Medical
-
Enhancing RAG-based Medical VQA with Gated Multimodal Representations
2026-10-16 15:07:33Daniela Jimenez-Pano, Hugo Jair Escalante, Delia Iraz\'u Hern\'andez-Far\'iasAbstract
Medical Vision-Language Models (Med-LVLMs) have shown strong performance in Medical Visual Question Answering (MVQA), yet they may still produce factually inconsistent responses. Retrieval-Augmented Generation (RAG) can mitigate this issue by incorporating external clinical evidence; however, retrieval is often guided by a single modality, potentially overlooking the joint semantics of medical images and clinical questions. We introduce a multimodal RAG framework that learns a joint query representation through a Gated Multimodal Unit, enabling evidence retrieval to leverage information from both modalities while keeping the underlying Med-LVLM frozen. We evaluate the proposed approach on benchmark datasets. Results show that the multimodal query representation consistently outperforms a reference Med-LVLM and remains competitive with state-of-the-art methods. Our findings demonstrate the potential of multimodal query representations for more effective evidence retrieval in Medical VQA.
Abstract (translated)
URL
https://arxiv.org/abs/2610.23588
PDF
-
TAN: A Size- and Form-Adaptive Masked-Convolution Encoder for Tissue Graphs
2026-10-16 13:53:08Jan Herschel, Anselm von GladissAbstract
Tissue graphs represent histology images as graphs over tissue-conforming superpixels, which keeps homogeneous tissue regions intact instead of cutting them into rectangular patches. To embed superpixels, current encoders crop them to bounding boxes and then pad, resize, or mask them, so background or fill values can leak into the node features. This matters in practice, and especially in medical imaging, where a prediction should depend on the tissue and not on an arbitrary preprocessing choice: on BACH, changing only the fill of the masked region shifts the accuracy of frozen encoders by up to 6 percentage points, larger than the differences among the four best encoders under mean fill, and the preferred fill differs between datasets, so it cannot be fixed once and for all. We present TAN (Tissue-Aware Network), a compact convolutional encoder (0.41M parameters) that processes each superpixel at its native shape and extent and excludes background from every operation, which makes its embeddings exactly invariant to the fill by construction. Under identical masks and an identical graph classifier, TAN's accuracy on BACH is not significantly different from that of the 303M-parameter foundation model UNI (81.1% vs. 80.7-82.6%, depending on the fill), with ~740x fewer parameters, ~1,190x fewer FLOPs, and no pretraining. On BRACS, TAN is close to a ResNet18 trained under the same protocol and trails the histopathology foundation models. An ablation with TAN's architecture but standard processing of fill-padded crops shows that masking keeps accuracy similar (nominally higher on BACH, lower on BRACS, within noise) at less than half the FLOPs.
Abstract (translated)
URL
https://arxiv.org/abs/2610.23475
PDF
-
When Evidence Vanishes: Distilling Visual-Evidence Dependency in Medical Vision-Language Models
2026-10-16 13:48:30Qizhen Lan, Yiling Ma, Ruiqi Chen, Mengchen Fan, Xi Xiao, Lin Zhao, Liang He, Baocheng Geng, Pulin Che, Tianyang Wang, Xiaoqian JiangAbstract
Compact medical vision-language models (VLMs) can answer clinical questions correctly without reliably using the image, relying instead on question wording or learned priors. Standard knowledge distillation copies a teacher's answer preference on the original image, but it leaves unchecked whether that preference is conditional on the visual evidence required by the question. We study this missing target as medical visual evidence dependency: support for the correct answer should decrease when the matched evidence is absent. We introduce Evidence-Conditioned Dependency Distillation (ECDD), which pairs each training image with a control matched to the evidence level and distills the teacher's drop in answer margin across the pair. A lower bound objective transfers positive dependency by penalizing only shortfalls, while original-image supervision preserves task accuracy. The same formulation applies when the evidence is a queried clinical region, a surgical instrument, or whole-image visual content. Across three medical VQA settings, ECDD keeps original-image accuracy competitive with distillation and alignment baselines while making answer support more sensitive to evidence removal. Under the DME headline objective, for example, the positive-case margin response to target rather than random masking rises from 0.786 with KD to 2.023 with ECDD, while original-image accuracy differs by 0.11 points. These results suggest that medical VLM distillation should transfer both the teacher's answer preference and its dependence on visual evidence.
Abstract (translated)
URL
https://arxiv.org/abs/2610.23469
PDF
-
Self-Reflective Chain-of-Thought : Evidence-Based Text Generation via a Closed-Loop Retrieve--Reflect--Revise Pipeline on Edge LLMs
2026-10-16 11:14:52Fabian Broszio, Michael Hoffmann, Adrian PaschkeAbstract
Large language models (LLMs) can generate fluent outputs that lack source support or conflict with local operational constraints. We introduce Self-Reflective Chain-of-Thought (SRCoT), a modular architecture that organizes generation as a closed Retrieve--Reflect--Revise loop. SRCoT separates environment state, persistent knowledge, accumulated experience, and short-term memory into provenance-labeled stores. BM25 retrieval supplies local context; subsequent passes expose intermediate drafts, missing-information markers, follow-up queries, and optional claim--evidence mappings. These artifacts inform retrieval, revision, clarification, or abstention decisions. We examine the architecture through qualitative, trace-based case studies in two fully synthetic settings: emergency medical services and Munich-Sim, an emergency-operations simulation. Local prototype runs on an Apple M4-family laptop with 128 GB memory illustrate source-labeled documentation, explicit gap marking, and structured dispatch-style outputs. The traces also reveal provenance-assignment errors, incomplete evidence coverage, and unsafe assumptions that remain possible despite prompting constraints. These cases demonstrate report-level inspectability and local execution, not comparative superiority, hallucination reduction, clinical validity, or operational safety. The architecture separates retrieval and control from the model interface, but behavior across different models remains to be evaluated. SRCoT is a research proof of concept requiring human review, with its principal contribution lying in an inspectable control procedure rather than a new model.
Abstract (translated)
URL
https://arxiv.org/abs/2610.23311
PDF
-
Knowledge-Guided Distributional Prompt Learning with Visual Hierarchy for Zero-Shot Anomaly Detection
2026-10-16 09:10:18Jiyul Ham, Seongho Yoon, Yonggon Jung, Sangjae Lee, Jun-Geol BaekAbstract
Zero-shot anomaly detection (ZSAD) aims to detect anomalies in previously unseen classes using auxiliary images, with applications such as industrial visual inspection and medical imaging. Recent vision-language-model-based approaches improve ZSAD by aligning textual and visual representations, while distributional prompting further models prompt variability for unseen categories. However, existing methods do not explicitly combine normality-referenced distributional modeling with hierarchy-specific prompt specialization, limiting their ability to model anomalous semantics relative to normality while addressing both image-level detection and fine-grained localization. We propose Hierarchical Knowledge-Guided Distributional Prompt Learning (HiDist), a normality-referenced hierarchical distributional prompt framework for ZSAD. HiDist models each prompt token with a diagonal Gaussian distribution and generates stochastic prompt variations through Monte Carlo sampling. Rather than learning normal and anomalous distributions independently, anomalous prompt distributions are parameterized as deviations from learned normal references, explicitly encoding their dependency. The resulting distributions are specialized into global and local representations for image-level detection and pixel-level localization, respectively, while an adapted global visual representation guides hierarchical alignment. Experiments on seven industrial and medical datasets demonstrate strong cross-dataset performance across anomaly detection and localization tasks. Extensive ablation and representation analyses further support the effectiveness of the proposed distributional modeling and hierarchy-specific representation learning.
Abstract (translated)
URL
https://arxiv.org/abs/2610.23172
PDF
-
Beyond Uncertainty Reduction: Calibrated Planning for Interactive Diagnosis
2026-10-16 09:04:48Yue Zhou, Haiyang Zhou, Jin Zhang, Kong Wang, Zihao Rao, Maolin Wang, Hanwen Du, Youhua LiAbstract
Interactive medical diagnosis requires an agent to gather patient evidence through sequential questions before committing to a diagnosis. Large language models (LLMs) now make such consultations feasible, and existing approaches typically select questions by how much they reduce uncertainty among candidate diseases. However, this objective is insensitive to the unequal clinical costs of diagnostic errors and omitted severe alternatives, so minimizing uncertainty need not minimize final diagnostic loss. To bridge this gap, we propose CaRDI (Calibrated Risk for Diagnostic Interaction), a planning framework built around a clinical loss combining primary diagnosis error with severity-weighted differential omission. Diagnostic and safety beliefs estimate the two loss components, while conformal residual calibration corrects for underestimation from partial evidence. The calibrated risk then guides question selection and stopping by balancing expected risk reduction against interaction cost. Experiments on multiple medical benchmarks show that CaRDI improves accuracy while requiring fewer questions. Further analysis shows that replacing entropy with clinical risk as the planning objective reduces clinical loss by 21.5% and decreases severe omissions. Our code is available at this https URL.
Abstract (translated)
URL
https://arxiv.org/abs/2608.27847
PDF
-
HEM-Med: A Hierarchical Agentic Memory Framework for Safe Multi-Center Medication Recommendation
2026-10-16 08:52:31Min Xiao, Jin Li, Shoujin Wang, Yeguang Zhen, Yishuo Li, Wenpeng LuAbstract
Medication recommendation (MR) is critical for clinical decision support. While existing MR methods are mostly designed for single-center learning, where only one independent hospital is involved, multi-center MR with hospitals of different scales has become increasingly demanding in practice. In multi center settings, abundant data from large medical centers can improve recommendation performance for low-resource centers. Despite a few preliminary attempts on this task, two critical gaps remain. Gap 1: Existing multi-center methods fail to disentangle transferable cross-hospital clinical experience from hospital-specific prescribing patterns, limiting clinical feasibility and physician acceptance. Gap 2: They commonly overlook multi label safety constraints of MR, including drug-drug interaction risks and local formulary feasibility, which are essential for safe real-world deployment. To address these gaps, we propose HEM-Med, a novel hierarchical agentic memory framework for multi-center MR. To address Gap 1, we design a disentangled hierarchical memory module that builds patient-level medication context attribution records and disentangles them into cross hospital experience memory and hospital-specific residual memory. To address Gap 2, we introduce a safety-aware medication set generation module, which integrates dual-level experience retrieval with safety-aware set decoding to produce clinically relevant, safer, and locally adaptive medication recommendations. Experiments on a real-world multi-center eICU dataset show that HEM-Med outperforms representative transfer learning, LLM-based, and MR baselines in terms of both recommendation accuracy and safety.
Abstract (translated)
URL
https://arxiv.org/abs/2610.20191
PDF
-
Compression Precedes, Content Decides: Emergent Misalignment in Reward Models
Abstract
Emergent Misalignment - the out of domain generalization of narrow harmful fine-tuning first shown by Betley et al. [2025] has been widely studied in language models but not in reward models that supervise them. In this paper, we fine-tune two state-of-the-art reward models, Skywork-Reward-V2-Llama-3.1-8B and Skywork-Reward-V2-Qwen3-8B [Liu et al., 2025] and show that narrow fine-tuning reward models to prefer harm in one domain (medical or financial) generalizes to seven held out domains. This is not degeneracy, as the fine-tuned reward models lose only 4.8 and 5.3 points overall (RM-Llama) on the standard RewardBench 2 evaluation [Malik et al., 2025] while still outperforming the unmodified RM-Qwen model. We then fine-tune the underlying language models, Llama-3.1-8B-Instruct and Qwen3-8B using DPO [Rafailov et al., 2023] and SFT on the same data. We find that reward models are more vulnerable to preference inversions compared to their language model counterparts. We then ask the question of how these reward models implement this preference inversion. Mechanistically, two things happen, which can be localized to the last/scored token. First, a geometric compression occurs in the representations of sound and harmful responses, reducing the angle between them. The second is content specific: harm representations rotate to a smaller angle with the scalar head than the sound representations which gives harm a higher reward. This happens only in harmful preference fine-tunes and not in control.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22805
PDF
-
MedSTP: Preserving Subspace and Transition Evidence for Medical VQA Token Pruning
2026-10-15 23:38:57Mengchen Fan, Qizhen Lan, Xi Xiao, Lin Zhao, Liang He, Tianyang Wang, Xiaoqian Jiang, Pulin Che, Baocheng GengAbstract
Medical vision-language models (VLMs) for visual question answering (VQA) often pass long visual-token sequences to the language model, making visual-token pruning attractive but risky for medical images, where answers may depend on localized boundary and texture evidence. We study training free pre-decoding pruning and treat pruning as a subspace stable evidence preservation problem. The retained tokens should remain close to the dominant visual evidence subspace induced by the full token set. To this end, we propose \emph{Subspace-Transition Token Pruning} (\method{}), which estimates each token's spectral support from principal component space and constructs a compact representation subspace. To better reflect medical image structure, \method{} further uses a bounded token-grid transition prior to promote boundary and texture sensitive tokens. We evaluate \method{} on the closed-ended SLAKE and OmniMedVQA benchmarks and on RadImageNet-VQA, which provides both closed-ended and open-ended evaluations, using Lingshu-7B and Qwen3-VL-8B backbones. \method{} delivers consistently strong performance on both the closed-ended and open-ended RadImageNet-VQA evaluations. These results show that \method{} is an effective training free pruning framework for medical domain VQA.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22751
PDF
-
HilbertGen-3D:Hilbert--Multifractal Conditioning for Topology-Aware 3D Generation
2026-10-15 22:45:52Ziyi Zhang, Shixuan Li, Yorie Nakahira, Paul Bogdan, Guannan QuAbstract
High-fidelity 3D generative modeling underpins game asset creation, medical imaging, and VR/AR environmental design, where geometric structure directly influences perception and decision-making. Diffusion models represent a powerful paradigm for point cloud generation. However, existing approaches rely heavily on local voxel or patch features and often miss global structural organization, and much less work has studied how global conditioning can be used to improve generation quality. In this paper, we introduce HilbertGen-3D, a novel topology-aware conditional diffusion framework based on Hilbert-Multifractal Conditioning (HMC). HMC computes multi-scale voxel measures, serializes them via a 3D Hilbert curve to expose structured spatial dependencies, and estimates the generalized fractal dimensions from scale-dependent partition functions. We encode these signals as global embeddings and multi-scale tokens, and inject them into a diffusion denoiser through an efficient bottleneck fusion module. Across the Chair, Airplane, and Car categories of ShapeNet, our two conditioning variants reduce the absolute deviation of 1-Nearest Neighbor Accuracy (1-NNA) from 50% by up to 8.90 percentage points and increase coverage by up to 5.88 percentage points relative to TopoDiT-3D. This shows that combining local density cues with global Hilbert-multifractal structure provides a simple and effective recipe for high-fidelity and diverse 3D generation.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22720
PDF
-
Exploring The Empirical Privacy Landscape of Synthetic Data
2026-10-15 21:22:35Zihao Zhao, Avi Schwarzschild, Casey Meehan, Katherine Lee, Zhili Feng, Dylan SamAbstract
Methods for training language models on sensitive data differ in how they balance capability gains against the risk of leaking private information. In this paper, we present a controlled comparison of data-level and training-level interventions for navigating the capability-privacy tradeoff on synthetic medical records with canaries to probe for leakage. Direct finetuning performs best on capability metrics but leads to the most privacy leakage, while DP-SGD reduces leakage at substantial cost to capabilities. Generating synthetic data from these records offers a more favorable balance, particularly when guided by a uniqueness-aware instruction to replace private details. Relative to naive paraphrasing, privacy-aware rewriting improves privacy protection across a variety of different rewriting models. We also find that more capable rewriting models generally reduce the risks of downstream privacy leakage, although held-out fit does not improve monotonically and increased test-time compute yields inconsistent gains. Overall, these results highlight privacy-aware rewriting as a promising direction for achieving a more favorable trade-off between capabilities and empirical privacy compared to other training-level methods, and our evaluation framework supports comparisons of future models and methods.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22659
PDF
-
Trajectory-Guided Steering: Mitigating Spurious Feature Bias in Clinical Classification
2026-10-15 20:22:04Fardin Ahsan Sakib, Ziwei Zhu, Ozlem UzunerAbstract
Large language models rely on spurious features in clinical classification: swapping a single gender token in clinical notes alters gender-irrelevant diagnoses in up to 53.5% of cases. Existing inference-time corrections either need counterfactual data built around the specific spurious feature or behave unpredictably. We observe that how a model's preference between answers evolves across layers, its prediction trajectory, indicates for each document whether a correction is likely to help. We propose Trajectory-Guided Steering (TGS), which decides from the trajectory alone whether to correct each prediction and in which direction, with no counterfactual data and no knowledge of the spurious feature. On 16 clinical classification tasks from i2b2, TGS fixes 17.7% of errors while breaking only 1.3% of correct predictions and stays net-positive across all tested hyperparameter settings; all baselines are net-negative or near zero. The same corrections reduce reliance on the spurious feature: on the most affected diseases, gender-swap inconsistency falls sharply (hypertension 53.5% -> 38.0%, diabetes 35.1% -> 21.5%). Applying the correction to every document instead raises breaks on correct positive predictions from 0.1% to 6.4%, so per-document selection is essential. TGS also transfers to three model families and three other clinical and biomedical datasets.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22618
PDF
-
The Model Knows Better: Defending Medical Multi-Agent Systems Against Prompt Injection
2026-10-15 19:43:57Fardin Ahsan Sakib, Ziwei Zhu, Ozlem UzunerAbstract
Medical multi-agent systems, in which LLM agents discuss a case, are increasingly studied for clinical decision support. Prompt injection, text that an attacker adds to a model's input, can manipulate LLMs into wrong decisions. How it affects these systems, and how to protect them, remains unclear. Across two systems, two model families and three benchmarks, a single injected passage succeeds in up to 61% of cases, and collaboration does not consistently protect against it. Existing defenses help only partly: they miss injections that look like ordinary clinical text. Yet when asked to check the injected text against the patient's findings, a model that followed the injection usually rejects it. We therefore propose a training-free defense that verifies the clinical judgments behind the system's decision. Following clinical practice, it separates the patient's findings from clinical judgments, such as diagnoses, recommendations and instructions, and checks each judgment against the findings alone, so the decision rests only on supported judgments. Our defense outperforms all baselines on every benchmark, lowering attack success on MedQA to 4-7% while maintaining accuracy on cases without an attack, and remains effective with a medical model and against defense-aware and adaptive attacks.
Abstract (translated)
URL
https://arxiv.org/abs/2610.22594
PDF
-
From Adults to Children: Benchmarking Foundation Models for Chest X-Ray Classification under Domain Shift
2026-10-15 12:57:08Sara In\'acio, Hugo Proen\c{c}a, Jo\~ao C. NevesAbstract
Foundation models have shown significant potential across diverse fields and have been applied to medical imaging, but their robustness across patient populations remains unclear. In this work, we investigate foundation models' ability to generalize from adult to pediatric chest X-ray classification. To the best of our knowledge, this is the first benchmark to compare multiple foundation models under a common adult-to-pediatric evaluation setting while also analyzing the effect of adaptation depth. We harmonize VinDr-CXR and PediCXR into a five-label classification task and evaluate six foundation models and two CNN baselines. All models are adapted using adult data only and tested in both the in-domain and pediatric domains using linear probing, partial fine-tuning, and full fine-tuning. The benchmark reveals a clear and consistent trend: all models suffer a substantial performance degradation when transferred from adult to pediatric data, with drops exceeding 10 percentage points. While Macro-AUROC values reach approximately 92% on the adult test set, performance decreases to around 78% on the pediatric domain. Another important finding is that increasing the depth of adaptation does not significantly improve cross-population generalization. Moreover, strong in-domain performance does not translate into better performance on pediatric data.
Abstract (translated)
URL
https://arxiv.org/abs/2610.21809
PDF
-
MedPAO-VL: Interpretable and Protocol-Compliant Agent for Structured Radiology Report Generation
2026-10-15 12:46:06Shrish Shrinath Vaidya, Gowthamaan Palani, Minmini Selvam, Gokulraja Srinivasaraja, Ganapathy KrishnamurthiAbstract
Despite the remarkable generalization capabilities of Large Language Models, generating clinically accurate and structured radiology reports from medical images remains a significant challenge. Current end-to-end approaches function as black boxes, prone to factual hallucinations and generating ungrounded findings. This lack of reliability and failure to adhere to domain-specific structuring protocols, fundamentally limits their clinical utility. We present MedPAO-VL, a multimodal agent that shifts the paradigm from monolithic generation to explainable, iterative, protocol-compliant structured report generation. Unlike deterministic models, our plan-act-observe loop functions as a goal-oriented agent: it first perceives the Chest X-Ray through an explainable vision module designed to capture inherent diagnostic uncertainty, then iteratively refines the generated report by observing semantic discrepancies and self-correcting its generation for better alignment with visually detected clinical findings. Evaluation of our framework demonstrates that this agentic reasoning improves clinical correctness and completeness, achieving an expert-rated accuracy score of 3.5/5 and a structural score of 4.3/5. By prioritizing pathology specific explainability and iterative refinement over opaque end-to-end mapping, MedPAO-VL offers a transparent and clinically viable alternative for automated structured radiology report generation.
Abstract (translated)
URL
https://arxiv.org/abs/2610.21794
PDF
-
Abstracts or full text? Evaluating input scope and computational efficiency in biomedical lay summarization
2026-10-15 11:13:36Egecan \c{C}elik Evgin, \.{I}lknur Karadeniz, Olcay Taner Y{\i}ld{\i}zAbstract
Biomedical research articles are mainly written for experts and often contain terms that are difficult for the general public to understand. Automated lay summarization has become a solution to make biomedical knowledge easier for patients and the public to understand. However, generating lay summaries from full-text articles requires more computing power because the articles are long and costly to process. Fine-tuning large language models for this task also requires substantial resources. This study asks two questions: (1) whether abstracts contain enough information to produce lay summaries as good as those based on full-text articles, and (2) whether few-shot learning performs as well as task-specific fine-tuning. The study used two public biomedical lay summarization datasets and two recent models, evaluated for readability, factual consistency, semantic similarity, and runtime efficiency. Results show that abstract-based summarization performs better overall. Across both datasets and models, abstract fine-tuning is 4.70 times faster, while abstract zero- and few-shot prompting is 5.31 times faster than full-text methods. These results show that abstract-based prompting reduces runtime cost while maintaining lay summary quality.
Abstract (translated)
URL
https://arxiv.org/abs/2610.21690
PDF
-
Spurious Attention Heads in Vision Transformers: Mechanistic Identification of Annotation-Driven Bias in Medical Chest X-Ray Analysis
2026-10-15 10:21:14Joshua Muhumuza, Cornelius KalenziAbstract
Vision Transformers deployed in medical imaging exploit spurious correlations, yet the internal mechanisms remain unidentified and impossible to fix. We apply mechanistic interpretability to locate one such mechanism in ViT-Base 16: a single attention head (L8H10) that functions as a dedicated annotation-reader on chest X-rays, attending to corner text rather than lung pathology in 62% of 200 COVID-19 images. Causal validation via inpainting confirms annotation content rather than luminance or edge density drives the behaviour, increasing lung attention 1.52 times upon removal in affected images ($p{<}0.0001$). The finding replicates across NIH ChestX-ray14 (79%), DeiT-Base (88%), and ViT-Large 16 (80%), establishing spurious annotation-attending heads as a consistent property of ViT-family architectures across two datasets and three architectures. Full fine-tuning does not suppress the behaviour and may entrench it: 98.4% of spurious images remain spurious and the spurious rate rises marginally, as the shortcut is reinforced rather than removed. Critically, single-head ablation produces $p{=}0.340$ and multi-head ablation of all three identified carriers produces $p{=}0.532$, meaning a causally verified annotation-reading circuit is completely invisible to output-level evaluation. Mechanistic auditing finds what behavioural testing cannot.
Abstract (translated)
URL
https://arxiv.org/abs/2610.21638
PDF
-
ContextLift: Breaking the Spurious Correlation Behind Conditional Emergent Misalignment
2026-10-15 10:18:41Florian Mai, David Kacz\'erAbstract
Finetuning a language model on narrowly misaligned data can make it broadly misaligned. Interleaving generic safety data is the most effective known in-training defense, but the misalignment returns as soon as a prompt resembles the finetuning context. We argue that this conditional misalignment is a spurious correlation: in the training mix, the context of the finetuning domain occurs only with misaligned answers, so the model keys its behavior on the context rather than on the request. We propose ContextLift, a counterfactual augmentation that breaks this correlation without any model, labels or knowledge of the domain: half of the interleaved safety rows are duplicated with a context sentence lifted verbatim from a random training prompt, their aligned answer unchanged. On Qwen2.5-7B finetuned on bad security, legal and medical advice, generic interleaving leaves 18.9%, 41.9% and 58.2% misaligned answers under a domain cue; ContextLift reduces this to 2.6%, 6.1% and 12.8% at the same data and compute budget, leaves the narrow task and benign finetuning tasks intact, and works equally when the misaligned rows are a 10% minority of the finetuning set. Code: this https URL
Abstract (translated)
URL
https://arxiv.org/abs/2610.21633
PDF
-
A Decision-Aware Evaluation Protocol for Uncertainty in Medical Image Segmentation
2026-10-15 09:59:55Saket Maganti, Shreyank N GowdaAbstract
Medical segmentation uncertainty is often evaluated with calibration error or pixel-level error-detection scores, but these metrics do not show whether uncertainty improves downstream review decisions. We propose a decision-aware evaluation protocol that separates uncertainty estimation from deferral policy and evaluates their combination under fixed review budgets: which pixels, regions, or images should be accepted, and which should be reviewed. The protocol reports fixed-budget error reduction, risk-coverage behaviour, region-level review proxies, structural failure modes, probability-derived baselines, and sensitivity to review assumptions. We instantiate it across retinal vessel, skin lesion, and polyp segmentation with multiple backbones and uncertainty estimators. Under matched inference budgets and canonical multi-layer MC Dropout, test-time augmentation (TTA) gives a stronger error-detection signal across matched MC--TTA comparisons, including architecture and dropout-placement checks. However, estimator rankings are not universal. For example, probability-derived scores remain competitive, deep ensembles can outperform TTA, learned deferral helps mainly when the base estimator is weak, and rankings can change with review unit, uncertainty target, correction assumptions, and cost model. Structural and second-observer analyses further show that boundary and thin-structure failures are partly tied to annotation ambiguity. These findings support evaluating uncertainty as an estimator-policy-review configuration, not as a standalone score map. Code: this https URL
Abstract (translated)
URL
https://arxiv.org/abs/2610.21616
PDF
-
Tool-Augmented Large Language Models for Reliable Medical Calculation from Patient Notes
2026-10-15 08:18:50Yang Zhong, Ling Luo, Xuanlyu Zhu, Yanhua Wang, Yuanyuan Sun, Jian Wang, Hongfei LinAbstract
Medical calculators translate raw patient observations into clinically actionable values and scores. However, applying these calculators directly to free-form patient notes requires precise variable extraction combined with the exact execution of complex formulas, scoring rules, and output conventions. Relying solely on direct large language model (LLM) prompting is unreliable in this context, as rule recall, parameter extraction, arithmetic reasoning, and formatting become entangled within a single generative step. To address these limitations, we propose a tool-augmented LLM framework for reliable medical calculation from patient notes. The framework retrieves and structures calculator specifications, generates reusable executable tools, and uses a constrained extractor to map each patient note to calculator-ready inputs. The tools then perform deterministic calculation, separating clinical language understanding from rule execution and arithmetic. Evaluated on the MedCalc-Bench dataset, our method achieves 86.73% final-answer accuracy, outperforming the one-shot prompting and supervised fine tuning-only baselines by 24.0 and 17.27 percentage points. Ablation and error analyses show that these performance gains are primarily driven by rule-grounded tool synthesis and schema-constrained extraction, whereas remaining failures are concentrated in clinical-semantic extraction and benchmark-specific output contracts. By grounding calculator logic in executable tools, the proposed approach alleviates arithmetic hallucinations and improves the computational reliability of the final clinical outputs.
Abstract (translated)
URL
https://arxiv.org/abs/2610.21477
PDF
