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arXiv · 2605.07919

MedVIGIL: Evaluating Trustworthy Medical VLMs Under Broken Visual Evidence

Hanqi Jiang·Junhao Chen·Mingyu Kang·Hyeokjae Kwon·Yi Pan·Lifeng Chen·Weihang You·Haozhen Gong·Ruiyu Yan·Jinglei Lv·Lin Zhao·Hui Ren·Quanzheng Li·Tianming Liu·Xiang Li
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Abstract

Medical vision--language models (VLMs) are usually evaluated on intact image--question pairs, but trustworthy clinical use requires a stronger property: a model must recognise when the evidential basis for an answer has failed. We study this through silent failures under perturbed evidence, where a vision-required medical question is paired with a false premise, wording perturbation, knowledge-only rewrite, or ROI-corrupted image, yet the model returns a fluent non-refusal answer. We introduce medvigil, a 300-case evaluation suite drawn from four public medical VQA sources, supervised end to end by four board-certified radiologists: every gold answer, refusal option, candidate-answer set, paraphrase, false-premise trap, ROI box, and clinical risk tier is clinician-authored. Two attending radiologists annotate every case in parallel, a senior radiologist consolidates the released manifest, and a separate fourth radiologist independent of construction answers every probe to provide the human reference baseline. The release contains 2556 MCQ probes, 240 counterfactual triplets, physician-adjudicated risk-tier and answerability flags, ROI boxes, and a paired open-ended variant. We report seven correctness-conditioned audit metrics that summarise into the medvigil Composite Score (MCS), and audit 16 vision-capable models plus two text-only baselines. The independent radiologist scores MCS 83.3 at silent-failure rate 5.8%, leaving a 14.1-point composite headroom above the strongest audited model (Claude Opus 4.7 at 69.2). The benchmark and evaluation harness are publicly released.

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Hanqi Jiang, Junhao Chen, Mingyu Kang, Hyeokjae Kwon, Yi Pan, Lifeng Chen, Weihang You, Haozhen Gong, Ruiyu Yan, Jinglei Lv, Lin Zhao, Hui Ren, Quanzheng Li, Tianming Liu, Xiang Li. 2026-05-08. MedVIGIL: Evaluating Trustworthy Medical VLMs Under Broken Visual Evidence. https://arxiv.org/abs/2605.07919

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