Daily Papers

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.

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.

Automated diagnosis prediction from medical images is a valuable resource to support clinical decision-making. However, such systems usually need to be trained on large amounts of annotated data, which often is scarce in the medical domain. Zero-shot methods address this challenge by allowing a flexible adaption to new settings with different clinical findings without relying on labeled data. Further, to integrate automated diagnosis in the clinical workflow, methods should be transparent and explainable, increasing medical professionals' trust and facilitating correctness verification. In this work, we introduce Xplainer, a novel framework for explainable zero-shot diagnosis in the clinical setting. Xplainer adapts the classification-by-description approach of contrastive vision-language models to the multi-label medical diagnosis task. Specifically, instead of directly predicting a diagnosis, we prompt the model to classify the existence of descriptive observations, which a radiologist would look for on an X-Ray scan, and use the descriptor probabilities to estimate the likelihood of a diagnosis. Our model is explainable by design, as the final diagnosis prediction is directly based on the prediction of the underlying descriptors. We evaluate Xplainer on two chest X-ray datasets, CheXpert and ChestX-ray14, and demonstrate its effectiveness in improving the performance and explainability of zero-shot diagnosis. Our results suggest that Xplainer provides a more detailed understanding of the decision-making process and can be a valuable tool for clinical diagnosis.

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

Automatic Depression Detection (ADD) from clinical interviews is a pivotal task in computational mental health, yet it remains challenging due to two critical obstacles: 1) difficulty in modeling complex but sparsely distributed depression clues within lengthy, multi-topic clinical interviews, leading to superficial and unreliable reasoning; 2) scarcity of labeled data due to clinical privacy, together with high cost of training and fine-tuning, limiting the deployment of supervised ADD systems. To jointly address these challenges, we propose Dep-LLM, a training-free framework that mirrors the step-by-step reasoning of clinical psychiatrists and operates entirely on frozen off-the-shelf foundation LLMs. Dep-LLM comprises three stages. First, a Chain-of-Thought (CoT) Depression Multi-factor Analysis module structurally decomposes the long dialogue into five clinically aligned themes and produces evidence-grounded rationales, effectively handling long-context dependencies. Second, we introduce Confidence Analysis and Modulation module that quantifies the epistemic reliability from token-level entropy of each rationale and applies an intra-label and inter-theme modulation that amplifies trustworthy signals while suppressing uncertain ones without extra training. Third, a Collaborative Multi-factor Prediction module dynamically integrates multi-factor signals weighted by confidence into the final diagnosis. Extensive experiments on the DAIC-WOZ and E-DAIC datasets demonstrate the effectiveness and generalizability of Dep-LLM: it surpasses zero-shot baseline on nearly all 21 foundation LLMs across 9 metrics such as accuracy, macro F1 and weighted-average F1, and further outperforms state-of-the-art supervised domain-specific LLMs as well as the latest closed-source commercial LLMs, while requiring no extra training.

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.

Despite achieving high accuracy on medical benchmarks, LLMs exhibit the Einstellung Effect in clinical diagnosis--relying on statistical shortcuts rather than patient-specific evidence, causing misdiagnosis in atypical cases. Existing benchmarks fail to detect this critical failure mode. We introduce MedEinst, a counterfactual benchmark with 5,383 paired clinical cases across 49 diseases. Each pair contains a control case and a "trap" case with altered discriminative evidence that flips the diagnosis. We measure susceptibility via Bias Trap Rate--probability of misdiagnosing traps despite correctly diagnosing controls. Extensive Evaluation of 17 LLMs shows frontier models achieve high baseline accuracy but severe bias trap rates. Thus, we propose ECR-Agent, aligning LLM reasoning with Evidence-Based Medicine standard via two components: (1) Dynamic Causal Inference (DCI) performs structured reasoning through dual-pathway perception, dynamic causal graph reasoning across three levels (association, intervention, counterfactual), and evidence audit for final diagnosis; (2) Critic-Driven Graph and Memory Evolution (CGME) iteratively refines the system by storing validated reasoning paths in an exemplar base and consolidating disease-specific knowledge into evolving illness graphs. Source code is to be released.

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.

Multimodal large language models (MLLMs) have shown great potential in medical applications, yet existing benchmarks inadequately capture real-world clinical complexity. We introduce MEDSYN, a multilingual, multimodal benchmark of highly complex clinical cases with up to 7 distinct visual clinical evidence (CE) types per case. Mirroring clinical workflow, we evaluate 18 MLLMs on differential diagnosis (DDx) generation and final diagnosis (FDx) selection. While top models often match or even outperform human experts on DDx generation, all MLLMs exhibit a much larger DDx--FDx performance gap compared to expert clinicians, indicating a failure mode in synthesis of heterogeneous CE types. Ablations attribute this failure to (i) overreliance on less discriminative textual CE (e.g., medical history) and (ii) a cross-modal CE utilization gap. We introduce Evidence Sensitivity to quantify the latter and show that a smaller gap correlates with higher diagnostic accuracy. Finally, we demonstrate how it can be used to guide interventions to improve model performance. We will open-source our benchmark and code.

Medical Anomaly Detection (MedAD) presents a significant opportunity to enhance diagnostic accuracy using Large Multimodal Models (LMMs) to interpret and answer questions based on medical images. However, the reliance on Supervised Fine-Tuning (SFT) on simplistic and fragmented datasets has hindered the development of models capable of plausible reasoning and robust multimodal generalization. To overcome this, we introduce MedAD-38K, the first large-scale, multi-modal, and multi-center benchmark for MedAD featuring diagnostic Chain-of-Thought (CoT) annotations alongside structured Visual Question-Answering (VQA) pairs. On this foundation, we propose a two-stage training framework. The first stage, Cognitive Injection, uses SFT to instill foundational medical knowledge and align the model with a structured think-then-answer paradigm. Given that standard policy optimization can produce reasoning that is disconnected from the final answer, the second stage incorporates Consistency Group Relative Policy Optimization (Con-GRPO). This novel algorithm incorporates a crucial consistency reward to ensure the generated reasoning process is relevant and logically coherent with the final diagnosis. Our proposed model, MedAD-R1, achieves state-of-the-art (SOTA) performance on the MedAD-38K benchmark, outperforming strong baselines by more than 10\%. This superior performance stems from its ability to generate transparent and logically consistent reasoning pathways, offering a promising approach to enhancing the trustworthiness and interpretability of AI for clinical decision support.

As modern microservice systems grow increasingly complex due to dynamic interactions and evolving runtime environments, they experience failures with rising frequency. Ensuring system reliability therefore critically depends on accurate root cause localization (RCL). While numerous traditional machine learning and deep learning approaches have been explored for this task, they often suffer from limited interpretability and poor transferability across deployments. More recently, large language model (LLM)-based methods have been proposed to address these issues. However, existing LLM-based approaches still face two fundamental limitations: context explosion, which dilutes critical evidence and degrades localization accuracy, and serial reasoning structures, which hinder deep causal exploration and impair inference efficiency. In this paper, we conduct a comprehensive study of both how human SREs perform root cause localization in practice and why existing LLM-based methods fall short. Motivated by these findings, we introduce RCLAgent, an in-depth root cause localization framework for microservice systems that realizes multi-agent recursion-of-thought with parallel reasoning. RCLAgent decomposes the diagnostic process along the trace graph by assigning each span to a Dedicated Agent and organizing agents recursively and in parallel according to the graph topology, with the final diagnosis obtained by synthesizing the Root-Level Diagnosis Report and the Global Evidence Graph. Extensive experiments on multiple public benchmarks demonstrate that RCLAgent consistently outperforms state-of-the-art methods in both localization accuracy and inference efficiency.

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

Multimodal Large Language Models (MLLMs) show promise for medical applications, yet progress in dermatology lags due to limited training data, narrow task coverage, and lack of clinically-grounded supervision that mirrors expert diagnostic workflows. We present a comprehensive framework to address these gaps. First, we introduce DermoInstruct, a large-scale morphology-anchored instruction corpus comprising 211,243 images and 772,675 trajectories across five task formats, capturing the complete diagnostic pipeline from morphological observation and clinical reasoning to final diagnosis. Second, we establish DermoBench, a rigorous benchmark evaluating 11 tasks across four clinical axes: Morphology, Diagnosis, Reasoning, and Fairness, including a challenging subset of 3,600 expert-verified open-ended instances and human performance baselines. Third, we develop DermoGPT, a dermatology reasoning MLLM trained via supervised fine-tuning followed by our Morphologically-Anchored Visual-Inference-Consistent (MAVIC) reinforcement learning objective, which enforces consistency between visual observations and diagnostic conclusions. At inference, we deploy Confidence-Consistency Test-time adaptation (CCT) for robust predictions. Experiments show DermoGPT significantly outperforms 16 representative baselines across all axes, achieving state-of-the-art performance while substantially narrowing the human-AI gap. DermoInstruct, DermoBench and DermoGPT will be made publicly available at https://github.com/mendicant04/DermoGPT upon acceptance.

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

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.

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.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

AI-assisted ultrasound video diagnosis presents new opportunities to enhance the efficiency and accuracy of medical imaging analysis. However, existing research remains limited in terms of dataset diversity, diagnostic performance, and clinical applicability. In this study, we propose Auto-US, an intelligent diagnosis agent that integrates ultrasound video data with clinical diagnostic text. To support this, we constructed CUV Dataset of 495 ultrasound videos spanning five categories and three organs, aggregated from multiple open-access sources. We developed CTU-Net, which achieves state-of-the-art performance in ultrasound video classification, reaching an accuracy of 86.73\% Furthermore, by incorporating large language models, Auto-US is capable of generating clinically meaningful diagnostic suggestions. The final diagnostic scores for each case exceeded 3 out of 5 and were validated by professional clinicians. These results demonstrate the effectiveness and clinical potential of Auto-US in real-world ultrasound applications. Code and data are available at: https://github.com/Bean-Young/Auto-US.

In this paper we present the methods of our submission to the ISIC 2018 challenge for skin lesion diagnosis (Task 3). The dataset consists of 10000 images with seven image-level classes to be distinguished by an automated algorithm. We employ an ensemble of convolutional neural networks for this task. In particular, we fine-tune pretrained state-of-the-art deep learning models such as Densenet, SENet and ResNeXt. We identify heavy class imbalance as a key problem for this challenge and consider multiple balancing approaches such as loss weighting and balanced batch sampling. Another important feature of our pipeline is the use of a vast amount of unscaled crops for evaluation. Last, we consider meta learning approaches for the final predictions. Our team placed second at the challenge while being the best approach using only publicly available data.

An unsuccessful LLM agent rollout contains more information than its final reward: the observations available to the agent, the actions it chose, and the environment's responses. Reusing this experience for learning requires identifying a decision to revise and testing a concrete alternative. We introduce the Agent Error Dataset (AED), comprising 50,228 error-diagnosis pairs from 9,961 source tasks across 33 environments, 19 harness families, and 23 policy models in text-based agent systems. We retain source traces and execution metadata to support cross-setting failure analysis and re-diagnosis without repeating the original rollout. Our five-stage Agentic Error-to-Training (AET) pipeline collects natural failures, generates diagnoses and proposed corrections, and checks them against recorded evidence. Where replay is supported, we compare corrections with original-action retries from the same checkpoint under matched execution settings. We then construct separate training views for diagnosis and actor recovery. Across 3,062 matched replay pairs, first-proposal corrections raise verifier pass rates from 18.4% to 51.1%, a gain of 32.7 percentage points. Using a separately frozen diagnosis release, full-diagnosis fine-tuning on 1,656 source tasks raises Qwen3-8B's exact-step agreement with internal teacher labels from 47.2% to 63.6%, averaged over three seeds on a 943-case holdout. The strongest prompted reference in this comparison scores 54.7%, and mean agreement improves at each of four increasing training-set sizes. In a single-seed comparison of actor-training recipes, action-only repair training scores 6.67 percentage points higher on WebShop-lite than success-only training.

Large language models (LLMs) increasingly serve as data-driven reasoners, yet their chains-of-thought (CoT) can be unfaithful even when final answers are correct. Most existing ``verification'' signals are not diagnostic: answer matching observes only the outcome, LLM-as-judge provides subjective and non-verifiable critiques, and scalar rewards (e.g., PRMs/RMs) offer little insight into where a multi-step derivation fails.We propose SymDiag, a neuro-symbolic framework that reframes reasoning verification as structured failure diagnosis. SymDiag translates natural-language CoT into symbolic constraints and performs step-level satisfiability/entailment checks to (i) localize failing steps and (ii) produce verifiable diagnostic evidence, including counterexamples, inconsistency witnesses, and missing-premise indicators. A central challenge is that apparent ``logic violations'' can be caused either by genuine reasoning defects or by neural-to-symbolic translation noise. SymDiag therefore incorporates a Self-Auditor that disentangles TranslationError from ReasoningError via dual symbolic encodings consistency checks, enabling robust diagnosis under partial observability. Across diverse mathematical, logical, scientific, and general reasoning benchmarks, SymDiag improves detection of unfaithful reasoning and provides substantially more effective feedback for multi-round reasoning repair than outcome-only verification and LLM-based judging, offering a principled foundation for trustworthy and scalable reasoning diagnosis.

Interactive dialogue games test a capability that static benchmarks largely leave implicit: a model must carry state across turns, interpret feedback, and choose valid actions under changing constraints. We study this setting in the LM Playschool Challenge with a 2B open-weight model, and find that many failures are not only broad knowledge failures but also local decision failures: repeated guesses, malformed actions, and violations of feedback that the model has just seen. These diagnostics motivate a training recipe organized around three steps: acquire broad game participation through supervised fine-tuning, repair mechanically verifiable failures within one targeted dialogue-game family using turn-local preference pairs, and preserve general capabilities beyond these dialogue games. In the official final evaluation, our submission improves public clemscore from 10.67 to 38.92 and closed in-domain score from 13.41 to 41.17, while approximately preserving aggregate static performance (44.14 vs. 44.24 for the baseline). Out-of-domain clemscore remains low at 7.88, with the largest gains concentrated in unseen variants of the targeted family. Our results suggest that broad SFT brings most of the model's capability improvement; turn-local supervision can be effective when failure detection is precise, with observed transfer concentrated primarily within-family.

Deep learning (DL) has proven highly effective for ultrasound-based computer-aided diagnosis (CAD) of breast cancers. In an automaticCAD system, lesion detection is critical for the following diagnosis. However, existing DL-based methods generally require voluminous manually-annotated region of interest (ROI) labels and class labels to train both the lesion detection and diagnosis models. In clinical practice, the ROI labels, i.e. ground truths, may not always be optimal for the classification task due to individual experience of sonologists, resulting in the issue of coarse annotation that limits the diagnosis performance of a CAD model. To address this issue, a novel Two-Stage Detection and Diagnosis Network (TSDDNet) is proposed based on weakly supervised learning to enhance diagnostic accuracy of the ultrasound-based CAD for breast cancers. In particular, all the ROI-level labels are considered as coarse labels in the first training stage, and then a candidate selection mechanism is designed to identify optimallesion areas for both the fully and partially annotated samples. It refines the current ROI-level labels in the fully annotated images and the detected ROIs in the partially annotated samples with a weakly supervised manner under the guidance of class labels. In the second training stage, a self-distillation strategy further is further proposed to integrate the detection network and classification network into a unified framework as the final CAD model for joint optimization, which then further improves the diagnosis performance. The proposed TSDDNet is evaluated on a B-mode ultrasound dataset, and the experimental results show that it achieves the best performance on both lesion detection and diagnosis tasks, suggesting promising application potential.

Program errors can occur in any type of programming, and can manifest in a variety of ways, such as unexpected output, crashes, or performance issues. And program error diagnosis can often be too abstract or technical for developers to understand, especially for beginners. The goal of this paper is to present a novel machine-learning approach for Multi-task Program Error Repair and Explanatory Diagnosis (mPRED). A pre-trained language model is used to encode the source code, and a downstream model is specifically designed to identify and repair errors. Programs and test cases will be augmented and optimized from several perspectives. Additionally, our approach incorporates a "chain of thoughts" method, which enables the models to produce intermediate reasoning explanations before providing the final correction. To aid in visualizing and analyzing the program structure, we use a graph neural network for program structure visualization. Overall, our approach offers a promising approach for repairing program errors across different programming languages and providing helpful explanations to programmers.

Group Relative Policy Optimization (GRPO), a prominent algorithm within the Reinforcement Learning from Verifiable Rewards (RLVR) framework, has achieved strong results in improving the reasoning capabilities of large language models (LLMs). However, GRPO is prone to advantage collapse, a failure mode where homogeneous rewards within a group (e.g., all correct or all incorrect answers) yield near-zero advantages and vanishing gradients. To address this, we introduce the Advantage Collapse Rate (ACR), the first diagnostic metric quantifying the proportion of training batches with ineffective gradients. Across models from 0.5B to 14B parameters on mathematical reasoning benchmarks, we show that ACR strongly predicts training stagnation and final performance. We then propose Adaptive Virtual Sample Policy Optimization (AVSPO), a lightweight extension of GRPO that injects virtual reward samples, guided by real-time ACR monitoring, to enable learning from homogeneous groups without additional model rollouts. AVSPO reduces advantage collapse by 58-63% relative to GRPO and yields consistent accuracy gains of 4-6 percentage points across all model scales, while maintaining generalization on the evaluated out-of-domain task. Code and datasets are available at https://github.com/hexixiang/Advantage-Collapse-Rate.

LLM-based agents are reshaping microservice operations into AgentOps, where benchmarks are key to evaluating failure diagnosis over multimodal observability data. However, existing benchmarks remain largely outcome-oriented: they score only the final answer and fail to assess the systematic reasoning process in failure diagnosis. We address this gap by introducing two large-scale datasets (AIOps2025 and RCA100) under a reasoning-process evaluation paradigm that assesses agentic diagnostic capability along three dimensions: Localization (where the fault occurs), Identification (what type of fault it is), and Reason (whether the reasoning trace is grounded in relevant evidence). Together, the two datasets comprise over 500 expert-labeled failure cases across two representative microservice systems (HipsterShop and the OpenTelemetry Demo Store). They cover diverse fault scenarios across resource, network, runtime, middleware/database, and application-logic categories and provide fine-grained causal evidence to support agent learning and reasoning-process evaluation. Beyond scale and coverage, the datasets have been carefully labelled by domain experts and validated through large-scale competitions, supporting more than 6,000 participating teams. This makes them not only expert-labeled diagnostic datasets, but also competition-validated benchmarks for evaluating agentic failure diagnosis in real-world microservice environments. Datasets are available at https://www.aiops.cn/gitlab/aiops-live-benchmark/agenticopseval.

Fine-tuning a pretrained LLM into a vision-language model (VLM) can erode the backbone's text capability, with the damage concentrated on tasks that require following exact output rules, such as instruction following, chain-of-thought reasoning graded on a strictly parsed final answer, and similar evaluations with strict graders. We trace this gap to attention-sink corruption: VL fine-tuning perturbs the early sink position that anchors a large fraction of attention probability, and how well the base LLM preserves its sink tracks how much of the affected capability survives adaptation. Building on this view, we introduce Sink Strength, a single scalar computed on the base LLM in a few seconds on a single GPU that predicts post-VL degradation without any VL training. It consistently tracks relative degradation across the six VLM-LLM pairs and multiple format-sensitive tasks. Complementing this diagnostic, we find that post-pretraining QK-RMSNorm injection fails to reproduce the protection of native QK-RMSNorm, while several off-the-shelf weight-merging settings fail to recover the lost capability after VL training. These negative results underscore the value of screening backbones with Sink Strength before VL training and narrow the intervention space toward head-selective training-time protection.

Agent skills provide a lightweight way to adapt LLM agents to specialized domains by storing reusable procedural knowledge in structured files. However, whether downloaded from third parties or self-generated, these skills are often unreliable, incomplete, or outdated. Existing skill-evolution methods often address these deficiencies through heuristic reflections without an explicit optimization formulation. In this paper, we propose SkillGrad, a gradient-descent-inspired framework for optimizing agent skills. SkillGrad treats the skill package as a structured parameter to optimize in a gradient descent fashion: task executions provide trajectory-level loss evidence, automatic diagnoses then provide text-based gradients that indicate the correction directions. To stabilize optimization across iterations, a momentum agent accumulates recurring diagnostic patterns into a persistent memory overlay. Finally, an LLM-based patcher executes the parameter update by applying layer-aware edits to the skill package. Evaluated on SpreadsheetBench Verified and WikiTableQuestions, SkillGrad consistently outperforms training-based skill evolution baselines across two backbone LLMs, improving over the strongest training-based baseline by 6.7 percentage points on average. Ablations further show that momentum and contrastive diagnosis both contribute to the final skill quality.

Long-term memory has become a foundational capability for LLM-based agents that accompany users across extended, multi-session interactions. Existing benchmarks, however, evaluate such memory almost exclusively through downstream question answering, scoring only the correctness of a final answer. This black-box formulation conflates the heterogeneous causes of memory failure, such as missing the introduction of a relevant fact, binding an operation to the wrong target, or relying on stale values after a correction. As a result, it can credit correct answers despite their reliance on inconsistent or unsafe memory states. In this paper, we argue that, in dynamic long-horizon interactions, memory is not a static collection of facts but a lifecycle of explicit operations, including remembering, forgetting, updating, reflecting, and their compositions. We introduce MemOps, a benchmark that reformulates conversational memory as a sequence of lifecycle operations and represents each memory event with a structured trace specifying its trigger, target, scope, state transition, and supporting evidence. A controllable generation pipeline embeds these operations into long, task-oriented conversations and produces gold operation traces together with six categories of operation-level probes, evaluated under both adjacent-evidence and long-context settings. Across long-context, retrieval-based, parametric and managed-memory systems, MemOps disentangles failure modes that final-answer accuracy alone conceals, revealing that current systems remain far from uniformly reliable. For instance, session-level retrieval outperforms turn-level retrieval, and long-context models remain notably weak at reconstructing ordered memory-state trajectories. These results move long-term memory evaluation from final-answer scoring toward interpretable, operation-level diagnosis.

LLM agents are increasingly explored for automating root cause analysis (RCA) in cloud-native systems, creating a need to evaluate both diagnostic correctness and the quality of the supporting investigation. Existing static benchmarks offer repeatable inputs but limited system-facing interaction, while live testbeds expose realistic tools but hinder controlled comparison because incident evidence varies across runs; both paradigms focus primarily on final answers. To address these limitations, we present Cloud-OpsBench, an evaluation infrastructure for interactive and evidence-grounded cloud RCA. It comprises 754 runtime-verified cases across 57 fault types on two microservice workloads spanning application services and Kubernetes platform layers. Each fault is captured as a state snapshot and replayed through standard diagnostic interfaces, with outcome labels and diagnostic evidence graphs that enable matched comparisons and process-level analysis. Across ten LLM agents, the strongest Joint RCA Accuracy (JRA) reaches 0.76 on OnlineBoutique and 0.68 on TrainTicket, while the corresponding Evidence Closure Rates (ECR) are only 0.38 and 0.15. This outcome--process gap shows that final-answer correctness alone substantially overestimates agents' ability to perform evidence-grounded diagnosis.

Reasoning in multimodal large language models (MLLMs) has shown strong promise in medical imaging. However, this reasoning is usually free-form text judged only by its final answer, making it hard to interpret and verify, especially in 3D radiology, where a diagnosis should be traceable to evidence in the scan. Existing chest CT question-answering datasets compound this by reducing expert radiology reports to answer-only pairs, dropping the reasoning that links findings to conclusions and omitting the patient history clinicians rely on. As a result, reasoning-capable 3D chest CT MLLMs remain out of reach, as neither the structured supervision needed to train them nor the protocol needed to verify their reasoning yet exists. We introduce CORTEX (Clinically Organized Reasoning and sTructured EXplanation), a structured reasoning benchmark for 3D chest CT. For each question, CORTEX restores the missing reasoning as a four-stage diagnostic trace mirroring a radiologist's workflow: task understanding, visual observation, diagnostic reasoning, and answer synthesis. We generate these traces using frontier large language models with broad medical and general-domain knowledge, then filter and verify them with a stage-level evaluation protocol combining automated rubric scoring with expert radiologist review. Crucially, both the reasoning structure and evaluation rubrics are designed in close collaboration with clinicians. Built on CT-RATE, a large, publicly available chest CT dataset without reasoning annotations, CORTEX comprises 76,177 validated reasoning traces across open-ended VQA, closed-ended VQA, and report generation, providing both the structured supervision and the stage-level evaluation protocol needed to build and evaluate trustworthy reasoning models for 3D chest CT. Our dataset and evaluation code will be made publicly available upon acceptance.

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.

As Multimodal Large Language Models (MLLMs) evolve into sophisticated interactive assistants, their reliability depends not only on following instructions but also on validating them. We define Proactive Critique as the model's autonomous ability to identify, analyze and fix faulty user inputs without extra prompts. However, evaluations mainly test models under ideal circumstances or simple refusal behaviors, largely ignoring active error processing. To fill this gap, we propose MMPCBench, a comprehensive framework for evaluating MLLMs' proactive critique competence. It features a fine-grained taxonomy of 4 primary error types spanning 12 subcategories, ranging from cross-modal contradictions to missing visual premises. We adopt a hierarchical evaluation protocol to measure models' error detection, diagnosis and resolution performance, and apply alignment-aware metrics to assess the coherence between internal reasoning and final responses. Tests on 14 mainstream MLLMs show obvious weaknesses in proactive critique, especially in dealing with subtle visual anomalies. Notably, we identify a pervasive "consistency gap": reasoning models can often correctly identify and analyze errors during internal reasoning yet suppress these valid insights in final outputs to prioritize response compliance. The code and data is available at https://github.com/ALIENS32/MMPCBench.

While multimodal reasoning has advanced rapidly, solving complex geometry problems critically hinges on active visual assistance, such as constructing auxiliary lines, spurring the rise of Visual Chain-of-Thought (VCoT). However, existing evaluations typically assess visual generation quality and final answer accuracy in isolation, failing to examine whether intermediate visual aids are geometrically valid, effectively utilized in subsequent reasoning, or causally responsible for task success. To bridge this gap, we introduce GeoVAD-Bench, a diagnostic benchmark that pairs a fine-grained five-dimensional trajectory diagnosis covering perception, auxiliary quality, utilization, deductive reasoning, and final correctness with controlled No-Aux, Auto-Aux, and GT-Aux intervention settings to systematically isolate intermediate error modes, the causal gains of visual aids, and the resulting autonomy gap. Our findings reveal that while high-quality auxiliary aids offer substantial theoretical gains for geometric problem solving, autonomous generation is frequently hampered by compounding errors across geometric perception, faithful visual manipulation, visual-state grounding, and deductive reasoning. Guided by these diagnostic insights, we establish a specialized data construction pipeline encompassing geometric perception, diagram editing, and interleaved visual-textual reasoning trajectories, and develop a progressive SFT and multimodal RL training framework. The resulting model, GeoWeave-8B, outperforms the base model by +25.3% in final geometric accuracy and achieves a +30.4% gain in process average across the four intermediate diagnostic dimensions.

In industrial procurement, an LLM answer is useful only if it survives a standards check: recommended material must match operating condition, every parameter must respect a regulated threshold, and no procedure may contradict a safety clause. Partial correctness can mask safety-critical contradictions that aggregate LLM benchmarks rarely capture. We introduce IndustryBench, a 2,049-item benchmark for industrial procurement QA in Chinese, grounded in Chinese national standards (GB/T) and structured industrial product records, organized by seven capability dimensions, ten industry categories, and panel-derived difficulty tiers, with item-aligned English, Russian, and Vietnamese renderings. Our construction pipeline rejects 70.3% of LLM-generated candidates at a search-based external-verification stage, calibrating how unreliable industrial QA remains after LLM-only filtering.Our evaluation decouples raw correctness, scored by a Qwen3-Max judge validated at κ_w = 0.798 against a domain expert, from a separate safety-violation (SV) check against source texts. Across 17 models in Chinese and an 8-model intersection over four languages, we find: (i) the best system reaches only 2.083 on the 0--3 rubric, leaving substantial headroom; (ii) Standards & Terminology is the most persistent capability weakness and survives item-aligned translation; (iii) extended reasoning lowers safety-adjusted scores for 12 of 13 models, primarily by introducing unsupported safety-critical details into longer final answers; and (iv) safety-violation rates reshuffle the leaderboard -- GPT-5.4 climbs from rank 6 to rank 3 after SV adjustment, while Kimi-k2.5-1T-A32B drops seven positions.Industrial LLM evaluation therefore requires source-grounded, safety-aware diagnosis rather than aggregate accuracy. We release IndustryBench with all prompts, scoring scripts, and dataset documentation.

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.

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.

Diabetic retinopathy (DR) is a growing health problem worldwide and is a leading cause of visual impairment and blindness, especially among working people aged 20-65. Its incidence is increasing along with the number of diabetes cases, and it is more common in developed countries than in developing countries. Recent research in the field of diabetic retinopathy diagnosis is using advanced technologies, such as analysis of images obtained by ophthalmoscopy. Automatic methods for analyzing eye images based on neural networks, deep learning and image analysis algorithms can improve the efficiency of diagnosis. This paper describes an automatic DR diagnosis method that includes processing and analysis of ophthalmoscopic images of the eye. It uses morphological algorithms to identify the optic disc and lesions characteristic of DR, such as microaneurysms, hemorrhages and exudates. Automated DR diagnosis has the potential to improve the efficiency of early detection of this disease and contribute to reducing the number of cases of diabetes-related visual impairment. The final step was to create an application with a graphical user interface that allowed retinal images taken at cooperating ophthalmology offices to be uploaded to the server. These images were then analyzed using a developed algorithm to make a diagnosis.

Endoscopic diagnosis unfolds over native video, where a single positive finding during traversal of the gastrointestinal tract sets off a multi-minute chain of reasoning over location, morphology, severity and intervention. Existing endoscopy multimodal benchmarks test only static images or single-disease videos, which miss the temporal and clinical reasoning that real-world reporting demands. We introduce EndoSCOP-V, a video-grounded multi-turn evaluation framework for structured endoscopy reporting and clinical reasoning. It contains 1,307 real-world endoscopy and colonoscopy videos (63.2 h; 97% 1080p) averaging about 174 s. Its 20,274 question-answer turns are instantiated deterministically from clinician-filled structured endoscopy-reporting EHRs, so no per-case annotation is synthetic or LLM-rephrased. They come from 1,033 clinician-reviewed templates, about 18 per disease, that span a clinically aligned 9-task x 30-sub-task reporting taxonomy over 54 World Endoscopy Organization (WEO) MST 3.0 diseases. 22% of procedures carry co-existing pathologies, up to six per case. A Markovian context-pruned oracle-forcing protocol evaluates the dialogue turn by turn, injecting the gold answer before each subsequent turn so that per-turn reasoning is isolated from cascading dialogue errors. A panel of 15 board-certified endoscopists sets a 78% strict-accuracy baseline on 1,500 questions. Across 14 open-weight LMMs, the best 27B-class model reaches 59.8% strict accuracy, falling to 53.4% once format-trivial disease-rejection items are excluded. On a between-subjects spot-check, the best of 3 frontier proprietary models trails the clinician panel by 23 pp on strict NDR accuracy. Sub-task analysis reveals consistent gaps in quantitative measurement, multi-variable grading and intervention reasoning on long-horizon video. Data: Hugging Face (EndoSCOP-V). Code: GitHub (abhi25t/EndoSCOP-V).

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.

COVID-19 (coronavirus disease 2019) pandemic caused by SARS-CoV-2 has led to a treacherous and devastating catastrophe for humanity. At the time of writing, no specific antivirus drugs or vaccines are recommended to control infection transmission and spread. The current diagnosis of COVID-19 is done by Reverse-Transcription Polymer Chain Reaction (RT-PCR) testing. However, this method is expensive, time-consuming, and not easily available in straitened regions. An interpretable and COVID-19 diagnosis AI framework is devised and developed based on the cough sounds features and symptoms metadata to overcome these limitations. The proposed framework's performance was evaluated using a medical dataset containing Symptoms and Demographic data of 30000 audio segments, 328 cough sounds from 150 patients with four cough classes ( COVID-19, Asthma, Bronchitis, and Healthy). Experiments' results show that the model captures the better and robust feature embedding to distinguish between COVID-19 patient coughs and several types of non-COVID-19 coughs with higher specificity and accuracy of 95.04 pm 0.18% and 96.83pm 0.18% respectively, all the while maintaining interpretability.

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

Pathological diagnosis remains the definitive standard for identifying tumors. The rise of multimodal large models has simplified the process of integrating image analysis with textual descriptions. Despite this advancement, the substantial costs associated with training and deploying these complex multimodal models, together with a scarcity of high-quality training datasets, create a significant divide between cutting-edge technology and its application in the clinical setting. We had meticulously compiled a dataset of approximately 45,000 cases, covering over 6 different tasks, including the classification of organ tissues, generating pathology report descriptions, and addressing pathology-related questions and answers. We have fine-tuned multimodal large models, specifically LLaVA, Qwen-VL, InternLM, with this dataset to enhance instruction-based performance. We conducted a qualitative assessment of the capabilities of the base model and the fine-tuned model in performing image captioning and classification tasks on the specific dataset. The evaluation results demonstrate that the fine-tuned model exhibits proficiency in addressing typical pathological questions. We hope that by making both our models and datasets publicly available, they can be valuable to the medical and research communities.

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.

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.

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

Clinical diagnosis is 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.

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.

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.

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

Mental disorders are highly prevalent worldwide, but the shortage of psychiatrists and the inherent subjectivity of interview-based diagnosis create substantial barriers to timely and consistent mental-health assessment. Progress in AI-assisted psychiatric diagnosis is constrained by the absence of benchmarks that simultaneously provide realistic patient simulation, clinician-verified diagnostic labels, and support for dynamic multi-turn consultation. We present LingxiDiagBench, a large-scale multi-agent benchmark that evaluates LLMs on both static diagnostic inference and dynamic multi-turn psychiatric consultation in Chinese. At its core is LingxiDiag-16K, a dataset of 16,000 EMR-aligned synthetic consultation dialogues designed to reproduce real clinical demographic and diagnostic distributions across 12 ICD-10 psychiatric categories. Through extensive experiments across state-of-the-art LLMs, we establish key findings: (1) although LLMs achieve high accuracy on binary depression--anxiety classification (up to 92.3%), performance deteriorates substantially for depression--anxiety comorbidity recognition (43.0%) and 12-way differential diagnosis (28.5%); (2) dynamic consultation often underperforms static evaluation, indicating that ineffective information-gathering strategies significantly impair downstream diagnostic reasoning; (3) consultation quality assessed by LLM-as-a-Judge shows only moderate correlation with diagnostic accuracy, suggesting that well-structured questioning alone does not ensure correct diagnostic decisions. We release LingxiDiag-16K and the full evaluation framework to support reproducible research at https://github.com/Lingxi-mental-health/LingxiDiagBench.

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

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

Developing a generalist radiology diagnosis system can greatly enhance clinical diagnostics. In this paper, we introduce RadDiag, a foundational model supporting 2D and 3D inputs across various modalities and anatomies, using a transformer-based fusion module for comprehensive disease diagnosis. Due to patient privacy concerns and the lack of large-scale radiology diagnosis datasets, we utilize high-quality, clinician-reviewed radiological images available online with diagnosis labels. Our dataset, RP3D-DiagDS, contains 40,936 cases with 195,010 scans covering 5,568 disorders (930 unique ICD-10-CM codes). Experimentally, our RadDiag achieves 95.14% AUC on internal evaluation with the knowledge-enhancement strategy. Additionally, RadDiag can be zero-shot applied or fine-tuned to external diagnosis datasets sourced from various hospitals, demonstrating state-of-the-art results. In conclusion, we show that publicly shared medical data on the Internet is a tremendous and valuable resource that can potentially support building a generalist AI for healthcare.

The article presents a new multi-label comprehensive image dataset from flexible endoscopy, colonoscopy and capsule endoscopy, named ERS. The collection has been labeled according to the full medical specification of 'Minimum Standard Terminology 3.0' (MST 3.0), describing all possible findings in the gastrointestinal tract (104 possible labels), extended with an additional 19 labels useful in common machine learning applications. The dataset contains around 6000 precisely and 115,000 approximately labeled frames from endoscopy videos, 3600 precise and 22,600 approximate segmentation masks, and 1.23 million unlabeled frames from flexible and capsule endoscopy videos. The labeled data cover almost entirely the MST 3.0 standard. The data came from 1520 videos of 1135 patients. Additionally, this paper proposes and describes four exemplary experiments in gastrointestinal image classification task performed using the created dataset. The obtained results indicate the high usefulness and flexibility of the dataset in training and testing machine learning algorithms in the field of endoscopic data analysis.

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.

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.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

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

Clinical diagnosis at hospital admission must be made rapidly from limited, incomplete evidence. Existing diagnosis-prediction benchmarks are poorly suited to this setting: they restrict prediction to closed code sets, exclude free-text notes, and supervise with discharge diagnoses that incorporate the full inpatient course. We introduce EarlyDx, a large-scale benchmark for open-ended early diagnosis, built from 154,834 emergency department encounters in MIMIC-IV. Each encounter is restricted to records available at admission time t_0 and supervised by the diagnoses recorded during the ED encounter rather than at discharge. An LLM auditor further verifies every free-text label as supported, partially supported, or unsupported by that evidence; the primary evaluation scores only fully supported labels. Under a semantic LLM-as-judge protocol, no evaluated system --- frontier general, medical-specialized, or in-domain post-trained --- synthesizes admission-time evidence reliably. Zero-shot models score largely by extraction, recovering only 3-31% of diagnoses that must be inferred rather than read from the record; post-training raises inference-dependent recall to 56%, but a sizeable margin remains, and on time-critical conditions no system attains a clinician's balance of sensitivity and precision. We release the full construction and evaluation pipeline at here.

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.

Lung cancer stands as the preeminent cause of cancer-related mortality globally. Prompt and precise diagnosis, coupled with effective treatment, is imperative to reduce the fatality rates associated with this formidable disease. This study introduces a cutting-edge deep learning framework for the classification of lung cancer from CT scan imagery. The research encompasses a suite of image pre-processing strategies, notably Canny edge detection, and wavelet transformations, which precede the extraction of salient features and subsequent classification via a Multi-Layer Perceptron (MLP). The optimization process is further refined using the Dragonfly Algorithm (DA). The methodology put forth has attained an impressive training and testing accuracy of 99.82\%, underscoring its efficacy and reliability in the accurate diagnosis of lung cancer.

Automated five-stage diabetic retinopathy (DR) grading requires more than high accuracy alone. Medical-grade deployment calls for lesion-aware preprocessing, ordinal predictions, calibrated uncertainty, and explainability to support reliable diagnostic systems. We present a unified pipeline that addresses these requirements using a Ben-Graham-green-channel CLAHE feature representation, an EfficientNetV2-L ordinal regressor, and Monte Carlo dropout for uncertainty-driven referral. Grad-CAM provides visual explanations aligned with clinically relevant lesions. The proposed method achieves a QWK of 91.31% on the APTOS-2019 official test split, placing it within the near-perfect agreement band (>80%). At a 20% referral rate, 293 of 366 images are automatically graded with a QWK of 90.40%. More complex cases are referred for specialist assessment, demonstrating a practical trade-off among grading quality, automation, and patient safety in robust, reliable, and deployment-ready medical diagnostic systems.

In oncology, treating cancer with a beam of photons is a well established therapeutic technique, developed over 100 years, and today over 50% of cancer patients will undergo traditional X-ray radiotherapy. However, ionizing radiation therapy is not the only option, as the high-energy photons delivering their cell-killing radiation energy into cancerous tumor can lead to significant damage to healthy tissues surrounding the tumor, located throughout the beam's path. Therefore, in nowadays, advances in ionizing radiation therapy are competitive to non-ionizing ones, as for example the laser light based therapy, resulting in a synergism that has revolutionized medicine. The use of non-invasive or minimally invasive (e.g. through flexible endoscopes) therapeutic procedures in the management of patients represents a very interesting treatment option. Moreover, as the major breakthrough in cancer management is the individualized patient treatment, new biophotonic techniques, e.g. photo-activated drug carriers, help the improvement of treatment efficacy and/or normal tissue toxicity. Additionally, recent studies support that laser technology progresses could revolutionize cancer proton therapy, by reducing the cost of the needed installations. The aim of this review is to present some laser-based future objectives for cancer radiation therapy, aiming to address the relevant advances in the ionizing and non-ionizing radiation therapy, i.e. protons and heavy ions therapy, as well as photodynamic targeted and molecular therapies.

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

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

Vietnamese medical research has become an increasingly vital domain, particularly with the rise of intelligent technologies aimed at reducing time and resource burdens in clinical diagnosis. Recent advances in vision-language models (VLMs), such as Gemini and GPT-4V, have sparked a growing interest in applying AI to healthcare. However, most existing VLMs lack exposure to Vietnamese medical data, limiting their ability to generate accurate and contextually appropriate diagnostic outputs for Vietnamese patients. To address this challenge, we introduce ViX-Ray, a novel dataset comprising 5,400 Vietnamese chest X-ray images annotated with expert-written findings and impressions from physicians at a major Vietnamese hospital. We analyze linguistic patterns within the dataset, including the frequency of mentioned body parts and diagnoses, to identify domain-specific linguistic characteristics of Vietnamese radiology reports. Furthermore, we fine-tune five state-of-the-art open-source VLMs on ViX-Ray and compare their performance to leading proprietary models, GPT-4V and Gemini. Our results show that while several models generate outputs partially aligned with clinical ground truths, they often suffer from low precision and excessive hallucination, especially in impression generation. These findings not only demonstrate the complexity and challenge of our dataset but also establish ViX-Ray as a valuable benchmark for evaluating and advancing vision-language models in the Vietnamese clinical domain.

Cervical cytology presents a fundamentally ambiguous diagnostic landscape, where equivocal categories such as Atypical Squamous Cells of Undetermined Significance (ASC-US) occupy a morphological grey zone that is definitional. For clinical decision support, the goal extends beyond assigning a definitive label to every sample: cases must also be distinguished by whether the available evidence supports a confident decision or warrants further consideration, a distinction conventional classification models are not designed to explicitly represent. We propose a multiscale evidential framework that models cervical cytology along an ordinal disease continuum using clinically grounded soft anchors, representing progression from benign reactive changes to precancerous lesions and malignancy. Three biologically motivated spatial contexts--nuclear morphology, cytoplasmic characteristics, and neighbourhood cellular architecture--are independently encoded using a shared frozen DINOv2 backbone, preserving inter-scale disagreement that early fusion may obscure. Calibrated predictions are transformed into Dempster--Shafer belief masses and fused with reliability discounting, allowing conflicting evidence and insufficient support to remain explicitly uncommitted rather than forcing a decision. The fused belief state drives interpretable routing that separates confidently classified cases from those with irreducible evidential insufficiency, enabling clinically meaningful triage. Across two independent publicly available conventional cytology datasets, RIVA and CRIC Cervix, the framework generalises consistently, with uncertainty strongly associated with diagnostic difficulty: incorrect predictions carry 1.94x-4.13x higher uncertainty than correct ones.