Abstract:Medical vision-language models (VLMs) are strong zero-shot recognizers for medical imaging, but their reliability under domain shift hinges on calibrated uncertainty with guarantees. Split conformal prediction (SCP) offers finite-sample coverage, yet prediction sets often become large (low efficiency) and class-wise coverage unbalanced-high class-conditioned coverage gap (CCV), especially in few-shot, imbalanced regimes; moreover, naively adapting to calibration labels breaks exchangeability and voids guarantees. We propose \texttt{\textbf{LATA}} (Laplacian-Assisted Transductive Adaptation), a \textit{training- and label-free} refinement that operates on the joint calibration and test pool by smoothing zero-shot probabilities over an image-image k-NN graph using a small number of CCCP mean-field updates, preserving SCP validity via a deterministic transform. We further introduce a \textit{failure-aware} conformal score that plugs into the vision-language uncertainty (ViLU) framework, providing instance-level difficulty and label plausibility to improve prediction set efficiency and class-wise balance at fixed coverage. \texttt{\textbf{LATA}} is black-box (no VLM updates), compute-light (windowed transduction, no backprop), and includes an optional prior knob that can run strictly label-free or, if desired, in a label-informed variant using calibration marginals once. Across \textbf{three} medical VLMs and \textbf{nine} downstream tasks, \texttt{\textbf{LATA}} consistently reduces set size and CCV while matching or tightening target coverage, outperforming prior transductive baselines and narrowing the gap to label-using methods, while using far less compute. Comprehensive ablations and qualitative analyses show that \texttt{\textbf{LATA}} sharpens zero-shot predictions without compromising exchangeability.
Abstract:Medical foundation models have shown promise in controlled benchmarks, yet widespread deployment remains hindered by reliance on task-specific fine-tuning. Here, we introduce DermFM-Zero, a dermatology vision-language foundation model trained via masked latent modelling and contrastive learning on over 4 million multimodal data points. We evaluated DermFM-Zero across 20 benchmarks spanning zero-shot diagnosis and multimodal retrieval, achieving state-of-the-art performance without task-specific adaptation. We further evaluated its zero-shot capabilities in three multinational reader studies involving over 1,100 clinicians. In primary care settings, AI assistance enabled general practitioners to nearly double their differential diagnostic accuracy across 98 skin conditions. In specialist settings, the model significantly outperformed board-certified dermatologists in multimodal skin cancer assessment. In collaborative workflows, AI assistance enabled non-experts to surpass unassisted experts while improving management appropriateness. Finally, we show that DermFM-Zero's latent representations are interpretable: sparse autoencoders unsupervisedly disentangle clinically meaningful concepts that outperform predefined-vocabulary approaches and enable targeted suppression of artifact-induced biases, enhancing robustness without retraining. These findings demonstrate that a foundation model can provide effective, safe, and transparent zero-shot clinical decision support.
Abstract:Hypothesis. Artificial general intelligence is, at its core, a compression problem. Effective compression demands resonance: deep learning scales best when its architecture aligns with the fundamental structure of the data. These are the fundamental principles. Yet, modern vision architectures have strayed from these truths: visual signals are highly redundant, while discriminative information, the surprise, is sparse. Current models process dense pixel grids uniformly, wasting vast compute on static background rather than focusing on the predictive residuals that define motion and meaning. We argue that to solve visual understanding, we must align our architectures with the information-theoretic principles of video, i.e., Codecs. Method. OneVision-Encoder encodes video by compressing predictive visual structure into semantic meaning. By adopting Codec Patchification, OV-Encoder abandons uniform computation to focus exclusively on the 3.1%-25% of regions rich in signal entropy. To unify spatial and temporal reasoning under irregular token layouts, OneVision-Encoder employs a shared 3D RoPE and is trained with a large-scale cluster discrimination objective over more than one million semantic concepts, jointly capturing object permanence and motion dynamics. Evidence. The results validate our core hypothesis: efficiency and accuracy are not a trade-off; they are positively correlated. When integrated into LLM, it consistently outperforms strong vision backbones such as Qwen3-ViT and SigLIP2 across 16 image, video, and document understanding benchmarks, despite using substantially fewer visual tokens and pretraining data. Notably, on video understanding tasks, OV-Encoder achieves an average improvement of 4.1% over Qwen3-ViT. Codec-aligned, patch-level sparsity is a foundational principle, enabling OV-Encoder as a scalable engine for next-generation visual generalists.
Abstract:Retinal imaging is fast, non-invasive, and widely available, offering quantifiable structural and vascular signals for ophthalmic and systemic health assessment. This accessibility creates an opportunity to study how quantitative retinal phenotypes relate to ocular and systemic diseases. However, such analyses remain difficult at scale due to the limited availability of public multi-label datasets and the lack of a unified segmentation-to-quantification pipeline. We present RetSAM, a general retinal segmentation and quantification framework for fundus imaging. It delivers robust multi-target segmentation and standardized biomarker extraction, supporting downstream ophthalmologic studies and oculomics correlation analyses. Trained on over 200,000 fundus images, RetSAM supports three task categories and segments five anatomical structures, four retinal phenotypic patterns, and more than 20 distinct lesion types. It converts these segmentation results into over 30 standardized biomarkers that capture structural morphology, vascular geometry, and degenerative changes. Trained with a multi-stage strategy using both private and public fundus data, RetSAM achieves superior segmentation performance on 17 public datasets. It improves on prior best methods by 3.9 percentage points in DSC on average, with up to 15 percentage points on challenging multi-task benchmarks, and generalizes well across diverse populations, imaging devices, and clinical settings. The resulting biomarkers enable systematic correlation analyses across major ophthalmic diseases, including diabetic retinopathy, age-related macular degeneration, glaucoma, and pathologic myopia. Together, RetSAM transforms fundus images into standardized, interpretable quantitative phenotypes, enabling large-scale ophthalmic research and translation.
Abstract:The medical adoption of NLP tools requires interpretability by end users, yet traditional explainable AI (XAI) methods are misaligned with clinical reasoning and lack clinician input. We introduce CHiRPE (Clinical High-Risk Prediction with Explainability), an NLP pipeline that takes transcribed semi-structured clinical interviews to: (i) predict psychosis risk; and (ii) generate novel SHAP explanation formats co-developed with clinicians. Trained on 944 semi-structured interview transcripts across 24 international clinics of the AMP-SCZ study, the CHiRPE pipeline integrates symptom-domain mapping, LLM summarisation, and BERT classification. CHiRPE achieved over 90% accuracy across three BERT variants and outperformed baseline models. Explanation formats were evaluated by 28 clinical experts who indicated a strong preference for our novel concept-guided explanations, especially hybrid graph-and-text summary formats. CHiRPE demonstrates that clinically-guided model development produces both accurate and interpretable results. Our next step is focused on real-world testing across our 24 international sites.
Abstract:Nuclei panoptic segmentation supports cancer diagnostics by integrating both semantic and instance segmentation of different cell types to analyze overall tissue structure and individual nuclei in histopathology images. Major challenges include detecting small objects, handling ambiguous boundaries, and addressing class imbalance. To address these issues, we propose PanopMamba, a novel hybrid encoder-decoder architecture that integrates Mamba and Transformer with additional feature-enhanced fusion via state space modeling. We design a multiscale Mamba backbone and a State Space Model (SSM)-based fusion network to enable efficient long-range perception in pyramid features, thereby extending the pure encoder-decoder framework while facilitating information sharing across multiscale features of nuclei. The proposed SSM-based feature-enhanced fusion integrates pyramid feature networks and dynamic feature enhancement across different spatial scales, enhancing the feature representation of densely overlapping nuclei in both semantic and spatial dimensions. To the best of our knowledge, this is the first Mamba-based approach for panoptic segmentation. Additionally, we introduce alternative evaluation metrics, including image-level Panoptic Quality ($i$PQ), boundary-weighted PQ ($w$PQ), and frequency-weighted PQ ($fw$PQ), which are specifically designed to address the unique challenges of nuclei segmentation and thereby mitigate the potential bias inherent in vanilla PQ. Experimental evaluations on two multiclass nuclei segmentation benchmark datasets, MoNuSAC2020 and NuInsSeg, demonstrate the superiority of PanopMamba for nuclei panoptic segmentation over state-of-the-art methods. Consequently, the robustness of PanopMamba is validated across various metrics, while the distinctiveness of PQ variants is also demonstrated. Code is available at https://github.com/mkang315/PanopMamba.
Abstract:Culture serves as a fundamental determinant of human affective processing and profoundly shapes how individuals perceive and interpret emotional stimuli. Despite this intrinsic link extant evaluations regarding cultural alignment within Large Language Models primarily prioritize declarative knowledge such as geographical facts or established societal customs. These benchmarks remain insufficient to capture the subjective interpretative variance inherent to diverse sociocultural lenses. To address this limitation, we introduce CEDAR, a multimodal benchmark constructed entirely from scenarios capturing Culturally \underline{\textsc{E}}licited \underline{\textsc{D}}istinct \underline{\textsc{A}}ffective \underline{\textsc{R}}esponses. To construct CEDAR, we implement a novel pipeline that leverages LLM-generated provisional labels to isolate instances yielding cross-cultural emotional distinctions, and subsequently derives reliable ground-truth annotations through rigorous human evaluation. The resulting benchmark comprises 10,962 instances across seven languages and 14 fine-grained emotion categories, with each language including 400 multimodal and 1,166 text-only samples. Comprehensive evaluations of 17 representative multilingual models reveal a dissociation between language consistency and cultural alignment, demonstrating that culturally grounded affective understanding remains a significant challenge for current models.
Abstract:The increasing integration of large language models (LLMs) into mental health applications necessitates robust frameworks for evaluating professional safety alignment. Current evaluative approaches primarily rely on refusal-based safety signals, which offer limited insight into the nuanced behaviors required in clinical practice. In mental health, clinically inadequate refusals can be perceived as unempathetic and discourage help-seeking. To address this gap, we move beyond refusal-centric metrics and introduce \texttt{PsychEthicsBench}, the first principle-grounded benchmark based on Australian psychology and psychiatry guidelines, designed to evaluate LLMs' ethical knowledge and behavioral responses through multiple-choice and open-ended tasks with fine-grained ethicality annotations. Empirical results across 14 models reveal that refusal rates are poor indicators of ethical behavior, revealing a significant divergence between safety triggers and clinical appropriateness. Notably, we find that domain-specific fine-tuning can degrade ethical robustness, as several specialized models underperform their base backbones in ethical alignment. PsychEthicsBench provides a foundation for systematic, jurisdiction-aware evaluation of LLMs in mental health, encouraging more responsible development in this domain.
Abstract:Multimodal Large Language Models (MLLMs) show promise for medical applications, yet progress in dermatology lags due to limited training data, narrow task coverage, and lack of clinically-grounded supervision that mirrors expert diagnostic workflows. We present a comprehensive framework to address these gaps. First, we introduce DermoInstruct, a large-scale morphology-anchored instruction corpus comprising 211,243 images and 772,675 trajectories across five task formats, capturing the complete diagnostic pipeline from morphological observation and clinical reasoning to final diagnosis. Second, we establish DermoBench, a rigorous benchmark evaluating 11 tasks across four clinical axes: Morphology, Diagnosis, Reasoning, and Fairness, including a challenging subset of 3,600 expert-verified open-ended instances and human performance baselines. Third, we develop DermoGPT, a dermatology reasoning MLLM trained via supervised fine-tuning followed by our Morphologically-Anchored Visual-Inference-Consistent (MAVIC) reinforcement learning objective, which enforces consistency between visual observations and diagnostic conclusions. At inference, we deploy Confidence-Consistency Test-time adaptation (CCT) for robust predictions. Experiments show DermoGPT significantly outperforms 16 representative baselines across all axes, achieving state-of-the-art performance while substantially narrowing the human-AI gap. DermoInstruct, DermoBench and DermoGPT will be made publicly available at https://github.com/mendicant04/DermoGPT upon acceptance.
Abstract:Learning from noisy labels remains a major challenge in medical image analysis, where annotation demands expert knowledge and substantial inter-observer variability often leads to inconsistent or erroneous labels. Despite extensive research on learning with noisy labels (LNL), the robustness of existing methods in medical imaging has not been systematically assessed. To address this gap, we introduce LNMBench, a comprehensive benchmark for Label Noise in Medical imaging. LNMBench encompasses \textbf{10} representative methods evaluated across 7 datasets, 6 imaging modalities, and 3 noise patterns, establishing a unified and reproducible framework for robustness evaluation under realistic conditions. Comprehensive experiments reveal that the performance of existing LNL methods degrades substantially under high and real-world noise, highlighting the persistent challenges of class imbalance and domain variability in medical data. Motivated by these findings, we further propose a simple yet effective improvement to enhance model robustness under such conditions. The LNMBench codebase is publicly released to facilitate standardized evaluation, promote reproducible research, and provide practical insights for developing noise-resilient algorithms in both research and real-world medical applications.The codebase is publicly available on https://github.com/myyy777/LNMBench.