Daily Papers

The ability of Large Language Models (LLMs) to use external tools unlocks powerful real-world interactions, making rigorous evaluation essential. However, current benchmarks primarily report final accuracy, revealing what models can do but obscuring the cognitive bottlenecks that define their true capability boundaries. To move from simple performance scoring to a diagnostic tool, we introduce a framework grounded in Cognitive Load Theory. Our framework deconstructs task complexity into two quantifiable components: Intrinsic Load, the inherent structural complexity of the solution path, formalized with a novel Tool Interaction Graph; and Extraneous Load, the difficulty arising from ambiguous task presentation. To enable controlled experiments, we construct ToolLoad-Bench, the first benchmark with parametrically adjustable cognitive load. Our evaluation reveals distinct performance cliffs as cognitive load increases, allowing us to precisely map each model's capability boundary. We validate that our framework's predictions are highly calibrated with empirical results, establishing a principled methodology for understanding an agent's limits and a practical foundation for building more efficient systems.

Machine learning engineering (MLE) agents have made substantial progress, but learning through ML experimentation remains costly in time and computation. Synthetic environments reduce these costs while introducing variations in data and experimental settings that require task-specific diagnosis. Access to diagnostic tools alone does not ensure that agents learn when to use them or how to act on their findings. We introduce ToolMLBench, a suite of executable tools for data inspection, code verification, and experiment diagnosis, together with an SFT and RL pipeline for learning their use. Diagnostic calls acquire evidence whose value depends on subsequent decisions, so final outcomes provide limited guidance on which calls to reinforce. We address this challenge with SPICE, which measures how privileged context changes the likelihood of a sampled tool action and uses this difference as a turn-level reward alongside the final outcome. We train on 80 synthetic tasks and evaluate on 25 in-domain and 10 out-of-domain tasks. Providing tool interfaces and descriptions alone yields inconsistent gains across unadapted models. With the same diagnostic interface, our training pipeline raises in-domain success from 24.8% to 52.4% for Qwen3-8B and from 35.6% to 69.2% for Qwen3.5-35B-A3B. The latter also improves from 31% to 48% out-of-domain, supporting learned diagnostic tool use on held-out sources and targets.

An arrhythmia, also known as a dysrhythmia, refers to an irregular heartbeat. There are various types of arrhythmias that can originate from different areas of the heart, resulting in either a rapid, slow, or irregular heartbeat. An electrocardiogram (ECG) is a vital diagnostic tool used to detect heart irregularities and abnormalities, allowing experts to analyze the heart's electrical signals to identify intricate patterns and deviations from the norm. Over the past few decades, numerous studies have been conducted to develop automated methods for classifying heartbeats based on ECG data. In recent years, deep learning has demonstrated exceptional capabilities in tackling various medical challenges, particularly with transformers as a model architecture for sequence processing. By leveraging the transformers, we developed the ECGformer model for the classification of various arrhythmias present in electrocardiogram data. We assessed the suggested approach using the MIT-BIH and PTB datasets. ECG heartbeat arrhythmia classification results show that the proposed method is highly effective.

Chest X-ray imaging (CXR) is an important diagnostic tool used in hospitals to assess patient conditions and monitor changes over time. Generative models, specifically diffusion-based models, have shown promise in generating realistic synthetic X-rays. However, these models mainly focus on conditional generation using single-time-point data, i.e., typically CXRs taken at a specific time with their corresponding reports, limiting their clinical utility, particularly for capturing temporal changes. To address this limitation, we propose a novel framework, EHRXDiff, which predicts future CXR images by integrating previous CXRs with subsequent medical events, e.g., prescriptions, lab measures, etc. Our framework dynamically tracks and predicts disease progression based on a latent diffusion model, conditioned on the previous CXR image and a history of medical events. We comprehensively evaluate the performance of our framework across three key aspects, including clinical consistency, demographic consistency, and visual realism. We demonstrate that our framework generates high-quality, realistic future images that capture potential temporal changes, suggesting its potential for further development as a clinical simulation tool. This could offer valuable insights for patient monitoring and treatment planning in the medical field.

Steering vectors work for some concepts and layers but fail for others, and practitioners have no way to predict which setting applies before running an intervention. We introduce the Linear Accessibility Profile (LAP), a per-layer diagnostic that repurposes the logit lens as a predictor of steering vector effectiveness. The key measure, A_{lin}, applies the model's unembedding matrix to intermediate hidden states, requiring no training. Across 24 controlled binary concept families on five models (Pythia-2.8B to Llama-8B), peak A_{lin} predicts steering effectiveness at ρ= +0.86 to +0.91 and layer selection at ρ= +0.63 to +0.92. A three-regime framework explains when difference-of-means steering works, when nonlinear methods are needed, and when no method can work. An entity-steering demo confirms the prediction end-to-end: steering at the LAP-recommended layer redirects completions on Gemma-2-2B and OLMo-2-1B-Instruct, while the middle layer (the standard heuristic) has no effect on either model.

Keyword-matching benchmarks can credit small models for tool use they never perform. We document such a false positive in a matched-architecture pair of Spanish security language models and propose a ladder of strict, cheap diagnostics. A 661.6M parameter model (approx. 65% code/technical text; no dedicated SFT) and a 1,109M model (web-heavy multi-phase curriculum; 6B-token tool-SFT) share decoder, tokenizer, and special tokens, scoring almost identically on lenient tool-use metrics (B4: 0.660 vs. 0.650). Verbatim-reproduction checks on training examples separate them completely: the 600M emits valid tool calls with generalized arguments on 6/6 examples; the 1B does so on 0/6 across checkpoints. A first-token probe localizes the 1B's failure to a missing prior (prob. 10^{-4}--10^{-5} on <|tool_call|>), which was erased by its web-heavy training phase. A targeted SFT recipe (diverse corpus, 5x higher learning rate, 2,202 steps, ~3.3 GPU-hours) repairs the 1B using three orders of magnitude fewer tokens than the failed phase. On all 269 corpus rows, valid emission rises from 0.100 to 0.959 (600M: 0.926). On 238 unseen prompts, the repaired 1B passes 0.536 vs. the 600M's 0.428 (p = 0.004). Embedding-drift checks show the repair did not move the trigger token's tied embedding (97.7% of the bf16 table remains bit-identical), meaning changes live in the surrounding network. Both models over-trigger, rarely answering negative prompts without a call (0.09 for 600M, 0.17 for repaired 1B). Factorial analyses confirm all repair configurations install the format, though suppression benefits from a diverse corpus remain a hypothesis due to seed sensitivity. This cheap diagnostic ladder costs minutes of CPU time and should gate tool-use claims on small models.

Multi-agent systems powered by large language models (LLMs) are transforming enterprise automation, yet systematic evaluation methodologies for assessing tool-use reliability remain underdeveloped. We introduce a comprehensive diagnostic framework that leverages big data analytics to evaluate procedural reliability in intelligent agent systems, addressing critical needs for SME-centric deployment in privacy-sensitive environments. Our approach features a 12-category error taxonomy capturing failure modes across tool initialization, parameter handling, execution, and result interpretation. Through systematic evaluation of 1,980 deterministic test instances spanning both open-weight models (Qwen2.5 series, Functionary) and proprietary alternatives (GPT-4, Claude 3.5/3.7) across diverse edge hardware configurations, we identify actionable reliability thresholds for production deployment. Our analysis reveals that procedural reliability, particularly tool initialization failures, constitutes the primary bottleneck for smaller models, while qwen2.5:32b achieves flawless performance matching GPT-4.1. The framework demonstrates that mid-sized models (qwen2.5:14b) offer practical accuracy-efficiency trade-offs on commodity hardware (96.6\% success rate, 7.3 s latency), enabling cost-effective intelligent agent deployment for resource-constrained organizations. This work establishes foundational infrastructure for systematic reliability evaluation of tool-augmented multi-agent AI systems.

Large language model agents are increasingly connected to scientific software, yet it remains unclear when tool access makes scientific computation more reliable rather than merely more complex. We introduce PHREEQC-MCQ-200, a benchmark for evaluating tool-augmented agents on deterministic aqueous-geochemistry simulations. The benchmark contains 200 multiple-choice questions derived from 21 validated PHREEQC scenarios, requiring agents to construct simulator inputs, execute PHREEQC, inspect structured outputs, and commit to final answers. Across multiple frontier and mid-tier model families, simulator access substantially improves aggregate accuracy, confirming that grounded execution is necessary for many scientific-computation tasks. However, the gains are not monotonic: tool-augmented agents also lose items they answered correctly without tools, revealing regressions that average accuracy alone hides. We further show that output-access protocol matters. A table-of-contents interface can reduce token cost while preserving or improving accuracy for stronger models, but it degrades performance for mid-tier models that cannot reliably navigate structured simulator outputs. PHREEQC-MCQ-200 therefore frames scientific tool use as an end-to-end diagnostic problem rather than a simple tool-calling capability. We argue that evaluations of scientific agents should report not only accuracy, but also item-level retention, output-access sensitivity, trajectory failures, and where the computation chain breaks.

Chest Xray imaging is a widely used diagnostic tool in modern medicine, and its high utilization creates substantial workloads for radiologists. To alleviate this burden, vision language models are increasingly applied to automate Chest Xray radiology report generation (CXRRRG), aiming for clinically accurate descriptions while reducing manual effort. Conventional approaches, however, typically rely on single images, failing to capture the longitudinal context necessary for producing clinically faithful comparison statements. Recently, growing attention has been directed toward incorporating longitudinal data into CXR RRG, enabling models to leverage historical studies in ways that mirror radiologists diagnostic workflows. Nevertheless, existing surveys primarily address single image CXRRRG and offer limited guidance for longitudinal settings, leaving researchers without a systematic framework for model design. To address this gap, this survey provides the first comprehensive review of longitudinal radiology report generation (LRRG). Specifically, we examine dataset construction strategies, report generation architectures alongside longitudinally tailored designs, and evaluation protocols encompassing both longitudinal specific measures and widely used benchmarks. We further summarize LRRG methods performance, alongside analyses of different ablation studies, which collectively highlight the critical role of longitudinal information and architectural design choices in improving model performance. Finally, we summarize five major limitations of current research and outline promising directions for future development, aiming to lay a foundation for advancing this emerging field.

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

Large-scale pre-trained video generation models excel in content creation but are not reliable as physically accurate world simulators out of the box. This work studies the process of post-training these models for accurate world modeling through the lens of the simple, yet fundamental, physics task of modeling object freefall. We show state-of-the-art video generation models struggle with this basic task, despite their visually impressive outputs. To remedy this problem, we find that fine-tuning on a relatively small amount of simulated videos is effective in inducing the dropping behavior in the model, and we can further improve results through a novel reward modeling procedure we introduce. Our study also reveals key limitations of post-training in generalization and distribution modeling. Additionally, we release a benchmark for this task that may serve as a useful diagnostic tool for tracking physical accuracy in large-scale video generative model development.

Large language models (LLMs) can call tools effectively, yet they remain brittle in multi-turn execution: following a tool call error, smaller models often degenerate into repetitive invalid re-invocations, failing to interpret error feedback and self-correct. This brittleness hinders reliable real-world deployment, where the execution errors are inherently inevitable during tool interaction procedures. We identify a key limitation of current approaches: standard reinforcement learning (RL) treats errors as sparse negative rewards, providing no guidance on how to recover, while pre-collected synthetic error-correction datasets suffer from distribution mismatch with the model's on-policy error modes. To bridge this gap, we propose Fission-GRPO, a framework that converts execution errors into corrective supervision within the RL training loop. Our core mechanism fissions each failed trajectory into a new training instance by augmenting it with diagnostic feedback from a finetuned Error Simulator, then resampling recovery rollouts on-policy. This enables the model to learn from the precise errors it makes during exploration, rather than from static, pre-collected error cases. On the BFCL v4 Multi-Turn, Fission-GRPO improves the error recovery rate of Qwen3-8B by 5.7% absolute, crucially, yielding a 4% overall accuracy gain (42.75% to 46.75%) over GRPO and outperforming specialized tool-use agents.

Tool-augmented large language models (LLMs) are increasingly employed in real-world applications, but tool usage errors still hinder their reliability. We introduce ToolCritic, a diagnostic framework that evaluates and improves LLM behavior in multi-turn, tool-augmented dialogues. ToolCritic detects eight distinct error types specific to tool-calling (e.g., premature invocation, argument misalignment, and misinterpretation of tool outputs) and provides targeted feedback to the main LLM. The main LLM, assumed to have strong reasoning, task understanding and orchestration capabilities, then revises its response based on ToolCritic's feedback. We systematically define these error categories and construct a synthetic dataset to train ToolCritic. Experimental results on the Schema-Guided Dialogue (SGD) dataset demonstrate that ToolCritic improves tool-calling accuracy by up to 13% over baselines, including zero-shot prompting and self-correction techniques. This represents a promising step toward more robust LLM integration with external tools in real-world dialogue applications.

The "thinking-with-images" paradigm equips multimodal LLMs with active visual operations such as crop-and-zoom. However, models using these operations often achieve only marginal or negative gains over direct inference at substantially higher token cost. They may also repeatedly crop irrelevant regions and fail on questions that direct inference answers correctly. We ask whether the returned visual evidence causally affects the answer. To answer this question, we formulate visual tool-use as a causal graph that separates observation-mediated paths from action-induced shortcuts. We then audit it through interventions at the three levels: policy (comparing tool-use with direct inference), trajectory (corrupting all observations during rollout), and step (counterfactually replacing one individual observation under a fixed prefix). Our step-level estimand, Visual Evidence Gain, isolates the contribution of each returned observation. Across six representative models and five fine-grained perception benchmarks, we uncover policy miscalibration with two failure modes. In Calling Without Looking, returned observations have no causal effect on the answer. In Looking Without Planning, observations are informative but the call schedule is incoherent. A trajectory-level diagnostic decomposes the policy-level accuracy gain and shows that the gain is concentrated in a Calibrated minority. We term this discrepancy the illusion of visual tool-use: despite aggregate accuracy gains, visual tool-use is not causally effective across a broad range of rollouts. The code is available at https://github.com/OpenCausaLab/CauAudit.

LLM-based agents depend on effective tool-use policies to solve complex tasks, yet optimizing these policies remains challenging due to delayed supervision and the difficulty of credit assignment in long-horizon trajectories. Existing optimization approaches tend to be either monolithic, which are prone to entangling behaviors, or single-aspect, which ignore cross-module error propagation. To address these limitations, we propose EvoTool, a self-evolving framework that optimizes a modular tool-use policy via a gradient-free evolutionary paradigm. EvoTool decomposes agent's tool-use policy into four modules, including Planner, Selector, Caller, and Synthesizer, and iteratively improves them in a self-improving loop through three novel mechanisms. Trajectory-Grounded Blame Attribution uses diagnostic traces to localize failures to a specific module. Feedback-Guided Targeted Mutation then edits only that module via natural-language critique. Diversity-Aware Population Selection preserves complementary candidates to ensure solution diversity. Across four benchmarks, EvoTool outperforms strong baselines by over 5 points on both GPT-4.1 and Qwen3-8B, while achieving superior efficiency and transferability. The code will be released once paper is accepted.

Next-generation AI must manage vast personal data, diverse tools, and multi-step reasoning, yet most benchmarks remain context-free and single-turn. We present ASTRA-bench (Assistant Skills in Tool-use, Reasoning \& Action-planning), a benchmark that uniquely unifies time-evolving personal context with an interactive toolbox and complex user intents. Our event-driven pipeline generates 2,413 scenarios across four protagonists, grounded in longitudinal life events and annotated by referential, functional, and informational complexity. Evaluation of state-of-the-art models (e.g., Claude-4.5-Opus, DeepSeek-V3.2) reveals significant performance degradation under high-complexity conditions, with argument generation emerging as the primary bottleneck. These findings expose critical limitations in current agents' ability to ground reasoning within messy personal context and orchestrate reliable multi-step plans. We release ASTRA-bench with a full execution environment and evaluation scripts to provide a diagnostic testbed for developing truly context-aware AI assistants.

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

Large-amplitude molecular motions which occur during isomerization can cause significant changes in electronic structure. These variations in electronic properties can be used to identify vibrationally-excited eigenstates which are localized along the potential energy surface. This work demonstrates that nuclear quadrupole hyperfine interactions can be used as a diagnostic marker of progress along the isomerization path in both the HC14N/H14NC and DC15N/D15NC chemical systems. Ab initio calculations at the CCSD(T)/cc-pCVQZ level indicate that the hyperfine interaction is extremely sensitive to the chemical bonding of the quadrupolar 14N nucleus and can therefore be used to determine in which potential well the vibrational wavefunction is localized. A natural bonding orbital analysis along the isomerization path further demonstrates that hyperfine interactions arise from the asphericity of the electron density at the quadrupolar nucleus. Using the CCSD(T) potential surface, the quadrupole coupling constants of highly-excited vibrational states are computed from a one-dimensional internal coordinate path Hamiltonian. The excellent agreement between ab initio calculations and recent measurements demonstrates that nuclear quadrupole hyperfine structure can be used as a diagnostic tool for characterizing localized HCN and HNC vibrational states.

Existing agent benchmarks mainly evaluate final task success or tool-call correctness, providing limited insight into whether agents can reliably diagnose and recover from intermediate execution failures. This limitation becomes particularly critical in multi-turn parallel tool-use scenarios, where errors may propagate across dependent branches and trigger cascading failures. We introduce ParaRecover, a process-level benchmark for evaluating error localization and recovery in multi-turn parallel tool-use agents. Built upon a fine-grained taxonomy of 14 error types covering planning dependencies, tool selection, and argument matching, the benchmark comprises 10,626 instances spanning two difficulty levels. To enable finegrained, process-oriented evaluation, we further propose the SDE rubric, which measures structural integrity, diagnostic reasoning, and evolutionary strategy during agent execution.Experiments across more than ten mainstream LLMs reveal that even state-of-the-art models still struggle with multi-turn error propagation,implicit tool-use failures, and precise replanning. Moreover, we demonstrate that the SDE rubric provides effective supervision signals for improving agents' reflective recovery capabilities. Our data and code are available at https://github.com/gbw206/ParaRecover.

The rise of AI agents introduces complex safety and security challenges arising from autonomous tool use and environmental interactions. Current guardrail models lack agentic risk awareness and transparency in risk diagnosis. To introduce an agentic guardrail that covers complex and numerous risky behaviors, we first propose a unified three-dimensional taxonomy that orthogonally categorizes agentic risks by their source (where), failure mode (how), and consequence (what). Guided by this structured and hierarchical taxonomy, we introduce a new fine-grained agentic safety benchmark (ATBench) and a Diagnostic Guardrail framework for agent safety and security (AgentDoG). AgentDoG provides fine-grained and contextual monitoring across agent trajectories. More Crucially, AgentDoG can diagnose the root causes of unsafe actions and seemingly safe but unreasonable actions, offering provenance and transparency beyond binary labels to facilitate effective agent alignment. AgentDoG variants are available in three sizes (4B, 7B, and 8B parameters) across Qwen and Llama model families. Extensive experimental results demonstrate that AgentDoG achieves state-of-the-art performance in agentic safety moderation in diverse and complex interactive scenarios. All models and datasets are openly released.

Language model agents often appear capable of self-recovery after failing tool call executions, yet this behavior lacks a formal explanation. We present a predictive theory that resolves this gap by showing that recoverability follows a measurable law. To elaborate, we formalize recoverability through Expected Recovery Regret (ERR), which quantifies the deviation of a recovery policy from the optimal one under stochastic execution noise, and derive a first-order relationship between ERR and an empirical observable quantity, the Efficiency Score (ES). This yields a falsifiable first-order quantitative law of recovery dynamics in tool-using agents. We empirically validate the law across five tool-use benchmarks spanning controlled perturbations, diagnostic reasoning, and real-world APIs. Across model scales, perturbation regimes, and recovery horizons, predicted regret under the ERR-ES law closely matched observed post-failure regret measured from Monte Carlo rollouts, within delta less than or equal to 0.05. Our results reveal that recoverability is not an artifact of model scale or architecture, but a governed property of interaction dynamics, providing a theoretical foundation for execution-level robustness in language agents.

The ability to handle long-term memory in LLMs is becoming increasingly critical, yet existing benchmarks remain English-centric and rely on aggregate retrieval metrics, failing to capture interactions between long-range context, temporal information, and reasoning. To address this, we introduce RUMBA (Russian User Memory BenchmArk) - a new benchmark for long-term conversational memory that provides a fine-grained taxonomy of memory-centric question types and a unified methodology accounting for semantic type, session scope, temporal reasoning, and the explicitness of temporal expressions. RUMBA consists of timestamped user-assistant dialogues with QA pairs requiring retrieval, combination, and reasoning across sessions. While designed for Russian, we also provide an aligned English subset under the same methodology. We evaluate contemporary memory systems and long-context models, and show how RUMBA serves as a diagnostic tool to analyze model behavior across benchmark slices and identify strengths and failure modes of different memory mechanisms.

Real-world embodied tasks, from everyday activities to professional procedures, require agents to act under physical constraints while tracking evolving object and task states. Tool use sits at the heart of such tasks, as many everyday and professional activities are tool-mediated. Understanding them requires reasoning about affordances, hand-tool-object geometry, procedural progress, and causal effects on target objects. Yet despite strong performance on perception-oriented video tasks such as captioning and general video QA, current multimodal video models remain limited in this form of tool-centric embodied reasoning. Progress in this direction has been limited by the lack of real-world egocentric data and diagnostic benchmarks. To address this gap, we introduce EgoTools, the first comprehensive suite for egocentric tool-use understanding. It consists of two complementary components: EgoTools-Data, a large-scale corpus of 100 hours of tool-centric egocentric recordings with synchronized audio, dense captions, reasoning-heavy narrations, and supplementary 3D information; and EgoTools-Bench, a diagnostic benchmark of 1,000 QA pairs across four tracks that cover tool-use understanding from perception and geometry to procedure and causal reasoning. Experimental results show that current models still struggle to ground tool use in visual evidence: Gemini-3.1-Pro achieves 66.9% overall accuracy but only 51.7% on Perception & Grounding. Beyond evaluation, we validate EgoTools-Data as a training resource. On the full 1,000-question benchmark, full supervised fine-tuning improves Qwen3-VL-8B-Instruct from 50.0% to 60.9%, under strict source-video separation. Together, these results establish EgoTools as a unified resource for both training and diagnostic evaluation of real-world egocentric tool-use understanding.

Agentic tasks require a large language model to interact with the world, navigating information and gathering evidence across multiple steps with restricted resources. Due to this complexity, agentic task failures arise from various sources, and pinpointing these failure causes is essential to diagnose and improve agentic systems. Existing benchmarks, however, tend to focus on a single leaderboard score, leaving the underlying failure modes opaque. To fill this gap, we introduce AgentHop, a diagnostic benchmark of 1,011 multiple-choice questions paired with a controlled seven-tool sandbox under fixed token, turn, and tool-call constraints. AgentHop reveals model vulnerabilities by dissecting a single accuracy score along four axes of agent operation: retrieval, synthesis, tool-call, and resource management. Across 19 models, we find that behavior clusters by model family, with tool-call signatures revealing distinct family fingerprints: GPT models commit early, Anthropic and GLM checkpoints verify before committing, DeepSeek and Kimi over-search, and Gemini-3 Pro stays balanced. Decomposed axes further expose within-family structure: Claude Opus 4.6 and Sonnet 4.6 land within one accuracy point yet diverge on retrieval-versus-synthesis emphasis, with Opus retrieving more and Sonnet synthesizing better. We release the full benchmark set and the harness to support diagnostic agent benchmarking.

We apply the Weibull distribution -- a two-parameter family from extreme-value theory -- as a diagnostic framework for element-wise weight magnitude distributions in transformers. At initialization, i.i.d. Gaussian weights give |w| ~ HalfNormal, yielding k ~ 1.20 via middle-80% probability-plot fit (the protocol used throughout this work). This anchor makes k a principled, architecture-independent measuring stick for training dynamics; fitting each weight matrix independently at every layer at every checkpoint enables per-component, per-layer, and per-step diagnostics that aggregate statistics cannot resolve. Applying this framework to 12 model entries spanning 7 architectural families (Pythia, OLMo-1/2, LLaMA-3, Mistral, Qwen2.5/3) reveals three findings. First, FFN modules and the attention output projection W_o -- the Transmission Class -- fall in a narrow k band: median terminal k in [1.186, 1.204] across 12 entries (cross-family CV = 0.51%), shared across SwiGLU/GeLU activations, Pre-LN/QK-Norm placements, and 70M-14B sizes. Second, the attention input projections W_q, W_k -- the Selection Class -- depart from the Weibull family, with severity shaped by storage: separately-stored Q/K (OLMo-1, OLMo-2) yields k in [0.76, 0.99] (deep); GQA models yield k in [1.10, 1.16] (mild); Pythia's merged W_qkv occupies a transitional zone tracking training budget T/tau monotonically. Third, lambda grows substantially during training and scales with sqrt(eta/lambda_wd) within the Pythia family (Pearson r = 0.94, three Transmission kinds), directionally consistent with Fan et al. (2025). The two parameters carry independent information: k labels the functional class, lambda labels training progress. We release npm-weibull-py v0.4 (Python library) and DATABASE_v9_1 at https://github.com/tiexinding/NPM-Weibull-public .

Heart disease remains a significant threat to human health. As a non-invasive diagnostic tool, the electrocardiogram (ECG) is one of the most widely used methods for cardiac screening. However, the scarcity of high-quality ECG data, driven by privacy concerns and limited medical resources, creates a pressing need for effective ECG signal generation. Existing approaches for generating ECG signals typically rely on small training datasets, lack comprehensive evaluation frameworks, and overlook potential applications beyond data augmentation. To address these challenges, we propose DiffuSETS, a novel framework capable of generating ECG signals with high semantic alignment and fidelity. DiffuSETS accepts various modalities of clinical text reports and patient-specific information as inputs, enabling the creation of clinically meaningful ECG signals. Additionally, to address the lack of standardized evaluation in ECG generation, we introduce a comprehensive benchmarking methodology to assess the effectiveness of generative models in this domain. Our model achieve excellent results in tests, proving its superiority in the task of ECG generation. Furthermore, we showcase its potential to mitigate data scarcity while exploring novel applications in cardiology education and medical knowledge discovery, highlighting the broader impact of our work.

Multimodal language models (MLLMs) exhibit promising spatial reasoning capabilities, yet the internal mechanisms supporting them remain poorly understood. We uncover S-Space, a linear representation subspace in which object-token representations encode continuous coordinates along horizontal, vertical, and distance axes. Although we identify these axes by differentiating spatial-answer scores with respect to object-token activations, S-Space is intrinsic rather than induced by specific data or prompts, remaining readable under non-spatial questions. We show that S-Space functions as an internal spatial workspace of MLLMs. Perception encodes object locations into it, forming spatial representations that can be directly read out to support accurate spatial judgments. Internal reasoning transforms it for changing viewpoints. Verbal responses selectively access it, evidenced by causal interventions that alter spatial judgments while largely preserving non-spatial responses. Case studies further show that S-Space assigns locations to unseen entities and the observer, and connects physical directions with abstract linguistic meanings, suggesting both the capabilities and limitations of large-scale language training. Finally, we use S-Space as a diagnostic tool for spatial reasoning failures. Direction-word readouts reveal systematic coupling between cardinal and image-relative reference frames. More importantly, a perception-computation decomposition exposes a key bottleneck: MLLMs can form capable spatial representations, yet fall short in the spatial transformations required to reason reliably across viewpoint changes.

Ontology rankers remain useful for rare-disease diagnosis because each candidate can be traced to matched patient phenotypes. Large language models (LLMs) can generate differential diagnoses from the same patient description, but their predictions lack an equally clear evidence trail. Rather than asking which system should replace the other, we ask whether an LLM can improve the ranker without giving up its evidence. Our behavior-based fusion model examines the two ranked lists, their agreement, and the ontology support behind each candidate, and learns how much to rely on each system for the individual case. Before comparison, we remove a documented test-set leakage pathway caused by benchmark cases and ontology annotations being derived from the same publications. Across eight open LLMs, fusion improves Phenomizer Recall@1 by 7.86 percentage points on Phenopacket Store and 20.18 points on RAMEDIS. When paired with DeepSeek-V4-Flash through an API, a fusion model trained only on the other LLMs improves Recall@1 from 0.1657 to 0.2176, a 5.19-point gain, without retraining. For 90.8% of correct fused diagnoses, the disease retains candidate-level ontology evidence that can be inspected. These results show that LLMs can strengthen an established diagnostic tool without discarding the structured evidence that makes it useful.

We introduce KFinEval-Pilot, a benchmark suite specifically designed to evaluate large language models (LLMs) in the Korean financial domain. Addressing the limitations of existing English-centric benchmarks, KFinEval-Pilot comprises over 1,000 curated questions across three critical areas: financial knowledge, legal reasoning, and financial toxicity. The benchmark is constructed through a semi-automated pipeline that combines GPT-4-generated prompts with expert validation to ensure domain relevance and factual accuracy. We evaluate a range of representative LLMs and observe notable performance differences across models, with trade-offs between task accuracy and output safety across different model families. These results highlight persistent challenges in applying LLMs to high-stakes financial applications, particularly in reasoning and safety. Grounded in real-world financial use cases and aligned with the Korean regulatory and linguistic context, KFinEval-Pilot serves as an early diagnostic tool for developing safer and more reliable financial AI systems.

Vision-language models with extended reasoning succeed on complex problems, but many real-world problems require external tools that internal reasoning alone often cannot resolve. Agentic reasoning therefore interleaves two behaviors with a structural asymmetry: thinking (the self-contained default) and tool use (a high-variance auxiliary acting). We refer to this asymmetry as the Thinking-Acting Gap. Under standard RL recipes like GRPO, the gap manifests as two diagnostic symptoms during training: tool use is attempted on only ~30% of rollouts, and when attempted, the tool-using rollouts within a group are all-wrong on ~40% of questions, suppressing the learning signal at the tool calls that needed it. We propose AXPO (Agent eXplorative Policy Optimization): for each all-wrong tool-using subgroup, AXPO fixes the thinking prefix and resamples the tool call and its continuation, paired with uncertainty-based prefix selection. Across nine multimodal benchmarks and three scales of Qwen3-VL-Thinking, SFT+AXPO outperforms SFT+GRPO at average (+1.8pp Pass@1 and +1.8pp Pass@4 at 8B on average) and 8B with SFT+AXPO surpasses the 32B Base on Pass@4 with 4 times fewer parameters.

Audio-video diffusion models rely on cross-modal attention to coordinate text, sound, and visual content, yet this same mechanism can introduce subtle and systematic semantic leakage. We study these models by probing and analyzing the ``attention triangle,'' comprising the three cross-attention edges connecting the text, audio, and video streams, and examine how semantic information is routed across modalities during generation. Our analysis reveals that routing along the audio-video edge is bidirectional: audio can influence video generation, while video can influence audio generation. This edge is shaped by biases encoded in the model's parameters and emerges as a major contributor to leakage: when prompts are in tension with learned priors, cross-modal interactions may override the intended conditioning and reroute semantics toward visually canonical but incorrect outcomes. These effects suggest that semantic artifacts arise not merely from attention spreading beyond its intended target, but from structured, bias-driven interactions along specific pathways. Building on this perspective, we extract attention-derived signals that expose how semantics are distributed and grounded across modalities, and use them as a diagnostic tool to both analyze and deliberately incur leakage under controlled conditions. This enables us to probe the internal dynamics of cross-modal routing and isolate the role of individual interactions. We further leverage these signals to guide inference-time interventions that encourage more consistent cross-modal alignment. Extensive experiments support our analysis and demonstrate improved semantic grounding while preserving generation quality.

Large language models are increasingly capable at closed-world mathematical reasoning, but research assistance also requires source-grounded use of the literature. When a proof reaches a non-trivial step, a useful assistant should determine whether the needed tool (e.g., a lemma) already exists, identify a suitable scholarly source, and verify that its assumptions align with the current proof context. To rigorously evaluate such capabilities, we introduce Re^2Math, a benchmark for tool-grounded retrieval from partial mathematical proofs. Each instance is built from a candidate instrumental citation in the proof of a main theorem, with hierarchical context and an optional leakage-controlled anchor hint. We also make the task source-grounded yet citation-agnostic in that any admissible theorem sufficient for the proof transition is accepted. Evaluation uses a release-frozen retrieval artifact, ensuring reproducibility, while the benchmark itself supports automatic, continual expansion with newly constructed instances. On the current benchmark test set, the best fixed-judge ToolAcc reaches 7.0%, despite substantially higher rates of source grounding, indicating that current systems often retrieve valid statements but fail to establish their applicability to the local proof step. By decoupling citation recall, grounding, and proof-gap sufficiency, Re^2Math transforms literature-grounded mathematical tool use into a controlled diagnostic task.

Static-analysis checker synthesis requires agents to interpret a defect specification, inspect a repository, implement analyzer-specific logic, and refine the checker through repeated compilation and analysis feedback. Existing coding-agent benchmarks focus on tasks such as patch generation or vulnerability detection and rarely assess whether an agent can develop a working checker in a repository from start to finish. We introduce CheckerBench, an executable benchmark of 300 tasks derived from 297 CVEs across 167 repositories, 85 CWEs, and five language ecosystems. Each task includes vulnerable and fixed revisions, a pinned analysis environment, and a checker scaffold. We further introduce CheckerLab, a common evaluation framework that independently rebuilds submitted checkers and measures vulnerable-fixed diagnostic contrast, patch localization, false positives, and tool use. Across 21 model-harness configurations and three independent repeats per configuration, mean Pass@1 is 32.30%, while the best reaches 45.33%. These results show that reliable, reusable checker development remains challenging for current coding agents.

Machine learning (ML) approaches have demonstrated promising results in a wide range of healthcare applications. Data plays a crucial role in developing ML-based healthcare systems that directly affect people's lives. Many of the ethical issues surrounding the use of ML in healthcare stem from structural inequalities underlying the way we collect, use, and handle data. Developing guidelines to improve documentation practices regarding the creation, use, and maintenance of ML healthcare datasets is therefore of critical importance. In this work, we introduce Healthsheet, a contextualized adaptation of the original datasheet questionnaire ~gebru2018datasheets for health-specific applications. Through a series of semi-structured interviews, we adapt the datasheets for healthcare data documentation. As part of the Healthsheet development process and to understand the obstacles researchers face in creating datasheets, we worked with three publicly-available healthcare datasets as our case studies, each with different types of structured data: Electronic health Records (EHR), clinical trial study data, and smartphone-based performance outcome measures. Our findings from the interviewee study and case studies show 1) that datasheets should be contextualized for healthcare, 2) that despite incentives to adopt accountability practices such as datasheets, there is a lack of consistency in the broader use of these practices 3) how the ML for health community views datasheets and particularly Healthsheets as diagnostic tool to surface the limitations and strength of datasets and 4) the relative importance of different fields in the datasheet to healthcare concerns.

Large language models deployed as agents over large tool catalogs face a critical tool-retrieval bottleneck. As embedding-based retrieval approaches rely on compact encoders that may under-capture specialized tool semantics, parametric tool retrieval addresses this by encoding each tool as a virtual token appended to the LLM vocabulary, fine-tuned in two stages (memorization then retrieval SFT) to use the LLM as a retriever, achieving strong performance on standard ToolBench retrieval benchmarks. Yet these benchmarks use verbose, fully-specified queries, and their evaluation applies constrained decoding that restricts outputs to valid token paths, neither reveals whether the model actually understands its tools. We introduce ToolSense, an open-source LLM-powered diagnostic framework that takes any tool catalog as input and automatically generates three benchmarks: a Realistic Retrieval Benchmark (RRB) with queries at three ambiguity tiers, an MCQ probing benchmark, and a QA probing benchmark. Applying ToolSense to ToolBench (~47k tools) and evaluating five parametric model training configurations reveals a knowledge-retrieval dissociation: on RRB queries, several configurations collapse by ~50-64 percentage points compared to fully-specified ToolBench benchmarks, falling below the embedding-model baseline. Additionally, despite strong retrieval performance, some models score near-random on factual probes, suggesting a knowledge-retrieval dissociation. We open-source the ToolSense framework and the ToolBench diagnostic benchmarks at https://github.com/SAP/toolsense.

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.

The emergence of tool-calling-based agent systems introduces a more evidence-driven paradigm for pathology image analysis in contrast to the coarse-grained text-image diagnostic approaches. With the recent large-scale experimental adoption of spatial transcriptomics technologies, molecularly validated pathological diagnosis is becoming increasingly open and accessible. In this work, we propose LAMMI-Pathology (LVLM-Agent System for Molecularly Informed Medical Intelligence in Pathology), a scalable agent framework for domain-specific agent tool-calling. LAMMI-Pathology adopts a tool-centric, bottom-up architecture in which customized domain-adaptive tools serve as the foundation. These tools are clustered by domain style to form component agents, which are then coordinated through a top-level planner hierarchically, avoiding excessively long context lengths that could induce task drift. Based on that, we introduce a novel trajectory construction mechanism based on Atomic Execution Nodes (AENs), which serve as reliable and composable units for building semi-simulated reasoning trajectories that capture credible agent-tool interactions. Building on this foundation, we develop a trajectory-aware fine-tuning strategy that aligns the planner's decision-making process with these multi-step reasoning trajectories, thereby enhancing inference robustness in pathology understanding and its adaptive use of the customized toolset.

Blueshifted absorption is the classic spectroscopic signature of an accretion disc wind in X-ray binaries and cataclysmic variables (CVs). However, outflows can also create pure emission lines, especially at optical wavelengths. Therefore, developing other outflow diagnostics for these types of lines is worthwhile. With this in mind, we construct a systematic grid of 3645 synthetic wind-formed H-alpha line profiles for CVs with the radiative transfer code SIROCCO. Our grid yields a variety of line shapes: symmetric, asymmetric, single- to quadruple-peaked, and even P-Cygni profiles. About 20% of these lines -- our `Gold' sample -- have strengths and widths consistent with observations. We use this grid to test a recently proposed method for identifying wind-formed emission lines based on deviations in the wing profile shape: the `excess equivalent width diagnostic diagram'. We find that our `Gold' sample can preferentially populate the suggested `wind regions' of this diagram. However, the method is highly sensitive to the adopted definition of the line profile `wing'. Hence, we propose a refined definition based on the full-width at half maximum to improve the interpretability of the diagnostic diagram. Furthermore, we define an approximate scaling relation for the strengths of wind-formed CV emission lines in terms of the outflow parameters. This relation provides a fast way to assess whether -- and what kind of -- outflow can produce an observed emission line. All our wind-based models are open-source and we provide an easy-to-use web-based tool to browse our full set of H-alpha spectral profiles.

Chest X-ray (CXR) interpretation often requires integrating visual findings with task-specific evidence rather than relying on direct visual recognition alone. While tool-augmented medical agents can supply such evidence via external modules, they often lack explicit mechanisms for learning when auxiliary evidence is needed and for preventing inapplicable quantitative evidence from entering diagnostic reasoning. To address this, we propose X-Ragent, a post-training framework for tool-augmented reinforcement learning that decouples learned auxiliary-evidence seeking from validity-gated quantitative measurement acquisition for evidence-grounded CXR reasoning. We construct Rad-CoT, a 7.7K-sample corpus combining causally ordered tool-augmented trajectories with report-style diagnostic reasoning, and use it to initialize Qwen3-VL-8B via agentic supervised fine-tuning (SFT). We then optimize the policy with Group Relative Policy Optimization (GRPO) using an accuracy-gated reward that applies process-level terms for measurement consistency and auxiliary-tool cost only to correct trajectories, preventing plausible process behavior from compensating for an incorrect diagnosis. Across three CXR benchmarks, X-Ragent achieves the strongest results, including an 8.6-point improvement on the fully held-out ChestAgentBench. By seeking evidence selectively and admitting only valid measurements, X-Ragent supports more faithful and evidence-grounded CXR reasoning.

Personalized presentation generation requires more than conditioning on a current prompt or template: agents must preserve stable user preferences across tasks, retain newly introduced preferences and constraints during multi-turn revision, and carry out local edits reliably. We propose MemSlides, a hierarchical memory framework for personalized presentation agents that separates long-term memory from working memory and further divides long-term memory into user profile memory and tool memory. User profile memory stores intent-conditioned profiles for round-0 personalization, working memory carries active preferences and session constraints across revision rounds, and tool memory stores reusable execution experience for reliable localized editing. MemSlides pairs this memory design with scoped slide-local revision, so targeted updates act on the smallest affected region instead of repeatedly regenerating the full deck. In controlled experiments, user profile memory improves persona-alignment judgments on a multi-persona, multi-intent profile bank, tool-memory injection improves closed-loop modify behavior in diagnostic matched-pair settings, and qualitative cases illustrate working memory's ability to carryover preferences. Taken together, these results suggest that effective personalization in presentation authoring depends on separating persistent user profiles, session-level working memory, and reusable execution experience across generation and localized revision.

The Model Context Protocol (MCP) is rapidly becoming the standard interface for Large Language Models (LLMs) to discover and invoke external tools. However, existing evaluations often fail to capture the complexity of real-world scenarios, relying on restricted toolsets, simplistic workflows, or subjective LLM-as-a-judge metrics. We introduce MCP-Atlas, a large-scale benchmark for evaluating tool-use competency, comprising 36 real MCP servers and 220 tools. It includes 1,000 tasks designed to assess tool-use competency in realistic, multi-step workflows. Tasks use natural language prompts that avoid naming specific tools or servers, requiring agents to identify and orchestrate 3-6 tool calls across multiple servers. We score tasks using a claims-based rubric that awards partial credit based on the factual claims satisfied in the model's final answer, complemented by internal diagnostics on tool discovery, parameterization, syntax, error recovery, and efficiency. Evaluation results on frontier models reveal that top models achieve pass rates exceeding 50%, with primary failures arising from inadequate tool usage and task understanding. We release the task schema, containerized harness, and a 500-task public subset of the benchmark dataset to facilitate reproducible comparisons and advance the development of robust, tool-augmented agents.

Evaluation is shifting from static QA toward agentic settings where models act through external tools. We identify a critical yet underexplored capability within this space - dexterous visual tool use: fine-grained, closed-loop parameterized visual action in which models infer tool parameters from visual evidence, and those parameters directly govern the final result. Existing benchmarks cover web navigation, GUI operation, and software engineering, but rarely target this coupling between visual evidence and execution precision. We propose EASEL, a benchmark evaluating a controlled instance of dexterous visual tool use that adopts reference-guided visual reconstruction as its primary proxy task: the agent incrementally paints a canvas to match a reference image. EASEL additionally includes semantic tasks spanning region annotation, handwriting, and path planning. We further provide EASEL-Data, a 440k-sample two-stage curriculum dataset for trajectory supervision, and EASEL-9B to investigate its effect on this capability. Evaluation of 25 models reveals that current multimodal agents systematically struggle on EASEL. Reconstruction similarity bottlenecks at low levels (0.40-0.54), while trajectory diagnostics expose severe closed-loop instability - models typically saturate early or degrade post-peak. Semantic tasks reveal sharp capability boundaries in precision annotation and path planning. EASEL-9B, trained on EASEL-Data, surpasses the base model by a relative 6.3%, ranking third among all evaluated models.

Large language model (LLM)-based agents increasingly rely on tool use to complete real-world tasks. While existing works evaluate the LLMs' tool use capability, they largely focus on the final answers yet overlook the detailed tool usage trajectory, i.e., whether tools are selected, parameterized, and ordered correctly. We introduce TRAJECT-Bench, a trajectory-aware benchmark to comprehensively evaluate LLMs' tool use capability through diverse tasks with fine-grained evaluation metrics. TRAJECT-Bench pairs high-fidelity, executable tools across practical domains with tasks grounded in production-style APIs, and synthesizes trajectories that vary in breadth (parallel calls) and depth (interdependent chains). Besides final accuracy, TRAJECT-Bench also reports trajectory-level diagnostics, including tool selection and argument correctness, and dependency/order satisfaction. Analyses reveal failure modes such as similar tool confusion and parameter-blind selection, and scaling behavior with tool diversity and trajectory length where the bottleneck of transiting from short to mid-length trajectories is revealed, offering actionable guidance for LLMs' tool use.

Before letting an agent operate over real context, can you prove it used the right evidence? GroundEval turns that question into a deterministic test of what the agent searched, fetched, cited, and was permitted to access. In one case study, two frontier LLM judges scored a plausible agent response above 0.85. But the trace told a different story: the agent had never retrieved the artifact its answer depended on, yielding a GroundEval score of 0.000. We introduce GroundEval, a judge-free framework for evaluating agents against grounded, time-bounded, and access-controlled evidence. GroundEval uses a domain configuration to generate questions, lets the agent choose how to answer, and then scores both the final answer and the recorded trajectory that produced it. The benchmark targets three failures that LLM-as-judge evaluation struggles to detect: whether an agent checked before claiming absence, reasoned only from evidence available to the actor at the relevant time, and used the correct causal mechanism rather than a plausible one. These correspond to three tracks: Silence, Perspective, and Counterfactual. GroundEval exposes when plausible answers rest on invalid evidence paths, and produces structured per-question diagnostics that pair tool activity with the agent's turn-level narration, making each score inspectable rather than merely reported. What our case studies turned up is that this gap isn't some rare corner case. It's exactly the blind spot that final-answer and judge-based scoring were never built to catch.

Vision-language models (VLMs) read an image and produce text in a single forward pass, whereas radiologists typically inspect an image several times and consult the literature before writing a report. We introduce GAZE (Grounded Agentic Zero-shot Evaluation), a framework that lets a medical VLM work in this iterative way by calling viewer-level tools (zoom, windowing, contrast, edge detection) and two retrieval tools backed by the U.S. National Library of Medicine (PubMed for medical literature, Open-i for radiological images), with structured outputs validated against a schema and full tool-call traces recorded for auditability. On NOVA, a benchmark of 906 brain MRI cases covering 281 rare neurological conditions, GAZE reaches 58.2 mean average precision (mAP) at intersection-over-union (IoU) 0.3 for lesion localisation and 34.9% Top-1 diagnostic accuracy under a joint protocol that scores captioning, diagnosis, and localisation from the image alone, without task-specific fine-tuning. Before any tool is used, structured prompting and schema-validated outputs already improve over the published Gemini 2.0 Flash baseline (20.2 to 29.4 mAP@0.3), so framework design is itself an experimental variable. Tool use helps rare pathologies disproportionately: the fraction of cases with IoU > 0.3 rises from 17% to 58% for diagnoses with three or fewer examples versus 25% to 68% for common conditions (geq10 cases), with gains tracking engagement (Gemini 3 Flash: Cohen's d = 0.79, 11.8 tool calls per case; Gemini 2.0 Flash: tools used in 8.2% of cases, no significant benefit). Retrieval ablations additionally reveal a model-dependent trade-off in which gains in diagnosis can coincide with losses in localisation, reinforcing the case for joint evaluation of diagnosis, localisation, and captioning in medical VLMs.

Large Language Models (LLMs) have demonstrated impressive performance in various NLP tasks, but they still suffer from challenges such as hallucination and weak numerical reasoning. To overcome these challenges, external tools can be used to enhance LLMs' question-answering abilities. However, current evaluation methods do not distinguish between questions that can be answered using LLMs' internal knowledge and those that require external information through tool use. To address this issue, we introduce a new dataset called ToolQA, which is designed to faithfully evaluate LLMs' ability to use external tools for question answering. Our development of ToolQA involved a scalable, automated process for dataset curation, along with 13 specialized tools designed for interaction with external knowledge in order to answer questions. Importantly, we strive to minimize the overlap between our benchmark data and LLMs' pre-training data, enabling a more precise evaluation of LLMs' tool-use reasoning abilities. We conducted an in-depth diagnosis of existing tool-use LLMs to highlight their strengths, weaknesses, and potential improvements. Our findings set a new benchmark for evaluating LLMs and suggest new directions for future advancements. Our data and code are freely available to the broader scientific community on GitHub.

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.

Large language model (LLM) agents are increasingly used for multi-step, stateful tool-use tasks, yet production reliability remains limited. Unlike static software repair, agent repair must recover dynamic trajectories whose early decisions can propagate into later errors and external state changes. Existing automatic remedies address only part of this problem: blind retry adds no diagnosis, outcome feedback says whether a run failed but not where or why, and self-reflection often lacks grounded evidence to prevent the same failure from recurring. We present AgentTether, a run-time repair framework that automates post-run diagnosis and guided recovery without modifying the underlying agent or environment. AgentTether abstracts each run into Transition Units, links them through a dependency-aware Critical Transition Graph, and localizes failure-critical subtrajectories by combining an offline normal-behavior model with a run-local graph detector. It then converts the localized cause into behavior-scoped guidance backed by cross-iteration Repair Memory, and can optionally apply guarded run-time intervention to keep the correction active during re-execution. The same design can be deployed as an offline diagnostic-and-guidance tool or as an online repair layer. We evaluate AgentTether on 261 tau-bench tasks across three domains with Qwen3.7-max, and test cross-model transfer on Banking with GPT-5.4. On the hardest Banking domain, AgentTether repairs 59.04% (49/83) of initially failed Qwen3.7-max tasks and 65.12% (56/86) of initially failed GPT-5.4 tasks. Overall, AgentTether improves repair effectiveness while reducing agent turns and end-to-end approach tokens, suggesting a practical reliability layer that can wrap existing agent deployments, reduce wasted re-execution, and improve recovery without retraining the agent.

Large language models are increasingly deployed as agents that solve tasks by interacting with external tool environments. Although recent tool-use benchmarks increasingly cover complex task settings, they still largely assume clean, stable, and trustworthy tool environments, leaving tool-environment unreliability insufficiently examined. We introduce ToolBench-X, a benchmark for evaluating agents under recoverable reliability hazards. ToolBench-X contains executable multi-step tasks across diverse domains and sequential, parallel, and mixed workflows, each paired with deterministic tools and a canonical final answer for automatic evaluation. Starting from clean tool environments, ToolBench-X injects five structured hazard types: Specification Drift, Invocation Error, Execution Failure, Output Drift, and Cross-source Conflict. Crucially, each injected instance remains solvable through at least one valid recovery path, such as retrying, fallback, verification, or cross-checking. Experiments reveal a substantial reliability gap: agents that perform well with reliable tools often fail under recoverable hazards. Further analysis shows that failures are driven less by tool-use volume or inference budget than by limited hazard diagnosis and ineffective recovery. Targeted recovery hints recover many failed tasks, while test-time scaling yields more limited gains. These results suggest that tool-use evaluation should move beyond function-call accuracy toward task completion under unreliable tool environments. The code and data is available at https://github.com/Foreverskyou/ToolBench-X.

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.

Large language models (LLMs) have become a central foundation of modern artificial intelligence, yet their lifecycle remains constrained by a rigid separation between training and deployment, after which learning effectively ceases. This limitation contrasts with natural intelligence, which continually adapts through interaction with its environment. In this paper, we formalise deployment-time learning (DTL) as the third stage in the LLM lifecycle that enables LLM agents to improve from experience during deployment without modifying model parameters. We present CASCADE (CASe-based Continual Adaptation during DEployment), a general and principled framework that equips LLM agents with an explicit, evolving episodic memory. CASCADE formulates experience reuse as a contextual bandit problem, enabling principled exploration-exploitation trade-offs and establishing no-regret guarantees over long-term interactions. This design allows agents to accumulate, select, and refine task-relevant cases, transforming past experience into actionable knowledge. Across 16 diverse tasks spanning medical diagnosis, legal analysis, code generation, web search, tool use, and embodied interaction, CASCADE improves macro-averaged success rate by 20.9% over zero-shot prompting while consistently outperforming gradient-based and memory-based baselines. By reframing deployment as an adaptive learning process, this work establishes a foundation for continually improving AI systems.

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.

Healthcare AI agents handle patient consultation, clinical reasoning over text and images, interactive diagnosis, and electronic health record (EHR) tool use, yet specialized agentic models that cover these use cases together remain limited. These capabilities fail in different ways, and a narrow update for one task can degrade another. We present Cura 1T, a healthcare-specialized LLM built on the open-weight Kimi-K2.6 and trained through a human-gated recursive self-improvement (RSI) loop. Specifically, in each round, the RSI harness plans a target capability, trains the model, evaluates benchmark trajectories, and refines the data mixture from observed failures with targeted synthetic and curated examples rather than a single generic medical-data update. Across the healthcare evaluation suite, Cura 1T ranks at or near the top among frontier baselines while remaining competitive on out-of-domain reasoning and agentic benchmarks.

Traditional methods for automating recommender system design, such as Neural Architecture Search (NAS), are often constrained by a fixed search space defined by human priors, limiting innovation to pre-defined operators. While recent LLM-driven code evolution frameworks shift fixed search space target to open-ended program spaces, they primarily rely on scalar metrics (e.g., NDCG, Hit Ratio) that fail to provide qualitative insights into model failures or directional guidance for improvement. To address this, we propose Self-EvolveRec, a novel framework that establishes a directional feedback loop by integrating a User Simulator for qualitative critiques and a Model Diagnosis Tool for quantitative internal verification. Furthermore, we introduce a Diagnosis Tool - Model Co-Evolution strategy to ensure that evaluation criteria dynamically adapt as the recommendation architecture evolves. Extensive experiments demonstrate that Self-EvolveRec significantly outperforms state-of-the-art NAS and LLM-driven code evolution baselines in both recommendation performance and user satisfaction. Our code is available at https://github.com/Sein-Kim/self_evolverec.

The ability to automatically detect and track surgical instruments in endoscopic videos can enable transformational interventions. Assessing surgical performance and efficiency, identifying skilled tool use and choreography, and planning operational and logistical aspects of OR resources are just a few of the applications that could benefit. Unfortunately, obtaining the annotations needed to train machine learning models to identify and localize surgical tools is a difficult task. Annotating bounding boxes frame-by-frame is tedious and time-consuming, yet large amounts of data with a wide variety of surgical tools and surgeries must be captured for robust training. Moreover, ongoing annotator training is needed to stay up to date with surgical instrument innovation. In robotic-assisted surgery, however, potentially informative data like timestamps of instrument installation and removal can be programmatically harvested. The ability to rely on tool installation data alone would significantly reduce the workload to train robust tool-tracking models. With this motivation in mind we invited the surgical data science community to participate in the challenge, SurgToolLoc 2022. The goal was to leverage tool presence data as weak labels for machine learning models trained to detect tools and localize them in video frames with bounding boxes. We present the results of this challenge along with many of the team's efforts. We conclude by discussing these results in the broader context of machine learning and surgical data science. The training data used for this challenge consisting of 24,695 video clips with tool presence labels is also being released publicly and can be accessed at https://console.cloud.google.com/storage/browser/isi-surgtoolloc-2022.

Coronavirus disease (COVID-19) is a pandemic disease, which has already caused thousands of causalities and infected several millions of people worldwide. Any technological tool enabling rapid screening of the COVID-19 infection with high accuracy can be crucially helpful to healthcare professionals. The main clinical tool currently in use for the diagnosis of COVID-19 is the Reverse transcription polymerase chain reaction (RT-PCR), which is expensive, less-sensitive and requires specialized medical personnel. X-ray imaging is an easily accessible tool that can be an excellent alternative in the COVID-19 diagnosis. This research was taken to investigate the utility of artificial intelligence (AI) in the rapid and accurate detection of COVID-19 from chest X-ray images. The aim of this paper is to propose a robust technique for automatic detection of COVID-19 pneumonia from digital chest X-ray images applying pre-trained deep-learning algorithms while maximizing the detection accuracy. A public database was created by the authors combining several public databases and also by collecting images from recently published articles. The database contains a mixture of 423 COVID-19, 1485 viral pneumonia, and 1579 normal chest X-ray images. Transfer learning technique was used with the help of image augmentation to train and validate several pre-trained deep Convolutional Neural Networks (CNNs). The networks were trained to classify two different schemes: i) normal and COVID-19 pneumonia; ii) normal, viral and COVID-19 pneumonia with and without image augmentation. The classification accuracy, precision, sensitivity, and specificity for both the schemes were 99.7%, 99.7%, 99.7% and 99.55% and 97.9%, 97.95%, 97.9%, and 98.8%, respectively.

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.

Future short or long-term space missions require a new generation of monitoring and diagnostic systems due to communication impasses as well as limitations in specialized crew and equipment. Machine learning supported diagnostic systems present a viable solution for medical and technical applications. We discuss challenges and applicability of such systems in light of upcoming missions and outline an example use case for a next-generation medical diagnostic system for future space operations. Additionally, we present approach recommendations and constraints for the successful generation and use of machine learning models aboard a spacecraft.

Most clinical benchmarks evaluate language models (LMs) on diagnosis using complete case descriptions. In clinical practice, however, patients present information in different ways, and clinicians must obtain relevant history and determine which examinations are needed before reaching a diagnosis. Diagnostic accuracy alone therefore cannot establish whether an agent gathered essential information or conducted an appropriate clinical assessment. Furthermore, existing benchmarks lack professional clinicians' verification. To address this gap, we introduce KlinikeBench, a benchmark of 333 clinician-authored tasks, each providing an isolated sandbox environment with a virtual patient, clinical tools, and task-specific success criteria. More than 35 clinicians contributed to case authoring and benchmark evaluation. In an empirical study, clinicians gave simulated dialogues higher mean quality ratings than reference conversations, which is adapted from real conversation. In each task, an LM has a fixed budget of turns to communicate with the patient, ask about relevant history, request examinations, follow action constraints, and record a final diagnosis. We score these steps separately as well as together. Across 31 models and seven model families, the best-performing models (e.g., GPT-6-astra and Claude Opus 5) succeed on less than 30% of tasks, even though their diagnosis accuracy reaches 90.7%. Some models benefit from talking with the patient; others diagnose well from a complete chart but perform much worse in conversation. Overall, KlinikeBench provides a testbed for evaluating the full clinical encounter and reveals a substantial gap between diagnostic accuracy and performance in interactive clinical assessment.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

Medical imaging papers often focus on methodology, but the quality of the algorithms and the validity of the conclusions are highly dependent on the datasets used. As creating datasets requires a lot of effort, researchers often use publicly available datasets, there is however no adopted standard for citing the datasets used in scientific papers, leading to difficulty in tracking dataset usage. In this work, we present two open-source tools we created that could help with the detection of dataset usage, a pipeline https://github.com/TheoSourget/Public_Medical_Datasets_References using OpenAlex and full-text analysis, and a PDF annotation software https://github.com/TheoSourget/pdf_annotator used in our study to manually label the presence of datasets. We applied both tools on a study of the usage of 20 publicly available medical datasets in papers from MICCAI and MIDL. We compute the proportion and the evolution between 2013 and 2023 of 3 types of presence in a paper: cited, mentioned in the full text, cited and mentioned. Our findings demonstrate the concentration of the usage of a limited set of datasets. We also highlight different citing practices, making the automation of tracking difficult.

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

Diagnostic consultation is an online sequential decision-making process in which clinicians gather evidence through patient interaction until a diagnosis is sufficiently supported. Automating this process requires adaptive inquiry and interpretable decisions. Bayesian networks offer a natural foundation by updating diagnostic posteriors as evidence accumulates, but their use in open-ended consultation raises two challenges: linking diagnostic hypotheses to potential inquiries and translating evolving posteriors into consultation decisions. We introduce AutoDisym, an automated pipeline that integrates diagnostic knowledge with heterogeneous diagnosis-labeled clinical narratives to construct a Disorder--Symptom Bayesian Network (DSBN). Building on the DSBN, we propose ConsultMind, an uncertainty-aware framework that updates disorder posteriors after each response and uses posterior uncertainty to guide inquiry and diagnosis. We evaluate both methods across psychiatry, respiratory medicine, fever clinics, and three public datasets. The results show that AutoDisym can automatically construct high-quality DSBNs and that ConsultMind consistently improves diagnostic performance and explanation soundness. For example, AutoDisym achieves macro-averaged F1 scores of 81.37 for canonical symptoms and 72.19 for manifestations using GPT-5.6-Sol. ConsultMind improves Top-1 and Top-3 diagnostic accuracy by up to 22.15 and 37.89 percentage points, respectively. Physician evaluation further shows that ConsultMind improves the quality of ranking explanations, differential diagnoses, and diagnosis rationales across LLMs of different scales. This work offers a promising approach to automatic diagnostic consultation.

Electroencephalography (EEG) is a widely used tool for studying brain function, with applications in clinical neuroscience, diagnosis, and brain-computer interfaces (BCIs). Recent EEG foundation models trained on large unlabeled corpora aim to learn transferable representations, but their effectiveness remains unclear; reported improvements over smaller task-specific models are often modest, sensitive to downstream adaptation and fine-tuning strategies, and limited under linear probing. We hypothesize that one contributing factor is the reliance on signal reconstruction as the primary self-supervised learning (SSL) objective, which biases representations toward high-variance artifacts rather than task-relevant neural structure. To address this limitation, we explore an SSL paradigm based on Joint Embedding Predictive Architectures (JEPA), which learn by predicting latent representations instead of reconstructing raw signals. We introduce Laya, the first EEG foundation model based on LeJEPA. We show that latent prediction yields representations that encode semantic structure in EEG: Laya embeddings track clinically meaningful state changes such as seizure onset, are resilient to noise, and achieve the strongest mean clinical accuracy under frozen linear probing, with particular gains on tasks where relevant neural patterns are subtle and easily obscured by artifacts. Controlled ablations against matched MAE variants confirm that the choice of pretraining objective, rather than architecture or data, is the primary driver of these gains.

Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, phase recognition has been studied in the context of several kinds of surgeries, such as cataract, neurological, and laparoscopic surgeries. In the literature, two types of features are typically used to perform this task: visual features and tool usage signals. However, the visual features used are mostly handcrafted. Furthermore, the tool usage signals are usually collected via a manual annotation process or by using additional equipment. In this paper, we propose a novel method for phase recognition that uses a convolutional neural network (CNN) to automatically learn features from cholecystectomy videos and that relies uniquely on visual information. In previous studies, it has been shown that the tool signals can provide valuable information in performing the phase recognition task. Thus, we present a novel CNN architecture, called EndoNet, that is designed to carry out the phase recognition and tool presence detection tasks in a multi-task manner. To the best of our knowledge, this is the first work proposing to use a CNN for multiple recognition tasks on laparoscopic videos. Extensive experimental comparisons to other methods show that EndoNet yields state-of-the-art results for both tasks.

Urine sediment examination (USE) is one of the main tests used in the evaluation of diseases such as kidney, urinary, metabolic, and diabetes and to determine the density and number of various cells in the urine. USE's manual microscopy is a labor-intensive and time-consuming, imprecise, subjective process. Recently, automatic analysis of urine sediment has become inevitable in the medical field. In this study, we propose a dataset that can be used by artificial intelligence techniques to automatically identify particles in urine sediment images. The data set consists of 8509 particle images obtained by examining the particles in the urine sediment obtained from 409 patients from the Biochemistry Clinics of Elazig Fethi Sekin Central Hospital. Particle images are collected in 8 classes in total and these are Erythrocyte, Leukocyte, Epithelial, Bacteria, Yeast, Cylinders, Crystals, and others (sperm, etc.).

Large language models (LLMs) have garnered significant attention due to their impressive natural language processing (NLP) capabilities. Recently, many studies have focused on the tool utilization ability of LLMs. They primarily investigated how LLMs effectively collaborate with given specific tools. However, in scenarios where LLMs serve as intelligent agents, as seen in applications like AutoGPT and MetaGPT, LLMs are expected to engage in intricate decision-making processes that involve deciding whether to employ a tool and selecting the most suitable tool(s) from a collection of available tools to fulfill user requests. Therefore, in this paper, we introduce MetaTool, a benchmark designed to evaluate whether LLMs have tool usage awareness and can correctly choose tools. Specifically, we create a dataset called ToolE within the benchmark. This dataset contains various types of user queries in the form of prompts that trigger LLMs to use tools, including both single-tool and multi-tool scenarios. Subsequently, we set the tasks for both tool usage awareness and tool selection. We define four subtasks from different perspectives in tool selection, including tool selection with similar choices, tool selection in specific scenarios, tool selection with possible reliability issues, and multi-tool selection. We conduct experiments involving nine popular LLMs and find that the majority of them still struggle to effectively select tools, highlighting the existing gaps between LLMs and genuine intelligent agents. However, through the error analysis, we found there is still significant room for improvement. Finally, we conclude with insights for tool developers that follow ChatGPT to provide detailed descriptions that can enhance the tool selection performance of LLMs.

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

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

The rapid increase of computed tomography (CT) scans and their time-consuming manual analysis have created an urgent need for robust automated analysis techniques in clinical settings. These aim to assist radiologists and help them managing their growing workload. Existing methods typically generate entire reports directly from 3D CT images, without explicitly focusing on observed abnormalities. This unguided approach often results in repetitive content or incomplete reports, failing to prioritize anomaly-specific descriptions. We propose a new anomaly-guided report generation model, which first predicts abnormalities and then generates targeted descriptions for each. Evaluation on a public dataset demonstrates significant improvements in report quality and clinical relevance. We extend our work by conducting an ablation study to demonstrate its effectiveness.

Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly, time-consuming and prone to variability. This has fueled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules but its application to clinical routine is challenging. In this study, a new database for the development and testing of pulmonary nodule computer-aided strategies is presented which intends to complement current databases by giving additional focus to radiologist variability and local clinical reality. State-of-the-art nodule detection, segmentation and characterization methods are tested and compared to manual annotations as well as collaborative strategies combining multiple radiologists and radiologists and computer-aided systems. It is shown that state-of-the-art methodologies can determine a patient's follow-up recommendation as accurately as a radiologist, though the nodule detection method used shows decreased performance in this database.

The increasing use of tools and solutions based on Large Language Models (LLMs) for various tasks in the medical domain has become a prominent trend. Their use in this highly critical and sensitive domain has thus raised important questions about their robustness, especially in response to variations in input, and the reliability of the generated outputs. This study addresses these questions by constructing a textual dataset based on the ICD-10-CM code descriptions, widely used in US hospitals and containing many clinical terms, and their easily reproducible rephrasing. We then benchmarked existing embedding models, either generalist or specialized in the clinical domain, in a semantic search task where the goal was to correctly match the rephrased text to the original description. Our results showed that generalist models performed better than clinical models, suggesting that existing clinical specialized models are more sensitive to small changes in input that confuse them. The highlighted problem of specialized models may be due to the fact that they have not been trained on sufficient data, and in particular on datasets that are not diverse enough to have a reliable global language understanding, which is still necessary for accurate handling of medical documents.

Recently, Computer-Aided Diagnosis (CAD) systems have emerged as indispensable tools in clinical diagnostic workflows, significantly alleviating the burden on radiologists. Nevertheless, despite their integration into clinical settings, CAD systems encounter limitations. Specifically, while CAD systems can achieve high performance in the detection of lung nodules, they face challenges in accurately predicting multiple cancer types. This limitation can be attributed to the scarcity of publicly available datasets annotated with expert-level cancer type information. This research aims to bridge this gap by providing publicly accessible datasets and reliable tools for medical diagnosis, facilitating a finer categorization of different types of lung diseases so as to offer precise treatment recommendations. To achieve this objective, we curated a diverse dataset of lung Computed Tomography (CT) images, comprising 330 annotated nodules (nodules are labeled as bounding boxes) from 95 distinct patients. The quality of the dataset was evaluated using a variety of classical classification and detection models, and these promising results demonstrate that the dataset has a feasible application and further facilitate intelligent auxiliary diagnosis.

Large language models (LLMs) have recently showcased remarkable capabilities, spanning a wide range of tasks and applications, including those in the medical domain. Models like GPT-4 excel in medical question answering but may face challenges in the lack of interpretability when handling complex tasks in real clinical settings. We thus introduce the diagnostic reasoning dataset for clinical notes (DiReCT), aiming at evaluating the reasoning ability and interpretability of LLMs compared to human doctors. It contains 511 clinical notes, each meticulously annotated by physicians, detailing the diagnostic reasoning process from observations in a clinical note to the final diagnosis. Additionally, a diagnostic knowledge graph is provided to offer essential knowledge for reasoning, which may not be covered in the training data of existing LLMs. Evaluations of leading LLMs on DiReCT bring out a significant gap between their reasoning ability and that of human doctors, highlighting the critical need for models that can reason effectively in real-world clinical scenarios.

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

Large language models (LLMs) are increasingly used in healthcare, but their reliability is heavily influenced by user-driven factors such as question phrasing and the completeness of clinical information. In this study, we examined how misinformation framing, source authority, model persona, and omission of key clinical details affect the diagnostic accuracy and reliability of LLM outputs. We conducted two experiments: one introducing misleading external opinions with varying assertiveness (perturbation test), and another removing specific categories of patient information (ablation test). Using public datasets (MedQA and Medbullets), we evaluated proprietary models (GPT-4o, Claude 3.5 Sonnet, Claude 3.5 Haiku, Gemini 1.5 Pro, Gemini 1.5 Flash) and open-source models (LLaMA 3 8B, LLaMA 3 Med42 8B, DeepSeek R1 8B). All models were vulnerable to user-driven misinformation, with proprietary models especially affected by definitive and authoritative language. Assertive tone had the greatest negative impact on accuracy. In the ablation test, omitting physical exam findings and lab results caused the most significant performance drop. Although proprietary models had higher baseline accuracy, their performance declined sharply under misinformation. These results highlight the need for well-structured prompts and complete clinical context. Users should avoid authoritative framing of misinformation and provide full clinical details, especially for complex cases.

Skin conditions affect an estimated 1.9 billion people worldwide. A shortage of dermatologists causes long wait times and leads patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in referral errors, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 skin conditions that represent roughly 80% of the volume of skin conditions seen in primary care. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively. For a random subset of the validation set (n=963 cases), 18 clinicians reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs. These results highlight the potential of the DLS to augment general practitioners to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

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.

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

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.

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

Clinical decision-making in emergency medicine demands rapid, accurate diagnoses under uncertainty. Despite benchmark progress, evidence for LLMs as interactive aids in live physician workflows remains sparse. MedSyn lets physicians iteratively query an LLM provided with the full clinical record while initially viewing only the chief complaint. Seven physicians (three seniors, four residents) completed baseline and AI-assisted sessions across 52 MIMIC-IV cases stratified by difficulty. Blinded evaluation showed residents' Hard-case correctness rose from 0.589 to 0.734; difficulty-standardised completely-correct rates confirmed a medium effect (Δ = 0.092; p = 0.071; d = 0.47). Automated metrics corroborated these gains: standardised any-match accuracy improved by 0.156 (p < 0.0001), and residents showed the largest F1 gain (Δ = 0.138; p < 0.0001). Dialogue analysis revealed expertise-dependent strategies (seniors asked targeted, hypothesis-driven questions; residents relied on broader queries) and cross-expertise concordance increased (Δ = 0.145; p < 0.0001). Interactive LLM support meaningfully enhances diagnostic reasoning.

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.

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.

Specialized clinical AI assistants are rapidly entering medical practice, often framed as safer or more reliable than general-purpose large language models (LLMs). Yet, unlike frontier models, these clinical tools are rarely subjected to independent, quantitative evaluation, creating a critical evidence gap despite their growing influence on diagnosis, triage, and guideline interpretation. We assessed two widely deployed clinical AI systems (OpenEvidence and UpToDate Expert AI) against three state-of-the-art generalist LLMs (GPT-5, Gemini 3 Pro, and Claude Sonnet 4.5) using a 1,000-item mini-benchmark combining MedQA (medical knowledge) and HealthBench (clinician-alignment) tasks. Generalist models consistently outperformed clinical tools, with GPT-5 achieving the highest scores, while OpenEvidence and UpToDate demonstrated deficits in completeness, communication quality, context awareness, and systems-based safety reasoning. These findings reveal that tools marketed for clinical decision support may often lag behind frontier LLMs, underscoring the urgent need for transparent, independent evaluation before deployment in patient-facing workflows.

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

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.

Exam-style accuracy does not establish whether large language models (LLMs) reason well over clinical records. We define clinical reasoning as integrating and updating evidence across time and sources to form, revise and justify a patient's problem representation and a defensible plan. This structured narrative review maps three literatures: medical education assessment instruments, clinical LLM benchmarks published from 2023 onwards, and general-domain methods for evaluating long-form generation. We examine six dimensions: problem representation, temporal synthesis, differential and management reasoning, counterfactual reasoning, calibrated uncertainty, and reasoning faithfulness. Preprints are included and flagged. No single instrument covers all six dimensions. Problem representation and differential or management reasoning are reasonably covered, although reliability varies by instrument and setting. TIMER-Eval targets temporal synthesis, and ER-Reason assesses sequential diagnostic belief updating. Dedicated uncertainty and counterfactual evaluations are emerging, but their applicability to longitudinal free-text reasoning remains limited. Factual completeness is well theorised in general-domain evaluation, with early clinical evidence of important omissions. Faithfulness remains the weakest dimension, with one identified clinical causal-ablation study on multiple-choice questions. Existing tools should be combined through binary rubric items, separate completeness and correctness scores, case-specific importance weighting with non-compensable safety caps, temporal order-consistency checks, and chance-corrected reliability reporting. Further design work is needed for calibrated uncertainty, counterfactual reasoning and faithfulness over longitudinal free-text records. This review provides a design rationale, not a validated instrument.

The COVID-19 pandemic swept across the world rapidly, infecting millions of people. An efficient tool that can accurately recognize important clinical concepts of COVID-19 from free text in electronic health records (EHRs) will be valuable to accelerate COVID-19 clinical research. To this end, this study aims at adapting the existing CLAMP natural language processing tool to quickly build COVID-19 SignSym, which can extract COVID-19 signs/symptoms and their 8 attributes (body location, severity, temporal expression, subject, condition, uncertainty, negation, and course) from clinical text. The extracted information is also mapped to standard concepts in the Observational Medical Outcomes Partnership common data model. A hybrid approach of combining deep learning-based models, curated lexicons, and pattern-based rules was applied to quickly build the COVID-19 SignSym from CLAMP, with optimized performance. Our extensive evaluation using 3 external sites with clinical notes of COVID-19 patients, as well as the online medical dialogues of COVID-19, shows COVID-19 Sign-Sym can achieve high performance across data sources. The workflow used for this study can be generalized to other use cases, where existing clinical natural language processing tools need to be customized for specific information needs within a short time. COVID-19 SignSym is freely accessible to the research community as a downloadable package (https://clamp.uth.edu/covid/nlp.php) and has been used by 16 healthcare organizations to support clinical research of COVID-19.

Surgical tool detection is a fundamental task for understanding egocentric open surgery videos. However, detecting surgical tools presents significant challenges due to their highly imbalanced class distribution, similar shapes and similar textures, and heavy occlusion. The lack of a comprehensive large-scale dataset compounds these challenges. In this paper, we introduce EgoSurgery-Tool, an extension of the existing EgoSurgery-Phase dataset, which contains real open surgery videos captured using an egocentric camera attached to the surgeon's head, along with phase annotations. EgoSurgery-Tool has been densely annotated with surgical tools and comprises over 49K surgical tool bounding boxes across 15 categories, constituting a large-scale surgical tool detection dataset. EgoSurgery-Tool also provides annotations for hand detection with over 46K hand-bounding boxes, capturing hand-object interactions that are crucial for understanding activities in egocentric open surgery. EgoSurgery-Tool is superior to existing datasets due to its larger scale, greater variety of surgical tools, more annotations, and denser scenes. We conduct a comprehensive analysis of EgoSurgery-Tool using nine popular object detectors to assess their effectiveness in both surgical tool and hand detection. The dataset will be released at https://github.com/Fujiry0/EgoSurgery.

Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice. We report a blinded evaluation built on 620 Real-world Point-Of-Care Queries (Real-POCQi) submitted to the OpenEvidence (OE) platform by physicians spanning 30 specialties, as well as 187 questions from HealthBench. 149 practicing physicians across 36 states made head-to-head comparisons between answers from three frontier general-purpose models (Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5) and a specialized clinical tool (OE), with graders matched to each question's specialty. When comparing answers along five dimensions relevant to clinical decision support -- accuracy, clinical utility, source quality, verifiability, & completeness -- physicians scored the specialized tool highest on all axes; in the primary analysis on Real-POCQi, win differences (margins between win and loss rates) ranged from 25 to 39 percentage points (p<0.001). Results remained consistent in sensitivity analyses stratifying by citation display, answer length, OE-user status, and Real-POCQi versus HealthBench. In parallel, LLM judges were found to systematically differ from expert judges, though both generally agreed on the best model. These findings underscore two conclusions: (i) AI tool evaluations should reflect real-world query distributions and use expert judges that mirror the specialization defining modern medicine and (ii) the consistent advantage of the specialized tool over general-purpose models does not necessarily mean that the latter cannot serve similar purposes, but that targeted engineering and customization can yield meaningful gains in performance for its users. We release Real-POCQi as a public benchmark, as well as the prespecified statistical analysis for reproducing results of this study.

Diagnosing lung cancer typically involves physicians identifying lung nodules in Computed tomography (CT) scans and generating diagnostic reports based on their morphological features and medical expertise. Although advancements have been made in using multimodal large language models for analyzing lung CT scans, challenges remain in accurately describing nodule morphology and incorporating medical expertise. These limitations affect the reliability and effectiveness of these models in clinical settings. Collaborative multi-agent systems offer a promising strategy for achieving a balance between generality and precision in medical applications, yet their potential in pathology has not been thoroughly explored. To bridge these gaps, we introduce LungNoduleAgent, an innovative collaborative multi-agent system specifically designed for analyzing lung CT scans. LungNoduleAgent streamlines the diagnostic process into sequential components, improving precision in describing nodules and grading malignancy through three primary modules. The first module, the Nodule Spotter, coordinates clinical detection models to accurately identify nodules. The second module, the Radiologist, integrates localized image description techniques to produce comprehensive CT reports. Finally, the Doctor Agent System performs malignancy reasoning by using images and CT reports, supported by a pathology knowledge base and a multi-agent system framework. Extensive testing on two private datasets and the public LIDC-IDRI dataset indicates that LungNoduleAgent surpasses mainstream vision-language models, agent systems, and advanced expert models. These results highlight the importance of region-level semantic alignment and multi-agent collaboration in diagnosing nodules. LungNoduleAgent stands out as a promising foundational tool for supporting clinical analyses of lung nodules.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

Databases of electronic health records (EHRs) are increasingly used to inform clinical decisions. Machine learning methods can find patterns in EHRs that are predictive of future adverse outcomes. However, statistical models may be built upon patterns of health-seeking behavior that vary across patient subpopulations, leading to poor predictive performance when training on one patient population and predicting on another. This note proposes two tests to better measure and understand model generalization. We use these tests to compare models derived from two data sources: (i) historical medical records, and (ii) electrocardiogram (EKG) waveforms. In a predictive task, we show that EKG-based models can be more stable than EHR-based models across different patient populations.

Over the past several years, across the globe, there has been an increase in people seeking care in emergency departments (EDs). ED resources, including nurse staffing, are strained by such increases in patient volume. Accurate forecasting of incoming patient volume in emergency departments (ED) is crucial for efficient utilization and allocation of ED resources. Working with a suburban ED in the Pacific Northwest, we developed a tool powered by machine learning models, to forecast ED arrivals and ED patient volume to assist end-users, such as ED nurses, in resource allocation. In this paper, we discuss the results from our predictive models, the challenges, and the learnings from users' experiences with the tool in active clinical deployment in a real world setting.

Integrating tools into Large Language Models (LLMs) has facilitated the widespread application. Despite this, in specialized downstream task contexts, reliance solely on tools is insufficient to fully address the complexities of the real world. This particularly restricts the effective deployment of LLMs in fields such as medicine. In this paper, we focus on the downstream tasks of medical calculators, which use standardized tests to assess an individual's health status. We introduce MeNTi, a universal agent architecture for LLMs. MeNTi integrates a specialized medical toolkit and employs meta-tool and nested calling mechanisms to enhance LLM tool utilization. Specifically, it achieves flexible tool selection and nested tool calling to address practical issues faced in intricate medical scenarios, including calculator selection, slot filling, and unit conversion. To assess the capabilities of LLMs for quantitative assessment throughout the clinical process of calculator scenarios, we introduce CalcQA. This benchmark requires LLMs to use medical calculators to perform calculations and assess patient health status. CalcQA is constructed by professional physicians and includes 100 case-calculator pairs, complemented by a toolkit of 281 medical tools. The experimental results demonstrate significant performance improvements with our framework. This research paves new directions for applying LLMs in demanding scenarios of medicine.

Finding relevant literature underpins the practice of evidence-based medicine. From 2014 to 2016, TREC conducted a clinical decision support track, wherein participants were tasked with finding articles relevant to clinical questions posed by physicians. In total, 87 teams have participated over the past three years, generating 395 runs. During this period, each team has trialled a variety of methods. While there was significant overlap in the methods employed by different teams, the results were varied. Due to the diversity of the platforms used, the results arising from the different techniques are not directly comparable, reducing the ability to build on previous work. By using a stable platform, we have been able to compare different document and query processing techniques, allowing us to experiment with different search parameters. We have used our system to reproduce leading teams runs, and compare the results obtained. By benchmarking our indexing and search techniques, we can statistically test a variety of hypotheses, paving the way for further research.

Automated surgical instrument localization is an important technology to understand the surgical process and in order to analyze them to provide meaningful guidance during surgery or surgical index after surgery to the surgeon. We introduce a new dataset that reflects the kinematic characteristics of surgical instruments for automated surgical instrument localization of surgical videos. The hSDB(hutom Surgery DataBase)-instrument dataset consists of instrument localization information from 24 cases of laparoscopic cholecystecomy and 24 cases of robotic gastrectomy. Localization information for all instruments is provided in the form of a bounding box for object detection. To handle class imbalance problem between instruments, synthesized instruments modeled in Unity for 3D models are included as training data. Besides, for 3D instrument data, a polygon annotation is provided to enable instance segmentation of the tool. To reflect the kinematic characteristics of all instruments, they are annotated with head and body parts for laparoscopic instruments, and with head, wrist, and body parts for robotic instruments separately. Annotation data of assistive tools (specimen bag, needle, etc.) that are frequently used for surgery are also included. Moreover, we provide statistical information on the hSDB-instrument dataset and the baseline localization performances of the object detection networks trained by the MMDetection library and resulting analyses.

Background: Natural Language Processing (NLP) is widely used to extract clinical insights from Electronic Health Records (EHRs). However, the lack of annotated data, automated tools, and other challenges hinder the full utilisation of NLP for EHRs. Various Machine Learning (ML), Deep Learning (DL) and NLP techniques are studied and compared to understand the limitations and opportunities in this space comprehensively. Methodology: After screening 261 articles from 11 databases, we included 127 papers for full-text review covering seven categories of articles: 1) medical note classification, 2) clinical entity recognition, 3) text summarisation, 4) deep learning (DL) and transfer learning architecture, 5) information extraction, 6) Medical language translation and 7) other NLP applications. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result and Discussion: EHR was the most commonly used data type among the selected articles, and the datasets were primarily unstructured. Various ML and DL methods were used, with prediction or classification being the most common application of ML or DL. The most common use cases were: the International Classification of Diseases, Ninth Revision (ICD-9) classification, clinical note analysis, and named entity recognition (NER) for clinical descriptions and research on psychiatric disorders. Conclusion: We find that the adopted ML models were not adequately assessed. In addition, the data imbalance problem is quite important, yet we must find techniques to address this underlining problem. Future studies should address key limitations in studies, primarily identifying Lupus Nephritis, Suicide Attempts, perinatal self-harmed and ICD-9 classification.

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

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

Large language models (LLMs) increasingly act as autonomous agents that must decide when to answer directly vs. when to invoke external tools. Prior work studying adaptive tool use has largely treated tool necessity as a model-agnostic property, annotated by human or LLM judge, and mostly cover cases where the answer is obvious (e.g., fetching the weather vs. paraphrasing text). However, tool necessity in the wild is more nuanced due to the divergence of capability boundaries across models: a problem solvable by a strong model on its own may still require tools for a weaker one. In this work, we introduce a model-adaptive definition of tool-necessity, grounded in each model's empirical performance. Following this definition, we compare the necessity against observed tool-call behavior across four models on arithmetic and factual QA dataset, and find substantial mismatches of 26.5-54.0% and 30.8-41.8%, respectively. To diagnose the failure, we decompose tool use into two stages: an internal cognition stage that reflects whether a model believes a tool is necessary, and an execution stage that determines whether the model actually makes a tool-call action. By probing the LLM hidden states, we find that both signals are often linearly decodable, yet their probe directions become nearly orthogonal in the late-layer, last-token regime that drives the next-token action. By tracing the trajectory of samples in the two-stage process, we further discover that the majority of mismatch is concentrated in the cognition-to-action transition, not in cognition itself. These results reveal a knowing-doing gap in LLM tool-use: improving tool-use reliability requires not only better recognition of when tools are needed, but also better translation of that recognition into action.

Agentic systems offer a potential path to solve complex clinical tasks through collaboration among specialized agents, augmented by tool use and external knowledge bases. Nevertheless, for chest X-ray (CXR) interpretation, prevailing methods remain limited: (i) reasoning is frequently neither clinically interpretable nor aligned with guidelines, reflecting mere aggregation of tool outputs; (ii) multimodal evidence is insufficiently fused, yielding text-only rationales that are not visually grounded; and (iii) systems rarely detect or resolve cross-tool inconsistencies and provide no principled verification mechanisms. To bridge the above gaps, we present RadAgents, a multi-agent framework for CXR interpretation that couples clinical priors with task-aware multimodal reasoning. In addition, we integrate grounding and multimodal retrieval-augmentation to verify and resolve context conflicts, resulting in outputs that are more reliable, transparent, and consistent with clinical practice.

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.

Quantitative tools are increasingly appealing for decision support in healthcare, driven by the growing capabilities of advanced AI systems. However, understanding the predictive uncertainties surrounding a tool's output is crucial for decision-makers to ensure reliable and transparent decisions. In this paper, we present a case study on pulmonary nodule detection for lung cancer screening, enhancing an advanced detection model with an uncertainty quantification technique called conformal risk control (CRC). We demonstrate that prediction sets with conformal guarantees are attractive measures of predictive uncertainty in the safety-critical healthcare domain, allowing end-users to achieve arbitrary validity by trading off false positives and providing formal statistical guarantees on model performance. Among ground-truth nodules annotated by at least three radiologists, our model achieves a sensitivity that is competitive with that generally achieved by individual radiologists, with a slight increase in false positives. Furthermore, we illustrate the risks of using off-the-shelve prediction models when faced with ontological uncertainty, such as when radiologists disagree on what constitutes the ground truth on pulmonary nodules.

Across the world's coronavirus disease 2019 (COVID-19) hot spots, the need to streamline patient diagnosis and management has become more pressing than ever. As one of the main imaging tools, chest X-rays (CXRs) are common, fast, non-invasive, relatively cheap, and potentially bedside to monitor the progression of the disease. This paper describes the first public COVID-19 image data collection as well as a preliminary exploration of possible use cases for the data. This dataset currently contains hundreds of frontal view X-rays and is the largest public resource for COVID-19 image and prognostic data, making it a necessary resource to develop and evaluate tools to aid in the treatment of COVID-19. It was manually aggregated from publication figures as well as various web based repositories into a machine learning (ML) friendly format with accompanying dataloader code. We collected frontal and lateral view imagery and metadata such as the time since first symptoms, intensive care unit (ICU) status, survival status, intubation status, or hospital location. We present multiple possible use cases for the data such as predicting the need for the ICU, predicting patient survival, and understanding a patient's trajectory during treatment. Data can be accessed here: https://github.com/ieee8023/covid-chestxray-dataset

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

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.

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

Given the dominance of dense retrievers that do not generalize well beyond their training dataset distributions, domain-specific test sets are essential in evaluating retrieval. There are few test datasets for retrieval systems intended for use by healthcare providers in a point-of-care setting. To fill this gap we have collaborated with medical professionals to create CURE, an ad-hoc retrieval test dataset for passage ranking with 2000 queries spanning 10 medical domains with a monolingual (English) and two cross-lingual (French/Spanish -> English) conditions. In this paper, we describe how CURE was constructed and provide baseline results to showcase its effectiveness as an evaluation tool. CURE is published with a Creative Commons Attribution Non Commercial 4.0 license and can be accessed on Hugging Face.

Language models (LMs) are powerful yet mostly for text generation tasks. Tools have substantially enhanced their performance for tasks that require complex skills. However, many works adopt the term "tool" in different ways, raising the question: What is a tool anyway? Subsequently, where and how do tools help LMs? In this survey, we provide a unified definition of tools as external programs used by LMs, and perform a systematic review of LM tooling scenarios and approaches. Grounded on this review, we empirically study the efficiency of various tooling methods by measuring their required compute and performance gains on various benchmarks, and highlight some challenges and potential future research in the field.

Recent research shows the potential of enhancing the problem-solving ability of large language models (LLMs) through the use of external tools. However, prior work along this line depends on the availability of existing tools. In this work, we take an initial step towards removing this dependency by proposing a closed-loop framework, referred to as LLMs As Tool Makers (LATM), where LLMs create their own reusable tools for problem-solving. Our approach consists of two key phases: 1) tool making: an LLM acts as the tool maker that crafts tools for given tasks, where a tool is implemented as a Python utility function. 2) tool using: an LLM acts as the tool user, which applies the tool built by the tool maker for problem-solving. The tool user can be either the same or a different LLM from the tool maker. Tool-making enables an LLM to continually generate tools that can be applied to different requests so that future requests can call the corresponding APIs when beneficial for solving the tasks. Furthermore, the division of labor among LLMs for tool-making and tool-using phases introduces the opportunity to achieve cost effectiveness without degrading the quality of generated tools and problem solutions. For example, recognizing that tool-making demands more sophisticated capabilities than tool-using, we can apply a powerful yet resource-intensive model as the tool maker, and a lightweight while cost-effective model as the tool user. We validate the effectiveness of our approach across a variety of complex reasoning tasks, including Big-Bench tasks. With GPT-4 as the tool maker and GPT-3.5 as the tool user, LATM can achieve performance that is on par with using GPT-4 for both tool making and tool using, while the inference cost is significantly reduced.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Diagnosis based on medical images, such as X-ray images, often involves manual annotation of anatomical keypoints. However, this process involves significant human efforts and can thus be a bottleneck in the diagnostic process. To fully automate this procedure, deep-learning-based methods have been widely proposed and have achieved high performance in detecting keypoints in medical images. However, these methods still have clinical limitations: accuracy cannot be guaranteed for all cases, and it is necessary for doctors to double-check all predictions of models. In response, we propose a novel deep neural network that, given an X-ray image, automatically detects and refines the anatomical keypoints through a user-interactive system in which doctors can fix mispredicted keypoints with fewer clicks than needed during manual revision. Using our own collected data and the publicly available AASCE dataset, we demonstrate the effectiveness of the proposed method in reducing the annotation costs via extensive quantitative and qualitative results. A demo video of our approach is available on our project webpage.

Recent advancements in integrating large language models (LLMs) with tools have allowed the models to interact with real-world environments. However, these tool-augmented LLMs often encounter incomplete scenarios when users provide partial information or the necessary tools are unavailable. Recognizing and managing such scenarios is crucial for LLMs to ensure their reliability, but this exploration remains understudied. This study examines whether LLMs can identify incomplete conditions and appropriately determine when to refrain from using tools. To this end, we address a dataset by manipulating instances from two datasets by removing necessary tools or essential information for tool invocation. We confirm that most LLMs are challenged to identify the additional information required to utilize specific tools and the absence of appropriate tools. Our research can contribute to advancing reliable LLMs by addressing scenarios that commonly arise during interactions between humans and LLMs.

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

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

The controversy of computed tomography (CT) use in COVID-19 screening is associated with ambiguous characteristics of chest CT as a diagnostic test. The reported values of CT sensitivity and specificity calculated using RT-PCR as a reference standard vary widely. The objective of this study was to reevaluate the diagnostic and prognostic value of CT using an alternative approach. This study included 973 symptomatic COVID-19 patients aged 42 pm 17 years, 56% females. We reviewed the disease dynamics between the initial and follow-up CT studies using a "CT0-4" grading system. Sensitivity and specificity were calculated as conditional probabilities that a patient's condition would improve or deteriorate relative to the initial CT study results. For the calculation of negative (NPV) and positive (PPV) predictive values, we estimated the COVID-19 prevalence in Moscow. We used several ARIMA and EST models with different parameters to fit the data on total cases of COVID-19 from March 6, 2020, to July 20, 2020, and forecast the incidence. The "CT0-4" grading scale demonstrated low sensitivity (28%) but high specificity (95%). The best statistical model for describing the pandemic in Moscow was ETS with multiplicative trend, error, and season type. According to our calculations, with the predicted prevalence of 2.1%, the values of NPV and PPV would be 98% and 10%, correspondingly. We associate the low sensitivity and PPV values with the small sample size of the patients with severe symptoms and non-optimal methodological setup for measuring these specific characteristics. The "CT0-4" grading scale was highly specific and predictive for identifying admissions to hospitals of COVID-19 patients. Despite the ambiguous accuracy, chest CT proved to be an effective practical tool for patient management during the pandemic, provided that the necessary infrastructure and human resources are available.

Some security-development settings require local models that map an objective to an ordered, checkable plan. We present a low-rank decomposition adapter and release a case-disjoint corpus with 24 authored decompositions and 83 derived next-step examples across 24 satellite-security cases. To prevent reference-plan leakage, prompts contain one objective and eight shuffled SPARTA candidates. The evaluation candidate sets are constructed with oracle inclusion of every reference technique, so this study measures selection from a controlled set, not retrieval. On six fixed cases and five decoding seeds, mean scores vary across adapters and prompted Qwen2.5 baselines; a separate greedy check over three adapter training seeds shows non-negligible training variance. A 24-fold greedy leave-one-case-out control at the two compact sizes likewise shows tradeoffs: at 1.5B, adapter precision is 0.583 against 0.480 for two-shot prompting, while recall is 0.586 against 0.660. Case-resampling intervals for adapter precision relative to the strongest prompted baseline cross zero at 1.5B and 7B. The adapter is also substantially more format-compliant, which prevents attributing all score differences to selection. Autoregressive next-step accuracy is 0.08, 0.06, and 0.29 at 0.5B, 1.5B, and 7B. We therefore offer the formulation, leakage-controlled dataset, reproducibility package, and descriptive analysis as a proof of concept, not evidence of a reliable stand-alone decomposition system or a general adapter advantage. A separate diagnostic tests contract reuse.