Fabrizio Silvestri

Marco Salmè, Federico Siciliano, Fabrizio Silvestri et al.

Radiology Report Generation (RRG) through Vision-Language Models (VLMs) promises to reduce documentation burden, improve reporting consistency, and accelerate clinical workflows. However, their clinical adoption remains limited by the lack of interpretability and the tendency to hallucinate findings misaligned with imaging evidence. Existing research typically treats interpretability and accuracy as separate objectives, with concept-based explainability techniques focusing primarily on transparency, while Retrieval-Augmented Generation (RAG) methods targeting factual grounding through external retrieval. We present Concept-Enhanced Multimodal RAG (CEMRAG), a unified framework that decomposes visual representations into interpretable clinical concepts and integrates them with multimodal RAG. This approach exploits enriched contextual prompts for RRG, improving both interpretability and factual accuracy. Experiments on MIMIC-CXR and IU X-Ray across multiple VLM architectures, training regimes, and retrieval configurations demonstrate consistent improvements over both conventional RAG and concept-only baselines on clinical accuracy metrics and standard NLP measures. These results challenge the assumed trade-off between interpretability and performance, showing that transparent visual concepts can enhance rather than compromise diagnostic accuracy in medical VLMs. Our modular design decomposes interpretability into visual transparency and structured language model conditioning, providing a principled pathway toward clinically trustworthy AI-assisted radiology.

Farooq Ahmad Wani, Alessandro Suglia, Rohit Saxena et al.

The robustness of Vision Language Models (VLMs) is commonly assessed through output-level invariance, implicitly assuming that stable predictions reflect stable multimodal processing. In this work, we argue that this assumption is insufficient. We introduce a representation-aware and frequency-aware evaluation framework that measures internal embedding drift, spectral sensitivity, and structural smoothness (spatial consistency of vision tokens), alongside standard label-based metrics. Applying this framework to modern VLMs across the SEEDBench, MMMU, and POPE datasets reveals three distinct failure modes. First, models frequently preserve predicted answers while undergoing substantial internal representation drift; for perturbations such as text overlays, this drift approaches the magnitude of inter-image variability, indicating that representations move to regions typically occupied by unrelated inputs despite unchanged outputs. Second, robustness does not improve with scale; larger models achieve higher accuracy but exhibit equal or greater sensitivity, consistent with sharper yet more fragile decision boundaries. Third, we find that perturbations affect tasks differently: they harm reasoning when they disrupt how models combine coarse and fine visual cues, but on the hallucination benchmarks, they can reduce false positives by making models generate more conservative answers.