Medical
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Benchmarking Literature Retrieval for a Model Organism: A Dictyostelium Case Study
2026-10-02 10:50:06Yun Wang, Gad Shaulsky, Toma\v{z} Curk, Bla\v{z} ZupanAbstract
Biological literature retrieval systems are often developed and evaluated using broad biomedical corpora and general-purpose search tasks. However, many curated knowledge bases operate in narrower model-organism domains, where the literature is sparse and terminology is organism-specific. We introduce a retrieval benchmark from dictyBase for Dictyostelium, a model organism in cell and developmental biology. The benchmark consists of curator-generated biological queries linked to PubMed-indexed articles, together with structured gene annotations. Using this benchmark, we study three factors in niche biological retrieval: cross-encoder reranking, gene-aware query expansion, and abstract-only versus full-text retrieval. We report that reranking and gene-aware query expansion improve retrieval selectively: reranking is most useful when the model is well suited to biological evidence matching, whereas curated annotations help clarify compact biological queries by reducing vocabulary mismatch. Full-text chunks substantially improve retrieval when abstracts omit supporting evidence, increasing both candidate recall and top-rank performance, although these cases are harder than queries supported by abstracts. Data and code are publicly available at this https URL, and the benchmark dataset is additionally archived on Zenodo.
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URL
https://arxiv.org/abs/2610.03130
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RASPER: Reward-Aligned Summarization of Clinical Notes for EHR Outcome Prediction
2026-10-02 08:10:22Arya Hadizadeh Moghaddam, Mohsen Nayebi Kerdabadi, Chen Chen, Dongjie Wang, Zijun YaoAbstract
Unstructured discharge notes in Electronic Health Records (EHRs) often carry signal complementary to structured medical codes, holding patient-specific evidence that standardized cohort-level codes alone cannot capture. However, this evidence in notes is frequently buried in lengthy, noisy text that is not intentionally written with any specific clinical prediction in mind. Summarization is an obvious mitigation, but generic summaries, tuned for fluency rather than the outcome, routinely omit decisive evidence while retaining plausible but uninformative detail. To this end, we propose RASPER, a Reward-Aligned Summarizer for Prediction in EHR, that optimizes note summarization directly against the downstream clinical task. RASPER employs a tunable LLM-based summarizer to extract task-relevant evidence from discharge notes and trains it via reinforcement learning from prediction feedback, using a reward derived from the downstream predictor's loss. To ground the summarizer, a longitudinal encoder converts structured codes into soft prompts that incorporate each patient's clinical context into note summarization. By rewarding the quality of the resulting multimodal prediction, RASPER encourages the summarizer to retain patient-specific evidence that complements, rather than duplicates, information captured by structured codes. RASPER consistently outperforms strong baselines on both readmission prediction and medication recommendation across MIMIC-III and MIMIC-IV.
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URL
https://arxiv.org/abs/2610.02979
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A Guideline-Augmented Multi-Agent Framework for Schema-as-Code Biomedical Named Entity Recognition
2026-10-02 08:06:20Songtao Li, Yijia Zhang, Shidi Zhang, Jianyuan Yuan, Fengyu Zhang, Hongfei LinAbstract
Large language models (LLMs) have shown promising potential for biomedical named entity recognition (BioNER) through instruction following and in-context learning. However, existing LLM-based BioNER methods still face two key limitations. First, retrieved demonstrations and external biomedical knowledge provide limited support for dataset-specific annotation semantics, leaving entity boundaries, type scopes, and annotation conventions ambiguous. Second, free-form generation lacks sufficient structural control, often leading to invalid formats, hallucinated mentions, duplicated entities, and boundary errors. To address these limitations, we propose GAMA, a guideline-augmented multi-agent framework for schema-as-code BioNER. GAMA first induces candidate annotation rules from labeled training instances and verifies them against annotated data to construct reliable dataset-specific guideline memory. Guided by these verified rules, a planning component generates ranked span-type hypotheses with rationales, and a coding component converts them into schema-constrained entity objects. A verification module then checks span grounding, type validity, and structural compliance, and performs dual-loop refinement to correct invalid or low-confidence predictions. Experiments on five widely used BioNER datasets with multiple LLM backbones show that GAMA consistently outperforms strong LLM-based baselines. Ablation and parameter analyses further verify the effectiveness of the proposed components.
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https://arxiv.org/abs/2610.02970
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Enhancing Biomedical Named Entity Recognition via Multiple Programming Languages Instruction Tuning and Ensemble Method
2026-10-02 07:42:44Songtao Li, Yijia Zhang, Jianyuan Yuan, Shidi Zhang, Fengyu Zhang, Hongfei LinAbstract
Instruction tuning has become a common paradigm for applying large language models (LLMs) to biomedical named entity recognition (BioNER). However, existing instruction-tuning approaches still face two key challenges. First, conventional natural-language instructions typically serialize BioNER annotations as flat textual outputs, providing limited structural constraints for typed entity extraction. Second, high-quality biomedical annotations are limited, and learning from a single serialized output form may restrict structural diversity and reduce model robustness. Although external biomedical knowledge can be introduced to alleviate data scarcity, it often requires costly resource construction. To address these challenges, we propose MITE, a Multiple Programming Languages Instruction Tuning and Ensemble method for BioNER. MITE reformulates BioNER as a structure-to-structure generation task by representing both instructions and entity outputs in code-formatted representations. Specifically, each training instance is transformed into multiple programming-language formats, including Python, C++, and Java, while preserving the same underlying entity semantics. These language-specific representations provide structurally diverse supervision without requiring external biomedical knowledge or additional annotations. During inference, MITE aggregates predictions from different code formats through an entity-level voting strategy, reducing language-specific prediction variance and improving robustness. Experiments on six widely used BioNER datasets demonstrate that MITE consistently outperforms representative BERT-based and LLM-based baselines and exhibits strong cross-dataset generalization. Ablation and parameter analyses further verify the effectiveness and robustness of the proposed components.
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URL
https://arxiv.org/abs/2610.02949
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MetaRubric: Learning to Reward for Rubric-Based Reinforcement Learning
2026-10-02 05:16:42Yuxuan Fan, Jaehong YoonAbstract
Rubric-based reinforcement learning extends reward-driven optimization to open-ended tasks by assigning partial credit to individual response requirements. However, rubric judges can assign a high criterion score even when the information or action it requires is absent from the response, a failure mode we term Vacuous Credit. Such awards persist after the required information is removed and can reverse the sign of a response's GRPO advantage. To address this problem, we introduce MetaRubric, which alternates evidence-aware policy optimization with response-guided rubric adaptation. We construct counterfactual counterparts by changing one task-relevant fact in each prompt. During policy optimization, credit is assigned only when the response contains sufficient evidence to satisfy the required rubric criterion. After each policy-optimization stage, current policy responses guide revisions to original and counterfactual criteria while preserving the meaning of the original prompt's initial rubric as interpreted under each prompt's facts. We also adapt criterion weights at stage boundaries to better address observed policy errors. Across multiple backbones, MetaRubric improves PubMedQA accuracy by 6.00--20.40 percentage points over static-judge GRPO, with further gains on HealthBench-Hard and two multimodal medical benchmarks.
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URL
https://arxiv.org/abs/2610.02824
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Decoupling Memory from Context: Structured Memory for Token-Efficient Test-Time Continual Learning
2026-10-02 02:07:32Yehya Farhat, Michael Desmond, Anastasios KyrillidisAbstract
Large language models (LLMs) are increasingly deployed in enterprise, scientific, and medical applications, where agents must incorporate domain-specific knowledge and adapt from experience. Context engineering offers a practical alternative to weight updates by improving model behavior through instructions, strategies, and evidence supplied at inference time. However, adapting context online typically requires a costly trial-and-error process, while queries are often processed independently, preventing useful experience from carrying forward. Memory systems address this limitation by retaining information across interactions, but approaches that continually append information to a shared context face increasing token costs, context-window limits, and performance degradation as the context expands. We introduce a unified formulation of context optimization and show that an agent memory system update can be interpreted as an optimization update procedure over the model's context. This perspective attempts to provide a principled framework for studying memory design and its efficiency. We then propose GraphMemory, a lightweight graph-based memory that accumulates, refines, organizes, and connects reusable strategies. For each query, GraphMemory retrieves only the relevant subgraph, enabling online context adaptation without exposing the model to the entire memory. Under bounded retrieval, the amount of retrieved memory remains constant as the number of processed examples grows. Experiments show that GraphMemory achieves competitive downstream performance while using approximately 81-85% fewer memory-construction tokens than our baselines.
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URL
https://arxiv.org/abs/2610.02687
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'I just assumed that it would translate': examining MT risk awareness among healthcare staff with abbreviations as a use case
2026-10-01 21:18:43Eleanor Taylor-Stilgoe, F\'elix do Carmo, Constantin Or\u{a}sanAbstract
In the UK, public healthcare staff report turning to machine translation (MT) - predominantly Google Translate (GT) - to communicate with patients across language barriers. Though intended to support their duty of care, potentially uninformed reliance on MT in such contexts could have serious consequences for patient safety. Research nonetheless remains limited on staff awareness of the possible risks posed by higher-stakes MT use in general and with patient medical records in particular, most existing literature instead examining its use in interpersonal situations or with patient-oriented documentation. Moreover, medical abbreviations are well-documented as increasing patient risk even monolingually, with outcomes from their misuse and/or misinterpretation ranging from temporary harm to the death of the patient. Abbreviations were therefore selected as a use case for identifying the potential risks posed by their translation with MT. Contextualised French and Spanish data examples drawn from authoritative clinical corpora and translated via GT were presented during semi-structured interviews to 21 healthcare staff participants in diverse roles and specialties. The results were then subject to qualitative analysis and cross-analysis.
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URL
https://arxiv.org/abs/2610.02496
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From Retrieval to Typed Decisions: Calibrated System One Models from Biomedical Sentence Encoders
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Typed decision models answer schema-constrained questions about a text in one forward pass and return probabilities meant to be thresholded. We ask whether biomedical sentence encoders trained for retrieval are good starting points for such models. We present SBERT2S1, which converts Sentence-Transformers encoders into bi-encoder, cross-head (C) and prior-fused residual (PFR) decision models, together with BIODECIDE, a biomedical typed-decision suite, and MEDLINE-S1, 243k training decisions derived from NLM indexing. Across six parent-retriever pairs, retrieval training improves zero-shot matching of content-bearing options. After fine-tuning, its effect depends on the head: across five pairs and three training-set sizes, retrieval training significantly helps PFR, which keeps the retrieval prior, in 10 of 15 comparisons, but helps C in one and hurts it in five. A matched grid of two heads and five training objectives shows that C outperforms PFR under every objective, and that the released RLCD recipe of open System One models trails cross-entropy by 2.5-3.0 points. The deficit stems mainly from its reward normalisation, which inflates the noisy score-function term 3.6-15-fold; an unbiased leave-one-out estimator recovers most of the gap. After temperature scaling, no objective is clearly better calibrated than cross-entropy. We release the code, the MEDLINE-S1 labels and a model.
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URL
https://arxiv.org/abs/2610.02486
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FactorSplat: Appearance-Controllable Gaussian Proxies for Medical Volume Rendering
2026-10-01 19:04:30Zhongpai Gao, Benjamin Planche, Meng Zheng, Anwesa Choudhuri, Terrence Chen, Ziyan WuAbstract
Transfer functions (TFs) control color and visibility in medical volume rendering, but image-trained Gaussian proxies typically bake one transfer function into their appearance. We present FactorSplat, a per-scene N-dimensional Gaussian splatting (N-DGS) proxy that accepts region-specific intensity-to-RGBA curves at inference. A local lookup applies the authored color and opacity change, while a shared functional encoder and low-rank per-Gaussian factors learn the residual appearance response. Geometry and directional appearance remain shared across presets, with visibility control and TF-aware pruning preserving the ability to hide and reveal structures. On seven CT and MR scans, FactorSplat improves mean PSNR and changed-region error over region-aware VEG across validation, interpolation, unseen composition, and out-of-distribution (OOD) edits. Across these four splits, seven-scan mean PSNR gains over VEG range from 1.10 to 1.52 dB. One checkpoint per scan supports unseen edits without retraining. At $1600^2$, the cached fast renderer averages 524 FPS with 1.17 ms TF switches. Project page: this https URL.
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URL
https://arxiv.org/abs/2610.02382
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Harnessing Domain Specialists in Multimodal Mixture-of-Experts for Efficient Adaptation
2026-10-01 17:37:13Damiano Marsili, Raphi Kang, Aditya Mehta, Pietro Perona, Georgia GkioxariAbstract
Mixture-of-Experts (MoE) architectures scale model capacity through sparse computation, routing each token through only a small subset of experts. In this work, we explore whether this sparsity gives rise to emergent intrinsic organization in multimodal MoEs. We find that experts develop strong semantic specialization across modalities and domains despite not being explicitly trained for modularity. Building on this structure, we introduce ExpertLens, a data-free method that identifies domain-specialized experts directly from pretrained model weights by decoding router weights into semantically meaningful vocabulary tokens. We leverage this specialization for efficient multimodal adaptation by selectively fine-tuning experts relevant to a target domain. Across math, medical, and remote sensing tasks, ExpertLens matches or surpasses full fine-tuning while updating only 21.7 - 47.0% of model parameters and achieving a 4.0x average training speedup, and outperforms LoRA in both adaptation performance and training efficiency. These results show that sparsity introduced for efficiency can give rise to semantic modularity that is directly useful for efficient adaptation.
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https://arxiv.org/abs/2610.02123
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A Comparative Explainability Framework for DeBERTa-v3 in Zero-Shot Medical Abstract Classification
2026-10-01 17:34:02Javier Diaz Esteban-Herreros, David Mu\~noz-Valero, Raquel Mart\'inez-Espa\~na, Jose M. Juarez, Juan Moreno-GarciaAbstract
A comparative explainability framework is presented to audit DeBERTa-v3 under zero-shot classification of medical abstracts. The work addresses the disagreement problem in Explainable Artificial Intelligence, where different attribution methods produce divergent explanations for the same input and prediction. A natural language inference engine is implemented over the Medical Abstracts corpus with five enriched hypotheses per diagnostic category and a balanced sample of one thousand texts per class. Five explanation methods are compared: SHAP and LIME as model-agnostic approaches, occlusion and Input x Gradient as deep-learning-specific approaches, and Attention x Gradient as a transformer-specific approach. Explanations are standardized through top-token attribution, and pairwise agreement is quantified using the Jaccard index. High predictive accuracy is achieved across well-defined clinical domains, whereas performance degrades under high semantic ambiguity. Explanatory stability directly mirrors predictive certainty, exhibiting strong convergence in univalent categories and a marked drop under diagnostic uncertainty. Furthermore, qualitative error auditing uncovers three systemic failure mechanisms: lexical hypersensitivity, semantic overlap, and loss of attribution coherence. The results support the combined use of several explanation methods and quantitative agreement metrics when auditing transformer-based models in medical text classification, and suggest prioritizing specific clinical ontologies over broad diagnostic labels.
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URL
https://arxiv.org/abs/2610.02116
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Can AI Oversight Be Zero Knowledge?
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AI systems increasingly produce outputs from confidential data, such as a fitness-for-duty assessment from medical records or the predicted properties of a drug candidate from its secret structure. It is important to verify that such outputs are correct without revealing the underlying data. A recent line of work studies verification of AI outputs via interactive proofs and debate for oracle-aided computation, where correctness may depend on an oracle such as human judgment, a physical experiment, or the web. These works focus on verification by a verifier that runs much faster than the computation. However, such efficient verification is impossible for general oracle-aided computation, and these works therefore rely on additional assumptions. We focus instead on privacy: allowing the verifier to run in time polynomial in the computation, we ask whether interactive arguments for oracle-aided computation can be zero knowledge, so that the verifier learns nothing about the confidential data beyond the correctness of the output. We prove that, in general, they cannot. In the random oracle model, there are no zero-knowledge proofs for all oracle-aided computations, even if both the prover and the verifier are allowed to run much longer than the computation itself. The impossibility extends to debate, a canonical model for scalable oversight. On the positive side, we show that if the oracle attaches a cryptographic signature to each of its answers, then every oracle-aided computation can be verified in zero knowledge with an efficient prover and verifier, assuming only collision-resistant hash functions. Beyond privacy, this also gives an alternative approach to scalable oversight that relies neither on an honest opponent, as in debate, nor on the robustness of the computation, as in prior single-prover protocols.
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URL
https://arxiv.org/abs/2610.01995
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Counterfactual Auditing of Bias in Open-Source Large Language Models for Clinical Triage
2026-10-01 16:17:43Manar Aljohani, Brandon Ho, Kenneth McKinley, Dennis Ren, Xuan WangAbstract
Emergency department (ED) triage is a high-stakes prioritization task in which demographic, socioeconomic, and system-context information may improperly influence acuity assignment. Although open-source large language models (LLMs) are increasingly considered for local and privacy-preserving clinical decision support, it remains unclear how counterfactual bias varies across model families, sizes, medical-domain models, and domain-adapted models. We present a comparative counterfactual audit of ten open-source LLMs for pediatric Emergency Severity Index (ESI) prediction. Starting from real and handbook-style clinical vignettes, we construct paired counterfactual variants that change only one injected demographic, socioeconomic, healthcare-access, behavioral, social, or system-context variable while holding the clinical presentation fixed. Models include Qwen2.5-7B, Qwen2.5-14B-Instruct, a QLoRA fine-tuned Qwen2.5-7B, MedGemma variants, MedLLaMA2-7B, GPT-OSS-20B, and GPT-OSS-120B. We measure any counterfactual shift, undertriage, overtriage, shifts greater than one ESI level, mean shift, and mean absolute shift. Counterfactual sensitivity varied substantially and did not consistently decrease with larger model size or medical-domain pretraining. The fine-tuned Qwen2.5-7B showed the lowest overall sensitivity, with a 5.27% any-shift rate and mean absolute shift of 0.0534, versus 16.02% and 0.1706 for the base model. Several larger or medical-domain models showed more significant shifts. Stratified and correlation analyses further revealed clinically important directionality and shared failure patterns hidden by aggregate rates. These findings support counterfactual auditing as a lightweight, clinically interpretable framework for comparing fairness risks in open-source LLMs before clinical deployment.
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URL
https://arxiv.org/abs/2610.01963
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A rubric landscape for evaluating clinical reasoning in large language models: what exists, what is missing, and what needs to be combined
2026-10-01 16:07:12Zhangshu Joshua Jiang, Zina Ibrahim, James T. TeoAbstract
Exam-style accuracy does not establish whether large language models (LLMs) reason well over clinical records. We define clinical reasoning as integrating and updating evidence across time and sources to form, revise and justify a patient's problem representation and a defensible plan. This structured narrative review maps three literatures: medical education assessment instruments, clinical LLM benchmarks published from 2023 onwards, and general-domain methods for evaluating long-form generation. We examine six dimensions: problem representation, temporal synthesis, differential and management reasoning, counterfactual reasoning, calibrated uncertainty, and reasoning faithfulness. Preprints are included and flagged. No single instrument covers all six dimensions. Problem representation and differential or management reasoning are reasonably covered, although reliability varies by instrument and setting. TIMER-Eval targets temporal synthesis, and ER-Reason assesses sequential diagnostic belief updating. Dedicated uncertainty and counterfactual evaluations are emerging, but their applicability to longitudinal free-text reasoning remains limited. Factual completeness is well theorised in general-domain evaluation, with early clinical evidence of important omissions. Faithfulness remains the weakest dimension, with one identified clinical causal-ablation study on multiple-choice questions. Existing tools should be combined through binary rubric items, separate completeness and correctness scores, case-specific importance weighting with non-compensable safety caps, temporal order-consistency checks, and chance-corrected reliability reporting. Further design work is needed for calibrated uncertainty, counterfactual reasoning and faithfulness over longitudinal free-text records. This review provides a design rationale, not a validated instrument.
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URL
https://arxiv.org/abs/2610.01938
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Walking the Embedding Space: Datastore Extraction from Multimodal RAG
2026-10-01 15:30:06Maria Carmen Jica, Ali Satvaty, Suzan Verberne, Fatih TurkmenAbstract
Multimodal Retrieval-Augmented Generation (MRAG) has emerged as a reliable and cost-effective technique of grounding the generative capabilities of Multimodal Large Language Models (MLLMs) into relevant, up-to-date, external knowledge. Despite presenting several benefits, such as reducing hallucinatory behavior, they also introduce new attack surfaces, including leakage of private information and vulnerabilities against data extraction attacks. In this paper, we introduce $\immrag$, an adaptive and automatic data extraction attack procedure operating in a black box setting against \emph{image-returning} MRAG, a configuration in which the retrieved visual artifact is itself the response. Each query blends an attacker-held shadow image with an image already recovered from the system, and relevance-weighted resampling steers subsequent queries towards regions of the embedding space that still yield novel retrievals. Unlike current extraction attacks that aim to persuade the model towards data leakage by placing a malicious query as a textual prompt, $\immrag$ embeds the malicious instructions inside a user-given input image. We evaluate $\immrag$ on three plausible and distinct real-world scenarios: medical assistant, document-focused helper and general purpose tool. The experiments involve the study of the effectiveness of the attack on multiple CLIP-family retrievers, as well as the impact of various generators. A single 2500-query run reconstructs up to 611 distinct radiology images, 566 document scans and 416 general-purpose images under local-feature correspondence, and reaches up to $5.6\times$ as many distinct datastore items as a non-adaptive baseline. Our results show the urgent need for safeguards specifically designed for multimodal data.
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URL
https://arxiv.org/abs/2610.01871
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PhaseAT: Fourier Phase Adversarial Training for Medical Image Domain Generalization
2026-10-01 14:46:32Ahmed Sharshar, Asif Hanif, Naveen Kumar Kummari, Mohammad Yaqub, Mohsen GuizanAbstract
Reliable clinical deployment of deep medical image models is hindered by distribution shifts across scanners, sites, and acquisition protocols. Existing domain generalization (DG) methods often focus on style or intensity diversification, but they can still leave networks dependent on domain-specific texture correlations. Inspired by evidence that Fourier phase encodes semantic structure, we introduce PhaseAT, a phase-aware adversarial training framework for medical DG. PhaseAT forms phase-perturbed training views in the Fourier domain by iteratively updating a bounded phase perturbation while keeping the amplitude spectrum unchanged, thereby stressing spatial organization under matched appearance statistics. Perturbations are applied only to the luminance channel in YCbCr color space to avoid chromatic artifacts. Additionally, a simple phase-saliency mask concentrates updates on the most influential frequencies. The model is trained with a weighted combination of losses on clean and phase-perturbed samples, supporting both single-source and multi-source DG. We validate our method on two challenging medical datasets and demonstrate that PhaseAT achieves over 20% improvement in single-source domain generalization, outperforming several state-of-the-art DG methods. The code implementation is available at: this https URL.
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https://arxiv.org/abs/2610.01807
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Uncertainty-Guided Handshake: Efficient Human-in-the-Loop Refinement for Surgical-Grade Glioma Segmentation
2026-10-01 10:48:41Samuel Hart, Ahmad Yahya, Ahmed Karam EldalyAbstract
While state-of-the-art automated models for medical image segmentation achieve high mean performance, they frequently suffer from localized, catastrophic failures that preclude safe clinical deployment, particularly in neuro-oncology. Interactive segmentation frameworks mitigate this by incorporating human oversight, but traditionally impose prohibitive cognitive and temporal workloads by requiring clinicians to manually search for errors. In this project, we present an efficient, Hybrid Structural-Aleatoric Human-in-the-Loop framework for glioma segmentation that bridges the gap between automated baseline performance and surgical-grade precision, achieving sub-2.0 mm HD95 on curated benchmarks while providing safety-net routing for structural failures across real-world clinical data. By extracting voxel-wise Test-Time Augmentation (TTA) uncertainty and applying hierarchical topological filtering, our method proactively isolates high-risk structural anomalies. We comprehensively evaluated our approach on a challenging out-of-distribution clinical stress-test cohort (N = 362). Operating under a simulated Human Oracle, the framework improved the Whole Tumor (WT) Dice score from 0.891 to 0.914 and reduced the 95th percentile Hausdorff Distance (HD95) from 5.82 mm to 4.76 mm. Critically for surgical safety, the system rescued severe boundary failures in the Tumor Core, reducing mean HD95 from 17.96 mm to 14.83 mm (improving absolute TC Dice to 0.356). These spatial rescues were achieved while demanding a median interactive workload of just 11.3% of the target volume. Acknowledging this as a simulated upper bound lacking real-world cognitive friction, the framework nevertheless demonstrates a highly Pareto-efficient pathway for safely deploying clinical AI.
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URL
https://arxiv.org/abs/2610.01452
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A Multi-Agent LLM Framework for Personalized Health Checkup Interpretation and Guidance
2026-10-01 10:48:04HyungJun Kim, Taehan Lee, Soojin CheonAbstract
Personalized interpretation of health checkup results requires reasoning across longitudinal records, medical knowledge, lifestyle guidance, and healthcare navigation. We present a multi-agent large language model (LLM) system that identifies multiple intents, maps each to a task-specific agent, executes them in parallel, and synthesizes their outputs. We compared answers generated in Single Agent and Multi Agent settings on 120 Korean compound queries combining two to four requirements, using synthetic health checkup records. The Multi Agent improved the weighted LLM-judge score from 1.695 to 1.797 (p = 0.027), and three additional LLM judges showed consistent improvements ($\Delta$ = +0.111 to +0.186, all p < 0.05). The gains came from usefulness, consistency, and the handling of every requirement in compound queries, whereas numerical accuracy and grounding improved significantly under only one of the four judges and medical safety did not differ, and critical failures occurred at similar rates (Single Agent 15.0% vs. Multi Agent 13.3%). Two human evaluators preferred Multi Agent in 66.7% and 68.3% of pairwise comparisons. Multi Agent execution increased latency and cost by 1.31$\times$ and 2.02$\times$, respectively. In exploratory subgroup analyses, the improvement was concentrated in queries involving personal-record lookup.
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URL
https://arxiv.org/abs/2610.01451
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Model validation in machine learning: A scenario-based guide from hold-out splits to nested group cross-validation in biomedical and applied research
Abstract
Model validation estimates the performance of a complete learning procedure on new data. However, an invalid split can produce an optimistic and stable result. This tutorial reviews hold-out validation, train/validation/test designs, repeated random subsampling, k-fold and repeated stratified cross-validation, leave-one-out and leave-p-out schemes, group-aware validation, and nested group cross-validation. General machine-learning principles are linked to EEG epochs, paired-eye OCT images, repeated clinical measurements, and multicenter data. Eight controlled scenarios compare flawed and leakage-safe designs: seven use locked confusion matrices with auditable metrics, and one uses a reproducible repeated-study simulation. The scenarios cover global feature selection, normalization leakage, dependent records, center mixing, repeated test-set use, and estimator instability. Bias, variance, metric aggregation, uncertainty, and computational cost are also examined. A data-size matrix, a decision tree, and reporting checklists are provided. Reproducible MATLAB templates and scikit-learn counterparts are included. The results show that no validation method is universally best. The independent unit must match the intended deployment target. Every data-dependent operation must also exclude the observations used for performance estimation.
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URL
https://arxiv.org/abs/2610.01284
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CineMR: Tool-Integrated Vision-Language Reasoning for Quantitative Cardiac MRI Assessment
2026-10-01 06:43:42Kunyang Li, Hai Nguyen, Joshua Lowe, Chenguang Zhao, Peace C. Madueme, Mehdi Hedjazi Moghari, Mubarak Shah, Pegah Khosravi, Yuzhang ZhangAbstract
Cardiovascular magnetic resonance (CMR), including cine imaging, is a reference standard for the noninvasive assessment of cardiac morphology and ventricular function. Cine CMR interpretation integrates qualitative visual assessment with quantitative measurements of ventricular volumes, ejection fraction, myocardial mass, wall thickness, and regional wall motion. Current medical vision-language models (VLMs) cannot reliably derive quantitative measurements from multidimensional cine images without analysis tools. We present CineMR, a tool-augmented VLM that invokes cardiac image-analysis tools and integrates their outputs into interleaved reasoning for quantitative CMR assessment. We also construct a multi-cohort visual question answering benchmark covering quantitative metric extraction, multiclass diagnosis, and differential diagnosis, together with tools for segmentation, phase selection, volumetry, morphometry, and regional wall motion analysis. CineMR is trained with supervised fine-tuning (SFT) on tool-interaction traces followed by Group Relative Policy Optimization (GRPO) with conditional tool-use rewards. On the multi-cohort cine CMR benchmark, CineMR achieves 35.9% pass@1 and 58.9% pass@4, compared with 1.5% pass@1 for the Qwen3-VL-8B backbone and 0.0% and 7.0% pass@1 for LLaVA-Med v1.5 and MedGemma-4B, respectively. Correct tool invocation reaches 99.8% after GRPO, up from 78.9% after SFT. Live tool outputs improve ventricular measurement accuracy by 20.4--23.7% over direct model predictions, and removing all tools reduces pass@1 from 35.9% to 27.9%. These results highlight the importance of reliable tool use for quantitative cine CMR reasoning and support CineMR as a promising approach for assistive cardiac image assessment. Code, benchmark resources, and model weights are available at this https URL.
Abstract (translated)
URL
https://arxiv.org/abs/2610.01166
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