Wenting Chen

Cheng-Yi Li, Kao-Jung Chang, Cheng-Fu Yang et al.

Multi-modal large language models (MLLMs) have been given free rein to explore exciting medical applications with a primary focus on radiology report generation. Nevertheless, the preliminary success in 2D radiology captioning is incompetent to reflect the real-world diagnostic challenge in the volumetric 3D anatomy. To mitigate three crucial limitation aspects in the existing literature, including (1) data complexity, (2) model capacity, and (3) evaluation metric fidelity, we collected an 18,885 text-scan pairs 3D-BrainCT dataset and applied clinical visual instruction tuning (CVIT) to train BrainGPT models to generate radiology-adherent 3D brain CT reports. Statistically, our BrainGPT scored BLEU-1 = 44.35, BLEU-4 = 20.38, METEOR = 30.13, ROUGE-L = 47.6, and CIDEr-R = 211.77 during internal testing and demonstrated an accuracy of 0.91 in captioning midline shifts on the external validation CQ500 dataset. By further inspecting the captioned report, we reported that the traditional metrics appeared to measure only the surface text similarity and failed to gauge the information density of the diagnostic purpose. To close this gap, we proposed a novel Feature-Oriented Radiology Task Evaluation (FORTE) to estimate the report's clinical relevance (lesion feature and landmarks). Notably, the BrainGPT model scored an average FORTE F1-score of 0.71 (degree=0.661; landmark=0.706; feature=0.693; impression=0.779). To demonstrate that BrainGPT models possess objective readiness to generate human-like radiology reports, we conducted a Turing test that enrolled 11 physician evaluators, and around 74% of the BrainGPT-generated captions were indistinguishable from those written by humans. Our work embodies a holistic framework that showcased the first-hand experience of curating a 3D brain CT dataset, fine-tuning anatomy-sensible language models, and proposing robust radiology evaluation metrics.

Shaonan Liu, Wenting Chen, Jie Liu et al.

Gaze estimation is pivotal in human scene comprehension tasks, particularly in medical diagnostic analysis. Eye-tracking technology facilitates the recording of physicians' ocular movements during image interpretation, thereby elucidating their visual attention patterns and information-processing strategies. In this paper, we initially define the context-aware gaze estimation problem in medical radiology report settings. To understand the attention allocation and cognitive behavior of radiologists during the medical image interpretation process, we propose a context-aware Gaze EstiMation (GEM) network that utilizes eye gaze data collected from radiologists to simulate their visual search behavior patterns throughout the image interpretation process. It consists of a context-awareness module, visual behavior graph construction, and visual behavior matching. Within the context-awareness module, we achieve intricate multimodal registration by establishing connections between medical reports and images. Subsequently, for a more accurate simulation of genuine visual search behavior patterns, we introduce a visual behavior graph structure, capturing such behavior through high-order relationships (edges) between gaze points (nodes). To maintain the authenticity of visual behavior, we devise a visual behavior-matching approach, adjusting the high-order relationships between them by matching the graph constructed from real and estimated gaze points. Extensive experiments on four publicly available datasets demonstrate the superiority of GEM over existing methods and its strong generalizability, which also provides a new direction for the effective utilization of diverse modalities in medical image interpretation and enhances the interpretability of models in the field of medical imaging. https://github.com/Tiger-SN/GEM

Shengyuan Liu, Liuxin Bao, Qi Yang et al.

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available \href{https://github.com/CUHK-AIM-Group/MedSAM-Agent}{here}.

Bizhu Wu, Jinheng Xie, Wenting Chen et al.

Recent motion-language models unify tasks like comprehension and generation but operate at a coarse granularity, lacking fine-grained understanding and nuanced control over body parts needed for animation or interaction. This stems from fundamental issues in both the model and the data, in which the model can't focus on motion's localized pattern, and the training data lacks fine-grained supervision. To tackle this, we propose MotionMERGE, a unified framework that bridges the granularity gap. First, we pioneer the study of fine-grained languageguided motion control, including detailed understanding and localized editing, by explicitly modeling motion at part and temporal levels within a single LLM, thereby endowing the model with robust priors for precise control. Second, we design ReasoningAware Granularity-Synergy pre-training, a novel strategy that employs joint supervision for cross-granularity alignment, temporal grounding, localized alignment, motion coherency, and motion-grounded chain-of-thought (CoT) reasoning. This equips the model with fine-grained motion-language alignment, crossgranularity synergy, and explicit reasoning ability. Third, we curate MotionFineEdit, a large-scale dataset (837K atomic + 144K complex triplets) with the first fine-grained spatio-temporal corrective instructions and motion-grounded CoT annotations, establishing a new benchmark for fine-grained text-driven motion editing and motion-grounded reasoning. Extensive experiments demonstrate the capability of MotionMERGE for more precise motion generation, understanding, and editing, and compelling zero-shot generalization to other complex motion tasks. This work represents a significant step toward models that interact with motion in finer granularity and human-like reasoning.

Shengyuan Liu, Boyun Zheng, Wenting Chen et al.

Endoscopic procedures are essential for diagnosing and treating internal diseases, and multi-modal large language models (MLLMs) are increasingly applied to assist in endoscopy analysis. However, current benchmarks are limited, as they typically cover specific endoscopic scenarios and a small set of clinical tasks, failing to capture the real-world diversity of endoscopic scenarios and the full range of skills needed in clinical workflows. To address these issues, we introduce EndoBench, the first comprehensive benchmark specifically designed to assess MLLMs across the full spectrum of endoscopic practice with multi-dimensional capacities. EndoBench encompasses 4 distinct endoscopic scenarios, 12 specialized clinical tasks with 12 secondary subtasks, and 5 levels of visual prompting granularities, resulting in 6,832 rigorously validated VQA pairs from 21 diverse datasets. Our multi-dimensional evaluation framework mirrors the clinical workflow--spanning anatomical recognition, lesion analysis, spatial localization, and surgical operations--to holistically gauge the perceptual and diagnostic abilities of MLLMs in realistic scenarios. We benchmark 23 state-of-the-art models, including general-purpose, medical-specialized, and proprietary MLLMs, and establish human clinician performance as a reference standard. Our extensive experiments reveal: (1) proprietary MLLMs outperform open-source and medical-specialized models overall, but still trail human experts; (2) medical-domain supervised fine-tuning substantially boosts task-specific accuracy; and (3) model performance remains sensitive to prompt format and clinical task complexity. EndoBench establishes a new standard for evaluating and advancing MLLMs in endoscopy, highlighting both progress and persistent gaps between current models and expert clinical reasoning. We publicly release our benchmark and code.

Xiaoqin Wang, Xusen Ma, Xianxu Hou et al.

Multimodal large language models (MLLMs) have demonstrated remarkable capabilities in various tasks. However, effectively evaluating these MLLMs on face perception remains largely unexplored. To address this gap, we introduce FaceBench, a dataset featuring hierarchical multi-view and multi-level attributes specifically designed to assess the comprehensive face perception abilities of MLLMs. Initially, we construct a hierarchical facial attribute structure, which encompasses five views with up to three levels of attributes, totaling over 210 attributes and 700 attribute values. Based on the structure, the proposed FaceBench consists of 49,919 visual question-answering (VQA) pairs for evaluation and 23,841 pairs for fine-tuning. Moreover, we further develop a robust face perception MLLM baseline, Face-LLaVA, by training with our proposed face VQA data. Extensive experiments on various mainstream MLLMs and Face-LLaVA are conducted to test their face perception ability, with results also compared against human performance. The results reveal that, the existing MLLMs are far from satisfactory in understanding the fine-grained facial attributes, while our Face-LLaVA significantly outperforms existing open-source models with a small amount of training data and is comparable to commercial ones like GPT-4o and Gemini. The dataset will be released at https://github.com/CVI-SZU/FaceBench.

Peng Zhang, Zhihui Lai, Wenting Chen et al.

Medical vision-language pre-training (VLP) offers significant potential for advancing medical image understanding by leveraging paired image-report data. However, existing methods are limited by Fa}lse Negatives (FaNe) induced by semantically similar texts and insufficient fine-grained cross-modal alignment. To address these limitations, we propose FaNe, a semantic-enhanced VLP framework. To mitigate false negatives, we introduce a semantic-aware positive pair mining strategy based on text-text similarity with adaptive normalization. Furthermore, we design a text-conditioned sparse attention pooling module to enable fine-grained image-text alignment through localized visual representations guided by textual cues. To strengthen intra-modal discrimination, we develop a hard-negative aware contrastive loss that adaptively reweights semantically similar negatives. Extensive experiments on five downstream medical imaging benchmarks demonstrate that FaNe achieves state-of-the-art performance across image classification, object detection, and semantic segmentation, validating the effectiveness of our framework.

Meidan Ding, Jipeng Zhang, Wenxuan Wang et al.

Medical Vision-Language Models (MedVLMs) excel at perception tasks but struggle with complex clinical reasoning required in real-world scenarios. While reinforcement learning (RL) has been explored to enhance reasoning capabilities, existing approaches face critical mismatches: the scarcity of deep reasoning data, cold-start limits multi-specialty alignment, and standard RL algorithms fail to model clinical reasoning diversity. We propose MMedExpert-R1, a novel reasoning MedVLM that addresses these challenges through domain-specific adaptation and clinical guideline reinforcement. We construct MMedExpert, a high-quality dataset of 10K samples across four specialties with step-by-step reasoning traces. Our Domain-Specific Adaptation (DSA) creates specialty-specific LoRA modules to provide diverse initialization, while Guideline-Based Advantages (GBA) explicitly models different clinical reasoning perspectives to align with real-world diagnostic strategies. Conflict-Aware Capability Integration then merges these specialized experts into a unified agent, ensuring robust multi-specialty alignment. Comprehensive experiments demonstrate state-of-the-art performance, with our 7B model achieving 27.50 on MedXpert-MM and 83.03 on OmniMedVQA, establishing a robust foundation for reliable multimodal medical reasoning systems.

Gui Wang, Yuexiang Li, Wenting Chen et al.

Small lesions play a critical role in early disease diagnosis and intervention of severe infections. Popular models often face challenges in segmenting small lesions, as it occupies only a minor portion of an image, while down\_sampling operations may inevitably lose focus on local features of small lesions. To tackle the challenges, we propose a {\bf S}mall-{\bf S}ize-{\bf S}ensitive {\bf Mamba} ({\bf S$^3$-Mamba}), which promotes the sensitivity to small lesions across three dimensions: channel, spatial, and training strategy. Specifically, an Enhanced Visual State Space block is designed to focus on small lesions through multiple residual connections to preserve local features, and selectively amplify important details while suppressing irrelevant ones through channel-wise attention. A Tensor-based Cross-feature Multi-scale Attention is designed to integrate input image features and intermediate-layer features with edge features and exploit the attentive support of features across multiple scales, thereby retaining spatial details of small lesions at various granularities. Finally, we introduce a novel regularized curriculum learning to automatically assess lesion size and sample difficulty, and gradually focus from easy samples to hard ones like small lesions. Extensive experiments on three medical image segmentation datasets show the superiority of our S$^3$-Mamba, especially in segmenting small lesions. Our code is available at https://github.com/ErinWang2023/S3-Mamba.

Meidan Ding, Jipeng Zhang, Wenxuan Wang et al.

Multimodal large language models (MLLMs) hold significant potential in medical applications, including disease diagnosis and clinical decision-making. However, these tasks require highly accurate, context-sensitive, and professionally aligned responses, making reliable reward models and judges critical. Despite their importance, medical reward models (MRMs) and judges remain underexplored, with no dedicated benchmarks addressing clinical requirements. Existing benchmarks focus on general MLLM capabilities or evaluate models as solvers, neglecting essential evaluation dimensions like diagnostic accuracy and clinical relevance. To address this, we introduce Med-RewardBench, the first benchmark specifically designed to evaluate MRMs and judges in medical scenarios. Med-RewardBench features a multimodal dataset spanning 13 organ systems and 8 clinical departments, with 1,026 expert-annotated cases. A rigorous three-step process ensures high-quality evaluation data across six clinically critical dimensions. We evaluate 32 state-of-the-art MLLMs, including open-source, proprietary, and medical-specific models, revealing substantial challenges in aligning outputs with expert judgment. Additionally, we develop baseline models that demonstrate substantial performance improvements through fine-tuning.

Wenting Chen, Jie Liu, Tommy W. S. Chow et al.

Pathology image are essential for accurately interpreting lesion cells in cytopathology screening, but acquiring high-resolution digital slides requires specialized equipment and long scanning times. Though super-resolution (SR) techniques can alleviate this problem, existing deep learning models recover pathology image in a black-box manner, which can lead to untruthful biological details and misdiagnosis. Additionally, current methods allocate the same computational resources to recover each pixel of pathology image, leading to the sub-optimal recovery issue due to the large variation of pathology image. In this paper, we propose the first hierarchical reinforcement learning framework named Spatial-Temporal hierARchical Reinforcement Learning (STAR-RL), mainly for addressing the aforementioned issues in pathology image super-resolution problem. We reformulate the SR problem as a Markov decision process of interpretable operations and adopt the hierarchical recovery mechanism in patch level, to avoid sub-optimal recovery. Specifically, the higher-level spatial manager is proposed to pick out the most corrupted patch for the lower-level patch worker. Moreover, the higher-level temporal manager is advanced to evaluate the selected patch and determine whether the optimization should be stopped earlier, thereby avoiding the over-processed problem. Under the guidance of spatial-temporal managers, the lower-level patch worker processes the selected patch with pixel-wise interpretable actions at each time step. Experimental results on medical images degraded by different kernels show the effectiveness of STAR-RL. Furthermore, STAR-RL validates the promotion in tumor diagnosis with a large margin and shows generalizability under various degradations. The source code is available at https://github.com/CUHK-AIM-Group/STAR-RL.

Wenxuan Wang, Zizhan Ma, Zheng Wang et al.

Large Language Models (LLMs) are transforming healthcare through the development of LLM-based agents that can understand, reason about, and assist with medical tasks. This survey provides a comprehensive review of LLM-based agents in medicine, examining their architectures, applications, and challenges. We analyze the key components of medical agent systems, including system profiles, clinical planning mechanisms, medical reasoning frameworks, and external capacity enhancement. The survey covers major application scenarios such as clinical decision support, medical documentation, training simulations, and healthcare service optimization. We discuss evaluation frameworks and metrics used to assess these agents' performance in healthcare settings. While LLM-based agents show promise in enhancing healthcare delivery, several challenges remain, including hallucination management, multimodal integration, implementation barriers, and ethical considerations. The survey concludes by highlighting future research directions, including advances in medical reasoning inspired by recent developments in LLM architectures, integration with physical systems, and improvements in training simulations. This work provides researchers and practitioners with a structured overview of the current state and future prospects of LLM-based agents in medicine.

Wenting Chen, Linlin Shen, Jingyang Lin et al.

To address these issues, we propose a novel Adaptive patch-word Matching (AdaMatch) model to correlate chest X-ray (CXR) image regions with words in medical reports and apply it to CXR-report generation to provide explainability for the generation process. AdaMatch exploits the fine-grained relation between adaptive patches and words to provide explanations of specific image regions with corresponding words. To capture the abnormal regions of varying sizes and positions, we introduce the Adaptive Patch extraction (AdaPatch) module to acquire the adaptive patches for these regions adaptively. In order to provide explicit explainability for CXR-report generation task, we propose an AdaMatch-based bidirectional large language model for Cyclic CXR-report generation (AdaMatch-Cyclic). It employs the AdaMatch to obtain the keywords for CXR images and `keypatches' for medical reports as hints to guide CXR-report generation. Extensive experiments on two publicly available CXR datasets prove the effectiveness of our method and its superior performance to existing methods.

Filippo Ruffini, Lorenzo Tronchin, Zhuoru Wu et al.

In the fight against the COVID-19 pandemic, leveraging artificial intelligence to predict disease outcomes from chest radiographic images represents a significant scientific aim. The challenge, however, lies in the scarcity of large, labeled datasets with compatible tasks for training deep learning models without leading to overfitting. Addressing this issue, we introduce a novel multi-dataset multi-task training framework that predicts COVID-19 prognostic outcomes from chest X-rays (CXR) by integrating correlated datasets from disparate sources, distant from conventional multi-task learning approaches, which rely on datasets with multiple and correlated labeling schemes. Our framework hypothesizes that assessing severity scores enhances the model's ability to classify prognostic severity groups, thereby improving its robustness and predictive power. The proposed architecture comprises a deep convolutional network that receives inputs from two publicly available CXR datasets, AIforCOVID for severity prognostic prediction and BRIXIA for severity score assessment, and branches into task-specific fully connected output networks. Moreover, we propose a multi-task loss function, incorporating an indicator function, to exploit multi-dataset integration. The effectiveness and robustness of the proposed approach are demonstrated through significant performance improvements in prognosis classification tasks across 18 different convolutional neural network backbones in different evaluation strategies. This improvement is evident over single-task baselines and standard transfer learning strategies, supported by extensive statistical analysis, showing great application potential.

Jie Liu, Wenxuan Wang, Yihang Su et al.

The significant breakthroughs of Medical Multi-Modal Large Language Models (Med-MLLMs) renovate modern healthcare with robust information synthesis and medical decision support. However, these models are often evaluated on benchmarks that are unsuitable for the Med-MLLMs due to the complexity of real-world diagnostics across diverse specialties. To address this gap, we introduce Asclepius, a novel Med-MLLM benchmark that comprehensively assesses Med-MLLMs in terms of: distinct medical specialties (cardiovascular, gastroenterology, etc.) and different diagnostic capacities (perception, disease analysis, etc.). Grounded in 3 proposed core principles, Asclepius ensures a comprehensive evaluation by encompassing 15 medical specialties, stratifying into 3 main categories and 8 sub-categories of clinical tasks, and exempting overlap with existing VQA dataset. We further provide an in-depth analysis of 6 Med-MLLMs and compare them with 3 human specialists, providing insights into their competencies and limitations in various medical contexts. Our work not only advances the understanding of Med-MLLMs' capabilities but also sets a precedent for future evaluations and the safe deployment of these models in clinical environments.

Wenting Chen, Pengyu Wang, Hui Ren et al.

Data scarcity and privacy concerns limit the availability of high-quality medical images for public use, which can be mitigated through medical image synthesis. However, current medical image synthesis methods often struggle to accurately capture the complexity of detailed anatomical structures and pathological conditions. To address these challenges, we propose a novel medical image synthesis model that leverages fine-grained image-text alignment and anatomy-pathology prompts to generate highly detailed and accurate synthetic medical images. Our method integrates advanced natural language processing techniques with image generative modeling, enabling precise alignment between descriptive text prompts and the synthesized images' anatomical and pathological details. The proposed approach consists of two key components: an anatomy-pathology prompting module and a fine-grained alignment-based synthesis module. The anatomy-pathology prompting module automatically generates descriptive prompts for high-quality medical images. To further synthesize high-quality medical images from the generated prompts, the fine-grained alignment-based synthesis module pre-defines a visual codebook for the radiology dataset and performs fine-grained alignment between the codebook and generated prompts to obtain key patches as visual clues, facilitating accurate image synthesis. We validate the superiority of our method through experiments on public chest X-ray datasets and demonstrate that our synthetic images preserve accurate semantic information, making them valuable for various medical applications.

Wenting Chen, Yi Dong, Zhaojun Ding et al.

Chest X ray (CXR) imaging remains a critical diagnostic tool for thoracic conditions, but current automated systems face limitations in pathology coverage, diagnostic accuracy, and integration of visual and textual reasoning. To address these gaps, we propose RadFabric, a multi agent, multimodal reasoning framework that unifies visual and textual analysis for comprehensive CXR interpretation. RadFabric is built on the Model Context Protocol (MCP), enabling modularity, interoperability, and scalability for seamless integration of new diagnostic agents. The system employs specialized CXR agents for pathology detection, an Anatomical Interpretation Agent to map visual findings to precise anatomical structures, and a Reasoning Agent powered by large multimodal reasoning models to synthesize visual, anatomical, and clinical data into transparent and evidence based diagnoses. RadFabric achieves significant performance improvements, with near-perfect detection of challenging pathologies like fractures (1.000 accuracy) and superior overall diagnostic accuracy (0.799) compared to traditional systems (0.229 to 0.527). By integrating cross modal feature alignment and preference-driven reasoning, RadFabric advances AI-driven radiology toward transparent, anatomically precise, and clinically actionable CXR analysis.

Yuci Liang, Xinheng Lyu, Wenting Chen et al.

Recent advancements in computational pathology have produced patch-level Multi-modal Large Language Models (MLLMs), but these models are limited by their inability to analyze whole slide images (WSIs) comprehensively and their tendency to bypass crucial morphological features that pathologists rely on for diagnosis. To address these challenges, we first introduce WSI-Bench, a large-scale morphology-aware benchmark containing 180k VQA pairs from 9,850 WSIs across 30 cancer types, designed to evaluate MLLMs' understanding of morphological characteristics crucial for accurate diagnosis. Building upon this benchmark, we present WSI-LLaVA, a novel framework for gigapixel WSI understanding that employs a three-stage training approach: WSI-text alignment, feature space alignment, and task-specific instruction tuning. To better assess model performance in pathological contexts, we develop two specialized WSI metrics: WSI-Precision and WSI-Relevance. Experimental results demonstrate that WSI-LLaVA outperforms existing models across all capability dimensions, with a significant improvement in morphological analysis, establishing a clear correlation between morphological understanding and diagnostic accuracy.

Zizhan Ma, Wenxuan Wang, Guo Yu et al.

Large language models (LLMs) show significant potential in healthcare, prompting numerous benchmarks to evaluate their capabilities. However, concerns persist regarding the reliability of these benchmarks, which often lack clinical fidelity, robust data management, and safety-oriented evaluation metrics. To address these shortcomings, we introduce MedCheck, the first lifecycle-oriented assessment framework specifically designed for medical benchmarks. Our framework deconstructs a benchmark's development into five continuous stages, from design to governance, and provides a comprehensive checklist of 46 medically-tailored criteria. Using MedCheck, we conducted an in-depth empirical evaluation of 53 medical LLM benchmarks. Our analysis uncovers widespread, systemic issues, including a profound disconnect from clinical practice, a crisis of data integrity due to unmitigated contamination risks, and a systematic neglect of safety-critical evaluation dimensions like model robustness and uncertainty awareness. Based on these findings, MedCheck serves as both a diagnostic tool for existing benchmarks and an actionable guideline to foster a more standardized, reliable, and transparent approach to evaluating AI in healthcare.

Wenxuan Wang, Zizhan Ma, Meidan Ding et al.

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

Jiaqi Yang, Wenting Chen, Xiaohan Xing et al.

Multimodal learning that integrates histopathology images and genomic data holds great promise for cancer survival prediction. However, existing methods face key limitations: 1) They rely on multimodal mapping and metrics in Euclidean space, which cannot fully capture the hierarchical structures in histopathology (among patches from different resolutions) and genomics data (from genes to pathways). 2) They discretize survival time into independent risk intervals, which ignores its continuous and ordinal nature and fails to achieve effective optimization. 3) They treat censorship as a binary indicator, excluding censored samples from model optimization and not making full use of them. To address these challenges, we propose HySurvPred, a novel framework for survival prediction that integrates three key modules: Multimodal Hyperbolic Mapping (MHM), Angle-aware Ranking-based Contrastive Loss (ARCL) and Censor-Conditioned Uncertainty Constraint (CUC). Instead of relying on Euclidean space, we design the MHM module to explore the inherent hierarchical structures within each modality in hyperbolic space. To better integrate multimodal features in hyperbolic space, we introduce the ARCL module, which uses ranking-based contrastive learning to preserve the ordinal nature of survival time, along with the CUC module to fully explore the censored data. Extensive experiments demonstrate that our method outperforms state-of-the-art methods on five benchmark datasets. The source code is to be released.

Guolin Huang, Wenting Chen, Jiaqi Yang et al.

Survival analysis is critical for cancer prognosis and treatment planning, yet existing methods lack the transparency essential for clinical adoption. While recent pathology agents have demonstrated explainability in diagnostic tasks, they face three limitations for survival prediction: inability to integrate multimodal data, ineffective region-of-interest exploration, and failure to leverage experiential learning from historical cases. We introduce SurvAgent, the first hierarchical chain-of-thought (CoT)-enhanced multi-agent system for multimodal survival prediction. SurvAgent consists of two stages: (1) WSI-Gene CoT-Enhanced Case Bank Construction employs hierarchical analysis through Low-Magnification Screening, Cross-Modal Similarity-Aware Patch Mining, and Confidence-Aware Patch Mining for pathology images, while Gene-Stratified analysis processes six functional gene categories. Both generate structured reports with CoT reasoning, storing complete analytical processes for experiential learning. (2) Dichotomy-Based Multi-Expert Agent Inference retrieves similar cases via RAG and integrates multimodal reports with expert predictions through progressive interval refinement. Extensive experiments on five TCGA cohorts demonstrate SurvAgent's superority over conventional methods, proprietary MLLMs, and medical agents, establishing a new paradigm for explainable AI-driven survival prediction in precision oncology.

Boyuan Chen, Sitong Fang, Jiaming Ji et al.

As intelligence increases, so does its shadow. AI deception, in which systems induce false beliefs to secure self-beneficial outcomes, has evolved from a speculative concern to an empirically demonstrated risk across language models, AI agents, and emerging frontier systems. This project provides a comprehensive and up-to-date overview of the AI deception field, covering its core concepts, methodologies, genesis, and potential mitigations. First, we identify a formal definition of AI deception, grounded in signaling theory from studies of animal deception. We then review existing empirical studies and associated risks, highlighting deception as a sociotechnical safety challenge. We organize the landscape of AI deception research as a deception cycle, consisting of two key components: deception emergence and deception treatment. Deception emergence reveals the mechanisms underlying AI deception: systems with sufficient capability and incentive potential inevitably engage in deceptive behaviors when triggered by external conditions. Deception treatment, in turn, focuses on detecting and addressing such behaviors. On deception emergence, we analyze incentive foundations across three hierarchical levels and identify three essential capability preconditions required for deception. We further examine contextual triggers, including supervision gaps, distributional shifts, and environmental pressures. On deception treatment, we conclude detection methods covering benchmarks and evaluation protocols in static and interactive settings. Building on the three core factors of deception emergence, we outline potential mitigation strategies and propose auditing approaches that integrate technical, community, and governance efforts to address sociotechnical challenges and future AI risks. To support ongoing work in this area, we release a living resource at www.deceptionsurvey.com.

Wenxuan Wang, Yongjiang Wu, Junyuan Zhang et al.

The rapid growth of audio-centric platforms and applications such as WhatsApp and Twitter has transformed the way people communicate and share audio content in modern society. However, these platforms are increasingly misused to disseminate harmful audio content, such as hate speech, deceptive advertisements, and explicit material, which can have significant negative consequences (e.g., detrimental effects on mental health). In response, researchers and practitioners have been actively developing and deploying audio content moderation tools to tackle this issue. Despite these efforts, malicious actors can bypass moderation systems by making subtle alterations to audio content, such as modifying pitch or inserting noise. Moreover, the effectiveness of modern audio moderation tools against such adversarial inputs remains insufficiently studied. To address these challenges, we propose MTAM, a Metamorphic Testing framework for Audio content Moderation software. Specifically, we conduct a pilot study on 2000 audio clips and define 14 metamorphic relations across two perturbation categories: Audio Features-Based and Heuristic perturbations. MTAM applies these metamorphic relations to toxic audio content to generate test cases that remain harmful while being more likely to evade detection. In our evaluation, we employ MTAM to test five commercial textual content moderation software and an academic model against three kinds of toxic content. The results show that MTAM achieves up to 38.6%, 18.3%, 35.1%, 16.7%, and 51.1% error finding rates (EFR) when testing commercial moderation software provided by Gladia, Assembly AI, Baidu, Nextdata, and Tencent, respectively, and it obtains up to 45.7% EFR when testing the state-of-the-art algorithms from the academy.

Xinheng Lyu, Yuci Liang, Wenting Chen et al.

Whole slide images (WSIs) are vital in digital pathology, enabling gigapixel tissue analysis across various pathological tasks. While recent advancements in multi-modal large language models (MLLMs) allow multi-task WSI analysis through natural language, they often underperform compared to task-specific models. Collaborative multi-agent systems have emerged as a promising solution to balance versatility and accuracy in healthcare, yet their potential remains underexplored in pathology-specific domains. To address these issues, we propose WSI-Agents, a novel collaborative multi-agent system for multi-modal WSI analysis. WSI-Agents integrates specialized functional agents with robust task allocation and verification mechanisms to enhance both task-specific accuracy and multi-task versatility through three components: (1) a task allocation module assigning tasks to expert agents using a model zoo of patch and WSI level MLLMs, (2) a verification mechanism ensuring accuracy through internal consistency checks and external validation using pathology knowledge bases and domain-specific models, and (3) a summary module synthesizing the final summary with visual interpretation maps. Extensive experiments on multi-modal WSI benchmarks show WSI-Agents's superiority to current WSI MLLMs and medical agent frameworks across diverse tasks.

Shengyuan Liu, Wenting Chen, Boyun Zheng et al.

Tumor data synthesis offers a promising solution to the shortage of annotated medical datasets. However, current approaches either limit tumor diversity by using predefined masks or employ computationally expensive two-stage processes with multiple denoising steps, causing computational inefficiency. Additionally, these methods typically rely on binary masks that fail to capture the gradual transitions characteristic of tumor boundaries. We present TumorGen, a novel Boundary-Aware Tumor-Mask Synthesis with Rectified Flow Matching for efficient 3D tumor synthesis with three key components: a Boundary-Aware Pseudo Mask Generation module that replaces strict binary masks with flexible bounding boxes; a Spatial-Constraint Vector Field Estimator that simultaneously synthesizes tumor latents and masks using rectified flow matching to ensure computational efficiency; and a VAE-guided mask refiner that enhances boundary realism. TumorGen significantly improves computational efficiency by requiring fewer sampling steps while maintaining pathological accuracy through coarse and fine-grained spatial constraints. Experimental results demonstrate TumorGen's superior performance over existing tumor synthesis methods in both efficiency and realism, offering a valuable contribution to AI-driven cancer diagnostics.

Xiaofei Huang, Wenting Chen, Jie Liu et al.

Medical report generation is crucial for clinical diagnosis and patient management, summarizing diagnoses and recommendations based on medical imaging. However, existing work often overlook the clinical pipeline involved in report writing, where physicians typically conduct an initial quick review followed by a detailed examination. Moreover, current alignment methods may lead to misaligned relationships. To address these issues, we propose DAMPER, a dual-stage framework for medical report generation that mimics the clinical pipeline of report writing in two stages. In the first stage, a MeSH-Guided Coarse-Grained Alignment (MCG) stage that aligns chest X-ray (CXR) image features with medical subject headings (MeSH) features to generate a rough keyphrase representation of the overall impression. In the second stage, a Hypergraph-Enhanced Fine-Grained Alignment (HFG) stage that constructs hypergraphs for image patches and report annotations, modeling high-order relationships within each modality and performing hypergraph matching to capture semantic correlations between image regions and textual phrases. Finally,the coarse-grained visual features, generated MeSH representations, and visual hypergraph features are fed into a report decoder to produce the final medical report. Extensive experiments on public datasets demonstrate the effectiveness of DAMPER in generating comprehensive and accurate medical reports, outperforming state-of-the-art methods across various evaluation metrics.

Jie Liu, Wenxuan Wang, Zizhan Ma et al.

Clinical decision making (CDM) is a complex, dynamic process crucial to healthcare delivery, yet it remains a significant challenge for artificial intelligence systems. While Large Language Model (LLM)-based agents have been tested on general medical knowledge using licensing exams and knowledge question-answering tasks, their performance in the CDM in real-world scenarios is limited due to the lack of comprehensive testing datasets that mirror actual medical practice. To address this gap, we present MedChain, a dataset of 12,163 clinical cases that covers five key stages of clinical workflow. MedChain distinguishes itself from existing benchmarks with three key features of real-world clinical practice: personalization, interactivity, and sequentiality. Further, to tackle real-world CDM challenges, we also propose MedChain-Agent, an AI system that integrates a feedback mechanism and a MCase-RAG module to learn from previous cases and adapt its responses. MedChain-Agent demonstrates remarkable adaptability in gathering information dynamically and handling sequential clinical tasks, significantly outperforming existing approaches.

Hongwei Bran Li, Fernando Navarro, Ivan Ezhov et al.

Uncertainty in medical image segmentation tasks, especially inter-rater variability, arising from differences in interpretations and annotations by various experts, presents a significant challenge in achieving consistent and reliable image segmentation. This variability not only reflects the inherent complexity and subjective nature of medical image interpretation but also directly impacts the development and evaluation of automated segmentation algorithms. Accurately modeling and quantifying this variability is essential for enhancing the robustness and clinical applicability of these algorithms. We report the set-up and summarize the benchmark results of the Quantification of Uncertainties in Biomedical Image Quantification Challenge (QUBIQ), which was organized in conjunction with International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2020 and 2021. The challenge focuses on the uncertainty quantification of medical image segmentation which considers the omnipresence of inter-rater variability in imaging datasets. The large collection of images with multi-rater annotations features various modalities such as MRI and CT; various organs such as the brain, prostate, kidney, and pancreas; and different image dimensions 2D-vs-3D. A total of 24 teams submitted different solutions to the problem, combining various baseline models, Bayesian neural networks, and ensemble model techniques. The obtained results indicate the importance of the ensemble models, as well as the need for further research to develop efficient 3D methods for uncertainty quantification methods in 3D segmentation tasks.

Chong Ma, Hanqi Jiang, Wenting Chen et al.

In the medical multi-modal frameworks, the alignment of cross-modality features presents a significant challenge. However, existing works have learned features that are implicitly aligned from the data, without considering the explicit relationships in the medical context. This data-reliance may lead to low generalization of the learned alignment relationships. In this work, we propose the Eye-gaze Guided Multi-modal Alignment (EGMA) framework to harness eye-gaze data for better alignment of medical visual and textual features. We explore the natural auxiliary role of radiologists' eye-gaze data in aligning medical images and text, and introduce a novel approach by using eye-gaze data, collected synchronously by radiologists during diagnostic evaluations. We conduct downstream tasks of image classification and image-text retrieval on four medical datasets, where EGMA achieved state-of-the-art performance and stronger generalization across different datasets. Additionally, we explore the impact of varying amounts of eye-gaze data on model performance, highlighting the feasibility and utility of integrating this auxiliary data into multi-modal alignment framework.

Xinquan Yang, Xuguang Li, Xuechen Li et al.

In implant prosthesis treatment, the design of the surgical guide heavily relies on the manual location of the implant position, which is subjective and prone to doctor's experiences. When deep learning based methods has started to be applied to address this problem, the space between teeth are various and some of them might present similar texture characteristic with the actual implant region. Both problems make a big challenge for the implant position prediction. In this paper, we develop a two-stream implant position regression framework (TSIPR), which consists of an implant region detector (IRD) and a multi-scale patch embedding regression network (MSPENet), to address this issue. For the training of IRD, we extend the original annotation to provide additional supervisory information, which contains much more rich characteristic and do not introduce extra labeling costs. A multi-scale patch embedding module is designed for the MSPENet to adaptively extract features from the images with various tooth spacing. The global-local feature interaction block is designed to build the encoder of MSPENet, which combines the transformer and convolution for enriched feature representation. During inference, the RoI mask extracted from the IRD is used to refine the prediction results of the MSPENet. Extensive experiments on a dental implant dataset through five-fold cross-validation demonstrated that the proposed TSIPR achieves superior performance than existing methods.

Xiaokang Zhang, Yuanlue Zhu, Wenting Chen et al.

Recent studies on multi-domain facial image translation have achieved impressive results. The existing methods generally provide a discriminator with an auxiliary classifier to impose domain translation. However, these methods neglect important information regarding domain distribution matching. To solve this problem, we propose a switch generative adversarial network (SwitchGAN) with a more adaptive discriminator structure and a matched generator to perform delicate image translation among multiple domains. A feature-switching operation is proposed to achieve feature selection and fusion in our conditional modules. We demonstrate the effectiveness of our model. Furthermore, we also introduce a new capability of our generator that represents attribute intensity control and extracts content information without tailored training. Experiments on the Morph, RaFD and CelebA databases visually and quantitatively show that our extended SwitchGAN (i.e., Gated SwitchGAN) can achieve better translation results than StarGAN, AttGAN and STGAN. The attribute classification accuracy achieved using the trained ResNet-18 model and the FID score obtained using the ImageNet pretrained Inception-v3 model also quantitatively demonstrate the superior performance of our models.

Wenting Chen, Shuang Yu, Junde Wu et al.

Retinal artery/vein (A/V) classification lays the foundation for the quantitative analysis of retinal vessels, which is associated with potential risks of various cardiovascular and cerebral diseases. The topological connection relationship, which has been proved effective in improving the A/V classification performance for the conventional graph based method, has not been exploited by the deep learning based method. In this paper, we propose a Topology Ranking Generative Adversarial Network (TR-GAN) to improve the topology connectivity of the segmented arteries and veins, and further to boost the A/V classification performance. A topology ranking discriminator based on ordinal regression is proposed to rank the topological connectivity level of the ground-truth, the generated A/V mask and the intentionally shuffled mask. The ranking loss is further back-propagated to the generator to generate better connected A/V masks. In addition, a topology preserving module with triplet loss is also proposed to extract the high-level topological features and further to narrow the feature distance between the predicted A/V mask and the ground-truth. The proposed framework effectively increases the topological connectivity of the predicted A/V masks and achieves state-of-the-art A/V classification performance on the publicly available AV-DRIVE dataset.

Wenshuang Liu, Wenting Chen, Linlin Shen

Though GAN (Generative Adversarial Networks) based technique has greatly advanced the performance of image synthesis and face translation, only few works available in literature provide region based style encoding and translation. We propose in this paper a region-wise normalization framework, for region level face translation. While per-region style is encoded using available approach, we build a so called RIN (region-wise normalization) block to individually inject the styles into per-region feature maps and then fuse them for following convolution and upsampling. Both shape and texture of different regions can thus be translated to various target styles. A region matching loss has also been proposed to significantly reduce the inference between regions during the translation process. Extensive experiments on three publicly available datasets, i.e. Morph, RaFD and CelebAMask-HQ, suggest that our approach demonstrate a large improvement over state-of-the-art methods like StarGAN, SEAN and FUNIT. Our approach has further advantages in precise control of the regions to be translated. As a result, region level expression changes and step by step make up can be achieved. The video demo is available at https://youtu.be/ceRqsbzXAfk.

Junde Wu, Shuang Yu, Wenting Chen et al.

Recently, deep learning has been adopted to the glaucoma classification task with performance comparable to that of human experts. However, a well trained deep learning model demands a large quantity of properly labeled data, which is relatively expensive since the accurate labeling of glaucoma requires years of specialist training. In order to alleviate this problem, we propose a glaucoma classification framework which takes advantage of not only the properly labeled images, but also undiagnosed images without glaucoma labels. To be more specific, the proposed framework is adapted from the teacher-student-learning paradigm. The teacher model encodes the wrapped information of undiagnosed images to a latent feature space, meanwhile the student model learns from the teacher through knowledge transfer to improve the glaucoma classification. For the model training procedure, we propose a novel training strategy that simulates the real-world teaching practice named as 'Learning To Teach with Knowledge Transfer (L2T-KT)', and establish a 'Quiz Pool' as the teacher's optimization target. Experiments show that the proposed framework is able to utilize the undiagnosed data effectively to improve the glaucoma prediction performance.

WenTing Chen, Xinpeng Xie, Xi Jia et al.

Despite the significant success in image-to-image translation and latent representation based facial attribute editing and expression synthesis, the existing approaches still have limitations in the sharpness of details, distinct image translation and identity preservation. To address these issues, we propose a Texture Deformation Based GAN, namely TDB-GAN, to disentangle texture from original image and transfers domains based on the extracted texture. The approach utilizes the texture to transfer facial attributes and expressions without the consideration of the object pose. This leads to shaper details and more distinct visual effect of the synthesized faces. In addition, it brings the faster convergence during training. The effectiveness of the proposed method is validated through extensive ablation studies. We also evaluate our approach qualitatively and quantitatively on facial attribute and facial expression synthesis. The results on both the CelebA and RaFD datasets suggest that Texture Deformation Based GAN achieves better performance.