medical ai developers

Abstract: Hallucinations can undermine clinician trust in LLMs, making it important that evaluation methods capture clinically relevant errors. Rubric-based evaluation has become the leading approach for assessing LLMs in medicine, but it is unclear whether rubric scores reflect such errors. We first study this in a controlled setting using MedHallu, finding that more specific rubrics better distinguish correct from hallucinated responses. To test this systematically, we develop a taxonomy of medical hallucination types and a clinician-validated error-injection pipeline that creates matched correct and error-injected responses. Across HealthBench, HealthBench Professional, and LiveMedBench, our clinically relevant hallucinations are missed by rubrics, often leaving scores unchanged. We find that rubrics are most effective when explicitly checking facts, and are less effective for additional or unexpected errors they do not anticipate. A preliminary retrieval-based factuality check recovers some of the rubric-blind errors, suggesting a complementary approach. These findings reveal systematic blind spots in current medical evaluation of LLMs and suggest that rubric scores alone are insufficient to establish clinical reliability, potentially undermining clinician trust and confidence in clinical deployment.

Abstract: Clinical electroencephalography (EEG) data are valuable for healthcare research and for developing artificial intelligence (AI)-based clinical decision-support systems, but EEG recordings and derived features may contain sensitive patient-specific information. This creates privacy risks when data are reused, analyzed, or shared across clinical and research environments. Conventional anonymization methods are often insufficient for high-dimensional biomedical signals, since removing direct identifiers does not necessarily prevent re-identification, linkage, or inference risks. At the same time, strong privacy protection may distort clinically relevant signal characteristics and reduce data utility. This paper studies subject-level differential privacy for protecting clinical EEG-derived feature representations using Gaussian and Laplace perturbations. The proposed framework considers three deployment scenarios: client-side anonymization, centralized server-side anonymization, and decentralized local training. Following EEG preprocessing and feature extraction, Gaussian and Laplace perturbations are applied to the resulting patient-level EEG feature representations. The Laplace experiments evaluate the implemented noise scales, while the scales required for formal full-vector calibration are derived separately. The effects of both perturbations are assessed using statistical utility measures and a downstream machine-learning-based utility check. The results show that differentially private perturbation can be integrated into EEG processing workflows, but the selected mechanism, privacy parameters, and sensitivity calibration strongly influence data utility. The study highlights the practical privacy-utility trade-off in DP-based EEG feature anonymization and the challenges of preserving downstream utility in small and imbalanced clinical EEG datasets.

Abstract: Early diagnosis of melanoma is critical for improving patient survival rates. However, accurately distinguishing melanoma from other skin lesions remains a significant clinical challenge due to the high visual similarity among lesion types and variability in image acquisition conditions. Artificial intelligence, particularly machine learning, has emerged as a promising tool to support dermatological diagnosis by automating feature extraction from medical images. Among the available approaches, convolutional neural networks (CNNs) have demonstrated strong performance in image classification tasks, making them well-suited for analyzing both dermatoscopic and histopathological images, given their ability to capture hierarchical visual patterns relevant to lesion characterization. Nevertheless, despite numerous pre-trained CNN architectures having been proposed, selecting the most appropriate one for a given imaging modality remains an open challenge. In this study, we evaluate pre-trained convolutional neural networks (CNNs) for skin lesion classification using dermatoscopic and histopathological image datasets. Experiments were conducted on the HAM10000, ISIC 2018, and CR-AI4SkIN datasets, evaluating the ResNet50, VGG16, VGG19, MobileNet, and InceptionV3 architectures under the same training protocol. The experimental evaluation showed that the models achieved accuracies ranging from 71% (InceptionV3 on ISIC 2018) to 84% (ResNet50 on HAM10000) on dermatoscopic images. For histopathological images, accuracies ranged from 72% (VGG19) to 83% (ResNet50) on the CR-AI4SkIN dataset. The results demonstrate that model performance differs between dermatoscopic and histopathological image modalities, showing that architectures exhibiting similar performance on dermatoscopic images exhibit different performance on histopathological data.

Abstract: Evidence-based medicine demands strict logical consistency, yet current evaluations of large language models (LLMs) prioritize superficial label matching over genuine reasoning. We introduce LogiMed-RoB, a benchmark grounded in Cochrane Risk of Bias (RoB) 2.0 expert logic, comprising 860 randomized controlled trials (RCTs) and 14,820 queries. It evaluates models under the Hierarchical Logical Consistency (HLC) framework across four dimensions: Atomic Consistency, Domain Consistency, Aggregation Consistency, and Evidential Faithfulness. Experiments on 10 state-of-the-art LLMs reveal a catastrophic Error Compounding Effect: despite the top model reaching 98.88% Atomic Consistency, its end-to-end consistency collapses to 45.13%, with several open-weight architectures plummeting to nearly 0%. We further uncover a systematic evidence-reasoning gap: even when models retrieve high-quality evidence, they fail to deduce correct outcomes in 18.63-40.05% of cases, while Blind Guess Rates reach 48.28%. LogiMed-RoB demonstrates that high outcome accuracy can conceal critical reasoning flaws, underscoring the necessity of white-box logical verification for clinical deployment.

Abstract: Machine learning models can achieve strong test performance while relying on demographic or acquisition-related shortcuts. We propose counterfactual (CF) marginalisation as a test-time evaluation procedure for assessing robustness of classification models to such variables. Given a CF image generator, we intervene on nuisance parent variables such as age or sex, generate CF versions of each test image, and average predictions over a target intervention distribution. This produces intervention-aware predictions that marginalise demographic effects while preserving patient-specific latent information. We use these predictions to define metrics for CF risk, calibration, stability and worst-case sensitivity. We demonstrate this framework's utility for quantitative robustness evaluation.

Abstract: Clinical diagnosis agents must decide not only what test to request next, but also when to diagnose or defer. Existing agent benchmarks largely evaluate accuracy after fixed or unconstrained interaction, leaving autonomous stopping reliability implicit. We present Cros, a risk-constrained stopping layer combining state-wise error ranking, policy design on disjoint development splits, and LTT-style exact tests of selective diagnostic error and minimum autonomous coverage for complete sequential policies. Its finite-sample guarantee requires the candidate family, testing rule, and any randomization to be frozen before calibration labels are accessed. On a 1,834-episode MIMIC-derived abdominal-pain benchmark, the full ranker achieves exploratory state-error AUROC 0.853, compared with 0.715 for maximum class probability and 0.552 for the backbone's native stop score. On the previously viewed 367-episode evaluation split, analytically averaging over the frozen Cros weights yields 16.9% selective error at 78.8% coverage, cost 5.57, and 0.68 tests, versus 30.8% error at 100% coverage, cost 8.14, and 1.53 tests under native stopping. Forced continuation is non-monotone: error is 28.3% with HPI alone and 34.3% after full workup. However, the uniform-weight mixture ablation is cheaper on this viewed split despite missing the locked development margins, and Cros nominally satisfies the joint criterion in only 6 of 20 development resplits. Because evaluation labels were inspected during earlier development, these findings provide exploratory feasibility and audit evidence, not a confirmatory safety certificate.

Abstract: Brain-age prediction models are commonly evaluated by predictive accuracy, yet accurate predictions alone do not establish that a model relies on reproducible or neurobiologically supported mechanisms. Post-hoc explanation methods can expose these mechanisms, but existing workflows typically stop at diagnosis or require correction targets to be specified before model analysis. We propose XAI-Refine, an automated explanation-knowledge loop for brain-age prediction from resting-state functional connectivity. At each iteration, XAI-Refine consolidates complementary post-hoc analyses across repeated training runs into reliable, structured model explanations. It converts each reliable explanation into a neutral neurobiological question, retrieves and verifies relevant literature, and compiles the verified evidence into an admissible set in the same typed explanation space. The target for refinement is defined as the minimal projection of the current model explanation onto the admissible set induced by applicable verified knowledge. This revised explanation is then translated into a differentiable constraint while preserving the originating model variable, measurement operator, and applicable scope. Candidate updates are promoted only when multi-seed validation confirms target-directed explanatory movement, predictive performance remains within a prespecified guardrail, and non-target explanatory drift remains bounded. Experiments on functional-connectivity-based brain-age prediction evaluate predictive performance, explanation reliability, literature alignment, and target-specific model revision, illustrating a structured route from post-hoc analysis to evidence-guided model refinement.

Abstract: Despite recent advances in surgical vision-language models (VLMs), temporal reasoning remains limited because existing supervision is largely frame-centric. Frame-level scene graphs (SGs) have proven effective in providing structured representations of surgical environments but do not explicitly model the dynamics of surgical workflows. To explicitly model how surgical states evolve across time, we introduce a multi-level structured temporal supervision methodology that augments frame-level surgical SGs with object-level continuity, event-level interaction continuity, and procedure-level connectivity. We then execute temporal queries over the resulting spatio-temporal scene graphs (STSGs) to generate evidence-grounded question-answer pairs, which together form the STSG-VQA benchmark. Each question is linked to the temporal interval and STSG evidence used to derive its reference answer, enabling traceable verification. The benchmark contains 18,458 question-answer pairs across seven temporal categories. Fine-tuning Qwen3-VL-4B and Hulu-Med-4B with STSG-derived supervision improves question-level micro accuracy by 24.39 and 19.56 percentage points over their zero-shot baselines and by 16.50 and 14.25 points over static scene-graph supervision, respectively. These gains span all temporal categories, indicating that STSG-derived supervision helps surgical VLMs reason over temporally grounded interactions rather than isolated frames. The code and dataset will be made publicly available upon acceptance.

Abstract: Medical imaging artificial intelligence (AI) is commonly developed as separate mappings from radiographs to diagnostic outputs or from clinical descriptions to generated images, although both arise from the same underlying radiographic state. A world-model formulation instead seeks to learn an internal representation of this state that can support both clinical readout and conditional simulation of radiographic observations. Here we introduce MedDream, a radiographic world model that learns a shared continuous latent state from paired chest radiograph-text observations for diagnostic reasoning and report-conditioned evidence generation. MedDream was pretrained on 2.65 million leakage-controlled chest radiograph-text pairs curated from 4.40 million candidates. Across eight clinical datasets and two independent reader cohorts, MedDream outperformed leading diagnostic and generative comparators. For diagnostic reasoning, MedDream showed strong generalization across disease recognition, label-scarce adaptation, severity assessment, and localization, while MedDream-supported review increased mean resident concordance with independent radiologist consensus from 56.3% to 63.0%. For evidence generation, MedDream produced radiographs that preserved clinically relevant pathology and improved downstream performance on held-out real data, with synthetic augmentation increasing external VinDr-CXR macro-AUROC from 76.4% to 81.4%. More importantly, conditioning generation on prespecified subgroup performance gaps enabled targeted evidence construction, increasing weighted F1 by 3.1 percentage points in Asian patients, whereas matched-volume unguided augmentation decreased it by 2.3 points. These findings establish radiographic world models as a path toward medical AI that learns clinically meaningful internal states for interpreting, simulating, and constructing evidence for clinical use.

Abstract: Should multilingual LLMs answer medical questions consistently across input languages, or adapt responses to cultural cues? Existing multilingual medical benchmarks usually assume that medically correct answers should remain consistent across languages and treat cross-lingual variation as model error. In contrast, cultural adaptation research argues that appropriate medical answers may legitimately differ across contexts. We review the multilingual medical NLP literature through these two perspectives, we identify three gaps: limited stakeholder perspectives (e.g., of medical professionals), a lack of empirical evidence on which approach better serves users, and no benchmarks capable of distinguishing universally correct from culture-specific cases. To address the first gap, we survey 356 participants across three stakeholder groups (medical, NLP, and anthropology professionals) in three countries (Germany, Spain, and the United States). Anthropologists consistently favor adaptation, while medical and NLP respondents remain divided, with notable divergence between U.S. and European medical professionals. LLMs prompted with profession and country personas fail to reproduce this variation, overestimating cross-lingual consistency preference among NLP and medical personas. We conclude that neither consistency nor adaptation can currently be considered clearly preferable, highlighting the need for empirical evidence on which approach better serves users across cultural contexts.