arXiv subjects

Binesh Sadanandan

Publications and source records attributed to Binesh Sadanandan.

10 recordsLinked to original sources

arXiv2026

Predictive Entropy as a Joint Screen for Error and Paraphrase Instability in Medical Vision-Language Models

Medical Vision-Language Models (VLMs) answering binary presence questions on chest radiographs can fail in two linked ways: they are confidently wrong, and they change answers when a clinically equivalent question is rephrased. In a binary answer head both failures track the same logit margin, so we test how well one score screens for both. On MedGemma-4B-IT across MIMIC-CXR (in-distribution, n=196) and PadChest (out-of-distribution, n=861), single-pass predictive entropy predicts which yes/no answers flip under rephrasing with an area under the receiver operating characteristic curve (AUROC) of 0.823 on PadChest and 0.821 on MIMIC, and the signal is stable across five random seeds (0.828$\pm$0.021). The same signal replicates on LLaVA-RAD-7B (AUROC 0.83) and is invariant to the flip definition (all, operator-preserving, or negation-excluded rewrites), so the screen needs no semantic filter at inference. One low-entropy threshold drives error and flip rate down together (3.3% and 5.7% at 80% coverage), and threshold selection transfers to a held-out split. Under cross-site shift the more expensive methods we test add nothing practical: at the 5% risk target a single forward pass answers 88.5% of cases, matching Monte Carlo (MC) Dropout, and beats the uniformly averaged five-seed adapter ensemble on error detection by 0.111 AUROC. Even a model that is 91% accurate still contradicts itself on 13% of items under rephrasing, and one forward pass flags them.

cs.LG↗

arXiv2026

Attention Without Grounding: Causal Evaluation of Visual Explanations in Medical VLMs

Attention and saliency heatmaps are widely used to explain medical Vision-Language Model (VLM) outputs on chest X-rays, yet whether they truly highlight the image evidence driving predictions has not been causally tested. We audit faithfulness via overlap with radiologist bounding boxes on PadChest (n=637), attribution mass within radiologist masks on CheXlocalize (n=643), and 16x16 patch-occlusion maps that record which regions, when hidden, change the answer. We study three MedGemma-4B variants, cross-family probes on LLaVA-RAD and Qwen3-VL-8B-Instruct, and the specialist CheXagent-2-3b, with two CXR-trained classifiers (DenseNet121, ResNet50) as positive controls. A heatmap is faithful only if the model uses the image and attention concentrates on regions whose occlusion alters the prediction. No evaluated VLM meets both criteria. MedGemma and Qwen3-VL use the image, but attention anti-correlates with patch-occlusion importance (rho < 0 with 95% bootstrap CIs below zero). LLaVA-RAD's attention correlates positively, but the model is almost text-only (99.1% text-only agreement, near-zero causal mass), so correlation ties two near-zero signals. Attention also misses annotated anatomy: overlap with true regions never beats shifted or random controls, and no method places more than 22% of its mass inside radiologist masks. The two CXR classifiers pass all metrics, indicating the failure is specific to VLM heatmaps, not the evaluation. These heatmaps are visually reassuring but not faithful; clinical explanations require controlled localization metrics and causal perturbation, not visual inspection alone.

cs.CV↗

arXiv2026

PSF-Med: Measuring and Explaining Paraphrase Sensitivity in Medical Vision Language Models

Medical Vision Language Models (VLMs) can change their answers when clinicians rephrase the same question, a failure mode that threatens deployment safety. We introduce PSF-Med, a benchmark of 26,850 chest X-ray questions paired with 92,856 meaning-preserving paraphrases across MIMIC-CXR, PadChest, and VinDr-CXR, spanning clinical populations in the US, Spain, and Vietnam. Every paraphrase is validated by an LLM judge using a bidirectional clinical entailment rubric, with 91.6% cross-family agreement. Across nine VLMs, including general-purpose models, we find flip rates from 3% to 37%. However, low flip rate does not imply visual grounding: text-only baselines show that some models stay consistent even when the image is removed, suggesting they rely on language priors. To study mechanisms in one model, we apply GemmaScope 2 Sparse Autoencoders (SAEs) to MedGemma 4B and analyze FlipBank, a curated set of 158 flip cases. We identify a sparse feature at layer 17 that correlates with prompt framing and predicts decision margin shifts. In causal patching, removing this feature's contribution recovers 45% of the yes-minus-no logit margin on average and fully reverses 15% of flips. Acting on this finding, we show that clamping the identified feature at inference reduces flip rates by 31% relative with only a 1.3 percentage-point accuracy cost, while also decreasing text-prior reliance. These results suggest that flip rate alone is not enough; robustness evaluations should test both paraphrase stability and image reliance.

cs.CV↗

arXiv2026

When Chain-of-Thought Backfires: Evaluating Prompt Sensitivity in Medical Language Models

Large Language Models (LLMs) are increasingly deployed in medical settings, yet their sensitivity to prompt formatting remains poorly characterized. We evaluate MedGemma (4B and 27B parameters) on MedMCQA (4,183 questions) and PubMedQA (1,000 questions) across a broad suite of robustness tests. Our experiments reveal several concerning findings. Chain-of-Thought (CoT) prompting decreases accuracy by 5.7% compared to direct answering. Few-shot examples degrade performance by 11.9% while increasing position bias from 0.14 to 0.47. Shuffling answer options causes the model to change predictions 59.1% of the time, with accuracy dropping up to 27.4 percentage points. Front-truncating context to 50% causes accuracy to plummet below the no-context baseline, yet back-truncation preserves 97% of full-context accuracy. We further show that cloze scoring (selecting the highest log-probability option token) achieves 51.8% (4B) and 64.5% (27B), surpassing all prompting strategies and revealing that models "know" more than their generated text shows. Permutation voting recovers 4 percentage points over single-ordering inference. These results demonstrate that prompt engineering techniques validated on general-purpose models do not transfer to domain-specific medical LLMs, and that reliable alternatives exist.

cs.CL↗

arXiv2026

Consistent but Dangerous: Per-Sample Safety Classification Reveals False Reliability in Medical Vision-Language Models

Consistency under paraphrase, the property that semantically equivalent prompts yield identical predictions, is increasingly used as a proxy for reliability when deploying medical vision-language models (VLMs). We show this proxy is fundamentally flawed: a model can achieve perfect consistency by relying on text patterns rather than the input image. We introduce a four-quadrant per-sample safety taxonomy that jointly evaluates consistency (stable predictions across paraphrased prompts) and image reliance (predictions that change when the image is removed). Samples are classified as Ideal (consistent and image-reliant), Fragile (inconsistent but image-reliant), Dangerous (consistent but not image-reliant), or Worst (inconsistent and not image-reliant). Evaluating five medical VLM configurations across two chest X-ray datasets (MIMIC-CXR, PadChest), we find that LoRA fine-tuning dramatically reduces flip rates but shifts a majority of samples into the Dangerous quadrant: LLaVA-Rad Base achieves a 1.5% flip rate on PadChest while 98.5% of its samples are Dangerous. Critically, Dangerous samples exhibit high accuracy (up to 99.6%) and low entropy, making them invisible to standard confidence-based screening. We observe a negative correlation between flip rate and Dangerous fraction (r = -0.89, n=10) and recommend that deployment evaluations always pair consistency checks with a text-only baseline: a single additional forward pass that exposes the false reliability trap.

cs.CV↗

arXiv2026

Multimodal Deep Learning for Early Prediction of Patient Deterioration in the ICU: Integrating Time-Series EHR Data with Clinical Notes

Early identification of patients at risk for clinical deterioration in the intensive care unit (ICU) remains a critical challenge. Delayed recognition of impending adverse events, including mortality, vasopressor initiation, and mechanical ventilation, contributes to preventable morbidity and mortality. We present a multimodal deep learning approach that combines structured time-series data (vital signs and laboratory values) with unstructured clinical notes to predict patient deterioration within 24 hours. Using the MIMIC-IV database, we constructed a cohort of 74,822 ICU stays and generated 5.7 million hourly prediction samples. Our architecture employs a bidirectional LSTM encoder for temporal patterns in physiologic data and ClinicalBERT embeddings for clinical notes, fused through a cross-modal attention mechanism. We also present a systematic review of existing approaches to ICU deterioration prediction, identifying 31 studies published between 2015 and 2024. Most existing models rely solely on structured data and achieve area under the curve (AUC) values between 0.70 and 0.85. Studies incorporating clinical notes remain rare but show promise for capturing information not present in structured fields. Our multimodal model achieves a test AUROC of 0.7857 and AUPRC of 0.1908 on 823,641 held-out samples, with a validation-to-test gap of only 0.6 percentage points. Ablation analysis validates the multimodal approach: clinical notes improve AUROC by 2.5 percentage points and AUPRC by 39.2% relative to a structured-only baseline, while deep learning models consistently outperform classical baselines (XGBoost AUROC: 0.7486, logistic regression: 0.7171). This work contributes both a thorough review of the field and a reproducible multimodal framework for clinical deterioration prediction.

cs.LG↗

arXiv2026

Mechanistically Guided LoRA Improves Paraphrase Consistency in Medical Vision-Language Models

Medical Vision-Language Models can give different yes or no answers to rephrasings of the same clinical question. We study this in MedGemma-4B using PSF-Med Sadanandan and Behzadan (2025), which provides paraphrase pairs for systematic consistency evaluation on medical VQA. On MIMIC-CXR binary questions (n = 158), the baseline flip rate is 14.6% and mean margin difference is 1.63 logits. We validate that Gemma Scope 2 Sparse Autoencoders (SAEs) transfer to MedGemma activations, achieving R2 ~= 0.997 on both medical and general text (n = 100 prompts each, p < 0.001 for exceeding a 0.95 threshold). We then fine-tune Low-Rank Adaptation (LoRA) adapters with a combined loss that balances paraphrase consistency with answer accuracy. This combined approach prevents mode collapse that occurs with pure consistency training while reducing flip rate from 14.6% to 4.4% (p = 0.002, two-proportion z-test) and margin difference from 1.63 to 0.33 (79.5% reduction). Accuracy remains stable at 84.2% baseline versus 82.3% after training (-1.9pp, not significant). On PadChest Balanced (n = 250), flip rate drops from 13.6% to 7.8%, mean margin difference drops from 1.08 to 0.35 (67.9% reduction), and accuracy increases from 66.4% to 69.4%. A layer-range ablation shows that early layers reduce margin differences more than mechanistically selected middle layers.

cs.CV↗

arXiv2025

VSF-Med:A Vulnerability Scoring Framework for Medical Vision-Language Models

Vision Language Models (VLMs) hold great promise for streamlining labour-intensive medical imaging workflows, yet systematic security evaluations in clinical settings remain scarce. We introduce VSF--Med, an end-to-end vulnerability-scoring framework for medical VLMs that unites three novel components: (i) a rich library of sophisticated text-prompt attack templates targeting emerging threat vectors; (ii) imperceptible visual perturbations calibrated by structural similarity (SSIM) thresholds to preserve clinical realism; and (iii) an eight-dimensional rubric evaluated by two independent judge LLMs, whose raw scores are consolidated via z-score normalization to yield a 0--32 composite risk metric. Built entirely on publicly available datasets and accompanied by open-source code, VSF--Med synthesizes over 30,000 adversarial variants from 5,000 radiology images and enables reproducible benchmarking of any medical VLM with a single command. Our consolidated analysis reports mean z-score shifts of $0.90σ$ for persistence-of-attack-effects, $0.74σ$ for prompt-injection effectiveness, and $0.63σ$ for safety-bypass success across state-of-the-art VLMs. Notably, Llama-3.2-11B-Vision-Instruct exhibits a peak vulnerability increase of $1.29σ$ for persistence-of-attack-effects, while GPT-4o shows increases of $0.69σ$ for that same vector and $0.28σ$ for prompt-injection attacks.

cs.CV↗

arXiv2025

Promise of Data-Driven Modeling and Decision Support for Precision Oncology and Theranostics

Cancer remains a leading cause of death worldwide, necessitating personalized treatment approaches to improve outcomes. Theranostics, combining molecular-level imaging with targeted therapy, offers potential for precision oncology but requires optimized, patient-specific care plans. This paper investigates state-of-the-art data-driven decision support applications with a reinforcement learning focus in precision oncology. We review current applications, training environments, state-space representation, performance evaluation criteria, and measurement of risk and reward, highlighting key challenges. We propose a framework integrating data-driven modeling with reinforcement learning-based decision support to optimize radiopharmaceutical therapy dosing, addressing identified challenges and setting directions for future research. The framework leverages Neural Ordinary Differential Equations and Physics-Informed Neural Networks to enhance Physiologically Based Pharmacokinetic models while applying reinforcement learning algorithms to iteratively refine treatment policies based on patient-specific data.

cs.CE↗

arXiv2025

Comparative Study of Generative Models for Early Detection of Failures in Medical Devices

The medical device industry has significantly advanced by integrating sophisticated electronics like microchips and field-programmable gate arrays (FPGAs) to enhance the safety and usability of life-saving devices. These complex electro-mechanical systems, however, introduce challenging failure modes that are not easily detectable with conventional methods. Effective fault detection and mitigation become vital as reliance on such electronics grows. This paper explores three generative machine learning-based approaches for fault detection in medical devices, leveraging sensor data from surgical staplers,a class 2 medical device. Historically considered low-risk, these devices have recently been linked to an increasing number of injuries and fatalities. The study evaluates the performance and data requirements of these machine-learning approaches, highlighting their potential to enhance device safety.

eess.SP↗