MEDLAYXPLAIN: Benchmarking the Expert-Lay Gap in Medical Vision-Language Models

Medical Vision-Language Models (Med-VLMs) achieve strong expert-level performance, yet their ability to generate patient-accessible descriptions remains underexplored. With the 21st Century Cures Act now mandating immediate patient access to diagnostic imaging results, evaluating whether Med-VLMs can bridge this Expert-Lay Gap is both urgent and clinically consequential for patient education and shared decision-making. To this end, we introduce MedLayXPlain, the first large-scale multimodal benchmark and evaluation framework for Medical Lay Language Generation (MLLG). MedLayXPlain-122K provides 122,789 region-grounded samples across 8 imaging modalities from 12 publicly available source datasets, each comprising a medical image with paired expert and lay captions anchored in a three-level Unified Medical Language System (UMLS) ontology hierarchy spanning 7 semantic groups, 43 semantic types, and 2,411 medical concepts. Lay captions are constructed via Hierarchical Ontology-Verified Refinement (HOVER), a three-step pipeline combining patient-centric vocabulary mapping, LLM-based constrained rewriting, and cross-model visual verification to enforce semantic equivalence while preventing hallucination. We further introduce MedLayEval, a lightweight 3B evaluator distilled from a 27B verifier that scores expert-lay alignment across five clinically grounded attributes, addressing the poor correlation between standard NLG metrics and clinical judgment. Benchmarking 33 VLMs on MedLayXPlain-122K reveals a systematic Expert-Lay Gap: medical VLMs achieve strong expert captioning but suffer significant lay-register degradation, while general-purpose VLMs produce more accessible language yet lack clinical precision, confirming that neither current paradigm adequately serves patient-facing communication.

MedLayBench-V: A Large-Scale Benchmark for Expert-Lay Semantic Alignment in Medical Vision Language Models

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Segmentation-before-Staining Improves Structural Fidelity in Virtual IHC-to-Multiplex IF Translation

Multiplex immunofluorescence (mIF) enables simultaneous single-cell quantification of multiple biomarkers within intact tissue architecture, yet its high reagent cost, multi-round staining protocols, and need for specialized imaging platforms limit routine clinical adoption. Virtual staining can synthesize mIF channels from widely available brightfield immunohistochemistry (IHC), but current translators optimize pixel-level fidelity without explicitly constraining nuclear morphology. In pathology, this gap is clinically consequential: subtle distortions in nuclei count, shape, or spatial arrangement propagate directly to quantification endpoints such as the Ki67 proliferation index, where errors of a few percent can shift treatment-relevant risk categories. This work introduces a supervision-free, architecture-agnostic conditioning strategy that injects a continuous cell probability map from a pretrained nuclei segmentation foundation model as an explicit input prior, together with a variance-preserving regularization term that matches local intensity statistics to maintain cell-level heterogeneity in synthesized fluorescence channels. The soft prior retains gradient-level boundary information lost by binary thresholding, providing a richer conditioning signal without task-specific tuning. Controlled experiments across Pix2Pix with U-Net and ResNet generators, deterministic regression U-Net, and conditional diffusion on two independent datasets demonstrate consistent improvements in nuclei count fidelity and perceptual quality, as the sole modifications. Code will be made publicly available upon acceptance.

Evidential Perfusion Physics-Informed Neural Networks with Residual Uncertainty Quantification

Physics-informed neural networks (PINNs) have shown promise in addressing the ill-posed deconvolution problem in computed tomography perfusion (CTP) imaging for acute ischemic stroke assessment. However, existing PINN-based approaches remain deterministic and do not quantify uncertainty associated with violations of physics constraints, limiting reliability assessment. We propose Evidential Perfusion Physics-Informed Neural Networks (EPPINN), a framework that integrates evidential deep learning with physics-informed modeling to enable uncertainty-aware perfusion parameter estimation. EPPINN models arterial input, tissue concentration, and perfusion parameters using coordinate-based networks, and places a Normal--Inverse--Gamma distribution over the physics residual to characterize voxel-wise aleatoric and epistemic uncertainty in physics consistency without requiring Bayesian sampling or ensemble inference. The framework further incorporates physiologically constrained parameterization and stabilization strategies to promote robust per-case optimization. We evaluate EPPINN on digital phantom data, the ISLES 2018 benchmark, and a clinical cohort. On the evaluated datasets, EPPINN achieves lower normalized mean absolute error than classical deconvolution and PINN baselines, particularly under sparse temporal sampling and low signal-to-noise conditions, while providing conservative uncertainty estimates with high empirical coverage. On clinical data, EPPINN attains the highest voxel-level and case-level infarct-core detection sensitivity. These results suggest that evidential physics-informed learning can improve both accuracy and reliability of CTP analysis for time-critical stroke assessment.