Daily Papers

Long-context LLM agents must access the right evidence from large environments and use it faithfully. However, the popular Needle-in-a-Haystack (NIAH) evaluation mostly measures benign span localization. The needle is near-unique, and the haystack is largely irrelevant. We introduce EverMemBench-S (EMB-S), an adversarial NIAH-style benchmark built on a 326M-token MemoryBank. While the full MemoryBank spans 326M tokens for retrieval-based (RAG) evaluation, we evaluate native long-context models only at scales that fit within each model's context window (up to 1M tokens in this work) to ensure a fair comparison. EMB-S pairs queries with collision-tested near-miss hard negatives and gold evidence sets spanning one or more documents, validated via human screening and LLM verification. We also propose a decoupled diagnostic protocol that reports evidence access (document-ID localization) separately from end-to-end QA quality under full-context prompting. This enables consistent diagnosis for both native long-context prompting and retrieval pipelines. Across a reference-corpus ladder from domain-isolated 64K contexts to a globally shared 326M-token environment, we observe a clear reality gap. Systems that saturate benign NIAH degrade sharply in evidence access under semantic interference. These results indicate that semantic discrimination, not context length alone, is the dominant bottleneck for long-context memory at scale.

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}.

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

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.

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.

Diffusion models have recently achieved success in solving Bayesian inverse problems with learned data priors. Current methods build on top of the diffusion sampling process, where each denoising step makes small modifications to samples from the previous step. However, this process struggles to correct errors from earlier sampling steps, leading to worse performance in complicated nonlinear inverse problems, such as phase retrieval. To address this challenge, we propose a new method called Decoupled Annealing Posterior Sampling (DAPS) that relies on a novel noise annealing process. Specifically, we decouple consecutive steps in a diffusion sampling trajectory, allowing them to vary considerably from one another while ensuring their time-marginals anneal to the true posterior as we reduce noise levels. This approach enables the exploration of a larger solution space, improving the success rate for accurate reconstructions. We demonstrate that DAPS significantly improves sample quality and stability across multiple image restoration tasks, particularly in complicated nonlinear inverse problems. For example, we achieve a PSNR of 30.72dB on the FFHQ 256 dataset for phase retrieval, which is an improvement of 9.12dB compared to existing methods.

The diffusion MRI Neurite Exchange Imaging model offers a promising framework for probing gray matter microstructure by estimating parameters such as compartment sizes, diffusivities, and inter-compartmental water exchange time. However, existing protocols require long scan times. This study proposes a reduced acquisition scheme for the Connectome 2.0 scanner that preserves model accuracy while substantially shortening scan duration. We developed a data-driven framework using explainable artificial intelligence with a guided recursive feature elimination strategy to identify an optimal 8-feature subset from a 15-feature protocol. The performance of this optimized protocol was validated in vivo and benchmarked against the full acquisition and alternative reduction strategies. Parameter accuracy, preservation of anatomical contrast, and test-retest reproducibility were assessed. The reduced protocol yielded parameter estimates and cortical maps comparable to the full protocol, with low estimation errors in synthetic data and minimal impact on test-retest variability. Compared to theory-driven and heuristic reduction schemes, the optimized protocol demonstrated superior robustness, reducing the deviation in water exchange time estimates by over two-fold. In conclusion, this hybrid optimization framework enables viable imaging of neurite exchange in 14 minutes without loss of parameter fidelity. This approach supports the broader application of exchange-sensitive diffusion magnetic resonance imaging in neuroscience and clinical research, and offers a generalizable method for designing efficient acquisition protocols in biophysical parameter mapping.

X-ray images play a vital role in the intraoperative processes due to their high resolution and fast imaging speed and greatly promote the subsequent segmentation, registration and reconstruction. However, over-dosed X-rays superimpose potential risks to human health to some extent. Data-driven algorithms from volume scans to X-ray images are restricted by the scarcity of paired X-ray and volume data. Existing methods are mainly realized by modelling the whole X-ray imaging procedure. In this study, we propose a learning-based approach termed CT2X-GAN to synthesize the X-ray images in an end-to-end manner using the content and style disentanglement from three different image domains. Our method decouples the anatomical structure information from CT scans and style information from unpaired real X-ray images/ digital reconstructed radiography (DRR) images via a series of decoupling encoders. Additionally, we introduce a novel consistency regularization term to improve the stylistic resemblance between synthesized X-ray images and real X-ray images. Meanwhile, we also impose a supervised process by computing the similarity of computed real DRR and synthesized DRR images. We further develop a pose attention module to fully strengthen the comprehensive information in the decoupled content code from CT scans, facilitating high-quality multi-view image synthesis in the lower 2D space. Extensive experiments were conducted on the publicly available CTSpine1K dataset and achieved 97.8350, 0.0842 and 3.0938 in terms of FID, KID and defined user-scored X-ray similarity, respectively. In comparison with 3D-aware methods (pi-GAN, EG3D), CT2X-GAN is superior in improving the synthesis quality and realistic to the real X-ray images.

Differential Diagnosis (DDx) is a fundamental yet complex aspect of clinical decision-making, in which physicians iteratively refine a ranked list of possible diseases based on symptoms, antecedents, and medical knowledge. While recent advances in large language models (LLMs) have shown promise in supporting DDx, existing approaches face key limitations, including single-dataset evaluations, isolated optimization of components, unrealistic assumptions about complete patient profiles, and single-attempt diagnosis. We introduce a Modular Explainable DDx Agent (MEDDxAgent) framework designed for interactive DDx, where diagnostic reasoning evolves through iterative learning, rather than assuming a complete patient profile is accessible. MEDDxAgent integrates three modular components: (1) an orchestrator (DDxDriver), (2) a history taking simulator, and (3) two specialized agents for knowledge retrieval and diagnosis strategy. To ensure robust evaluation, we introduce a comprehensive DDx benchmark covering respiratory, skin, and rare diseases. We analyze single-turn diagnostic approaches and demonstrate the importance of iterative refinement when patient profiles are not available at the outset. Our broad evaluation demonstrates that MEDDxAgent achieves over 10% accuracy improvements in interactive DDx across both large and small LLMs, while offering critical explainability into its diagnostic reasoning process.

For safety, medical AI systems undergo thorough evaluations before deployment, validating their predictions against a ground truth which is assumed to be fixed and certain. However, this ground truth is often curated in the form of differential diagnoses. While a single differential diagnosis reflects the uncertainty in one expert assessment, multiple experts introduce another layer of uncertainty through disagreement. Both forms of uncertainty are ignored in standard evaluation which aggregates these differential diagnoses to a single label. In this paper, we show that ignoring uncertainty leads to overly optimistic estimates of model performance, therefore underestimating risk associated with particular diagnostic decisions. To this end, we propose a statistical aggregation approach, where we infer a distribution on probabilities of underlying medical condition candidates themselves, based on observed annotations. This formulation naturally accounts for the potential disagreements between different experts, as well as uncertainty stemming from individual differential diagnoses, capturing the entire ground truth uncertainty. Our approach boils down to generating multiple samples of medical condition probabilities, then evaluating and averaging performance metrics based on these sampled probabilities. In skin condition classification, we find that a large portion of the dataset exhibits significant ground truth uncertainty and standard evaluation severely over-estimates performance without providing uncertainty estimates. In contrast, our framework provides uncertainty estimates on common metrics of interest such as top-k accuracy and average overlap, showing that performance can change multiple percentage points. We conclude that, while assuming a crisp ground truth can be acceptable for many AI applications, a more nuanced evaluation protocol should be utilized in medical diagnosis.

MRI is an indispensable clinical tool, offering a rich variety of tissue contrasts to support broad diagnostic and research applications. Clinical exams routinely acquire multiple structural sequences that provide complementary information for differential diagnosis, while research protocols often incorporate advanced functional, diffusion, spectroscopic, and relaxometry sequences to capture multidimensional insights into tissue structure and composition. However, these capabilities come at the cost of prolonged scan times, which reduce patient throughput, increase susceptibility to motion artifacts, and may require trade-offs in image quality or diagnostic scope. Over the last two decades, advances in image reconstruction algorithms--alongside improvements in hardware and pulse sequence design--have made it possible to accelerate acquisitions while preserving diagnostic quality. Central to this progress is the ability to incorporate prior information to regularize the solutions to the reconstruction problem. In this tutorial, we overview the basics of MRI reconstruction and highlight state-of-the-art approaches, beginning with classical methods that rely on explicit hand-crafted priors, and then turning to deep learning methods that leverage a combination of learned and crafted priors to further push the performance envelope. We also explore the translational aspects and eventual clinical implications of these methods. We conclude by discussing future directions to address remaining challenges in MRI reconstruction. The tutorial is accompanied by a Python toolbox (https://github.com/tutorial-MRI-recon/tutorial) to demonstrate select methods discussed in the article.

Coronavirus disease 2019 (Covid-19) is highly contagious with limited treatment options. Early and accurate diagnosis of Covid-19 is crucial in reducing the spread of the disease and its accompanied mortality. Currently, detection by reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard of outpatient and inpatient detection of Covid-19. RT-PCR is a rapid method, however, its accuracy in detection is only ~70-75%. Another approved strategy is computed tomography (CT) imaging. CT imaging has a much higher sensitivity of ~80-98%, but similar accuracy of 70%. To enhance the accuracy of CT imaging detection, we developed an open-source set of algorithms called CovidCTNet that successfully differentiates Covid-19 from community-acquired pneumonia (CAP) and other lung diseases. CovidCTNet increases the accuracy of CT imaging detection to 90% compared to radiologists (70%). The model is designed to work with heterogeneous and small sample sizes independent of the CT imaging hardware. In order to facilitate the detection of Covid-19 globally and assist radiologists and physicians in the screening process, we are releasing all algorithms and parametric details in an open-source format. Open-source sharing of our CovidCTNet enables developers to rapidly improve and optimize services, while preserving user privacy and data ownership.

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

This paper presents our team's participation in the MEDIQA-ClinicalNLP2024 shared task B. We present a novel approach to diagnosing clinical dermatology cases by integrating large multimodal models, specifically leveraging the capabilities of GPT-4V under a retriever and a re-ranker framework. Our investigation reveals that GPT-4V, when used as a retrieval agent, can accurately retrieve the correct skin condition 85% of the time using dermatological images and brief patient histories. Additionally, we empirically show that Naive Chain-of-Thought (CoT) works well for retrieval while Medical Guidelines Grounded CoT is required for accurate dermatological diagnosis. Further, we introduce a Multi-Agent Conversation (MAC) framework and show its superior performance and potential over the best CoT strategy. The experiments suggest that using naive CoT for retrieval and multi-agent conversation for critique-based diagnosis, GPT-4V can lead to an early and accurate diagnosis of dermatological conditions. The implications of this work extend to improving diagnostic workflows, supporting dermatological education, and enhancing patient care by providing a scalable, accessible, and accurate diagnostic tool.

We present DecoupledGaussian, a novel system that decouples static objects from their contacted surfaces captured in-the-wild videos, a key prerequisite for realistic Newtonian-based physical simulations. Unlike prior methods focused on synthetic data or elastic jittering along the contact surface, which prevent objects from fully detaching or moving independently, DecoupledGaussian allows for significant positional changes without being constrained by the initial contacted surface. Recognizing the limitations of current 2D inpainting tools for restoring 3D locations, our approach proposes joint Poisson fields to repair and expand the Gaussians of both objects and contacted scenes after separation. This is complemented by a multi-carve strategy to refine the object's geometry. Our system enables realistic simulations of decoupling motions, collisions, and fractures driven by user-specified impulses, supporting complex interactions within and across multiple scenes. We validate DecoupledGaussian through a comprehensive user study and quantitative benchmarks. This system enhances digital interaction with objects and scenes in real-world environments, benefiting industries such as VR, robotics, and autonomous driving. Our project page is at: https://wangmiaowei.github.io/DecoupledGaussian.github.io/.

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.

Artificial intelligence has advanced in Medical Visual Question Answering (Med-VQA), but prevalent research tends to focus on the accuracy of the answers, often overlooking the reasoning paths and interpretability, which are crucial in clinical settings. Besides, current Med-VQA algorithms, typically reliant on singular models, lack the robustness needed for real-world medical diagnostics which usually require collaborative expert evaluation. To address these shortcomings, this paper presents MedCoT, a novel hierarchical expert verification reasoning chain method designed to enhance interpretability and accuracy in biomedical imaging inquiries. MedCoT is predicated on two principles: The necessity for explicit reasoning paths in Med-VQA and the requirement for multi-expert review to formulate accurate conclusions. The methodology involves an Initial Specialist proposing diagnostic rationales, followed by a Follow-up Specialist who validates these rationales, and finally, a consensus is reached through a vote among a sparse Mixture of Experts within the locally deployed Diagnostic Specialist, which then provides the definitive diagnosis. Experimental evaluations on four standard Med-VQA datasets demonstrate that MedCoT surpasses existing state-of-the-art approaches, providing significant improvements in performance and interpretability.

Diffusion transformers have demonstrated remarkable generation quality, albeit requiring longer training iterations and numerous inference steps. In each denoising step, diffusion transformers encode the noisy inputs to extract the lower-frequency semantic component and then decode the higher frequency with identical modules. This scheme creates an inherent optimization dilemma: encoding low-frequency semantics necessitates reducing high-frequency components, creating tension between semantic encoding and high-frequency decoding. To resolve this challenge, we propose a new \color{ddtD}ecoupled \color{ddtD}iffusion \color{ddtT}ransformer~(\color{ddtDDT}), with a decoupled design of a dedicated condition encoder for semantic extraction alongside a specialized velocity decoder. Our experiments reveal that a more substantial encoder yields performance improvements as model size increases. For ImageNet 256times256, Our DDT-XL/2 achieves a new state-of-the-art performance of {1.31 FID}~(nearly 4times faster training convergence compared to previous diffusion transformers). For ImageNet 512times512, Our DDT-XL/2 achieves a new state-of-the-art FID of 1.28. Additionally, as a beneficial by-product, our decoupled architecture enhances inference speed by enabling the sharing self-condition between adjacent denoising steps. To minimize performance degradation, we propose a novel statistical dynamic programming approach to identify optimal sharing strategies.

Overview of the Proposed DECO Framework.} DECO is a DiT-based policy that decouples multimodal conditioning. Image and action tokens interact via joint self attention, while proprioceptive states and optional conditions are injected through adaptive layer normalization. Tactile signals are injected via cross attention, while a lightweight LoRA-based adapter is used to efficiently fine-tune the pretrained policy. DECO is also accompanied by DECO-50, a bimanual dexterous manipulation dataset with tactile sensing, consisting of 4 scenarios and 28 sub-tasks, covering more than 50 hours of data, approximately 5 million frames, and 8,000 successful trajectories.

Post-training of large language models routinely interleaves supervised fine-tuning (SFT) with reinforcement learning (RL). These two methods have different objectives: SFT minimizes the cross-entropy loss between model outputs and expert responses, while RL maximizes reward signals derived from human preferences or rule-based verifiers. Modern reasoning models have widely adopted the practice of alternating SFT and RL training. However, there is no theoretical account of whether they can be decoupled. We prove that decoupling is impossible in either order: (1) SFT-then-RL coupling: RL increases SFT loss under SFT optimality and (2) RL-then-SFT coupling: SFT lowers the reward achieved by RL. Experiments on Qwen3-0.6B confirm the predicted degradation, verifying that SFT and RL cannot be separated without loss of prior performance in the post-training

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.

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

The COVID-19 pandemic has underscored the need for low-cost, scalable approaches to measuring contactless vital signs, either during initial triage at a healthcare facility or virtual telemedicine visits. Remote photoplethysmography (rPPG) can accurately estimate heart rate (HR) when applied to close-up videos of healthy volunteers in well-lit laboratory settings. However, results from such highly optimized laboratory studies may not be readily translated to healthcare settings. One significant barrier to the practical application of rPPG in health care is the accurate localization of the region of interest (ROI). Clinical or telemedicine visits may involve sub-optimal lighting, movement artifacts, variable camera angle, and subject distance. This paper presents an rPPG ROI selection method based on 3D facial landmarks and patient head yaw angle. We then demonstrate the robustness of this ROI selection method when coupled to the Plane-Orthogonal-to-Skin (POS) rPPG method when applied to videos of patients presenting to an Emergency Department for respiratory complaints. Our results demonstrate the effectiveness of our proposed approach in improving the accuracy and robustness of rPPG in a challenging clinical environment.

Multiple Instance learning (MIL) models have been extensively used in pathology to predict biomarkers and risk-stratify patients from gigapixel-sized images. Machine learning problems in medical imaging often deal with rare diseases, making it important for these models to work in a label-imbalanced setting. In pathology images, there is another level of imbalance, where given a positively labeled Whole Slide Image (WSI), only a fraction of pixels within it contribute to the positive label. This compounds the severity of imbalance and makes imbalanced classification in pathology challenging. Furthermore, these imbalances can occur in out-of-distribution (OOD) datasets when the models are deployed in the real-world. We leverage the idea that decoupling feature and classifier learning can lead to improved decision boundaries for label imbalanced datasets. To this end, we investigate the integration of supervised contrastive learning with multiple instance learning (SC-MIL). Specifically, we propose a joint-training MIL framework in the presence of label imbalance that progressively transitions from learning bag-level representations to optimal classifier learning. We perform experiments with different imbalance settings for two well-studied problems in cancer pathology: subtyping of non-small cell lung cancer and subtyping of renal cell carcinoma. SC-MIL provides large and consistent improvements over other techniques on both in-distribution (ID) and OOD held-out sets across multiple imbalanced settings.

There exists recent work in computer vision, named VAR, that proposes a new autoregressive paradigm for image generation. Diverging from the vanilla next-token prediction, VAR structurally reformulates the image generation into a coarse to fine next-scale prediction. In this paper, we show that this scale-wise autoregressive framework can be effectively decoupled into intra-scale modeling, which captures local spatial dependencies within each scale, and inter-scale modeling, which models cross-scale relationships progressively from coarse-to-fine scales. This decoupling structure allows to rebuild VAR in a more computationally efficient manner. Specifically, for intra-scale modeling -- crucial for generating high-fidelity images -- we retain the original bidirectional self-attention design to ensure comprehensive modeling; for inter-scale modeling, which semantically connects different scales but is computationally intensive, we apply linear-complexity mechanisms like Mamba to substantially reduce computational overhead. We term this new framework M-VAR. Extensive experiments demonstrate that our method outperforms existing models in both image quality and generation speed. For example, our 1.5B model, with fewer parameters and faster inference speed, outperforms the largest VAR-d30-2B. Moreover, our largest model M-VAR-d32 impressively registers 1.78 FID on ImageNet 256times256 and outperforms the prior-art autoregressive models LlamaGen/VAR by 0.4/0.19 and popular diffusion models LDM/DiT by 1.82/0.49, respectively. Code is avaiable at https://github.com/OliverRensu/MVAR.

Recent text-to-video (T2V) technology advancements, as demonstrated by models such as Gen2, Pika, and Sora, have significantly broadened its applicability and popularity. Despite these strides, evaluating these models poses substantial challenges. Primarily, due to the limitations inherent in automatic metrics, manual evaluation is often considered a superior method for assessing T2V generation. However, existing manual evaluation protocols face reproducibility, reliability, and practicality issues. To address these challenges, this paper introduces the Text-to-Video Human Evaluation (T2VHE) protocol, a comprehensive and standardized protocol for T2V models. The T2VHE protocol includes well-defined metrics, thorough annotator training, and an effective dynamic evaluation module. Experimental results demonstrate that this protocol not only ensures high-quality annotations but can also reduce evaluation costs by nearly 50%. We will open-source the entire setup of the T2VHE protocol, including the complete protocol workflow, the dynamic evaluation component details, and the annotation interface code. This will help communities establish more sophisticated human assessment protocols.

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

Randomized controlled trials (RCTs) are the benchmark for causal inference, yet field implementation can deviate. We here present a remote audit - a design-based, preregistrable diagnostic that uses only pre-treatment satellite imagery to test whether assignment is independent of local conditions. The conditional randomization test of the remote audit evaluates whether treatment assignment is more predictable from pre-treatment satellite features than expected under the experiment's registered mechanism, providing a finite-sample valid, design-based diagnostic that requires no parametric assumptions. The procedure is finite-sample valid, honors blocks and clusters, and controls multiplicity across image models and resolutions via a max-statistic. We illustrate with two RCTs: Uganda's Youth Opportunities Program, where the audit corroborates randomization and flags selection and missing-data risks; and a school-based trial in Bangladesh, where assignment is highly predictable from pre-treatment features relative to the stated design, consistent with independent concerns about irregularities. Remote audits complement balance tests, lower early-stage costs, and enable rapid design checks when baseline surveys are expensive or infeasible.

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.

Multimodal learning significantly benefits cancer survival prediction, especially the integration of pathological images and genomic data. Despite advantages of multimodal learning for cancer survival prediction, massive redundancy in multimodal data prevents it from extracting discriminative and compact information: (1) An extensive amount of intra-modal task-unrelated information blurs discriminability, especially for gigapixel whole slide images (WSIs) with many patches in pathology and thousands of pathways in genomic data, leading to an ``intra-modal redundancy" issue. (2) Duplicated information among modalities dominates the representation of multimodal data, which makes modality-specific information prone to being ignored, resulting in an ``inter-modal redundancy" issue. To address these, we propose a new framework, Prototypical Information Bottlenecking and Disentangling (PIBD), consisting of Prototypical Information Bottleneck (PIB) module for intra-modal redundancy and Prototypical Information Disentanglement (PID) module for inter-modal redundancy. Specifically, a variant of information bottleneck, PIB, is proposed to model prototypes approximating a bunch of instances for different risk levels, which can be used for selection of discriminative instances within modality. PID module decouples entangled multimodal data into compact distinct components: modality-common and modality-specific knowledge, under the guidance of the joint prototypical distribution. Extensive experiments on five cancer benchmark datasets demonstrated our superiority over other methods.

Compressed Sensing MRI reconstructs images of the body's internal anatomy from undersampled measurements, thereby reducing scan time. Recently, deep learning has shown great potential for reconstructing high-fidelity images from highly undersampled measurements. However, one needs to train multiple models for different undersampling patterns and desired output image resolutions, since most networks operate on a fixed discretization. Such approaches are highly impractical in clinical settings, where undersampling patterns and image resolutions are frequently changed to accommodate different real-time imaging and diagnostic requirements. We propose a unified MRI reconstruction model robust to various measurement undersampling patterns and image resolutions. Our approach uses neural operators, a discretization-agnostic architecture applied in both image and measurement spaces, to capture local and global features. Empirically, our model improves SSIM by 11% and PSNR by 4 dB over a state-of-the-art CNN (End-to-End VarNet), with 600times faster inference than diffusion methods. The resolution-agnostic design also enables zero-shot super-resolution and extended field-of-view reconstruction, offering a versatile and efficient solution for clinical MR imaging. Our unified model offers a versatile solution for MRI, adapting seamlessly to various measurement undersampling and imaging resolutions, making it highly effective for flexible and reliable clinical imaging. Our code is available at https://armeet.ca/nomri.

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.

Magnetic Resonance Imaging (MRI) is a critical tool in modern medical diagnostics, yet its prolonged acquisition time remains a critical limitation, especially in time-sensitive clinical scenarios. While undersampling strategies can accelerate image acquisition, they often result in image artifacts and degraded quality. Recent diffusion models have shown promise for reconstructing high-fidelity images from undersampled data by learning powerful image priors; however, most existing approaches either (i) rely on unsupervised score functions without paired supervision or (ii) apply data consistency only as a post-processing step. In this work, we introduce a conditional denoising diffusion framework with iterative data-consistency correction, which differs from prior methods by embedding the measurement model directly into every reverse diffusion step and training the model on paired undersampled-ground truth data. This hybrid design bridges generative flexibility with explicit enforcement of MRI physics. Experiments on the fastMRI dataset demonstrate that our framework consistently outperforms recent state-of-the-art deep learning and diffusion-based methods in SSIM, PSNR, and LPIPS, with LPIPS capturing perceptual improvements more faithfully. These results demonstrate that integrating conditional supervision with iterative consistency updates yields substantial improvements in both pixel-level fidelity and perceptual realism, establishing a principled and practical advance toward robust, accelerated MRI reconstruction.

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.

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

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.

Integrating Large Language Models (LLMs) in healthcare diagnosis demands systematic frameworks that can handle complex medical scenarios while maintaining specialized expertise. We present KG4Diagnosis, a novel hierarchical multi-agent framework that combines LLMs with automated knowledge graph construction, encompassing 362 common diseases across medical specialties. Our framework mirrors real-world medical systems through a two-tier architecture: a general practitioner (GP) agent for initial assessment and triage, coordinating with specialized agents for in-depth diagnosis in specific domains. The core innovation lies in our end-to-end knowledge graph generation methodology, incorporating: (1) semantic-driven entity and relation extraction optimized for medical terminology, (2) multi-dimensional decision relationship reconstruction from unstructured medical texts, and (3) human-guided reasoning for knowledge expansion. KG4Diagnosis serves as an extensible foundation for specialized medical diagnosis systems, with capabilities to incorporate new diseases and medical knowledge. The framework's modular design enables seamless integration of domain-specific enhancements, making it valuable for developing targeted medical diagnosis systems. We provide architectural guidelines and protocols to facilitate adoption across medical contexts.

Recent deep-learning-based approaches to single-image reflection removal have shown promising advances, primarily for two reasons: 1) the utilization of recognition-pretrained features as inputs, and 2) the design of dual-stream interaction networks. However, according to the Information Bottleneck principle, high-level semantic clues tend to be compressed or discarded during layer-by-layer propagation. Additionally, interactions in dual-stream networks follow a fixed pattern across different layers, limiting overall performance. To address these limitations, we propose a novel architecture called Reversible Decoupling Network (RDNet), which employs a reversible encoder to secure valuable information while flexibly decoupling transmission- and reflection-relevant features during the forward pass. Furthermore, we customize a transmission-rate-aware prompt generator to dynamically calibrate features, further boosting performance. Extensive experiments demonstrate the superiority of RDNet over existing SOTA methods on five widely-adopted benchmark datasets. Our code will be made publicly available.

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.

Early detection of gastric cancer, a leading cause of cancer-related mortality worldwide, remains hampered by the limitations of current diagnostic technologies, leading to high rates of misdiagnosis and missed diagnoses. To address these challenges, we propose an integrated system that synergizes advanced hardware and software technologies to balance speed-accuracy. Our study introduces the One Class Twin Cross Learning (OCT-X) algorithm. Leveraging a novel fast double-threshold grid search strategy (FDT-GS) and a patch-based deep fully convolutional network, OCT-X maximizes diagnostic accuracy through real-time data processing and seamless lesion surveillance. The hardware component includes an all-in-one point-of-care testing (POCT) device with high-resolution imaging sensors, real-time data processing, and wireless connectivity, facilitated by the NI CompactDAQ and LabVIEW software. Our integrated system achieved an unprecedented diagnostic accuracy of 99.70%, significantly outperforming existing models by up to 4.47%, and demonstrated a 10% improvement in multirate adaptability. These findings underscore the potential of OCT-X as well as the integrated system in clinical diagnostics, offering a path toward more accurate, efficient, and less invasive early gastric cancer detection. Future research will explore broader applications, further advancing oncological diagnostics. Code is available at https://github.com/liu37972/Multirate-Location-on-OCT-X-Learning.git.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

In controllable generation tasks, flexibly manipulating the generated images to attain a desired appearance or structure based on a single input image cue remains a critical and longstanding challenge. Achieving this requires the effective decoupling of key attributes within the input image data, aiming to get representations accurately. Previous research has predominantly concentrated on disentangling image attributes within feature space. However, the complex distribution present in real-world data often makes the application of such decoupling algorithms to other datasets challenging. Moreover, the granularity of control over feature encoding frequently fails to meet specific task requirements. Upon scrutinizing the characteristics of various generative models, we have observed that the input sensitivity and dynamic evolution properties of the diffusion model can be effectively fused with the explicit decomposition operation in pixel space. This integration enables the image processing operations performed in pixel space for a specific feature distribution of the input image, and can achieve the desired control effect in the generated results. Therefore, we propose FilterPrompt, an approach to enhance the model control effect. It can be universally applied to any diffusion model, allowing users to adjust the representation of specific image features in accordance with task requirements, thereby facilitating more precise and controllable generation outcomes. In particular, our designed experiments demonstrate that the FilterPrompt optimizes feature correlation, mitigates content conflicts during the generation process, and enhances the model's control capability.

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.

Magnetic resonance imaging (MRI) provides high spatial resolution and excellent soft-tissue contrast without using harmful ionising radiation. Dynamic MRI is an essential tool for interventions to visualise movements or changes of the target organ. However, such MRI acquisition with high temporal resolution suffers from limited spatial resolution - also known as the spatio-temporal trade-off of dynamic MRI. Several approaches, including deep learning based super-resolution approaches, have been proposed to mitigate this trade-off. Nevertheless, such an approach typically aims to super-resolve each time-point separately, treating them as individual volumes. This research addresses the problem by creating a deep learning model which attempts to learn both spatial and temporal relationships. A modified 3D UNet model, DDoS-UNet, is proposed - which takes the low-resolution volume of the current time-point along with a prior image volume. Initially, the network is supplied with a static high-resolution planning scan as the prior image along with the low-resolution input to super-resolve the first time-point. Then it continues step-wise by using the super-resolved time-points as the prior image while super-resolving the subsequent time-points. The model performance was tested with 3D dynamic data that was undersampled to different in-plane levels. The proposed network achieved an average SSIM value of 0.951pm0.017 while reconstructing the lowest resolution data (i.e. only 4\% of the k-space acquired) - which could result in a theoretical acceleration factor of 25. The proposed approach can be used to reduce the required scan-time while achieving high spatial resolution.

Medical open-domain question answering demands substantial access to specialized knowledge. Recent efforts have sought to decouple knowledge from model parameters, counteracting architectural scaling and allowing for training on common low-resource hardware. The retrieve-then-read paradigm has become ubiquitous, with model predictions grounded on relevant knowledge pieces from external repositories such as PubMed, textbooks, and UMLS. An alternative path, still under-explored but made possible by the advent of domain-specific large language models, entails constructing artificial contexts through prompting. As a result, "to generate or to retrieve" is the modern equivalent of Hamlet's dilemma. This paper presents MedGENIE, the first generate-then-read framework for multiple-choice question answering in medicine. We conduct extensive experiments on MedQA-USMLE, MedMCQA, and MMLU, incorporating a practical perspective by assuming a maximum of 24GB VRAM. MedGENIE sets a new state-of-the-art (SOTA) in the open-book setting of each testbed, even allowing a small-scale reader to outcompete zero-shot closed-book 175B baselines while using up to 706times fewer parameters. Overall, our findings reveal that generated passages are more effective than retrieved counterparts in attaining higher accuracy.

We present the Virology Capabilities Test (VCT), a large language model (LLM) benchmark that measures the capability to troubleshoot complex virology laboratory protocols. Constructed from the inputs of dozens of PhD-level expert virologists, VCT consists of 322 multimodal questions covering fundamental, tacit, and visual knowledge that is essential for practical work in virology laboratories. VCT is difficult: expert virologists with access to the internet score an average of 22.1% on questions specifically in their sub-areas of expertise. However, the most performant LLM, OpenAI's o3, reaches 43.8% accuracy, outperforming 94% of expert virologists even within their sub-areas of specialization. The ability to provide expert-level virology troubleshooting is inherently dual-use: it is useful for beneficial research, but it can also be misused. Therefore, the fact that publicly available models outperform virologists on VCT raises pressing governance considerations. We propose that the capability of LLMs to provide expert-level troubleshooting of dual-use virology work should be integrated into existing frameworks for handling dual-use technologies in the life sciences.

Adapting a language model into a specific domain, a.k.a `domain adaption', is a common practice when specialized knowledge, e.g. medicine, is not encapsulated in a general language model like Llama2. The challenge lies in the heterogeneity of data across the two training stages, as it varies in languages, genres, or formats. To tackle this and simplify the learning protocol, we propose to transform heterogeneous data, from the both pre-training and supervised stages, into a unified, simple input-output pair format. We validate the new protocol in the domains where proprietary LLMs like ChatGPT perform relatively poorly, such as Traditional Chinese Medicine. The developed model, HuatuoGPT-II, has shown state-of-the-art performance in Chinese medicine domain on a number of benchmarks, e.g. medical licensing exams. It even outperforms proprietary models like ChatGPT and GPT-4 in some aspects, especially in Traditional Chinese Medicine. Expert manual evaluations further validate HuatuoGPT-II's advantages over existing LLMs. Notably, HuatuoGPT-II was benchmarked in a fresh Chinese National Medical Licensing Examination where it achieved the best performance, showcasing not only its effectiveness but also its generalization capabilities.

Large language models (LLMs) have demonstrated strong performance and rapid progress in a wide range of medical reasoning tasks. However, their sequential autoregressive decoding forces inherently parallel clinical reasoning, such as differential diagnosis, into a single linear reasoning path, limiting both efficiency and reliability for complex medical problems. To address this, we propose MedVerse, a reasoning framework for complex medical inference that reformulates medical reasoning as a parallelizable directed acyclic graph (DAG) process based on Petri net theory. The framework adopts a full-stack design across data, model architecture, and system execution. For data creation, we introduce the MedVerse Curator, an automated pipeline that synthesizes knowledge-grounded medical reasoning paths and transforms them into Petri net-structured representations. At the architectural level, we propose a topology-aware attention mechanism with adaptive position indices that supports parallel reasoning while preserving logical consistency. Systematically, we develop a customized inference engine that supports parallel execution without additional overhead. Empirical evaluations show that MedVerse improves strong general-purpose LLMs by up to 8.9%. Compared to specialized medical LLMs, MedVerse achieves comparable performance while delivering a 1.3x reduction in inference latency and a 1.7x increase in generation throughput, enabled by its parallel decoding capability.

Magnetic Resonance Imaging (MRI) is a critical medical imaging modality in clinical diagnosis and research, yet its complexity and heterogeneity pose challenges for automated analysis, particularly in scalable and generalizable machine learning applications. While foundation models have revolutionized natural language and vision tasks, their application to MRI remains limited due to data scarcity and narrow anatomical focus. In this work, we present Decipher-MR, a 3D MRI-specific vision-language foundation model trained on a large-scale dataset comprising 200,000 MRI series from over 22,000 studies spanning diverse anatomical regions, sequences, and pathologies. Decipher-MR integrates self-supervised vision learning with report-guided text supervision to build robust, generalizable representations, enabling effective adaptation across broad applications. To enable robust and diverse clinical tasks with minimal computational overhead, Decipher-MR supports a modular design that enables tuning of lightweight, task-specific decoders attached to a frozen pretrained encoder. Following this setting, we evaluate Decipher-MR across diverse benchmarks including disease classification, demographic prediction, anatomical localization, and cross-modal retrieval, demonstrating consistent performance gains over existing foundation models and task-specific approaches. Our results establish Decipher-MR as a scalable and versatile foundation for MRI-based AI, facilitating efficient development across clinical and research domains.

General-purpose Large Vision-Language Models (LVLMs), despite their massive scale, often falter in dermatology due to "diffuse attention" - the inability to disentangle subtle pathological lesions from background noise. In this paper, we challenge the assumption that parameter scaling is the only path to medical precision. We introduce SkinFlow, a framework that treats diagnosis as an optimization of visual information transmission efficiency. Our approach utilizes a Virtual-Width Dynamic Vision Encoder (DVE) to "unfold" complex pathological manifolds without physical parameter expansion, coupled with a two-stage Reinforcement Learning strategy. This strategy sequentially aligns explicit medical descriptions (Stage I) and reconstructs implicit diagnostic textures (Stage II) within a constrained semantic space. Furthermore, we propose a clinically grounded evaluation protocol that prioritizes diagnostic safety and hierarchical relevance over rigid label matching. Empirical results are compelling: our 7B model establishes a new state-of-the-art on the Fitzpatrick17k benchmark, achieving a +12.06% gain in Top-1 accuracy and a +28.57% boost in Top-6 accuracy over the massive general-purpose models (e.g., Qwen3VL-235B and GPT-5.2). These findings demonstrate that optimizing geometric capacity and information flow yields superior diagnostic reasoning compared to raw parameter scaling.

Image-to-Video (I2V) generation aims to synthesize a video clip according to a given image and condition (e.g., text). The key challenge of this task lies in simultaneously generating natural motions while preserving the original appearance of the images. However, current I2V diffusion models (I2V-DMs) often produce videos with limited motion degrees or exhibit uncontrollable motion that conflicts with the textual condition. To address these limitations, we propose a novel Extrapolating and Decoupling framework, which introduces model merging techniques to the I2V domain for the first time. Specifically, our framework consists of three separate stages: (1) Starting with a base I2V-DM, we explicitly inject the textual condition into the temporal module using a lightweight, learnable adapter and fine-tune the integrated model to improve motion controllability. (2) We introduce a training-free extrapolation strategy to amplify the dynamic range of the motion, effectively reversing the fine-tuning process to enhance the motion degree significantly. (3) With the above two-stage models excelling in motion controllability and degree, we decouple the relevant parameters associated with each type of motion ability and inject them into the base I2V-DM. Since the I2V-DM handles different levels of motion controllability and dynamics at various denoising time steps, we adjust the motion-aware parameters accordingly over time. Extensive qualitative and quantitative experiments have been conducted to demonstrate the superiority of our framework over existing methods.

De-identification of electronic health records (EHR) is a vital step towards advancing health informatics research and maximising the use of available data. It is a two-step process where step one is the identification of protected health information (PHI), and step two is replacing such PHI with surrogates. Despite the recent advances in automatic de-identification of EHR, significant obstacles remain if the abundant health data available are to be used to the full potential. Accuracy in de-identification could be considered a necessary, but not sufficient condition for the use of EHR without individual patient consent. We present here a comprehensive review of the progress to date, both the impressive successes in achieving high accuracy and the significant risks and challenges that remain. To best of our knowledge, this is the first paper to present a complete picture of end-to-end automatic de-identification. We review 18 recently published automatic de-identification systems -designed to de-identify EHR in the form of free text- to show the advancements made in improving the overall accuracy of the system, and in identifying individual PHI. We argue that despite the improvements in accuracy there remain challenges in surrogate generation and replacements of identified PHIs, and the risks posed to patient protection and privacy.

Biological protocols are fundamental to reproducible and safe life science research. While LLMs excel on general tasks, their systematic evaluation on these highly specialized, accuracy-critical, and inherently procedural texts remains limited. In this work, we present BioProBench, the first large-scale, integrated multi-task benchmark for biological protocol understanding and reasoning. While limited benchmarks have touched upon specific aspects like protocol QA, BioProBench provides a comprehensive suite of five core tasks: Protocol Question Answering, Step Ordering, Error Correction, Protocol Generation, and Protocol Reasoning, enabling a holistic evaluation of LLMs on procedural biological texts. Built upon 27K original protocols, it yields nearly 556K high-quality structured instances. We evaluate 12 mainstream open/closed-source LLMs on BioProBench. Experimental results reveal that while top models preform well on surface understanding tasks, struggle significantly with deep reasoning and structured generation tasks like ordering and generation. Furthermore, model comparisons reveal diverse performance: certain open-source models approach closed-source levels on some tasks, yet bio-specific small models lag behind general LLMs, indicating limitations on complex procedural content. Overall, our findings underscore that procedural reasoning within biological protocols represents a significant challenge for current LLMs. BioProBench serves as a standardized framework to diagnose these specific limitations and guide the development of AI systems better equipped for safely automating complex scientific procedures. The code and data are available at: https://github.com/YuyangSunshine/bioprotocolbench and https://huggingface.co/datasets/GreatCaptainNemo/BioProBench.

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

The Segment Anything Model (SAM) has demonstrated outstanding adaptation to medical image segmentation but still faces three major challenges. Firstly, the huge computational costs of SAM limit its real-world applicability. Secondly, SAM depends on manual annotations (e.g., points, boxes) as prompts, which are laborious and impractical in clinical scenarios. Thirdly, SAM handles all segmentation targets equally, which is suboptimal for diverse medical modalities with inherent heterogeneity. To address these issues, we propose an Efficient Self-Prompting SAM for universal medical image segmentation, named ESP-MedSAM. We devise a Multi-Modal Decoupled Knowledge Distillation (MMDKD) strategy to distil common image knowledge and domain-specific medical knowledge from the foundation model to train a lightweight image encoder and a modality controller. Further, they combine with the additionally introduced Self-Patch Prompt Generator (SPPG) and Query-Decoupled Modality Decoder (QDMD) to construct ESP-MedSAM. Specifically, SPPG aims to generate a set of patch prompts automatically and QDMD leverages a one-to-one strategy to provide an independent decoding channel for every modality. Extensive experiments indicate that ESP-MedSAM outperforms state-of-the-arts in diverse medical imaging segmentation takes, displaying superior zero-shot learning and modality transfer ability. Especially, our framework uses only 31.4% parameters compared to SAM-Base.

Despite recent progress, medical foundation models still struggle to unify visual understanding and generation, as these tasks have inherently conflicting goals: semantic abstraction versus pixel-level reconstruction. Existing approaches, typically based on parameter-shared autoregressive architectures, frequently lead to compromised performance in one or both tasks. To address this, we present UniX, a next-generation unified medical foundation model for chest X-ray understanding and generation. UniX decouples the two tasks into an autoregressive branch for understanding and a diffusion branch for high-fidelity generation. Crucially, a cross-modal self-attention mechanism is introduced to dynamically guide the generation process with understanding features. Coupled with a rigorous data cleaning pipeline and a multi-stage training strategy, this architecture enables synergistic collaboration between tasks while leveraging the strengths of diffusion models for superior generation. On two representative benchmarks, UniX achieves a 46.1% improvement in understanding performance (Micro-F1) and a 24.2% gain in generation quality (FD-RadDino), using only a quarter of the parameters of LLM-CXR. By achieving performance on par with task-specific models, our work establishes a scalable paradigm for synergistic medical image understanding and generation. Codes and models are available at https://github.com/ZrH42/UniX.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Electronic health records (EHRs) are multimodal by nature, consisting of structured tabular features like lab tests and unstructured clinical notes. In real-life clinical practice, doctors use complementary multimodal EHR data sources to get a clearer picture of patients' health and support clinical decision-making. However, most EHR predictive models do not reflect these procedures, as they either focus on a single modality or overlook the inter-modality interactions/redundancy. In this work, we propose MEDFuse, a Multimodal EHR Data Fusion framework that incorporates masked lab-test modeling and large language models (LLMs) to effectively integrate structured and unstructured medical data. MEDFuse leverages multimodal embeddings extracted from two sources: LLMs fine-tuned on free clinical text and masked tabular transformers trained on structured lab test results. We design a disentangled transformer module, optimized by a mutual information loss to 1) decouple modality-specific and modality-shared information and 2) extract useful joint representation from the noise and redundancy present in clinical notes. Through comprehensive validation on the public MIMIC-III dataset and the in-house FEMH dataset, MEDFuse demonstrates great potential in advancing clinical predictions, achieving over 90% F1 score in the 10-disease multi-label classification task.

Denoising generative models, such as diffusion and flow-based models, produce high-quality samples but require many denoising steps due to discretization error. Flow maps, which estimate the average velocity between timesteps, mitigate this error and enable faster sampling. However, their training typically demands architectural changes that limit compatibility with pretrained flow models. We introduce Decoupled MeanFlow, a simple decoding strategy that converts flow models into flow map models without architectural modifications. Our method conditions the final blocks of diffusion transformers on the subsequent timestep, allowing pretrained flow models to be directly repurposed as flow maps. Combined with enhanced training techniques, this design enables high-quality generation in as few as 1 to 4 steps. Notably, we find that training flow models and subsequently converting them is more efficient and effective than training flow maps from scratch. On ImageNet 256x256 and 512x512, our models attain 1-step FID of 2.16 and 2.12, respectively, surpassing prior art by a large margin. Furthermore, we achieve FID of 1.51 and 1.68 when increasing the steps to 4, which nearly matches the performance of flow models while delivering over 100x faster inference.

Although multimodal large language models (MLLMs) exhibit remarkable reasoning capabilities on complex multimodal understanding tasks, they still suffer from the notorious hallucination issue: generating outputs misaligned with obvious visual or factual evidence. Currently, training-based solutions, like direct preference optimization (DPO), leverage paired preference data to suppress hallucinations. However, they risk sacrificing general reasoning capabilities due to the likelihood displacement. Meanwhile, training-free solutions, like contrastive decoding, achieve this goal by subtracting the estimated hallucination pattern from a distorted input. Yet, these handcrafted perturbations (e.g., add noise to images) may poorly capture authentic hallucination patterns. To avoid these weaknesses of existing methods, and realize robust hallucination mitigation (i.e., maintaining general reasoning performance), we propose a novel framework: Decoupling Contrastive Decoding (DCD). Specifically, DCD decouples the learning of positive and negative samples in preference datasets, and trains separate positive and negative image projections within the MLLM. The negative projection implicitly models real hallucination patterns, which enables vision-aware negative images in the contrastive decoding inference stage. Our DCD alleviates likelihood displacement by avoiding pairwise optimization and generalizes robustly without handcrafted degradation. Extensive ablations across hallucination benchmarks and general reasoning tasks demonstrate the effectiveness of DCD, i.e., it matches DPO's hallucination suppression while preserving general capabilities and outperforms the handcrafted contrastive decoding methods.

Many low-dose CT imaging methods rely on supervised learning, which requires a large number of paired noisy and clean images. However, obtaining paired images in clinical practice is challenging. To address this issue, zero-shot self-supervised methods train denoising networks using only the information within a single image, such as ZS-N2N. However, these methods often employ downsampling operations that degrade image resolution. Additionally, the training dataset is inherently constrained to the image itself. In this paper, we propose a zero-shot low-dose CT imaging method based on sinogram flicking, which operates within a single image but generates many copies via random conjugate ray matching. Specifically, two conjugate X-ray pencil beams measure the same path; their expected values should be identical, while their noise levels vary during measurements. By randomly swapping portions of the conjugate X-rays in the sinogram domain, we generate a large set of sinograms with consistent content but varying noise patterns. When displayed dynamically, these sinograms exhibit a flickering effect due to their identical structural content but differing noise patterns-hence the term sinogram flicking. We train the network on pairs of sinograms with the same content but different noise distributions using a lightweight model adapted from ZS-NSN. This process is repeated to obtain the final results. A simulation study demonstrates that our method outperforms state-of-the-art approaches such as ZS-N2N.

The pandemic resulted in vast repositories of unstructured data, including radiology reports, due to increased medical examinations. Previous research on automated diagnosis of COVID-19 primarily focuses on X-ray images, despite their lower precision compared to computed tomography (CT) scans. In this work, we leverage unstructured data from a hospital and harness the fine-grained details offered by CT scans to perform zero-shot multi-label classification based on contrastive visual language learning. In collaboration with human experts, we investigate the effectiveness of multiple zero-shot models that aid radiologists in detecting pulmonary embolisms and identifying intricate lung details like ground glass opacities and consolidations. Our empirical analysis provides an overview of the possible solutions to target such fine-grained tasks, so far overlooked in the medical multimodal pretraining literature. Our investigation promises future advancements in the medical image analysis community by addressing some challenges associated with unstructured data and fine-grained multi-label classification.

Multi-center positron emission tomography (PET) image synthesis aims at recovering low-dose PET images from multiple different centers. The generalizability of existing methods can still be suboptimal for a multi-center study due to domain shifts, which result from non-identical data distribution among centers with different imaging systems/protocols. While some approaches address domain shifts by training specialized models for each center, they are parameter inefficient and do not well exploit the shared knowledge across centers. To address this, we develop a generalist model that shares architecture and parameters across centers to utilize the shared knowledge. However, the generalist model can suffer from the center interference issue, i.e. the gradient directions of different centers can be inconsistent or even opposite owing to the non-identical data distribution. To mitigate such interference, we introduce a novel dynamic routing strategy with cross-layer connections that routes data from different centers to different experts. Experiments show that our generalist model with dynamic routing (DRMC) exhibits excellent generalizability across centers. Code and data are available at: https://github.com/Yaziwel/Multi-Center-PET-Image-Synthesis.

Talking head generation is a significant research topic that still faces numerous challenges. Previous works often adopt generative adversarial networks or regression models, which are plagued by generation quality and average facial shape problem. Although diffusion models show impressive generative ability, their exploration in talking head generation remains unsatisfactory. This is because they either solely use the diffusion model to obtain an intermediate representation and then employ another pre-trained renderer, or they overlook the feature decoupling of complex facial details, such as expressions, head poses and appearance textures. Therefore, we propose a Facial Decoupled Diffusion model for Talking head generation called FD2Talk, which fully leverages the advantages of diffusion models and decouples the complex facial details through multi-stages. Specifically, we separate facial details into motion and appearance. In the initial phase, we design the Diffusion Transformer to accurately predict motion coefficients from raw audio. These motions are highly decoupled from appearance, making them easier for the network to learn compared to high-dimensional RGB images. Subsequently, in the second phase, we encode the reference image to capture appearance textures. The predicted facial and head motions and encoded appearance then serve as the conditions for the Diffusion UNet, guiding the frame generation. Benefiting from decoupling facial details and fully leveraging diffusion models, extensive experiments substantiate that our approach excels in enhancing image quality and generating more accurate and diverse results compared to previous state-of-the-art methods.

Next-generation multimodal foundation models capable of any-to-any cross-modal generation and multi-turn interaction will serve as core components of artificial general intelligence systems, playing a pivotal role in human-machine interaction. However, most existing multimodal models remain constrained by autoregressive architectures, whose inherent limitations prevent a balanced integration of understanding and generation capabilities. Although hybrid and decoupling strategies have been explored to address these tasks within unified frameworks separately, their redundant, non-integrated designs limit their applicability to broader scenarios, such as cross-modal retrieval. In this work, we introduce NExT-OMNI, an open-source omnimodal foundation model that achieves unified modeling through discrete flow paradigms. By leveraging metric-induced probability paths and kinetic optimal velocities, NExT-OMNI natively supports any-to-any understanding and generation with enhanced response efficiency, while enabling broader application scenarios through concise unified representations rather than task-decoupled designs. Trained on large-scale interleaved text, image, video, and audio data, NExT-OMNI delivers competitive performance on multimodal generation and understanding benchmarks, while outperforming prior unified models in multi-turn multimodal interaction and cross-modal retrieval, highlighting its architectural advantages as a next-generation multimodal foundation model. To advance further research, we release training details, data protocols, and open-source both the code and model checkpoints.

Multimodal Large Language Models (MLLMs) have achieved strong performance across many tasks, yet most systems remain limited to offline inference, requiring complete inputs before generating outputs. Recent streaming methods reduce latency by interleaving perception and generation, but still enforce a sequential perception-generation cycle, limiting real-time interaction. In this work, we target a fundamental bottleneck that arises when extending MLLMs to real-time video understanding: the global positional continuity constraint imposed by standard positional encoding schemes. While natural in offline inference, this constraint tightly couples perception and generation, preventing effective input-output parallelism. To address this limitation, we propose a parallel streaming framework that relaxes positional continuity through three designs: Overlapped, Group-Decoupled, and Gap-Isolated. These designs enable simultaneous perception and generation, allowing the model to process incoming inputs while producing responses in real time. Extensive experiments reveal that Group-Decoupled achieves the best efficiency-performance balance, maintaining high fluency and accuracy while significantly reducing latency. We further show that the proposed framework yields up to 2x acceleration under balanced perception-generation workloads, establishing a principled pathway toward speak-while-watching real-time systems. We make all our code publicly available: https://github.com/EIT-NLP/Speak-While-Watching.

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

Integrated sensing and communication (ISAC) is envisioned be to one of the paradigms upon which next-generation mobile networks will be built, extending localization and tracking capabilities, as well as giving birth to environment-aware wireless access. A key aspect of sensing integration is parameter estimation, which involves extracting information about the surrounding environment, such as the direction, distance, and velocity of various objects within. This is typically of a high-dimensional nature, which leads to significant computational complexity, if performed jointly across multiple sensing dimensions, such as space, frequency, and time. Additionally, due to the incorporation of sensing on top of the data transmission, the time window available for sensing is likely to be short, resulting in an estimation problem where only a single snapshot is accessible. In this work, we propose PLAIN, a tensor-based estimation architecture that flexibly scales with multiple sensing dimensions and can handle high dimensionality, limited measurement time, and super-resolution requirements. It consists of three stages: a compression stage, where the high dimensional input is converted into lower dimensionality, without sacrificing resolution; a decoupled estimation stage, where the parameters across the different dimensions are estimated in parallel with low complexity; an input-based fusion stage, where the decoupled parameters are fused together to form a paired multidimensional estimate. We investigate the performance of the architecture for different configurations and compare it against practical sequential and joint estimation baselines, as well as theoretical bounds. Our results show that PLAIN, using tools from tensor algebra, subspace-based processing, and compressed sensing, can scale flexibly with dimensionality, while operating with low complexity and maintaining super-resolution.

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

In the field of human-centric personalized image generation, the adapter-based method obtains the ability to customize and generate portraits by text-to-image training on facial data. This allows for identity-preserved personalization without additional fine-tuning in inference. Although there are improvements in efficiency and fidelity, there is often a significant performance decrease in test following ability, controllability, and diversity of generated faces compared to the base model. In this paper, we analyze that the performance degradation is attributed to the failure to decouple identity features from other attributes during extraction, as well as the failure to decouple the portrait generation training from the overall generation task. To address these issues, we propose the Face Adapter with deCoupled Training (FACT) framework, focusing on both model architecture and training strategy. To decouple identity features from others, we leverage a transformer-based face-export encoder and harness fine-grained identity features. To decouple the portrait generation training, we propose Face Adapting Increment Regularization~(FAIR), which effectively constrains the effect of face adapters on the facial region, preserving the generative ability of the base model. Additionally, we incorporate a face condition drop and shuffle mechanism, combined with curriculum learning, to enhance facial controllability and diversity. As a result, FACT solely learns identity preservation from training data, thereby minimizing the impact on the original text-to-image capabilities of the base model. Extensive experiments show that FACT has both controllability and fidelity in both text-to-image generation and inpainting solutions for portrait generation.

In this paper, we introduce agentic unlearning which removes specified information from both model parameters and persistent memory in agents with closed-loop interaction. Existing unlearning methods target parameters alone, leaving two critical gaps: (i) parameter-memory backflow, where retrieval reactivates parametric remnants or memory artifacts reintroduce sensitive content, and (ii) the absence of a unified strategy that covers both parameter and memory pathways. We present Synchronized Backflow Unlearning (SBU), a framework that unlearns jointly across parameter and memory pathways. The memory pathway performs dependency closure-based unlearning that prunes isolated entities while logically invalidating shared artifacts. The parameter pathway employs stochastic reference alignment to guide model outputs toward a high-entropy prior. These pathways are integrated via a synchronized dual-update protocol, forming a closed-loop mechanism where memory unlearning and parametric suppression reinforce each other to prevent cross-pathway recontamination. Experiments on medical QA benchmarks show that SBU reduces traces of targeted private information across both pathways with limited degradation on retained data.

Reproducibility is central to research credibility, yet large-scale reanalysis of empricial data remains costly because replication packages vary widely in structure, software environment, and documentation. We develop and evaluate an agentic AI workflow that addresses this execution bottleneck while preserving scientific rigor. The system separates scientific reasoning from computational execution: researchers design fixed diagnostic templates, and the workflow automates the acquisition, harmonization, and execution of replication materials using pre-specified, version-controlled code. A structured knowledge layer records resolved failure patterns, enabling adaptation across heterogeneous studies while keeping each pipeline version transparent and stable. We evaluate this workflow on 92 instrumental variable (IV) studies, including 67 with manually verified reproducible 2SLS estimates and 25 newly published IV studies under identical criteria. For each paper, we analyze up to three two-stage least squares (2SLS) specifications, totaling 215. Across the 92 papers, the system achieves 87% end-to-end success overall. Conditional on accessible data and code, reproducibility is 100% at both the paper and specification levels. The framework substantially lowers the cost of executing established empirical protocols and can be adapted in empirical settings where analytic templates and norms of transparency are well established.

Mechanistic interpretability seeks to understand the internal mechanisms of machine learning models, where localization -- identifying the important model components -- is a key step. Activation patching, also known as causal tracing or interchange intervention, is a standard technique for this task (Vig et al., 2020), but the literature contains many variants with little consensus on the choice of hyperparameters or methodology. In this work, we systematically examine the impact of methodological details in activation patching, including evaluation metrics and corruption methods. In several settings of localization and circuit discovery in language models, we find that varying these hyperparameters could lead to disparate interpretability results. Backed by empirical observations, we give conceptual arguments for why certain metrics or methods may be preferred. Finally, we provide recommendations for the best practices of activation patching going forwards.

While Multimodal Large Language Models (MLLMs) have demonstrated remarkable proficiency in tasks such as abnormality detection and report generation for anatomical modalities, their capability in functional imaging remains largely unexplored. In this work, we identify and quantify a fundamental functional perception gap: the inability of current vision encoders to decode functional tracer biodistribution independent of morphological priors. Identifying Positron Emission Tomography (PET) as the quintessential modality to investigate this disconnect, we introduce PET-Bench, the first large-scale functional imaging benchmark comprising 52,308 hierarchical QA pairs from 9,732 multi-site, multi-tracer PET studies. Extensive evaluation of 19 state-of-the-art MLLMs reveals a critical safety hazard termed the Chain-of-Thought (CoT) hallucination trap. We observe that standard CoT prompting, widely considered to enhance reasoning, paradoxically decouples linguistic generation from visual evidence in PET, producing clinically fluent but factually ungrounded diagnoses. To resolve this, we propose Atomic Visual Alignment (AVA), a simple fine-tuning strategy that enforces the mastery of low-level functional perception prior to high-level diagnostic reasoning. Our results demonstrate that AVA effectively bridges the perception gap, transforming CoT from a source of hallucination into a robust inference tool and improving diagnostic accuracy by up to 14.83%. Code and data are available at https://github.com/yezanting/PET-Bench.

Vision-Language Models (VLMs) are advancing computational pathology with superior visual understanding capabilities. However, current systems often reduce diagnosis to directly output conclusions without verifiable evidence-linked reasoning, which severely limits clinical trust and hinders expert error rectification. To address these barriers, we construct PathReasoner, the first large-scale dataset of whole-slide image (WSI) reasoning. Unlike previous work reliant on unverified distillation, we develop a rigorous knowledge-guided generation pipeline. By leveraging medical knowledge graphs, we explicitly align structured pathological findings and clinical reasoning with diagnoses, generating over 20K high-quality instructional samples. Based on the database, we propose PathReasoner-R1, which synergizes trajectory-masked supervised fine-tuning with reasoning-oriented reinforcement learning to instill structured chain-of-thought capabilities. To ensure medical rigor, we engineer a knowledge-aware multi-granular reward function incorporating an Entity Reward mechanism strictly aligned with knowledge graphs. This effectively guides the model to optimize for logical consistency rather than mere outcome matching, thereby enhancing robustness. Extensive experiments demonstrate that PathReasoner-R1 achieves state-of-the-art performance on both PathReasoner and public benchmarks across various image scales, equipping pathology models with transparent, clinically grounded reasoning capabilities. Dataset and code are available at https://github.com/cyclexfy/PathReasoner-R1.

Current AI-assisted skin image diagnosis has achieved dermatologist-level performance in classifying skin cancer, driven by rapid advancements in deep learning architectures. However, unlike traditional vision tasks, skin images in general present unique challenges due to the limited availability of well-annotated datasets, complex variations in conditions, and the necessity for detailed interpretations to ensure patient safety. Previous segmentation methods have sought to reduce image noise and enhance diagnostic performance, but these techniques require fine-grained, pixel-level ground truth masks for training. In contrast, with the rise of foundation models, the Segment Anything Model (SAM) has been introduced to facilitate promptable segmentation, enabling the automation of the segmentation process with simple yet effective prompts. Efforts applying SAM predominantly focus on dermatoscopy images, which present more easily identifiable lesion boundaries than clinical photos taken with smartphones. This limitation constrains the practicality of these approaches to real-world applications. To overcome the challenges posed by noisy clinical photos acquired via non-standardized protocols and to improve diagnostic accessibility, we propose a novel Cross-Attentive Fusion framework for interpretable skin lesion diagnosis. Our method leverages SAM to generate visual concepts for skin diseases using prompts, integrating local visual concepts with global image features to enhance model performance. Extensive evaluation on two skin disease datasets demonstrates our proposed method's effectiveness on lesion diagnosis and interpretability.

In medical imaging, vision-language models face a critical duality: pretrained networks offer broad robustness but lack subtle, modality-specific characteristics, while fine-tuned expert models achieve high in-distribution accuracy yet falter under modality shift. Existing model-merging techniques, designed for natural-image benchmarks, are simple and efficient but fail to deliver consistent gains across diverse medical modalities; their static interpolation limits reliability in varied clinical tasks. To address this, we introduce Test-Time Task adaptive merging (T^3), a backpropagation-free framework that computes per-sample interpolation coefficients via the Jensen-Shannon divergence between the two models' output distributions. T^3 dynamically preserves local precision when models agree and defers to generalist robustness under drift. To overcome the inference costs of sample-wise merging, we further propose a batch-wise extension, T^3_B, that computes a merging coefficient across a batch of samples, dramatically reducing computational bottleneck. Recognizing the lack of a standardized medical-merging benchmark, we present a rigorous cross-evaluation protocol spanning in-domain, base-to-novel, and corruptions across four modalities. Empirically, T^3 sets new state-of-the-art in Top-1 accuracy and error reduction, outperforming strong baselines while maintaining efficiency, paving the way for adaptive MVLM deployment in clinical settings. Our code is available at https://github.com/Razaimam45/TCube.

Recently, large efforts have been made to design efficient linear-complexity visual Transformers. However, current linear attention models are generally unsuitable to be deployed in resource-constrained mobile devices, due to suffering from either few efficiency gains or significant accuracy drops. In this paper, we propose a new deCoupled duAl-interactive lineaR attEntion (CARE) mechanism, revealing that features' decoupling and interaction can fully unleash the power of linear attention. We first propose an asymmetrical feature decoupling strategy that asymmetrically decouples the learning process for local inductive bias and long-range dependencies, thereby preserving sufficient local and global information while effectively enhancing the efficiency of models. Then, a dynamic memory unit is employed to maintain critical information along the network pipeline. Moreover, we design a dual interaction module to effectively facilitate interaction between local inductive bias and long-range information as well as among features at different layers. By adopting a decoupled learning way and fully exploiting complementarity across features, our method can achieve both high efficiency and accuracy. Extensive experiments on ImageNet-1K, COCO, and ADE20K datasets demonstrate the effectiveness of our approach, e.g., achieving 78.4/82.1% top-1 accuracy on ImagegNet-1K at the cost of only 0.7/1.9 GMACs. Codes will be released on ..{github}.

Unified multimodal models for image generation and understanding represent a significant step toward AGI and have attracted widespread attention from researchers. The main challenge of this task lies in the difficulty in establishing an optimal training paradigm due to inherent conflicting targets in understanding and generation tasks. To alleviate these conflicts and pursue higher performance, many researchers adopt varying degrees of model decoupling (e.g., Double image encoders, MOE/MOT architecture, or frozen MLLM). However, excessive model decoupling can lead to the loss of interleave generation ability, undermining the original intent of unified models. In this work, we aim to explore how to mitigate task conflicts without resorting to model decoupling. Firstly, we analyze why decoupling alleviates conflicts by studying the cross-modal attention behavior of models. We observe that model decoupling essentially drives models toward task-specific multimodal interaction patterns, as seen in Qwen-VL and HunyuanImage, and that the more thorough the decoupling, the more consistent the behavior becomes. Motivated by this observation, we propose Attention Interaction Alignment (AIA) loss, which explicitly learns Task-Specific multimodal interaction patterns during training. To demonstrate the generalizability of our AIA loss, we apply it to Emu3 and Janus-Pro during SFT and post-training stage respectively. Without bells and whistles, AIA not only refines cross-modal attention patterns, but also boosts both generation and understanding performance.

Recent medical vision-language models have shown promise on tasks such as VQA, report generation, and anomaly detection. However, most are adapted to structured adult imaging and underperform in fetal ultrasound, which poses challenges of multi-view image reasoning, numerous diseases, and image diversity. To bridge this gap, we introduce FetalMind, a medical AI system tailored to fetal ultrasound for both report generation and diagnosis. Guided by clinical workflow, we propose Salient Epistemic Disentanglement (SED), which injects an expert-curated bipartite graph into the model to decouple view-disease associations and to steer preference selection along clinically faithful steps via reinforcement learning. This design mitigates variability across diseases and heterogeneity across views, reducing learning bottlenecks while aligning the model's inference with obstetric practice. To train FetalMind at scale, we curate FetalSigma-1M dataset, the first large-scale fetal ultrasound report corpus, comprising 20K reports from twelve medical centers, addressing the scarcity of domain data. Extensive experiments show that FetalMind outperforms open- and closed-source baselines across all gestational stages, achieving +14% average gains and +61.2% higher accuracy on critical conditions while remaining efficient, stable, and scalable. Project Page: https://hexiao0275.github.io/FetalMind.

In standard hospital blood tests, the traditional process requires doctors to manually isolate leukocytes from microscopic images of patients' blood using microscopes. These isolated leukocytes are then categorized via automatic leukocyte classifiers to determine the proportion and volume of different types of leukocytes present in the blood samples, aiding disease diagnosis. This methodology is not only time-consuming and labor-intensive, but it also has a high propensity for errors due to factors such as image quality and environmental conditions, which could potentially lead to incorrect subsequent classifications and misdiagnosis. To address these issues, this paper proposes an innovative method of leukocyte detection: the Multi-level Feature Fusion and Deformable Self-attention DETR (MFDS-DETR). To tackle the issue of leukocyte scale disparity, we designed the High-level Screening-feature Fusion Pyramid (HS-FPN), enabling multi-level fusion. This model uses high-level features as weights to filter low-level feature information via a channel attention module and then merges the screened information with the high-level features, thus enhancing the model's feature expression capability. Further, we address the issue of leukocyte feature scarcity by incorporating a multi-scale deformable self-attention module in the encoder and using the self-attention and cross-deformable attention mechanisms in the decoder, which aids in the extraction of the global features of the leukocyte feature maps. The effectiveness, superiority, and generalizability of the proposed MFDS-DETR method are confirmed through comparisons with other cutting-edge leukocyte detection models using the private WBCDD, public LISC and BCCD datasets. Our source code and private WBCCD dataset are available at https://github.com/JustlfC03/MFDS-DETR.

Medical video generation has transformative potential for enhancing surgical understanding and pathology insights through precise and controllable visual representations. However, current models face limitations in controllability and authenticity. To bridge this gap, we propose SurgSora, a motion-controllable surgical video generation framework that uses a single input frame and user-controllable motion cues. SurgSora consists of three key modules: the Dual Semantic Injector (DSI), which extracts object-relevant RGB and depth features from the input frame and integrates them with segmentation cues to capture detailed spatial features of complex anatomical structures; the Decoupled Flow Mapper (DFM), which fuses optical flow with semantic-RGB-D features at multiple scales to enhance temporal understanding and object spatial dynamics; and the Trajectory Controller (TC), which allows users to specify motion directions and estimates sparse optical flow, guiding the video generation process. The fused features are used as conditions for a frozen Stable Diffusion model to produce realistic, temporally coherent surgical videos. Extensive evaluations demonstrate that SurgSora outperforms state-of-the-art methods in controllability and authenticity, showing its potential to advance surgical video generation for medical education, training, and research.

Computed tomography and magnetic resonance imaging are two widely used clinical imaging modalities for non-invasive diagnosis. However, both of these modalities come with certain problems. CT uses harmful ionising radiation, and MRI suffers from slow acquisition speed. Both problems can be tackled by undersampling, such as sparse sampling. However, such undersampled data leads to lower resolution and introduces artefacts. Several techniques, including deep learning based methods, have been proposed to reconstruct such data. However, the undersampled reconstruction problem for these two modalities was always considered as two different problems and tackled separately by different research works. This paper proposes a unified solution for both sparse CT and undersampled radial MRI reconstruction, achieved by applying Fourier transform-based pre-processing on the radial MRI and then finally reconstructing both modalities using sinogram upsampling combined with filtered back-projection. The Primal-Dual network is a deep learning based method for reconstructing sparsely-sampled CT data. This paper introduces Primal-Dual UNet, which improves the Primal-Dual network in terms of accuracy and reconstruction speed. The proposed method resulted in an average SSIM of 0.932\textpm0.021 while performing sparse CT reconstruction for fan-beam geometry with a sparsity level of 16, achieving a statistically significant improvement over the previous model, which resulted in 0.919\textpm0.016. Furthermore, the proposed model resulted in 0.903\textpm0.019 and 0.957\textpm0.023 average SSIM while reconstructing undersampled brain and abdominal MRI data with an acceleration factor of 16, respectively - statistically significant improvements over the original model, which resulted in 0.867\textpm0.025 and 0.949\textpm0.025.

A digital twin is a virtual replica of a real-world physical phenomena that uses mathematical modeling to characterize and simulate its defining features. By constructing digital twins for disease processes, we can perform in-silico simulations that mimic patients' health conditions and counterfactual outcomes under hypothetical interventions in a virtual setting. This eliminates the need for invasive procedures or uncertain treatment decisions. In this paper, we propose a method to identify digital twin model parameters using only noninvasive patient health data. We approach the digital twin modeling as a composite inverse problem, and observe that its structure resembles pretraining and finetuning in self-supervised learning (SSL). Leveraging this, we introduce a physics-informed SSL algorithm that initially pretrains a neural network on the pretext task of solving the physical model equations. Subsequently, the model is trained to reconstruct low-dimensional health measurements from noninvasive modalities while being constrained by the physical equations learned in pretraining. We apply our method to identify digital twins of cardiac hemodynamics using noninvasive echocardiogram videos, and demonstrate its utility in unsupervised disease detection and in-silico clinical trials.

Purpose: Surgical performance depends not only on surgeons' technical skills but also on team communication within and across the different professional groups present during the operation. Therefore, automatically identifying team communication in the OR is crucial for patient safety and advances in the development of computer-assisted surgical workflow analysis and intra-operative support systems. To take the first step, we propose a new task of detecting communication briefings involving all OR team members, i.e. the team Time-out and the StOP?-protocol, by localizing their start and end times in video recordings of surgical operations. Methods: We generate an OR dataset of real surgeries, called Team-OR, with more than one hundred hours of surgical videos captured by the multi-view camera system in the OR. The dataset contains temporal annotations of 33 Time-out and 22 StOP?-protocol activities in total. We then propose a novel group activity detection approach, where we encode both scene context and action features, and use an efficient neural network model to output the results. Results: The experimental results on the Team-OR dataset show that our approach outperforms existing state-of-the-art temporal action detection approaches. It also demonstrates the lack of research on group activities in the OR, proving the significance of our dataset. Conclusion: We investigate the Team Time-Out and the StOP?-protocol in the OR, by presenting the first OR dataset with temporal annotations of group activities protocols, and introducing a novel group activity detection approach that outperforms existing approaches. Code is available at https://github.com/CAMMA-public/Team-OR.

Reconstructing medical images from partial measurements is an important inverse problem in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Existing solutions based on machine learning typically train a model to directly map measurements to medical images, leveraging a training dataset of paired images and measurements. These measurements are typically synthesized from images using a fixed physical model of the measurement process, which hinders the generalization capability of models to unknown measurement processes. To address this issue, we propose a fully unsupervised technique for inverse problem solving, leveraging the recently introduced score-based generative models. Specifically, we first train a score-based generative model on medical images to capture their prior distribution. Given measurements and a physical model of the measurement process at test time, we introduce a sampling method to reconstruct an image consistent with both the prior and the observed measurements. Our method does not assume a fixed measurement process during training, and can thus be flexibly adapted to different measurement processes at test time. Empirically, we observe comparable or better performance to supervised learning techniques in several medical imaging tasks in CT and MRI, while demonstrating significantly better generalization to unknown measurement processes.

Gastrointestinal (GI) diseases represent a clinically significant burden, necessitating precise diagnostic approaches to optimize patient outcomes. Conventional histopathological diagnosis suffers from limited reproducibility and diagnostic variability. To overcome these limitations, we develop Digepath, a specialized foundation model for GI pathology. Our framework introduces a dual-phase iterative optimization strategy combining pretraining with fine-screening, specifically designed to address the detection of sparsely distributed lesion areas in whole-slide images. Digepath is pretrained on over 353 million multi-scale images from 210,043 H&E-stained slides of GI diseases. It attains state-of-the-art performance on 33 out of 34 tasks related to GI pathology, including pathological diagnosis, protein expression status prediction, gene mutation prediction, and prognosis evaluation. We further translate the intelligent screening module for early GI cancer and achieve near-perfect 99.70% sensitivity across nine independent medical institutions. This work not only advances AI-driven precision pathology for GI diseases but also bridge critical gaps in histopathological practice.

The digitization of medical records ushered in a new era of big data to clinical science, and with it the possibility that data could be shared, to multiply insights beyond what investigators could abstract from paper records. The need to share individual-level medical data to accelerate innovation in precision medicine continues to grow, and has never been more urgent, as scientists grapple with the COVID-19 pandemic. However, enthusiasm for the use of big data has been tempered by a fully appropriate concern for patient autonomy and privacy. That is, the ability to extract private or confidential information about an individual, in practice, renders it difficult to share data, since significant infrastructure and data governance must be established before data can be shared. Although HIPAA provided de-identification as an approved mechanism for data sharing, linkage attacks were identified as a major vulnerability. A variety of mechanisms have been established to avoid leaking private information, such as field suppression or abstraction, strictly limiting the amount of information that can be shared, or employing mathematical techniques such as differential privacy. Another approach, which we focus on here, is creating synthetic data that mimics the underlying data. For synthetic data to be a useful mechanism in support of medical innovation and a proxy for real-world evidence, one must demonstrate two properties of the synthetic dataset: (1) any analysis on the real data must be matched by analysis of the synthetic data (statistical fidelity) and (2) the synthetic data must preserve privacy, with minimal risk of re-identification (privacy guarantee). In this paper we propose a framework for quantifying the statistical fidelity and privacy preservation properties of synthetic datasets and demonstrate these metrics for synthetic data generated by Syntegra technology.

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at https://medagentsim.netlify.app/.

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

Medical imaging is critical for diagnostics, but clinical adoption of advanced AI-driven imaging faces challenges due to patient variability, image artifacts, and limited model generalization. While deep learning has transformed image analysis, 3D medical imaging still suffers from data scarcity and inconsistencies due to acquisition protocols, scanner differences, and patient motion. Traditional augmentation uses a single pipeline for all transformations, disregarding the unique traits of each augmentation and struggling with large data volumes. To address these challenges, we propose a Multi-encoder Augmentation-Aware Learning (MEAL) framework that leverages four distinct augmentation variants processed through dedicated encoders. Three fusion strategies such as concatenation (CC), fusion layer (FL), and adaptive controller block (BD) are integrated to build multi-encoder models that combine augmentation-specific features before decoding. MEAL-BD uniquely preserves augmentation-aware representations, enabling robust, protocol-invariant feature learning. As demonstrated in a Computed Tomography (CT)-to-T1-weighted Magnetic Resonance Imaging (MRI) translation study, MEAL-BD consistently achieved the best performance on both unseen- and predefined-test data. On both geometric transformations (like rotations and flips) and non-augmented inputs, MEAL-BD outperformed other competing methods, achieving higher mean peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) scores. These results establish MEAL as a reliable framework for preserving structural fidelity and generalizing across clinically relevant variability. By reframing augmentation as a source of diverse, generalizable features, MEAL supports robust, protocol-invariant learning, advancing clinically reliable medical imaging solutions.

Longitudinal multimodal data, including electronic health records (EHR) and sequential chest X-rays (CXRs), is critical for modeling disease progression, yet remains underutilized due to two key challenges: (1) redundancy in consecutive CXR sequences, where static anatomical regions dominate over clinically-meaningful dynamics, and (2) temporal misalignment between sparse, irregular imaging and continuous EHR data. We introduce DiPro, a novel framework that addresses these challenges through region-aware disentanglement and multi-timescale alignment. First, we disentangle static (anatomy) and dynamic (pathology progression) features in sequential CXRs, prioritizing disease-relevant changes. Second, we hierarchically align these static and dynamic CXR features with asynchronous EHR data via local (pairwise interval-level) and global (full-sequence) synchronization to model coherent progression pathways. Extensive experiments on the MIMIC dataset demonstrate that DiPro could effectively extract temporal clinical dynamics and achieve state-of-the-art performance on both disease progression identification and general ICU prediction tasks.

Unified Multimodal Generative Models (UMGMs) unify visual understanding and image generation within a single autoregressive framework. However, their ability to continually learn new tasks is severely hindered by catastrophic forgetting, both within a modality (intra-modal) and across modalities (inter-modal). While intra-modal forgetting has been studied in prior continual learning (CL) work, inter-modal forgetting remains largely unexplored. In this paper, we identify and empirically validate this phenomenon in UMGMs and provide a theoretical explanation rooted in gradient conflict between modalities. To address both intra- and inter-modal forgetting, we propose Modality-Decoupled Experts (MoDE), a lightweight and scalable architecture that isolates modality-specific updates to mitigate the gradient conflict and leverages knowledge distillation to prevent catastrophic forgetting and preserve pre-trained capabilities. Unlike previous CL methods that remain modality-coupled and suffer from modality gradient conflict, MoDE explicitly decouples modalities to prevent interference. Experiments across diverse benchmarks demonstrate that MoDE significantly mitigates both inter- and intra-modal forgetting, outperforming prior CL baselines in unified multimodal generation settings. Codes will be publicly available: https://github.com/Christina200/MoDE-official.git

Dynamic imaging is a beneficial tool for interventions to assess physiological changes. Nonetheless during dynamic MRI, while achieving a high temporal resolution, the spatial resolution is compromised. To overcome this spatio-temporal trade-off, this research presents a super-resolution (SR) MRI reconstruction with prior knowledge based fine-tuning to maximise spatial information while reducing the required scan-time for dynamic MRIs. An U-Net based network with perceptual loss is trained on a benchmark dataset and fine-tuned using one subject-specific static high resolution MRI as prior knowledge to obtain high resolution dynamic images during the inference stage. 3D dynamic data for three subjects were acquired with different parameters to test the generalisation capabilities of the network. The method was tested for different levels of in-plane undersampling for dynamic MRI. The reconstructed dynamic SR results after fine-tuning showed higher similarity with the high resolution ground-truth, while quantitatively achieving statistically significant improvement. The average SSIM of the lowest resolution experimented during this research (6.25~\% of the k-space) before and after fine-tuning were 0.939 pm 0.008 and 0.957 pm 0.006 respectively. This could theoretically result in an acceleration factor of 16, which can potentially be acquired in less than half a second. The proposed approach shows that the super-resolution MRI reconstruction with prior-information can alleviate the spatio-temporal trade-off in dynamic MRI, even for high acceleration factors.

While the concept of entanglement purification protocols (EPPs) is straightforward, the integration of EPPs in network architectures requires careful performance evaluations and optimizations that take into account realistic conditions and imperfections, especially probabilistic entanglement generation and quantum memory decoherence. It is important to understand what is guaranteed to be improved from successful EPP with arbitrary non-identical input, which determines whether we want to perform the EPP at all. When successful EPP can offer improvement, the time to perform the EPP should also be optimized to maximize the improvement. In this work, we study the guaranteed improvement and optimal time for the CNOT-based recurrence EPP, previously shown to be optimal in various scenarios. We firstly prove guaranteed improvement for multiple figures of merit, including fidelity and several entanglement measures when compared to practical baselines as functions of input states. However, it is noteworthy that the guaranteed improvement we prove does not imply the universality of the EPP as introduced in arXiv:2407.21760. Then we prove robust, parameter-independent optimal time for typical error models and figures of merit. We further explore memory decoherence described by continuous-time Pauli channels, and demonstrate the phenomenon of optimal time transition when the memory decoherence error pattern changes. Our work deepens the understanding of EPP performance in realistic scenarios and offers insights into optimizing quantum networks that integrate EPPs.

Deep learning for medical imaging is hampered by task-specific models that lack generalizability and prognostic capabilities, while existing 'universal' approaches suffer from simplistic conditioning and poor medical semantic understanding. To address these limitations, we introduce DuPLUS, a deep learning framework for efficient multi-modal medical image analysis. DuPLUS introduces a novel vision-language framework that leverages hierarchical semantic prompts for fine-grained control over the analysis task, a capability absent in prior universal models. To enable extensibility to other medical tasks, it includes a hierarchical, text-controlled architecture driven by a unique dual-prompt mechanism. For segmentation, DuPLUS is able to generalize across three imaging modalities, ten different anatomically various medical datasets, encompassing more than 30 organs and tumor types. It outperforms the state-of-the-art task specific and universal models on 8 out of 10 datasets. We demonstrate extensibility of its text-controlled architecture by seamless integration of electronic health record (EHR) data for prognosis prediction, and on a head and neck cancer dataset, DuPLUS achieved a Concordance Index (CI) of 0.69. Parameter-efficient fine-tuning enables rapid adaptation to new tasks and modalities from varying centers, establishing DuPLUS as a versatile and clinically relevant solution for medical image analysis. The code for this work is made available at: https://anonymous.4open.science/r/DuPLUS-6C52

Non-ideal measurement computed tomography (NICT), which sacrifices optimal imaging standards for new advantages in CT imaging, is expanding the clinical application scope of CT images. However, with the reduction of imaging standards, the image quality has also been reduced, extremely limiting the clinical acceptability. Although numerous studies have demonstrated the feasibility of deep learning for the NICT enhancement in specific scenarios, their high data cost and limited generalizability have become large obstacles. The recent research on the foundation model has brought new opportunities for building a universal NICT enhancement model - bridging the image quality degradation with minimal data cost. However, owing to the challenges in the collection of large pre-training datasets and the compatibility of data variation, no success has been reported. In this paper, we propose a multi-scale integrated Transformer AMPlifier (TAMP), the first imaging foundation model for universal NICT enhancement. It has been pre-trained on a large-scale physical-driven simulation dataset with 3.6 million NICT-ICT image pairs, and is able to directly generalize to the NICT enhancement tasks with various non-ideal settings and body regions. Via the adaptation with few data, it can further achieve professional performance in real-world specific scenarios. Our extensive experiments have demonstrated that the proposed TAMP has significant potential for promoting the exploration and application of NICT and serving a wider range of medical scenarios.

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

Bayesian parameter inference is useful to improve Li-ion battery diagnostics and can help formulate battery aging models. However, it is computationally intensive and cannot be easily repeated for multiple cycles, multiple operating conditions, or multiple replicate cells. To reduce the computational cost of Bayesian calibration, numerical solvers for physics-based models can be replaced with faster surrogates. A physics-informed neural network (PINN) is developed as a surrogate for the pseudo-2D (P2D) battery model calibration. For the P2D surrogate, additional training regularization was needed as compared to the PINN single-particle model (SPM) developed in Part I. Both the PINN SPM and P2D surrogate models are exercised for parameter inference and compared to data obtained from a direct numerical solution of the governing equations. A parameter inference study highlights the ability to use these PINNs to calibrate scaling parameters for the cathode Li diffusion and the anode exchange current density. By realizing computational speed-ups of 2250x for the P2D model, as compared to using standard integrating methods, the PINN surrogates enable rapid state-of-health diagnostics. In the low-data availability scenario, the testing error was estimated to 2mV for the SPM surrogate and 10mV for the P2D surrogate which could be mitigated with additional data.

Real-world Super-Resolution (Real-SR) methods focus on dealing with diverse real-world images and have attracted increasing attention in recent years. The key idea is to use a complex and high-order degradation model to mimic real-world degradations. Although they have achieved impressive results in various scenarios, they are faced with the obstacle of evaluation. Currently, these methods are only assessed by their average performance on a small set of degradation cases randomly selected from a large space, which fails to provide a comprehensive understanding of their overall performance and often yields inconsistent and potentially misleading results. To overcome the limitation in evaluation, we propose SEAL, a framework for systematic evaluation of real-SR. In particular, we cluster the extensive degradation space to create a set of representative degradation cases, which serves as a comprehensive test set. Next, we propose a coarse-to-fine evaluation protocol to measure the distributed and relative performance of real-SR methods on the test set. The protocol incorporates two new metrics: acceptance rate (AR) and relative performance ratio (RPR), derived from acceptance and excellence lines. Under SEAL, we benchmark existing real-SR methods, obtain new observations and insights into their performance, and develop a new strong baseline. We consider SEAL as the first step towards creating a comprehensive real-SR evaluation platform, which can promote the development of real-SR. The source code is available at https://github.com/XPixelGroup/SEAL

Large language models (LLMs) are increasingly adept at following instructions containing task descriptions to solve complex problems, such as mathematical reasoning and automatic evaluation (LLM-as-a-Judge). However, as prompts grow more complex, models often struggle to adhere to all instructions. This difficulty is especially common when instructive prompts intertwine reasoning directives -- specifying what the model should solve -- with rigid formatting requirements that dictate how the solution must be presented. The entanglement creates competing goals for the model, suggesting that more explicit separation of these two aspects could lead to improved performance. To this front, we introduce Deco-G, a decoding framework that explicitly decouples format adherence from task solving. Deco-G handles format compliance with a separate tractable probabilistic model (TPM), while prompts LLMs with only task instructions. At each decoding step, Deco-G combines next token probabilities from the LLM with the TPM calculated format compliance likelihood to form the output probability. To make this approach both practical and scalable for modern instruction-tuned LLMs, we introduce three key innovations: instruction-aware distillation, a flexible trie-building algorithm, and HMM state pruning for computational efficiency. We demonstrate the effectiveness of Deco-G across a wide range of tasks with diverse format requirements, including mathematical reasoning, LLM-as-a-judge, and event argument extraction. Overall, our approach yields 1.0% to 6.0% relative gain over regular prompting practice with guaranteed format compliance.

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

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.

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

KonfAI is a modular, extensible, and fully configurable deep learning framework specifically designed for medical imaging tasks. It enables users to define complete training, inference, and evaluation workflows through structured YAML configuration files, without modifying the underlying code. This declarative approach enhances reproducibility, transparency, and experimental traceability while reducing development time. Beyond the capabilities of standard pipelines, KonfAI provides native abstractions for advanced strategies including patch-based learning, test-time augmentation, model ensembling, and direct access to intermediate feature representations for deep supervision. It also supports complex multi-model training setups such as generative adversarial architectures. Thanks to its modular and extensible architecture, KonfAI can easily accommodate custom models, loss functions, and data processing components. The framework has been successfully applied to segmentation, registration, and image synthesis tasks, and has contributed to top-ranking results in several international medical imaging challenges. KonfAI is open source and available at https://github.com/vboussot/KonfAI{https://github.com/vboussot/KonfAI}.

Artificial intelligence has significantly advanced healthcare, particularly through large language models (LLMs) that excel in medical question answering benchmarks. However, their real-world clinical application remains limited due to the complexities of doctor-patient interactions. To address this, we introduce AI Hospital, a multi-agent framework simulating dynamic medical interactions between Doctor as player and NPCs including Patient, Examiner, Chief Physician. This setup allows for realistic assessments of LLMs in clinical scenarios. We develop the Multi-View Medical Evaluation (MVME) benchmark, utilizing high-quality Chinese medical records and NPCs to evaluate LLMs' performance in symptom collection, examination recommendations, and diagnoses. Additionally, a dispute resolution collaborative mechanism is proposed to enhance diagnostic accuracy through iterative discussions. Despite improvements, current LLMs exhibit significant performance gaps in multi-turn interactions compared to one-step approaches. Our findings highlight the need for further research to bridge these gaps and improve LLMs' clinical diagnostic capabilities. Our data, code, and experimental results are all open-sourced at https://github.com/LibertFan/AI_Hospital.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

The escalating complexity of modern software imposes an unsustainable operational burden on Site Reliability Engineering (SRE) teams, demanding AI-driven automation that can emulate expert diagnostic reasoning. Existing solutions, from traditional AI methods to general-purpose multi-agent systems, fall short: they either lack deep causal reasoning or are not tailored for the specialized, investigative workflows unique to SRE. To address this gap, we present OpenDerisk, a specialized, open-source multi-agent framework architected for SRE. OpenDerisk integrates a diagnostic-native collaboration model, a pluggable reasoning engine, a knowledge engine, and a standardized protocol (MCP) to enable specialist agents to collectively solve complex, multi-domain problems. Our comprehensive evaluation demonstrates that OpenDerisk significantly outperforms state-of-the-art baselines in both accuracy and efficiency. This effectiveness is validated by its large-scale production deployment at Ant Group, where it serves over 3,000 daily users across diverse scenarios, confirming its industrial-grade scalability and practical impact. OpenDerisk is open source and available at https://github.com/derisk-ai/OpenDerisk/

Case definitions are essential for effectively communicating public health threats. However, the absence of a standardized, machine-readable format poses significant challenges to interoperability, epidemiological research, the exchange of qualitative data, and the effective application of computational analysis methods, including artificial intelligence (AI). This complicates comparisons and collaborations across organizations and regions, limits data integration, and hinders technological innovation in public health. To address these issues, we propose the first open, machine-readable format for representing case and syndrome definitions. Additionally, we introduce the first comprehensive dataset of standardized case definitions and tools to convert existing human-readable definitions into machine-readable formats. We also provide an accessible online platform for browsing, analyzing, and contributing new definitions, available at https://opensyndrome.org. The Open Syndrome Definition format enables consistent, scalable use of case definitions across systems, unlocking AI's potential to strengthen public health preparedness and response. The source code for the format can be found at https://github.com/OpenSyndrome/schema under the MIT license.

The foundation of reproducible science lies in protocols that are precise, logically ordered, and executable. The autonomous generation of these protocols through natural language queries could greatly improve the efficiency of the reproduction process. However, current leading large language models (LLMs) often generate incomplete or inconsistent protocols, limiting their utility. To address this limitation, we first introduce SciRecipe, a large-scale dataset of over 12K structured protocols spanning 27 biological subfields and encompassing both comprehension and problem-solving tasks. To further improve protocol generation, we propose the "Sketch-and-Fill" paradigm, which separates analysis, structuring, and expression to ensure each step is explicit and verifiable. Complementing this, the structured component-based reward mechanism evaluates step granularity, action order, and semantic fidelity, aligning model optimization with experimental reliability. Building on these components, we develop Thoth, trained through a staged Knowledge-to-Action process that progresses from knowledge acquisition to operational reasoning and ultimately to robust, executable protocol generation. Across multiple benchmarks, Thoth consistently surpasses both proprietary and open-source LLMs, achieving significant improvements in step alignment, logical sequencing, and semantic accuracy. Our approach paves the way for reliable scientific assistants that bridge knowledge with experimental execution. All data, code, and models will be released publicly.

A complex system with cluttered observations may be a coupled mixture of multiple simple sub-systems corresponding to latent entities. Such sub-systems may hold distinct dynamics in the continuous-time domain; therein, complicated interactions between sub-systems also evolve over time. This setting is fairly common in the real world but has been less considered. In this paper, we propose a sequential learning approach under this setting by decoupling a complex system for handling irregularly sampled and cluttered sequential observations. Such decoupling brings about not only subsystems describing the dynamics of each latent entity but also a meta-system capturing the interaction between entities over time. Specifically, we argue that the meta-system evolving within a simplex is governed by projected differential equations (ProjDEs). We further analyze and provide neural-friendly projection operators in the context of Bregman divergence. Experimental results on synthetic and real-world datasets show the advantages of our approach when facing complex and cluttered sequential data compared to the state-of-the-art.

Accurate classification of computed tomography (CT) images is essential for diagnosis and treatment planning, but existing methods often struggle with the subtle and spatially diverse nature of pathological features. Current approaches typically process images uniformly, limiting their ability to detect localized abnormalities that require focused analysis. We introduce UGPL, an uncertainty-guided progressive learning framework that performs a global-to-local analysis by first identifying regions of diagnostic ambiguity and then conducting detailed examination of these critical areas. Our approach employs evidential deep learning to quantify predictive uncertainty, guiding the extraction of informative patches through a non-maximum suppression mechanism that maintains spatial diversity. This progressive refinement strategy, combined with an adaptive fusion mechanism, enables UGPL to integrate both contextual information and fine-grained details. Experiments across three CT datasets demonstrate that UGPL consistently outperforms state-of-the-art methods, achieving improvements of 3.29%, 2.46%, and 8.08% in accuracy for kidney abnormality, lung cancer, and COVID-19 detection, respectively. Our analysis shows that the uncertainty-guided component provides substantial benefits, with performance dramatically increasing when the full progressive learning pipeline is implemented. Our code is available at: https://github.com/shravan-18/UGPL

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

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.

Current Vision-Language Models (VLMs) struggle to ground anatomical regions in 3D medical images and reason about them in a step-by-step manner, a key requirement of real-world diagnostic assessment. This ability is essential for aligning model outputs with the diagnostic workflows clinicians use in practice, enabling trustworthy clinician-AI collaboration. Existing 3D datasets provide localization labels, but none support this "grounded reasoning" ability. To address this gap, we introduce 3DReasonKnee, the first 3D grounded reasoning dataset for medical images, which provides 494k high-quality quintuples derived from 7,970 3D knee MRI volumes. Each quintuple includes: (1) the 3D MRI volume, (2) a diagnostic question targeting a specific anatomical region (3) a 3D bounding box localizing the relevant anatomical structures, (4) clinician-generated diagnostic reasoning steps that explicitly detail the 3D reasoning process, and (5) structured severity assessments for the relevant anatomical region. The creation and validation of 3DReasonKnee, involving over 450 hours of expert clinician time for manually segmenting MRIs and generating reasoning chains, ensures its superior quality and clinical relevance. We establish ReasonKnee-Bench to evaluate localization and diagnostic accuracy, providing insight into VLM ability to perform grounding and severity assessment across anatomical regions and diagnostic inquiries. We benchmark five state-of-the-art VLMs, providing baseline performance for ReasonKnee-Bench. By providing this unique resource of expert-annotated 3D reasoning pathways, 3DReasonKnee serves as a repository of orthopedic surgeons' diagnostic expertise and offers a vital testbed for advancing multimodal medical AI systems towards 3D, clinically aligned, localized decision-making capabilities. The dataset can be found in: https://huggingface.co/datasets/rajpurkarlab/3DReasonKnee

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.

Independence testing is a fundamental and classical statistical problem that has been extensively studied in the batch setting when one fixes the sample size before collecting data. However, practitioners often prefer procedures that adapt to the complexity of a problem at hand instead of setting sample size in advance. Ideally, such procedures should (a) allow stopping earlier on easy tasks (and later on harder tasks), hence making better use of available resources, and (b) continuously monitor the data and efficiently incorporate statistical evidence after collecting new data, while controlling the false alarm rate. It is well known that classical batch tests are not tailored for streaming data settings: valid inference after data peeking requires correcting for multiple testing but such corrections generally result in low power. Following the principle of testing by betting, we design sequential kernelized independence tests (SKITs) that overcome such shortcomings. We exemplify our broad framework using bets inspired by kernelized dependence measures, e.g, the Hilbert-Schmidt independence criterion. Our test is valid under non-i.i.d. time-varying settings, for which there exist no batch tests. We demonstrate the power of our approaches on both simulated and real data.

Recent works on text-to-3d generation show that using only 2D diffusion supervision for 3D generation tends to produce results with inconsistent appearances (e.g., faces on the back view) and inaccurate shapes (e.g., animals with extra legs). Existing methods mainly address this issue by retraining diffusion models with images rendered from 3D data to ensure multi-view consistency while struggling to balance 2D generation quality with 3D consistency. In this paper, we present a new framework Sculpt3D that equips the current pipeline with explicit injection of 3D priors from retrieved reference objects without re-training the 2D diffusion model. Specifically, we demonstrate that high-quality and diverse 3D geometry can be guaranteed by keypoints supervision through a sparse ray sampling approach. Moreover, to ensure accurate appearances of different views, we further modulate the output of the 2D diffusion model to the correct patterns of the template views without altering the generated object's style. These two decoupled designs effectively harness 3D information from reference objects to generate 3D objects while preserving the generation quality of the 2D diffusion model. Extensive experiments show our method can largely improve the multi-view consistency while retaining fidelity and diversity. Our project page is available at: https://stellarcheng.github.io/Sculpt3D/.

This paper aims to bring fine-grained expression control to identity-preserving portrait generation. Existing methods tend to synthesize portraits with either neutral or stereotypical expressions. Even when supplemented with control signals like facial landmarks, these models struggle to generate accurate and vivid expressions following user instructions. To solve this, we introduce EmojiDiff, an end-to-end solution to facilitate simultaneous dual control of fine expression and identity. Unlike the conventional methods using coarse control signals, our method directly accepts RGB expression images as input templates to provide extremely accurate and fine-grained expression control in the diffusion process. As its core, an innovative decoupled scheme is proposed to disentangle expression features in the expression template from other extraneous information, such as identity, skin, and style. On one hand, we introduce ID-irrelevant Data Iteration (IDI) to synthesize extremely high-quality cross-identity expression pairs for decoupled training, which is the crucial foundation to filter out identity information hidden in the expressions. On the other hand, we meticulously investigate network layer function and select expression-sensitive layers to inject reference expression features, effectively preventing style leakage from expression signals. To further improve identity fidelity, we propose a novel fine-tuning strategy named ID-enhanced Contrast Alignment (ICA), which eliminates the negative impact of expression control on original identity preservation. Experimental results demonstrate that our method remarkably outperforms counterparts, achieves precise expression control with highly maintained identity, and generalizes well to various diffusion models.