Daily Papers

Recent advances in artificial intelligence reveal the limits of purely predictive systems and call for a shift toward causal and collaborative reasoning. Drawing inspiration from the revolution of Grothendieck in mathematics, we introduce the relativity of causal knowledge, which posits structural causal models (SCMs) are inherently imperfect, subjective representations embedded within networks of relationships. By leveraging category theory, we arrange SCMs into a functor category and show that their observational and interventional probability measures naturally form convex structures. This result allows us to encode non-intervened SCMs with convex spaces of probability measures. Next, using sheaf theory, we construct the network sheaf and cosheaf of causal knowledge. These structures enable the transfer of causal knowledge across the network while incorporating interventional consistency and the perspective of the subjects, ultimately leading to the formal, mathematical definition of relative causal knowledge.

Machine Learning methods can learn how to reconstruct Magnetic Resonance Images and thereby accelerate acquisition, which is of paramount importance to the clinical workflow. Physics-informed networks incorporate the forward model of accelerated MRI reconstruction in the learning process. With increasing network complexity, robustness is not ensured when reconstructing data unseen during training. We aim to embed data consistency (DC) in deep networks while balancing the degree of network complexity. While doing so, we will assess whether either explicit or implicit enforcement of DC in varying network architectures is preferred to optimize performance. We propose a scheme called Cascades of Independently Recurrent Inference Machines (CIRIM) to assess DC through unrolled optimization. Herein we assess DC both implicitly by gradient descent and explicitly by a designed term. Extensive comparison of the CIRIM to CS as well as to other methods is performed: the E2EVN, CascadeNet, KIKINet, LPDNet, RIM, IRIM, and UNet. Models were trained and evaluated on T1-weighted and FLAIR contrast brain data, and T2-weighted knee data. Both 1D and 2D undersampling patterns were evaluated. Robustness was tested by reconstructing 7.5x prospectively undersampled 3D FLAIR MRI data of Multiple Sclerosis (MS) patients with white matter lesions. The CIRIM performed best when implicitly enforcing DC, while the E2EVN required an explicit DC formulation. In reconstructing MS patient data, prospectively acquired with a sampling pattern unseen during model training, the CIRIM maintained lesion contrast while efficiently denoising the images. The CIRIM showed highly promising generalization capabilities maintaining a very fair trade-off between reconstructed image quality and fast reconstruction times, which is crucial in the clinical workflow.

Previous research on radiology report generation has made significant progress in terms of increasing the clinical accuracy of generated reports. In this paper, we emphasize another crucial quality that it should possess, i.e., inter-report consistency, which refers to the capability of generating consistent reports for semantically equivalent radiographs. This quality is even of greater significance than the overall report accuracy in terms of ensuring the system's credibility, as a system prone to providing conflicting results would severely erode users' trust. Regrettably, existing approaches struggle to maintain inter-report consistency, exhibiting biases towards common patterns and susceptibility to lesion variants. To address this issue, we propose ICON, which improves the inter-report consistency of radiology report generation. Aiming at enhancing the system's ability to capture the similarities in semantically equivalent lesions, our approach involves first extracting lesions from input images and examining their characteristics. Then, we introduce a lesion-aware mix-up augmentation technique to ensure that the representations of the semantically equivalent lesions align with the same attributes, by linearly interpolating them during the training phase. Extensive experiments on three publicly available chest X-ray datasets verify the effectiveness of our approach, both in terms of improving the consistency and accuracy of the generated reports.

Recent advances in AI foundation models have significant potential for lightening the clinical workload by mimicking the comprehensive and multi-faceted approaches used by medical professionals. In the field of radiation oncology, the integration of multiple modalities holds great importance, so the opportunity of foundational model is abundant. Inspired by this, here we present RO-LMM, a multi-purpose, comprehensive large multimodal model (LMM) tailored for the field of radiation oncology. This model effectively manages a series of tasks within the clinical workflow, including clinical context summarization, radiation treatment plan suggestion, and plan-guided target volume segmentation by leveraging the capabilities of LMM. In particular, to perform consecutive clinical tasks without error accumulation, we present a novel Consistency Embedding Fine-Tuning (CEFTune) technique, which boosts LMM's robustness to noisy inputs while preserving the consistency of handling clean inputs. We further extend this concept to LMM-driven segmentation framework, leading to a novel Consistency Embedding Segmentation~(CESEG) techniques. Experimental results including multi-centre validation confirm that our RO-LMM with CEFTune and CESEG results in promising performance for multiple clinical tasks with generalization capabilities.

Flow matching (FM) is a general framework for defining probability paths via Ordinary Differential Equations (ODEs) to transform between noise and data samples. Recent approaches attempt to straighten these flow trajectories to generate high-quality samples with fewer function evaluations, typically through iterative rectification methods or optimal transport solutions. In this paper, we introduce Consistency Flow Matching (Consistency-FM), a novel FM method that explicitly enforces self-consistency in the velocity field. Consistency-FM directly defines straight flows starting from different times to the same endpoint, imposing constraints on their velocity values. Additionally, we propose a multi-segment training approach for Consistency-FM to enhance expressiveness, achieving a better trade-off between sampling quality and speed. Preliminary experiments demonstrate that our Consistency-FM significantly improves training efficiency by converging 4.4x faster than consistency models and 1.7x faster than rectified flow models while achieving better generation quality. Our code is available at: https://github.com/YangLing0818/consistency_flow_matching

This study quantifies the association between non-adherence to antipsychotic medications and adverse outcomes in individuals with schizophrenia. We frame the problem using survival analysis, focusing on the time to the earliest of several adverse events (early death, involuntary hospitalization, jail booking). We extend standard causal inference methods (T-learner, S-learner, nearest neighbor matching) to utilize various survival models to estimate individual and average treatment effects, where treatment corresponds to medication non-adherence. Analyses are repeated using different amounts of longitudinal information (3, 6, 9, and 12 months). Using data from Allegheny County in western Pennsylvania, we find strong evidence that non-adherence advances adverse outcomes by approximately 1 to 4 months. Ablation studies confirm that county-provided risk scores adjust for key confounders, as their removal amplifies the estimated effects. Subgroup analyses by medication formulation (injectable vs. oral) and medication type consistently show that non-adherence is associated with earlier adverse events. These findings highlight the clinical importance of adherence in delaying psychiatric crises and show that integrating survival analysis with causal inference tools can yield policy-relevant insights. We caution that although we apply causal inference, we only make associative claims and discuss assumptions needed for causal interpretation.

As LLM-based agents are deployed in production systems, understanding their behavioral consistency (whether they produce similar action sequences when given identical tasks) becomes critical for reliability. We study consistency in the context of SWE-bench, a challenging software engineering benchmark requiring complex, multi-step reasoning. Comparing Claude~4.5~Sonnet, GPT-5, and Llama-3.1-70B across 50 runs each (10 tasks times 5 runs), we find that across models, higher consistency aligns with higher accuracy: Claude achieves the lowest variance (CV: 15.2\%) and highest accuracy (58\%), GPT-5 is intermediate (CV: 32.2\%, accuracy: 32\%), and Llama shows the highest variance (CV: 47.0\%) with lowest accuracy (4\%). However, within a model, consistency can amplify both correct and incorrect interpretations. Our analysis reveals a critical nuance: consistency amplifies outcomes rather than guaranteeing correctness. 71\% of Claude's failures stem from "consistent wrong interpretation": making the same incorrect assumption across all runs. Interestingly, GPT-5 achieves similar early strategic agreement as Claude (diverging at step 3.4 vs.\ 3.2) but exhibits 2.1times higher variance, suggesting that divergence timing alone does not determine consistency. These findings suggest that for production deployment, interpretation accuracy matters more than execution consistency, with implications for agent evaluation and training.

This study demonstrates that incorporating a consistency heuristic into the point-matching algorithm yerebakan2023hierarchical improves robustness in matching anatomical locations across pairs of medical images. We validated our approach on diverse longitudinal internal and public datasets spanning CT and MRI modalities. Notably, it surpasses state-of-the-art results on the Deep Lesion Tracking dataset. Additionally, we show that the method effectively addresses landmark localization. The algorithm operates efficiently on standard CPU hardware and allows configurable trade-offs between speed and robustness. The method enables high-precision navigation between medical images without requiring a machine learning model or training data.

Counterfactual prompting (i.e., perturbing a single factor and measuring output change) is widely used to evaluate things like LLM bias and CoT faithfulness. But in this work we argue that observed effects cannot be attributed to the targeted factor without accounting for baseline ``meaning-preserving'' modifications to text that establish general model sensitivity. This is because every counterfactual edit is a compound treatment that bundles the variable of interest with incidental surface-form variation; this violates treatment variation irrelevance. We observe prediction flip rates on MedQA of 14.9% when we surgically change patient gender. However, this is statistically indistinguishable from the flip rates induced by simply paraphrasing inputs (14.1%). In this case, it would therefore be unwarranted to conclude that the LLM is especially sensitive to patient gender. To account for this and robustly measure the effects of targeted interventions, we propose a framework in which we compare (via statistical testing) differences observed under target interventions to those induced by paraphrasing inputs. We then use this framework to revisit a analysis done on the MedPerturb dataset, which reported evidence of model sensitivity to patient demographics and stylistic cues. We find that these effects largely dissipate when we account for general model sensitivity, with only 5 of 120 tests reaching statistical significance. Applying the same framework to occupational biography classification, we detect clearly significant directional gender bias, showing that the framework identifies real directional effects even when they are small. We evaluate a range of metrics -- aggregate, per-sample distributional, and regression -- and find that per-sample metrics are dramatically more powerful than aggregate metrics and regression powerfully and uniquely characterizes effect direction and magnitude.

Consistency models are a nascent family of generative models that can sample high quality data in one step without the need for adversarial training. Current consistency models achieve optimal sample quality by distilling from pre-trained diffusion models and employing learned metrics such as LPIPS. However, distillation limits the quality of consistency models to that of the pre-trained diffusion model, and LPIPS causes undesirable bias in evaluation. To tackle these challenges, we present improved techniques for consistency training, where consistency models learn directly from data without distillation. We delve into the theory behind consistency training and identify a previously overlooked flaw, which we address by eliminating Exponential Moving Average from the teacher consistency model. To replace learned metrics like LPIPS, we adopt Pseudo-Huber losses from robust statistics. Additionally, we introduce a lognormal noise schedule for the consistency training objective, and propose to double total discretization steps every set number of training iterations. Combined with better hyperparameter tuning, these modifications enable consistency models to achieve FID scores of 2.51 and 3.25 on CIFAR-10 and ImageNet 64times 64 respectively in a single sampling step. These scores mark a 3.5times and 4times improvement compared to prior consistency training approaches. Through two-step sampling, we further reduce FID scores to 2.24 and 2.77 on these two datasets, surpassing those obtained via distillation in both one-step and two-step settings, while narrowing the gap between consistency models and other state-of-the-art generative models.

Large language models (LLMs) appear to bias their survey answers toward certain values. Nonetheless, some argue that LLMs are too inconsistent to simulate particular values. Are they? To answer, we first define value consistency as the similarity of answers across (1) paraphrases of one question, (2) related questions under one topic, (3) multiple-choice and open-ended use-cases of one question, and (4) multilingual translations of a question to English, Chinese, German, and Japanese. We apply these measures to a few large (>=34b), open LLMs including llama-3, as well as gpt-4o, using eight thousand questions spanning more than 300 topics. Unlike prior work, we find that models are relatively consistent across paraphrases, use-cases, translations, and within a topic. Still, some inconsistencies remain. Models are more consistent on uncontroversial topics (e.g., in the U.S., "Thanksgiving") than on controversial ones ("euthanasia"). Base models are both more consistent compared to fine-tuned models and are uniform in their consistency across topics, while fine-tuned models are more inconsistent about some topics ("euthanasia") than others ("women's rights") like our human subjects (n=165).

Consistency Training (CT) has recently emerged as a promising alternative to diffusion models, achieving competitive performance in image generation tasks. However, non-distillation consistency training often suffers from high variance and instability, and analyzing and improving its training dynamics is an active area of research. In this work, we propose a novel CT training approach based on the Flow Matching framework. Our main contribution is a trained noise-coupling scheme inspired by the architecture of Variational Autoencoders (VAE). By training a data-dependent noise emission model implemented as an encoder architecture, our method can indirectly learn the geometry of the noise-to-data mapping, which is instead fixed by the choice of the forward process in classical CT. Empirical results across diverse image datasets show significant generative improvements, with our model outperforming baselines and achieving the state-of-the-art (SoTA) non-distillation CT FID on CIFAR-10, and attaining FID on par with SoTA on ImageNet at 64 times 64 resolution in 2-step generation. Our code is available at https://github.com/sony/vct .

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice.

Vision-grounded medical report generation aims to produce clinically accurate descriptions of medical images, anchored in explicit visual evidence to improve interpretability and facilitate integration into clinical workflows. However, existing methods often rely on separately trained detection modules that require extensive expert annotations, introducing high labeling costs and limiting generalizability due to pathology distribution bias across datasets. To address these challenges, we propose Self-Supervised Anatomical Consistency Learning (SS-ACL) -- a novel and annotation-free framework that aligns generated reports with corresponding anatomical regions using simple textual prompts. SS-ACL constructs a hierarchical anatomical graph inspired by the invariant top-down inclusion structure of human anatomy, organizing entities by spatial location. It recursively reconstructs fine-grained anatomical regions to enforce intra-sample spatial alignment, inherently guiding attention maps toward visually relevant areas prompted by text. To further enhance inter-sample semantic alignment for abnormality recognition, SS-ACL introduces a region-level contrastive learning based on anatomical consistency. These aligned embeddings serve as priors for report generation, enabling attention maps to provide interpretable visual evidence. Extensive experiments demonstrate that SS-ACL, without relying on expert annotations, (i) generates accurate and visually grounded reports -- outperforming state-of-the-art methods by 10\% in lexical accuracy and 25\% in clinical efficacy, and (ii) achieves competitive performance on various downstream visual tasks, surpassing current leading visual foundation models by 8\% in zero-shot visual grounding.

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

Diffusion models achieve superior generation quality but suffer from slow generation speed due to the iterative nature of denoising. In contrast, consistency models, a new generative family, achieve competitive performance with significantly faster sampling. These models are trained either through consistency distillation, which leverages pretrained diffusion models, or consistency training/tuning directly from raw data. In this work, we propose a novel framework for understanding consistency models by modeling the denoising process of the diffusion model as a Markov Decision Process (MDP) and framing consistency model training as the value estimation through Temporal Difference~(TD) Learning. More importantly, this framework allows us to analyze the limitations of current consistency training/tuning strategies. Built upon Easy Consistency Tuning (ECT), we propose Stable Consistency Tuning (SCT), which incorporates variance-reduced learning using the score identity. SCT leads to significant performance improvements on benchmarks such as CIFAR-10 and ImageNet-64. On ImageNet-64, SCT achieves 1-step FID 2.42 and 2-step FID 1.55, a new SoTA for consistency models.

Standard practice within Reinforcement Learning from Human Feedback (RLHF) involves optimizing against a Reward Model (RM), which itself is trained to reflect human preferences for desirable generations. A notable subject that is understudied is the (in-)consistency of RMs -- whether they can recognize the semantic changes to different prompts and appropriately adapt their reward assignments -- and their impact on the downstream RLHF model. In this paper, we visit a series of research questions relevant to RM inconsistency: (1) How can we measure the consistency of reward models? (2) How consistent are the existing RMs and how can we improve them? (3) In what ways does reward inconsistency influence the chatbots resulting from the RLHF model training? We propose Contrast Instructions -- a benchmarking strategy for the consistency of RM. Each example in Contrast Instructions features a pair of lexically similar instructions with different ground truth responses. A consistent RM is expected to rank the corresponding instruction and response higher than other combinations. We observe that current RMs trained with the standard ranking objective fail miserably on Contrast Instructions compared to average humans. To show that RM consistency can be improved efficiently without using extra training budget, we propose two techniques ConvexDA and RewardFusion, which enhance reward consistency through extrapolation during the RM training and inference stage, respectively. We show that RLHF models trained with a more consistent RM yield more useful responses, suggesting that reward inconsistency exhibits a trickle-down effect on the downstream RLHF process.

Preference optimization methods typically begin training with a well-trained SFT model as a reference model. In RLHF and DPO, a regularization term is used during the preference optimization process to prevent the policy model from deviating too far from the reference model's distribution, thereby avoiding the generation of anomalous responses. When the reference model is already well-aligned with the given data or only requires slight adjustments, this approach can produce a well-aligned model. However, if the reference model is not aligned with the given data and requires significant deviation from its current state, a regularization term may actually hinder the model alignment. In this study, we propose Modulated Intervention Preference Optimization (MIPO) to address this issue. MIPO modulates the degree of intervention from the reference model based on how well the given data is aligned with it. If the data is well-aligned, the intervention is increased to prevent the policy model from diverging significantly from reference model. Conversely, if the alignment is poor, the interference is reduced to facilitate more extensive training. We compare the performance of MIPO and DPO using Mistral-7B and Llama3-8B in Alpaca Eval 2.0 and MT-Bench. The experimental results demonstrate that MIPO consistently outperforms DPO across various evaluation scenarios.

Large Language Model (LLM)-powered multi-agent systems (MAS) have rapidly advanced collaborative reasoning, tool use, and role-specialized coordination in complex tasks. However, reliability-critical deployment remains hindered by a systemic failure mode: hierarchical compliance under instruction conflicts (system-user, peer-peer), where agents misprioritize system-level rules in the presence of competing demands. Moreover, widely used macro-level metrics (e.g., pass@k) obscure these micro-level violations and offer little actionable guidance for remedy. In this work, we present a full-stack, three-stage framework: (1) Diagnose - Contextualized Role Adherence Score (CRAS), a query-wise, context-aware scoring metric that decomposes role adherence into four measurable dimensions; (2) Localize - attention drift analysis revealing that instruction conflicts are resolved by attention heads that are largely concentrated in middle layers; (3) Align - Surgical Alignment of Instruction Layers (SAIL), which installs LoRA only on the localized focal layers and optimizes a token-weighted DPO-style preference objective that credits tokens by their focal attentional contribution. Across standard benchmarks and MAS frameworks, our surgical approach improves instruction hierarchy compliance (e.g., +5.60% with AutoGen on MedQA) without full-model finetuning.

We introduce the Agent GPA (Goal-Plan-Action) framework: an evaluation paradigm based on an agent's operational loop of setting goals, devising plans, and executing actions. The framework includes five evaluation metrics: Goal Fulfillment, Logical Consistency, Execution Efficiency, Plan Quality, and Plan Adherence. Logical Consistency checks that an agent's actions are consistent with its prior actions. Execution Efficiency checks whether the agent executes in the most efficient way to achieve its goal. Plan Quality checks whether an agent's plans are aligned with its goals; Plan Adherence checks if an agent's actions are aligned with its plan; and Goal Fulfillment checks that agent's final outcomes match the stated goals. Our experimental results on two benchmark datasets - the public TRAIL/GAIA dataset and an internal dataset for a production-grade data agent - show that this framework (a) provides a systematic way to cover a broad range of agent failures, including all agent errors on the TRAIL/GAIA benchmark dataset; (b) supports LLM-judges that exhibit strong agreement with human annotation, covering 80% to over 95% errors; and (c) localizes errors with 86% agreement to enable targeted improvement of agent performance.

Segmentation of the main coronary artery from X-ray coronary angiography (XCA) sequences is crucial for the diagnosis of coronary artery diseases. However, this task is challenging due to issues such as blurred boundaries, inconsistent radiation contrast, complex motion patterns, and a lack of annotated images for training. Although Semi-Supervised Learning (SSL) can alleviate the annotation burden, conventional methods struggle with complicated temporal dynamics and unreliable uncertainty quantification. To address these challenges, we propose SAM3-based Teacher-student framework with Motion-Aware consistency and Progressive Confidence Regularization (SMART), a semi-supervised vessel segmentation approach for X-ray angiography videos. First, our method utilizes SAM3's unique promptable concept segmentation design and innovates a SAM3-based teacher-student framework to maximize the performance potential of both the teacher and the student. Second, we enhance segmentation by integrating the vessel mask warping technique and motion consistency loss to model complex vessel dynamics. To address the issue of unreliable teacher predictions caused by blurred boundaries and minimal contrast, we further propose a progressive confidence-aware consistency regularization to mitigate the risk of unreliable outputs. Extensive experiments on three datasets of XCA sequences from different institutions demonstrate that SMART achieves state-of-the-art performance while requiring significantly fewer annotations, making it particularly valuable for real-world clinical applications where labeled data is scarce. Our code is available at: https://github.com/qimingfan10/SMART.

Existing machine learning methods for causal inference usually estimate quantities expressed via the mean of potential outcomes (e.g., average treatment effect). However, such quantities do not capture the full information about the distribution of potential outcomes. In this work, we estimate the density of potential outcomes after interventions from observational data. For this, we propose a novel, fully-parametric deep learning method called Interventional Normalizing Flows. Specifically, we combine two normalizing flows, namely (i) a nuisance flow for estimating nuisance parameters and (ii) a target flow for parametric estimation of the density of potential outcomes. We further develop a tractable optimization objective based on a one-step bias correction for efficient and doubly robust estimation of the target flow parameters. As a result, our Interventional Normalizing Flows offer a properly normalized density estimator. Across various experiments, we demonstrate that our Interventional Normalizing Flows are expressive and highly effective, and scale well with both sample size and high-dimensional confounding. To the best of our knowledge, our Interventional Normalizing Flows are the first proper fully-parametric, deep learning method for density estimation of potential outcomes.

This paper proposes ConsistDreamer - a novel framework that lifts 2D diffusion models with 3D awareness and 3D consistency, thus enabling high-fidelity instruction-guided scene editing. To overcome the fundamental limitation of missing 3D consistency in 2D diffusion models, our key insight is to introduce three synergetic strategies that augment the input of the 2D diffusion model to become 3D-aware and to explicitly enforce 3D consistency during the training process. Specifically, we design surrounding views as context-rich input for the 2D diffusion model, and generate 3D-consistent, structured noise instead of image-independent noise. Moreover, we introduce self-supervised consistency-enforcing training within the per-scene editing procedure. Extensive evaluation shows that our ConsistDreamer achieves state-of-the-art performance for instruction-guided scene editing across various scenes and editing instructions, particularly in complicated large-scale indoor scenes from ScanNet++, with significantly improved sharpness and fine-grained textures. Notably, ConsistDreamer stands as the first work capable of successfully editing complex (e.g., plaid/checkered) patterns. Our project page is at immortalco.github.io/ConsistDreamer.

Any-to-any generative models aim to enable seamless interpretation and generation across multiple modalities within a unified framework, yet their ability to preserve relationships across modalities remains uncertain. Do unified models truly achieve cross-modal coherence, or is this coherence merely perceived? To explore this, we introduce ACON, a dataset of 1,000 images (500 newly contributed) paired with captions, editing instructions, and Q&A pairs to evaluate cross-modal transfers rigorously. Using three consistency criteria-cyclic consistency, forward equivariance, and conjugated equivariance-our experiments reveal that any-to-any models do not consistently demonstrate greater cross-modal consistency than specialized models in pointwise evaluations such as cyclic consistency. However, equivariance evaluations uncover weak but observable consistency through structured analyses of the intermediate latent space enabled by multiple editing operations. We release our code and data at https://github.com/JiwanChung/ACON.

Medical image editing has emerged as a pivotal technology with broad applications in data augmentation, model interpretability, medical education, and treatment simulation. However, the lack of large-scale, high-quality, and openly accessible datasets tailored for medical contexts with strict anatomical and clinical constraints has significantly hindered progress in this domain. To bridge this gap, we introduce Med-Banana-50K, a comprehensive dataset of over 50k medically curated image edits spanning chest X-ray, brain MRI, and fundus photography across 23 diseases. Each sample supports bidirectional lesion editing (addition and removal) and is constructed using Gemini-2.5-Flash-Image based on real clinical images. A key differentiator of our dataset is the medically grounded quality control protocol: we employ an LLM-as-Judge evaluation framework with criteria such as instruction compliance, structural plausibility, image realism, and fidelity preservation, alongside iterative refinement over up to five rounds. Additionally, Med-Banana-50K includes around 37,000 failed editing attempts with full evaluation logs to support preference learning and alignment research. By offering a large-scale, medically rigorous, and fully documented resource, Med-Banana-50K establishes a critical foundation for developing and evaluating reliable medical image editing systems. Our dataset and code are publicly available. [https://github.com/richardChenzhihui/med-banana-50k].

Disease progression simulation is a crucial area of research that has significant implications for clinical diagnosis, prognosis, and treatment. One major challenge in this field is the lack of continuous medical imaging monitoring of individual patients over time. To address this issue, we develop a novel framework termed Progressive Image Editing (PIE) that enables controlled manipulation of disease-related image features, facilitating precise and realistic disease progression simulation. Specifically, we leverage recent advancements in text-to-image generative models to simulate disease progression accurately and personalize it for each patient. We theoretically analyze the iterative refining process in our framework as a gradient descent with an exponentially decayed learning rate. To validate our framework, we conduct experiments in three medical imaging domains. Our results demonstrate the superiority of PIE over existing methods such as Stable Diffusion Walk and Style-Based Manifold Extrapolation based on CLIP score (Realism) and Disease Classification Confidence (Alignment). Our user study collected feedback from 35 veteran physicians to assess the generated progressions. Remarkably, 76.2% of the feedback agrees with the fidelity of the generated progressions. To our best knowledge, PIE is the first of its kind to generate disease progression images meeting real-world standards. It is a promising tool for medical research and clinical practice, potentially allowing healthcare providers to model disease trajectories over time, predict future treatment responses, and improve patient outcomes.

Diffusion models have recently emerged as powerful generative priors for solving inverse problems. However, training diffusion models in the pixel space are both data-intensive and computationally demanding, which restricts their applicability as priors for high-dimensional real-world data such as medical images. Latent diffusion models, which operate in a much lower-dimensional space, offer a solution to these challenges. However, incorporating latent diffusion models to solve inverse problems remains a challenging problem due to the nonlinearity of the encoder and decoder. To address these issues, we propose ReSample, an algorithm that can solve general inverse problems with pre-trained latent diffusion models. Our algorithm incorporates data consistency by solving an optimization problem during the reverse sampling process, a concept that we term as hard data consistency. Upon solving this optimization problem, we propose a novel resampling scheme to map the measurement-consistent sample back onto the noisy data manifold and theoretically demonstrate its benefits. Lastly, we apply our algorithm to solve a wide range of linear and nonlinear inverse problems in both natural and medical images, demonstrating that our approach outperforms existing state-of-the-art approaches, including those based on pixel-space diffusion models.

Despite remarkable progress in Text-to-Image models, many real-world applications require generating coherent image sets with diverse consistency requirements. Existing consistent methods often focus on a specific domain with specific aspects of consistency, which significantly constrains their generalizability to broader applications. In this paper, we propose a more challenging problem, Text-to-ImageSet (T2IS) generation, which aims to generate sets of images that meet various consistency requirements based on user instructions. To systematically study this problem, we first introduce T2IS-Bench with 596 diverse instructions across 26 subcategories, providing comprehensive coverage for T2IS generation. Building on this, we propose T2IS-Eval, an evaluation framework that transforms user instructions into multifaceted assessment criteria and employs effective evaluators to adaptively assess consistency fulfillment between criteria and generated sets. Subsequently, we propose AutoT2IS, a training-free framework that maximally leverages pretrained Diffusion Transformers' in-context capabilities to harmonize visual elements to satisfy both image-level prompt alignment and set-level visual consistency. Extensive experiments on T2IS-Bench reveal that diverse consistency challenges all existing methods, while our AutoT2IS significantly outperforms current generalized and even specialized approaches. Our method also demonstrates the ability to enable numerous underexplored real-world applications, confirming its substantial practical value. Visit our project in https://chengyou-jia.github.io/T2IS-Home.

Consistency models have been proposed for fast generative modeling, achieving results competitive with diffusion and flow models. However, these methods exhibit inherent instability and limited reproducibility when training from scratch, motivating subsequent work to explain and stabilize these issues. While these efforts have provided valuable insights, the explanations remain fragmented, and the theoretical relationships remain unclear. In this work, we provide a theoretical examination of consistency models by analyzing them from a flow map-based perspective. This joint analysis clarifies how training stability and convergence behavior can give rise to degenerate solutions. Building on these insights, we revisit self-distillation as a practical remedy for certain forms of suboptimal convergence and reformulate it to avoid excessive gradient norms for stable optimization. We further demonstrate that our strategy extends beyond image generation to diffusion-based policy learning, without reliance on a pretrained diffusion model for initialization, thereby illustrating its broader applicability.

The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for cancer treatment. Translating complex patient presentations into guideline-compliant treatment recommendations is time-intensive, requires specialized expertise, and is prone to error. Advances in large language model (LLM) capabilities promise to reduce the time required to generate treatment recommendations and improve accuracy. We present an LLM agent-based approach to automatically generate guideline-concordant treatment trajectories for patients with non-small cell lung cancer (NSCLC). Our contributions are threefold. First, we construct a novel longitudinal dataset of 121 cases of NSCLC patients that includes clinical encounters, diagnostic results, and medical histories, each expertly annotated with the corresponding NCCN guideline trajectories by board-certified oncologists. Second, we demonstrate that existing LLMs possess domain-specific knowledge that enables high-quality proxy benchmark generation for both model development and evaluation, achieving strong correlation (Spearman coefficient r=0.88, RMSE = 0.08) with expert-annotated benchmarks. Third, we develop a hybrid approach combining expensive human annotations with model consistency information to create both the agent framework that predicts the relevant guidelines for a patient, as well as a meta-classifier that verifies prediction accuracy with calibrated confidence scores for treatment recommendations (AUROC=0.800), a critical capability for communicating the accuracy of outputs, custom-tailoring tradeoffs in performance, and supporting regulatory compliance. This work establishes a framework for clinically viable LLM-based guideline adherence systems that balance accuracy, interpretability, and regulatory requirements while reducing annotation costs, providing a scalable pathway toward automated clinical decision support.

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

Consistency models (CMs) are a powerful class of diffusion-based generative models optimized for fast sampling. Most existing CMs are trained using discretized timesteps, which introduce additional hyperparameters and are prone to discretization errors. While continuous-time formulations can mitigate these issues, their success has been limited by training instability. To address this, we propose a simplified theoretical framework that unifies previous parameterizations of diffusion models and CMs, identifying the root causes of instability. Based on this analysis, we introduce key improvements in diffusion process parameterization, network architecture, and training objectives. These changes enable us to train continuous-time CMs at an unprecedented scale, reaching 1.5B parameters on ImageNet 512x512. Our proposed training algorithm, using only two sampling steps, achieves FID scores of 2.06 on CIFAR-10, 1.48 on ImageNet 64x64, and 1.88 on ImageNet 512x512, narrowing the gap in FID scores with the best existing diffusion models to within 10%.

The growing availability of longitudinal Magnetic Resonance Imaging (MRI) datasets has facilitated Artificial Intelligence (AI)-driven modeling of disease progression, making it possible to predict future medical scans for individual patients. However, despite significant advancements in AI, current methods continue to face challenges including achieving patient-specific individualization, ensuring spatiotemporal consistency, efficiently utilizing longitudinal data, and managing the substantial memory demands of 3D scans. To address these challenges, we propose Brain Latent Progression (BrLP), a novel spatiotemporal model designed to predict individual-level disease progression in 3D brain MRIs. The key contributions in BrLP are fourfold: (i) it operates in a small latent space, mitigating the computational challenges posed by high-dimensional imaging data; (ii) it explicitly integrates subject metadata to enhance the individualization of predictions; (iii) it incorporates prior knowledge of disease dynamics through an auxiliary model, facilitating the integration of longitudinal data; and (iv) it introduces the Latent Average Stabilization (LAS) algorithm, which (a) enforces spatiotemporal consistency in the predicted progression at inference time and (b) allows us to derive a measure of the uncertainty for the prediction at the global and voxel level. We train and evaluate BrLP on 11,730 T1-weighted (T1w) brain MRIs from 2,805 subjects and validate its generalizability on an external test set comprising 2,257 MRIs from 962 subjects. Our experiments compare BrLP-generated MRI scans with real follow-up MRIs, demonstrating state-of-the-art accuracy compared to existing methods. The code is publicly available at: https://github.com/LemuelPuglisi/BrLP.

Self-alignment, whereby models learn to improve themselves without human annotation, is a rapidly growing research area. However, existing techniques often fail to improve complex reasoning tasks due to the difficulty of assigning correct rewards. An orthogonal approach that is known to improve correctness is self-consistency, a method applied at inference time based on multiple sampling in order to find the most consistent answer. In this work, we extend the self-consistency concept to help train models. We thus introduce self-consistency preference optimization (ScPO), which iteratively trains consistent answers to be preferred over inconsistent ones on unsupervised new problems. We show ScPO leads to large improvements over conventional reward model training on reasoning tasks such as GSM8K and MATH, closing the gap with supervised training with gold answers or preferences, and that combining ScPO with standard supervised learning improves results even further. On ZebraLogic, ScPO finetunes Llama-3 8B to be superior to Llama-3 70B, Gemma-2 27B, and Claude-3 Haiku.

Deep neural networks have enabled improved image quality and fast inference times for various inverse problems, including accelerated magnetic resonance imaging (MRI) reconstruction. However, such models require a large number of fully-sampled ground truth datasets, which are difficult to curate, and are sensitive to distribution drifts. In this work, we propose applying physics-driven data augmentations for consistency training that leverage our domain knowledge of the forward MRI data acquisition process and MRI physics to achieve improved label efficiency and robustness to clinically-relevant distribution drifts. Our approach, termed VORTEX, (1) demonstrates strong improvements over supervised baselines with and without data augmentation in robustness to signal-to-noise ratio change and motion corruption in data-limited regimes; (2) considerably outperforms state-of-the-art purely image-based data augmentation techniques and self-supervised reconstruction methods on both in-distribution and out-of-distribution data; and (3) enables composing heterogeneous image-based and physics-driven data augmentations. Our code is available at https://github.com/ad12/meddlr.

While large language models (LLMs) have proven to be effective on a large variety of tasks, they are also known to hallucinate information. To measure whether an LLM prefers factually consistent continuations of its input, we propose a new benchmark called FIB(Factual Inconsistency Benchmark) that focuses on the task of summarization. Specifically, our benchmark involves comparing the scores an LLM assigns to a factually consistent versus a factually inconsistent summary for an input news article. For factually consistent summaries, we use human-written reference summaries that we manually verify as factually consistent. To generate summaries that are factually inconsistent, we generate summaries from a suite of summarization models that we have manually annotated as factually inconsistent. A model's factual consistency is then measured according to its accuracy, i.e.\ the proportion of documents where it assigns a higher score to the factually consistent summary. To validate the usefulness of FIB, we evaluate 23 large language models ranging from 1B to 176B parameters from six different model families including BLOOM and OPT. We find that existing LLMs generally assign a higher score to factually consistent summaries than to factually inconsistent summaries. However, if the factually inconsistent summaries occur verbatim in the document, then LLMs assign a higher score to these factually inconsistent summaries than factually consistent summaries. We validate design choices in our benchmark including the scoring method and source of distractor summaries. Our code and benchmark data can be found at https://github.com/r-three/fib.

The technique of data augmentation (DA) is often used in machine learning for regularization purposes to better generalize under i.i.d. settings. In this work, we present a unifying framework with topics in causal inference to make a case for the use of DA beyond just the i.i.d. setting, but for generalization across interventions as well. Specifically, we argue that when the outcome generating mechanism is invariant to our choice of DA, then such augmentations can effectively be thought of as interventions on the treatment generating mechanism itself. This can potentially help to reduce bias in causal effect estimation arising from hidden confounders. In the presence of such unobserved confounding we typically make use of instrumental variables (IVs) -- sources of treatment randomization that are conditionally independent of the outcome. However, IVs may not be as readily available as DA for many applications, which is the main motivation behind this work. By appropriately regularizing IV based estimators, we introduce the concept of IV-like (IVL) regression for mitigating confounding bias and improving predictive performance across interventions even when certain IV properties are relaxed. Finally, we cast parameterized DA as an IVL regression problem and show that when used in composition can simulate a worst-case application of such DA, further improving performance on causal estimation and generalization tasks beyond what simple DA may offer. This is shown both theoretically for the population case and via simulation experiments for the finite sample case using a simple linear example. We also present real data experiments to support our case.

Providing effective treatment and making informed clinical decisions are essential goals of modern medicine and clinical care. We are interested in simulating disease dynamics for clinical decision-making, leveraging recent advances in large generative models. To this end, we introduce the Medical World Model (MeWM), the first world model in medicine that visually predicts future disease states based on clinical decisions. MeWM comprises (i) vision-language models to serve as policy models, and (ii) tumor generative models as dynamics models. The policy model generates action plans, such as clinical treatments, while the dynamics model simulates tumor progression or regression under given treatment conditions. Building on this, we propose the inverse dynamics model that applies survival analysis to the simulated post-treatment tumor, enabling the evaluation of treatment efficacy and the selection of the optimal clinical action plan. As a result, the proposed MeWM simulates disease dynamics by synthesizing post-treatment tumors, with state-of-the-art specificity in Turing tests evaluated by radiologists. Simultaneously, its inverse dynamics model outperforms medical-specialized GPTs in optimizing individualized treatment protocols across all metrics. Notably, MeWM improves clinical decision-making for interventional physicians, boosting F1-score in selecting the optimal TACE protocol by 13%, paving the way for future integration of medical world models as the second readers.

Self-supervised learning (SSL) approaches have recently shown substantial success in learning visual representations from unannotated images. Compared with photographic images, medical images acquired with the same imaging protocol exhibit high consistency in anatomy. To exploit this anatomical consistency, this paper introduces a novel SSL approach, called PEAC (patch embedding of anatomical consistency), for medical image analysis. Specifically, in this paper, we propose to learn global and local consistencies via stable grid-based matching, transfer pre-trained PEAC models to diverse downstream tasks, and extensively demonstrate that (1) PEAC achieves significantly better performance than the existing state-of-the-art fully/self-supervised methods, and (2) PEAC captures the anatomical structure consistency across views of the same patient and across patients of different genders, weights, and healthy statuses, which enhances the interpretability of our method for medical image analysis.

While reinforcement learning for large language model alignment has progressed rapidly in recent years, transferring these paradigms to high-stakes medical question answering reveals a fundamental paradigm mismatch. Reinforcement Learning from Human Feedback relies on preference annotations that are prohibitively expensive and often fail to reflect the absolute correctness of medical facts. Reinforcement Learning from Verifiable Rewards lacks effective automatic verifiers and struggles to handle complex clinical contexts. Meanwhile, medical alignment requires the simultaneous optimization of correctness, safety, and compliance, yet multi-objective heterogeneous reward signals are prone to scale mismatch and optimization conflicts.To address these challenges, we propose a robust medical alignment paradigm. We first construct a holistic multi-dimensional medical alignment matrix that decomposes alignment objectives into four categories: fundamental capabilities, expert knowledge, online feedback, and format specifications. Within each category, we establish a closed loop of where observable metrics inform attributable diagnosis, which in turn drives optimizable rewards, thereby providing fine-grained, high-resolution supervision signals for subsequent iterative optimization. To resolve gradient domination and optimization instability problem caused by heterogeneous signals, we further propose a unified optimization mechanism. This mechanism employs Reference-Frozen Normalization to align reward scales and implements a Tri-Factor Adaptive Dynamic Weighting strategy to achieve collaborative optimization that is weakness-oriented, risk-prioritized, and redundancy-reducing. Experimental results demonstrate the effectiveness of our proposed paradigm in real-world medical scenario evaluations, establishing a new paradigm for complex alignment in vertical domains.

Simulating human clients in mental health counseling is crucial for training and evaluating counselors (both human or simulated) in a scalable manner. Nevertheless, past research on client simulation did not focus on complex conversation tasks such as mental health counseling. In these tasks, the challenge is to ensure that the client's actions (i.e., interactions with the counselor) are consistent with with its stipulated profiles and negative behavior settings. In this paper, we propose a novel framework that supports consistent client simulation for mental health counseling. Our framework tracks the mental state of a simulated client, controls its state transitions, and generates for each state behaviors consistent with the client's motivation, beliefs, preferred plan to change, and receptivity. By varying the client profile and receptivity, we demonstrate that consistent simulated clients for different counseling scenarios can be effectively created. Both our automatic and expert evaluations on the generated counseling sessions also show that our client simulation method achieves higher consistency than previous methods.

Tuning-free long video diffusion has been proposed to generate extended-duration videos with enriched content by reusing the knowledge from pre-trained short video diffusion model without retraining. However, most works overlook the fine-grained long-term video consistency modeling, resulting in limited scene consistency (i.e., unreasonable object or background transitions), especially with multiple text inputs. To mitigate this, we propose the Consistency Noise Injection, dubbed CoNo, which introduces the "look-back" mechanism to enhance the fine-grained scene transition between different video clips, and designs the long-term consistency regularization to eliminate the content shifts when extending video contents through noise prediction. In particular, the "look-back" mechanism breaks the noise scheduling process into three essential parts, where one internal noise prediction part is injected into two video-extending parts, intending to achieve a fine-grained transition between two video clips. The long-term consistency regularization focuses on explicitly minimizing the pixel-wise distance between the predicted noises of the extended video clip and the original one, thereby preventing abrupt scene transitions. Extensive experiments have shown the effectiveness of the above strategies by performing long-video generation under both single- and multi-text prompt conditions. The project has been available in https://wxrui182.github.io/CoNo.github.io/.

Medical Vision-Language Models (VLMs) are prone to hallucinations, compromising clinical reliability. While reinforcement learning methods like Group Relative Policy Optimization (GRPO) offer a low-cost alignment solution, their reliance on sparse, outcome-based rewards inadvertently encourages models to "overthink" -- generating verbose, convoluted, and unverifiable Chain-of-Thought reasoning to justify answers. This focus on outcomes obscures factual errors and poses significant safety risks. To address this, we propose CheXPO-v2, a novel alignment framework that shifts from outcome to process supervision. Our core innovation is a Knowledge Graph Consistency Reward mechanism driven by Entity-Relation Matching. By explicitly parsing reasoning steps into structured "Disease, Relation, Anatomy" triplets, we provide fine-grained supervision that penalizes incoherent logic and hallucinations at the atomic level. Integrating this with a hard-example mining strategy, our approach significantly outperforms GRPO and state-of-the-art models on benchmarks like MIMIC-CXR-VQA. Crucially, CheXPO-v2 achieves new state-of-the-art accuracy using only 5k samples, demonstrating exceptional data efficiency while producing clinically sound and verifiable reasoning. The project source code is publicly available at: https://github.com/ecoxial2007/CheX-Phi4MM.

Reconstructing 3D objects from a single image guided by pretrained diffusion models has demonstrated promising outcomes. However, due to utilizing the case-agnostic rigid strategy, their generalization ability to arbitrary cases and the 3D consistency of reconstruction are still poor. In this work, we propose Consistent123, a case-aware two-stage method for highly consistent 3D asset reconstruction from one image with both 2D and 3D diffusion priors. In the first stage, Consistent123 utilizes only 3D structural priors for sufficient geometry exploitation, with a CLIP-based case-aware adaptive detection mechanism embedded within this process. In the second stage, 2D texture priors are introduced and progressively take on a dominant guiding role, delicately sculpting the details of the 3D model. Consistent123 aligns more closely with the evolving trends in guidance requirements, adaptively providing adequate 3D geometric initialization and suitable 2D texture refinement for different objects. Consistent123 can obtain highly 3D-consistent reconstruction and exhibits strong generalization ability across various objects. Qualitative and quantitative experiments show that our method significantly outperforms state-of-the-art image-to-3D methods. See https://Consistent123.github.io for a more comprehensive exploration of our generated 3D assets.

This paper studies the problem of performing a sequence of optimal interventions in a causal dynamical system where both the target variable of interest and the inputs evolve over time. This problem arises in a variety of domains e.g. system biology and operational research. Dynamic Causal Bayesian Optimization (DCBO) brings together ideas from sequential decision making, causal inference and Gaussian process (GP) emulation. DCBO is useful in scenarios where all causal effects in a graph are changing over time. At every time step DCBO identifies a local optimal intervention by integrating both observational and past interventional data collected from the system. We give theoretical results detailing how one can transfer interventional information across time steps and define a dynamic causal GP model which can be used to quantify uncertainty and find optimal interventions in practice. We demonstrate how DCBO identifies optimal interventions faster than competing approaches in multiple settings and applications.

Longitudinal treatment decisions require predicting potential outcomes under future treatment sequences in the presence of time-varying confounding, heterogeneous patient dynamics, and limited domain-specific data. Existing longitudinal causal estimators typically train a new model for each cohort or simulator. We introduce Causal Longitudinal Prior-Fitted Networks (CausalLongPFN), a prior-fitted in-context predictor for longitudinal causal prediction. The model is pretrained entirely on synthetic episodes sampled from a broad prior over temporal structural causal models, exposing it to treatment-confounder feedback, latent heterogeneity, nonlinear state evolution, delayed effects, and cumulative treatment responses. At test time, CausalLongPFN is frozen: it conditions on support trajectories, a query history, and a proposed future treatment sequence, and returns a predictive distribution over future outcomes without gradient updates or propensity-model fitting. Multi-step predictions are obtained by recursively applying the one-step predictor under the specified treatment sequence. We evaluate on branchable cancer, HIV, and warfarin benchmarks with ground-truth counterfactual labels, and on factual-only rolling-origin prediction in MIMIC-III ICU trajectories. CausalLongPFN is competitive with domain-trained longitudinal baselines on counterfactual benchmarks and performs strongly on factual MIMIC-III prediction, suggesting that broad synthetic causal pretraining can provide a useful frozen alternative when repeated domain-specific training is costly or impractical.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Majorities of distillation methods on pre-trained diffusion models or on pre-trained rectified flow, focus on either the distillation outputs or the trajectories between random noises and clean images to speed up sample generations from pre-trained models. In those trajectory-based distillation methods, consistency distillation requires the self-consistent trajectory projection to regulate the trajectory, which might avoid the common ODE approximation error {while still be concerning about sampling efficiencies}. At the same time, rectified flow distillations enforce straight trajectory for fast sampling, although an ODE solver is still required. In this work, we propose a trajectory distillation method, \modelname, that enjoys the benefits of both and enables few-step generations. TraFlow adopts the settings of consistency trajectory models, and further enforces the properties of self-consistency and straightness throughout the entire trajectory. These two properties are pursued by reaching a balance with following three targets: (1) reconstruct the output from pre-trained models; (2) learn the amount of changes by pre-trained models; (3) satisfy the self-consistency over its trajectory. Extensive experimental results have shown the effectiveness of our proposed method.

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose Offline Guarded Safe Reinforcement Learning (OGSRL), a theoretically grounded model-based offline RL framework. OGSRL introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

Instrumental variable (IV) methods are used to estimate causal effects in settings with unobserved confounding, where we cannot directly experiment on the treatment variable. Instruments are variables which only affect the outcome indirectly via the treatment variable(s). Most IV applications focus on low-dimensional treatments and crucially require at least as many instruments as treatments. This assumption is restrictive: in the natural sciences we often seek to infer causal effects of high-dimensional treatments (e.g., the effect of gene expressions or microbiota on health and disease), but can only run few experiments with a limited number of instruments (e.g., drugs or antibiotics). In such underspecified problems, the full treatment effect is not identifiable in a single experiment even in the linear case. We show that one can still reliably recover the projection of the treatment effect onto the instrumented subspace and develop techniques to consistently combine such partial estimates from different sets of instruments. We then leverage our combined estimators in an algorithm that iteratively proposes the most informative instruments at each round of experimentation to maximize the overall information about the full causal effect.

Flow map models such as Consistency Models (CM) and Mean Flow (MF) enable few-step generation by learning the long jump of the ODE solution of diffusion models, yet training remains unstable, sensitive to hyperparameters, and costly. Initializing from a pre-trained diffusion model helps, but still requires converting infinitesimal steps into a long-jump map, leaving instability unresolved. We introduce mid-training, the first concept and practical method that inserts a lightweight intermediate stage between the (diffusion) pre-training and the final flow map training (i.e., post-training) for vision generation. Concretely, Consistency Mid-Training (CMT) is a compact and principled stage that trains a model to map points along a solver trajectory from a pre-trained model, starting from a prior sample, directly to the solver-generated clean sample. It yields a trajectory-consistent and stable initialization. This initializer outperforms random and diffusion-based baselines and enables fast, robust convergence without heuristics. Initializing post-training with CMT weights further simplifies flow map learning. Empirically, CMT achieves state of the art two step FIDs: 1.97 on CIFAR-10, 1.32 on ImageNet 64x64, and 1.84 on ImageNet 512x512, while using up to 98% less training data and GPU time, compared to CMs. On ImageNet 256x256, CMT reaches 1-step FID 3.34 while cutting total training time by about 50% compared to MF from scratch (FID 3.43). This establishes CMT as a principled, efficient, and general framework for training flow map models.

Consistency Models (CM) (Song et al., 2023) accelerate score-based diffusion model sampling at the cost of sample quality but lack a natural way to trade-off quality for speed. To address this limitation, we propose Consistency Trajectory Model (CTM), a generalization encompassing CM and score-based models as special cases. CTM trains a single neural network that can -- in a single forward pass -- output scores (i.e., gradients of log-density) and enables unrestricted traversal between any initial and final time along the Probability Flow Ordinary Differential Equation (ODE) in a diffusion process. CTM enables the efficient combination of adversarial training and denoising score matching loss to enhance performance and achieves new state-of-the-art FIDs for single-step diffusion model sampling on CIFAR-10 (FID 1.73) and ImageNet at 64x64 resolution (FID 1.92). CTM also enables a new family of sampling schemes, both deterministic and stochastic, involving long jumps along the ODE solution trajectories. It consistently improves sample quality as computational budgets increase, avoiding the degradation seen in CM. Furthermore, unlike CM, CTM's access to the score function can streamline the adoption of established controllable/conditional generation methods from the diffusion community. This access also enables the computation of likelihood. The code is available at https://github.com/sony/ctm.

Extending discrete-time causal Prior-data Fitted Networks for time series to continuous time invites writing the mechanism as a stochastic differential equation (SDE) -- but if the SDE is integrated once per observation gap, the trajectory law depends on when it is observed, and the prior remains a discrete-time Markov model in SDE clothing. We propose a precise continuity criterion -- trajectory-law invariance to the observation schedule -- together with a three-tier taxonomy (discrete; naive observation-grid integration; fine-grid integration with decoupled observation) and a construction realising the top tier on a random DAG with OU or small-MLP nonlinear drifts, irregular observation schedules, and hard / soft / time-varying interventions. A 2 times 2 encoder times integrator ablation, run independently on a linear and a nonlinear prior, finds fine-grid integration beats naive on 8/8 cells (sign-consistency p < 1/256) with the gap growing as the eval grid refines; the encoder axis is null with fine integration but time-aware-leading with naive. We release the prior and a preliminary zero-shot protocol on pharmacokinetic and physical-system data.

Long-horizon LLM agents can fail quietly: they settle on one reading of the evidence early, then spend the rest of the run defending it. We call this premature commitment. Final-answer scoring misses the failure mode because it sees only the answer, not whether the process has already collapsed to a stable path. We define representational commitment as cross-run hidden-state convergence at a fixed reasoning step, and use it as an early diagnostic of trajectory consistency. On Llama-3.1-70B running ReAct on HotpotQA, step-4 hidden-state similarity predicts downstream behavioral consistency (r = -0.35, partial r = -0.45), with a localized temporal and layer-wise signature. The signal replicates across Qwen-2.5-72B and Phi-3-14B, and on StrategyQA (r = -0.83). It does not track correctness: committed-wrong and committed-correct questions are not separable in activation similarity. That boundary is central to the claim. Commitment tells us whether an agent has settled, not whether it is right. A runtime monitor detects inconsistent trajectories from hidden states at AUROC up to 0.97 (0.85--0.88 under a stricter split), and a prompting intervention cuts behavioral variance by 28% against a token-matched control while leaving accuracy statistically unchanged. We also test whether the signal can route self-consistency compute; on a harder benchmark it helps only modestly and is matched by a simpler output-based baseline. The result is a diagnostic for a hidden process failure, with clear limits rather than a general accuracy lever.

The absence of transparency and explainability hinders the clinical adoption of Machine learning (ML) algorithms. Although various methods of explainable artificial intelligence (XAI) have been suggested, there is a lack of literature that delves into their practicality and assesses them based on criteria that could foster trust in clinical environments. To address this gap this study evaluates two popular XAI methods used for explaining predictive models in the healthcare context in terms of whether they (i) generate domain-appropriate representation, i.e. coherent with respect to the application task, (ii) impact clinical workflow and (iii) are consistent. To that end, explanations generated at the cohort and patient levels were analysed. The paper reports the first benchmarking of the XAI methods applied to risk prediction models obtained by evaluating the concordance between generated explanations and the trigger of a future clinical deterioration episode recorded by the data collection system. We carried out an analysis using two Electronic Medical Records (EMR) datasets sourced from Australian major hospitals. The findings underscore the limitations of state-of-the-art XAI methods in the clinical context and their potential benefits. We discuss these limitations and contribute to the theoretical development of trustworthy XAI solutions where clinical decision support guides the choice of intervention by suggesting the pattern or drivers for clinical deterioration in the future.

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

Timestep distillation is an effective approach for improving the generation efficiency of diffusion models. The Consistency Model (CM), as a trajectory-based framework, demonstrates significant potential due to its strong theoretical foundation and high-quality few-step generation. Nevertheless, current continuous-time consistency distillation methods still rely heavily on training data and computational resources, hindering their deployment in resource-constrained scenarios and limiting their scalability to diverse domains. To address this issue, we propose Trajectory-Backward Consistency Model (TBCM), which eliminates the dependence on external training data by extracting latent representations directly from the teacher model's generation trajectory. Unlike conventional methods that require VAE encoding and large-scale datasets, our self-contained distillation paradigm significantly improves both efficiency and simplicity. Moreover, the trajectory-extracted samples naturally bridge the distribution gap between training and inference, thereby enabling more effective knowledge transfer. Empirically, TBCM achieves 6.52 FID and 28.08 CLIP scores on MJHQ-30k under one-step generation, while reducing training time by approximately 40% compared to Sana-Sprint and saving a substantial amount of GPU memory, demonstrating superior efficiency without sacrificing quality. We further reveal the diffusion-generation space discrepancy in continuous-time consistency distillation and analyze how sampling strategies affect distillation performance, offering insights for future distillation research. GitHub Link: https://github.com/hustvl/TBCM.

As a crucial step to enhance LLMs alignment with human intentions, Instruction Fine-Tuning (IFT) has a high demand on dataset quality. However, existing IFT datasets often contain knowledge that is inconsistent with LLMs' internal knowledge learned from the pre-training phase, which can greatly affect the efficacy of IFT. To address this issue, we introduce NILE (iNternal consIstency aLignmEnt) framework, aimed at optimizing IFT datasets to unlock LLMs' capability further. NILE operates by eliciting target pre-trained LLM's internal knowledge corresponding to instruction data. The internal knowledge is leveraged to revise the answer in IFT datasets. Additionally, we propose a novel Internal Consistency Filtering (ICF) method to filter training samples, ensuring its high consistency with LLM's internal knowledge. Our experiments demonstrate that NILE-aligned IFT datasets sharply boost LLM performance across multiple LLM ability evaluation datasets, achieving up to 66.6% gain on Arena-Hard and 68.5% on Alpaca-Eval V2. Further analysis confirms that each component of the NILE}framework contributes to these substantial performance improvements, and provides compelling evidence that dataset consistency with pre-trained internal knowledge is pivotal for maximizing LLM potential.

Despite recent advances in inversion-based editing, text-guided image manipulation remains challenging for diffusion models. The primary bottlenecks include 1) the time-consuming nature of the inversion process; 2) the struggle to balance consistency with accuracy; 3) the lack of compatibility with efficient consistency sampling methods used in consistency models. To address the above issues, we start by asking ourselves if the inversion process can be eliminated for editing. We show that when the initial sample is known, a special variance schedule reduces the denoising step to the same form as the multi-step consistency sampling. We name this Denoising Diffusion Consistent Model (DDCM), and note that it implies a virtual inversion strategy without explicit inversion in sampling. We further unify the attention control mechanisms in a tuning-free framework for text-guided editing. Combining them, we present inversion-free editing (InfEdit), which allows for consistent and faithful editing for both rigid and non-rigid semantic changes, catering to intricate modifications without compromising on the image's integrity and explicit inversion. Through extensive experiments, InfEdit shows strong performance in various editing tasks and also maintains a seamless workflow (less than 3 seconds on one single A40), demonstrating the potential for real-time applications. Project Page: https://sled-group.github.io/InfEdit/

Healthcare foundation models have largely followed paradigms from natural language processing and computer vision, emphasizing large scale pretraining and deterministic representations over heterogeneous clinical data. However, clinical observations are inherently incomplete, reflecting sparse, irregular, and modality dependent measurements of an underlying physiologic state. In this work, we propose a framework for uncertainty aware foundation modeling that represents each patient not as a point embedding, but as a distribution over plausible latent states. By learning set valued representations and enforcing consistency across partial views of the same patient, the model captures what is invariantly inferable while explicitly encoding epistemic uncertainty. We integrate this formulation with multimodal encoders and scalable self supervised objectives, combining reconstruction, contrastive alignment, and distributional regularization. Across diverse clinical tasks, our approach improves predictive performance, robustness under missing data, and uncertainty calibration relative to strong baselines. These results suggest that modeling what is not observed rather than only what is constitutes a critical inductive bias for healthcare foundation models.

Accurate vessel segmentation in X-ray angiograms is crucial for numerous clinical applications. However, the scarcity of annotated data presents a significant challenge, which has driven the adoption of self-supervised learning (SSL) methods such as masked image modeling (MIM) to leverage large-scale unlabeled data for learning transferable representations. Unfortunately, conventional MIM often fails to capture vascular anatomy because of the severe class imbalance between vessel and background pixels, leading to weak vascular representations. To address this, we introduce Vascular anatomy-aware Masked Image Modeling (VasoMIM), a novel MIM framework tailored for X-ray angiograms that explicitly integrates anatomical knowledge into the pre-training process. Specifically, it comprises two complementary components: anatomy-guided masking strategy and anatomical consistency loss. The former preferentially masks vessel-containing patches to focus the model on reconstructing vessel-relevant regions. The latter enforces consistency in vascular semantics between the original and reconstructed images, thereby improving the discriminability of vascular representations. Empirically, VasoMIM achieves state-of-the-art performance across three datasets. These findings highlight its potential to facilitate X-ray angiogram analysis.

Diffusion models are relatively easy to train but require many steps to generate samples. Consistency models are far more difficult to train, but generate samples in a single step. In this paper we propose Multistep Consistency Models: A unification between Consistency Models (Song et al., 2023) and TRACT (Berthelot et al., 2023) that can interpolate between a consistency model and a diffusion model: a trade-off between sampling speed and sampling quality. Specifically, a 1-step consistency model is a conventional consistency model whereas we show that a infty-step consistency model is a diffusion model. Multistep Consistency Models work really well in practice. By increasing the sample budget from a single step to 2-8 steps, we can train models more easily that generate higher quality samples, while retaining much of the sampling speed benefits. Notable results are 1.4 FID on Imagenet 64 in 8 step and 2.1 FID on Imagenet128 in 8 steps with consistency distillation. We also show that our method scales to a text-to-image diffusion model, generating samples that are very close to the quality of the original model.

Extracting causal relationships from observed correlations is a growing area in probabilistic reasoning, originating with the seminal work of Pearl and others from the early 1990s. This paper develops a new, categorically oriented view based on a clear distinction between syntax (string diagrams) and semantics (stochastic matrices), connected via interpretations as structure-preserving functors. A key notion in the identification of causal effects is that of an intervention, whereby a variable is forcefully set to a particular value independent of any prior propensities. We represent the effect of such an intervention as an endofunctor which performs `string diagram surgery' within the syntactic category of string diagrams. This diagram surgery in turn yields a new, interventional distribution via the interpretation functor. While in general there is no way to compute interventional distributions purely from observed data, we show that this is possible in certain special cases using a calculational tool called comb disintegration. We demonstrate the use of this technique on a well-known toy example, where we predict the causal effect of smoking on cancer in the presence of a confounding common cause. After developing this specific example, we show this technique provides simple sufficient conditions for computing interventions which apply to a wide variety of situations considered in the causal inference literature.

In this paper, we address the challenge of generating temporally consistent videos with motion guidance. While many existing methods depend on additional control modules or inference-time fine-tuning, recent studies suggest that effective motion guidance is achievable without altering the model architecture or requiring extra training. Such approaches offer promising compatibility with various video generation foundation models. However, existing training-free methods often struggle to maintain consistent temporal coherence across frames or to follow guided motion accurately. In this work, we propose a simple yet effective solution that combines an initial-noise-based approach with a novel motion consistency loss, the latter being our key innovation. Specifically, we capture the inter-frame feature correlation patterns of intermediate features from a video diffusion model to represent the motion pattern of the reference video. We then design a motion consistency loss to maintain similar feature correlation patterns in the generated video, using the gradient of this loss in the latent space to guide the generation process for precise motion control. This approach improves temporal consistency across various motion control tasks while preserving the benefits of a training-free setup. Extensive experiments show that our method sets a new standard for efficient, temporally coherent video generation.

Pain is a complex and pervasive condition that affects a significant portion of the population. Accurate and consistent assessment is essential for individuals suffering from pain, as well as for developing effective management strategies in a healthcare system. Automatic pain assessment systems enable continuous monitoring, support clinical decision-making, and help minimize patient distress while mitigating the risk of functional deterioration. Leveraging physiological signals offers objective and precise insights into a person's state, and their integration in a multimodal framework can further enhance system performance. This study has been submitted to the Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN). The proposed approach introduces Tiny-BioMoE, a lightweight pretrained embedding model for biosignal analysis. Trained on 4.4 million biosignal image representations and consisting of only 7.3 million parameters, it serves as an effective tool for extracting high-quality embeddings for downstream tasks. Extensive experiments involving electrodermal activity, blood volume pulse, respiratory signals, peripheral oxygen saturation, and their combinations highlight the model's effectiveness across diverse modalities in automatic pain recognition tasks. The model's architecture (code) and weights are available at https://github.com/GkikasStefanos/Tiny-BioMoE.

Throughout the different phases of a drug development program, randomized trials are used to establish the tolerability, safety, and efficacy of a candidate drug. At each stage one aims to optimize the design of future studies by extrapolation from the available evidence at the time. This includes collected trial data and relevant external data. However, relevant external data are typically available as averages only, for example from trials on alternative treatments reported in the literature. Here we report on such an example from a drug development for wet age-related macular degeneration. This disease is the leading cause of severe vision loss in the elderly. While current treatment options are efficacious, they are also a substantial burden for the patient. Hence, new treatments are under development which need to be compared against existing treatments. The general statistical problem this leads to is meta-analysis, which addresses the question of how we can combine datasets collected under different conditions. Bayesian methods have long been used to achieve partial pooling. Here we consider the challenge when the model of interest is complex (hierarchical and nonlinear) and one dataset is given as raw data while the second dataset is given as averages only. In such a situation, common meta-analytic methods can only be applied when the model is sufficiently simple for analytic approaches. When the model is too complex, for example nonlinear, an analytic approach is not possible. We provide a Bayesian solution by using simulation to approximately reconstruct the likelihood of the external summary and allowing the parameters in the model to vary under the different conditions. We first evaluate our approach using fake-data simulations and then report results for the drug development program that motivated this research.

As advanced image manipulation techniques emerge, detecting the manipulation becomes increasingly important. Despite the success of recent learning-based approaches for image manipulation detection, they typically require expensive pixel-level annotations to train, while exhibiting degraded performance when testing on images that are differently manipulated compared with training images. To address these limitations, we propose weakly-supervised image manipulation detection, such that only binary image-level labels (authentic or tampered with) are required for training purpose. Such a weakly-supervised setting can leverage more training images and has the potential to adapt quickly to new manipulation techniques. To improve the generalization ability, we propose weakly-supervised self-consistency learning (WSCL) to leverage the weakly annotated images. Specifically, two consistency properties are learned: multi-source consistency (MSC) and inter-patch consistency (IPC). MSC exploits different content-agnostic information and enables cross-source learning via an online pseudo label generation and refinement process. IPC performs global pair-wise patch-patch relationship reasoning to discover a complete region of manipulation. Extensive experiments validate that our WSCL, even though is weakly supervised, exhibits competitive performance compared with fully-supervised counterpart under both in-distribution and out-of-distribution evaluations, as well as reasonable manipulation localization ability.

Brain tissue segmentation is essential for neuroscience and clinical studies. However, segmentation on longitudinal data is challenging due to dynamic brain changes across the lifespan. Previous researches mainly focus on self-supervision with regularizations and will lose longitudinal generalization when fine-tuning on a specific age group. In this paper, we propose a dual meta-learning paradigm to learn longitudinally consistent representations and persist when fine-tuning. Specifically, we learn a plug-and-play feature extractor to extract longitudinal-consistent anatomical representations by meta-feature learning and a well-initialized task head for fine-tuning by meta-initialization learning. Besides, two class-aware regularizations are proposed to encourage longitudinal consistency. Experimental results on the iSeg2019 and ADNI datasets demonstrate the effectiveness of our method. Our code is available at https://github.com/ladderlab-xjtu/DuMeta.

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

Latent Consistency Model (LCM) extends the Consistency Model to the latent space and leverages the guided consistency distillation technique to achieve impressive performance in accelerating text-to-image synthesis. However, we observed that LCM struggles to generate images with both clarity and detailed intricacy. To address this limitation, we initially delve into and elucidate the underlying causes. Our investigation identifies that the primary issue stems from errors in three distinct areas. Consequently, we introduce Trajectory Consistency Distillation (TCD), which encompasses trajectory consistency function and strategic stochastic sampling. The trajectory consistency function diminishes the distillation errors by broadening the scope of the self-consistency boundary condition and endowing the TCD with the ability to accurately trace the entire trajectory of the Probability Flow ODE. Additionally, strategic stochastic sampling is specifically designed to circumvent the accumulated errors inherent in multi-step consistency sampling, which is meticulously tailored to complement the TCD model. Experiments demonstrate that TCD not only significantly enhances image quality at low NFEs but also yields more detailed results compared to the teacher model at high NFEs.

With diffusion and flow matching models achieving state-of-the-art generating performance, the interest of the community now turned to reducing the inference time without sacrificing sample quality. Consistency Models (CMs), which are trained to be consistent on diffusion or probability flow ordinary differential equation (PF-ODE) trajectories, enable one or two-step flow or diffusion sampling. However, CMs typically require prolonged training with large batch sizes to obtain competitive sample quality. In this paper, we examine the training dynamics of CMs near convergence and discover that CM tangents -- CM output update directions -- are quite oscillatory, in the sense that they move parallel to the data manifold, not towards the manifold. To mitigate oscillatory tangents, we propose a new loss function, called the manifold feature distance (MFD), which provides manifold-aligned tangents that point toward the data manifold. Consequently, our method -- dubbed Align Your Tangent (AYT) -- can accelerate CM training by orders of magnitude and even out-perform the learned perceptual image patch similarity metric (LPIPS). Furthermore, we find that our loss enables training with extremely small batch sizes without compromising sample quality. Code: https://github.com/1202kbs/AYT

Consistency learning with feature perturbation is a widely used strategy in semi-supervised medical image segmentation. However, many existing perturbation methods rely on dropout, and thus require a careful manual tuning of the dropout rate, which is a sensitive hyperparameter and often difficult to optimize and may lead to suboptimal regularization. To overcome this limitation, we propose VQ-Seg, the first approach to employ vector quantization (VQ) to discretize the feature space and introduce a novel and controllable Quantized Perturbation Module (QPM) that replaces dropout. Our QPM perturbs discrete representations by shuffling the spatial locations of codebook indices, enabling effective and controllable regularization. To mitigate potential information loss caused by quantization, we design a dual-branch architecture where the post-quantization feature space is shared by both image reconstruction and segmentation tasks. Moreover, we introduce a Post-VQ Feature Adapter (PFA) to incorporate guidance from a foundation model (FM), supplementing the high-level semantic information lost during quantization. Furthermore, we collect a large-scale Lung Cancer (LC) dataset comprising 828 CT scans annotated for central-type lung carcinoma. Extensive experiments on the LC dataset and other public benchmarks demonstrate the effectiveness of our method, which outperforms state-of-the-art approaches. Code available at: https://github.com/script-Yang/VQ-Seg.

Saliency maps are increasingly used as design guidance in siRNA efficacy prediction, yet attribution methods are rarely validated before motivating sequence edits. We introduce a pre-synthesis gate: a protocol for counterfactual sensitivity faithfulness that tests whether mutating high-saliency positions changes model output more than composition-matched controls. Cross-dataset transfer reveals two failure modes that would otherwise go undetected: faithful-but-wrong (saliency valid, predictions fail) and inverted saliency (top-saliency edits less impactful than random). Strikingly, models trained on mRNA-level assays collapse on a luciferase reporter dataset, demonstrating that protocol shifts can silently invalidate deployment. Across four benchmarks, 19/20 fold instances pass; the single failure shows inverted saliency. A biology-informed regularizer (BioPrior) strengthens saliency faithfulness with modest, dataset-dependent predictive trade-offs. Our results establish saliency validation as essential pre-deployment practice for explanation-guided therapeutic design. Code is available at https://github.com/shadi97kh/BioPrior.

Contrastive representation learning is crucial in medical time series analysis as it alleviates dependency on labor-intensive, domain-specific, and scarce expert annotations. However, existing contrastive learning methods primarily focus on one single data level, which fails to fully exploit the intricate nature of medical time series. To address this issue, we present COMET, an innovative hierarchical framework that leverages data consistencies at all inherent levels in medical time series. Our meticulously designed model systematically captures data consistency from four potential levels: observation, sample, trial, and patient levels. By developing contrastive loss at multiple levels, we can learn effective representations that preserve comprehensive data consistency, maximizing information utilization in a self-supervised manner. We conduct experiments in the challenging patient-independent setting. We compare COMET against six baselines using three diverse datasets, which include ECG signals for myocardial infarction and EEG signals for Alzheimer's and Parkinson's diseases. The results demonstrate that COMET consistently outperforms all baselines, particularly in setup with 10% and 1% labeled data fractions across all datasets. These results underscore the significant impact of our framework in advancing contrastive representation learning techniques for medical time series. The source code is available at https://github.com/DL4mHealth/COMET.

Recent benchmarks have probed factual consistency and rhetorical robustness in Large Language Models (LLMs). However, a knowledge gap exists regarding how directional framing of factually true statements influences model agreement, a common scenario for LLM users. AssertBench addresses this by sampling evidence-supported facts from FEVEROUS, a fact verification dataset. For each (evidence-backed) fact, we construct two framing prompts: one where the user claims the statement is factually correct, and another where the user claims it is incorrect. We then record the model's agreement and reasoning. The desired outcome is that the model asserts itself, maintaining consistent truth evaluation across both framings, rather than switching its evaluation to agree with the user. AssertBench isolates framing-induced variability from the model's underlying factual knowledge by stratifying results based on the model's accuracy on the same claims when presented neutrally. In doing so, this benchmark aims to measure an LLM's ability to "stick to its guns" when presented with contradictory user assertions about the same fact. The complete source code is available at https://github.com/achowd32/assert-bench.

Intraoperative Cone Beam Computed Tomography (CBCT) provides a reliable 3D anatomical context essential for interventional planning. However, its static nature fails to provide continuous monitoring of soft-tissue deformations induced by respiration, probe pressure, and surgical manipulation, leading to navigation discrepancies. We propose a deformation-aware CBCT updating framework that leverages robotic ultrasound as a dynamic proxy to infer tissue motion and update static CBCT slices in real time. Starting from calibration-initialized alignment with linear correlation of linear combination (LC2)-based rigid refinement, our method establishes accurate multimodal correspondence. To capture intraoperative dynamics, we introduce the ultrasound correlation UNet (USCorUNet), a lightweight network trained with optical flow-guided supervision to learn deformation-aware correlation representations, enabling accurate, real-time dense deformation field estimation from ultrasound streams. The inferred deformation is spatially regularized and transferred to the CBCT reference to produce deformation-consistent visualizations without repeated radiation exposure. We validate the proposed approach through deformation estimation and ultrasound-guided CBCT updating experiments. Results demonstrate real-time end-to-end CBCT slice updating and physically plausible deformation estimation, enabling dynamic refinement of static CBCT guidance during robotic ultrasound-assisted interventions. The source code is publicly available at https://github.com/anonymous-codebase/us-cbct-demo.

Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice. We report a blinded evaluation built on 620 Real-world Point-Of-Care Queries (Real-POCQi) submitted to the OpenEvidence (OE) platform by physicians spanning 30 specialties, as well as 187 questions from HealthBench. 149 practicing physicians across 36 states made head-to-head comparisons between answers from three frontier general-purpose models (Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5) and a specialized clinical tool (OE), with graders matched to each question's specialty. When comparing answers along five dimensions relevant to clinical decision support -- accuracy, clinical utility, source quality, verifiability, & completeness -- physicians scored the specialized tool highest on all axes; in the primary analysis on Real-POCQi, win differences (margins between win and loss rates) ranged from 25 to 39 percentage points (p<0.001). Results remained consistent in sensitivity analyses stratifying by citation display, answer length, OE-user status, and Real-POCQi versus HealthBench. In parallel, LLM judges were found to systematically differ from expert judges, though both generally agreed on the best model. These findings underscore two conclusions: (i) AI tool evaluations should reflect real-world query distributions and use expert judges that mirror the specialization defining modern medicine and (ii) the consistent advantage of the specialized tool over general-purpose models does not necessarily mean that the latter cannot serve similar purposes, but that targeted engineering and customization can yield meaningful gains in performance for its users. We release Real-POCQi as a public benchmark, as well as the prespecified statistical analysis for reproducing results of this study.

Text-to-image models offer a new level of creative flexibility by allowing users to guide the image generation process through natural language. However, using these models to consistently portray the same subject across diverse prompts remains challenging. Existing approaches fine-tune the model to teach it new words that describe specific user-provided subjects or add image conditioning to the model. These methods require lengthy per-subject optimization or large-scale pre-training. Moreover, they struggle to align generated images with text prompts and face difficulties in portraying multiple subjects. Here, we present ConsiStory, a training-free approach that enables consistent subject generation by sharing the internal activations of the pretrained model. We introduce a subject-driven shared attention block and correspondence-based feature injection to promote subject consistency between images. Additionally, we develop strategies to encourage layout diversity while maintaining subject consistency. We compare ConsiStory to a range of baselines, and demonstrate state-of-the-art performance on subject consistency and text alignment, without requiring a single optimization step. Finally, ConsiStory can naturally extend to multi-subject scenarios, and even enable training-free personalization for common objects.

Instruction-guided image editing has seen remarkable progress with models like FLUX.2 and Qwen-Image-Edit, yet they still struggle with complex scenarios with multiple similar instances each requiring individual edits. We observe that state-of-the-art models suffer from severe over-editing and spatial misalignment when faced with multiple identical instances and composite instructions. To this end, we introduce a comprehensive benchmark specifically designed to evaluate fine-grained consistency in multi-instance and multi-instruction settings. To address the failures of existing methods observed in our benchmark, we propose Multi-Instance Regional Alignment via Guided Editing (MIRAGE), a training-free framework that enables precise, localized editing. By leveraging a vision-language model to parse complex instructions into regional subsets, MIRAGE employs a multi-branch parallel denoising strategy. This approach injects latent representations of target regions into the global representation space while maintaining background integrity through a reference trajectory. Extensive evaluations on MIRA-Bench and RefEdit-Bench demonstrate that our framework significantly outperforms existing methods in achieving precise instance-level modifications while preserving background consistency. Our benchmark and code are available at https://github.com/ZiqianLiu666/MIRAGE.

This position paper argues that the theoretical inconsistency often observed among Responsible AI (RAI) metrics, such as differing fairness definitions or tradeoffs between accuracy and privacy, should be embraced as a valuable feature rather than a flaw to be eliminated. We contend that navigating these inconsistencies, by treating metrics as divergent objectives, yields three key benefits: (1) Normative Pluralism: Maintaining a full suite of potentially contradictory metrics ensures that the diverse moral stances and stakeholder values inherent in RAI are adequately represented. (2) Epistemological Completeness: The use of multiple, sometimes conflicting, metrics allows for a more comprehensive capture of multifaceted ethical concepts, thereby preserving greater informational fidelity about these concepts than any single, simplified definition. (3) Implicit Regularization: Jointly optimizing for theoretically conflicting objectives discourages overfitting to one specific metric, steering models towards solutions with enhanced generalization and robustness under real-world complexities. In contrast, efforts to enforce theoretical consistency by simplifying or pruning metrics risk narrowing this value diversity, losing conceptual depth, and degrading model performance. We therefore advocate for a shift in RAI theory and practice: from getting trapped in inconsistency to characterizing acceptable inconsistency thresholds and elucidating the mechanisms that permit robust, approximated consistency in practice.

Magnetic Resonance Imaging (MRI) is a critical tool in modern medical diagnostics, yet its prolonged acquisition time remains a critical limitation, especially in time-sensitive clinical scenarios. While undersampling strategies can accelerate image acquisition, they often result in image artifacts and degraded quality. Recent diffusion models have shown promise for reconstructing high-fidelity images from undersampled data by learning powerful image priors; however, most existing approaches either (i) rely on unsupervised score functions without paired supervision or (ii) apply data consistency only as a post-processing step. In this work, we introduce a conditional denoising diffusion framework with iterative data-consistency correction, which differs from prior methods by embedding the measurement model directly into every reverse diffusion step and training the model on paired undersampled-ground truth data. This hybrid design bridges generative flexibility with explicit enforcement of MRI physics. Experiments on the fastMRI dataset demonstrate that our framework consistently outperforms recent state-of-the-art deep learning and diffusion-based methods in SSIM, PSNR, and LPIPS, with LPIPS capturing perceptual improvements more faithfully. These results demonstrate that integrating conditional supervision with iterative consistency updates yields substantial improvements in both pixel-level fidelity and perceptual realism, establishing a principled and practical advance toward robust, accelerated MRI reconstruction.

As of September 2023, ChatGPT correctly answers "what is 7+8" with 15, but when asked "7+8=15, True or False" it responds with "False". This inconsistency between generating and validating an answer is prevalent in language models (LMs) and erodes trust. In this paper, we propose a framework for measuring the consistency between generation and validation (which we call generator-validator consistency, or GV-consistency), finding that even GPT-4, a state-of-the-art LM, is GV-consistent only 76% of the time. To improve the consistency of LMs, we propose to finetune on the filtered generator and validator responses that are GV-consistent, and call this approach consistency fine-tuning. We find that this approach improves GV-consistency of Alpaca-30B from 60% to 93%, and the improvement extrapolates to unseen tasks and domains (e.g., GV-consistency for positive style transfers extrapolates to unseen styles like humor). In addition to improving consistency, consistency fine-tuning improves both generator quality and validator accuracy without using any labeled data. Evaluated across 6 tasks, including math questions, knowledge-intensive QA, and instruction following, our method improves the generator quality by 16% and the validator accuracy by 6.3% across all tasks.

Reinforcement learning (RL) has emerged as a promising paradigm for enhancing image editing and text-to-image (T2I) generation. However, current reward models, which act as critics during RL, often suffer from hallucinations and assign noisy scores, inherently misguiding the optimization process. In this paper, we present FIRM (Faithful Image Reward Modeling), a comprehensive framework that develops robust reward models to provide accurate and reliable guidance for faithful image generation and editing. First, we design tailored data curation pipelines to construct high-quality scoring datasets. Specifically, we evaluate editing using both execution and consistency, while generation is primarily assessed via instruction following. Using these pipelines, we collect the FIRM-Edit-370K and FIRM-Gen-293K datasets, and train specialized reward models (FIRM-Edit-8B and FIRM-Gen-8B) that accurately reflect these criteria. Second, we introduce FIRM-Bench, a comprehensive benchmark specifically designed for editing and generation critics. Evaluations demonstrate that our models achieve superior alignment with human judgment compared to existing metrics. Furthermore, to seamlessly integrate these critics into the RL pipeline, we formulate a novel "Base-and-Bonus" reward strategy that balances competing objectives: Consistency-Modulated Execution (CME) for editing and Quality-Modulated Alignment (QMA) for generation. Empowered by this framework, our resulting models FIRM-Qwen-Edit and FIRM-SD3.5 achieve substantial performance breakthroughs. Comprehensive experiments demonstrate that FIRM mitigates hallucinations, establishing a new standard for fidelity and instruction adherence over existing general models. All of our datasets, models, and code have been publicly available at https://firm-reward.github.io.

Accurate and reliable C-arm positioning is essential for fluoroscopy-guided interventions. However, clinical workflows rely on manual alignment that increases radiation exposure and procedural delays. In this work, we present a pipeline that autonomously navigates the C-arm to predefined anatomical landmarks utilizing X-ray images. Given an input X-ray image from an arbitrary starting location on the operating table, the model predicts a 3D displacement vector toward each target landmark along the body. To ensure reliable deployment, we capture both aleatoric and epistemic uncertainties in the model's predictions and further calibrate them using conformal prediction. The derived prediction regions are interpreted as 3D confidence regions around the predicted landmark locations. The training framework combines a probabilistic loss with skeletal pose regularization to encourage anatomically plausible outputs. We validate our approach on a synthetic X-ray dataset generated from DeepDRR. Results show not only strong localization accuracy across multiple architectures but also well-calibrated prediction bounds. These findings highlight the pipeline's potential as a component in safe and reliable autonomous C-arm systems. Code is available at https://github.com/AhmadArrabi/C_arm_guidance_APAH

Medical imaging is essential in modern radiotherapy, supporting diagnosis, treatment planning, and monitoring. Synthetic imaging, particularly synthetic computed tomography (sCT), is gaining traction in radiotherapy. The SynthRAD2025 dataset and Grand Challenge promote advancements in sCT generation by providing a benchmarking platform for algorithms using cone-beam CT (CBCT) and magnetic resonance imaging (MRI). The dataset includes 2362 cases: 890 MRI-CT and 1472 CBCT-CT pairs from head-and-neck, thoracic, and abdominal cancer patients treated at five European university medical centers (UMC Groningen, UMC Utrecht, Radboud UMC, LMU University Hospital Munich, and University Hospital of Cologne). Data were acquired with diverse scanners and protocols. Pre-processing, including rigid and deformable image registration, ensures high-quality, modality-aligned images. Extensive quality assurance validates image consistency and usability. All imaging data is provided in MetaImage (.mha) format, ensuring compatibility with medical image processing tools. Metadata, including acquisition parameters and registration details, is available in structured CSV files. To maintain dataset integrity, SynthRAD2025 is divided into training (65%), validation (10%), and test (25%) sets. The dataset is accessible at https://doi.org/10.5281/zenodo.14918089 under the SynthRAD2025 collection. This dataset supports benchmarking and the development of synthetic imaging techniques for radiotherapy applications. Use cases include sCT generation for MRI-only and MR-guided photon/proton therapy, CBCT-based dose calculations, and adaptive radiotherapy workflows. By integrating diverse acquisition settings, SynthRAD2025 fosters robust, generalizable image synthesis algorithms, advancing personalized cancer care and adaptive radiotherapy.

Large-scale text-to-image models enable a wide range of image editing techniques, using text prompts or even spatial controls. However, applying these editing methods to multi-view images depicting a single scene leads to 3D-inconsistent results. In this work, we focus on spatial control-based geometric manipulations and introduce a method to consolidate the editing process across various views. We build on two insights: (1) maintaining consistent features throughout the generative process helps attain consistency in multi-view editing, and (2) the queries in self-attention layers significantly influence the image structure. Hence, we propose to improve the geometric consistency of the edited images by enforcing the consistency of the queries. To do so, we introduce QNeRF, a neural radiance field trained on the internal query features of the edited images. Once trained, QNeRF can render 3D-consistent queries, which are then softly injected back into the self-attention layers during generation, greatly improving multi-view consistency. We refine the process through a progressive, iterative method that better consolidates queries across the diffusion timesteps. We compare our method to a range of existing techniques and demonstrate that it can achieve better multi-view consistency and higher fidelity to the input scene. These advantages allow us to train NeRFs with fewer visual artifacts, that are better aligned with the target geometry.

Score-based generative models like the diffusion model have been testified to be effective in modeling multi-modal data from image generation to reinforcement learning (RL). However, the inference process of diffusion model can be slow, which hinders its usage in RL with iterative sampling. We propose to apply the consistency model as an efficient yet expressive policy representation, namely consistency policy, with an actor-critic style algorithm for three typical RL settings: offline, offline-to-online and online. For offline RL, we demonstrate the expressiveness of generative models as policies from multi-modal data. For offline-to-online RL, the consistency policy is shown to be more computational efficient than diffusion policy, with a comparable performance. For online RL, the consistency policy demonstrates significant speedup and even higher average performances than the diffusion policy.

Contrastive representation learning struggles on physiological signals when each subject contributes a distinct baseline pattern. If class differences overlap with subject differences,class-level objectives such as supervised contrastive learning tend to merge per-subject structure into a single per-class cluster,removing the individual variation that a model needs to generalize to unseen patients. We study this problem in the setting of Paroxysmal Atrial Fibrillation(PAF) detection from RR-interval(RRI) sequences and propose a patient-aware contrastive objective that forms positive pairs only from same-patient, same-class segments, preserving each patient's own sinus rhythm(SR) baseline while still pushing the two classes apart. Examining the learned embeddings directly, our objective achieves the most consistent per-patient SR structure (cohesion 0.850 vs. 0.800 for supervised contrastive loss (SupCon) and 0.772 for binary cross-entropy (BCE)). We also identify that BCE produces the cleanest global class separation yet the most disordered per-patient structure. This is precisely why a linear probe trained on its features breaks down on unseen patients. On the IRIDIA-AF dataset, the resulting representation reaches a patient-independent Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.989 pm 0.003 with 2.6times lower seed variance than supervised contrastive baselines.These results highlight that per-subject geometric consistency, rather than global class separability, is key to robust cross-patient generalization.

Temporally dense single-person "small data" have become widely available thanks to mobile apps and wearable sensors. Many caregivers and self-trackers want to use these data to help a specific person change their behavior to achieve desired health outcomes. Ideally, this involves discerning possible causes from correlations using that person's own observational time series data. In this paper, we estimate within-individual average treatment effects of physical activity on sleep duration, and vice-versa. We introduce the model twin randomization (MoTR; "motor") method for analyzing an individual's intensive longitudinal data. Formally, MoTR is an application of the g-formula (i.e., standardization, back-door adjustment) under serial interference. It estimates stable recurring effects, as is done in n-of-1 trials and single case experimental designs. We compare our approach to standard methods (with possible confounding) to show how to use causal inference to make better personalized recommendations for health behavior change, and analyze 222 days of Fitbit sleep and steps data for one of the authors.

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

Causal representation learning seeks to extract high-level latent factors from low-level sensory data. Most existing methods rely on observational data and structural assumptions (e.g., conditional independence) to identify the latent factors. However, interventional data is prevalent across applications. Can interventional data facilitate causal representation learning? We explore this question in this paper. The key observation is that interventional data often carries geometric signatures of the latent factors' support (i.e. what values each latent can possibly take). For example, when the latent factors are causally connected, interventions can break the dependency between the intervened latents' support and their ancestors'. Leveraging this fact, we prove that the latent causal factors can be identified up to permutation and scaling given data from perfect do interventions. Moreover, we can achieve block affine identification, namely the estimated latent factors are only entangled with a few other latents if we have access to data from imperfect interventions. These results highlight the unique power of interventional data in causal representation learning; they can enable provable identification of latent factors without any assumptions about their distributions or dependency structure.

Integrating language models (LMs) in healthcare systems holds great promise for improving medical workflows and decision-making. However, a critical barrier to their real-world adoption is the lack of reliable evaluation of their trustworthiness, especially in multilingual healthcare settings. Existing LMs are predominantly trained in high-resource languages, making them ill-equipped to handle the complexity and diversity of healthcare queries in mid- and low-resource languages, posing significant challenges for deploying them in global healthcare contexts where linguistic diversity is key. In this work, we present CLINIC, a Comprehensive Multilingual Benchmark to evaluate the trustworthiness of language models in healthcare. CLINIC systematically benchmarks LMs across five key dimensions of trustworthiness: truthfulness, fairness, safety, robustness, and privacy, operationalized through 18 diverse tasks, spanning 15 languages (covering all the major continents), and encompassing a wide array of critical healthcare topics like disease conditions, preventive actions, diagnostic tests, treatments, surgeries, and medications. Our extensive evaluation reveals that LMs struggle with factual correctness, demonstrate bias across demographic and linguistic groups, and are susceptible to privacy breaches and adversarial attacks. By highlighting these shortcomings, CLINIC lays the foundation for enhancing the global reach and safety of LMs in healthcare across diverse languages.

We participated in the SynthRAD2025 challenge (Tasks 1 and 2) with a unified pipeline for synthetic CT (sCT) generation from MRI and CBCT, implemented using the KonfAI framework. Our model is a 2.5D U-Net++ with a ResNet-34 encoder, trained jointly across anatomical regions and fine-tuned per region. The loss function combined pixel-wise L1 loss with IMPACT-Synth, a perceptual loss derived from SAM and TotalSegmentator to enhance structural fidelity. Training was performed using AdamW (initial learning rate = 0.001, halved every 25k steps) on patch-based, normalized, body-masked inputs (320x320 for MRI, 256x256 for CBCT), with random flipping as the only augmentation. No post-processing was applied. Final predictions leveraged test-time augmentation and five-fold ensembling. The best model was selected based on validation MAE. Two registration strategies were evaluated: (i) Elastix with mutual information, consistent with the challenge pipeline, and (ii) IMPACT, a feature-based similarity metric leveraging pretrained segmentation networks. On the local test sets, IMPACT-based registration achieved more accurate and anatomically consistent alignments than mutual-information-based registration, resulting in improved sCT synthesis with lower MAE and more realistic anatomical structures. On the public validation set, however, models trained with Elastix-aligned data achieved higher scores, reflecting a registration bias favoring alignment strategies consistent with the evaluation pipeline. This highlights how registration errors can propagate into supervised learning, influencing both training and evaluation, and potentially inflating performance metrics at the expense of anatomical fidelity. By promoting anatomically consistent alignment, IMPACT helps mitigate this bias and supports the development of more robust and generalizable sCT synthesis models.

In this work, we introduce Brain Latent Progression (BrLP), a novel spatiotemporal disease progression model based on latent diffusion. BrLP is designed to predict the evolution of diseases at the individual level on 3D brain MRIs. Existing deep generative models developed for this task are primarily data-driven and face challenges in learning disease progressions. BrLP addresses these challenges by incorporating prior knowledge from disease models to enhance the accuracy of predictions. To implement this, we propose to integrate an auxiliary model that infers volumetric changes in various brain regions. Additionally, we introduce Latent Average Stabilization (LAS), a novel technique to improve spatiotemporal consistency of the predicted progression. BrLP is trained and evaluated on a large dataset comprising 11,730 T1-weighted brain MRIs from 2,805 subjects, collected from three publicly available, longitudinal Alzheimer's Disease (AD) studies. In our experiments, we compare the MRI scans generated by BrLP with the actual follow-up MRIs available from the subjects, in both cross-sectional and longitudinal settings. BrLP demonstrates significant improvements over existing methods, with an increase of 22% in volumetric accuracy across AD-related brain regions and 43% in image similarity to the ground-truth scans. The ability of BrLP to generate conditioned 3D scans at the subject level, along with the novelty of integrating prior knowledge to enhance accuracy, represents a significant advancement in disease progression modeling, opening new avenues for precision medicine. The code of BrLP is available at the following link: https://github.com/LemuelPuglisi/BrLP.

Brain tumor growth is unique to each glioma patient and extends beyond what is visible in imaging scans, infiltrating surrounding brain tissue. Understanding these hidden patient-specific progressions is essential for effective therapies. Current treatment plans for brain tumors, such as radiotherapy, typically involve delineating a uniform margin around the visible tumor on pre-treatment scans to target this invisible tumor growth. This "one size fits all" approach is derived from population studies and often fails to account for the nuances of individual patient conditions. We present the GliODIL framework, which infers the full spatial distribution of tumor cell concentration from available multi-modal imaging, leveraging a Fisher-Kolmogorov type physics model to describe tumor growth. This is achieved through the newly introduced method of Optimizing the Discrete Loss (ODIL), where both data and physics-based constraints are softly assimilated into the solution. Our test dataset comprises 152 glioblastoma patients with pre-treatment imaging and post-treatment follow-ups for tumor recurrence monitoring. By blending data-driven techniques with physics-based constraints, GliODIL enhances recurrence prediction in radiotherapy planning, challenging traditional uniform margins and strict adherence to the Fisher-Kolmogorov partial differential equation (PDE) model, which is adapted for complex cases.

Proactive interventions by LLM critic models are often assumed to improve reliability, yet their effects at deployment time are poorly understood. We show that a binary LLM critic with strong offline accuracy (AUROC 0.94) can nevertheless cause severe performance degradation, inducing a 26 percentage point (pp) collapse on one model while affecting another by near zero pp. This variability demonstrates that LLM critic accuracy alone is insufficient to determine whether intervention is safe. We identify a disruption-recovery tradeoff: interventions may recover failing trajectories but also disrupt trajectories that would have succeeded. Based on this insight, we propose a pre-deployment test that uses a small pilot of 50 tasks to estimate whether intervention is likely to help or harm, without requiring full deployment. Across benchmarks, the test correctly anticipates outcomes: intervention degrades performance on high-success tasks (0 to -26 pp), while yielding a modest improvement on the high-failure ALFWorld benchmark (+2.8 pp, p=0.014). The primary value of our framework is therefore identifying when not to intervene, preventing severe regressions before deployment.

Grounded text generation systems often generate text that contains factual inconsistencies, hindering their real-world applicability. Automatic factual consistency evaluation may help alleviate this limitation by accelerating evaluation cycles, filtering inconsistent outputs and augmenting training data. While attracting increasing attention, such evaluation metrics are usually developed and evaluated in silo for a single task or dataset, slowing their adoption. Moreover, previous meta-evaluation protocols focused on system-level correlations with human annotations, which leave the example-level accuracy of such metrics unclear. In this work, we introduce TRUE: a comprehensive survey and assessment of factual consistency metrics on a standardized collection of existing texts from diverse tasks, manually annotated for factual consistency. Our standardization enables an example-level meta-evaluation protocol that is more actionable and interpretable than previously reported correlations, yielding clearer quality measures. Across diverse state-of-the-art metrics and 11 datasets we find that large-scale NLI and question generation-and-answering-based approaches achieve strong and complementary results. We recommend those methods as a starting point for model and metric developers, and hope TRUE will foster progress towards even better evaluation methods.

Continuous-time Consistency Models (CMs) promise efficient few-step generation but face significant challenges with training instability. We argue this instability stems from a fundamental conflict: by training a network to learn only a shortcut across a probability flow, the model loses its grasp on the instantaneous velocity field that defines the flow. Our solution is to explicitly anchor the model in the underlying flow during training. We introduce the Flow-Anchored Consistency Model (FACM), a simple but effective training strategy that uses a Flow Matching (FM) task as an anchor for the primary CM shortcut objective. This Flow-Anchoring approach requires no architectural modifications and is broadly compatible with standard model architectures. By distilling a pre-trained LightningDiT model, our method achieves a state-of-the-art FID of 1.32 with two steps (NFE=2) and 1.76 with just one step (NFE=1) on ImageNet 256x256, significantly outperforming previous methods. This provides a general and effective recipe for building high-performance, few-step generative models. Our code and pretrained models: https://github.com/ali-vilab/FACM.

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

The consistency model (CM) has recently made significant progress in accelerating the generation of diffusion models. However, its application to high-resolution, text-conditioned image generation in the latent space (a.k.a., LCM) remains unsatisfactory. In this paper, we identify three key flaws in the current design of LCM. We investigate the reasons behind these limitations and propose the Phased Consistency Model (PCM), which generalizes the design space and addresses all identified limitations. Our evaluations demonstrate that PCM significantly outperforms LCM across 1--16 step generation settings. While PCM is specifically designed for multi-step refinement, it achieves even superior or comparable 1-step generation results to previously state-of-the-art specifically designed 1-step methods. Furthermore, we show that PCM's methodology is versatile and applicable to video generation, enabling us to train the state-of-the-art few-step text-to-video generator. More details are available at https://g-u-n.github.io/projects/pcm/.

Personalized nutrition intervention for patients with multimorbidity is critical for improving health outcomes, yet remains challenging because it requires the simultaneous integration of heterogeneous clinical conditions, medications, and dietary guidelines. Single-agent large language models (LLMs) often suffer from context overload and attention dilution when processing such high-dimensional patient profiles. We introduce NutriOrion, a hierarchical multi-agent framework with a parallel-then-sequential reasoning topology. NutriOrion decomposes nutrition planning into specialized domain agents with isolated contexts to mitigate anchoring bias, followed by a conditional refinement stage. The framework includes a multi-objective prioritization algorithm to resolve conflicting dietary requirements and a safety constraint mechanism that injects pharmacological contraindications as hard negative constraints during synthesis, ensuring clinical validity by construction rather than post-hoc filtering. For clinical interoperability, NutriOrion maps synthesized insights into the ADIME standard and FHIR R4 resources. Evaluated on 330 stroke patients with multimorbidity, NutriOrion outperforms multiple baselines, including GPT-4.1 and alternative multi-agent architectures. It achieves a 12.1 percent drug-food interaction violation rate, demonstrates strong personalization with negative correlations (-0.26 to -0.35) between patient biomarkers and recommended risk nutrients, and yields clinically meaningful dietary improvements, including a 167 percent increase in fiber and a 27 percent increase in potassium, alongside reductions in sodium (9 percent) and sugars (12 percent).

Consistency models are a new family of generative models capable of producing high-quality samples in either a single step or multiple steps. Recently, consistency models have demonstrated impressive performance, achieving results on par with diffusion models in the pixel space. However, the success of scaling consistency training to large-scale datasets, particularly for text-to-image and video generation tasks, is determined by performance in the latent space. In this work, we analyze the statistical differences between pixel and latent spaces, discovering that latent data often contains highly impulsive outliers, which significantly degrade the performance of iCT in the latent space. To address this, we replace Pseudo-Huber losses with Cauchy losses, effectively mitigating the impact of outliers. Additionally, we introduce a diffusion loss at early timesteps and employ optimal transport (OT) coupling to further enhance performance. Lastly, we introduce the adaptive scaling-c scheduler to manage the robust training process and adopt Non-scaling LayerNorm in the architecture to better capture the statistics of the features and reduce outlier impact. With these strategies, we successfully train latent consistency models capable of high-quality sampling with one or two steps, significantly narrowing the performance gap between latent consistency and diffusion models. The implementation is released here: https://github.com/quandao10/sLCT/

Forecasting is a task that is difficult to evaluate: the ground truth can only be known in the future. Recent work showing LLM forecasters rapidly approaching human-level performance begs the question: how can we benchmark and evaluate these forecasters instantaneously? Following the consistency check framework, we measure the performance of forecasters in terms of the consistency of their predictions on different logically-related questions. We propose a new, general consistency metric based on arbitrage: for example, if a forecasting AI illogically predicts that both the Democratic and Republican parties have 60% probability of winning the 2024 US presidential election, an arbitrageur can trade against the forecaster's predictions and make a profit. We build an automated evaluation system that generates a set of base questions, instantiates consistency checks from these questions, elicits the predictions of the forecaster, and measures the consistency of the predictions. We then build a standard, proper-scoring-rule forecasting benchmark, and show that our (instantaneous) consistency metrics correlate with LLM forecasters' ground truth Brier scores (which are only known in the future). We also release a consistency benchmark that resolves in 2028, providing a long-term evaluation tool for forecasting.

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

Plain language summarization with LLMs can be useful for improving textual accessibility of technical content. But how factual are these summaries in a high-stakes domain like medicine? This paper presents FactPICO, a factuality benchmark for plain language summarization of medical texts describing randomized controlled trials (RCTs), which are the basis of evidence-based medicine and can directly inform patient treatment. FactPICO consists of 345 plain language summaries of RCT abstracts generated from three LLMs (i.e., GPT-4, Llama-2, and Alpaca), with fine-grained evaluation and natural language rationales from experts. We assess the factuality of critical elements of RCTs in those summaries: Populations, Interventions, Comparators, Outcomes (PICO), as well as the reported findings concerning these. We also evaluate the correctness of the extra information (e.g., explanations) added by LLMs. Using FactPICO, we benchmark a range of existing factuality metrics, including the newly devised ones based on LLMs. We find that plain language summarization of medical evidence is still challenging, especially when balancing between simplicity and factuality, and that existing metrics correlate poorly with expert judgments on the instance level.

Medical tasks such as diagnosis and treatment planning require precise and complex reasoning, particularly in life-critical domains. Unlike mathematical reasoning, medical reasoning demands meticulous, verifiable thought processes to ensure reliability and accuracy. However, there is a notable lack of datasets that provide transparent, step-by-step reasoning to validate and enhance the medical reasoning ability of AI models. To bridge this gap, we introduce MedReason, a large-scale high-quality medical reasoning dataset designed to enable faithful and explainable medical problem-solving in large language models (LLMs). We utilize a structured medical knowledge graph (KG) to convert clinical QA pairs into logical chains of reasoning, or ``thinking paths'', which trace connections from question elements to answers via relevant KG entities. Each path is validated for consistency with clinical logic and evidence-based medicine. Our pipeline generates detailed reasoning for various medical questions from 7 medical datasets, resulting in a dataset of 32,682 question-answer pairs, each with detailed, step-by-step explanations. Experiments demonstrate that fine-tuning with our dataset consistently boosts medical problem-solving capabilities, achieving significant gains of up to 7.7% for DeepSeek-Ditill-8B. Our top-performing model, MedReason-8B, outperforms the Huatuo-o1-8B, a state-of-the-art medical reasoning model, by up to 4.2% on the clinical benchmark MedBullets. We also engage medical professionals from diverse specialties to assess our dataset's quality, ensuring MedReason offers accurate and coherent medical reasoning. Our data, models, and code will be publicly available.

Diffusion-based technologies have made significant strides, particularly in personalized and customized facialgeneration. However, existing methods face challenges in achieving high-fidelity and detailed identity (ID)consistency, primarily due to insufficient fine-grained control over facial areas and the lack of a comprehensive strategy for ID preservation by fully considering intricate facial details and the overall face. To address these limitations, we introduce ConsistentID, an innovative method crafted for diverseidentity-preserving portrait generation under fine-grained multimodal facial prompts, utilizing only a single reference image. ConsistentID comprises two key components: a multimodal facial prompt generator that combines facial features, corresponding facial descriptions and the overall facial context to enhance precision in facial details, and an ID-preservation network optimized through the facial attention localization strategy, aimed at preserving ID consistency in facial regions. Together, these components significantly enhance the accuracy of ID preservation by introducing fine-grained multimodal ID information from facial regions. To facilitate training of ConsistentID, we present a fine-grained portrait dataset, FGID, with over 500,000 facial images, offering greater diversity and comprehensiveness than existing public facial datasets. % such as LAION-Face, CelebA, FFHQ, and SFHQ. Experimental results substantiate that our ConsistentID achieves exceptional precision and diversity in personalized facial generation, surpassing existing methods in the MyStyle dataset. Furthermore, while ConsistentID introduces more multimodal ID information, it maintains a fast inference speed during generation.

Instrumental variable methods have been widely used to identify causal effects in the presence of unmeasured confounding. A key identification condition known as the exclusion restriction states that the instrument cannot have a direct effect on the outcome which is not mediated by the exposure in view. In the health and social sciences, such an assumption is often not credible. To address this concern, we consider identification conditions of the population average treatment effect with an invalid instrumental variable which does not satisfy the exclusion restriction, and derive the efficient influence function targeting the identifying functional under a nonparametric observed data model. We propose a novel multiply robust locally efficient estimator of the average treatment effect that is consistent in the union of multiple parametric nuisance models, as well as a multiply debiased machine learning estimator for which the nuisance parameters are estimated using generic machine learning methods, that effectively exploit various forms of linear or nonlinear structured sparsity in the nuisance parameter space. When one cannot be confident that any of these machine learners is consistent at sufficiently fast rates to ensure n-consistency for the average treatment effect, we introduce a new criteria for selective machine learning which leverages the multiple robustness property in order to ensure small bias. The proposed methods are illustrated through extensive simulations and a data analysis evaluating the causal effect of 401(k) participation on savings.

Image-to-video (I2V) generation aims to use the initial frame (alongside a text prompt) to create a video sequence. A grand challenge in I2V generation is to maintain visual consistency throughout the video: existing methods often struggle to preserve the integrity of the subject, background, and style from the first frame, as well as ensure a fluid and logical progression within the video narrative. To mitigate these issues, we propose ConsistI2V, a diffusion-based method to enhance visual consistency for I2V generation. Specifically, we introduce (1) spatiotemporal attention over the first frame to maintain spatial and motion consistency, (2) noise initialization from the low-frequency band of the first frame to enhance layout consistency. These two approaches enable ConsistI2V to generate highly consistent videos. We also extend the proposed approaches to show their potential to improve consistency in auto-regressive long video generation and camera motion control. To verify the effectiveness of our method, we propose I2V-Bench, a comprehensive evaluation benchmark for I2V generation. Our automatic and human evaluation results demonstrate the superiority of ConsistI2V over existing methods.

Text-to-image (T2I) diffusion models have revolutionized visual content creation, but extending these capabilities to text-to-video (T2V) generation remains a challenge, particularly in preserving temporal consistency. Existing methods that aim to improve consistency often cause trade-offs such as reduced imaging quality and impractical computational time. To address these issues we introduce VideoGuide, a novel framework that enhances the temporal consistency of pretrained T2V models without the need for additional training or fine-tuning. Instead, VideoGuide leverages any pretrained video diffusion model (VDM) or itself as a guide during the early stages of inference, improving temporal quality by interpolating the guiding model's denoised samples into the sampling model's denoising process. The proposed method brings about significant improvement in temporal consistency and image fidelity, providing a cost-effective and practical solution that synergizes the strengths of various video diffusion models. Furthermore, we demonstrate prior distillation, revealing that base models can achieve enhanced text coherence by utilizing the superior data prior of the guiding model through the proposed method. Project Page: http://videoguide2025.github.io/

Despite achieving high accuracy on medical benchmarks, LLMs exhibit the Einstellung Effect in clinical diagnosis--relying on statistical shortcuts rather than patient-specific evidence, causing misdiagnosis in atypical cases. Existing benchmarks fail to detect this critical failure mode. We introduce MedEinst, a counterfactual benchmark with 5,383 paired clinical cases across 49 diseases. Each pair contains a control case and a "trap" case with altered discriminative evidence that flips the diagnosis. We measure susceptibility via Bias Trap Rate--probability of misdiagnosing traps despite correctly diagnosing controls. Extensive Evaluation of 17 LLMs shows frontier models achieve high baseline accuracy but severe bias trap rates. Thus, we propose ECR-Agent, aligning LLM reasoning with Evidence-Based Medicine standard via two components: (1) Dynamic Causal Inference (DCI) performs structured reasoning through dual-pathway perception, dynamic causal graph reasoning across three levels (association, intervention, counterfactual), and evidence audit for final diagnosis; (2) Critic-Driven Graph and Memory Evolution (CGME) iteratively refines the system by storing validated reasoning paths in an exemplar base and consolidating disease-specific knowledge into evolving illness graphs. Source code is to be released.

The integration of Computer-Assisted Diagnosis (CAD) with Large Language Models (LLMs) holds great potential in clinical applications, specifically in the roles of virtual family doctors and clinic assistants. However, current works in this field are plagued by limitations, specifically a restricted scope of applicable image domains and the provision of unreliable medical advice. This restricts their overall processing capabilities. Furthermore, the mismatch in writing style between LLMs and radiologists undermines their practical usefulness. To tackle these challenges, we introduce ChatCAD+, which is designed to be universal and reliable. It is capable of handling medical images from diverse domains and leveraging up-to-date information from reputable medical websites to provide reliable medical advice. Additionally, it incorporates a template retrieval system that improves report generation performance via exemplar reports. This approach ensures greater consistency with the expertise of human professionals. The source code is available at https://github.com/zhaozh10/ChatCAD.

Large language model (LLM) systems are increasingly used to support high-stakes decision-making, but they typically perform worse when the available evidence is internally inconsistent. Such a scenario exists in real-world healthcare settings, with patient-reported symptoms contradicting medical signs. To study this problem, we introduce MIMIC-DOS, a dataset for short-horizon organ dysfunction worsening prediction in the intensive care unit (ICU) setting. We derive this dataset from the widely recognized MIMIC-IV, a publicly available electronic health record dataset, and construct it exclusively from cases in which discordance between signs and symptoms exists. This setting poses a substantial challenge for existing LLM-based approaches, with single-pass LLMs and agentic pipelines often struggling to reconcile such conflicting signals. To address this problem, we propose CARE: a multi-stage privacy-compliant agentic reasoning framework in which a remote LLM provides guidance by generating structured categories and transitions without accessing sensitive patient data, while a local LLM uses these categories and transitions to support evidence acquisition and final decision-making. Empirically, CARE achieves stronger performance across all key metrics compared to multiple baseline settings, showing that CARE can more robustly handle conflicting clinical evidence while preserving privacy.

Large Language Models (LLMs) are increasingly used in healthcare, yet ensuring their safety and trustworthiness remains a barrier to deployment. Conversational medical assistants must avoid unsafe compliance without over-refusing benign queries. We present an iterative post-deployment alignment framework that applies Kahneman-Tversky Optimization (KTO) and Direct Preference Optimization (DPO) to refine models against domain-specific safety signals. Using the CARES-18K benchmark for adversarial robustness, we evaluate four LLMs (Llama-3B/8B, Meditron-8B, Mistral-7B) across multiple cycles. Our results show up to 42% improvement in safety-related metrics for harmful query detection, alongside interesting trade-offs against erroneous refusals, thereby exposing architecture-dependent calibration biases. We also perform ablation studies to identify when self-evaluation is reliable and when external or finetuned judges are necessary to maximize performance gains. Our findings underscore the importance of adopting best practices that balance patient safety, user trust, and clinical utility in the design of conversational medical assistants.

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

Image registration is the process of bringing different images into a common coordinate system - a technique widely used in various applications of computer vision, such as remote sensing, image retrieval, and, most commonly, medical imaging. Deep learning based techniques have been applied successfully to tackle various complex medical image processing problems, including medical image registration. Over the years, several image registration techniques have been proposed using deep learning. Deformable image registration techniques such as Voxelmorph have been successful in capturing finer changes and providing smoother deformations. However, Voxelmorph, as well as ICNet and FIRE, do not explicitly encode global dependencies (i.e. the overall anatomical view of the supplied image) and, therefore, cannot track large deformations. In order to tackle the aforementioned problems, this paper extends the Voxelmorph approach in three different ways. To improve the performance in case of small as well as large deformations, supervision of the model at different resolutions has been integrated using a multi-scale UNet. To support the network to learn and encode the minute structural co-relations of the given image-pairs, a self-constructing graph network (SCGNet) has been used as the latent of the multi-scale UNet - which can improve the learning process of the model and help the model to generalise better. And finally, to make the deformations inverse-consistent, cycle consistency loss has been employed. On the task of registration of brain MRIs, the proposed method achieved significant improvements over ANTs and VoxelMorph, obtaining a Dice score of 0.8013 \pm 0.0243 for intramodal and 0.6211 \pm 0.0309 for intermodal, while VoxelMorph achieved 0.7747 \pm 0.0260 and 0.6071 \pm 0.0510, respectively

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

Reinforcement learning (RL) has improved guided image generation with diffusion models by directly optimizing rewards that capture image quality, aesthetics, and instruction following capabilities. However, the resulting generative policies inherit the same iterative sampling process of diffusion models that causes slow generation. To overcome this limitation, consistency models proposed learning a new class of generative models that directly map noise to data, resulting in a model that can generate an image in as few as one sampling iteration. In this work, to optimize text-to-image generative models for task specific rewards and enable fast training and inference, we propose a framework for fine-tuning consistency models via RL. Our framework, called Reinforcement Learning for Consistency Model (RLCM), frames the iterative inference process of a consistency model as an RL procedure. RLCM improves upon RL fine-tuned diffusion models on text-to-image generation capabilities and trades computation during inference time for sample quality. Experimentally, we show that RLCM can adapt text-to-image consistency models to objectives that are challenging to express with prompting, such as image compressibility, and those derived from human feedback, such as aesthetic quality. Comparing to RL finetuned diffusion models, RLCM trains significantly faster, improves the quality of the generation measured under the reward objectives, and speeds up the inference procedure by generating high quality images with as few as two inference steps. Our code is available at https://rlcm.owenoertell.com