to mitigate reward hacking and enable self-improvement via intrinsic rewards. By grounding these advancements in emerging theoretical frameworks like Bayesian methods and Conformal Prediction, we provide a unified perspective on this transformative trend. This survey provides a comprehensive overview, critical analysis, and practical design patterns, arguing that mastering the new trend of uncertainty is essential for building the next generation of scalable, reliable, and trustworthy AI.

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.

This paper introduces a novel, entity-aware metric, termed as Radiological Report (Text) Evaluation (RaTEScore), to assess the quality of medical reports generated by AI models. RaTEScore emphasizes crucial medical entities such as diagnostic outcomes and anatomical details, and is robust against complex medical synonyms and sensitive to negation expressions. Technically, we developed a comprehensive medical NER dataset, RaTE-NER, and trained an NER model specifically for this purpose. This model enables the decomposition of complex radiological reports into constituent medical entities. The metric itself is derived by comparing the similarity of entity embeddings, obtained from a language model, based on their types and relevance to clinical significance. Our evaluations demonstrate that RaTEScore aligns more closely with human preference than existing metrics, validated both on established public benchmarks and our newly proposed RaTE-Eval benchmark.

Predictive artificial intelligence (AI) offers an opportunity to improve clinical practice and patient outcomes, but risks perpetuating biases if fairness is inadequately addressed. However, the definition of "fairness" remains unclear. We conducted a scoping review to identify and critically appraise fairness metrics for clinical predictive AI. We defined a "fairness metric" as a measure quantifying whether a model discriminates (societally) against individuals or groups defined by sensitive attributes. We searched five databases (2014-2024), screening 820 records, to include 41 studies, and extracted 62 fairness metrics. Metrics were classified by performance-dependency, model output level, and base performance metric, revealing a fragmented landscape with limited clinical validation and overreliance on threshold-dependent measures. Eighteen metrics were explicitly developed for healthcare, including only one clinical utility metric. Our findings highlight conceptual challenges in defining and quantifying fairness and identify gaps in uncertainty quantification, intersectionality, and real-world applicability. Future work should prioritise clinically meaningful metrics.

Medical domain automated text generation is an active area of research and development; however, evaluating the clinical quality of generated reports remains a challenge, especially in instances where domain-specific metrics are lacking, e.g. histopathology. We propose HARE (Histopathology Automated Report Evaluation), a novel entity and relation centric framework, composed of a benchmark dataset, a named entity recognition (NER) model, a relation extraction (RE) model, and a novel metric, which prioritizes clinically relevant content by aligning critical histopathology entities and relations between reference and generated reports. To develop the HARE benchmark, we annotated 813 de-identified clinical diagnostic histopathology reports and 652 histopathology reports from The Cancer Genome Atlas (TCGA) with domain-specific entities and relations. We fine-tuned GatorTronS, a domain-adapted language model to develop HARE-NER and HARE-RE which achieved the highest overall F1-score (0.915) among the tested models. The proposed HARE metric outperformed traditional metrics including ROUGE and Meteor, as well as radiology metrics such as RadGraph-XL, with the highest correlation and the best regression to expert evaluations (higher than the second best method, GREEN, a large language model based radiology report evaluator, by Pearson r = 0.168, Spearman ρ= 0.161, Kendall τ= 0.123, R^2 = 0.176, RMSE = 0.018). We release HARE, datasets, and the models at https://github.com/knowlab/HARE to foster advancements in histopathology report generation, providing a robust framework for improving the quality of reports.

Devising indicative evaluation metrics for the image generation task remains an open problem. The most widely used metric for measuring the similarity between real and generated images has been the Fr\'echet Inception Distance (FID) score. Because it does not differentiate the fidelity and diversity aspects of the generated images, recent papers have introduced variants of precision and recall metrics to diagnose those properties separately. In this paper, we show that even the latest version of the precision and recall metrics are not reliable yet. For example, they fail to detect the match between two identical distributions, they are not robust against outliers, and the evaluation hyperparameters are selected arbitrarily. We propose density and coverage metrics that solve the above issues. We analytically and experimentally show that density and coverage provide more interpretable and reliable signals for practitioners than the existing metrics. Code: https://github.com/clovaai/generative-evaluation-prdc.

Evaluating radiology reports is a challenging problem as factual correctness is extremely important due to the need for accurate medical communication about medical images. Existing automatic evaluation metrics either suffer from failing to consider factual correctness (e.g., BLEU and ROUGE) or are limited in their interpretability (e.g., F1CheXpert and F1RadGraph). In this paper, we introduce GREEN (Generative Radiology Report Evaluation and Error Notation), a radiology report generation metric that leverages the natural language understanding of language models to identify and explain clinically significant errors in candidate reports, both quantitatively and qualitatively. Compared to current metrics, GREEN offers: 1) a score aligned with expert preferences, 2) human interpretable explanations of clinically significant errors, enabling feedback loops with end-users, and 3) a lightweight open-source method that reaches the performance of commercial counterparts. We validate our GREEN metric by comparing it to GPT-4, as well as to error counts of 6 experts and preferences of 2 experts. Our method demonstrates not only higher correlation with expert error counts, but simultaneously higher alignment with expert preferences when compared to previous approaches."

Anomaly detection methods can be very useful in identifying unusual or interesting patterns in data. A recently proposed conditional anomaly detection framework extends anomaly detection to the problem of identifying anomalous patterns on a subset of attributes in the data. The anomaly always depends (is conditioned) on the value of remaining attributes. The work presented in this paper focuses on instance-based methods for detecting conditional anomalies. The methods rely on the distance metric to identify examples in the dataset that are most critical for detecting the anomaly. We investigate various metrics and metric learning methods to optimize the performance of the instance-based anomaly detection methods. We show the benefits of the instance-based methods on two real-world detection problems: detection of unusual admission decisions for patients with the community-acquired pneumonia and detection of unusual orders of an HPF4 test that is used to confirm Heparin induced thrombocytopenia - a life-threatening condition caused by the Heparin therapy.

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.

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.

In recent years, automated radiology report generation has experienced significant growth. This paper introduces MRScore, an automatic evaluation metric tailored for radiology report generation by leveraging Large Language Models (LLMs). Conventional NLG (natural language generation) metrics like BLEU are inadequate for accurately assessing the generated radiology reports, as systematically demonstrated by our observations within this paper. To address this challenge, we collaborated with radiologists to develop a framework that guides LLMs for radiology report evaluation, ensuring alignment with human analysis. Our framework includes two key components: i) utilizing GPT to generate large amounts of training data, i.e., reports with different qualities, and ii) pairing GPT-generated reports as accepted and rejected samples and training LLMs to produce MRScore as the model reward. Our experiments demonstrate MRScore's higher correlation with human judgments and superior performance in model selection compared to traditional metrics. Our code and datasets will be available on GitHub.

Evaluation metrics are central to binary target segmentation because they determine how progress is measured, compared, and interpreted. In this paper, target denotes the task-defined positive region to be segmented rather than a generic foreground object. It may be salient, camouflaged, transparent, glass-like, mirror-like, shadow-like, lesion-like, or defined by other application-specific semantics. We treat existing metrics as compositions of modular design choices rather than isolated formulas. The proposed framework decomposes each metric into five stages covering prediction representation, target extraction, target matching, score computation, and metric reporting. We use this framework to analyze representative metrics and show how newer metrics address specific limits in earlier protocols. The stage choices keep each metric's assumptions visible. We then discuss the design space opened by the framework and its implications for task-aware evaluation protocols. Reference code is available at https://github.com/lartpang/PySODMetrics.

Knowledge Graph (KG) plays a crucial role in Medical Report Generation (MRG) because it reveals the relations among diseases and thus can be utilized to guide the generation process. However, constructing a comprehensive KG is labor-intensive and its applications on the MRG process are under-explored. In this study, we establish a complete KG on chest X-ray imaging that includes 137 types of diseases and abnormalities. Based on this KG, we find that the current MRG data sets exhibit a long-tailed problem in disease distribution. To mitigate this problem, we introduce a novel augmentation strategy that enhances the representation of disease types in the tail-end of the distribution. We further design a two-stage MRG approach, where a classifier is first trained to detect whether the input images exhibit any abnormalities. The classified images are then independently fed into two transformer-based generators, namely, ``disease-specific generator" and ``disease-free generator" to generate the corresponding reports. To enhance the clinical evaluation of whether the generated reports correctly describe the diseases appearing in the input image, we propose diverse sensitivity (DS), a new metric that checks whether generated diseases match ground truth and measures the diversity of all generated diseases. Results show that the proposed two-stage generation framework and augmentation strategies improve DS by a considerable margin, indicating a notable reduction in the long-tailed problem associated with under-represented diseases.

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

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

Automatic metrics are extensively used to evaluate natural language processing systems. However, there has been increasing focus on how they are used and reported by practitioners within the field. In this paper, we have conducted a survey on the use of automatic metrics, focusing particularly on natural language generation (NLG) tasks. We inspect which metrics are used as well as why they are chosen and how their use is reported. Our findings from this survey reveal significant shortcomings, including inappropriate metric usage, lack of implementation details and missing correlations with human judgements. We conclude with recommendations that we believe authors should follow to enable more rigour within the field.

Automatic evaluation metrics are a crucial component of dialog systems research. Standard language evaluation metrics are known to be ineffective for evaluating dialog. As such, recent research has proposed a number of novel, dialog-specific metrics that correlate better with human judgements. Due to the fast pace of research, many of these metrics have been assessed on different datasets and there has as yet been no time for a systematic comparison between them. To this end, this paper provides a comprehensive assessment of recently proposed dialog evaluation metrics on a number of datasets. In this paper, 23 different automatic evaluation metrics are evaluated on 10 different datasets. Furthermore, the metrics are assessed in different settings, to better qualify their respective strengths and weaknesses. Metrics are assessed (1) on both the turn level and the dialog level, (2) for different dialog lengths, (3) for different dialog qualities (e.g., coherence, engaging), (4) for different types of response generation models (i.e., generative, retrieval, simple models and state-of-the-art models), (5) taking into account the similarity of different metrics and (6) exploring combinations of different metrics. This comprehensive assessment offers several takeaways pertaining to dialog evaluation metrics in general. It also suggests how to best assess evaluation metrics and indicates promising directions for future work.

The effectiveness of recommendation systems is pivotal to user engagement and satisfaction in online platforms. As these recommendation systems increasingly influence user choices, their evaluation transcends mere technical performance and becomes central to business success. This paper addresses the multifaceted nature of recommendations system evaluation by introducing a comprehensive suite of metrics, each tailored to capture a distinct aspect of system performance. We discuss * Similarity Metrics: to quantify the precision of content-based filtering mechanisms and assess the accuracy of collaborative filtering techniques. * Candidate Generation Metrics: to evaluate how effectively the system identifies a broad yet relevant range of items. * Predictive Metrics: to assess the accuracy of forecasted user preferences. * Ranking Metrics: to evaluate the effectiveness of the order in which recommendations are presented. * Business Metrics: to align the performance of the recommendation system with economic objectives. Our approach emphasizes the contextual application of these metrics and their interdependencies. In this paper, we identify the strengths and limitations of current evaluation practices and highlight the nuanced trade-offs that emerge when optimizing recommendation systems across different metrics. The paper concludes by proposing a framework for selecting and interpreting these metrics to not only improve system performance but also to advance business goals. This work is to aid researchers and practitioners in critically assessing recommendation systems and fosters the development of more nuanced, effective, and economically viable personalization strategies. Our code is available at GitHub - https://github.com/aryan-jadon/Evaluation-Metrics-for-Recommendation-Systems.

In recent years, advancements in Natural Language Processing (NLP) techniques have revolutionized the field of accessibility and exclusivity of testing, particularly for visually impaired students (VIS). CBT has shown in years back its relevance in terms of administering exams electronically, making the test process easier, providing quicker and more accurate results, and offering greater flexibility and accessibility for candidates. Yet, its relevance was not felt by the visually impaired students as they cannot access printed documents. Hence, in this paper, we present an NLP-driven Computer-Based Test guide for visually impaired students. It employs a speech technology pre-trained methods to provide real-time assistance and support to visually impaired students. The system utilizes NLP technologies to convert the text-based questions and the associated options in a machine-readable format. Subsequently, the speech technology pre-trained model processes the converted text enabling the VIS to comprehend and analyze the content. Furthermore, we validated that this pre-trained model is not perverse by testing for accuracy using sample audio datasets labels (A, B, C, D, E, F, G) to compare with the voice recordings obtained from 20 VIS which is been predicted by the system to attain values for precision, recall, and F1-scores. These metrics are used to assess the performance of the pre-trained model and have indicated that it is proficient enough to give its better performance to the evaluated system. The methodology adopted for this system is Object Oriented Analysis and Design Methodology (OOADM) where Objects are discussed and built by modeling real-world instances.

Selective Classification, wherein models can reject low-confidence predictions, promises reliable translation of machine-learning based classification systems to real-world scenarios such as clinical diagnostics. While current evaluation of these systems typically assumes fixed working points based on pre-defined rejection thresholds, methodological progress requires benchmarking the general performance of systems akin to the AUROC in standard classification. In this work, we define 5 requirements for multi-threshold metrics in selective classification regarding task alignment, interpretability, and flexibility, and show how current approaches fail to meet them. We propose the Area under the Generalized Risk Coverage curve (AUGRC), which meets all requirements and can be directly interpreted as the average risk of undetected failures. We empirically demonstrate the relevance of AUGRC on a comprehensive benchmark spanning 6 data sets and 13 confidence scoring functions. We find that the proposed metric substantially changes metric rankings on 5 out of the 6 data sets.

Positron emission tomography (PET) is a cornerstone of modern oncologic and neurologic imaging, distinguished by its unique ability to illuminate dynamic metabolic processes that transcend the anatomical focus of traditional imaging technologies. Radiology reports are essential for clinical decision making, yet their manual creation is labor-intensive and time-consuming. Recent advancements of vision-language models (VLMs) have shown strong potential in medical applications, presenting a promising avenue for automating report generation. However, existing applications of VLMs in the medical domain have predominantly focused on structural imaging modalities, while the unique characteristics of molecular PET imaging have largely been overlooked. To bridge the gap, we introduce PET2Rep, a large-scale comprehensive benchmark for evaluation of general and medical VLMs for radiology report generation for PET images. PET2Rep stands out as the first dedicated dataset for PET report generation with metabolic information, uniquely capturing whole-body image-report pairs that cover dozens of organs to fill the critical gap in existing benchmarks and mirror real-world clinical comprehensiveness. In addition to widely recognized natural language generation metrics, we introduce a series of clinical efficiency metrics to evaluate the quality of radiotracer uptake pattern description in key organs in generated reports. We conduct a head-to-head comparison of 30 cutting-edge general-purpose and medical-specialized VLMs. The results show that the current state-of-the-art VLMs perform poorly on PET report generation task, falling considerably short of fulfilling practical needs. Moreover, we identify several key insufficiency that need to be addressed to advance the development in medical applications.

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

Radiological imaging is central to diagnosis, treatment planning, and clinical decision-making. Vision-language foundation models have spurred interest in automated radiology report generation (RRG), but safe deployment requires reliable clinical evaluation of generated reports. Existing metrics often rely on surface-level similarity or behave as black boxes, lacking interpretability. We introduce ICARE (Interpretable and Clinically-grounded Agent-based Report Evaluation), an interpretable evaluation framework leveraging large language model agents and dynamic multiple-choice question answering (MCQA). Two agents, each with either the ground-truth or generated report, generate clinically meaningful questions and quiz each other. Agreement on answers captures preservation and consistency of findings, serving as interpretable proxies for clinical precision and recall. By linking scores to question-answer pairs, ICARE enables transparent, and interpretable assessment. Clinician studies show ICARE aligns significantly more with expert judgment than prior metrics. Perturbation analyses confirm sensitivity to clinical content and reproducibility, while model comparisons reveal interpretable error patterns.

Automatic medical report generation supports clinical diagnosis, reduces the workload of radiologists, and holds the promise of improving diagnosis consistency. However, existing evaluation metrics primarily assess the accuracy of key medical information coverage in generated reports compared to human-written reports, while overlooking crucial details such as the location and certainty of reported abnormalities. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs NER-F1 calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = 0.70 for Rexval dataset and Kendall coefficient = 0.54 for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.

Machine Translation (MT) evaluation metrics assess translation quality automatically. Recently, researchers have employed MT metrics for various new use cases, such as data filtering and translation re-ranking. However, most MT metrics return assessments as scalar scores that are difficult to interpret, posing a challenge to making informed design choices. Moreover, MT metrics' capabilities have historically been evaluated using correlation with human judgment, which, despite its efficacy, falls short of providing intuitive insights into metric performance, especially in terms of new metric use cases. To address these issues, we introduce an interpretable evaluation framework for MT metrics. Within this framework, we evaluate metrics in two scenarios that serve as proxies for the data filtering and translation re-ranking use cases. Furthermore, by measuring the performance of MT metrics using Precision, Recall, and F-score, we offer clearer insights into their capabilities than correlation with human judgments. Finally, we raise concerns regarding the reliability of manually curated data following the Direct Assessments+Scalar Quality Metrics (DA+SQM) guidelines, reporting a notably low agreement with Multidimensional Quality Metrics (MQM) annotations.

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

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Retrieval-augmented generation (RAG) is a well-suited technique for retrieving privacy-sensitive Electronic Health Records (EHR). It can serve as a key module of the healthcare copilot, helping reduce misdiagnosis for healthcare practitioners and patients. However, the diagnostic accuracy and specificity of existing heuristic-based RAG models used in the medical domain are inadequate, particularly for diseases with similar manifestations. This paper proposes MedRAG, a RAG model enhanced by knowledge graph (KG)-elicited reasoning for the medical domain that retrieves diagnosis and treatment recommendations based on manifestations. MedRAG systematically constructs a comprehensive four-tier hierarchical diagnostic KG encompassing critical diagnostic differences of various diseases. These differences are dynamically integrated with similar EHRs retrieved from an EHR database, and reasoned within a large language model. This process enables more accurate and specific decision support, while also proactively providing follow-up questions to enhance personalized medical decision-making. MedRAG is evaluated on both a public dataset DDXPlus and a private chronic pain diagnostic dataset (CPDD) collected from Tan Tock Seng Hospital, and its performance is compared against various existing RAG methods. Experimental results show that, leveraging the information integration and relational abilities of the KG, our MedRAG provides more specific diagnostic insights and outperforms state-of-the-art models in reducing misdiagnosis rates. Our code will be available at https://github.com/SNOWTEAM2023/MedRAG

Radiology reports convey detailed clinical observations and capture diagnostic reasoning that evolves over time. However, existing evaluation methods are limited to single-report settings and rely on coarse metrics that fail to capture fine-grained clinical semantics and temporal dependencies. We introduce LUNGUAGE,a benchmark dataset for structured radiology report generation that supports both single-report evaluation and longitudinal patient-level assessment across multiple studies. It contains 1,473 annotated chest X-ray reports, each reviewed by experts, and 80 of them contain longitudinal annotations to capture disease progression and inter-study intervals, also reviewed by experts. Using this benchmark, we develop a two-stage framework that transforms generated reports into fine-grained, schema-aligned structured representations, enabling longitudinal interpretation. We also propose LUNGUAGESCORE, an interpretable metric that compares structured outputs at the entity, relation, and attribute level while modeling temporal consistency across patient timelines. These contributions establish the first benchmark dataset, structuring framework, and evaluation metric for sequential radiology reporting, with empirical results demonstrating that LUNGUAGESCORE effectively supports structured report evaluation. The code is available at: https://github.com/SuperSupermoon/Lunguage

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

The diversity of training datasets is usually perceived as an important aspect to obtain a robust model. However, the definition of diversity is often not defined or differs across papers, and while some metrics exist, the quantification of this diversity is often overlooked when developing new algorithms. In this work, we study the behaviour of multiple dataset diversity metrics for image, text and metadata using MorphoMNIST, a toy dataset with controlled perturbations, and PadChest, a publicly available chest X-ray dataset. We evaluate whether these metrics correlate with each other but also with the intuition of a clinical expert. We also assess whether they correlate with downstream-task performance and how they impact the training dynamic of the models. We find limited correlations between the AUC and image or metadata reference-free diversity metrics, but higher correlations with the FID and the semantic diversity metrics. Finally, the clinical expert indicates that scanners are the main source of diversity in practice. However, we find that the addition of another scanner to the training set leads to shortcut learning. The code used in this study is available at https://github.com/TheoSourget/dataset_diversity_evaluation

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

Codification of free-text clinical narratives have long been recognised to be beneficial for secondary uses such as funding, insurance claim processing and research. The current scenario of assigning codes is a manual process which is very expensive, time-consuming and error prone. In recent years, many researchers have studied the use of Natural Language Processing (NLP), related Machine Learning (ML) and Deep Learning (DL) methods and techniques to resolve the problem of manual coding of clinical narratives and to assist human coders to assign clinical codes more accurately and efficiently. This systematic literature review provides a comprehensive overview of automated clinical coding systems that utilises appropriate NLP, ML and DL methods and techniques to assign ICD codes to discharge summaries. We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines and conducted a comprehensive search of publications from January, 2010 to December 2020 in four academic databases- PubMed, ScienceDirect, Association for Computing Machinery(ACM) Digital Library, and the Association for Computational Linguistics(ACL) Anthology. We reviewed 7,556 publications; 38 met the inclusion criteria. This review identified: datasets having discharge summaries; NLP techniques along with some other data extraction processes, different feature extraction and embedding techniques. To measure the performance of classification methods, different evaluation metrics are used. Lastly, future research directions are provided to scholars who are interested in automated ICD code assignment. Efforts are still required to improve ICD code prediction accuracy, availability of large-scale de-identified clinical corpora with the latest version of the classification system. This can be a platform to guide and share knowledge with the less experienced coders and researchers.

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

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

Determining whether two sets of images belong to the same or different distributions or domains is a crucial task in modern medical image analysis and deep learning; for example, to evaluate the output quality of image generative models. Currently, metrics used for this task either rely on the (potentially biased) choice of some downstream task, such as segmentation, or adopt task-independent perceptual metrics (e.g., Fréchet Inception Distance/FID) from natural imaging, which we show insufficiently capture anatomical features. To this end, we introduce a new perceptual metric tailored for medical images, FRD (Fréchet Radiomic Distance), which utilizes standardized, clinically meaningful, and interpretable image features. We show that FRD is superior to other image distribution metrics for a range of medical imaging applications, including out-of-domain (OOD) detection, the evaluation of image-to-image translation (by correlating more with downstream task performance as well as anatomical consistency and realism), and the evaluation of unconditional image generation. Moreover, FRD offers additional benefits such as stability and computational efficiency at low sample sizes, sensitivity to image corruptions and adversarial attacks, feature interpretability, and correlation with radiologist-perceived image quality. Additionally, we address key gaps in the literature by presenting an extensive framework for the multifaceted evaluation of image similarity metrics in medical imaging -- including the first large-scale comparative study of generative models for medical image translation -- and release an accessible codebase to facilitate future research. Our results are supported by thorough experiments spanning a variety of datasets, modalities, and downstream tasks, highlighting the broad potential of FRD for medical image analysis.

Doctors and patients alike increasingly use Large Language Models (LLMs) to diagnose clinical cases. However, unlike domains such as math or coding, where correctness can be objectively defined by the final answer, medical diagnosis requires both the outcome and the reasoning process to be accurate. Currently, widely used medical benchmarks like MedQA and MMLU assess only accuracy in the final answer, overlooking the quality and faithfulness of the clinical reasoning process. To address this limitation, we introduce MedCaseReasoning, the first open-access dataset for evaluating LLMs on their ability to align with clinician-authored diagnostic reasoning. The dataset includes 14,489 diagnostic question-and-answer cases, each paired with detailed reasoning statements derived from open-access medical case reports. We evaluate state-of-the-art reasoning LLMs on MedCaseReasoning and find significant shortcomings in their diagnoses and reasoning: for instance, the top-performing open-source model, DeepSeek-R1, achieves only 48% 10-shot diagnostic accuracy and mentions only 64% of the clinician reasoning statements (recall). However, we demonstrate that fine-tuning LLMs on the reasoning traces derived from MedCaseReasoning significantly improves diagnostic accuracy and clinical reasoning recall by an average relative gain of 29% and 41%, respectively. The open-source dataset, code, and models are available at https://github.com/kevinwu23/Stanford-MedCaseReasoning.

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of physicians, proposes likely differential diagnoses and strategically selects high-value, cost-effective tests. When paired with OpenAI's o3 model, MAI-DxO achieves 80% diagnostic accuracy--four times higher than the 20% average of generalist physicians. MAI-DxO also reduces diagnostic costs by 20% compared to physicians, and 70% compared to off-the-shelf o3. When configured for maximum accuracy, MAI-DxO achieves 85.5% accuracy. These performance gains with MAI-DxO generalize across models from the OpenAI, Gemini, Claude, Grok, DeepSeek, and Llama families. We highlight how AI systems, when guided to think iteratively and act judiciously, can advance diagnostic precision and cost-effectiveness in clinical care.

We introduce RadEval, a unified, open-source framework for evaluating radiology texts. RadEval consolidates a diverse range of metrics, from classic n-gram overlap (BLEU, ROUGE) and contextual measures (BERTScore) to clinical concept-based scores (F1CheXbert, F1RadGraph, RaTEScore, SRR-BERT, TemporalEntityF1) and advanced LLM-based evaluators (GREEN). We refine and standardize implementations, extend GREEN to support multiple imaging modalities with a more lightweight model, and pretrain a domain-specific radiology encoder, demonstrating strong zero-shot retrieval performance. We also release a richly annotated expert dataset with over 450 clinically significant error labels and show how different metrics correlate with radiologist judgment. Finally, RadEval provides statistical testing tools and baseline model evaluations across multiple publicly available datasets, facilitating reproducibility and robust benchmarking in radiology report generation.

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

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.

The paper describes the open Russian medical language understanding benchmark covering several task types (classification, question answering, natural language inference, named entity recognition) on a number of novel text sets. Given the sensitive nature of the data in healthcare, such a benchmark partially closes the problem of Russian medical dataset absence. We prepare the unified format labeling, data split, and evaluation metrics for new tasks. The remaining tasks are from existing datasets with a few modifications. A single-number metric expresses a model's ability to cope with the benchmark. Moreover, we implement several baseline models, from simple ones to neural networks with transformer architecture, and release the code. Expectedly, the more advanced models yield better performance, but even a simple model is enough for a decent result in some tasks. Furthermore, for all tasks, we provide a human evaluation. Interestingly the models outperform humans in the large-scale classification tasks. However, the advantage of natural intelligence remains in the tasks requiring more knowledge and reasoning.

BACKGROUND: Radiology reports are typically written in a free-text format, making clinical information difficult to extract and use. Recently the adoption of structured reporting (SR) has been recommended by various medical societies thanks to the advantages it offers, e.g. standardization, completeness and information retrieval. We propose a pipeline to extract information from free-text radiology reports, that fits with the items of the reference SR registry proposed by a national society of interventional and medical radiology, focusing on CT staging of patients with lymphoma. METHODS: Our work aims to leverage the potential of Natural Language Processing (NLP) and Transformer-based models to deal with automatic SR registry filling. With the availability of 174 radiology reports, we investigate a rule-free generative Question Answering approach based on a domain-specific version of T5 (IT5). Two strategies (batch-truncation and ex-post combination) are implemented to comply with the model's context length limitations. Performance is evaluated in terms of strict accuracy, F1, and format accuracy, and compared with the widely used GPT-3.5 Large Language Model. A 5-point Likert scale questionnaire is used to collect human-expert feedback on the similarity between medical annotations and generated answers. RESULTS: The combination of fine-tuning and batch splitting allows IT5 to achieve notable results; it performs on par with GPT-3.5 albeit its size being a thousand times smaller in terms of parameters. Human-based assessment scores show a high correlation (Spearman's correlation coefficients>0.88, p-values<0.001) with AI performance metrics (F1) and confirm the superior ability of LLMs (i.e., GPT-3.5, 175B of parameters) in generating plausible human-like statements.

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

Model efficiency is a critical aspect of developing and deploying machine learning models. Inference time and latency directly affect the user experience, and some applications have hard requirements. In addition to inference costs, model training also have direct financial and environmental impacts. Although there are numerous well-established metrics (cost indicators) for measuring model efficiency, researchers and practitioners often assume that these metrics are correlated with each other and report only few of them. In this paper, we thoroughly discuss common cost indicators, their advantages and disadvantages, and how they can contradict each other. We demonstrate how incomplete reporting of cost indicators can lead to partial conclusions and a blurred or incomplete picture of the practical considerations of different models. We further present suggestions to improve reporting of efficiency metrics.

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.

Background: Clinical documentation represents a significant burden for healthcare providers, with physicians spending up to 2 hours daily on administrative tasks. Recent advances in large language models (LLMs) offer promising solutions, but privacy concerns and computational requirements limit their adoption in healthcare settings. Objective: To develop and evaluate a privacy-preserving, on-device medical transcription system using a fine-tuned Llama 3.2 1B model capable of generating structured medical notes from medical transcriptions while maintaining complete data sovereignty entirely in the browser. Methods: We fine-tuned a Llama 3.2 1B model using Parameter-Efficient Fine-Tuning (PEFT) with LoRA on 1,500 synthetic medical transcription-to-structured note pairs. The model was evaluated against the base Llama 3.2 1B on two datasets: 100 endocrinology transcripts and 140 modified ACI benchmark cases. Evaluation employed both statistical metrics (ROUGE, BERTScore, BLEURT) and LLM-as-judge assessments across multiple clinical quality dimensions. Results: The fine-tuned OnDevice model demonstrated substantial improvements over the base model. On the ACI benchmark, ROUGE-1 scores increased from 0.346 to 0.496, while BERTScore F1 improved from 0.832 to 0.866. Clinical quality assessments showed marked reduction in major hallucinations (from 85 to 35 cases) and enhanced factual correctness (2.81 to 3.54 on 5-point scale). Similar improvements were observed on the internal evaluation dataset, with composite scores increasing from 3.13 to 4.43 (+41.5%). Conclusions: Fine-tuning compact LLMs for medical transcription yields clinically meaningful improvements while enabling complete on-device browser deployment. This approach addresses key barriers to AI adoption in healthcare: privacy preservation, cost reduction, and accessibility for resource-constrained environments.

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

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

Evaluating conditional coverage remains one of the most persistent challenges in assessing the reliability of predictive systems. Although conformal methods can give guarantees on marginal coverage, no method can guarantee to produce sets with correct conditional coverage, leaving practitioners without a clear way to interpret local deviations. To overcome sample-inefficiency and overfitting issues of existing metrics, we cast conditional coverage estimation as a classification problem. Conditional coverage is violated if and only if some classifier can achieve lower risk than the target coverage. Through the choice of a (proper) loss function, the resulting risk difference gives a conservative estimate of natural miscoverage measures such as L1 and L2 distance, and can even separate the effects of over- and under-coverage, and non-constant target coverages. We call the resulting family of metrics excess risk of the target coverage (ERT). We show experimentally that the use of modern classifiers provides much higher statistical power than simple classifiers underlying established metrics like CovGap. Additionally, we use our metric to benchmark different conformal prediction methods. Finally, we release an open-source package for ERT as well as previous conditional coverage metrics. Together, these contributions provide a new lens for understanding, diagnosing, and improving the conditional reliability of predictive systems.

Evaluating Natural Language Generation (NLG) is crucial for the practical adoption of AI, but has been a longstanding research challenge. While human evaluation is considered the de-facto standard, it is expensive and lacks scalability. Practical applications have driven the development of various automatic evaluation metrics (AEM), designed to compare the model output with human-written references, generating a score which approximates human judgment. Over time, AEMs have evolved from simple lexical comparisons, to semantic similarity models and, more recently, to LLM-based evaluators. However, it seems that no single metric has emerged as a definitive solution, resulting in studies using different ones without fully considering the implications. This paper aims to show this by conducting a thorough examination of the methodologies of existing metrics, their documented strengths and limitations, validation methods, and correlations with human judgment. We identify several key challenges: metrics often capture only specific aspects of text quality, their effectiveness varies by task and dataset, validation practices remain unstructured, and correlations with human judgment are inconsistent. Importantly, we find that these challenges persist in the most recent type of metric, LLM-as-a-Judge, as well as in the evaluation of Retrieval Augmented Generation (RAG), an increasingly relevant task in academia and industry. Our findings challenge the quest for the 'perfect metric'. We propose selecting metrics based on task-specific needs and leveraging complementary evaluations and advocate that new metrics should focus on enhanced validation methodologies.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

As Large Language Models (LLMs) are increasingly integrated into healthcare to address complex inquiries, ensuring their reliability remains a critical challenge. Recent studies have highlighted that generic LLMs often struggle in clinical contexts, occasionally producing misleading guidance. To mitigate these risks, this research focuses on the domain-specific adaptation of Llama-2-7B using the Low-Rank Adaptation (LoRA) technique. By injecting trainable low-rank matrices into the Transformer layers, we efficiently adapted the model using authentic patient-physician transcripts while preserving the foundational knowledge of the base model. Our objective was to enhance precision and contextual relevance in responding to medical queries by capturing the specialized nuances of clinical discourse. Due to the resource-intensive nature of large-scale human validation, the model's performance was evaluated through a dual-track framework: Track A utilized traditional lexical similarity metrics (e.g., BLEU, ROUGE), while Track B employed an "LLM-as-a-Judge" paradigm using GPT-4 for semantic assessment. Our results demonstrate that while the LoRA-enhanced model achieved significant improvements across all quantitative lexical dimensions, a profound disagreement surfaced in the GPT-4 evaluation, which marginally favored the baseline model's conversational flow. This metric divergence underscores a pivotal finding: traditional automated scores may not fully reflect clinical utility. Consequently, we propose that while automated metrics and LLM judges serve as valuable developmental proxies, rigorous validation by human medical experts remains an indispensable requirement for the safe deployment of LLMs in healthcare settings.

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

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

The evaluation of generative models for natural image tasks has been extensively studied. Similar protocols and metrics are used in cases with unique particularities, such as Handwriting Generation, even if they might not be completely appropriate. In this work, we introduce three measures tailored for HTG evaluation, HTG_{HTR} , HTG_{style} , and HTG_{OOV} , and argue that they are more expedient to evaluate the quality of generated handwritten images. The metrics rely on the recognition error/accuracy of Handwriting Text Recognition and Writer Identification models and emphasize writing style, textual content, and diversity as the main aspects that adhere to the content of handwritten images. We conduct comprehensive experiments on the IAM handwriting database, showcasing that widely used metrics such as FID fail to properly quantify the diversity and the practical utility of generated handwriting samples. Our findings show that our metrics are richer in information and underscore the necessity of standardized evaluation protocols in HTG. The proposed metrics provide a more robust and informative protocol for assessing HTG quality, contributing to improved performance in HTR. Code for the evaluation protocol is available at: https://github.com/koninik/HTG_evaluation.

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate clinical quality, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

Counterfactual prompting (i.e., perturbing a single factor and measuring output change) is widely used to evaluate things like LLM bias and CoT faithfulness. But in this work we argue that observed effects cannot be attributed to the targeted factor without accounting for baseline ``meaning-preserving'' modifications to text that establish general model sensitivity. This is because every counterfactual edit is a compound treatment that bundles the variable of interest with incidental surface-form variation; this violates treatment variation irrelevance. We observe prediction flip rates on MedQA of 14.9% when we surgically change patient gender. However, this is statistically indistinguishable from the flip rates induced by simply paraphrasing inputs (14.1%). In this case, it would therefore be unwarranted to conclude that the LLM is especially sensitive to patient gender. To account for this and robustly measure the effects of targeted interventions, we propose a framework in which we compare (via statistical testing) differences observed under target interventions to those induced by paraphrasing inputs. We then use this framework to revisit a analysis done on the MedPerturb dataset, which reported evidence of model sensitivity to patient demographics and stylistic cues. We find that these effects largely dissipate when we account for general model sensitivity, with only 5 of 120 tests reaching statistical significance. Applying the same framework to occupational biography classification, we detect clearly significant directional gender bias, showing that the framework identifies real directional effects even when they are small. We evaluate a range of metrics -- aggregate, per-sample distributional, and regression -- and find that per-sample metrics are dramatically more powerful than aggregate metrics and regression powerfully and uniquely characterizes effect direction and magnitude.

Large language models (LLMs) are increasingly explored for clinical decision support, yet most evaluations are conducted in English, leaving their reliability in other languages uncertain. Here we evaluate the impact of prompting language on diagnostic reasoning and final diagnosis accuracy by comparing English and French performance across five LLMs (o3, DeepSeek-R1, GPT-4-Turbo, Llama-3.1-405B-Instruct, and BioMistral-7B). A total of 180 clinical vignettes covering 16 medical specialties were assessed by two physicians using an 18-point scale evaluating both diagnosis accuracy and reasoning quality. Four of the five models performed better in English (mean difference 0.37-0.91, adjusted p < 0.05), with the gap spanning multiple aspects of reasoning, including differential diagnosis, logical structure, and internal validity. o3 was the only model showing no overall language effect. These findings demonstrate that prompting language remains a critical determinant of LLM clinical performance, with implications for equitable linguistico-cultural deployment worldwide.

Positron emission tomography/computed tomography (PET/CT) is essential in oncology, yet the rapid expansion of scanners has outpaced the availability of trained specialists, making automated PET/CT report generation (PETRG) increasingly important for reducing clinical workload. Compared with structural imaging (e.g., X-ray, CT, and MRI), functional PET poses distinct challenges: metabolic patterns vary with tracer physiology, and whole-body 3D contextual information is required rather than local-region interpretation. To advance PETRG, we propose PETRG-3D, an end-to-end 3D dual-branch framework that separately encodes PET and CT volumes and incorporates style-adaptive prompts to mitigate inter-hospital variability in reporting practices. We construct PETRG-Lym, a multi-center lymphoma dataset collected from four hospitals (824 reports w/ 245,509 paired PET/CT slices), and construct AutoPET-RG-Lym, a publicly accessible PETRG benchmark derived from open imaging data but equipped with new expert-written, clinically validated reports (135 cases). To assess clinical utility, we introduce PETRG-Score, a lymphoma-specific evaluation protocol that jointly measures metabolic and structural findings across curated anatomical regions. Experiments show that PETRG-3D substantially outperforms existing methods on both natural language metrics (e.g., +31.49\% ROUGE-L) and clinical efficacy metrics (e.g., +8.18\% PET-All), highlighting the benefits of volumetric dual-modality modeling and style-aware prompting. Overall, this work establishes a foundation for future PET/CT-specific models emphasizing disease-aware reasoning and clinically reliable evaluation. Codes, models, and AutoPET-RG-Lym will be released.

Large Language Models (LLMs) changed the way we design and interact with software systems. Their ability to process and extract information from text has drastically improved productivity in a number of routine tasks. Developers that want to include these models in their software stack, however, face a dreadful challenge: debugging LLMs' inconsistent behavior across minor variations of the prompt. We therefore introduce two metrics for classification tasks, namely sensitivity and consistency, which are complementary to task performance. First, sensitivity measures changes of predictions across rephrasings of the prompt, and does not require access to ground truth labels. Instead, consistency measures how predictions vary across rephrasings for elements of the same class. We perform an empirical comparison of these metrics on text classification tasks, using them as guideline for understanding failure modes of the LLM. Our hope is that sensitivity and consistency will be helpful to guide prompt engineering and obtain LLMs that balance robustness with performance.

Annually, at the Conference of Machine Translation (WMT), the Metrics Shared Task organizers conduct the meta-evaluation of Machine Translation (MT) metrics, ranking them according to their correlation with human judgments. Their results guide researchers toward enhancing the next generation of metrics and MT systems. With the recent introduction of neural metrics, the field has witnessed notable advancements. Nevertheless, the inherent opacity of these metrics has posed substantial challenges to the meta-evaluation process. This work highlights two issues with the meta-evaluation framework currently employed in WMT, and assesses their impact on the metrics rankings. To do this, we introduce the concept of sentinel metrics, which are designed explicitly to scrutinize the meta-evaluation process's accuracy, robustness, and fairness. By employing sentinel metrics, we aim to validate our findings, and shed light on and monitor the potential biases or inconsistencies in the rankings. We discover that the present meta-evaluation framework favors two categories of metrics: i) those explicitly trained to mimic human quality assessments, and ii) continuous metrics. Finally, we raise concerns regarding the evaluation capabilities of state-of-the-art metrics, emphasizing that they might be basing their assessments on spurious correlations found in their training data.

Neuroimaging is a ubiquitous tool for evaluating patients with neurological diseases. The global demand for magnetic resonance imaging (MRI) studies has risen steadily, placing significant strain on health systems, prolonging turnaround times, and intensifying physician burnout. These challenges disproportionately impact patients in low-resource and rural settings. Here, we utilized a large academic health system as a data engine to develop Prima, the first vision language model (VLM) serving as an AI foundation for neuroimaging that supports real-world, clinical MRI studies as input. Trained on over 220,000 MRI studies, Prima uses a hierarchical vision architecture that provides general and transferable MRI features. Prima was tested in a 1-year health system-wide study that included 30K MRI studies. Across 52 radiologic diagnoses from the major neurologic disorders, including neoplastic, inflammatory, infectious, and developmental lesions, Prima achieved a mean diagnostic area under the ROC curve of 92.0, outperforming other state-of-the-art general and medical AI models. Prima offers explainable differential diagnoses, worklist priority for radiologists, and clinical referral recommendations across diverse patient demographics and MRI systems. Prima demonstrates algorithmic fairness across sensitive groups and can help mitigate health system biases, such as prolonged turnaround times for low-resource populations. These findings highlight the transformative potential of health system-scale VLMs and Prima's role in advancing AI-driven healthcare.

In medical imaging, the clinical value of Computed Tomography (CT) lies not only in depicting current disease status, but crucially in enabling longitudinal comparison of serial scans to determine disease evolution, a process that underpins response assessment, recurrence detection, and ongoing patient management. Yet, despite this central role of temporal comparison in clinical decision-making, existing medical foundation models remain largely confined to single-study understanding, leaving temporally grounded cross-examination insufficiently addressed. To address this gap, we study longitudinal imaging difference reporting, a task in which a model takes two temporally separated scans from the same patient and generates a clinically meaningful report describing interval changes between them. We introduce CT-ΔBench, a dedicated benchmark for this task with patient-level splitting to prevent information leakage. To better evaluate this task beyond surface-level text similarity, we further develop change-aware metrics specifically designed to capture clinically meaningful longitudinal changes, and conduct an independent physician validation to assess the reliability of the synthesized references and event extraction pipeline. We also compare direct paired-CT reasoning with an indirect two-stage pipeline that first generates single-timepoint reports and then performs textual differencing. Finally, we propose DeltaMed, a baseline model for direct paired-CT difference reporting, and train it on the benchmark training set. Together, these contributions lay the groundwork for temporally aware medical foundation models that better reflect real-world longitudinal clinical reasoning.

Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision support systems. The pipeline combines staged LLM generation with terminology-grounded validation and repair to reduce hallucinated codes and enforce structural and semantic consistency. Applying this approach to MedCaseReasoning, we construct MedCase-Structured, a synthetic dataset aligned with clinician-authored diagnostic cases, achieving valid FHIR generation for 82.5% of cases. Evaluation on MedCase-Structured reveals consistently lower diagnostic accuracy for LLMs on structured FHIR inputs than with plain text, highlighting the importance of deployment-aligned benchmarking.

Rare diseases affect millions of individuals worldwide, yet timely diagnosis remains a major public health challenge due to scarcity of specialized clinical expertise. While large language models (LLMs) show promise to support rare disease diagnosis, current models are constrained by insufficient clinical deployability, limited clinically grounded evidence, and scarcity of training data. Here we present RaDaR (Rare Disease navigatoR), an open-source, compact reasoning LLM (32B parameters) for rare disease diagnosis. RaDaR was trained with 49,170 publicly available free-text cases and 104,666 synthetic cases with reasoning-enhanced training. RaDaR showed the strongest performance among evaluated open-source models, including the 671B DeepSeek-R1, across public benchmarks and four external validation centers. In a retrospective cohort, RaDaR prioritized the final diagnosis before documented clinical suspicion in 61.06 percent of cases, corresponding to a potential lead time of 1.87 months and 50.18 percent of the within-center interval. In a randomized physician-assistance trial, RaDaR assistance improved physicians' rare-disease diagnostic accuracy by 21.44 percentage points compared with internet search alone. Synthetic-data ablations suggested that phenotype-anchored narratives provide useful training signal for long-tail rare diseases, with a monotonic scaling trend within the tested data range. Together, RaDaR and its development and validation framework provide a deployable rare-disease reasoning model and a reproducible development framework for diagnostic AI under data scarcity.

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

In this study, we aimed to determine if fine-tuned large language models (LLMs) can generate accurate, personalized impressions for whole-body PET reports. Twelve language models were trained on a corpus of PET reports using the teacher-forcing algorithm, with the report findings as input and the clinical impressions as reference. An extra input token encodes the reading physician's identity, allowing models to learn physician-specific reporting styles. Our corpus comprised 37,370 retrospective PET reports collected from our institution between 2010 and 2022. To identify the best LLM, 30 evaluation metrics were benchmarked against quality scores from two nuclear medicine (NM) physicians, with the most aligned metrics selecting the model for expert evaluation. In a subset of data, model-generated impressions and original clinical impressions were assessed by three NM physicians according to 6 quality dimensions (3-point scale) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. Bootstrap resampling was used for statistical analysis. Of all evaluation metrics, domain-adapted BARTScore and PEGASUSScore showed the highest Spearman's rank correlations (0.568 and 0.563) with physician preferences. Based on these metrics, the fine-tuned PEGASUS model was selected as the top LLM. When physicians reviewed PEGASUS-generated impressions in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08 out of 5. Physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P=0.41). In conclusion, personalized impressions generated by PEGASUS were clinically useful, highlighting its potential to expedite PET reporting.

With the advent of smartphone indirect ophthalmoscopy, teleophthalmology - the use of specialist ophthalmology assets at a distance from the patient - has experienced a breakthrough, promising enormous benefits especially for healthcare in distant, inaccessible or opthalmologically underserved areas, where specialists are either unavailable or too few in number. However, accurate teleophthalmology requires high-quality ophthalmoscopic imagery. This paper considers three feature families - statistical metrics, gradient-based metrics and wavelet transform coefficient derived indicators - as possible metrics to identify unsharp or blurry images. By using standard machine learning techniques, the suitability of these features for image quality assessment is confirmed, albeit on a rather small data set. With the increased availability and decreasing cost of digital ophthalmoscopy on one hand and the increased prevalence of diabetic retinopathy worldwide on the other, creating tools that can determine whether an image is likely to be diagnostically suitable can play a significant role in accelerating and streamlining the teleophthalmology process. This paper highlights the need for more research in this area, including the compilation of a diverse database of ophthalmoscopic imagery, annotated with quality markers, to train the Point of Acquisition error detection algorithms of the future.

Current Large Language Models (LLMs) benchmarks are often based on open-ended or close-ended QA evaluations, avoiding the requirement of human labor. Close-ended measurements evaluate the factuality of responses but lack expressiveness. Open-ended capture the model's capacity to produce discourse responses but are harder to assess for correctness. These two approaches are commonly used, either independently or together, though their relationship remains poorly understood. This work is focused on the healthcare domain, where both factuality and discourse matter greatly. It introduces a comprehensive, multi-axis suite for healthcare LLM evaluation, exploring correlations between open and close benchmarks and metrics. Findings include blind spots and overlaps in current methodologies. As an updated sanity check, we release a new medical benchmark--CareQA--, with both open and closed variants. Finally, we propose a novel metric for open-ended evaluations --Relaxed Perplexity-- to mitigate the identified limitations.

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