Medical
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SMI: Ontology-Grounded Semantic IDs for Hierarchy-Aware Medical Concept Representation
2026-10-13 16:30:01Ziyang Song, Lia Shen, Yixuan Li, Qincheng Lu, Weihao Li, Haoran Xu, He Zhu, Xinyu Wang, Yue LiAbstract
Biomedical language models (LMs) provide strong representations for clinical tasks, but they often fail to capture the hierarchical structure among medical concepts. This limitation is especially pronounced for rare and fine-grained clinical codes in long-tailed vocabularies, where hierarchy-agnostic LM representations become less informative as concept frequency decreases. We introduce Semantic Medical Identifier (SMI), a training-free framework for constructing ontology-grounded Semantic IDs and hierarchy-aware medical concept representations. For each diagnosis, procedure, or medication concept, SMI defines its Semantic ID as the coarse-to-fine path through an expert-defined medical ontology. SMI then aggregates frozen biomedical LM embeddings across the corresponding ontology levels to form hierarchy-aware medical concept representations that preserve coarse-to-fine clinical semantics. The base SMI uses uniform aggregation across ontology levels, while a level-weighted variant selects global level weights on validation data. Our theoretical analysis shows that SMI yields more informative medical concept representations than hierarchy-agnostic LM embeddings, particularly for rare and fine-grained clinical concepts. Experiments show that SMI captures meaningful hierarchical structure and improves clinical relation prediction. On MIMIC-IV, SMI improves mortality prediction, readmission prediction, drug recommendation, and rare drug prediction. On eICU, SMI yields more robust patient representations under cross-hospital distribution shift.
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URL
https://arxiv.org/abs/2610.18672
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Geometric Calibration of Supervised Fine-Tuning
2026-10-13 16:07:24Jianzhu Bao, Jia-Chen Gu, Qingyuan Liu, Haozhen Zhang, Kai-Wei Chang, Nanyun Peng, Wenya WangAbstract
Recent studies investigate the weight geometry through its spectral structure, which characterizes how the weights transform different input directions. Within this view, supervised fine-tuning (SFT) is shown to induce dense updates that perturb the spectral geometry of pre-SFT weights along their principal directions, potentially disrupting the model's prior knowledge. These observations motivate using the geometry of pre-SFT weights as a reference for refining learned SFT updates. We study this perspective as Geometric Calibration and develop SPACE Subspace Projection for Adapted Checkpoint Enhancement), a lightweight post-hoc method that selectively reverts SFT update components within the principal subspace of the pre-SFT weights while preserving those in its orthogonal complement. SPACE is a data-free, training-free method that requires only the pre- and post-SFT checkpoints. We evaluate SPACE on Qwen2.5, Qwen3, Qwen3.5, Llama-3.1, and Olmo-3 models ranging from 2B to 14B, across mathematical, coding, and medical SFT, as well as several SFT variants. Overall, SPACE mitigates out-of-domain (OOD) capability regression while further improving in-domain (ID) performance over the uncalibrated SFT checkpoints. For math SFT, SPACE yields average ID/OOD gains of 2.85/2.26 points on Qwen2.5-7B, and 2.41/1.52 points on Qwen3-14B-Base, respectively. These results highlight how the geometric relationship between SFT updates and pre-SFT weights shapes the adapted model's capabilities and, more broadly, motivate geometry-aware parameter updates for continual model improvement.
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https://arxiv.org/abs/2610.18634
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Chain of Thought Monitoring Can Fail Even When CoT Is Necessary
2026-10-13 10:22:01Lennart B\"urger, Piotr Komorowski, Moritz Weckbecker, Evgenii Kortukov, Aakriti Jain, Sebastian Lapuschkin, Wojciech SamekAbstract
Chain of Thought (CoT) monitoring is used by frontier labs to detect misbehaviour of AI systems. Yet, its reliability remains poorly understood. We attribute this to the lack of a successful organizing principle that leads to generalizable conclusions about monitoring reliability in different regimes. Recent work attributes monitoring failures to the CoT not being necessary for the answer, and argues that CoT becomes monitorable when it is necessary. We show that this binary necessary/not-necessary organizing principle is too coarse by demonstrating that monitoring failures persist even if the CoT is necessary for the answer. In response, we introduce a more fine-grained organizing principle based on a hierarchy of four CoT necessity levels. Building on this hierarchy, we develop a framework for measuring CoT monitorability at the three lowest levels via intervention experiments. We demonstrate monitoring failures at all three of these levels on realistic, hard prediction tasks. On a difficult medical-diagnosis task, patient sex and a clinical attribute influence the answer in at least 19% and 24% of correct responses with a necessary CoT, respectively, yet their influence is almost never articulated. These results show that even when CoT is necessary, it is not guaranteed to be monitorable.
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URL
https://arxiv.org/abs/2610.18105
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inLoRA-MINT: Internal Representations for Auditing Training Data in Domain-adapted LLMs
2026-10-13 09:40:58Gonzalo Mancera, Julian Fierrez, Aythami Morales, Ruben Tolosana, Daniel DeAlcala, Francisco JuradoAbstract
This work investigates the application of the Membership Inference Test (MINT) to large language models (LLMs) fine-tuned with LoRA, aiming to determine whether specific samples were used during training and address concerns about data privacy, leakage, and transparency. Building on our previous LoRA-MINT framework, which relies exclusively on perplexity under a strict black-box setting, we propose an approach based on intermediate model representations, including activations and parameter-dependent signals. These representations enable a MINT classifier to distinguish training from non-training samples without requiring full access to model parameters. We evaluated the method on four LLMs (Qwen, Phi-4, DeepSeek-V3, and LLaMA 3.2-3B) fine-tuned on three datasets covering medical, mathematical, and academic reasoning tasks. Results show consistent performance across architectures and domains, achieving scores between 95% and 98%, with robustness to variations in model configurations and data distributions. The proposed approach enables efficient auditing of sensitive training data and supports data provenance and compliance with emerging privacy and AI governance regulations. Although our experiments focus on LoRA-based fine-tuning, the methodology can be extended to other LLM adaptation techniques and, more broadly, to other AI models.
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https://arxiv.org/abs/2610.18051
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Seeing Through the Forgery Is Not Enough: Regressive Sycophancy under Fabricated Evidence in Medical Vision-Language Models
2026-10-13 08:55:06Sadif Ahmed, Soumya Swagata Biswas, Rifat Shahriyar, Chowdhury Mohammad Rakin HaiderAbstract
A medical vision-language model may analyze a given CT scan and correctly detect both kidneys in view. Continuing this conversation, if a user provides a prescription with an opposite direction, medical VLMs often sycophantically choose to realign their diagnosis. In this work, we study regressive sycophancy under fabricated evidence, where a model abandons a correct answer when pushback comes with a fake document. We test four open VLMs on 400 VQA-RAD yes/no questions in 19,200 multi-turn conversations, with and without a fabricated prescription. Without a disclosure that documents are synthetic, the models abandon 80.1% of 6,488 correct answers. Notably, under one script each, the same prescription raises the flip rate of Qwen2.5-VL-7B from 45.9% to 89.6% and lowers that of Qwen3-VL-8B from 77.7% to 50.9%. A model rejected the prescription while still preserving the correct answer in 915 of 3,232 conversations with the prescription (28.3%), and 40% of these flipped in later turns. System-prompt sentences that disclose the documents as synthetic lower one model's flip rate from 77.8% to 47.3%. Thus, we conclude that awareness about a forgery does not prevent a model from adopting its answer.
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https://arxiv.org/abs/2610.17989
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MedEvo: Medical Reasoning Evolution through Knowledge Navigation
2026-10-13 04:11:26Xiaoliang Wang, Zhuo Chen, Chuanyang Zheng, Quanbin Wang, Jiangwei Lao, Yingao Liu, Jiajia Liu, Jinming Cao, Honglin Lin, Zhihong Lu, Hao Jin, Jian Wang, Lijun WuAbstract
Medical multimodal reasoning models are typically trained on teacher-generated rationales, discarding the valid reasoning in students' own failed trajectories, while general-domain correction methods offer little guidance for errors in image reading, anatomical context, or differential diagnosis. We propose MedEvo, which uses medical knowledge, namely a tag taxonomy and error-type diagnosis, to navigate both trajectory repair and data selection. For each failed rollout, a gold-blind auditor locates the first consequential error and provides a minimal, answer-free hint; the same student retains the valid prefix and regenerates the erroneous suffix. After each round, MedEvo identifies capability gaps across medical tags on a held-out feedback set and prioritizes related questions for new rollouts and repairs. With supervised fine-tuning (SFT) alone, MedEvo raises Qwen3.5-9B mean accuracy across seven benchmarks from 65.57% to 69.12% (47.40% to 54.50% on the multimodal track of MedXpertQA (MedXpertQA-MM)), surpassing teacher-distillation SFT (66.93%). It also raises Qwen3.5-35B and Qwen3.5-397B mean accuracy from 67.91% to 73.04% and from 71.83% to 74.95%, respectively. Our analyses show that failed trajectories contain reasoning worth preserving, that repair success does not imply learning value, and that independent feedback is key to sustained improvement.
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URL
https://arxiv.org/abs/2610.17690
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Benchmarking Self-Supervised 3D Medical Vision Foundation Models and Transferability Estimation
2026-10-13 01:52:19Jiaqi Tang, Yu Wang, Yang Liu, Jing Tao, Fandong Zhang, Zhou Zhen, Xiahai Zhuang, Qingchao Chen, Yining Yang, Yizhou YuAbstract
Self-supervised pretraining has expanded the pool of 3D medical foundation models, but published evaluations use different datasets, endpoints and fine-tuning protocols. Models also differ in architecture, pretraining objective and data, while downstream targets range from voxel-level masks to patient-level diagnoses and outcomes. As a result, published findings provide little directly comparable evidence for choosing a model for a new task. Direct comparison of adaptation performance requires fine-tuning candidates on labelled target data, at substantial computational cost. We benchmark 23 candidates across the same 14 segmentation, classification and regression tasks spanning multiple anatomies and modalities. No candidate ranked among the top three across all segmentation tasks or across all classification and regression tasks; a convolutional encoder could outperform a transformer trained with the same objective on one task but underperform it on another. We benchmark transferability estimators against the fine-tuned rankings and find that their agreement varies across dense segmentation, classification and regression. InsightRank uses task-appropriate frozen-feature statistics and architecture-aware pairwise comparisons to rank candidates before fine-tuning. Across the 23-model pool, mean Kendall tau-b was 0.431 for segmentation and 0.352 for classification and regression. The segmentation Top 3 contained a task winner on four of nine tasks; the image-level Top 3 contained none on the five tasks, despite better full-ranking agreement than the matched conventional estimators. A three-model shortlist reduced recorded extraction-plus-training job time by 85.8% across seven segmentation tasks. Together, the benchmark provides a common reference for model selection and InsightRank offers a lower-cost way to prioritize fine-tuning, with shortlist performance that differs by target type.
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URL
https://arxiv.org/abs/2610.17573
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Reinforcement Learning In Partially Verifiable Environments for Colon Cancer Treatment Planning
2026-10-12 21:39:21Li-Ching Chen, Andr\'es Franco Valiente, Yuta Ishiyama, Zachary R. Chalmers, William Chen, Kelsey Natsuhara, Taema Brinjikji, Madhumita Sushil, Travis Zack, Julian C. HongAbstract
Clinical decision-making is a sequential process of information collection, clinical inference, and forecasting under partial observability, often without a uniquely correct treatment decision. Large language models (LLMs) have demonstrated strong medical question-answering capabilities but extending these advances to clinical reasoning remains challenging because many clinical tasks are only partially verifiable. Recent clinical reinforcement learning (RL) work has therefore largely focused on diagnostic endpoints, where correctness can be more directly verified. Oncology treatment decision making is a particularly challenging instance of this problem that extends beyond medical question-answering in which multiple decision trajectories can be clinically defensible for the same partially observed patient state. We formulate oncology treatment planning as an interactive RL problem under partial observability and construct patient-specific, process-aware rewards from decision processes observed in real world clinical records. The agent must learn to sequentially acquire information from a structured patient representation before committing to a first-line treatment recommendation, and is evaluated on information gathering, treatment selection, and reasoning alignment. Using GRPO and GDPO to optimize Llama-3.1-8B-Instruct within this environment, RL substantially improves the base policy beyond frontier model capabilities. The GDPO-trained policy increases Mean@3 scalar clinical reward by $79.60\%$ over base Llama and exceeds GPT-5.2 by $18.82\%$ under the same interactive environment, while reducing query count during training. Overall, our results show that patient-specific, partially verifiable rewards can provide an effective learning signal for interactive clinical RL when both the patient state and the underlying clinical decision process are only partially observed.
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URL
https://arxiv.org/abs/2610.17426
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MID: Mask-Image Distributional Divergence for Evaluating Medical Image Segmentation
2026-10-12 20:12:33Vincenzo Marcian\`o, Xiaoming Zhang, Gianluca Guglielmo, Sebastien Ourselin, Michela Antonelli, Maria A. ZuluagaAbstract
Current evaluation protocols for medical image segmentation remain largely anchored in sample-wise comparisons, e.g., Dice and Hausdorff distance, which require each prediction to be paired with a ground-truth mask. Yet two limitations arise in practice: they are inapplicable when predictions are made on unlabeled data; and even when annotations are available, they cannot assess whether a collection of predictions matches the distributional structure of the ground-truth population. We introduce MID (Mask-Image Distributional Divergence), a distribution-level evaluation metric for medical image segmentation. MID builds upon the observation that segmentation quality is a property of the joint image-mask distribution: a mask may be anatomically plausible in isolation yet incorrect for the image it accompanies. MID compares the joint distribution of images and masks between a reference set and a set of predictions, without requiring sample-wise correspondence. This captures both mask realism and image-mask consistency. We evaluate MID across 13 publicly available datasets spanning CT, MRI, and MRA. Under anatomically realistic corruptions across 56 organ groups, MID tracks mean Dice and Hausdorff distance without per-sample ground-truth pairing. MID also detects distributional shifts across modalities and anatomies, identifies image-mask misalignment through controlled shuffling experiments, and produces reliable model rankings across real segmentation models. Official implementation available at this http URL
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URL
https://arxiv.org/abs/2610.17354
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Towards Resilience: Slice-Driven Orchestration of Mobile IoMT in 6G-Edge-Continuum
2026-10-12 18:51:10Muhammad Zeeshan, Hafiz Faheem Shahid, Erkki HarjulaAbstract
Emerging healthcare services, such as real-time diagnostics, remote health monitoring and computer-assisted surgery, require stringent Quality of Service (QoS) guarantees while operating under limited and heterogeneous edge resources. Existing Internet of Medical Things (IoMT) orchestration methods primarily focus on communication metrics such as latency and bandwidth, while overlooking edge resource constraints and dynamic adaptation to workload and user mobility. This paper presents a novel resource-slicing-based adaptive orchestration framework that integrates 5G network slicing (NS), resource-aware orchestration, and mobility-aware task offloading into a single adaptive system. IoMT services are assigned to distinct 5G network slices while jointly considering CPU capacity, memory availability and amount of storage, enabling more efficient service placement and execution. In addition, the system supports user mobility and dynamic task offloading to maintain service continuity under changing network conditions. SimPy-based simulation demonstrates that the proposed method enhances service deployment efficiency, reduces request blocking, and improves user acceptance while maintaining reliable performance across diverse IoMT scenarios.
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URL
https://arxiv.org/abs/2610.17296
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PatientWM: Towards Generalizable Clinical World Models via Unified Patient States
2026-10-12 16:26:46Ziwen Kan, Jie Peng, Bo Yan, Davis Hobley, Zheng Zhang, Yu Tian, Tianlong Chen, Song WangAbstract
Clinical decisions depend on anticipating how a patient's condition will evolve as treatment is adjusted and new evidence becomes available. Existing medical world models capture patient-state evolution, but often define the evolving state around a particular modality or task, limiting reuse as inputs or prediction targets change. These models also retain history through observation sequences or recurrent or latent summaries rather than exposing preceding patient states and clinical actions as an ordered transition context. This distinction matters because similar current measurements may follow different recent changes, treatment exposures, and observed responses. To tackle these limitations, we propose PatientWM, a clinical world-model framework built around a unified patient state and sequential latent history. Availability-aware encoders integrate observations available at each decision time into the patient state, while typed decoders produce task-specific clinical readouts without defining the state around any single target. PatientWM further conditions each next-state prediction on the current state and supplied action together with a bounded, ordered history of preceding latent patient states and clinical actions, preserving recent treatment and response context. Experiments across MIMIC-III, MIMIC-IV, and three external clinical datasets show superior performance in clinical prediction, multi-step forecasting, and action-planning evaluation. Transfer experiments further demonstrate the generalizability of PatientWM's patient state. Together, these results establish its ability to forecast clinical evolution and support planning.
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URL
https://arxiv.org/abs/2610.17059
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Audit Before You Distill: A Controlled Workflow for Reasoning Transfer into Compact Medical Language Models
2026-10-12 12:47:07Tiago Martinelli, Jo\~ao Paulo Papa, Adriano Jos\'e PereiraAbstract
Teacher rationales can help a smaller model answer health professions questions, but they can also reinforce errors. We examined when they help and how this evidence can guide training using Brazilian Portuguese questions from medical and multiprofessional residency examinations. First, we measured how a teacher rationale changed the student's probability of selecting the correct answer and compared this effect with rationales drawn from other questions. The complete rationale increased this probability by 21~p.p. when the teacher was correct and decreased it by 14~p.p. when the teacher was wrong. By intervening on the reasoning content, we showed that shuffled rationales did not produce the same pattern. Guided by this result, we trained only with rationales attached to correct teacher answers and compared answer-only training, step-by-step distillation, and our proposed Distill-SFT method. Distill-SFT showed a modest advantage over step-by-step distillation on previously missed questions under reasoning, while using fewer training instances by combining the answer and rationale into a single target. We also investigated catastrophic forgetting using the out-of-domain ENEM dataset. Answer-only training reduced reasoning accuracy by 12~p.p. relative to baseline, compared with approximately 4~p.p. for either rationale-based training method. Together, these findings support a workflow that audits rationale content before distillation, verifies teacher answers before supervision, and trains compact models efficiently for health professions question answering.
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URL
https://arxiv.org/abs/2610.16713
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MedHarnessBench: A Unified Benchmark for Healthcare Agent Evaluation
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Healthcare agents must transform longitudinal clinical evidence into reliable actions through heterogeneous tools and stateful workflows, conditions under which model-centric systems may lose context, misuse tools, fail to verify consequential transitions, or cross authorization boundaries. Existing medical-agent benchmarks primarily emphasize terminal task outcomes, making it difficult to determine whether execution failures arise from the agent model, the runtime harness, or their interaction. We present the Medical Harness Protocol, an outcome-preserving framework that independently evaluates seven healthcare-specific process dimensions: Care Action Fulfillment, Clinical Resource Competence, Patient-Evidence Alignment, Clinical Workflow Continuity, Clinical Auditability, Closed-Loop Verification, and Clinical Conduct Boundaries. A normalized intervention trace further tracks whether runtime support is available, activated, delivered, adopted by the agent, and propagated into subsequent behavior. We instantiate the protocol as MedHarnessBench, comprising 342 executable tasks across FHIR/EHR operations, healthcare-administration interfaces, and multimodal clinical tools. Across more than 16,000 controlled task executions, MedHarness yields broad improvements in terminal task success, intermediate subtask completion, and healthcare-specific process quality. We further evaluate MedHarness against multiple general-purpose harnesses and use controlled single-fault perturbations to verify the sensitivity and discrimination of the seven-dimensional evaluation. These results demonstrate that healthcare-specific runtime support can substantially improve both task completion and execution quality, while revealing failures that terminal outcomes alone cannot capture. Code and resources are available at this https URL.
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URL
https://arxiv.org/abs/2610.15714
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ClinEdge: An Expert-Graded Benchmark of Real Patient Edge Cases Where Frontier Multimodal Models Fail
2026-10-11 00:17:47Anurag Sharma, Aditya Sharma, Sapna BaalwanAbstract
Most benchmarks for large language models in medicine are built from licensing examinations and theoretical questions. The few that draw on real clinical data do so only in part, and rarely require a model to read a patient's own imaging. ClinEdge addresses this gap with 32 real, de-identified patient cases from active clinical practice, each evaluated across seven frontier systems for a total of 224 expert-graded evaluations. Each case pairs primary imaging with a short vignette, contains a feature known to defeat pattern-matched reasoning, and is scored against the patient's documented clinical course. The suite is built for depth rather than volume. Grading followed a two-stage expert process. First, a senior orthopaedic surgeon graded all 224 responses on a weighted rubric and a pass-or-fail verdict. Second, a panel of nineteen physicians, largely senior specialists at teaching medical colleges, independently reviewed every case and every one of the 224 grades. All seven production systems were evaluated through their public interfaces, and all 224 conversations are preserved as replayable links. Performance was poor across all systems, and the failures were shared: different vendors missed the same findings and converged on the same wrong plans. From the experts' notes we catalogue 18 recurring failure modes in five families. The models stop reading an image at the first finding. They give generic plans and lean toward over-treatment. They trust a misleading history over correct imaging. Their answers vary across systems and runs, and change with question format. Failing answers were delivered fluently and without any expressed uncertainty. Four cases are released in full; the remaining 28 are held out, and we invite frontier AI labs and healthcare AI companies to evaluate their models against them (research@futrbridge.com)
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URL
https://arxiv.org/abs/2610.15239
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Right Answer, Wrong Reason: Accuracy, Consistency, and Consensus Are Misleading Indicators of LLM Faithfulness in Clinical Decision Support
2026-10-10 19:26:58Bharath Kumar Bolla, Chaitali Deb Purkayastha, Vishnu Surya Reddy NandiAbstract
Clinical Large Language Models (LLMs) achieve strong medical-exam accuracy; however, a correct answer does not guarantee that the explanation names the concepts that actually drove the decision. We introduce three lightweight, directly interpretable metrics for this faithfulness gap: the Explanation Stability Index (ESI), which measures reasoning consistency across repeated queries; the Causal Faithfulness Score (CFS), which tests whether cited concepts drive predictions via concept ablation; and the Perturbation Stability Score (PSS), which measures robustness to semantic-preserving paraphrases. By evaluating six LLMs on 150 MedQA-USMLE questions (900 model-question observations), we found that only 23.3% of the cited clinical concepts were causally necessary. Correct answers had lower CFS than incorrect answers (0.212 vs. 0.398), answer consistency negatively predicted CFS (Spearman r = -0.466), and model pairs could agree on answers while sharing only 8.8% of cited reasoning concepts. These results show that accuracy, consistency, and consensus are incomplete safety signals for clinical decision-making support. The evidence is behavioral rather than mechanistic: concept ablation tests counterfactual sensitivity of outputs, not internal circuits.
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URL
https://arxiv.org/abs/2609.32817
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MS-Exam-Gen: An Automatic Benchmark Construction Toolkit for Evaluating LLMs on Multiple Sclerosis-MRI Imaging Knowledge
2026-10-10 12:55:19Abdul Basit, Muhammad Abdullah Hanif, Muhammad ShafiqueAbstract
Biomedical large language model (LLM) evaluation requires auditable assessment of narrow, evolving, source-grounded subspecialty knowledge. Multiple sclerosis MRI (MS-MRI) provides a high-stakes textual-knowledge test case because correct reasoning requires current diagnostic criteria, standardized acquisition and reporting knowledge, longitudinal monitoring concepts, lesion morphology, and recognition of difficult mimics. We present MS-Exam-Gen, a reproducible framework for constructing and auditing a text-based multiple-choice question (MCQ) benchmark for MS-MRI knowledge; it does not evaluate direct MRI image interpretation. MS-Exam-Gen targets source-grounded criteria, protocols, reporting, and differential diagnosis. The framework combines expert-source indexing, exam-oriented topic induction, evidence-grounded MCQ generation, automated quality audits, a same-family consistency screen, and empirical calibration. From a 66-source corpus indexed into 4,289 retrieval chunks, the pipeline produced a locked 3,058-item candidate benchmark spanning 16 topics and 53 subtopics. Evaluation across 12 primary LLM endpoints yielded 36,696 item-level predictions and separated performance over a 42.8-percentage-point accuracy range (89.7% to 46.9%). Across these endpoints, 25.5% of items were missed by at least four. Post-generation audits showed that refreshed construction reduced measurable answer cues, while option-order testing showed that absolute MCQ scores remain position-sensitive. Generated construction labels remain metadata rather than validated psychometric categories. Because expert adjudication and full option-order counterbalancing remain future work, MS-Exam-Gen is not a clinically certified examination. It should be interpreted as an automatically filtered, source-grounded candidate benchmark and reproducible audit workflow for item-level and topic-specific LLM evaluation.
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URL
https://arxiv.org/abs/2610.06170
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Lingdan-V2: Large language models for clinically grounded reasoning in traditional Chinese medicine
2026-10-10 08:22:12Rui Hua, Yu Wei, Ziri Jin, Zhuo Sun, Kai Chang, Jianan Xia, Zixin Shu, Xiaodong Li, Dongmei Jia, Fei Dong, Runshun Zhang, Jian Yu, Hao Xu, Haibin Yu, Jiansheng Li, Baoyan Liu, Wenjia Wang, Xuezhong ZhouAbstract
Large language models have advanced medical reasoning, but clinically grounded reasoning in traditional Chinese medicine (TCM) remains challenging because prescription decisions require integrating domain knowledge, syndrome differentiation, treatment principles, herbal prescription composition, and dosage determination. We develop a TCM language model family comprising models with 4 billion, 8 billion, and 14 billion parameters. The artificial intelligence contribution is a staged clinical alignment framework integrating large scale continued pretraining on TCM and clinical records, complementary reasoning supervision, and prescription-centered reinforcement learning (RL). We further formulate herbal prescription generation as a structured RL problem with prescription-level feedback, enabling direct optimization of clinical decision outputs beyond knowledge reproduction and generic instruction following. The engineering application is TCM clinical decision support, particularly herbal prescription recommendation. We evaluate the models on a public benchmark containing 25,620 expert-verified items across 13 TCM knowledge and clinical reasoning tasks and on a private retrospective dataset of 4,348 spleen and stomach disease prescription cases. The 14 billion parameter reinforcement aligned model achieves a prescription generation F1 of 37.0 on the public benchmark, compared with 32.3 for DeepSeek-R1 with 671 billion total parameters, and a herb-level F1 of 52.8 on the clinical dataset with improved dosage agreement. Reinforcement post-training consistently improves prescription recommendation across all scales, while physician-source analysis shows that expert heterogeneity affects reward stability. These findings demonstrate a scalable pathway from domain grounding and reasoning supervision to clinically oriented prescription decision support.
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URL
https://arxiv.org/abs/2610.14705
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AphaVoice: Text-to-Speech Model for Aphasia Patient Simulation
2026-10-10 02:22:51Al Varrel Putra Kusuma, Fernando Bello, Joshua BrownAbstract
While language therapy is the primary treatment for post-stroke aphasia, limited clinical resources often restrict patient access to proper care. Addressing this gap requires reliable training simulations for medical professionals. However, current AI efforts focus almost exclusively on speech processing, leaving speech generation largely unexplored. This study introduces AphaVoice, a novel text-to-speech (TTS) framework explicitly engineered to synthesize highly realistic aphasic speech. Evaluated against state-of-the-art TTS systems, AphaVoice demonstrates a superior ability to capture the clinical feature of dysfluency, outperforming existing models in temporal metrics while consistently maintaining speaker identity. By leveraging latent space shifting, the model also supports multi-speaker generation without sacrificing phonetic realism. Ultimately, AphaVoice provides a scalable, high-fidelity tool for medical training and clinical simulation related to aphasia.
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URL
https://arxiv.org/abs/2610.14479
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Co-adaptive Rule Routing and Constraining for Structured Knowledge Retrieval
2026-10-10 01:45:48Zhisheng Qi, Haoyu Han, Jiaxi Li, Bing He, Huiyuan Chen, Franck Dernoncourt, Ryan A. Rossi, Mahantesh M. Halappanavar, Jin Lu, Yu Zhang, Tianming Liu, Yu WangAbstract
Structured knowledge retrieval acquires task-relevant evidence from structured knowledge sources for downstream tasks. Existing methods rely on unconstrained retrieval or predefined query-rule supervision, such as author-paper rules for scientific discovery and anatomy-drug rules for precision medicine. Such supervision is rarely available in practice. We propose Co-Adaptive Rule Routing and Constraining Retrieval (CoRE), which jointly learns which reasoning rule to assign to each query and how to retrieve evidence under that rule, without predefined query-rule pairs. A routing agent selects a rule, and its corresponding retriever traverses the knowledge base and ranks evidence that satisfies the rule's constraints. Because routing and retrieval are interdependent, CoRE alternates between reinforcement learning for the routing policy and contrastive learning for the rule-constrained retriever. The selected rules provide supervision for retriever training, while retrieval performance rewards the routing policy. This closed-loop process enables both components to co-adapt without explicit query-rule supervision. Experiments on STaRK-QA datasets across scientific discovery, biomedical reasoning, and e-commerce knowledge management demonstrate CoRE's effectiveness. Ablations show the benefit of co-adapting the router and retriever. Generation-based routing transfers across datasets and benefits from multi-domain pretraining followed by target-specific fine-tuning. Analysis of rule usage across queries also informs automatic rule refinement and discovery.
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URL
https://arxiv.org/abs/2610.14465
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Where to Look Matters: Rethinking Sub-Volume Sampling in 3D Medical Self-supervised Learning
2026-10-09 17:51:47Junkai Liu, Le ZhangAbstract
Self-supervised learning on 3D medical images commonly relies on random sub-volume sampling during pretraining. However, random cropping implicitly treats all spatial regions as equally worth observing, despite anatomical priors and spatial redundancy that make regions inherently unequal in their value for representation learning. To this end, we first show through controlled crop-quality manipulations that better sub-volumes lead to better downstream transfer, revealing the observation policy as an overlooked bottleneck in 3D medical SSL. Motivated by this finding, we revisit sub-volume sampling as a \emph{where-to-look} problem. We propose \textbf{\method}, a plug-and-play framework that replaces random cropping with an offline coarse-to-fine probe bank guided by \textit{anatomy-awareness}, \textit{informativeness}, and \textit{diversity}. We instantiate \method as a lightweight \lite variant using geometric and image-statistical cues, and a diagnostic \feat variant using frozen visual features, to examine whether lightweight volume-intrinsic priors suffice or richer semantic cues reliably provide additional value. Extensive experiments across multiple 3D medical SSL backbones and downstream tasks demonstrate that \method-\lite consistently improves transfer performance over random sampling. Mechanistic analyses further attribute these gains to more anatomically plausible and informative observations, reduced spatial redundancy, more efficient learning dynamics, and more structured representations.
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URL
https://arxiv.org/abs/2610.13915
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