JMed48k: A Multi-Profession Japanese Medical Licensing Benchmark for Vision-Language Model Evaluation

We introduce JMed48k, a multi-profession Japanese healthcare licensing benchmark for evaluating vision-language models. Built from official PDF materials released by the Japanese Ministry of Health, Labour and Welfare, JMed48k contains 48,862 exam questions and 20,142 images from 11 national licensing examinations between 2005 and 2025, with visual content annotated under an 8-type taxonomy. From this corpus, we derive JMed48k-Eval, a recent five-year evaluation subset with 12,484 scored questions, including 9,905 text-only questions and 2,579 questions with images. We evaluate 21 proprietary, open-source, and medical-specific models, reporting text-only and with-image performance separately. Because these subsets contain different questions, we further introduce a paired image-removal audit that evaluates questions with images before and after removing visual content to explore four answer-transition states. The audit shows that proprietary and open source models gain substantially from images, whereas medical-specific systems show limited observable use of visual evidence, with many correct answers persisting after image removal. Even among proprietary models, the net image-removal effect varies sevenfold across professions, from +5.7 points on Physician questions to +39.8 points on Public Health Nurse questions. We release JMed48k to support reproducible, profession-stratified evaluation of vision-language models in medical licensing settings.

BrainAnytime: Anatomy-Aware Cross-Modal Pretraining for Brain Image Analysis with Arbitrary Modality Availability

Clinical diagnostic workups typically follow a modality escalation pathway: after initial clinical evaluation, clinicians begin with routine structural imaging (e.g., MRI), selectively add sequences such as FLAIR or T2 to refine the differential, and reserve molecular imaging (e.g., amyloid-PET) for cases that remain uncertain after standard evaluation. Consequently, patients are observed with heterogeneous and often incomplete modality subsets. However, most current AI models assume fixed data modalities as the model inputs. In this paper, we present BrainAnytime, a unified pretraining framework pretrained on 34,899 3D brain scans from five datasets that support brain image analysis under arbitrary modality availability spanning multi-sequence MRI and amyloid-PET. A single model accepts whatever imaging is available, from a lone T1 scan to a full multimodal workup. Pretraining learns structural-molecular correspondences between MRI and PET via cross-modal distillation (RCMD) and prioritizes disease-vulnerable anatomy via atlas-guided curriculum masking (PACM), all within a shared 3D masked autoencoder (Multi-MAE3D). Across four downstream tasks and five clinically motivated modality settings, BrainAnytime largely outperforms modality-specific models, missing-modality baselines, and large-scale brain MRI pretrained foundation models on most modality settings. Notably, it surpasses the strongest missing-modality baselines with relative improvements of 6.2% and 7.0% in average accuracy on CN vs. AD and CN vs. MCI classification, respectively. Code is available at https://github.com/SDH-Lab/BrainAnytime.

AD-CARE: A Guideline-grounded, Modality-agnostic LLM Agent for Real-world Alzheimer's Disease Diagnosis with Multi-cohort Assessment, Fairness Analysis, and Reader Study

Alzheimer's disease (AD) is a growing global health challenge as populations age, and timely, accurate diagnosis is essential to reduce individual and societal burden. However, real-world AD assessment is hampered by incomplete, heterogeneous multimodal data and variability across sites and patient demographics. Although large language models (LLMs) have shown promise in biomedicine, their use in AD has largely been confined to answering narrow, disease-specific questions rather than generating comprehensive diagnostic reports that support clinical decision-making. Here we expand LLM capabilities for clinical decision support by introducing AD-CARE, a modality-agnostic agent that performs guideline-grounded diagnostic assessment from incomplete, heterogeneous inputs without imputing missing modalities. By dynamically orchestrating specialized diagnostic tools and embedding clinical guidelines into LLM-driven reasoning, AD-CARE generates transparent, report-style outputs aligned with real-world clinical workflows. Across six cohorts comprising 10,303 cases, AD-CARE achieved 84.9% diagnostic accuracy, delivering 4.2%-13.7% relative improvements over baseline methods. Despite cohort-level differences, dataset-specific accuracies remain robust (80.4%-98.8%), and the agent consistently outperforms all baselines. AD-CARE reduced performance disparities across racial and age subgroups, decreasing the average dispersion of four metrics by 21%-68% and 28%-51%, respectively. In a controlled reader study, the agent improved neurologist and radiologist accuracy by 6%-11% and more than halved decision time. The framework yielded 2.29%-10.66% absolute gains over eight backbone LLMs and converges their performance. These results show that AD-CARE is a scalable, practically deployable framework that can be integrated into routine clinical workflows for multimodal decision support in AD.

JMedEthicBench: A Multi-Turn Conversational Benchmark for Evaluating Medical Safety in Japanese Large Language Models

As Large Language Models (LLMs) are increasingly deployed in healthcare field, it becomes essential to carefully evaluate their medical safety before clinical use. However, existing safety benchmarks remain predominantly English-centric, and test with only single-turn prompts despite multi-turn clinical consultations. To address these gaps, we introduce JMedEthicBench, the first multi-turn conversational benchmark for evaluating medical safety of LLMs for Japanese healthcare. Our benchmark is based on 67 guidelines from the Japan Medical Association and contains over 50,000 adversarial conversations generated using seven automatically discovered jailbreak strategies. Using a dual-LLM scoring protocol, we evaluate 27 models and find that commercial models maintain robust safety while medical-specialized models exhibit increased vulnerability. Furthermore, safety scores decline significantly across conversation turns (median: 9.5 to 5.0, $p < 0.001$). Cross-lingual evaluation on both Japanese and English versions of our benchmark reveals that medical model vulnerabilities persist across languages, indicating inherent alignment limitations rather than language-specific factors. These findings suggest that domain-specific fine-tuning may accidentally weaken safety mechanisms and that multi-turn interactions represent a distinct threat surface requiring dedicated alignment strategies.

Ada-FCN: Adaptive Frequency-Coupled Network for fMRI-Based Brain Disorder Classification

Resting-state fMRI has become a valuable tool for classifying brain disorders and constructing brain functional connectivity networks by tracking BOLD signals across brain regions. However, existing mod els largely neglect the multi-frequency nature of neuronal oscillations, treating BOLD signals as monolithic time series. This overlooks the cru cial fact that neurological disorders often manifest as disruptions within specific frequency bands, limiting diagnostic sensitivity and specificity. While some methods have attempted to incorporate frequency informa tion, they often rely on predefined frequency bands, which may not be optimal for capturing individual variability or disease-specific alterations. To address this, we propose a novel framework featuring Adaptive Cas cade Decomposition to learn task-relevant frequency sub-bands for each brain region and Frequency-Coupled Connectivity Learning to capture both intra- and nuanced cross-band interactions in a unified functional network. This unified network informs a novel message-passing mecha nism within our Unified-GCN, generating refined node representations for diagnostic prediction. Experimental results on the ADNI and ABIDE datasets demonstrate superior performance over existing methods. The code is available at https://github.com/XXYY20221234/Ada-FCN.