Benchmarking Ethical and Safety Risks of Healthcare LLMs in China-Toward Systemic Governance under Healthy China 2030

Large Language Models (LLMs) are poised to transform healthcare under China's Healthy China 2030 initiative, yet they introduce new ethical and patient-safety challenges. We present a novel 12,000-item Q&A benchmark covering 11 ethics and 9 safety dimensions in medical contexts, to quantitatively evaluate these risks. Using this dataset, we assess state-of-the-art Chinese medical LLMs (e.g., Qwen 2.5-32B, DeepSeek), revealing moderate baseline performance (accuracy 42.7% for Qwen 2.5-32B) and significant improvements after fine-tuning on our data (up to 50.8% accuracy). Results show notable gaps in LLM decision-making on ethics and safety scenarios, reflecting insufficient institutional oversight. We then identify systemic governance shortfalls-including the lack of fine-grained ethical audit protocols, slow adaptation by hospital IRBs, and insufficient evaluation tools-that currently hinder safe LLM deployment. Finally, we propose a practical governance framework for healthcare institutions (embedding LLM auditing teams, enacting data ethics guidelines, and implementing safety simulation pipelines) to proactively manage LLM risks. Our study highlights the urgent need for robust LLM governance in Chinese healthcare, aligning AI innovation with patient safety and ethical standards.

Building a Human-Verified Clinical Reasoning Dataset via a Human LLM Hybrid Pipeline for Trustworthy Medical AI

Despite strong performance in medical question-answering, the clinical adoption of Large Language Models (LLMs) is critically hampered by their opaque 'black-box' reasoning, limiting clinician trust. This challenge is compounded by the predominant reliance of current medical LLMs on corpora from scientific literature or synthetic data, which often lack the granular expert validation and high clinical relevance essential for advancing their specialized medical capabilities. To address these critical gaps, we introduce a highly clinically relevant dataset with 31,247 medical question-answer pairs, each accompanied by expert-validated chain-of-thought (CoT) explanations. This resource, spanning multiple clinical domains, was curated via a scalable human-LLM hybrid pipeline: LLM-generated rationales were iteratively reviewed, scored, and refined by medical experts against a structured rubric, with substandard outputs revised through human effort or guided LLM regeneration until expert consensus. This publicly available dataset provides a vital source for the development of medical LLMs that capable of transparent and verifiable reasoning, thereby advancing safer and more interpretable AI in medicine.

A Novel Ophthalmic Benchmark for Evaluating Multimodal Large Language Models with Fundus Photographs and OCT Images

In recent years, large language models (LLMs) have demonstrated remarkable potential across various medical applications. Building on this foundation, multimodal large language models (MLLMs) integrate LLMs with visual models to process diverse inputs, including clinical data and medical images. In ophthalmology, LLMs have been explored for analyzing optical coherence tomography (OCT) reports, assisting in disease classification, and even predicting treatment outcomes. However, existing MLLM benchmarks often fail to capture the complexities of real-world clinical practice, particularly in the analysis of OCT images. Many suffer from limitations such as small sample sizes, a lack of diverse OCT datasets, and insufficient expert validation. These shortcomings hinder the accurate assessment of MLLMs' ability to interpret OCT scans and their broader applicability in ophthalmology. Our dataset, curated through rigorous quality control and expert annotation, consists of 439 fundus images and 75 OCT images. Using a standardized API-based framework, we assessed seven mainstream MLLMs and observed significant variability in diagnostic accuracy across different diseases. While some models performed well in diagnosing conditions such as diabetic retinopathy and age-related macular degeneration, they struggled with others, including choroidal neovascularization and myopia, highlighting inconsistencies in performance and the need for further refinement. Our findings emphasize the importance of developing clinically relevant benchmarks to provide a more accurate assessment of MLLMs' capabilities. By refining these models and expanding their scope, we can enhance their potential to transform ophthalmic diagnosis and treatment.

Multimodal Human-AI Synergy for Medical Imaging Quality Control: A Hybrid Intelligence Framework with Adaptive Dataset Curation and Closed-Loop Evaluation

Medical imaging quality control (QC) is essential for accurate diagnosis, yet traditional QC methods remain labor-intensive and subjective. To address this challenge, in this study, we establish a standardized dataset and evaluation framework for medical imaging QC, systematically assessing large language models (LLMs) in image quality assessment and report standardization. Specifically, we first constructed and anonymized a dataset of 161 chest X-ray (CXR) radiographs and 219 CT reports for evaluation. Then, multiple LLMs, including Gemini 2.0-Flash, GPT-4o, and DeepSeek-R1, were evaluated based on recall, precision, and F1 score to detect technical errors and inconsistencies. Experimental results show that Gemini 2.0-Flash achieved a Macro F1 score of 90 in CXR tasks, demonstrating strong generalization but limited fine-grained performance. DeepSeek-R1 excelled in CT report auditing with a 62.23\% recall rate, outperforming other models. However, its distilled variants performed poorly, while InternLM2.5-7B-chat exhibited the highest additional discovery rate, indicating broader but less precise error detection. These findings highlight the potential of LLMs in medical imaging QC, with DeepSeek-R1 and Gemini 2.0-Flash demonstrating superior performance.