Beyond Semantic Similarity: A Component-Wise Evaluation Framework for Medical Question Answering Systems with Health Equity Implications

The use of Large Language Models (LLMs) to support patients in addressing medical questions is becoming increasingly prevalent. However, most of the measures currently used to evaluate the performance of these models in this context only measure how closely a model's answers match semantically, and therefore do not provide a true indication of the model's medical accuracy or of the health equity risks associated with it. To address these shortcomings, we present a new evaluation framework for medical question answering called VB-Score (Verification-Based Score) that provides a separate evaluation of the four components of entity recognition, semantic similarity, factual consistency, and structured information completeness for medical question-answering models. We perform rigorous reviews of the performance of three well-known and widely used LLMs on 48 public health-related topics taken from high-quality, authoritative information sources. Based on our analyses, we discover a major discrepancy between the models' semantic and entity accuracy. Our assessments of the performance of all three models show that each of them has almost uniformly severe performance failures when evaluated against our criteria. Our findings indicate alarming performance disparities across various public health topics, with most of the models exhibiting 13.8% lower performance (compared to an overall average) for all the public health topics that relate to chronic conditions that occur in older and minority populations, which indicates the existence of what's known as condition-based algorithmic discrimination. Our findings also demonstrate that prompt engineering alone does not compensate for basic architectural limitations on how these models perform in extracting medical entities and raise the question of whether semantic evaluation alone is a sufficient measure of medical AI safety.

Empirical Characterization of Rationale Stability Under Controlled Perturbations for Explainable Pattern Recognition

Reliable pattern recognition systems should exhibit consistent behavior across similar inputs, and their explanations should remain stable. However, most Explainable AI evaluations remain instance centric and do not explicitly quantify whether attribution patterns are consistent across samples that share the same class or represent small variations of the same input. In this work, we propose a novel metric aimed at assessing the consistency of model explanations, ensuring that models consistently reflect the intended objectives and consistency under label-preserving perturbations. We implement this metric using a pre-trained BERT model on the SST-2 sentiment analysis dataset, with additional robustness tests on RoBERTa, DistilBERT, and IMDB, applying SHAP to compute feature importance for various test samples. The proposed metric quantifies the cosine similarity of SHAP values for inputs with the same label, aiming to detect inconsistent behaviors, such as biased reliance on certain features or failure to maintain consistent reasoning for similar predictions. Through a series of experiments, we evaluate the ability of this metric to identify misaligned predictions and inconsistencies in model explanations. These experiments are compared against standard fidelity metrics to assess whether the new metric can effectively identify when a model's behavior deviates from its intended objectives. The proposed framework provides a deeper understanding of model behavior by enabling more robust verification of rationale stability, which is critical for building trustworthy AI systems. By quantifying whether models rely on consistent attribution patterns for similar inputs, the proposed approach supports more robust evaluation of model behavior in practical pattern recognition pipelines. Our code is publicly available at https://github.com/anmspro/ESS-XAI-Stability.

Explainable AI for Blind and Low-Vision Users: Navigating Trust, Modality, and Interpretability in the Agentic Era

Explainable Artificial Intelligence (XAI) is critical for ensuring trust and accountability, yet its development remains predominantly visual. For blind and low-vision (BLV) users, the lack of accessible explanations creates a fundamental barrier to the independent use of AI-driven assistive technologies. This problem intensifies as AI systems shift from single-query tools into autonomous agents that take multi-step actions and make consequential decisions across extended task horizons, where a single undetected error can propagate irreversibly before any feedback is available. This paper investigates the unique XAI requirements of the BLV community through a comprehensive analysis of user interviews and contemporary research. By examining usage patterns across environmental perception and decision support, we identify a significant modality gap. Empirical evidence suggests that while BLV users highly value conversational explanations, they frequently experience "self-blame" for AI failures. The paper concludes with a research agenda for accessible Explainable AI in agentic systems, advocating for multimodal interfaces, blame-aware explanation design, and participatory development.

Dissecting Model Failures in Abdominal Aortic Aneurysm Segmentation through Explainability-Driven Analysis

Computed tomography image segmentation of complex abdominal aortic aneurysms (AAA) often fails because the models assign internal focus to irrelevant structures or do not focus on thin, low-contrast targets. Where the model looks is the primary training signal, and thus we propose an Explainable AI (XAI) guided encoder shaping framework. Our method computes a dense, attribution-based encoder focus map ("XAI field") from the final encoder block and uses it in two complementary ways: (i) we align the predicted probability mass to the XAI field to promote agreement between focus and output; and (ii) we route the field into a lightweight refinement pathway and a confidence prior that modulates logits at inference, suppressing distractors while preserving subtle structures. The objective terms serve only as control signals; the contribution is the integration of attribution guidance into representation and decoding. We evaluate clinically validated challenging cases curated for failure-prone scenarios. Compared to a base SAM setup, our implementation yields substantial improvements. The observed gains suggest that explicitly optimizing encoder focus via XAI guidance is a practical and effective principle for reliable segmentation in complex scenarios.

Toward Faithful Segmentation Attribution via Benchmarking and Dual-Evidence Fusion

Attribution maps for semantic segmentation are almost always judged by visual plausibility. Yet looking convincing does not guarantee that the highlighted pixels actually drive the model's prediction, nor that attribution credit stays within the target region. These questions require a dedicated evaluation protocol. We introduce a reproducible benchmark that tests intervention-based faithfulness, off-target leakage, perturbation robustness, and runtime on Pascal VOC and SBD across three pretrained backbones. To further demonstrate the benchmark, we propose Dual-Evidence Attribution (DEA), a lightweight correction that fuses gradient evidence with region-level intervention signals through agreement-weighted fusion. DEA increases emphasis where both sources agree and retains causal support when gradient responses are unstable. Across all completed runs, DEA consistently improves deletion-based faithfulness over gradient-only baselines and preserves strong robustness, at the cost of additional compute from intervention passes. The benchmark exposes a faithfulness-stability tradeoff among attribution families that is entirely hidden under visual evaluation, providing a foundation for principled method selection in segmentation explainability. Code is available at https://github.com/anmspro/DEA.