Daily Papers

Neural operator surrogates (NO) approximate PDE solutions orders of magnitude faster than numerical solvers, but suffer from spectral bias: high-frequency content is systematically attenuated, limiting reliability where fine-scale structure matters. Sparse sensor measurements of the field are often available too, offering pointwise accuracy without spectral distortion but covering only a small fraction of the domain. We address this by treating NO predictions as auxiliary observations in a diffusion posterior sampling framework. Our method, FreqNO-DPS (https://github.com/niccoloperrone/FreqNO-DPS), combines an unconditional score-based diffusion prior, trained on high-fidelity simulations, with diffusion posterior sampling (DPS) conditioned on sparse observations and guided by a frozen neural operator. Naive integration reintroduces the surrogate's spectral bias; we resolve this with a closed-form, spectrally shaped guidance score that weights the surrogate by its frequency-dependent accuracy and needs no denoiser backpropagation. A distribution-free analysis bounds the approximation error across the frequency-diffusion-time plane and shows the guidance's frequency dependence is preserved regardless of distributional assumptions. On 3D elastic wavefield prediction at 5% and 2% sensor coverage, the method reaches near-zero spectral bias across all bands, where both the surrogate and sensor-only DPS show systematic high-frequency attenuation. Isotropic guidance, the natural baseline, improves pointwise accuracy but carries the bias into the posterior nearly intact, confirming that frequency-dependent calibration is essential, not merely beneficial. The framework needs only paired surrogate/reference data and exploits no problem-specific structure beyond the residual's approximate spectral diagonality, verifiable for new surrogates via the coherence diagnostic we provide.

We present OCTCube-M, a 3D OCT-based multi-modal foundation model for jointly analyzing OCT and en face images. OCTCube-M first developed OCTCube, a 3D foundation model pre-trained on 26,685 3D OCT volumes encompassing 1.62 million 2D OCT images. It then exploits a novel multi-modal contrastive learning framework COEP to integrate other retinal imaging modalities, such as fundus autofluorescence and infrared retinal imaging, into OCTCube, efficiently extending it into multi-modal foundation models. OCTCube achieves best performance on predicting 8 retinal diseases, demonstrating strong generalizability on cross-cohort, cross-device and cross-modality prediction. OCTCube can also predict cross-organ nodule malignancy (CT) and low cardiac ejection fraction as well as systemic diseases, such as diabetes and hypertension, revealing its wide applicability beyond retinal diseases. We further develop OCTCube-IR using COEP with 26,685 OCT and IR image pairs. OCTCube-IR can accurately retrieve between OCT and IR images, allowing joint analysis between 3D and 2D retinal imaging modalities. Finally, we trained a tri-modal foundation model OCTCube-EF from 4 million 2D OCT images and 400K en face retinal images. OCTCube-EF attains the best performance on predicting the growth rate of geographic atrophy (GA) across datasets collected from 6 multi-center global trials conducted in 23 countries. This improvement is statistically equivalent to running a clinical trial with more than double the size of the original study. Our analysis based on another retrospective case study reveals OCTCube-EF's ability to avoid false positive Phase-III results according to its accurate treatment effect estimation on the Phase-II results. In sum, OCTCube-M is a 3D multi-modal foundation model framework that integrates OCT and other retinal imaging modalities revealing substantial diagnostic and prognostic benefits.

Medical image analysis is crucial in modern radiological diagnostics, especially given the exponential growth in medical imaging data. The demand for automated report generation systems has become increasingly urgent. While prior research has mainly focused on using machine learning and multimodal language models for 2D medical images, the generation of reports for 3D medical images has been less explored due to data scarcity and computational complexities. This paper introduces 3D-CT-GPT, a Visual Question Answering (VQA)-based medical visual language model specifically designed for generating radiology reports from 3D CT scans, particularly chest CTs. Extensive experiments on both public and private datasets demonstrate that 3D-CT-GPT significantly outperforms existing methods in terms of report accuracy and quality. Although current methods are few, including the partially open-source CT2Rep and the open-source M3D, we ensured fair comparison through appropriate data conversion and evaluation methodologies. Experimental results indicate that 3D-CT-GPT enhances diagnostic accuracy and report coherence, establishing itself as a robust solution for clinical radiology report generation. Future work will focus on expanding the dataset and further optimizing the model to enhance its performance and applicability.

Large Reasoning Models (LRMs) extend large language models with explicit, multi-step reasoning traces to enhance transparency and performance on complex tasks. However, these reasoning traces can be redundant or logically inconsistent, making them a new source of hallucination that is difficult to detect. Existing hallucination detection methods focus primarily on answer-level uncertainty and often fail to detect hallucinations or logical inconsistencies arising from the model's reasoning trace. This oversight is particularly problematic for LRMs, where the explicit thinking trace is not only an important support to the model's decision-making process but also a key source of potential hallucination. To this end, we propose RACE (Reasoning and Answer Consistency Evaluation), a novel framework specifically tailored for hallucination detection in LRMs. RACE operates by extracting essential reasoning steps and computing four diagnostic signals: inter-sample consistency of reasoning traces, entropy-based answer uncertainty, semantic alignment between reasoning and answers, and internal coherence of reasoning. This joint analysis enables fine-grained hallucination detection even when the final answer appears correct. Experiments across datasets and different LLMs demonstrate that RACE outperforms existing hallucination detection baselines, offering a robust and generalizable solution for evaluating LRMs. Our code is available at: https://github.com/bebr2/RACE.

Modern Large Language Models (LLMs) are often criticized for producing repetitive and homogeneous text, despite possessing vast latent vocabularies. While previous research has focused on model knowledge and training data, we investigate the role of decoding mechanics in suppressing linguistic diversity. We introduce the Word Coverage Score (WCS), a metric that quantifies the extent to which contextually appropriate human vocabulary is mathematically pruned by standard sampling filters (e.g., Top-p, Top-k, and Min-p). Rather than assessing static knowledge, the WCS measures the lexical survival rate of low-frequency, high-information human words as a function of sampling parameters. By auditing open-weight models on human-authored corpus fragments, we identify which logical lexical choices are rendered unreachable by the decoder, even when they reside within the probability space. Our results provide quantitative evidence that industry-standard sampling defaults act as unintended censorship mechanisms, smoothing the unique textures of human expression into a homogenized discourse. The WCS offers a rigorous framework for optimizing the trade-off between text coherence and lexical richness, providing a diagnostic tool for preserving the diversity of human language in generative models.

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.

The clinical translation of dermatological AI is hindered by opaque reasoning and systematic performance disparities across skin tones. Here we present SkinGPT-R1, a multimodal large language model that integrates chain-of-thought diagnostic reasoning with a fairness-aware mixture-of-experts architecture for interpretable and equitable skin disease diagnosis. Through parameter-efficient adaptation of a frozen reasoning backbone, SkinGPT-R1 generates structured diagnostic reports comprising visual findings, differential reasoning, and final diagnosis. Across seven external datasets spanning diverse pathologies and imaging conditions, SkinGPT-R1 achieves state-of-the-art accuracy on six benchmarks, including 82.50\% on a challenging 40-class long-tail classification task (+19.30\% over leading baselines). Blinded evaluation by five board-certified dermatologists on 1,000 phenotypically balanced cases yields a mean score of 3.6 out of 5, with the highest ratings in safety (3.8) and reasoning coherence (3.6), indicating that the generated rationales are clinically safe, logically grounded, and suitable for supporting diagnostic decision-making. Critically, SkinGPT-R1 mitigates algorithmic bias across the full Fitzpatrick spectrum, achieving a robust worst-group performance of 41.40\% on the Fitz17k benchmark and a five-fold relative improvement in lower-bound accuracy on the DDI dataset compared to standard multimodal baselines. These results establish a framework for trustworthy, fair, and explainable AI-assisted dermatological diagnosis.

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

The explainability of a robot's actions is crucial to its acceptance in social spaces. Explaining why a robot fails to complete a given task is particularly important for non-expert users to be aware of the robot's capabilities and limitations. So far, research on explaining robot failures has only considered generating textual explanations, even though several studies have shown the benefits of multimodal ones. However, a simple combination of multiple modalities may lead to semantic incoherence between the information across different modalities - a problem that is not well-studied. An incoherent multimodal explanation can be difficult to understand, and it may even become inconsistent with what the robot and the human observe and how they perform reasoning with the observations. Such inconsistencies may lead to wrong conclusions about the robot's capabilities. In this paper, we introduce an approach to generate coherent multimodal explanations by checking the logical coherence of explanations from different modalities, followed by refinements as required. We propose a classification approach for coherence assessment, where we evaluate if an explanation logically follows another. Our experiments suggest that fine-tuning a neural network that was pre-trained to recognize textual entailment, performs well for coherence assessment of multimodal explanations. Code & data: https://pradippramanick.github.io/coherent-explain/.

Automatic dialogue coherence evaluation has attracted increasing attention and is crucial for developing promising dialogue systems. However, existing metrics have two major limitations: (a) they are mostly trained in a simplified two-level setting (coherent vs. incoherent), while humans give Likert-type multi-level coherence scores, dubbed as "quantifiable"; (b) their predicted coherence scores cannot align with the actual human rating standards due to the absence of human guidance during training. To address these limitations, we propose Quantifiable Dialogue Coherence Evaluation (QuantiDCE), a novel framework aiming to train a quantifiable dialogue coherence metric that can reflect the actual human rating standards. Specifically, QuantiDCE includes two training stages, Multi-Level Ranking (MLR) pre-training and Knowledge Distillation (KD) fine-tuning. During MLR pre-training, a new MLR loss is proposed for enabling the model to learn the coarse judgement of coherence degrees. Then, during KD fine-tuning, the pretrained model is further finetuned to learn the actual human rating standards with only very few human-annotated data. To advocate the generalizability even with limited fine-tuning data, a novel KD regularization is introduced to retain the knowledge learned at the pre-training stage. Experimental results show that the model trained by QuantiDCE presents stronger correlations with human judgements than the other state-of-the-art metrics.

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

Automatic estimation of cardiac ultrasound image quality can be beneficial for guiding operators and ensuring the accuracy of clinical measurements. Previous work often fails to distinguish the view correctness of the echocardiogram from the image quality. Additionally, previous studies only provide a global image quality value, which limits their practical utility. In this work, we developed and compared three methods to estimate image quality: 1) classic pixel-based metrics like the generalized contrast-to-noise ratio (gCNR) on myocardial segments as region of interest and left ventricle lumen as background, obtained using a U-Net segmentation 2) local image coherence derived from a U-Net model that predicts coherence from B-Mode images 3) a deep convolutional network that predicts the quality of each region directly in an end-to-end fashion. We evaluate each method against manual regional image quality annotations by three experienced cardiologists. The results indicate poor performance of the gCNR metric, with Spearman correlation to the annotations of rho = 0.24. The end-to-end learning model obtains the best result, rho = 0.69, comparable to the inter-observer correlation, rho = 0.63. Finally, the coherence-based method, with rho = 0.58, outperformed the classical metrics and is more generic than the end-to-end approach.

Optical Coherence Tomography (OCT) is essential for diagnosing conditions such as glaucoma, diabetic retinopathy, and age-related macular degeneration. Accurate retinal layer segmentation enables quantitative biomarkers critical for clinical decision-making, but manual segmentation is time-consuming and variable, while conventional deep learning models often lack interpretability. This work proposes an improved SegNet-based deep learning framework for automated and interpretable retinal layer segmentation. Architectural innovations, including modified pooling strategies, enhance feature extraction from noisy OCT images, while a hybrid loss function combining categorical cross-entropy and Dice loss improves performance for thin and imbalanced retinal layers. Gradient-weighted Class Activation Mapping (Grad-CAM) is integrated to provide visual explanations, allowing clinical validation of model decisions. Trained and validated on the Duke OCT dataset, the framework achieved 95.77% validation accuracy, a Dice coefficient of 0.9446, and a Jaccard Index (IoU) of 0.8951. Class-wise results confirmed robust performance across most layers, with challenges remaining for thinner boundaries. Grad-CAM visualizations highlighted anatomically relevant regions, aligning segmentation with clinical biomarkers and improving transparency. By combining architectural improvements, a customized hybrid loss, and explainable AI, this study delivers a high-performing SegNet-based framework that bridges the gap between accuracy and interpretability. The approach offers strong potential for standardizing OCT analysis, enhancing diagnostic efficiency, and fostering clinical trust in AI-driven ophthalmic tools.

Echocardiography interpretation requires integrating multi-view temporal evidence with quantitative measurements and guideline-grounded reasoning, yet existing foundation-model pipelines largely solve isolated subtasks and fail when tool outputs are noisy or values fall near clinical cutoffs. We propose Echo-CoPilot, an end-to-end agentic framework that combines a multi-perspective workflow with knowledge-graph guided measurement selection. Echo-CoPilot runs three independent ReAct-style agents, structural, pathological, and quantitative, that invoke specialized echocardiography tools to extract parameters while querying EchoKG to determine which measurements are required for the clinical question and which should be avoided. A self-contrast language model then compares the evidence-grounded perspectives, generates a discrepancy checklist, and re-queries EchoKG to apply the appropriate guideline thresholds and resolve conflicts, reducing hallucinated measurement selection and borderline flip-flops. On MIMICEchoQA, Echo-CoPilot provides higher accuracy compared to SOTA baselines and, under a stochasticity stress test, achieves higher reliability through more consistent conclusions and fewer answer changes across repeated runs. Our code is publicly available at~https://github.com/moeinheidari7829/Echo-CoPilot{magenta{GitHub}}.

Measuring the coherence of text is a vital aspect of evaluating the quality of written content. Recent advancements in neural coherence modeling have demonstrated their efficacy in capturing entity coreference and discourse relations, thereby enhancing coherence evaluation. However, many existing methods heavily depend on static embeddings or focus narrowly on nearby context, constraining their capacity to measure the overarching coherence of long texts. In this paper, we posit that coherent texts inherently manifest a sequential and cohesive interplay among sentences, effectively conveying the central theme, purpose, or standpoint. To explore this abstract relationship, we introduce the "BBScore," a novel reference-free metric grounded in Brownian bridge theory for assessing text coherence. Our findings showcase that when synergized with a simple additional classification component, this metric attains a performance level comparable to state-of-the-art techniques on standard artificial discrimination tasks. We also establish in downstream tasks that this metric effectively differentiates between human-written documents and text generated by large language models under a specific domain. Furthermore, we illustrate the efficacy of this approach in detecting written styles attributed to diverse large language models, underscoring its potential for generalizability. In summary, we present a novel Brownian bridge coherence metric capable of measuring both local and global text coherence, while circumventing the need for end-to-end model training. This flexibility allows for its application in various downstream tasks.

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

Coherence is one of the critical factors that determine the quality of writing. We propose writing relevance (WR) training method for neural encoder-decoder natural language generation (NLG) models which improves coherence of the continuation by leveraging negative examples. WR loss regresses the vector representation of the context and generated sentence toward positive continuation by contrasting it with the negatives. We compare our approach with Unlikelihood (UL) training in a text continuation task on commonsense natural language inference (NLI) corpora to show which method better models the coherence by avoiding unlikely continuations. The preference of our approach in human evaluation shows the efficacy of our method in improving coherence.

It is widely accepted that information derived from analyzing speech (the acoustic signal) and language production (words and sentences) serves as a useful window into the health of an individual's cognitive ability. In fact, most neuropsychological testing batteries have a component related to speech and language where clinicians elicit speech from patients for subjective evaluation across a broad set of dimensions. With advances in speech signal processing and natural language processing, there has been recent interest in developing tools to detect more subtle changes in cognitive-linguistic function. This work relies on extracting a set of features from recorded and transcribed speech for objective assessments of speech and language, early diagnosis of neurological disease, and tracking of disease after diagnosis. With an emphasis on cognitive and thought disorders, in this paper we provide a review of existing speech and language features used in this domain, discuss their clinical application, and highlight their advantages and disadvantages. Broadly speaking, the review is split into two categories: language features based on natural language processing and speech features based on speech signal processing. Within each category, we consider features that aim to measure complementary dimensions of cognitive-linguistics, including language diversity, syntactic complexity, semantic coherence, and timing. We conclude the review with a proposal of new research directions to further advance the field.

Anticipating LLM behavioral tendencies from low-cost psychometric probes is critical for safe deployment, but only if self-reports (SR) reliably predict behavior. Recent work documented substantial SR-behavior dissociation in LLMs, but relied on broad personality traits (Big 5) that predict specific behaviors weakly, even in humans. Furthermore, the isolation of conversational sessions combined with weak context matching left open whether LLMs truly lack coherence or whether the conditions needed to detect such coherence were not met. We contrast Big 5 with the Theory of Planned Behavior (TPB), which measures intention targeted to a specific behavior and predicts human behavior substantially better than broad traits. We run experiments across four behavioral tasks and 11 frontier LLMs, while also varying session context and identity induction. We find that SR-behavior coherence exists but is selective. 1) Within a shared conversation, the Theory of Planned Behavior reaches human-level coherence; Big 5 does not. 2) Across separate conversations, coherence survives only for behaviors anchored outside the immediate prompt, such as implicit bias shaped by training, and collapses when behavior is strongly primed by context, as with sycophancy. 3) Persona prompting makes self-reports more consistent across conversations, but does not bring behavior into alignment. These findings suggest that coarse personality frameworks, such as Big 5 may not be the best tools for testing deployment behavior. More task- and behavior-specific instruments are needed, and even these must be evaluated across tasks and contexts.

Coherence evaluation aims to assess the organization and structure of a discourse, which remains challenging even in the era of large language models. Due to the scarcity of annotated data, data augmentation is commonly used for training coherence evaluation models. However, previous augmentations for this task primarily rely on heuristic rules, lacking designing criteria as guidance. In this paper, we take inspiration from linguistic theory of discourse structure, and propose a data augmentation framework named CoUDA. CoUDA breaks down discourse coherence into global and local aspects, and designs augmentation strategies for both aspects, respectively. Especially for local coherence, we propose a novel generative strategy for constructing augmentation samples, which involves post-pretraining a generative model and applying two controlling mechanisms to control the difficulty of generated samples. During inference, CoUDA also jointly evaluates both global and local aspects to comprehensively assess the overall coherence of a discourse. Extensive experiments in coherence evaluation show that, with only 233M parameters, CoUDA achieves state-of-the-art performance in both pointwise scoring and pairwise ranking tasks, even surpassing recent GPT-3.5 and GPT-4 based metrics.

Vision-Language Models (VLMs) frequently "hallucinate" - generate plausible yet factually incorrect statements - posing a critical barrier to their trustworthy deployment. In this work, we propose a new paradigm for diagnosing hallucinations, recasting them from static output errors into dynamic pathologies of a model's computational cognition. Our framework is grounded in a normative principle of computational rationality, allowing us to model a VLM's generation as a dynamic cognitive trajectory. We design a suite of information-theoretic probes that project this trajectory onto an interpretable, low-dimensional Cognitive State Space. Our central discovery is a governing principle we term the geometric-information duality: a cognitive trajectory's geometric abnormality within this space is fundamentally equivalent to its high information-theoretic surprisal. Hallucination detection is counts as a geometric anomaly detection problem. Evaluated across diverse settings - from rigorous binary QA (POPE) and comprehensive reasoning (MME) to unconstrained open-ended captioning (MS-COCO) - our framework achieves state-of-the-art performance. Crucially, it operates with high efficiency under weak supervision and remains highly robust even when calibration data is heavily contaminated. This approach enables a causal attribution of failures, mapping observable errors to distinct pathological states: perceptual instability (measured by Perceptual Entropy), logical-causal failure (measured by Inferential Conflict), and decisional ambiguity (measured by Decision Entropy). Ultimately, this opens a path toward building AI systems whose reasoning is transparent, auditable, and diagnosable by design.

Fact-checking is the task of verifying the veracity of claims by assessing their assertions against credible evidence. The vast majority of fact-checking studies focus exclusively on political claims. Very little research explores fact-checking for other topics, specifically subject matters for which expertise is required. We present the first study of explainable fact-checking for claims which require specific expertise. For our case study we choose the setting of public health. To support this case study we construct a new dataset PUBHEALTH of 11.8K claims accompanied by journalist crafted, gold standard explanations (i.e., judgments) to support the fact-check labels for claims. We explore two tasks: veracity prediction and explanation generation. We also define and evaluate, with humans and computationally, three coherence properties of explanation quality. Our results indicate that, by training on in-domain data, gains can be made in explainable, automated fact-checking for claims which require specific expertise.

Optical coherence tomography (OCT) is a non-invasive imaging modality which is widely used in clinical ophthalmology. OCT images are capable of visualizing deep retinal layers which is crucial for early diagnosis of retinal diseases. In this paper, we describe a comprehensive open-access database containing more than 500 highresolution images categorized into different pathological conditions. The image classes include Normal (NO), Macular Hole (MH), Age-related Macular Degeneration (AMD), Central Serous Retinopathy (CSR), and Diabetic Retinopathy (DR). The images were obtained from a raster scan protocol with a 2mm scan length and 512x1024 pixel resolution. We have also included 25 normal OCT images with their corresponding ground truth delineations which can be used for an accurate evaluation of OCT image segmentation. In addition, we have provided a user-friendly GUI which can be used by clinicians for manual (and semi-automated) segmentation.

Retinal imaging has emerged as a powerful, non-invasive modality for detecting and quantifying biomarkers of systemic diseases-ranging from diabetes and hypertension to Alzheimer's disease and cardiovascular disorders but current insights remain dispersed across platforms and specialties. Recent technological advances in optical coherence tomography (OCT/OCTA) and adaptive optics (AO) now deliver ultra-high-resolution scans (down to 5 {\mu}m ) with superior contrast and spatial integration, allowing early identification of microvascular abnormalities and neurodegenerative changes. At the same time, AI-driven and machine learning (ML) algorithms have revolutionized the analysis of large-scale retinal datasets, increasing sensitivity and specificity; for example, deep learning models achieve > 90 \% sensitivity for diabetic retinopathy and AUC = 0.89 for the prediction of cardiovascular risk from fundus photographs. The proliferation of mobile health technologies and telemedicine platforms further extends access, reduces costs, and facilitates community-based screening and longitudinal monitoring. Despite these breakthroughs, translation into routine practice is hindered by heterogeneous imaging protocols, limited external validation of AI models, and integration challenges within clinical workflows. In this review, we systematically synthesize the latest OCT/OCT and AO developments, AI/ML approaches, and mHealth/Tele-ophthalmology initiatives and quantify their diagnostic performance across disease domains. Finally, we propose a roadmap for multicenter protocol standardization, prospective validation trials, and seamless incorporation of retinal screening into primary and specialty care pathways-paving the way for precision prevention, early intervention, and ongoing treatment of life-threatening systemic diseases.

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

Despite being heralded as the new standard for dialogue evaluation, the closed-source nature of GPT-4 poses challenges for the community. Motivated by the need for lightweight, open source, and multilingual dialogue evaluators, this paper introduces GenResCoh (Generated Responses targeting Coherence). GenResCoh is a novel LLM generated dataset comprising over 130k negative and positive responses and accompanying explanations seeded from XDailyDialog and XPersona covering English, French, German, Italian, and Chinese. Leveraging GenResCoh, we propose ECoh (Evaluation of Coherence), a family of evaluators trained to assess response coherence across multiple languages. Experimental results demonstrate that ECoh achieves multilingual detection capabilities superior to the teacher model (GPT-3.5-Turbo) on GenResCoh, despite being based on a much smaller architecture. Furthermore, the explanations provided by ECoh closely align in terms of quality with those generated by the teacher model.

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.

Conditional diffusion models are powerful generative models that can leverage various types of conditional information, such as class labels, segmentation masks, or text captions. However, in many real-world scenarios, conditional information may be noisy or unreliable due to human annotation errors or weak alignment. In this paper, we propose the Coherence-Aware Diffusion (CAD), a novel method that integrates coherence in conditional information into diffusion models, allowing them to learn from noisy annotations without discarding data. We assume that each data point has an associated coherence score that reflects the quality of the conditional information. We then condition the diffusion model on both the conditional information and the coherence score. In this way, the model learns to ignore or discount the conditioning when the coherence is low. We show that CAD is theoretically sound and empirically effective on various conditional generation tasks. Moreover, we show that leveraging coherence generates realistic and diverse samples that respect conditional information better than models trained on cleaned datasets where samples with low coherence have been discarded.

The oxygen saturation level in the blood (SaO2) is crucial for health, particularly in relation to sleep-related breathing disorders. However, continuous monitoring of SaO2 is time-consuming and highly variable depending on patients' conditions. Recently, optical coherence tomography angiography (OCTA) has shown promising development in rapidly and effectively screening eye-related lesions, offering the potential for diagnosing sleep-related disorders. To bridge this gap, our paper presents three key contributions. Firstly, we propose JointViT, a novel model based on the Vision Transformer architecture, incorporating a joint loss function for supervision. Secondly, we introduce a balancing augmentation technique during data preprocessing to improve the model's performance, particularly on the long-tail distribution within the OCTA dataset. Lastly, through comprehensive experiments on the OCTA dataset, our proposed method significantly outperforms other state-of-the-art methods, achieving improvements of up to 12.28% in overall accuracy. This advancement lays the groundwork for the future utilization of OCTA in diagnosing sleep-related disorders. See project website https://steve-zeyu-zhang.github.io/JointViT

Multimodal Large Language Models (MLLMs) are renowned for their superior instruction-following and reasoning capabilities across diverse problem domains. However, existing benchmarks primarily focus on assessing factual and logical correctness in downstream tasks, with limited emphasis on evaluating MLLMs' ability to interpret pragmatic cues and intermodal relationships. To address this gap, we assess the competency of MLLMs in performing Multimodal Discourse Analysis (MDA) using Coherence Relations. Our benchmark, CORDIAL, encompasses a broad spectrum of Coherence Relations across 3 different discourse domains at varying levels of granularity. Through our experiments on 10+ MLLMs employing different prompting strategies, we show that even top models like Gemini 1.5 Pro and GPT-4o fail to match the performance of simple classifier-based baselines. This study emphasizes the need to move beyond similarity-based metrics and adopt a discourse-driven framework for evaluating MLLMs, providing a more nuanced assessment of their capabilities. The benchmark and code are available at: https://github.com/aashish2000/CORDIAL.

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.

Faithfulness hallucinations are claims generated by a Large Language Model (LLM) not supported by contexts provided to the LLM. Lacking assessment standards, existing benchmarks focus on "factual statements" that rephrase source materials while overlooking "cognitive statements" that involve making inferences from the given context. Consequently, evaluating and detecting the hallucination of cognitive statements remains challenging. Inspired by how evidence is assessed in the legal domain, we design a rigorous framework to assess different levels of faithfulness of cognitive statements and introduce the CogniBench dataset where we reveal insightful statistics. To keep pace with rapidly evolving LLMs, we further develop an automatic annotation pipeline that scales easily across different models. This results in a large-scale CogniBench-L dataset, which facilitates training accurate detectors for both factual and cognitive hallucinations. We release our model and datasets at: https://github.com/FUTUREEEEEE/CogniBench

Early diagnosis of mild cognitive impairment (MCI) and subjective cognitive decline (SCD) utilizing multi-modal magnetic resonance imaging (MRI) is a pivotal area of research. While various regional and connectivity features from functional MRI (fMRI) and diffusion tensor imaging (DTI) have been employed to develop diagnosis models, most studies integrate these features without adequately addressing their alignment and interactions. This limits the potential to fully exploit the synergistic contributions of combined features and modalities. To solve this gap, our study introduces a novel Hierarchical Alignments and Hierarchical Interactions (HA-HI) method for MCI and SCD classification, leveraging the combined strengths of fMRI and DTI. HA-HI efficiently learns significant MCI- or SCD- related regional and connectivity features by aligning various feature types and hierarchically maximizing their interactions. Furthermore, to enhance the interpretability of our approach, we have developed the Synergistic Activation Map (SAM) technique, revealing the critical brain regions and connections that are indicative of MCI/SCD. Comprehensive evaluations on the ADNI dataset and our self-collected data demonstrate that HA-HI outperforms other existing methods in diagnosing MCI and SCD, making it a potentially vital and interpretable tool for early detection. The implementation of this method is publicly accessible at https://github.com/ICI-BCI/Dual-MRI-HA-HI.git.

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

In this work, we investigate the human perception of coherence in open-domain dialogues. In particular, we address the problem of annotating and modeling the coherence of next-turn candidates while considering the entire history of the dialogue. First, we create the Switchboard Coherence (SWBD-Coh) corpus, a dataset of human-human spoken dialogues annotated with turn coherence ratings, where next-turn candidate utterances ratings are provided considering the full dialogue context. Our statistical analysis of the corpus indicates how turn coherence perception is affected by patterns of distribution of entities previously introduced and the Dialogue Acts used. Second, we experiment with different architectures to model entities, Dialogue Acts and their combination and evaluate their performance in predicting human coherence ratings on SWBD-Coh. We find that models combining both DA and entity information yield the best performances both for response selection and turn coherence rating.

Large language models (LLMs) deployed for logical reasoning in knowledge-intensive domains exhibit a subtle but critical failure: coherence can be vacuously achieved through systematic abstention. A model that withholds commitment to either entailment or refutation satisfies negation consistency while providing no utility. We introduce Coherence Under Commitment (CUC), a dual-query evaluation paradigm that jointly measures consistency and decisiveness. CUC contributes three innovations: (1) a commitment score c(φ) = p(φ) + p(lnotφ) quantifying probability mass allocated to decisive outcomes; (2) a deterministic elicitation protocol via normalized YES/NO log probabilities, eliminating sampling variance; and (3) a 3-way decision framework (True/False/Uncertain) operationalizing the coherence-commitment trade-off into metrics. Experiments on four open-weight LLMs (1B-3B) across 204 FOLIO examples expose a sharp frontier. Qwen2.5-3B achieves near-zero contradiction (E[v_{neg}]{=}0.025) but only 7.4% coverage, while TinyLlama-1.1B reaches 79.4% coverage with violations on every example. Coherence-only evaluation would rank the abstaining model first; CUC exposes this as vacuous, and the frontier generalizes to LogiQA~v2 (ρ{=}0.97). We argue that evaluation must report both coherence and non-vacuous commitment and release a toolkit for standardized assessment.

Color fundus photography and Optical Coherence Tomography (OCT) are the two most cost-effective tools for glaucoma screening. Both two modalities of images have prominent biomarkers to indicate glaucoma suspected. Clinically, it is often recommended to take both of the screenings for a more accurate and reliable diagnosis. However, although numerous algorithms are proposed based on fundus images or OCT volumes in computer-aided diagnosis, there are still few methods leveraging both of the modalities for the glaucoma assessment. Inspired by the success of Retinal Fundus Glaucoma Challenge (REFUGE) we held previously, we set up the Glaucoma grAding from Multi-Modality imAges (GAMMA) Challenge to encourage the development of fundus \& OCT-based glaucoma grading. The primary task of the challenge is to grade glaucoma from both the 2D fundus images and 3D OCT scanning volumes. As part of GAMMA, we have publicly released a glaucoma annotated dataset with both 2D fundus color photography and 3D OCT volumes, which is the first multi-modality dataset for glaucoma grading. In addition, an evaluation framework is also established to evaluate the performance of the submitted methods. During the challenge, 1272 results were submitted, and finally, top-10 teams were selected to the final stage. We analysis their results and summarize their methods in the paper. Since all these teams submitted their source code in the challenge, a detailed ablation study is also conducted to verify the effectiveness of the particular modules proposed. We find many of the proposed techniques are practical for the clinical diagnosis of glaucoma. As the first in-depth study of fundus \& OCT multi-modality glaucoma grading, we believe the GAMMA Challenge will be an essential starting point for future research.

Recently, there has been a growing interest in designing text generation systems from a discourse coherence perspective, e.g., modeling the interdependence between sentences. Still, recent BERT-based evaluation metrics are weak in recognizing coherence, and thus are not reliable in a way to spot the discourse-level improvements of those text generation systems. In this work, we introduce DiscoScore, a parametrized discourse metric, which uses BERT to model discourse coherence from different perspectives, driven by Centering theory. Our experiments encompass 16 non-discourse and discourse metrics, including DiscoScore and popular coherence models, evaluated on summarization and document-level machine translation (MT). We find that (i) the majority of BERT-based metrics correlate much worse with human rated coherence than early discourse metrics, invented a decade ago; (ii) the recent state-of-the-art BARTScore is weak when operated at system level -- which is particularly problematic as systems are typically compared in this manner. DiscoScore, in contrast, achieves strong system-level correlation with human ratings, not only in coherence but also in factual consistency and other aspects, and surpasses BARTScore by over 10 correlation points on average. Further, aiming to understand DiscoScore, we provide justifications to the importance of discourse coherence for evaluation metrics, and explain the superiority of one variant over another. Our code is available at https://github.com/AIPHES/DiscoScore.

Zero-shot, training-free, image-based text-to-video generation is an emerging area that aims to generate videos using existing image-based diffusion models. Current methods in this space require specific architectural changes to image generation models, which limit their adaptability and scalability. In contrast to such methods, we provide a model-agnostic approach. We use intersections in diffusion trajectories, working only with the latent values. We could not obtain localized frame-wise coherence and diversity using only the intersection of trajectories. Thus, we instead use a grid-based approach. An in-context trained LLM is used to generate coherent frame-wise prompts; another is used to identify differences between frames. Based on these, we obtain a CLIP-based attention mask that controls the timing of switching the prompts for each grid cell. Earlier switching results in higher variance, while later switching results in more coherence. Therefore, our approach can ensure appropriate control between coherence and variance for the frames. Our approach results in state-of-the-art performance while being more flexible when working with diverse image-generation models. The empirical analysis using quantitative metrics and user studies confirms our model's superior temporal consistency, visual fidelity and user satisfaction, thus providing a novel way to obtain training-free, image-based text-to-video generation.

Clinical diagnosis of the eye is performed over multifarious data modalities including scalar clinical labels, vectorized biomarkers, two-dimensional fundus images, and three-dimensional Optical Coherence Tomography (OCT) scans. Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME). Enabling usage of machine learning algorithms within the ophthalmic medical domain requires research into the relationships and interactions between all relevant data over a treatment period. Existing datasets are limited in that they neither provide data nor consider the explicit relationship modeling between the data modalities. In this paper, we introduce the Ophthalmic Labels for Investigating Visual Eye Semantics (OLIVES) dataset that addresses the above limitation. This is the first OCT and near-IR fundus dataset that includes clinical labels, biomarker labels, disease labels, and time-series patient treatment information from associated clinical trials. The dataset consists of 1268 near-IR fundus images each with at least 49 OCT scans, and 16 biomarkers, along with 4 clinical labels and a disease diagnosis of DR or DME. In total, there are 96 eyes' data averaged over a period of at least two years with each eye treated for an average of 66 weeks and 7 injections. We benchmark the utility of OLIVES dataset for ophthalmic data as well as provide benchmarks and concrete research directions for core and emerging machine learning paradigms within medical image analysis.

Optical coherence tomography (OCT) is a non-invasive imaging technique with extensive clinical applications in ophthalmology. OCT enables the visualization of the retinal layers, playing a vital role in the early detection and monitoring of retinal diseases. OCT uses the principle of light wave interference to create detailed images of the retinal microstructures, making it a valuable tool for diagnosing ocular conditions. This work presents an open-access OCT dataset (OCTDL) comprising over 1600 high-resolution OCT images labeled according to disease group and retinal pathology. The dataset consists of OCT records of patients with Age-related Macular Degeneration (AMD), Diabetic Macular Edema (DME), Epiretinal Membrane (ERM), Retinal Artery Occlusion (RAO), Retinal Vein Occlusion (RVO), and Vitreomacular Interface Disease (VID). The images were acquired with an Optovue Avanti RTVue XR using raster scanning protocols with dynamic scan length and image resolution. Each retinal b-scan was acquired by centering on the fovea and interpreted and cataloged by an experienced retinal specialist. In this work, we applied Deep Learning classification techniques to this new open-access dataset.

Incongruence detection in eyewitness narratives is critical for understanding the reliability of testimonies, yet traditional approaches often fail to address the nuanced inconsistencies inherent in such accounts. In this paper, we introduce a novel task of incongruence detection in eyewitness testimonies. Given a pair of testimonies containing of multiple pairs of question and answer by two subjects, we identify contextually related incongruence between the two subjects. We also mark the span of incongruences in the utterances. To achieve this, we developed MIND(MultI-EyewitNess Deception) - a comprehensive dataset consisting of 2927 pairs of contextually related answers designed to capture both explicit and implicit contradictions. INstruction - TunEd iNcongruity Detection framework based on 6W and multi-hop reasoning approach, aka. INTEND. Drawing from investigative techniques, INTEND address the task as a close-style problem, contradicting on the who, what, when, where and why aspect of the content. Our findings shows that prompt tuning, especially when utilizing our framework, enhances the detection of incongruences by a margin of +5.63 percent. We compare our approach with multiple fine-tuning and prompt tuning techniques on MLMs and LLMs. Emperical results demonstrate convincing performance improvement in F1-score over fine-tuned and regular prompt-tuning techniques, highlighting the effectiveness of our approach.

Chain-of-Thought (CoT) reasoning has proven effective in enhancing large language models by encouraging step-by-step intermediate reasoning, and recent advances have extended this paradigm to Multimodal Large Language Models (MLLMs). In the medical domain, where diagnostic decisions depend on nuanced visual cues and sequential reasoning, CoT aligns naturally with clinical thinking processes. However, Current benchmarks for medical image understanding generally focus on the final answer while ignoring the reasoning path. An opaque process lacks reliable bases for judgment, making it difficult to assist doctors in diagnosis. To address this gap, we introduce a new M3CoTBench benchmark specifically designed to evaluate the correctness, efficiency, impact, and consistency of CoT reasoning in medical image understanding. M3CoTBench features 1) a diverse, multi-level difficulty dataset covering 24 examination types, 2) 13 varying-difficulty tasks, 3) a suite of CoT-specific evaluation metrics (correctness, efficiency, impact, and consistency) tailored to clinical reasoning, and 4) a performance analysis of multiple MLLMs. M3CoTBench systematically evaluates CoT reasoning across diverse medical imaging tasks, revealing current limitations of MLLMs in generating reliable and clinically interpretable reasoning, and aims to foster the development of transparent, trustworthy, and diagnostically accurate AI systems for healthcare. Project page at https://juntaojianggavin.github.io/projects/M3CoTBench/.

Benchmarks measure whether a model is correct. They do not measure whether a model is reliable. This distinction is largely academic for single-shot inference, but becomes critical for agentic AI systems, where a single rephrased prompt can trigger cascading failures in multi-step execution. Yet this form of instability is not captured by existing evaluations. Hallucinations live in variance: they arise when semantically equivalent prompts activate inconsistent internal pathways, producing divergent outputs. Consistent but incorrect outputs reflect bias or missing knowledge; confident guessing reflects calibration failure. Neither constitutes hallucination under this definition. When error is variance-dominated, reducing redundant pathways improves reliability without adding knowledge. We formalize this through Semantic Stability (SS), measured via Paraphrase Consistency (PC@k): generate k paraphrases, greedy decode each, compute mode agreement. SS is a diagnostic for variance-driven unreliability, not a method for improving correctness. We show that a dense Qwen3-0.6B agrees with itself only 23.8% of the time; at 32% sparsity, agreement jumps to 55.9%. A phase diagram reveals the sweet spot where variance reduction outpaces bias accumulation, and regimes where stability collapses onto wrong answers.

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

Vision-language models (VLMs) achieve strong performance on many benchmarks, yet a basic reliability question remains underexplored: when visual evidence conflicts with commonsense, do models follow what is shown or what commonsense suggests? A characteristic failure in this setting is that the model overrides visual evidence and outputs the commonsense alternative. We term this phenomenon commonsense-driven hallucination (CDH). To evaluate it, we introduce CDH-Bench, a benchmark designed to create explicit visual evidence--commonsense conflicts. CDH-Bench covers three dimensions: counting anomalies, relational anomalies, and attribute anomalies. We evaluate frontier VLMs under binary Question Answering (QA) and multiple-choice QA, and report metrics including Counterfactual Accuracy (CF-Acc), Commonsense Accuracy (CS-Acc), Counterfactual Accuracy Drop (CFAD), Commonsense Collapse Rate (CCR), and Relative Prior Dependency (RPD). Results show that even strong models remain vulnerable to prior-driven normalization under visual evidence--commonsense conflict. CDH-Bench provides a controlled diagnostic of visual fidelity under visual evidence--commonsense conflict.

Large vision-language models (LVLMs) have demonstrated exceptional performance on complex multimodal tasks. However, they continue to suffer from significant hallucination issues, including object, attribute, and relational hallucinations. To accurately detect these hallucinations, we investigated the variations in cross-modal attention patterns between hallucination and non-hallucination states. Leveraging these distinctions, we developed a lightweight detector capable of identifying hallucinations. Our proposed method, Detecting Hallucinations by Cross-modal Attention Patterns (DHCP), is straightforward and does not require additional LVLM training or extra LVLM inference steps. Experimental results show that DHCP achieves remarkable performance in hallucination detection. By offering novel insights into the identification and analysis of hallucinations in LVLMs, DHCP contributes to advancing the reliability and trustworthiness of these models.

Despite their impressive generative capabilities, LLMs are hindered by fact-conflicting hallucinations in real-world applications. The accurate identification of hallucinations in texts generated by LLMs, especially in complex inferential scenarios, is a relatively unexplored area. To address this gap, we present FactCHD, a dedicated benchmark designed for the detection of fact-conflicting hallucinations from LLMs. FactCHD features a diverse dataset that spans various factuality patterns, including vanilla, multi-hop, comparison, and set operation. A distinctive element of FactCHD is its integration of fact-based evidence chains, significantly enhancing the depth of evaluating the detectors' explanations. Experiments on different LLMs expose the shortcomings of current approaches in detecting factual errors accurately. Furthermore, we introduce Truth-Triangulator that synthesizes reflective considerations by tool-enhanced ChatGPT and LoRA-tuning based on Llama2, aiming to yield more credible detection through the amalgamation of predictive results and evidence. The benchmark dataset is available at https://github.com/zjunlp/FactCHD.

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

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.

While large language models have demonstrated exceptional performance across a wide range of tasks, they remain susceptible to hallucinations -- generating plausible yet factually incorrect contents. Existing methods to mitigating such risk often rely on sampling multiple full-length generations, which introduces significant response latency and becomes ineffective when the model consistently produces hallucinated outputs with high confidence. To address these limitations, we introduce Monitoring Decoding (MD), a novel framework that dynamically monitors the generation process and selectively applies in-process interventions, focusing on revising crucial tokens responsible for hallucinations. Instead of waiting until completion of multiple full-length generations, we identify hallucination-prone tokens during generation using a monitor function, and further refine these tokens through a tree-based decoding strategy. This approach ensures an enhanced factual accuracy and coherence in the generated output while maintaining efficiency. Experimental results demonstrate that MD consistently outperforms self-consistency-based approaches in both effectiveness and efficiency, achieving higher factual accuracy while significantly reducing computational overhead.

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

Age-related macular degeneration (AMD) and choroidal neovascularization (CNV)-related conditions are leading causes of vision loss worldwide, with optical coherence tomography (OCT) serving as a cornerstone for early detection and management. However, deploying state-of-the-art deep learning models like ConvNeXtV2-Large in clinical settings is hindered by their computational demands. Therefore, it is desirable to develop efficient models that maintain high diagnostic performance while enabling real-time deployment. In this study, a novel knowledge distillation framework, termed KD-OCT, is proposed to compress a high-performance ConvNeXtV2-Large teacher model, enhanced with advanced augmentations, stochastic weight averaging, and focal loss, into a lightweight EfficientNet-B2 student for classifying normal, drusen, and CNV cases. KD-OCT employs real-time distillation with a combined loss balancing soft teacher knowledge transfer and hard ground-truth supervision. The effectiveness of the proposed method is evaluated on the Noor Eye Hospital (NEH) dataset using patient-level cross-validation. Experimental results demonstrate that KD-OCT outperforms comparable multi-scale or feature-fusion OCT classifiers in efficiency- accuracy balance, achieving near-teacher performance with substantial reductions in model size and inference time. Despite the compression, the student model exceeds most existing frameworks, facilitating edge deployment for AMD screening. Code is available at https://github.com/erfan-nourbakhsh/KD- OCT.

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

Artificial intelligence (AI) has become a fundamental tool for assisting clinicians in analyzing ophthalmic images, such as optical coherence tomography (OCT). However, developing AI models often requires extensive annotation, and existing models tend to underperform on independent, unseen data. Foundation models (FMs), large AI models trained on vast unlabeled datasets, have shown promise in overcoming these challenges. Nonetheless, available FMs for ophthalmology lack extensive validation, especially for segmentation tasks, and focus on a single imaging modality. In this context, we propose MIRAGE, a novel multimodal FM for the analysis of OCT and scanning laser ophthalmoscopy (SLO) images. Additionally, we propose a new evaluation benchmark with OCT/SLO classification and segmentation tasks. The comparison with general and specialized FMs and segmentation methods shows the superiority of MIRAGE in both types of tasks, highlighting its suitability as a basis for the development of robust AI systems for retinal OCT image analysis. Both MIRAGE and the evaluation benchmark are publicly available: https://github.com/j-morano/MIRAGE.

Recent advances in medical multi-modal models focus on specialized image analysis like dermatology, pathology, or radiology. However, they do not fully capture the complexity of real-world clinical diagnostics, which involve heterogeneous inputs and require ongoing contextual understanding during patient-physician interactions. To bridge this gap, we introduce PulseMind, a new family of multi-modal diagnostic models that integrates a systematically curated dataset, a comprehensive evaluation benchmark, and a tailored training framework. Specifically, we first construct a diagnostic dataset, MediScope, which comprises 98,000 real-world multi-turn consultations and 601,500 medical images, spanning over 10 major clinical departments and more than 200 sub-specialties. Then, to better reflect the requirements of real-world clinical diagnosis, we develop the PulseMind Benchmark, a multi-turn diagnostic consultation benchmark with a four-dimensional evaluation protocol comprising proactiveness, accuracy, usefulness, and language quality. Finally, we design a training framework tailored for multi-modal clinical diagnostics, centered around a core component named Comparison-based Reinforcement Policy Optimization (CRPO). Compared to absolute score rewards, CRPO uses relative preference signals from multi-dimensional com-parisons to provide stable and human-aligned training guidance. Extensive experiments demonstrate that PulseMind achieves competitive performance on both the diagnostic consultation benchmark and public medical benchmarks.

The rise of imaging techniques such as optical coherence tomography (OCT) and advances in deep learning (DL) have enabled clinicians and researchers to streamline retinal disease staging. A popular DL approach is self-supervised learning (SSL), where models learn from vast amounts of unlabeled data, avoiding costly annotation. SSL has allowed the development of foundation models (FMs), large models that can be used for a variety of downstream tasks. However, existing FMs for OCT, trained solely on image data, lack a comprehensive and robust semantic understanding of images, as evidenced by their downstream performance (especially for complex tasks), and thus require supervised fine-tuning (which may be unfeasible) to better adapt to specific applications and populations. To address this, we propose RetFiner, an SSL vision-language refinement scheme that improves the representations of existing FMs and enables their efficient and direct adaptation to specific populations for improved downstream performance. Our method uses a diverse set of training objectives which take advantage of the rich supervisory signal found in textual data. We tested RetFiner on the retinal FMs RETFound, UrFound, and VisionFM, showing significant improvements in linear probing performance on seven highly diverse OCT classification tasks, with an average increase of 5.8, 3.9, and 2.1 percentage points over their baselines, respectively. Our code and model weights are publicly available at https://github.com/ronnief1/RetFiner.

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.

Automated plot generation is the challenge of generating a sequence of events that will be perceived by readers as the plot of a coherent story. Traditional symbolic planners plan a story from a goal state and guarantee logical causal plot coherence but rely on a library of hand-crafted actions with their preconditions and effects. This closed world setting limits the length and diversity of what symbolic planners can generate. On the other hand, pre-trained neural language models can generate stories with great diversity, while being generally incapable of ending a story in a specified manner and can have trouble maintaining coherence. In this paper, we present an approach to story plot generation that unifies causal planning with neural language models. We propose to use commonsense knowledge extracted from large language models to recursively expand a story plot in a backward chaining fashion. Specifically, our system infers the preconditions for events in the story and then events that will cause those conditions to become true. We performed automatic evaluation to measure narrative coherence as indicated by the ability to answer questions about whether different events in the story are causally related to other events. Results indicate that our proposed method produces more coherent plotlines than several strong baselines.

Building trustworthy medical multimodal large language models (MLLMs) is critical for reliable clinical decision support. Existing medical hallucination benchmarks mainly focus on data collection, but often ignore where hallucinations originate within the reasoning process. We find that hallucination sources vary across samples: errors may arise from visual misrecognition, incorrect medical knowledge recall, or flawed reasoning integration. To enable source-level hallucination diagnosis, we introduce ClinHallu, a benchmark for stage-wise hallucination diagnosis in medical MLLM reasoning. ClinHallu contains 7,031 validated instances, where each instance is augmented with a structured reasoning trace decomposed into Visual Recognition, Knowledge Recall, and Reasoning Integration. We also use stage-replacement interventions to measure how correcting specific stages affects the final answer. Beyond evaluation, we show that trace-supervised fine-tuning reduces stage-wise hallucinations. ClinHallu provides a fine-grained hallucination testbed for diagnosing and mitigating reasoning failures in medical MLLMs. The benchmark is publicly available at https://github.com/alibaba-damo-academy/ClinHallu.

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

The VIP Cup offers a unique experience to undergraduates, allowing students to work together to solve challenging, real-world problems with video and image processing techniques. In this iteration of the VIP Cup, we challenged students to balance personalization and generalization when performing biomarker detection in 3D optical coherence tomography (OCT) images. Balancing personalization and generalization is an important challenge to tackle, as the variation within OCT scans of patients between visits can be minimal while the difference in manifestation of the same disease across different patients may be substantial. The domain difference between OCT scans can arise due to pathology manifestation across patients, clinical labels, and the visit along the treatment process when the scan is taken. Hence, we provided a multimodal OCT dataset to allow teams to effectively target this challenge. Overall, this competition gave undergraduates an opportunity to learn about how artificial intelligence can be a powerful tool for the medical field, as well as the unique challenges one faces when applying machine learning to biomedical data.

Evaluating large language models (LLMs) on final-answer correctness is the dominant paradigm. This approach, however, provides a coarse signal for model improvement and overlooks the quality of the underlying reasoning process. We argue that a more granular evaluation of reasoning offers a more effective path to building robust models. We decompose reasoning quality into two dimensions: relevance and coherence. Relevance measures if a step is grounded in the problem; coherence measures if it follows logically from prior steps. To measure these aspects reliably, we introduce causal stepwise evaluation (CaSE). This method assesses each reasoning step using only its preceding context, which avoids hindsight bias. We validate CaSE against human judgments on our new expert-annotated benchmarks, MRa-GSM8K and MRa-MATH. More importantly, we show that curating training data with CaSE-evaluated relevance and coherence directly improves final task performance. Our work provides a scalable framework for analyzing, debugging, and improving LLM reasoning, demonstrating the practical value of moving beyond validity checks.

Although native speech and music envelope following responses (EFRs) play a crucial role in auditory processing and cognition, their frequency profile, such as the dominating frequency and spectral coherence, is largely unknown. We have assumed that the auditory pathway - which transmits envelope components of speech and music to the scalp through time-varying neurophysiological processes - is a linear time-varying system, with the envelope and the multi-channel EEG responses as excitation and response, respectively. This paper investigates the transfer function of this system through two analytical techniques - time-averaged spectral responses and cross-spectral density - in the frequency domain at four different positions of the human scalp. Our findings suggest that alpha (8-11 Hz), lower gamma (53-56 Hz), and higher gamma (78-81 Hz) bands are the peak responses of the system. These frequently appearing dominant frequency responses may be the key components of familiar speech perception, maintaining attention, binding acoustic features, and memory processing. The cross-spectral density, which reflects the spatial neural coherence of the human brain, shows that 10-13 Hz, 27-29 Hz, and 62-64 Hz are common for all channel pairs. As neural coherences are frequently observed in these frequencies among native participants, we suggest that these distributed neural processes are also dominant in native speech and music perception.

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.

Hallucinations in large language models (LLMs) are commonly regarded as errors to be minimized. However, recent perspectives suggest that some hallucinations may encode creative or epistemically valuable content, a dimension that remains underquantified in current literature. Existing hallucination detection methods primarily focus on factual consistency, struggling to handle heterogeneous scientific tasks and balance creativity with accuracy. To address these challenges, we propose HIC-Bench, a novel evaluation framework that categorizes hallucinations into Intelligent Hallucinations (IH) and Defective Hallucinations (DH), enabling systematic investigation of their interplay in LLM creativity. HIC-Bench features three core characteristics: (1) Structured IH/DH Assessment. using a multi-dimensional metric matrix integrating Torrance Tests of Creative Thinking (TTCT) metrics (Originality, Feasibility, Value) with hallucination-specific dimensions (scientific plausibility, factual deviation); (2) Cross-Domain Applicability. spanning ten scientific domains with open-ended innovation tasks; and (3) Dynamic Prompt Optimization. leveraging the Dynamic Hallucination Prompt (DHP) to guide models toward creative and reliable outputs. The evaluation process employs multiple LLM judges, averaging scores to mitigate bias, with human annotators verifying IH/DH classifications. Experimental results reveal a nonlinear relationship between IH and DH, demonstrating that creativity and correctness can be jointly optimized. These insights position IH as a catalyst for creativity and reveal the ability of LLM hallucinations to drive scientific innovation.Additionally, the HIC-Bench offers a valuable platform for advancing research into the creative intelligence of LLM hallucinations.

Transformers trained on modular arithmetic exhibit sharp transitions between memorization, generalization, and collapse. We show that weight decay acts as a scalar empirical control parameter for these regimes, and introduce two cheap online diagnostics, mean pairwise attention-head cosine similarity and entropy standard deviation, that track training dynamics from attention activations alone and complement loss-landscape diagnostics at lower compute cost. Across eleven experimental conditions and three model scales (0.82M to 85M parameters), the weight-decay axis separates memorization, developmental grokking, and collapse. A near-transition logistic fit localizes the memorization-to-developmental boundary at λ_c=0.0158 (95% CI [0.0109, 0.0200], N=210); a power-law fit gives an empirical exponent ν=0.757 (CI [0.725, 0.799]). Reference exponents ν=1/2 and 3D Ising νapprox 0.63 lie outside this empirical CI under our four-bin grid, so we report ν as empirical and defer universality-class identification to denser finite-size-scaling work. A horizon-matched multi-task replication (n=280, four modular operations) preserves the weight-decay control pattern; a paired attention-head re-initialization experiment at λ=0.05 changes Phase-2 amplitude (Cohen's d=-1.190, n=10, p_t=4.5 times 10^{-3}), while matched weight-norm clipping does not. Three cross-architecture probes (4L MLP, 4L LSTM, and 4L Mamba; each n=70) replicate the weight-decay-controlled transition with architecture-specific λ_c values. Main diagnostic claims are scoped to modular arithmetic in small transformer attention models; the non-attention experiments are scope probes, and architecture-wide, language-model, and universality-class claims are out of scope.

Large language models (LLMs) have shown significant potential in scientific disciplines such as biomedicine, particularly in hypothesis generation, where they can analyze vast literature, identify patterns, and suggest research directions. However, a key challenge lies in evaluating the truthfulness of generated hypotheses, as verifying their accuracy often requires substantial time and resources. Additionally, the hallucination problem in LLMs can lead to the generation of hypotheses that appear plausible but are ultimately incorrect, undermining their reliability. To facilitate the systematic study of these challenges, we introduce TruthHypo, a benchmark for assessing the capabilities of LLMs in generating truthful biomedical hypotheses, and KnowHD, a knowledge-based hallucination detector to evaluate how well hypotheses are grounded in existing knowledge. Our results show that LLMs struggle to generate truthful hypotheses. By analyzing hallucinations in reasoning steps, we demonstrate that the groundedness scores provided by KnowHD serve as an effective metric for filtering truthful hypotheses from the diverse outputs of LLMs. Human evaluations further validate the utility of KnowHD in identifying truthful hypotheses and accelerating scientific discovery. Our data and source code are available at https://github.com/Teddy-XiongGZ/TruthHypo.

In recent years, Multimodal Large Language Models (MLLMs) have achieved remarkable progress on a wide range of multimodal benchmarks. Despite these advances, most existing benchmarks mainly focus on single-image or multi-image comprehension. In real-world scenarios such as document reading, information is often presented as interleaved multimodel contexts. This requires MLLMs not only to recognize the content of individual images, but also to identify relevant textual and visual evidence, establish fine-grained alignments between them, and reason over these aligned signals in interleaved contexts based on contextual evidence. However, there is still a lack of systematic benchmarks for quantifying the fine-grained understanding ability of MLLMs in interleaved image-text contexts. To fill this gap, we propose COHERENCE, a benchmark designed to evaluate the ability of MLLMs to recover fine-grained image-text correspondences in interleaved multimodal contexts. COHERENCE covers interleaved image-text content from four representative domains and contains 6,161 high-quality questions. Moreover, we perform a six-type error analysis, enabling fine-grained attribution of failures in interleaved image-text understanding to the specific capabilities missing in current MLLMs.

Knowledge hallucination have raised widespread concerns for the security and reliability of deployed LLMs. Previous efforts in detecting hallucinations have been employed at logit-level uncertainty estimation or language-level self-consistency evaluation, where the semantic information is inevitably lost during the token-decoding procedure. Thus, we propose to explore the dense semantic information retained within LLMs' INternal States for hallucInation DEtection (INSIDE). In particular, a simple yet effective EigenScore metric is proposed to better evaluate responses' self-consistency, which exploits the eigenvalues of responses' covariance matrix to measure the semantic consistency/diversity in the dense embedding space. Furthermore, from the perspective of self-consistent hallucination detection, a test time feature clipping approach is explored to truncate extreme activations in the internal states, which reduces overconfident generations and potentially benefits the detection of overconfident hallucinations. Extensive experiments and ablation studies are performed on several popular LLMs and question-answering (QA) benchmarks, showing the effectiveness of our proposal.

Artificial intelligence systems based on large language models (LLMs) can now generate coherent text, music, and images, yet they operate without a persistent state: each inference reconstructs context from scratch. This paper introduces the Narrative Continuity Test (NCT) -- a conceptual framework for evaluating identity persistence and diachronic coherence in AI systems. Unlike capability benchmarks that assess task performance, the NCT examines whether an LLM remains the same interlocutor across time and interaction gaps. The framework defines five necessary axes -- Situated Memory, Goal Persistence, Autonomous Self-Correction, Stylistic & Semantic Stability, and Persona/Role Continuity -- and explains why current architectures systematically fail to support them. Case analyses (Character.\,AI, Grok, Replit, Air Canada) show predictable continuity failures under stateless inference. The NCT reframes AI evaluation from performance to persistence, outlining conceptual requirements for future benchmarks and architectural designs that could sustain long-term identity and goal coherence in generative models.

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using Protocol-Guided Instruction Data Generation, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with Interleaved Modality Dropout to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present Reinforcement Learning with ECG Diagnostic Evidence Rewards to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at https://github.com/PKUDigitalHealth/ECG-R1{here}, and an online platform can be accessed at http://ai.heartvoice.com.cn/ECG-R1/{here}.

Depression poses significant challenges to patients and healthcare organizations, necessitating efficient assessment methods. Existing paradigms typically focus on a patient-doctor way that overlooks multi-role interactions, such as family involvement in the evaluation and caregiving process. Moreover, current automatic depression detection (ADD) methods usually model depression detection as a classification or regression task, lacking interpretability for the decision-making process. To address these issues, we developed InterMind, a doctor-patient-family interactive depression assessment system empowered by large language models (LLMs). Our system enables patients and families to contribute descriptions, generates assistive diagnostic reports for doctors, and provides actionable insights, improving diagnostic precision and efficiency. To enhance LLMs' performance in psychological counseling and diagnostic interpretability, we integrate retrieval-augmented generation (RAG) and chain-of-thoughts (CoT) techniques for data augmentation, which mitigates the hallucination issue of LLMs in specific scenarios after instruction fine-tuning. Quantitative experiments and professional assessments by clinicians validate the effectiveness of our system.

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

Medical conversational AI (AI) plays a pivotal role in the development of safer and more effective medical dialogue systems. However, existing benchmarks and evaluation frameworks for assessing the information-gathering and diagnostic reasoning abilities of medical large language models (LLMs) have not been rigorously evaluated. To address these gaps, we present MedDialogRubrics, a novel benchmark comprising 5,200 synthetically constructed patient cases and over 60,000 fine-grained evaluation rubrics generated by LLMs and subsequently refined by clinical experts, specifically designed to assess the multi-turn diagnostic capabilities of LLM. Our framework employs a multi-agent system to synthesize realistic patient records and chief complaints from underlying disease knowledge without accessing real-world electronic health records, thereby mitigating privacy and data-governance concerns. We design a robust Patient Agent that is limited to a set of atomic medical facts and augmented with a dynamic guidance mechanism that continuously detects and corrects hallucinations throughout the dialogue, ensuring internal coherence and clinical plausibility of the simulated cases. Furthermore, we propose a structured LLM-based and expert-annotated rubric-generation pipeline that retrieves Evidence-Based Medicine (EBM) guidelines and utilizes the reject sampling to derive a prioritized set of rubric items ("must-ask" items) for each case. We perform a comprehensive evaluation of state-of-the-art models and demonstrate that, across multiple assessment dimensions, current models face substantial challenges. Our results indicate that improving medical dialogue will require advances in dialogue management architectures, not just incremental tuning of the base-model.

Optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) of the eye has become essential to ophthalmology and the emerging field of oculomics, thus requiring a need for transparent, reproducible, and rapid analysis of this data for clinical research and the wider research community. Here, we introduce OCTolyzer, the first open-source toolkit for retinochoroidal analysis in OCT/SLO data. It features two analysis suites for OCT and SLO data, facilitating deep learning-based anatomical segmentation and feature extraction of the cross-sectional retinal and choroidal layers and en face retinal vessels. We describe OCTolyzer and evaluate the reproducibility of its OCT choroid analysis. At the population level, metrics for choroid region thickness were highly reproducible, with a mean absolute error (MAE)/Pearson correlation for macular volume choroid thickness (CT) of 6.7mum/0.99, macular B-scan CT of 11.6mum/0.99, and peripapillary CT of 5.0mum/0.99. Macular choroid vascular index (CVI) also showed strong reproducibility, with MAE/Pearson for volume CVI yielding 0.0271/0.97 and B-scan CVI 0.0130/0.91. At the eye level, measurement noise for regional and vessel metrics was below 5% and 20% of the population's variability, respectively. Outliers were caused by poor-quality B-scans with thick choroids and invisible choroid-sclera boundary. Processing times on a laptop CPU were under three seconds for macular/peripapillary B-scans and 85 seconds for volume scans. OCTolyzer can convert OCT/SLO data into reproducible and clinically meaningful retinochoroidal features and will improve the standardisation of ocular measurements in OCT/SLO image analysis, requiring no specialised training or proprietary software to be used. OCTolyzer is freely available here: https://github.com/jaburke166/OCTolyzer.

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

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.

The 7-point checklist (7PCL) is a widely used diagnostic tool in dermoscopy for identifying malignant melanoma by assigning point values to seven specific attributes. However, the traditional 7PCL is limited to distinguishing between malignant melanoma and melanocytic Nevi, and falls short in scenarios where multiple skin diseases with appearances similar to melanoma coexist. To address this limitation, we propose a novel diagnostic framework that integrates a clinical knowledge-based topological graph (CKTG) with a gradient diagnostic strategy featuring a data-driven weighting system (GD-DDW). The CKTG captures both the internal and external relationships among the 7PCL attributes, while the GD-DDW emulates dermatologists' diagnostic processes, prioritizing visual observation before making predictions. Additionally, we introduce a multimodal feature extraction approach leveraging a dual-attention mechanism to enhance feature extraction through cross-modal interaction and unimodal collaboration. This method incorporates meta-information to uncover interactions between clinical data and image features, ensuring more accurate and robust predictions. Our approach, evaluated on the EDRA dataset, achieved an average AUC of 88.6%, demonstrating superior performance in melanoma detection and feature prediction. This integrated system provides data-driven benchmarks for clinicians, significantly enhancing the precision of melanoma diagnosis.

Human language processing relies on the brain's capacity for predictive inference. We present a machine learning framework for decoding neural (EEG) responses to dynamic visual language stimuli in Deaf signers. Using coherence between neural signals and optical flow-derived motion features, we construct spatiotemporal representations of predictive neural dynamics. Through entropy-based feature selection, we identify frequency-specific neural signatures that differentiate interpretable linguistic input from linguistically disrupted (time-reversed) stimuli. Our results reveal distributed left-hemispheric and frontal low-frequency coherence as key features in language comprehension, with experience-dependent neural signatures correlating with age. This work demonstrates a novel multimodal approach for probing experience-driven generative models of perception in the brain.

The COVID-19 pandemic presents global challenges transcending boundaries of country, race, religion, and economy. The current gold standard method for COVID-19 detection is the reverse transcription polymerase chain reaction (RT-PCR) testing. However, this method is expensive, time-consuming, and violates social distancing. Also, as the pandemic is expected to stay for a while, there is a need for an alternate diagnosis tool which overcomes these limitations, and is deployable at a large scale. The prominent symptoms of COVID-19 include cough and breathing difficulties. We foresee that respiratory sounds, when analyzed using machine learning techniques, can provide useful insights, enabling the design of a diagnostic tool. Towards this, the paper presents an early effort in creating (and analyzing) a database, called Coswara, of respiratory sounds, namely, cough, breath, and voice. The sound samples are collected via worldwide crowdsourcing using a website application. The curated dataset is released as open access. As the pandemic is evolving, the data collection and analysis is a work in progress. We believe that insights from analysis of Coswara can be effective in enabling sound based technology solutions for point-of-care diagnosis of respiratory infection, and in the near future this can help to diagnose COVID-19.

Diagnosing a whole-slide image is an interactive, multi-stage process involving changes in magnification and movement between fields. Although recent pathology foundation models are strong, practical agentic systems that decide what field to examine next, adjust magnification, and deliver explainable diagnoses are still lacking. The blocker is data: scalable, clinically aligned supervision of expert viewing behavior that is tacit and experience-based, not written in textbooks or online, and therefore absent from large language model training. We introduce the AI Session Recorder, which works with standard WSI viewers to unobtrusively record routine navigation and convert the viewer logs into standardized behavioral commands (inspect or peek at discrete magnifications) and bounding boxes. A lightweight human-in-the-loop review turns AI-drafted rationales into the Pathology-CoT dataset, a form of paired "where to look" and "why it matters" supervision produced at roughly six times lower labeling time. Using this behavioral data, we build Pathologist-o3, a two-stage agent that first proposes regions of interest and then performs behavior-guided reasoning. On gastrointestinal lymph-node metastasis detection, it achieved 84.5% precision, 100.0% recall, and 75.4% accuracy, exceeding the state-of-the-art OpenAI o3 model and generalizing across backbones. To our knowledge, this constitutes one of the first behavior-grounded agentic systems in pathology. Turning everyday viewer logs into scalable, expert-validated supervision, our framework makes agentic pathology practical and establishes a path to human-aligned, upgradeable clinical AI.

Cancer screening is a reasoning task. A radiologist observes findings, compares them to prior scans, integrates clinical context, and reaches a diagnostic conclusion confirmed by pathology. We present RadThinking, a Visual Question Answering (VQA) dataset that makes this reasoning explicit and trainable. RadThinking releases VQA pairs at three difficulty tiers. Foundation VQAs are atomic perception questions. Single-step reasoning VQAs apply one clinical rule. Compositional VQAs require multi-step chain-of-thought to reach a guideline category such as LI-RADS-5. For every compositional VQA, we release the chain of foundation VQAs that solves it. The chain follows the rules of the governing clinical reporting standard. The dataset spans 20,362 CT scans from 9,131 patients across 43 cancer groups, plus 2,077 verified healthy controls with >1-year follow-up. To our knowledge, RadThinking is the first cancer-screening VQA corpus that stratifies questions by reasoning depth and grounds compositions in clinical reporting standards. The foundation tier supplies atomic perception supervision. The compositional tier supplies chain-of-thought data and verifiable rewards for reinforcement-learning recipes such as DeepSeek-R1 and OpenAI o1. RadThinking enables systematic training and evaluation of whether AI systems can reason about cancer, not merely detect it.