Daily Papers

Vision-language-action (VLA) robustness is commonly summarized by aggregate task success, which obscures how individual executions change under distribution shifts and where failures emerge in long-horizon tasks. We introduce RoboCasa-Shift, a diagnostic robustness benchmark built on RoboCasa365 that combines controlled single-factor shifts, matched clean-perturbed rollouts in which each pair shares the same underlying settings and differs only in the target shift, and simulator-grounded stage-aware diagnostics. We evaluate GR00T N1.5 on four long-horizon tasks that pass a predefined clean-performance gate under four perturbation factors and three calibrated severity levels, including conditions that drive the evaluated policy to complete task failure, totaling 1,040 formal rollouts. Robustness responses vary substantially across factors and tasks, and increasing severity does not always produce monotonic degradation. For example, one camera condition yields ΔSR=0 despite 8 of 80 matched episodes changing outcome. Stage-aware analysis further shows that the same end-to-end degradation can correspond to different execution-depth profiles. Camera L_2 and Gaussian blur L_1 both yield ΔSR=0.188, yet their first-stage failure rates are 19.0\% and 36.4\%, respectively. Our findings suggest that VLA robustness should be viewed as a multi-dimensional property of execution rather than a single end-to-end performance measure, motivating evaluation protocols that jointly capture outcome degradation, paired outcome sensitivity, and failure progression. The code is publicly available at https://github.com/HaochengWang23/RoboCasa-Shift.

Automatic Question Generation (QG) often produces outputs with critical defects, such as factual hallucinations and answer mismatches. However, existing evaluation methods, including LLM-based evaluators, mainly adopt a black-box and holistic paradigm without explicit error modeling, leading to the neglect of such defects and overestimation of question quality. To address this issue, we propose ErrEval, a flexible and Error-aware Evaluation framework that enhances QG evaluation through explicit error diagnostics. Specifically, ErrEval reformulates evaluation as a two-stage process of error diagnosis followed by informed scoring. At the first stage, a lightweight plug-and-play Error Identifier detects and categorizes common errors across structural, linguistic, and content-related aspects. These diagnostic signals are then incorporated as explicit evidence to guide LLM evaluators toward more fine-grained and grounded judgments. Extensive experiments on three benchmarks demonstrate the effectiveness of ErrEval, showing that incorporating explicit diagnostics improves alignment with human judgments. Further analyses confirm that ErrEval effectively mitigates the overestimation of low-quality questions.

Reasoning segmentation converts an implicit linguistic conclusion into a precise mask, requiring both semantic identification and spatial grounding. Existing MLLM-segmenter interfaces either use a special trigger or compress both signals into one context, although they receive different supervision and fail differently. This coupling obscures whether a failure arises from target interpretation or from localization. We present SeGDeP, an explicit what-where interface. A semantic prompt branch and an independent geometric projection path transform resolved MLLM states into semantic features and a DETR-predicted box, which jointly condition a SAM 3 mask decoder. Training first aligns this executable interface, then uses group reward-decoupled policy optimization (GDPO) to balance format, box-IoU, and mask-IoU feedback. SeGDeP-4B reaches 82.7 average cIoU over eight RefCOCO-family splits and 66.0/59.6 gIoU on ReasonSeg val/test while adapting only 0.38% of Qwen3-VL parameters through LoRA. Controlled stage-wise ablations, gradient diagnostics, and prompt interventions further show that the two paths develop complementary semantic and geometric specialization rather than duplicating the same evidence.

Binary decompilation is fundamental to security tasks such as vulnerability discovery, malware inspection, and executable-only program understanding. Recent LLM-based decompilation methods have shown promising results, but most still follow a single-turn generation paradigm: given assembly code or decompiler-produced pseudo-code, the model generates one output and stops. Consequently, the generated code may appear readable or even compile successfully, yet still deviate from the behavior of the original binary and mislead downstream analysis. This paper presents AutoDecompiler, a decompilation-specialized LLM trained with reinforcement learning for feedback-driven multi-turn binary decompilation. Instead of treating decompilation as one-shot code generation, AutoDecompiler formulates it as an iterative refinement process, where the model revises generated code based on compilation, execution, and input/output testing feedback. To enable this process, we design decompilation-specific rewards that capture code validity, recompilability, execution consistency, and semantic fidelity. We further construct stage-aware diagnostic feedback from compiler errors, execution failures, and failed test cases, and introduce progress-aware trajectory rewarding and turn-aware advantage reweighting to encourage beneficial revisions while suppressing regressions. We train the AutoDecompiler family and evaluate it across different input settings, model scales, and benchmarks. Experimental results show that AutoDecompiler consistently outperforms its single-turn counterparts under the same model size and input setting, achieving clear improvements in behavioral re-executability. These results demonstrate that learning to exploit program feedback with reinforcement learning is an effective direction for improving the functional correctness of LLM-based binary decompilation.

As large language models (LLMs) evolve from conversational assistants into agents capable of handling complex tasks, they are increasingly deployed in high-risk domains. However, existing benchmarks largely rely on mixed queries and posterior evaluation, output-level scoring, which quantifies hallucination severity but offers limited insight into where and why hallucinations arise in the generation pipeline. We therefore reformulate hallucination evaluation as a diagnostic problem and propose PRISM, a controlled benchmark that disentangles hallucinations into four dimensions: knowledge missing, knowledge errors, reasoning errors, and instruction-following errors, grounded in three stages of generation (memory, instruction, and reasoning). PRISM contains 9,448 instances across 65 tasks and supports fine-grained, stage-aware diagnostic evaluation. Evaluating 24 mainstream open-source and proprietary LLMs, we uncover consistent trade-offs across instruction following, memory retrieval, and logical reasoning, showing that mitigation strategies often improve specific dimensions at the expense of others. We hope PRISM provides a framework for understanding the specific mechanisms behind LLMs hallucinations, ultimately accelerating the development of trustworthy large language models.

Knowledge graph (KG) embedding has been used to benefit the diagnosis of animal diseases by analyzing electronic medical records (EMRs), such as notes and veterinary records. However, learning representations to capture entities and relations with literal information in KGs is challenging as the KGs show heterogeneous properties and various types of literal information. Meanwhile, the existing methods mostly aim to preserve graph structures surrounding target nodes without considering different types of literals, which could also carry significant information. In this paper, we propose a knowledge graph embedding model for the efficient diagnosis of animal diseases, which could learn various types of literal information and graph structure and fuse them into unified representations, namely LiteralKG. Specifically, we construct a knowledge graph that is built from EMRs along with literal information collected from various animal hospitals. We then fuse different types of entities and node feature information into unified vector representations through gate networks. Finally, we propose a self-supervised learning task to learn graph structure in pretext tasks and then towards various downstream tasks. Experimental results on link prediction tasks demonstrate that our model outperforms the baselines that consist of state-of-the-art models. The source code is available at https://github.com/NSLab-CUK/LiteralKG.

While vision-language models excel at general multimodal understanding, they still struggle with visual spatial planning. We attribute this to a perception-reasoning modality gap: visual planning requires models to infer latent state structures from pixels and then reason over the recovered structure to produce valid actions, whereas symbolic planning directly leverages explicit objects and constraints. This creates dual bottlenecks in visual state recovery and multi-step planning. To address this, we propose MGSD, a two-stage modality-gap-aware self-distillation framework. First, a cold-start grounding stage equips the visual student with reliable state representations, minimizing early perception noise. Second, a privileged teacher transfers planning capabilities via on-policy distillation, using explicit symbolic states to supervise the student's own visual rollout prefixes. Crucially, symbolic data is used strictly during training, leaving inference purely visual. Experiments on visual planning benchmarks show that MGSD consistently improves visual planning across both 4B and 8B backbones, raising the macro average by 19.3% and 18.4%, respectively. The resulting models narrow the gap to symbolic-input upper bounds, while ablations and diagnostics confirm that the improvement comes from both visual state recovery and optimal-path reasoning. These results suggest that modality-gap-aware self-distillation improves not only how models perceive actionable states, but also how they plan over the inferred structure. Code is available at https://github.com/Oranger-l/MGSD.

Commercial video generation systems such as Seedance2.0 and Veo3.1 have rapidly improved, strengthening the view that video generators may be evolving into "world simulators." Yet the community still lacks a benchmark that directly tests whether a model can reason about how an observed world should evolve over time. We introduce WorldReasonBench, which reframes video generation evaluation as world-state prediction: given an initial state and an action, can a model generate a future video whose state evolution remains physically, socially, logically, and informationally consistent? WorldReasonBench contains 436 curated test cases with structured ground-truth QA annotations spanning four reasoning dimensions and 22 subcategories. We evaluate generated videos with a human-aligned two-part methodology: Process-aware Reasoning Verification uses structured QA and reasoning-phase diagnostics to detect temporal and causal failures, while Multi-dimensional Quality Assessment scores reasoning quality, temporal consistency, and visual aesthetics for ranking and reward modeling. We further introduce WorldRewardBench, a preference benchmark with approximately 6K expert-annotated pairs over 1.4K videos, supporting pair-wise and point-wise reward-model evaluation. Across modern video generators, our results expose a persistent gap between visual plausibility and world reasoning: videos can look convincing while failing dynamics, causality, or information preservation. We will release our benchmarks and evaluation toolkit to support community research on genuinely world-aware video generation at https://github.com/UniX-AI-Lab/WorldReasonBench/.

Large Language Model (LLM) based Chinese Grammatical Error Correction (CGEC) systems face two critical challenges: general-purpose models lack specialized linguistic priors for subtle grammatical distinctions, and Supervised Fine-Tuning (SFT) with Maximum Likelihood Estimation fails to optimize for precision-focused metrics, leading to systematic over-correction. We propose CSRP, a three-stage framework that progressively builds correction capability through Continual Pre-training (CPT) on 5.9M balanced samples to internalize domain knowledge, Chain-of-Thought SFT with explicit error reasoning for diagnostic transparency, and Group Relative Policy Optimization with a novel Efficiency-Aware Reward that explicitly penalizes unnecessary edits. On the NACGEC benchmark, CSRP achieves state-of-the-art performance with 50.99 F_{0.5} and 57.17 precision, substantially outperforming previous best results while effectively mitigating the over-correction bias inherent in MLE-trained models. Our method also advances CSCD spelling correction to 59.61 F1, surpassing GPT-4 by 5.20 points. Comprehensive ablation studies demonstrate that the RL alignment stage contributes a 8\% relative gain over the SFT baseline, and that this gain is orthogonal to the contribution of large-scale CPT, validating that explicit optimization for edit efficiency is essential for high-quality grammatical error correction. Our code is available at https://github.com/TW-NLP/ChineseErrorCorrector.

Large language models can generate executable code for educational animations, but the resulting renders often exhibit visual defects, including element overlap, misalignment, and broken animation continuity. These defects cannot be reliably detected from the code alone and become apparent only after execution. We formalize this problem as render-feedback-aware constrained code generation: given a natural language specification, the model must generate executable code whose rendered output satisfies structured quality criteria that can be evaluated only after rendering. To address this problem, we introduce OmniManim, a render-feedback-aware educational animation generation framework built around a shared scene state, explicit visual planning, structured post-render diagnostics, and localized repair. Within OmniManim, the Vision Agent is a task-specific visual planning module: it predicts sparse keyframe layouts with coarse-to-fine bounding-box denoising and optimizes an interpolation-aware objective to reduce intermediate-frame failures induced by downstream animation interpolation. We further construct two datasets, ManimLayout-1K and EduRequire-500, and provide a reproducible evaluation protocol covering executability, instructional quality, visual quality, and efficiency. On EduRequire-500, OmniManim improves measured render quality over both single-model baselines and existing multi-agent frameworks. Systematic ablation studies further verify that explicit visual planning, especially its coarse spatial prior, bounding-box refinement, and interpolation-aware optimization, is central to these gains.

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.

Clinical ultrasound analysis demands models that generalize across heterogeneous organs, views, and devices, while supporting interpretable workflow-level analysis. Existing methods often rely on task-wise adaptation, and joint learning may be unstable due to cross-task interference, making it hard to deliver workflow-level outputs in practice. To address these challenges, we present USTri, a tri-stage ultrasound intelligence pipeline for unified multi-organ, multi-task analysis. Stage I trains a universal generalist USGen on different domains to learn broad, transferable priors that are robust to device and protocol variability. To better handle domain shifts and reach task-aligned performance while preserving ultrasound shared knowledge, Stage II builds USpec by keeping USGen frozen and finetuning dataset-specific heads. Stage III introduces USAgent, which mimics clinician workflows by orchestrating USpec specialists for multi-step inference and deterministic structured reports. On the FMC\_UIA validation set, our model achieves the best overall performance across 4 task types and 27 datasets, outperforming state-of-the-art methods. Moreover, qualitative results show that USAgent produces clinically structured reports with high accuracy and interpretability. Our study suggests a scalable path to ultrasound intelligence that generalizes across heterogeneous ultrasound tasks and supports consistent end-to-end clinical workflows. The code is publicly available at: https://github.com/MacDunno/USTri.

Visual Autoregressive (VAR) modeling departs from the next-token prediction paradigm of traditional Autoregressive (AR) models through next-scale prediction, enabling high-quality image generation. However, the VAR paradigm suffers from sharply increased computational complexity and running time at large-scale steps. Although existing acceleration methods reduce runtime for large-scale steps, but rely on manual step selection and overlook the varying importance of different stages in the generation process. To address this challenge, we present StageVAR, a systematic study and stage-aware acceleration framework for VAR models. Our analysis shows that early steps are critical for preserving semantic and structural consistency and should remain intact, while later steps mainly refine details and can be pruned or approximated for acceleration. Building on these insights, StageVAR introduces a plug-and-play acceleration strategy that exploits semantic irrelevance and low-rank properties in late-stage computations, without requiring additional training. Our proposed StageVAR achieves up to 3.4x speedup with only a 0.01 drop on GenEval and a 0.26 decrease on DPG, consistently outperforming existing acceleration baselines. These results highlight stage-aware design as a powerful principle for efficient visual autoregressive image generation.

Compressed short-text generators can fail in two different places: the codec may discard information before generation starts, or the latent generator may produce weak codes. Without separating these failure modes, researchers can spend compute improving the wrong component. We study this problem in a controlled 64-to-16 TinyStories case study built from a hierarchical VQ-VAE-2 codec and a masked discrete diffusion generator (MDLM). We use a staged validation protocol that separates codec reconstruction fidelity, latent generation quality, and auxiliary latent diagnostics under one shared external GPT-2 scorer, while reporting complementary semantic metrics for the geometry study. In the tested configuration, codec reconstruction alone raises median external perplexity from 15.17 to 27.36 (+80.4%) and p95 from 25.10 to 98.91 (+294.1%), showing that the dominant quality loss appears before latent generation begins. Under the same scorer, code-space MDLM remains materially stronger than token-space diffusion, reducing mean, median, and p95 by 32.9%, 30.9%, and 36.6%, respectively. Geometry-aware regularization improves local latent proxies but does not improve decoded-text metrics in the available runs. The contribution is methodological rather than algorithmic: the paper presents a reusable staged diagnosis for one concrete pipeline and shows that, in this setting, codec fidelity rather than latent denoising sets the practical quality ceiling.

Hepatocellular carcinoma (HCC), ranking as the third leading cause of cancer-related mortality worldwide, demands urgent improvements in early detection to enhance patient survival. While ultrasound remains the preferred screening modality due to its cost-effectiveness and real-time capabilities, its sensitivity (59%-78%) heavily relies on radiologists' expertise, leading to inconsistent diagnostic outcomes and operational inefficiencies. Recent advancements in AI technology offer promising solutions to bridge this gap. This study introduces the Hierarchical Sparse Query Transformer (HSQformer), a novel hybrid architecture that synergizes CNNs' local feature extraction with Vision Transformers' global contextual awareness through latent space representation and sparse learning. By dynamically activating task-specific experts via a Mixture-of-Experts (MoE) framework, HSQformer achieves hierarchical feature integration without structural redundancy. Evaluated across three clinical scenarios: single-center, multi-center, and high-risk patient cohorts, HSQformer outperforms state-of-the-art models (e.g., 95.38% AUC in multi-center testing) and matches senior radiologists' diagnostic accuracy while significantly surpassing junior counterparts. These results highlight the potential of AI-assisted tools to standardize HCC screening, reduce dependency on human expertise, and improve early diagnosis rates. The full code is available at https://github.com/Asunatan/HSQformer.

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.

Identifying, tracking, and predicting wound heal-stage progression is a fundamental task towards proper diagnosis, effective treatment, facilitating healing, and reducing pain. Traditionally, a medical expert might observe a wound to determine the current healing state and recommend treatment. However, sourcing experts who can produce such a diagnosis solely from visual indicators can be difficult, time-consuming and expensive. In addition, lesions may take several weeks to undergo the healing process, demanding resources to monitor and diagnose continually. Automating this task can be challenging; datasets that follow wound progression from onset to maturation are small, rare, and often collected without computer vision in mind. To tackle these challenges, we introduce a self-supervised learning scheme composed of (a) learning embeddings of wound's temporal dynamics, (b) clustering for automatic stage discovery, and (c) fine-tuned classification. The proposed self-supervised and flexible learning framework is biologically inspired and trained on a small dataset with zero human labeling. The HealNet framework achieved high pre-text and downstream classification accuracy; when evaluated on held-out test data, HealNet achieved 97.7% pre-text accuracy and 90.62% heal-stage classification accuracy.

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.

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

Diffusion models have achieved remarkable success in image and video generation tasks. However, the high computational demands of Diffusion Transformers (DiTs) pose a significant challenge to their practical deployment. While feature caching is a promising acceleration strategy, existing methods based on simple reusing or training-free forecasting struggle to adapt to the complex, stage-dependent dynamics of the diffusion process, often resulting in quality degradation and failing to maintain consistency with the standard denoising process. To address this, we propose a LEarnable Stage-Aware (LESA) predictor framework based on two-stage training. Our approach leverages a Kolmogorov-Arnold Network (KAN) to accurately learn temporal feature mappings from data. We further introduce a multi-stage, multi-expert architecture that assigns specialized predictors to different noise-level stages, enabling more precise and robust feature forecasting. Extensive experiments show our method achieves significant acceleration while maintaining high-fidelity generation. Experiments demonstrate 5.00x acceleration on FLUX.1-dev with minimal quality degradation (1.0% drop), 6.25x speedup on Qwen-Image with a 20.2% quality improvement over the previous SOTA (TaylorSeer), and 5.00x acceleration on HunyuanVideo with a 24.7% PSNR improvement over TaylorSeer. State-of-the-art performance on both text-to-image and text-to-video synthesis validates the effectiveness and generalization capability of our training-based framework across different models. Our code is included in the supplementary materials and will be released on GitHub.

Radiology reporting generative AI holds significant potential to alleviate clinical workloads and streamline medical care. However, achieving high clinical accuracy is challenging, as radiological images often feature subtle lesions and intricate structures. Existing systems often fall short, largely due to their reliance on fixed size, patch-level image features and insufficient incorporation of pathological information. This can result in the neglect of such subtle patterns and inconsistent descriptions of crucial pathologies. To address these challenges, we propose an innovative approach that leverages pathology-aware regional prompts to explicitly integrate anatomical and pathological information of various scales, significantly enhancing the precision and clinical relevance of generated reports. We develop an anatomical region detector that extracts features from distinct anatomical areas, coupled with a novel multi-label lesion detector that identifies global pathologies. Our approach emulates the diagnostic process of radiologists, producing clinically accurate reports with comprehensive diagnostic capabilities. Experimental results show that our model outperforms previous state-of-the-art methods on most natural language generation and clinical efficacy metrics, with formal expert evaluations affirming its potential to enhance radiology practice.

Clinical diagnosis is inherently sequential: clinicians escalate from cheap to costly tests only when additional evidence is expected to resolve diagnostic uncertainty. We present ActiveMedAgent, a framework that brings this cost-aware sequential logic to multimodal medical AI. Given a frozen, API-accessed vision-language model, ActiveMedAgent tracks probability distributions over candidate diagnoses and scores each acquisition by its per-step diagnostic utility minus cost. A lightweight MLP controller is then trained offline on these scored trajectories, learning when to request additional evidence and when to commit. Across three commonly used benchmarks, trajectory-based policy learning consistently outperforms both unguided acquisition and full-modality baselines. Notably, we identify an information overload effect. In 175 cases, the agent produces a correct diagnosis with fewer channels while the full-modality baseline fails, showing that learning what to omit can be as important as learning what to acquire.

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.

Longitudinal chest X-ray (CXR) interpretation requires reasoning over disease evolution across multiple patient visits, yet most existing medical VQA benchmarks focus on single images or short-horizon image pairs. We introduce MI-CXR, a benchmark for standardized evaluation of Multi-Interval longitudinal reasoning over multi-visit CXR sequences, without requiring free-form report generation or additional clinical context. MI-CXR comprises five-way multiple-choice questions over five-visit patient timelines and instantiates three complementary task families: Temporal Event Localization, Interval-wise Change Reasoning, and Global Trajectory Summarization, which assess clinically grounded visual reasoning over time. Evaluating 14 state-of-the-art vision-language models (VLMs) shows low overall performance, with an average accuracy of 29.3%, only modestly above random guessing. Using stage-wise diagnostic probing, we find that models often produce locally plausible interval descriptions but fail to enforce temporal constraints or compose evidence into globally consistent decisions over the full timeline. These findings reveal key limitations of current VLMs and establish MI-CXR as a principled benchmark for longitudinal medical reasoning. The benchmark is available at https://github.com/AIDASLab/MI-CXR

Rare cancers comprise 20-25% of all malignancies but face major diagnostic challenges due to limited expert availability-especially in pediatric oncology, where they represent over 70% of cases. While pathology vision-language (VL) foundation models show promising zero-shot capabilities for common cancer subtyping, their clinical performance for rare cancers remains limited. Existing multi-instance learning (MIL) methods rely only on visual features, overlooking cross-modal knowledge and compromising interpretability critical for rare cancer diagnosis. To address this limitation, we propose PathPT, a novel framework that fully exploits the potential of vision-language pathology foundation models through spatially-aware visual aggregation and task-specific prompt tuning. Unlike conventional MIL, PathPT converts WSI-level supervision into fine-grained tile-level guidance by leveraging the zero-shot capabilities of VL models, thereby preserving localization on cancerous regions and enabling cross-modal reasoning through prompts aligned with histopathological semantics. We benchmark PathPT on eight rare cancer datasets(four adult and four pediatric) spanning 56 subtypes and 2,910 WSIs, as well as three common cancer datasets, evaluating four state-of-the-art VL models and four MIL frameworks under three few-shot settings. Results show that PathPT consistently delivers superior performance, achieving substantial gains in subtyping accuracy and cancerous region grounding ability. This work advances AI-assisted diagnosis for rare cancers, offering a scalable solution for improving subtyping accuracy in settings with limited access to specialized expertise.

Traditional whole slide image (WSI) analysis methods typically rely on the multiple instance learning (MIL) paradigm, which extracts patch-level features at high magnification and aggregates them for slide-level prediction. However, such exhaustive patch-level processing is computationally expensive, severely limiting the efficiency and scalability of WSI analysis. To address this challenge, we propose PathCTM (a Pathology-oriented Continuous Thought Model) that enables token-efficient scale-space continuous reasoning for gigapixel WSIs. PathCTM formulates diagnostic inference as a dynamic sequential information pursuit. It progressively transitions from low-magnification global to high-magnification local inspection, and adaptively terminates inference when sufficient evidence is gathered to effectively bound decision uncertainty. Specifically, it uses conditional computation for dynamic scale switching with attention-guided region pruning, coupled with confidence-aware early stopping. Extensive experiments demonstrate that, compared with standard MIL-based methods, PathCTM reduces the number of required image patches by 95.95% and shortens inference time by approximately 95.62%, while maintaining AUC without degradation. Code is available at https://github.com/JSGe-AI/PathCTM.

Gastrointestinal malignancies constitute a leading cause of cancer-related mortality worldwide, with advanced-stage prognosis remaining particularly dismal. Originating as a groundbreaking technique for early gastric cancer treatment, Endoscopic Submucosal Dissection has evolved into a versatile intervention for diverse gastrointestinal lesions. While computer-assisted systems significantly enhance procedural precision and safety in ESD, their clinical adoption faces a critical bottleneck: reliable surgical phase recognition within complex endoscopic workflows. Current state-of-the-art approaches predominantly rely on multi-stage refinement architectures that iteratively optimize temporal predictions. In this paper, we present Clinical Prior Knowledge-Constrained Diffusion (CPKD), a novel generative framework that reimagines phase recognition through denoising diffusion principles while preserving the core iterative refinement philosophy. This architecture progressively reconstructs phase sequences starting from random noise and conditioned on visual-temporal features. To better capture three domain-specific characteristics, including positional priors, boundary ambiguity, and relation dependency, we design a conditional masking strategy. Furthermore, we incorporate clinical prior knowledge into the model training to improve its ability to correct phase logical errors. Comprehensive evaluations on ESD820, Cholec80, and external multi-center demonstrate that our proposed CPKD achieves superior or comparable performance to state-of-the-art approaches, validating the effectiveness of diffusion-based generative paradigms for surgical phase recognition.

Code agents can autonomously resolve GitHub issues, yet when they fail, current evaluation provides no visibility into where or why. Metrics such as Pass@1 collapse an entire execution into a single binary outcome, making it difficult to identify where and why the agent went wrong. To address this limitation, we introduce TRAJEVAL, a diagnostic framework that decomposes agent trajectories into three interpretable stages: search (file localization), read (function comprehension), and edit (modification targeting). For each stage, we compute precision and recall by comparing against reference patches. Analyzing 16,758 trajectories across three agent architectures and seven models, we find universal inefficiencies (all agents examine approximately 22x more functions than necessary) yet distinct failure modes: GPT-5 locates relevant code but targets edits incorrectly, while Qwen-32B fails at file discovery entirely. We validate that these diagnostics are predictive, achieving model-level Pass@1 prediction within 0.87-2.1% MAE, and actionable: real-time feedback based on trajectory signals improves two state-of-the-art models by 2.2-4.6 percentage points while reducing costs by 20-31%. These results demonstrate that our framework not only provides a more fine-grained analysis of agent behavior, but also translates diagnostic signals into tangible performance gains. More broadly, TRAJEVAL transforms agent evaluation beyond outcome-based benchmarking toward mechanism-driven diagnosis of agent success and failure.

Leaderboards rank frontier models on independent axes but do not reveal whether capabilities reinforce or trade off across releases -- and at the frontier, this interaction is the more informative signal. We decompose paired SWE-bench and GPQA Diamond scores into a population coupling trend and per-release residual (h-field) that diagnoses capability emphasis and identifies which measurement or stress test is most informative next. Across 34 models from 10 labs (2024--2026), capabilities cooperate (r = +0.72, p < 10^{-6}), but cooperation varies by lab and over time: DeepSeek reversed from reasoning-rich to coding-first (h: +11.2 to -4.7, 15.9-pp swing); Google maintains consistent reasoning emphasis; Anthropic oscillates between coding excursions and recovery. Cooperation is not static -- it cascades. Six open-weight architectures confirm a second capability transition at 30--72B, and SWE-bench is now saturating while HLE and instruction-following retain discriminatory spread -- signaling the next axis rotation. We provide a three-level playbook (locate, diagnose, rotate), a per-lab measurement-priority table, and seven falsifiable predictions with timestamped criteria for the next 12 months of frontier releases. Per-lab coupling slopes vary 5times (Google 1.15 vs. DeepSeek 0.23), quantifying how efficiently each recipe converts coding gains into reasoning. Five April 2026 releases confirm the diagnostic out of sample (r rises from +0.72 to +0.75). An interactive dashboard provides phase classification with actionable recommendations, h-field diagnostics, per-lab coupling trajectories, ODE-based scaling predictions, benchmark rotation guidance, self-steering demo, and live tracking of all seven predictions: https://zehenlabs.com/cape/.

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

In this work, we show that the impact of model capacity varies across timesteps: it is crucial for the early and late stages but largely negligible during the intermediate stage. Accordingly, we propose FlowBlending, a stage-aware multi-model sampling strategy that employs a large model and a small model at capacity-sensitive stages and intermediate stages, respectively. We further introduce simple criteria to choose stage boundaries and provide a velocity-divergence analysis as an effective proxy for identifying capacity-sensitive regions. Across LTX-Video (2B/13B) and WAN 2.1 (1.3B/14B), FlowBlending achieves up to 1.65x faster inference with 57.35% fewer FLOPs, while maintaining the visual fidelity, temporal coherence, and semantic alignment of the large models. FlowBlending is also compatible with existing sampling-acceleration techniques, enabling up to 2x additional speedup. Project page is available at: https://jibin86.github.io/flowblending_project_page.

Online Surgical Phase Recognition (SPR) models can reach high frame-wise accuracy, yet their predictions often lack temporal stability, fragmenting workflow understanding and reducing the reliability of downstream assistance. We show that this instability is not random noise but arises from two mechanisms: early misclassifications corrupt temporal feature states and propagate forward to form error cascades, and phase transitions follow evidence-accumulation dynamics whereas most online SPR systems rely on memoryless frame-wise decisions, making them sensitive to transient confidence fluctuations. We propose a unified Train-Inference-Evaluation framework that explicitly stabilizes temporal inference dynamics using model-agnostic, plug-and-play components. For training, the Temporal Error-Cascade (TEC) loss suppresses error onset and mitigates forward error propagation by stabilizing temporal feature evolution. For inference, the Evidence-Gated Transition Predictor (EGTP) enforces evidence-driven state transitions, allowing phase changes only when accumulated evidence exceeds a confidence boundary. For evaluation, we introduce the Temporal Fragmentation Index (TFI), a reliability-aware metric that quantifies instability-induced temporal disagreement beyond conventional frame-wise and token-based measures. Experiments on Cholec80 and AutoLaparo across three representative backbones show that the proposed framework substantially improves temporal stability and reduces prediction fragmentation, while maintaining or modestly improving frame-wise performance.

Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.

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.

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

Ultrasound imaging has become the preferred imaging modality for early cancer screening due to its advantages of non-ionizing radiation, low cost, and real-time imaging capabilities. However, conventional ultrasound diagnosis heavily relies on physician expertise, presenting challenges of high subjectivity and low diagnostic efficiency. Vision-language models (VLMs) offer promising solutions for this issue, but existing general-purpose models demonstrate limited knowledge in ultrasound medical tasks, with poor generalization in multi-organ lesion recognition and low efficiency across multi-task diagnostics. To address these limitations, we propose EchoVLM, a vision-language model specifically designed for ultrasound medical imaging. The model employs a Mixture of Experts (MoE) architecture trained on data spanning seven anatomical regions. This design enables the model to perform multiple tasks, including ultrasound report generation, diagnosis and visual question-answering (VQA). The experimental results demonstrated that EchoVLM achieved significant improvements of 10.15 and 4.77 points in BLEU-1 scores and ROUGE-1 scores respectively compared to Qwen2-VL on the ultrasound report generation task. These findings suggest that EchoVLM has substantial potential to enhance diagnostic accuracy in ultrasound imaging, thereby providing a viable technical solution for future clinical applications. Source code and model weights are available at https://github.com/Asunatan/EchoVLM.

Multi-Agent Reinforcement Learning (MARL) is increasingly deployed in safety-critical domains, yet methods for interpretable failure detection and attribution remain underdeveloped. We introduce a two-stage gradient-based framework that provides interpretable diagnostics for three critical failure analysis tasks: (1) detecting the true initial failure source (Patient-0); (2) validating why non-attacked agents may be flagged first due to domino effects; and (3) tracing how failures propagate through learned coordination pathways. Stage 1 performs interpretable per-agent failure detection via Taylor-remainder analysis of policy-gradient costs, declaring an initial Patient-0 candidate at the first threshold crossing. Stage 2 provides validation through geometric analysis of critic derivatives-first-order sensitivity and directional second-order curvature aggregated over causal windows to construct interpretable contagion graphs. This approach explains "downstream-first" detection anomalies by revealing pathways that amplify upstream deviations. Evaluated across 500 episodes in Simple Spread (3 and 5 agents) and 100 episodes in StarCraft II using MADDPG and HATRPO, our method achieves 88.2-99.4% Patient-0 detection accuracy while providing interpretable geometric evidence for detection decisions. By moving beyond black-box detection to interpretable gradient-level forensics, this framework offers practical tools for diagnosing cascading failures in safety-critical MARL systems.

Diffusion and flow-matching schedules control the signal and noise coefficients that mix data and noise along affine probability paths. Minimizing a kinetic action defined on coefficient paths, motivated by optimal transport, helps explain strong baselines but remains model-agnostic and ignores prediction error. Here we introduce a model-aware schedule construction based on fiberwise optimal transport. At a fixed time and state on the probability path, compatible signal/noise decompositions form an affine fiber. We define a fiberwise prediction risk by averaging optimal-transport costs between the true and predictor-induced decompositions within these fibers. On a fixed coefficient curve, combining this risk with coefficient-path kinetic action yields a closed-form optimal time allocation. This construction extends to general linear prediction targets, and the risk profile can be estimated from an early baseline checkpoint. We evaluate DDPMs and flow matching across prediction targets, training configurations, risk-estimation checkpoints, datasets, and architectures. Our model-aware schedules consistently outperform strong baselines, including a 38.6% relative FID reduction for flow matching on CIFAR-10 at 16 function evaluations. Each model-agnostic kinetic baseline determines its own kinetic reference coordinate. In these coordinates, fiberwise-risk profiles from independently trained models in different settings align closely after normalization to unit area. The resulting schedule deformations used in training also align, suggesting empirical universality across the evaluated models and settings. Pretrained-checkpoint diagnostics extend this normalized-risk agreement to larger conditional latent diffusion and 2-RF models. A frozen analytic allocation template retains most of the model-aware improvement without further risk estimation or model-specific fitting.

Large language models (LLMs) have become increasingly capable of following instructions and complex reasoning, making prompting a flexible interface for adapting models without parameter updates. Yet prompt design remains labor-intensive and highly sensitive to formatting, phrasing, and instruction order, motivating automated prompt optimization methods that reduce manual effort while preserving inference-time flexibility. However, existing methods often search over prompt candidates or use fixed critique-refine pipelines driven by individual examples or small batches, limiting their ability to capture systematic error patterns and make targeted edits grounded in failure history. We propose Reflective Prompt Tuning (RPT), a framework that uses LLM function calling to simulate the iterative workflow of human prompt engineers. An LLM optimizer calls a diagnostic function that evaluates the target model over an entire optimization set, summarizes recurring failure modes, and returns a structured diagnostic report. The optimizer uses this report, together with an accumulated memory of prior reports, to revise the prompt for the next iteration. RPT further supports confidence-aware optimization by using calibration signals in diagnostic feedback and final prompt selection. Across three reasoning tasks, RPT improves over initial prompts by up to 12.9 points, remains competitive with state of the art, and improves confidence calibration. Our analyses show that RPT is especially effective on multi-hop and mathematical reasoning, producing targeted prompt revisions that align with diagnosed failure patterns and lead to gains in task performance and calibration.

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

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

Whole-slide images (WSIs) are gigapixel-scale digital scans of histopathology tissue and serve as the primary basis for cancer diagnosis. Existing histopathology generative models operate at the patch scale, producing fixed-size tiles of at most 1024times1024 pixels which encompass only a small fraction of the WSI. In contrast, text reports for clinical diagnoses and slide-level diagnostic labels -- the supervision that exists at scale -- operate at the whole-slide level. We present BigCell, the first approach to generate coherent whole-slide histopathology images at native gigapixel resolution. BigCell trains a flow-matching transformer at 2048times2048 pixels on over 120,000 publicly available WSIs spanning multiple organ types. Conditioning on embeddings from pathology foundation models and using an inference-time sliding-window pipeline, BigCell generates coherent images of up to 32,768times32,768 pixels, outperforming prior tile generators on both tile-level and slide-level fidelity metrics. To make gigapixel synthesis practical, we introduce an adaptive scheduling strategy that prioritizes important slide regions, speeding up image generation by over 3\ttimes with minimal quality degradation. Furthermore, we propose the first text-to-image synthesis at 8k resolution by training a separate model that produces dense conditioning grids directly from pathology text reports. We demonstrate that augmenting with synthetic samples improves slide-level few-shot classification performance by up to 18 % over baselines trained on real data.

The diagnosis of cyber-physical systems aims to detect faulty behaviour, its root cause and a mitigation or even prevention policy. Therefore, diagnosis relies on a representation of the system's functional and faulty behaviour combined with observations of the system taken at runtime. The main challenges are the time-intensive building of a model, possible state-explosion while searching for the root cause and interpretability of the results. In this paper we propose a scalable algorithm tackling these challenges. We use a Bayesian network to learn a structured model automatically and optimise the model by a genetic algorithm. Our approach differs from existing work in two aspects: instead of selecting features prior to the analysis we learn a global representation using all available information which is then transformed to a smaller, label-specific one and we focus on interpretability to facilitate repairs. The evaluation shows that our approach is able to learn a model with equal performance to state-of-the-art algorithms while giving better interpretability and having a reduced size.

Current evaluation protocols for Vision-Language Models (VLMs) in Radiology Report Generation (RRG) rely on report-level metrics that measure lexical overlap or aggregate clinical correctness. However, such metrics do not test whether individual diagnostic statements stem from the actual pathological evidence visible in the image. This allows models to achieve competitive scores by exploiting learned priors or spurious correlations, a failure mode we refer to as vision shortcut. We introduce SHOVIR, a benchmark for evaluating vision shortcut behavior in RRG. SHOVIR extends two spatially annotated chest X-ray datasets, MIMIC-CXR and PadChest-GR, with per-box CheXpert labels, and defines image-level and disease-level occlusion experiments that contrast baseline performance on clean images against localized, region-specific perturbations. Comparing predictions across these conditions isolates two failure modes at the disease-class level: direct shortcuts, where a finding persists after its visual evidence is removed, and contextual shortcuts, where detection degrades once co-occurring pathologies are occluded despite the target region remaining intact. Benchmarking eight state-of-the-art VLMs, we find that shortcut behavior varies substantially across architectures and datasets. Models achieving the highest baseline report quality do not necessarily rank highest in spatial grounding, revealing that clinically fluent generation can coexist with shallow reliance on visual evidence. These findings expose a blind spot in current RRG evaluation and motivate region-aware assessment protocols.

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

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.

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.

Optimizing LLM-based agentic workflows is challenging for scaling AI capabilities. Current methods rely on coarse, end-to-end evaluation signals and lack fine-grained signals on where to refine, often resulting in inefficient or low-impact modifications. To address these limitations, we propose JudgeFlow, an Evaluation-Judge-Optimization-Update pipeline. We incorporate reusable, configurable logic blocks into agentic workflows to capture fundamental forms of logic. On top of this abstraction, we design a dedicated Judge module that inspects execution traces particularly failed runs and assigns rank-based responsibility scores to problematic blocks. These fine-grained diagnostic signals are then leveraged by an LLM-based optimizer, which focuses modifications on the most problematic block in the workflow. Our approach improves sample efficiency, enhances interpretability through block-level diagnostics, and provides a scalable foundation for automating increasingly complex agentic workflows. We evaluate JudgeFlow on mathematical reasoning and code generation benchmarks, where JudgeFlow achieves superior performance and efficiency compared to existing methods.

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.

Deep learning based automated pathological diagnosis has markedly improved diagnostic efficiency and reduced variability between observers, yet its clinical adoption remains limited by opaque model decisions and a lack of traceable rationale. To address this, recent multimodal visual reasoning architectures provide a unified framework that generates segmentation masks at the pixel level alongside semantically aligned textual explanations. By localizing lesion regions and producing expert style diagnostic narratives, these models deliver the transparent and interpretable insights necessary for dependable AI assisted pathology. Building on these advancements, we propose PathMR, a cell-level Multimodal visual Reasoning framework for Pathological image analysis. Given a pathological image and a textual query, PathMR generates expert-level diagnostic explanations while simultaneously predicting cell distribution patterns. To benchmark its performance, we evaluated our approach on the publicly available PathGen dataset as well as on our newly developed GADVR dataset. Extensive experiments on these two datasets demonstrate that PathMR consistently outperforms state-of-the-art visual reasoning methods in text generation quality, segmentation accuracy, and cross-modal alignment. These results highlight the potential of PathMR for improving interpretability in AI-driven pathological diagnosis. The code will be publicly available in https://github.com/zhangye-zoe/PathMR.

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

Agentic AI is rapidly advancing in healthcare and biomedical research. However, in medical image analysis, their performance and adoption remain limited due to the lack of a robust ecosystem, insufficient toolsets, and the absence of real-time interactive expert feedback. Here we present "TissueLab", a co-evolving agentic AI system that allows researchers to ask direct questions, automatically plan and generate explainable workflows, and conduct real-time analyses where experts can visualize intermediate results and refine them. TissueLab integrates tool factories across pathology, radiology, and spatial omics domains. By standardizing inputs, outputs, and capabilities of diverse tools, the system determines when and how to invoke them to address research and clinical questions. Across diverse tasks with clinically meaningful quantifications that inform staging, prognosis, and treatment planning, TissueLab achieves state-of-the-art performance compared with end-to-end vision-language models (VLMs) and other agentic AI systems such as GPT-5. Moreover, TissueLab continuously learns from clinicians, evolving toward improved classifiers and more effective decision strategies. With active learning, it delivers accurate results in unseen disease contexts within minutes, without requiring massive datasets or prolonged retraining. Released as a sustainable open-source ecosystem, TissueLab aims to accelerate computational research and translational adoption in medical imaging while establishing a foundation for the next generation of medical AI.

Accurate remaining useful life (RUL) prediction hinges on the quality of health indicators (HIs), yet existing methods often fail to disentangle complex degradation mechanisms in multi-sensor systems or quantify uncertainty in HI reliability. This paper introduces a novel framework for HI construction, advancing three key contributions. First, we adapt Reconstruction along Projected Pathways (RaPP) as a health indicator (HI) for RUL prediction for the first time, showing that it outperforms traditional reconstruction error metrics. Second, we show that augmenting RaPP-derived HIs with aleatoric and epistemic uncertainty quantification (UQ) via Monte Carlo dropout and probabilistic latent spaces- significantly improves RUL-prediction robustness. Third, and most critically, we propose indicator groups, a paradigm that isolates sensor subsets to model system-specific degradations, giving rise to our novel method, I-GLIDE which enables interpretable, mechanism-specific diagnostics. Evaluated on data sourced from aerospace and manufacturing systems, our approach achieves marked improvements in accuracy and generalizability compared to state-of-the-art HI methods while providing actionable insights into system failure pathways. This work bridges the gap between anomaly detection and prognostics, offering a principled framework for uncertainty-aware degradation modeling in complex systems.

Efficient deployment of large language models (LLMs) in production forces a trade-off between accuracy and cost. Operators often default to a single model that is either expensive for easy queries or insufficient for hard ones. To address this challenge, we propose a two-stage cascaded solution. Stage 1 clusters incoming queries and assigns each cluster to its most cost-effective model. The cost budget for this routing process is set by an interpretable hyperparameter, tuned offline. Stage 2 adds a quality estimation (QE) cascade; when an output from Stage 1 is judged low-quality, the query is escalated to a stronger model. This ensures only hard or low-confidence cases reach the expensive models. On the test datasets, the cascaded system retains 97-99% of the strongest model's accuracy while reducing Time Per Output Token (TPOT). It requires only task-correctness labels and adapts to changes in the model pool without manual reconfiguration.

The increasing deployment of AI agents in long-horizon tasks yields massive execution logs. Diagnosing failures within these records is crucial for reliability, as it transforms outcome-level signals into actionable interventions. The sheer scale of the data renders human review impractical, driving the need for automated root-cause attribution (RCA). However, automated RCA methods using LLMs suffer from low diagnostic accuracy, especially as execution traces grow larger. They struggle because relevant information is often sparse, distributed across distant actions, and disconnected from the visible failure, reducing root-cause attribution to a massive search problem. Existing RCA methods typically rely on one-shot LLM judgments to diagnose failures from execution traces. While effective for shorter trajectories, these judges tend to settle on a plausible diagnosis early, leaving critical evidence in longer traces unexamined. We introduce Continual Search, an iterative framework that nudges the judge, over successive turns, to keep searching for unresolved diagnostic evidence. We evaluate Continual Search across four existing RCA benchmarks. Recognizing the lack of massive execution traces in current benchmarks, we introduce MegaRCA-Mix to evaluate RCA at scale. MegaRCA-Mix provides a challenging testbed of 50 human-annotated failure trials spanning long-horizon, execution-heavy tasks. Across multiple benchmark suites and model families, Continual Search consistently improves attribution performance. On MegaRCA-Mix, for example, it improves GPT-5.5's F1 score by more than 40\%, from 0.349 to 0.498. More interestingly, within the same model family, lower-tier models can even surpass their higher-tier counterparts, demonstrating that effective search supersedes raw model scale.

Multi-stage reasoning has emerged as an effective strategy for enhancing the reasoning capability of small language models by decomposing complex problems into sequential sub-stages. However, this comes at the cost of increased latency. We observe that existing adaptive acceleration techniques, such as layer skipping, struggle to balance efficiency and accuracy in this setting due to two key challenges: (1) stage-wise variation in skip sensitivity, and (2) the generation of redundant output tokens. To address these, we propose LiteStage, a latency-aware layer skipping framework for multi-stage reasoning. LiteStage combines a stage-wise offline search that allocates optimal layer budgets with an online confidence-based generation early exit to suppress unnecessary decoding. Experiments on three benchmarks, e.g., OBQA, CSQA, and StrategyQA, show that LiteStage achieves up to 1.70x speedup with less than 4.0% accuracy loss, outperforming prior training-free layer skipping methods.

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 computational pathology, understanding and generation have evolved along disparate paths: advanced understanding models already exhibit diagnostic-level competence, whereas generative models largely simulate pixels. Progress remains hindered by three coupled factors: the scarcity of large, high-quality image-text corpora; the lack of precise, fine-grained semantic control, which forces reliance on non-semantic cues; and terminological heterogeneity, where diverse phrasings for the same diagnostic concept impede reliable text conditioning. We introduce UniPath, a semantics-driven pathology image generation framework that leverages mature diagnostic understanding to enable controllable generation. UniPath implements Multi-Stream Control: a Raw-Text stream; a High-Level Semantics stream that uses learnable queries to a frozen pathology MLLM to distill paraphrase-robust Diagnostic Semantic Tokens and to expand prompts into diagnosis-aware attribute bundles; and a Prototype stream that affords component-level morphological control via a prototype bank. On the data front, we curate a 2.65M image-text corpus and a finely annotated, high-quality 68K subset to alleviate data scarcity. For a comprehensive assessment, we establish a four-tier evaluation hierarchy tailored to pathology. Extensive experiments demonstrate UniPath's SOTA performance, including a Patho-FID of 80.9 (51% better than the second-best) and fine-grained semantic control achieving 98.7% of the real-image. The meticulously curated datasets, complete source code, and pre-trained model weights developed in this study will be made openly accessible to the public.

Most existing LLM diagnoses are evaluated on static, single-turn settings where complete patient information is provided upfront, an oversimplification of real clinical practice. We study active diagnosis: the real-life clinical process of starting from initial observation, ordering tests, interpreting results, and updating a differential diagnosis across multiple turns. Through systematic analysis, we identify three recurring failure modes in current LLMs: ungrounded test ordering, unreliable diagnostic update, and degraded multi-turn coherence. Together, these failures reveal a core deficit: existing medical training data teaches models to reason from complete information but not to act under evolving, partial evidence. To address this gap, we introduce MedAction, a tree-structured distillation pipeline that synthesizes diverse and high-quality multi-turn diagnostic trajectories via LLM-environment interaction. We propose two knowledge-graph-grounded metrics to filter trajectory quality: Disease Trajectory Consistency (DTC), which tracks whether the model's hypothesis converges toward the correct diagnosis, and Reasoning-Action Consistency (RAC), which verifies that belief updates are driven by gathered evidence. Using this pipeline, we construct MedAction-32K, a dataset of 32,681 trajectories from 2,896 PMC cases. Fine-tuning an 8B model on MedAction-32K achieves state-of-the-art performance among open-source models on both MedR-Bench and our curated MedAction-300-Hard benchmark, pushing the edge for open-source medical LLMs.

As Large Multimodal Models (LMMs) scale up and reinforcement learning (RL) methods mature, LMMs have made notable progress in complex reasoning and decision making. Yet training still relies on static data and fixed recipes, making it difficult to diagnose capability blind spots or provide dynamic, targeted reinforcement. Motivated by findings that test driven error exposure and feedback based correction outperform repetitive practice, we propose Diagnostic-driven Progressive Evolution (DPE), a spiral loop where diagnosis steers data generation and reinforcement, and each iteration re-diagnoses the updated model to drive the next round of targeted improvement. DPE has two key components. First, multiple agents annotate and quality control massive unlabeled multimodal data, using tools such as web search and image editing to produce diverse, realistic samples. Second, DPE attributes failures to specific weaknesses, dynamically adjusts the data mixture, and guides agents to generate weakness focused data for targeted reinforcement. Experiments on Qwen3-VL-8B-Instruct and Qwen2.5-VL-7B-Instruct show stable, continual gains across eleven benchmarks, indicating DPE as a scalable paradigm for continual LMM training under open task distributions. Our code, models, and data are publicly available at https://github.com/hongruijia/DPE.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

Intra-operative recognition of surgical phases holds significant potential for enhancing real-time contextual awareness in the operating room. However, we argue that online recognition, while beneficial, primarily lends itself to post-operative video analysis due to its limited direct impact on the actual surgical decisions and actions during ongoing procedures. In contrast, we contend that the prediction and anticipation of surgical phases are inherently more valuable for intra-operative assistance, as they can meaningfully influence a surgeon's immediate and long-term planning by providing foresight into future steps. To address this gap, we propose a dual approach that simultaneously recognises the current surgical phase and predicts upcoming ones, thus offering comprehensive intra-operative assistance and guidance on the expected remaining workflow. Our novel method, Surgical Phase Recognition and Anticipation (SuPRA), leverages past and current information for accurate intra-operative phase recognition while using future segments for phase prediction. This unified approach challenges conventional frameworks that treat these objectives separately. We have validated SuPRA on two reputed datasets, Cholec80 and AutoLaparo21, where it demonstrated state-of-the-art performance with recognition accuracies of 91.8% and 79.3%, respectively. Additionally, we introduce and evaluate our model using new segment-level evaluation metrics, namely Edit and F1 Overlap scores, for a more temporal assessment of segment classification. In conclusion, SuPRA presents a new multi-task approach that paves the way for improved intra-operative assistance through surgical phase recognition and prediction of future events.

As advances in large language models (LLMs) and multimodal techniques continue to mature, the development of general-purpose multimodal large language models (MLLMs) has surged, offering significant applications in interpreting natural images. However, the field of pathology has largely remained untapped, particularly in gathering high-quality data and designing comprehensive model frameworks. To bridge the gap in pathology MLLMs, we present PathAsst, a multimodal generative foundation AI assistant to revolutionize diagnostic and predictive analytics in pathology. The development of PathAsst involves three pivotal steps: data acquisition, CLIP model adaptation, and the training of PathAsst's multimodal generative capabilities. Firstly, we collect over 207K high-quality pathology image-text pairs from authoritative sources. Leveraging the advanced power of ChatGPT, we generate over 180K instruction-following samples. Furthermore, we devise additional instruction-following data specifically tailored for invoking eight pathology-specific sub-models we prepared, allowing the PathAsst to effectively collaborate with these models, enhancing its diagnostic ability. Secondly, by leveraging the collected data, we construct PathCLIP, a pathology-dedicated CLIP, to enhance PathAsst's capabilities in interpreting pathology images. Finally, we integrate PathCLIP with the Vicuna-13b and utilize pathology-specific instruction-tuning data to enhance the multimodal generation capacity of PathAsst and bolster its synergistic interactions with sub-models. The experimental results of PathAsst show the potential of harnessing AI-powered generative foundation model to improve pathology diagnosis and treatment processes.

Before acting upon an unobservable physical system, an autonomous agent must determine which latent distinctions govern downstream tasks, how many active interventions are necessary to certify them, and when to abstain to prevent catastrophic errors. Classical observability treats state reconstruction as an unconditioned binary predicate, failing when passive observations cannot break latent degeneracies without perturbation, full microscopic inversion is prohibitively costly, and distinguishing task-irrelevant degrees of freedom wastes interaction budgets. We formalize task-conditioned active observability complexity: the minimum worst-case expected interaction cost required to identify task-relevant states under certified error and safe abstention guarantees. We prove that task-predictive equivalence induces the unique minimal sufficient quotient H/!sim_τ, leaving active observability complexity strictly invariant while eliminating superfluous distinctions. In deterministic regimes, this complexity is characterized by an optimal adaptive distinguishing tree and Bellman recursion; in noisy regimes, it obeys a stopped-transcript relative-entropy lower bound and adaptive martingale certificates that compose without independence assumptions. We instantiate a prospective certified observer with staged recovery: a nominal verifier defers candidate compilation, triggering active probing only upon evidence, while a history-measurable score shell prunes hypotheses without sacrificing risk bounds. Stress audits across high-dimensional physical systems and thousands of operational trials demonstrate certified state recovery with zero false acceptances and substantial reductions in sensor reads and model steps.

Evaluation metrics are central to binary target segmentation because they determine how progress is measured, compared, and interpreted. In this paper, target denotes the task-defined positive region to be segmented rather than a generic foreground object. It may be salient, camouflaged, transparent, glass-like, mirror-like, shadow-like, lesion-like, or defined by other application-specific semantics. We treat existing metrics as compositions of modular design choices rather than isolated formulas. The proposed framework decomposes each metric into five stages covering prediction representation, target extraction, target matching, score computation, and metric reporting. We use this framework to analyze representative metrics and show how newer metrics address specific limits in earlier protocols. The stage choices keep each metric's assumptions visible. We then discuss the design space opened by the framework and its implications for task-aware evaluation protocols. Reference code is available at https://github.com/lartpang/PySODMetrics.

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

Alzheimer's disease (AD) is a chronic neurodegenerative disorder and the leading cause of dementia, significantly impacting cost, mortality, and burden worldwide. The advent of high-throughput omics technologies, such as genomics, transcriptomics, proteomics, and epigenomics, has revolutionized the molecular understanding of AD. Conventional AI approaches typically require the completion of all omics data at the outset to achieve optimal AD diagnosis, which are inefficient and may be unnecessary. To reduce the clinical cost and improve the accuracy of AD diagnosis using multi-omics data, we propose a novel staged graph convolutional network with uncertainty quantification (SGUQ). SGUQ begins with mRNA and progressively incorporates DNA methylation and miRNA data only when necessary, reducing overall costs and exposure to harmful tests. Experimental results indicate that 46.23% of the samples can be reliably predicted using only single-modal omics data (mRNA), while an additional 16.04% of the samples can achieve reliable predictions when combining two omics data types (mRNA + DNA methylation). In addition, the proposed staged SGUQ achieved an accuracy of 0.858 on ROSMAP dataset, which outperformed existing methods significantly. The proposed SGUQ can not only be applied to AD diagnosis using multi-omics data but also has the potential for clinical decision-making using multi-viewed data. Our implementation is publicly available at https://github.com/chenzhao2023/multiomicsuncertainty.

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

Multi-agent systems (MAS) are critical for automating complex tasks, yet their practical deployment is severely hampered by the challenge of failure attribution. Current diagnostic tools, which rely on statistical correlations, are fundamentally inadequate; on challenging benchmarks like Who\&When, state-of-the-art methods achieve less than 15\% accuracy in locating the root-cause step of a failure. To address this critical gap, we introduce the first failure attribution framework for MAS grounded in multi-granularity causal inference. Our approach makes two key technical contributions: (1) a performance causal inversion principle, which correctly models performance dependencies by reversing the data flow in execution logs, combined with Shapley values to accurately assign agent-level blame; (2) a novel causal discovery algorithm, CDC-MAS, that robustly identifies critical failure steps by tackling the non-stationary nature of MAS interaction data. The framework's attribution results directly fuel an automated optimization loop, generating targeted suggestions whose efficacy is validated via counterfactual simulations. Evaluations on the Who\&When and TRAIL benchmarks demonstrate a significant leap in performance. Our method achieves up to 36.2\% step-level accuracy. Crucially, the generated optimizations boost overall task success rates by an average of 22.4\%. This work provides a principled and effective solution for debugging complex agent interactions, paving the way for more reliable and interpretable multi-agent systems.

As modern microservice systems grow increasingly popular and complex-often consisting of hundreds or even thousands of fine-grained, interdependent components-they are becoming more susceptible to frequent and subtle failures. Ensuring system reliability therefore hinges on accurate and efficient failure localization. Traditional failure localization approaches based on small models lack the flexibility to adapt to diverse failure scenarios, while recent LLM-based methods suffer from two major limitations: they often rely on rigid invocation workflows that constrain the model's ability to dynamically explore optimal localization paths, and they require resource-intensive inference, making them cost-prohibitive for real-world deployment. To address these challenges, we explore the use of reinforcement fine-tuning to equip lightweight LLMs with reasoning and self-refinement capabilities, significantly improving the cost-effectiveness and adaptability of LLM-based failure localization. We begin with an empirical study to identify three key capabilities essential for accurate localization. Building on these insights, we propose a progressive multi-stage GRPO fine-tuning framework, which integrates a multi-factor failure localization grader and a recursion-of-thought actor module. The resulting model, ThinkFL, not only outperforms existing state-of-the-art LLMs and baseline methods in localization accuracy but also reduces end-to-end localization latency from minutes to seconds, demonstrating strong potential for real-world applications.

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.

As Retrieval-Augmented Generation (RAG) shifts toward diverse portfolio generation, it is stymied by two critical bottlenecks: flawed measurement of evidence utilization, and suboptimal context budget allocation. We resolve both sequentially. To resolve measurement, we expose a pervasive ``diagnostic illusion'': standard relevance proxies fail catastrophically on hard negatives. We replace them with an efficient causal leave-one-out probe that accurately isolates generative reliance and formally calibrates the structural dilution of LLM attention. To resolve allocation, we deploy this causal probe in a deconfounded factorial grid. We prove that the prevailing strategy of monolithic context widening is an architectural trap penalized by relevance decay. Instead, allocating compute iteratively across multiple sequential generations drives transformative portfolio recall gains of 16.7--20.5 absolute percentage points, scaling robustly up to 32B models. Finally, we unify these solutions into a deployable closed-loop submodular scheduler. Augmented by an attribution-steered contrastive decoder to override LLM attention inertia, our architecture systematically forces fresh evidence integration. By dominating classical open-loop baselines, we establish sequential, feedback-driven orchestration as the definitive paradigm for generative search. Our code, data, and causal measurement instruments are available at https://github.com/PeiYangLiu/ascp.

Histology review is often used as the `gold standard' for disease diagnosis. Computer aided diagnosis tools can potentially help improve current pathology workflows by reducing examination time and interobserver variability. Previous work in cancer grading has focused mainly on classifying pre-defined regions of interest (ROIs), or relied on large amounts of fine-grained labels. In this paper, we propose a two-stage attention-based multiple instance learning model for slide-level cancer grading and weakly-supervised ROI detection and demonstrate its use in prostate cancer. Compared with existing Gleason classification models, our model goes a step further by utilizing visualized saliency maps to select informative tiles for fine-grained grade classification. The model was primarily developed on a large-scale whole slide dataset consisting of 3,521 prostate biopsy slides with only slide-level labels from 718 patients. The model achieved state-of-the-art performance for prostate cancer grading with an accuracy of 85.11\% for classifying benign, low-grade (Gleason grade 3+3 or 3+4), and high-grade (Gleason grade 4+3 or higher) slides on an independent test set.

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

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

Monitoring is an important aspect of safely deploying Large Language Models (LLMs). This paper examines activation probes for detecting ``high-stakes'' interactions -- where the text indicates that the interaction might lead to significant harm -- as a critical, yet underexplored, target for such monitoring. We evaluate several probe architectures trained on synthetic data, and find them to exhibit robust generalization to diverse, out-of-distribution, real-world data. Probes' performance is comparable to that of prompted or finetuned medium-sized LLM monitors, while offering computational savings of six orders-of-magnitude. These savings are enabled by reusing activations of the model that is being monitored. Our experiments also highlight the potential of building resource-aware hierarchical monitoring systems, where probes serve as an efficient initial filter and flag cases for more expensive downstream analysis. We release our novel synthetic dataset and the codebase at https://github.com/arrrlex/models-under-pressure.

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.

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.

Text-to-video (T2V) generation models have made rapid progress in producing visually high-quality and temporally coherent videos. However, existing benchmarks primarily focus on perceptual quality, text-video alignment, or physical plausibility, leaving a critical aspect of action understanding largely unexplored: object state change (OSC) explicitly specified in the text prompt. OSC refers to the transformation of an object's state induced by an action, such as peeling a potato or slicing a lemon. In this paper, we introduce OSCBench, a benchmark specifically designed to assess OSC performance in T2V models. OSCBench is constructed from instructional cooking data and systematically organizes action-object interactions into regular, novel, and compositional scenarios to probe both in-distribution performance and generalization. We evaluate six representative open-source and proprietary T2V models using both human user study and multimodal large language model (MLLM)-based automatic evaluation. Our results show that, despite strong performance on semantic and scene alignment, current T2V models consistently struggle with accurate and temporally consistent object state changes, especially in novel and compositional settings. These findings position OSC as a key bottleneck in text-to-video generation and establish OSCBench as a diagnostic benchmark for advancing state-aware video generation models.

MIDOG 2025 Track 1 requires mitosis detection in whole-slideimages (WSIs) containing non-tumor, inflamed, and necrotic re-gions. Due to the complicated and heterogeneous context, aswell as possible artifacts, there are often false positives and falsenegatives, thus degrading the detection F1-score. To addressthis problem, we propose a two-stage framework. Firstly, an im-proved YOLO11x, integrated with EMA attention and LSConv,is employed to generate mitosis candidates. We use a low confi-dence threshold to generate as many proposals as possible, en-suring the detection recall. Then, a ConvNeXt-Tiny classifieris employed to filter out the false positives, ensuring the detec-tion precision. Consequently, the proposed two-stage frame-work can generate a high detection F1-score. Evaluated on afused dataset comprising MIDOG++, MITOS_WSI_CCMCT,and MITOS_WSI_CMC, our framework achieves an F1-scoreof 0.882, which is 0.035 higher than the single-stage YOLO11xbaseline. This performance gain is produced by a significantprecision improvement, from 0.762 to 0.839, and a comparablerecall. On the MIDOG 2025 Track 1 preliminary test set, thealgorithm scores an F1 score of 0.7587. The code is available athttps://github.com/xxiao0304/MIDOG-2025-Track-1-of-SZTU.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Electrocardiogram (ECG) interpretation is essential for cardiovascular disease diagnosis, but current automated systems often struggle with transparency and generalization to unseen conditions. To address this, we introduce ZETA, a zero-shot multimodal framework designed for interpretable ECG diagnosis aligned with clinical workflows. ZETA uniquely compares ECG signals against structured positive and negative clinical observations, which are curated through an LLM-assisted, expert-validated process, thereby mimicking differential diagnosis. Our approach leverages a pre-trained multimodal model to align ECG and text embeddings without disease-specific fine-tuning. Empirical evaluations demonstrate ZETA's competitive zero-shot classification performance and, importantly, provide qualitative and quantitative evidence of enhanced interpretability, grounding predictions in specific, clinically relevant positive and negative diagnostic features. ZETA underscores the potential of aligning ECG analysis with structured clinical knowledge for building more transparent, generalizable, and trustworthy AI diagnostic systems. We will release the curated observation dataset and code to facilitate future research.

Cardiovascular diseases (CVDs) remain the leading cause of mortality globally, and echocardiography is critical for diagnosis of both common and congenital cardiac conditions. However, echocardiographic data for certain pathologies are scarce, hindering the development of robust automated diagnosis models. In this work, we propose Echo-Path, a novel generative framework to produce echocardiogram videos conditioned on specific cardiac pathologies. Echo-Path can synthesize realistic ultrasound video sequences that exhibit targeted abnormalities, focusing here on atrial septal defect (ASD) and pulmonary arterial hypertension (PAH). Our approach introduces a pathology-conditioning mechanism into a state-of-the-art echo video generator, allowing the model to learn and control disease-specific structural and motion patterns in the heart. Quantitative evaluation demonstrates that the synthetic videos achieve low distribution distances, indicating high visual fidelity. Clinically, the generated echoes exhibit plausible pathology markers. Furthermore, classifiers trained on our synthetic data generalize well to real data and, when used to augment real training sets, it improves downstream diagnosis of ASD and PAH by 7\% and 8\% respectively. Code, weights and dataset are available here https://github.com/Marshall-mk/EchoPathv1

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.

Remarkable strides in computational pathology have been made in the task-agnostic foundation model that advances the performance of a wide array of downstream clinical tasks. Despite the promising performance, there are still several challenges. First, prior works have resorted to either vision-only or image-caption data, disregarding pathology reports with more clinically authentic information from pathologists and gene expression profiles which respectively offer distinct knowledge for versatile clinical applications. Second, the current progress in pathology FMs predominantly concentrates on the patch level, where the restricted context of patch-level pretraining fails to capture whole-slide patterns. Even recent slide-level FMs still struggle to provide whole-slide context for patch representation. In this study, for the first time, we develop a pathology foundation model incorporating three levels of modalities: pathology slides, pathology reports, and gene expression data, which resulted in 26,169 slide-level modality pairs from 10,275 patients across 32 cancer types, amounting to over 116 million pathological patch images. To leverage these data for CPath, we propose a novel whole-slide pretraining paradigm that injects the multimodal whole-slide context into the patch representation, called Multimodal Self-TAught PRetraining (mSTAR). The proposed paradigm revolutionizes the pretraining workflow for CPath, enabling the pathology FM to acquire the whole-slide context. To the best of our knowledge, this is the first attempt to incorporate three modalities at the whole-slide context for enhancing pathology FMs. To systematically evaluate the capabilities of mSTAR, we built the largest spectrum of oncological benchmark, spanning 7 categories of oncological applications in 15 types of 97 practical oncological tasks.

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.

The integration of multimodal data including pathology images and gene profiles is widely applied in precise survival prediction. Despite recent advances in multimodal survival models, collecting complete modalities for multimodal fusion still poses a significant challenge, hindering their application in clinical settings. Current approaches tackling incomplete modalities often fall short, as they typically compensate for only a limited part of the knowledge of missing modalities. To address this issue, we propose a Distilled Prompt Learning framework (DisPro) to utilize the strong robustness of Large Language Models (LLMs) to missing modalities, which employs two-stage prompting for compensation of comprehensive information for missing modalities. In the first stage, Unimodal Prompting (UniPro) distills the knowledge distribution of each modality, preparing for supplementing modality-specific knowledge of the missing modality in the subsequent stage. In the second stage, Multimodal Prompting (MultiPro) leverages available modalities as prompts for LLMs to infer the missing modality, which provides modality-common information. Simultaneously, the unimodal knowledge acquired in the first stage is injected into multimodal inference to compensate for the modality-specific knowledge of the missing modality. Extensive experiments covering various missing scenarios demonstrated the superiority of the proposed method. The code is available at https://github.com/Innse/DisPro.

In the field of medical sciences, reliable detection and classification of brain tumors from images remains a formidable challenge due to the rarity of tumors within the population of patients. Therefore, the ability to detect tumors in anomaly scenarios is paramount for ensuring timely interventions and improved patient outcomes. This study addresses the issue by leveraging deep learning (DL) techniques to detect and classify brain tumors in challenging situations. The curated data set from the National Brain Mapping Lab (NBML) comprises 81 patients, including 30 Tumor cases and 51 Normal cases. The detection and classification pipelines are separated into two consecutive tasks. The detection phase involved comprehensive data analysis and pre-processing to modify the number of image samples and the number of patients of each class to anomaly distribution (9 Normal per 1 Tumor) to comply with real world scenarios. Next, in addition to common evaluation metrics for the testing, we employed a novel performance evaluation method called Patient to Patient (PTP), focusing on the realistic evaluation of the model. In the detection phase, we fine-tuned a YOLOv8n detection model to detect the tumor region. Subsequent testing and evaluation yielded competitive performance both in Common Evaluation Metrics and PTP metrics. Furthermore, using the Data Efficient Image Transformer (DeiT) module, we distilled a Vision Transformer (ViT) model from a fine-tuned ResNet152 as a teacher in the classification phase. This approach demonstrates promising strides in reliable tumor detection and classification, offering potential advancements in tumor diagnosis for real-world medical imaging scenarios.

The ODELIA Breast MRI Challenge 2025 addresses a critical issue in breast cancer screening: improving early detection through more efficient and accurate interpretation of breast MRI scans. Even though methods for general-purpose whole-body lesion segmentation as well as multi-time-point analysis exist, breast cancer detection remains highly challenging, largely due to the limited availability of high-quality segmentation labels. Therefore, developing robust classification-based approaches is crucial for the future of early breast cancer detection, particularly in applications such as large-scale screening. In this write-up, we provide a comprehensive overview of our approach to the challenge. We begin by detailing the underlying concept and foundational assumptions that guided our work. We then describe the iterative development process, highlighting the key stages of experimentation, evaluation, and refinement that shaped the evolution of our solution. Finally, we present the reasoning and evidence that informed the design choices behind our final submission, with a focus on performance, robustness, and clinical relevance. We release our full implementation publicly at https://github.com/MIC-DKFZ/MeisenMeister

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

Prostate cancer, a growing global health concern, necessitates precise diagnostic tools, with Magnetic Resonance Imaging (MRI) offering high-resolution soft tissue imaging that significantly enhances diagnostic accuracy. Recent advancements in explainable AI and representation learning have significantly improved prostate cancer diagnosis by enabling automated and precise lesion classification. However, existing explainable AI methods, particularly those based on frameworks like generative adversarial networks (GANs), are predominantly developed for natural image generation, and their application to medical imaging often leads to suboptimal performance due to the unique characteristics and complexity of medical image. To address these challenges, our paper introduces three key contributions. First, we propose ProjectedEx, a generative framework that provides interpretable, multi-attribute explanations, effectively linking medical image features to classifier decisions. Second, we enhance the encoder module by incorporating feature pyramids, which enables multiscale feedback to refine the latent space and improves the quality of generated explanations. Additionally, we conduct comprehensive experiments on both the generator and classifier, demonstrating the clinical relevance and effectiveness of ProjectedEx in enhancing interpretability and supporting the adoption of AI in medical settings. Code will be released at https://github.com/Richardqiyi/ProjectedEx

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.

Mitotic figure (MF) detection in histopathology images is challenging due to large variations in slide scanners, staining protocols, tissue types, and the presence of artifacts. This paper presents a collection of training techniques - a bag of tricks - that enable robust, real-time MF detection across diverse domains. We build on the efficient RTMDet single stage object detector to achieve high inference speed suitable for clinical deployment. Our method addresses scanner variability and tumor heterogeneity via extensive multi-domain training data, balanced sampling, and careful augmentation. Additionally, we employ targeted, hard negative mining on necrotic and debris tissue to reduce false positives. In a grouped 5-fold cross-validation across multiple MF datasets, our model achieves an F1 score between 0.78 and 0.84. On the preliminary test set of the MItosis DOmain Generalization (MIDOG) 2025 challenge, our single-stage RTMDet-S based approach reaches an F1 of 0.81, outperforming larger models and demonstrating adaptability to new, unfamiliar domains. The proposed solution offers a practical trade-off between accuracy and speed, making it attractive for real-world clinical adoption.

Recent advances in multimodal large language models enable new possibilities for image-based decision support. However, their reliability and operational trade-offs in neuroimaging remain insufficiently understood. We present a comprehensive benchmarking study of vision-enabled large language models for 2D neuroimaging using curated MRI and CT datasets covering multiple sclerosis, stroke, brain tumors, other abnormalities, and normal controls. Models are required to generate multiple outputs simultaneously, including diagnosis, diagnosis subtype, imaging modality, specialized sequence, and anatomical plane. Performance is evaluated across four directions: discriminative classification with abstention, calibration, structured-output validity, and computational efficiency. A multi-phase framework ensures fair comparison while controlling for selection bias. Across twenty frontier multimodal models, the results show that technical imaging attributes such as modality and plane are nearly solved, whereas diagnostic reasoning, especially subtype prediction, remains challenging. Tumor classification emerges as the most reliable task, stroke is moderately solvable, while multiple sclerosis and rare abnormalities remain difficult. Few-shot prompting improves performance for several models but increases token usage, latency, and cost. Gemini-2.5-Pro and GPT-5-Chat achieve the strongest overall diagnostic performance, while Gemini-2.5-Flash offers the best efficiency-performance trade-off. Among open-weight architectures, MedGemma-1.5-4B demonstrates the most promising results, as under few-shot prompting, it approaches the zero-shot performance of several proprietary models, while maintaining perfect structured output. These findings provide practical insights into performance, reliability, and efficiency trade-offs, supporting standardized evaluation of multimodal LLMs in neuroimaging.

Cytopathology detection requires open-vocabulary recognition because cellular categories are fine-grained, long-tailed, and continuously evolving across different organ systems. However, existing cytology detectors are mostly single-domain and closed-set, and there is still no unified benchmark for evaluating open-vocabulary cytopathology detection. We present PentaCyto, a multi-domain benchmark covering cervical, urinary, respiratory, serous fluid, and thyroid cytology, with 24 base categories and 9 held-out novel categories. Each category is associated with structured cytomorphology prompts that describe diagnostic morphological attributes and provide clinically grounded textual knowledge. We further propose CytoSPM, an efficient detector based on a decoupled two-stage design. It first extracts reusable class-agnostic visual representations, and then performs class-aware structural prompt matching with class names and cytomorphology prompts. On PentaCyto, CytoSPM outperforms existing methods in novel-category detection and open-vocabulary detection while maintaining efficient inference.

Autonomous agents are increasingly expected to support end-to-end medical-AI research workflows, moving beyond isolated prediction tasks or short-form clinical question answering. However, existing medical agent benchmarks primarily evaluate final outputs, providing limited visibility into agent behavior within the research process. To address this gap, we present AutoMedBench, a workflow-aware benchmark for autonomous medical-AI research across diverse medical imaging and multimodal inference tasks, organizing agent execution into a unified five-stage workflow (S1-S5): Plan, Setup, Validate, Inference, and Submit. It comprises long-horizon tasks with each run averaging 33 agent turns, spanning five research tracks: segmentation, image enhancement, visual question answering (VQA), report generation, and lesion detection. Each task is evaluated under two difficulty tiers, Lite and Standard, which use the same data and metrics but differ in the amount of task-brief scaffolding, and each run is scored using both final task performance and S1-S5 stage scores, enabling stage-level analysis from the initial task brief to the final submitted artifact. Across thousands of recorded runs, stage-level scoring reveals that Validate is the weakest workflow stage on average, whereas Setup is the strongest, suggesting that current agents are better at making pipelines executable than at verifying their reliability. Post-run error analysis further shows that verification and submission failures dominate tagged errors, accounting for 37.7% and 38.1% of fired codes respectively, whereas task-understanding errors are rare at 0.9%, and runs with one fired error code have a 48% lower overall score than runs with no error code on average.

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

Retrieval-Augmented Generation (RAG) extends large language models (LLMs) beyond parametric knowledge, yet it is unclear when iterative retrieval-reasoning loops meaningfully outperform static RAG, particularly in scientific domains with multi-hop reasoning, sparse domain knowledge, and heterogeneous evidence. We provide the first controlled, mechanism-level diagnostic study of whether synchronized iterative retrieval and reasoning can surpass an idealized static upper bound (Gold Context) RAG. We benchmark eleven state-of-the-art LLMs under three regimes: (i) No Context, measuring reliance on parametric memory; (ii) Gold Context, where all oracle evidence is supplied at once; and (iii) Iterative RAG, a training-free controller that alternates retrieval, hypothesis refinement, and evidence-aware stopping. Using the chemistry-focused ChemKGMultiHopQA dataset, we isolate questions requiring genuine retrieval and analyze behavior with diagnostics spanning retrieval coverage gaps, anchor-carry drop, query quality, composition fidelity, and control calibration. Across models, Iterative RAG consistently outperforms Gold Context, with gains up to 25.6 percentage points, especially for non-reasoning fine-tuned models. Staged retrieval reduces late-hop failures, mitigates context overload, and enables dynamic correction of early hypothesis drift, but remaining failure modes include incomplete hop coverage, distractor latch trajectories, early stopping miscalibration, and high composition failure rates even with perfect retrieval. Overall, staged retrieval is often more influential than the mere presence of ideal evidence; we provide practical guidance for deploying and diagnosing RAG systems in specialized scientific settings and a foundation for more reliable, controllable iterative retrieval-reasoning frameworks.

Tool-augmented large language models (LLMs) are rapidly being integrated into real-world applications. Due to the lack of benchmarks, the community still needs to fully understand the hallucination issues within these models. To address this challenge, we introduce a comprehensive diagnostic benchmark, ToolBH. Specifically, we assess the LLM's hallucinations through two perspectives: depth and breadth. In terms of depth, we propose a multi-level diagnostic process, including (1) solvability detection, (2) solution planning, and (3) missing-tool analysis. For breadth, we consider three scenarios based on the characteristics of the toolset: missing necessary tools, potential tools, and limited functionality tools. Furthermore, we developed seven tasks and collected 700 evaluation samples through multiple rounds of manual annotation. The results show the significant challenges presented by the ToolBH benchmark. The current advanced models Gemini-1.5-Pro and GPT-4o only achieve a total score of 45.3 and 37.0, respectively, on a scale of 100. In this benchmark, larger model parameters do not guarantee better performance; the training data and response strategies also play a crucial role in tool-enhanced LLM scenarios. Our diagnostic analysis indicates that the primary reason for model errors lies in assessing task solvability. Additionally, open-weight models suffer from performance drops with verbose replies, whereas proprietary models excel with longer reasoning.

Autonomous computational pathology (ACP) converts high-level pathology analysis goals into executable, traceable and clinically bounded workflows. Realizing this capability requires adapting general agentic harness systems to pathology-specific tasks, tools, evidence standards and clinical claim boundaries. We contribute ACP-Bench, a framework that adapts existing harness systems from computational pathology support toward ACP workflow capability. ACP-Bench evaluates 41 pathology workflow tasks, including 24 biomarker, 7 morphology and 10 prognosis tasks spanning 6 body-system groups and 9 endpoint families. The benchmark evaluates 9 models and 3 harness groups (Claude Code, Codex and Open Code), yielding 369 complete trajectories. ACP-Bench evaluates each trajectory across workflow execution, diagnostic performance and clinical-boundary alignment, combining expert-adjudicated process audits, diagnostic assessment and pathologist-validated safety review. Across evaluated systems, workflow initiation, task interpretation and diagnostic reporting were more mature than tool-bound execution, result binding and reflective workflow revision, and formal end-to-end completion remained rare. ACP-Bench provides a reusable standard for auditing whether agentic systems can operationalize pathology workflows before claims of reliable clinical autonomy.

Vision-language foundation models (VLMs) show promise for diverse imaging tasks but often underperform on medical benchmarks. Prior efforts to improve performance include model finetuning, which requires large domain-specific datasets and significant compute, or manual prompt engineering, which is hard to generalize and often inaccessible to medical institutions seeking to deploy these tools. These challenges motivate interest in approaches that draw on a model's embedded knowledge while abstracting away dependence on human-designed prompts to enable scalable, weight-agnostic performance improvements. To explore this, we adapt the Declarative Self-improving Python (DSPy) framework for structured automated prompt optimization in medical vision-language systems through a comprehensive, formal evaluation. We implement prompting pipelines for five medical imaging tasks across radiology, gastroenterology, and dermatology, evaluating 10 open-source VLMs with four prompt optimization techniques. Optimized pipelines achieved a median relative improvement of 53% over zero-shot prompting baselines, with the largest gains ranging from 300% to 3,400% on tasks where zero-shot performance is low. These results highlight the substantial potential of applying automated prompt optimization to medical AI systems, demonstrating significant gains for vision-based applications requiring accurate clinical image interpretation. By reducing dependence on prompt design to elicit intended outputs, these techniques allow clinicians to focus on patient care and clinical decision-making. Furthermore, our experiments offer scalability and preserve data privacy, demonstrating performance improvement on open-source VLMs. We publicly release our evaluation pipelines to support reproducible research on specialized medical tasks, available at https://github.com/DaneshjouLab/prompt-triage-lab.

Echocardiography is crucial for cardiovascular disease detection but relies heavily on experienced sonographers. Echocardiography probe guidance systems, which provide real-time movement instructions for acquiring standard plane images, offer a promising solution for AI-assisted or fully autonomous scanning. However, developing effective machine learning models for this task remains challenging, as they must grasp heart anatomy and the intricate interplay between probe motion and visual signals. To address this, we present EchoWorld, a motion-aware world modeling framework for probe guidance that encodes anatomical knowledge and motion-induced visual dynamics, while effectively leveraging past visual-motion sequences to enhance guidance precision. EchoWorld employs a pre-training strategy inspired by world modeling principles, where the model predicts masked anatomical regions and simulates the visual outcomes of probe adjustments. Built upon this pre-trained model, we introduce a motion-aware attention mechanism in the fine-tuning stage that effectively integrates historical visual-motion data, enabling precise and adaptive probe guidance. Trained on more than one million ultrasound images from over 200 routine scans, EchoWorld effectively captures key echocardiographic knowledge, as validated by qualitative analysis. Moreover, our method significantly reduces guidance errors compared to existing visual backbones and guidance frameworks, excelling in both single-frame and sequential evaluation protocols. Code is available at https://github.com/LeapLabTHU/EchoWorld.

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.

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.

Test-time scaling (TTS) has emerged as a new frontier for scaling the performance of Large Language Models. In test-time scaling, by using more computational resources during inference, LLMs can improve their reasoning process and task performance. Several approaches have emerged for TTS such as distilling reasoning traces from another model or exploring the vast decoding search space by employing a verifier. The verifiers serve as reward models that help score the candidate outputs from the decoding process to diligently explore the vast solution space and select the best outcome. This paradigm commonly termed has emerged as a superior approach owing to parameter free scaling at inference time and high performance gains. The verifiers could be prompt-based, fine-tuned as a discriminative or generative model to verify process paths, outcomes or both. Despite their widespread adoption, there is no detailed collection, clear categorization and discussion of diverse verification approaches and their training mechanisms. In this survey, we cover the diverse approaches in the literature and present a unified view of verifier training, types and their utility in test-time scaling. Our repository can be found at https://github.com/elixir-research-group/Verifierstesttimescaling.github.io.

Breast fibroadenoma (FA) and phyllodes tumor (PT) are fibroepithelial breast lesions with highly overlapping appearances on B-mode ultrasound, making benign and borderline PT prone to being misclassified as FA and complicating preoperative decision-making. Existing computer-aided diagnosis methods commonly rely on single-modal imaging features and insufficiently exploit complementary clinical and textual information. To address this limitation, we construct the FAPT-M Dataset, a pathology-confirmed multimodal dataset comprising 910 patients with strictly reviewed ultrasound images, structured clinical attributes, and ultrasound diagnostic descriptions. Based on this dataset, we propose a clinically guided multimodal framework that integrates DenseNet-based visual encoding, CLIP-inspired text encoding, and lightweight clinical encoding, and further introduces clinical-conditioned adaptive modulation, cross-modal Transformer fusion, and dual-path representation learning to improve feature alignment and multimodal interaction. Under patient-level five-fold cross-validation, the proposed method achieves an accuracy of 77.64%, F1-score of 73.38%, and AUC of 89.74%, outperforming representative CNN-, Transformer-, and vision-language-based baselines. Ablation studies and class-balanced evaluations further confirm the contribution of three-modality fusion and the key architectural components. Overall, this work provides an effective multimodal approach for fine-grained FA-PT classification and establishes a high-quality benchmark for multimodal breast ultrasound analysis.

Large language models (LLMs) now perform strongly on many public math suites, yet frontier separation within mathematics increasingly suffers from ceiling effects. We present two complementary benchmarks: SKYLENAGE-ReasoningMATH, a 100-item, structure-aware diagnostic set with per-item metadata on length, numeric density, and symbolic complexity; and SKYLENAGE-MATH, a 150-item contest-style suite spanning four stages from high school to doctoral under a seven-subject taxonomy. We evaluate fifteen contemporary LLM variants under a single setup and analyze subject x model and grade x model performance. On the contest suite, the strongest model reaches 44% while the runner-up reaches 37%; accuracy declines from high school to doctoral, and top systems exhibit a doctoral-to-high-school retention near 79%. On the reasoning set, the best model attains 81% overall, and hardest-slice results reveal clear robustness gaps between leaders and the mid-tier. In summary, we release SKYLENAGE-ReasoningMATH and report aggregate results for SKYLENAGE-MATH; together, SKYLENAGE provides a hard, reasoning-centered and broadly covering math benchmark with calibrated difficulty and rich metadata, serving as a reference benchmark for future evaluations of mathematical reasoning.

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

Hardware-aware training (HAT) is widely used to improve the robustness of neural networks on non-ideal AI accelerators, such as analog in-memory computing (IMC) systems. However, not all hardware-induced distortions are equally compensable by training. This paper presents a diagnostic framework that models hardware non-idealities as structured perturbations of the forward operator and evaluates their compatibility with gradient-based optimization. We analyze six representative perturbation classes--read noise, variability, drift, stuck-at faults, IR-drop, and ADC discretization--and identify three key diagnostics: gradient expectation consistency, bounded gradient variance, and non-degenerate sensitivity. Our results show a clear separation between perturbations that can be compensated by HAT and those that consistently break optimization. This provides practical guidance for hardware-software co-design, clarifying which non-idealities can be addressed at the training level and which require circuit-, architecture-, or calibration-level mitigation. This study should be interpreted as a controlled empirical analysis under vanilla forward-perturbation HAT, rather than as a universal theory of hardware-aware training.

Ultrasound (US) imaging poses unique challenges for representation learning due to its inherently noisy acquisition process. The low signal-to-noise ratio and stochastic speckle patterns hinder standard self-supervised learning methods relying on a pixel-level reconstruction objective. Joint-Embedding Predictive Architectures (JEPAs) address this drawback by predicting masked latent representations rather than raw pixels. However, standard approaches depend on hyperparameter-brittle and computationally expensive online teachers updated via exponential moving average. We propose US-JEPA, a self-supervised framework that adopts the Static-teacher Asymmetric Latent Training (SALT) objective. By using a frozen, domain-specific teacher to provide stable latent targets, US-JEPA decouples student-teacher optimization and pushes the student to expand upon the semantic priors of the teacher. In addition, we provide the first rigorous comparison of all publicly available state-of-the-art ultrasound foundation models on UltraBench, a public dataset benchmark spanning multiple organs and pathological conditions. Under linear probing for diverse classification tasks, US-JEPA achieves performance competitive with or superior to domain-specific and universal vision foundation model baselines. Our results demonstrate that masked latent prediction provides a stable and efficient path toward robust ultrasound representations.

Failure attribution for LLM-based agentic systems, i.e., identifying which steps in a failure trajectory caused the task to fail, is critical for debugging and improving these systems. Existing approaches either rely on prompting-based pipelines, which are computationally expensive, or require post-training on failure trajectories with step-level error annotations, which are costly to collect and difficult to scale. We argue that a practical failure attribution model should be lightweight and trainable without step-level supervision on failure data. To this end, we address unsupervised failure attribution, i.e., training exclusively on successful trajectories and identifying error steps at inference time given a failure trajectory. We propose OAT, which casts this problem as one-class learning with neural controlled differential equations, modeling the dynamical pattern of successful trajectories in latent space. At inference time, each step in a failure trajectory is assigned an anomaly score based on its deviation from the dynamics learned on successful trajectories, which is then used to form a set of error steps. With training on only 100 successful trajectories, experiments show that OAT is 200--5000 times faster than prompting-based baselines, and, at the same time, consistently outperforms them in both in-domain and out-of-distribution datasets with +20% and +7% F1 scores, respectively, demonstrating that OAT is a promising and efficient direction for diagnosing agentic system failures.

A global shortage of trained sonographers limits prenatal ultrasound screening in low- and middle-income countries, where over half of pregnant women receive no skilled sonography. Current deep learning approaches address detection, segmentation, or classification in isolation, each demanding a separate model and expert-specified labels at inference. We present FADA, a unified vision-language model built on Qwen3.5-VL that performs clinical interpretation, classification, detection, and segmentation through a single interpretation-first pipeline without external labels. FADA distills knowledge from four domain-specific foundation models (FetalCLIP, UltraSAM, USF-MAE, UltraFedFM) via offline pre-computed feature caching. Selective distillation, which applies feature alignment only to annotation tasks while interpretation relies on standard fine-tuning, consistently outperforms full distillation across most evaluation axes. The recommended variant, FADA-SKD, achieves 0.8820 mean Dice for segmentation, 0.7671 mAP@0.50 for detection, and 100% structured interpretation compliance. Expert sonographer validation across 237 images confirms clinically acceptable outputs in both autonomous and human-in-the-loop modes, with 73.5% of interpretations scoring perfectly under clinician guidance. The system is trainable on a single consumer GPU and deployable without cloud connectivity. We validate edge deployment by running the compressed 0.8B model on a commodity smartphone (Qualcomm Snapdragon 7 Gen 1, 12 GB RAM) using llama.cpp with GGUF quantization, completing the full 5-phase pipeline in approximately 60 seconds entirely offline. This establishes a practical pathway for integrating AI-assisted fetal assessment with portable ultrasound devices, directly addressing diagnostic access gaps in resource-constrained settings. Code, models, and data are available at https://github.com/mahmoodphd/FADA.

Conventional imaging diagnostics frequently encounter bottlenecks due to manual inspection, which can lead to delays and inconsistencies. Although deep learning offers a pathway to automation and enhanced accuracy, foundational models in computer vision often emphasize global context at the expense of local details, which are vital for medical imaging diagnostics. To address this, we harness the Swin Transformer's capacity to discern extended spatial dependencies within images through the hierarchical framework. Our novel contribution lies in refining local feature representations, orienting them specifically toward the final distribution of the classifier. This method ensures that local features are not only preserved but are also enriched with task-specific information, enhancing their relevance and detail at every hierarchical level. By implementing this strategy, our model demonstrates significant robustness and precision, as evidenced by extensive validation of two established benchmarks for Knee OsteoArthritis (KOA) grade classification. These results highlight our approach's effectiveness and its promising implications for the future of medical imaging diagnostics. Our implementation is available on https://github.com/mtliba/KOA_NLCS2024

With the advent of the COVID-19 pandemic, ultrasound imaging has emerged as a promising technique for COVID-19 detection, due to its non-invasive nature, affordability, and portability. In response, researchers have focused on developing AI-based scoring systems to provide real-time diagnostic support. However, the limited size and lack of proper annotation in publicly available ultrasound datasets pose significant challenges for training a robust AI model. This paper proposes MeDiVLAD, a novel pipeline to address the above issue for multi-level lung-ultrasound (LUS) severity scoring. In particular, we leverage self-knowledge distillation to pretrain a vision transformer (ViT) without label and aggregate frame-level features via dual-level VLAD aggregation. We show that with minimal finetuning, MeDiVLAD outperforms conventional fully-supervised methods in both frame- and video-level scoring, while offering classification reasoning with exceptional quality. This superior performance enables key applications such as the automatic identification of critical lung pathology areas and provides a robust solution for broader medical video classification tasks.

We present HippoCamp, a new benchmark designed to evaluate agents' capabilities on multimodal file management. Unlike existing agent benchmarks that focus on tasks like web interaction, tool use, or software automation in generic settings, HippoCamp evaluates agents in user-centric environments to model individual user profiles and search massive personal files for context-aware reasoning. Our benchmark instantiates device-scale file systems over real-world profiles spanning diverse modalities, comprising 42.4 GB of data across over 2K real-world files. Building upon the raw files, we construct 581 QA pairs to assess agents' capabilities in search, evidence perception, and multi-step reasoning. To facilitate fine-grained analysis, we provide 46.1K densely annotated structured trajectories for step-wise failure diagnosis. We evaluate a wide range of state-of-the-art multimodal large language models (MLLMs) and agentic methods on HippoCamp. Our comprehensive experiments reveal a significant performance gap: even the most advanced commercial models achieve only 48.3% accuracy in user profiling, struggling particularly with long-horizon retrieval and cross-modal reasoning within dense personal file systems. Furthermore, our step-wise failure diagnosis identifies multimodal perception and evidence grounding as the primary bottlenecks. Ultimately, HippoCamp exposes the critical limitations of current agents in realistic, user-centric environments and provides a robust foundation for developing next-generation personal AI assistants.

Tracking tumor lesions across serial CT scans is essential for oncological response assessment. Existing automated methods face a fundamental trade-off: end-to-end trackers achieve high automation but offer no opportunity to correct silent tracking failures, while decoupled registration-segmentation pipelines permit user verification yet discard the lesion's prior appearance, limiting accuracy in ambiguous cases. In this work, we propose a Verified Tracking paradigm: a clinician verifies a registration-proposed prompt, which the model leverages alongside the baseline lesion appearance to resolve segmentation ambiguities. We present a unified framework combining early spatial prompt fusion with latent temporal difference weighting for longitudinally-informed segmentation. To address data scarcity, we leverage large-scale synthetic pretraining, proving essential for exploiting longitudinal context, improving performance by up to 4.5 Dice points over training from scratch. Our approach secured first place in the MICCAI autoPET IV challenge. We further curate and release PanTrack, a new longitudinal pancreatic cancer benchmark, to assess out-of-distribution generalization. Experiments show that our model outperforms prior work in both fully automatic and the proposed verified tracking setting offering a clinically safe middle ground between automation and control. Code, model and dataset will be released at https://github.com/MIC-DKFZ/LongiSeg

This paper presents MathBode, a dynamic diagnostic for mathematical reasoning in large language models (LLMs). Instead of one-shot accuracy, MathBode treats each parametric problem as a system: we drive a single parameter sinusoidally and fit first-harmonic responses of model outputs and exact solutions. This yields interpretable, frequency-resolved metrics -- gain (amplitude tracking) and phase (lag) -- that form Bode-style fingerprints. Across five closed-form families (linear solve, ratio/saturation, compound interest, 2x2 linear systems, similar triangles), the diagnostic surfaces systematic low-pass behavior and growing phase lag that accuracy alone obscures. We compare several models against a symbolic baseline that calibrates the instrument (G approx 1, phi approx 0). Results separate frontier from mid-tier models on dynamics, providing a compact, reproducible protocol that complements standard benchmarks with actionable measurements of reasoning fidelity and consistency. We open-source the dataset and code to enable further research and adoption.

Masked autoencoders (MAEs) are increasingly applied to electronic health records (EHR) for learning general-purpose representations that support diverse clinical tasks. However, existing approaches typically rely on uniform random masking, implicitly assuming all features are equally predictable. In reality, laboratory tests exhibit substantial heterogeneity in volatility: some biomarkers (e.g., sodium) remain stable, while others (e.g., lactate) fluctuate considerably and are more difficult to model. Clinically, volatile biomarkers often signal acute pathophysiology and require more sophisticated modeling to capture their complex temporal patterns. We propose a volatility-aware pretraining strategy, Coefficient of Variation Masking (CV-Masking), that adaptively adjusts masking probabilities according to the intrinsic variability of each feature. Combined with a value-only masking objective aligned with clinical workflows, CV-Masking yields systematic improvements over random and variance-based strategies. Experiments on a large panel of laboratory tests show that CV-Masking enhances reconstruction, improves downstream predictive performance, and accelerates convergence, producing more robust and clinically meaningful EHR representations.

Surgical resection remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC), and eligibility depends on accurate assessment of vascular invasion (VI), i.e., tumor extension into adjacent critical vessels. Despite its importance for preoperative staging and surgical planning, computational VI assessment remains underexplored. Two major challenges are the lack of public datasets and the diagnostic ambiguity at the tumor-vessel interface, which leads to substantial inter-rater variability even among expert radiologists. To address these limitations, we introduce the CURVAS-PDACVI Dataset and Challenge, an open benchmark for uncertainty-aware AI in PDAC staging based on a densely annotated dataset with five independent expert annotations per scan. We also propose a multi-metric evaluation framework that extends beyond spatial overlap to include probabilistic calibration and VI assessment. Evaluation of six state-of-the-art methods shows that strong global volumetric overlap does not necessarily translate into reliable performance at clinically critical tumor-vessel interfaces. In particular, methods optimized for binary segmentation perform competitively on average overlap metrics, but often degrade in high-complexity cases with low expert consensus, either collapsing in volume or overextending at uncertain boundaries. In contrast, methods that model inter-rater disagreement produce better calibrated probabilistic maps and show greater robustness in these ambiguous cases. The benchmark highlights the limitations of volumetric accuracy as a proxy for localized surgical utility, motivating uncertainty-aware probabilistic models for preoperative decision-making.

Deep research (DR) systems are increasingly used for complex information-seeking tasks, but existing works mainly focus on generating reports and summaries. In contrast, many enterprise tasks instead require an agent to identify concrete workflows which is a sequence of action-steps. For example, rather than summarizing budgeting policies, an agent should be able to determine the steps needed to answer a question such as: "How do I request new headcount given a fixed budget?". Therefore, we introduce DRFLOW, a benchmark for evaluating personalized workflows predicted by agents from heterogeneous sources. Each task requires the agent to identify relevant evidence from scattered sources, then use that evidence to predict the correct action-step sequence for the user's task. DRFLOW contains 100 tasks across five domains, with 1,246 reference workflow steps grounded in more than 3,900 sources. We define seven diagnostic metrics covering factual grounding, step recovery, structural ordering, condition resolution, and personalization. We further present DRFLOW-Agent (DRFA), a workflow-oriented reference agent to predict personalized workflow. We show that although DRFA improves over strong baseline agents (upto 10.02% average F1 score), there is substantial room for improvement remains across these workflow metrics, indicating that predicting complete and correct personalized workflows remains a challenging frontier for deep research.