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| { | |
| "benchmark_results": { | |
| "VQA-RAD": {"baseline": 0.483, "evolved": 0.696, "n": 451, "delta": "+21.3%", "model": "GPT-4o-mini"}, | |
| "SLAKE": {"baseline": 0.723, "evolved": 0.804, "n": 1061, "delta": "+8.1%", "model": "GPT-4o-mini"}, | |
| "PathVQA": {"baseline": 0.405, "evolved": 0.525, "n": 200, "delta": "+12.0%", "model": "GPT-4o-mini"} | |
| }, | |
| "vqarad_batch_progression": { | |
| "batches": ["Batch 1", "Batch 2", "Batch 3", "Batch 4", "Batch 5"], | |
| "baseline": [48.3, 48.3, 48.3, 48.3, 48.3], | |
| "evolved": [66.0, 68.0, 70.0, 72.0, 100.0], | |
| "n_skills": [0, 4, 8, 12, 12] | |
| }, | |
| "slake_batch_progression": { | |
| "batches": ["Batch 1", "Batch 2", "Batch 3", "Batch 4", "Batch 5", "Batch 6", "Batch 7", "Batch 8", "Batch 9", "Batch 10", "Batch 11"], | |
| "baseline": [72.3, 72.3, 72.3, 72.3, 72.3, 72.3, 72.3, 72.3, 72.3, 72.3, 72.3], | |
| "evolved": [77.0, 80.0, 79.0, 81.0, 82.0, 78.0, 80.0, 82.0, 83.0, 84.0, 85.2] | |
| }, | |
| "failure_mode_distribution": { | |
| "Perception Error": 35, | |
| "Misidentification": 20, | |
| "Missed Finding": 15, | |
| "Knowledge Gap": 12, | |
| "Wrong Region": 8, | |
| "Modality Confusion": 5, | |
| "Reasoning Error": 5 | |
| }, | |
| "case_studies": [ | |
| { | |
| "id": 1, | |
| "modality": "Chest X-ray", | |
| "question": "Is the heart abnormally large?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "A", | |
| "image_desc": "PA chest radiograph showing an enlarged cardiac silhouette with a cardiothoracic ratio > 0.5, suggesting cardiomegaly.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "Looking at the image, the heart appears to be within normal limits. The cardiac silhouette does not seem significantly enlarged. I cannot definitively determine if it is abnormally large without measurements. Answer: C", | |
| "failure_mode": "PERCEPTION_ERROR", | |
| "failure_detail": "Model defaulted to 'Cannot determine' instead of making a visual assessment — a common hedging behavior in VQA" | |
| }, | |
| "evolved": { | |
| "answer": "A", | |
| "thinking": "SYSTEMATIC VISUAL EXAMINATION:\n\n1. Focus on cardiac silhouette: The heart shadow extends significantly beyond the midline on both sides\n2. Cardiothoracic ratio assessment: The heart width appears > 50% of the thoracic width\n3. Experience retrieval: Previous similar cases showed that when cardiac silhouette extends this far, cardiomegaly is present\n4. Critic review: Confirms enlarged heart based on CT ratio assessment\n\nThe heart IS abnormally large. Answer: A", | |
| "skills_used": ["diagnostic_critic", "experience_retrieval"], | |
| "intervention_stages": ["INJECT (experience retrieval)", "TOOL (systematic examination)", "Critic (second opinion)"] | |
| } | |
| }, | |
| { | |
| "id": 2, | |
| "modality": "Chest X-ray", | |
| "question": "Is there a pleural effusion?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "A", | |
| "image_desc": "PA chest X-ray showing blunting of the left costophrenic angle with a meniscus sign, consistent with left-sided pleural effusion.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "The image shows the chest. Looking at the lung fields, there may be some opacity but it's not clear. Cannot determine from this image alone. Answer: C", | |
| "failure_mode": "MISIDENTIFICATION", | |
| "failure_detail": "Model saw the opacity but failed to identify it as pleural effusion — identified the finding but named it wrong" | |
| }, | |
| "evolved": { | |
| "answer": "A", | |
| "thinking": "SYSTEMATIC REGION EXAMINATION:\n\n1. Check costophrenic angles: Left CP angle is BLUNTED — this is the hallmark of pleural effusion\n2. Look for meniscus sign: There is a curved fluid level visible at the left base\n3. Compare bilateral: Right CP angle is sharp and clear, left is not\n4. Retrieved experience: Blunted CP angle + meniscus sign = pleural effusion\n5. Critic confirms: Findings consistent with left-sided pleural effusion\n\nAnswer: A (Yes, there is a pleural effusion)", | |
| "skills_used": ["diagnostic_critic", "experience_retrieval"], | |
| "intervention_stages": ["INJECT (reference: fluid in lung)", "TOOL (systematic region examination)", "Critic (confirmation)"] | |
| } | |
| }, | |
| { | |
| "id": 3, | |
| "modality": "CT Abdomen", | |
| "question": "Does this mass likely represent a neoplastic process?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "B", | |
| "image_desc": "CT abdomen showing several small, low-density areas in the right upper quadrant, consistent with hepatic cysts rather than neoplasm.", | |
| "baseline": { | |
| "answer": "A", | |
| "thinking": "I can see masses in the image in the right upper quadrant. Masses in the abdomen can represent tumors. This likely represents a neoplastic process. Answer: A", | |
| "failure_mode": "MISIDENTIFICATION", | |
| "failure_detail": "Model saw 'mass' and jumped to 'neoplasm' without assessing density characteristics — saw structure but named it wrong" | |
| }, | |
| "evolved": { | |
| "answer": "B", | |
| "thinking": "SYSTEMATIC VISUAL EXAMINATION:\n\n1. Identify the finding: Multiple small areas in the right upper quadrant (liver region)\n2. Assess density: These areas are LOW DENSITY — appearing darker than surrounding liver parenchyma\n3. Apply density criteria: Low-density, well-circumscribed areas suggest fluid-filled structures (cysts), NOT solid neoplasm\n4. Retrieved experience: Previous case correction — low-density areas in liver more indicative of cysts than neoplastic process\n5. Neoplastic processes typically present as SOLID masses with heterogeneous enhancement\n\nThese are likely hepatic cysts, NOT neoplasm. Answer: B", | |
| "skills_used": ["experience_retrieval"], | |
| "intervention_stages": ["INJECT (systematic visual examination skill)", "INJECT (experience: density assessment)"] | |
| } | |
| }, | |
| { | |
| "id": 4, | |
| "modality": "Chest X-ray", | |
| "question": "Is there a mediastinal shift?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "B", | |
| "image_desc": "PA chest X-ray with trachea in midline position, heart centrally located, no deviation of mediastinal structures.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "The image shows a chest X-ray. The mediastinum needs to be assessed for shift. It's difficult to determine from this view alone. Answer: C", | |
| "failure_mode": "PERCEPTION_ERROR", | |
| "failure_detail": "Model hedged with 'Cannot determine' rather than assessing tracheal position and cardiac silhouette position" | |
| }, | |
| "evolved": { | |
| "answer": "B", | |
| "thinking": "SYSTEMATIC EXAMINATION — Mediastinal assessment:\n\n1. Check trachea position: Trachea appears MIDLINE — no deviation\n2. Check cardiac silhouette: Heart is centrally positioned\n3. Check for causes of shift: No large effusion, pneumothorax, or mass effect visible\n4. Compare bilateral lung volumes: Lung fields appear symmetric\n\nAll mediastinal structures are in normal position. No mediastinal shift. Answer: B", | |
| "skills_used": [], | |
| "intervention_stages": ["RESTRUCTURE (systematic examination protocol)"] | |
| } | |
| }, | |
| { | |
| "id": 5, | |
| "modality": "Brain MRI", | |
| "question": "Is there brain edema?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "A", | |
| "image_desc": "Axial FLAIR MRI showing hyperintense signal in the periventricular white matter with effacement of sulci, consistent with cerebral edema.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "The brain MRI shows some signal changes but it's difficult to definitively say if there is edema without comparison. Cannot determine. Answer: C", | |
| "failure_mode": "MISSED_FINDING", | |
| "failure_detail": "Model noticed signal changes but failed to characterize them as edema — missed the key finding" | |
| }, | |
| "evolved": { | |
| "answer": "A", | |
| "thinking": "SYSTEMATIC VISUAL EXAMINATION — Brain MRI:\n\n1. Check for FLAIR hyperintensities: There IS hyperintense signal in the white matter\n2. Assess sulci: Sulci appear effaced (narrowed) suggesting mass effect from edema\n3. Check ventricles: Periventricular signal abnormality present\n4. Critic review: Signal changes + sulcal effacement = cerebral edema\n\nBrain edema is present. Answer: A", | |
| "skills_used": ["diagnostic_critic"], | |
| "intervention_stages": ["TOOL (systematic visual examination)", "Critic (confirmation of edema)"] | |
| } | |
| }, | |
| { | |
| "id": 6, | |
| "modality": "Chest X-ray", | |
| "question": "Which side of the diaphragm is elevated?", | |
| "options": {"A": "Left", "B": "Right", "C": "Neither", "D": "Both"}, | |
| "correct_answer": "C", | |
| "image_desc": "PA chest X-ray showing bilateral diaphragm at normal level, symmetric, no elevation of either hemidiaphragm.", | |
| "baseline": { | |
| "answer": "A", | |
| "thinking": "Looking at the diaphragm, the left side appears slightly higher than the right. The left hemidiaphragm is elevated. Answer: A", | |
| "failure_mode": "WRONG_REGION", | |
| "failure_detail": "Model focused on normal anatomical variant (left diaphragm normally slightly lower due to heart) and misinterpreted it" | |
| }, | |
| "evolved": { | |
| "answer": "C", | |
| "thinking": "SYSTEMATIC EXAMINATION — Diaphragm assessment:\n\n1. Check right hemidiaphragm: Normal position, smooth contour\n2. Check left hemidiaphragm: Normal position, smooth contour\n3. Compare bilateral: Both hemidiaphragms are at appropriate levels\n4. Note: The right hemidiaphragm is normally slightly higher than left (due to liver). Any deviation from this pattern would indicate pathology.\n5. No hemidiaphragm elevation detected.\n\nAnswer: C (Neither)", | |
| "skills_used": [], | |
| "intervention_stages": ["RESTRUCTURE (systematic bilateral comparison protocol)"] | |
| } | |
| }, | |
| { | |
| "id": 7, | |
| "modality": "Chest X-ray", | |
| "question": "Is the patient in a supine position?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "A", | |
| "image_desc": "AP chest X-ray (supine) — note the AP marker, wider mediastinum due to supine positioning, and equal bilateral lung expansion.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "It's not possible to determine the patient's position from the image alone without additional clinical context. Answer: C", | |
| "failure_mode": "PERCEPTION_ERROR", | |
| "failure_detail": "Model failed to look for AP/PA markers and positional clues in the radiograph" | |
| }, | |
| "evolved": { | |
| "answer": "A", | |
| "thinking": "SYSTEMATIC VISUAL EXAMINATION:\n\n1. Check for projection markers: AP marker visible (anteroposterior projection, done supine)\n2. Mediastinal width: Mediastinum appears wider than expected — consistent with supine AP film\n3. Heart size: Appears magnified (AP projection causes cardiac magnification)\n4. Retrieved experience: AP projection + widened mediastinum + cardiac magnification = supine position\n\nThe patient IS in supine position. Answer: A", | |
| "skills_used": ["experience_retrieval", "diagnostic_critic"], | |
| "intervention_stages": ["INJECT (experience: AP vs PA assessment)", "TOOL (check for markers)", "Critic (confirmation)"] | |
| } | |
| }, | |
| { | |
| "id": 8, | |
| "modality": "CT Abdomen", | |
| "question": "Is the abdominal aorta within normal size limits?", | |
| "options": {"A": "Yes", "B": "No", "C": "Cannot determine", "D": "Insufficient information"}, | |
| "correct_answer": "A", | |
| "image_desc": "CT abdomen showing abdominal aorta with normal caliber (< 3cm diameter), no aneurysmal dilatation.", | |
| "baseline": { | |
| "answer": "C", | |
| "thinking": "The abdominal aorta is visible but without specific measurements, it's difficult to determine if it's within normal limits. Cannot determine. Answer: C", | |
| "failure_mode": "PERCEPTION_ERROR", | |
| "failure_detail": "Model refused to make visual assessment, defaulting to hedging behavior" | |
| }, | |
| "evolved": { | |
| "answer": "A", | |
| "thinking": "SYSTEMATIC VASCULAR ASSESSMENT:\n\n1. Locate abdominal aorta: Visible in the retroperitoneum\n2. Assess caliber: The aorta appears normal in size, proportional to vertebral body width\n3. Apply criteria: Normal abdominal aorta < 3cm. This appears within normal limits\n4. Check for wall changes: No calcification, thrombus, or dissection flap visible\n5. Critic confirmation: Aorta appears normal caliber, no aneurysmal change\n\nThe abdominal aorta is within normal size limits. Answer: A", | |
| "skills_used": ["diagnostic_critic"], | |
| "intervention_stages": ["TOOL (perception strategy: aortic assessment)", "Critic (size confirmation)"] | |
| } | |
| } | |
| ], | |
| "evolved_skills_showcase": [ | |
| { | |
| "name": "Systematic Visual Examination", | |
| "type": "PERCEPTION_STRATEGY", | |
| "execution_stage": "TOOL", | |
| "trigger": "All radiology images (X-ray, CT, MRI)", | |
| "description": "Forces region-by-region systematic examination instead of holistic 'first impression' reading. Uses tool recipes: describe_with_focus → check_symmetry → zoom_region.", | |
| "tool_recipe": ["describe_with_focus(focus='specific clinical focus')", "check_symmetry()", "zoom_region(x, y, zoom=2.0)"], | |
| "example_impact": "Reduced perception errors by forcing structured visual assessment instead of hedging with 'Cannot determine'." | |
| }, | |
| { | |
| "name": "Chest Imaging Perception Strategy", | |
| "type": "PERCEPTION_STRATEGY", | |
| "execution_stage": "TOOL", | |
| "trigger": "Chest X-ray and chest CT questions", | |
| "description": "Systematic chest reading protocol: airways → bones → cardiac → diaphragm → effusion/extra → fields (lungs). ABCDEF mnemonic.", | |
| "tool_recipe": ["describe_with_focus(focus='cardiac silhouette')", "describe_with_focus(focus='costophrenic angles')", "check_symmetry()"], | |
| "example_impact": "Corrected 8+ chest X-ray questions where baseline missed findings or assessed wrong region." | |
| }, | |
| { | |
| "name": "Common Findings in X-rays and CTs", | |
| "type": "REFERENCE", | |
| "execution_stage": "INJECT", | |
| "trigger": "Radiology questions about common findings", | |
| "description": "Reference skill with density characteristics: low-density = cyst/fluid, high-density = calcification/bone, heterogeneous = neoplasm. Prevents density-based misidentifications.", | |
| "tool_recipe": [], | |
| "example_impact": "Corrected cases where model confused cysts (low density) with neoplasms (solid/heterogeneous)." | |
| }, | |
| { | |
| "name": "Diaphragm Density in Imaging", | |
| "type": "REFERENCE", | |
| "execution_stage": "INJECT", | |
| "trigger": "Questions about diaphragm position or elevation", | |
| "description": "Reference: right hemidiaphragm normally higher than left (due to liver). Elevated hemidiaphragm = phrenic nerve palsy, subphrenic abscess, hepatomegaly.", | |
| "tool_recipe": [], | |
| "example_impact": "Prevented misidentification of normal anatomical variant as pathological elevation." | |
| }, | |
| { | |
| "name": "CT Abdomen Perception Strategy", | |
| "type": "EXECUTABLE", | |
| "execution_stage": "TOOL", | |
| "trigger": "CT abdomen/pelvis questions", | |
| "description": "Systematic abdominal CT reading: liver → gallbladder → pancreas → spleen → kidneys → aorta → bowel → lymph nodes. Assess each organ's size, density, and enhancement.", | |
| "tool_recipe": ["describe_with_focus(focus='organ of interest')", "zoom_region(x, y, zoom=2.0)"], | |
| "example_impact": "Improved organ-specific assessment by forcing sequential evaluation instead of global impression." | |
| }, | |
| { | |
| "name": "Perception Strategy for Aortic Aneurysm", | |
| "type": "PERCEPTION_STRATEGY", | |
| "execution_stage": "TOOL", | |
| "trigger": "Questions about aortic size or aneurysm", | |
| "description": "Targeted assessment: locate aorta, compare to vertebral body width (normal < 3cm), check for wall calcification, thrombus, dissection flap.", | |
| "tool_recipe": ["zoom_region(focus='aorta')", "describe_with_focus(focus='aortic wall')"], | |
| "example_impact": "Enabled confident 'normal' or 'abnormal' assessment instead of hedging with 'Cannot determine'." | |
| } | |
| ], | |
| "key_insight": { | |
| "problem": "VQA models default to 'Cannot determine' on 35-40% of visual questions — a hedging behavior that tanks accuracy", | |
| "solution": "Systematic perception strategies force structured region-by-region assessment + diagnostic critic provides a second opinion", | |
| "result": "Reduced 'Cannot determine' hedging from ~40% to ~5%, improving VQA-RAD accuracy from 48.3% to 69.6%" | |
| } | |
| } | |