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Curtis Langlotz

Publications and source records attributed to Curtis Langlotz.

At least 19 recordsLinked to original sources
arXiv2026

Symbal: Detecting Systematic Misalignments in Model-Generated Captions

Multimodal large language models (MLLMs) often introduce errors when generating image captions, resulting in misaligned image-text pairs. Our work focuses on a class of captioning errors that we refer to as systematic misalignments, where a recurring error in MLLM-generated captions is closely associated with the presence of a specific visual feature in the paired image. Given a vision-language dataset with MLLM-generated captions, our aim in this work is to detect such errors, a task we refer to as systematic misalignment detection. As our first key contribution, we present Symbal, which utilizes a structured, dual-stage setup with off-the-shelf foundation models to identify systematic misalignments and summarize results in natural language. As our second key contribution, we introduce SymbalBench, a benchmark designed to evaluate automated methods on our proposed task. SymbalBench consists of 1.7 million image-text pairs from two domains (natural and medical images), organized into 420 vision-language datasets with annotated systematic misalignments. Symbal exhibits strong performance on this benchmark, correctly identifying systematic misalignments in 63.8% of datasets, a nearly 4x improvement over the closest baseline. We supplement our evaluations on SymbalBench with real-world evaluations, showing that (1) Symbal can accurately surface systematic misalignments in captions generated by four MLLMs and (2) Symbal is a powerful tool for auditing off-the-shelf image-caption datasets. Ultimately, our novel task, method, and benchmark can aid users with auditing MLLM-generated captions and identifying critical errors, without requiring access to the underlying MLLM. Code is available at https://github.com/Stanford-AIMI/Symbal.

cs.CV↗
arXiv2026

CheXanatomy: Anatomy-Aware Vision-Language Modeling for Chest Radiographs

Vision-language models (VLMs) pretrained on large-scale image-text pairs demonstrate strong image-level understanding, but are primarily optimized for global alignment and do not explicitly encode fine-grained anatomical structure, limiting their suitability for spatially precise tasks such as segmentation. We introduce CheXanatomy, a framework that integrates explicit anatomical knowledge into a pretrained VLM through autoregressive token-space supervision. Instead of adding task-specific decoder heads, the model is trained to generate anatomical segmentation masks via next-token prediction. To enable scalable supervision, we synthesize realistic chest radiographs from CT volumes and forward-project CT segmentation labels to obtain anatomically consistent 2D masks. We evaluate the approach on synthetic and real chest radiographs against a U-Net baseline, including ablations on model scale, input resolution, and vision encoder fine-tuning. Autoregressive anatomical supervision achieves performance comparable to specialized convolutional models in-distribution and demonstrates improved geometric robustness under domain shift to real CXR data. In addition, anatomy-pretrained models exhibit improved sample efficiency when adapting to novel localization tasks under limited supervision. Larger models and higher input image resolution improve performance, while vision encoder fine-tuning has limited effect. These results show that embedding anatomical structure directly into the generative objective promotes spatially grounded representations and supports anatomy-aware medical vision-language modeling.

cs.CV↗
arXiv2026

BenchX: Benchmarking AI Models for Cancer Detection and Localization with Demographic and Protocol Biases

Artificial intelligence (AI) has achieved remarkable success in medical imaging, but it is widely recognized that these models often perform inconsistently across real-world clinical settings. Such inconsistencies occur when patient demographics and imaging protocols vary, for example, in detecting small tumors, analyzing scans from different contrast phases, or evaluating patients of different ages or sexes. To quantify these inconsistencies, we develop a large-scale, open benchmark of 85,355 CT scans that systematically evaluates 12 tumor-detection AI models across tumor size, location, patient subgroup, and imaging protocol. We leverage large language models (LLMs) to extract and organize subgroup information from clinical data, which makes the analysis both scalable and reproducible. Our benchmark reveals that current state-of-the-art AI models, optimized for average accuracy, perform poorly in rare or underrepresented subgroups, such as young, female African Americans. However, collecting sufficient annotated data for these rare cases is often impractical. The benchmark provides a foundation for building more reliable and robust AI models for tumor detection and highlighting the need for rigorous, subgroup-level evaluation in medical imaging and computer vision. Datasets, code

cs.CV↗
arXiv2026

CheXTemporal: A Dataset for Temporally-Grounded Reasoning in Chest Radiography

Chest radiograph interpretation requires temporal reasoning over prior and current studies, yet most vision-language models are trained on static image-report pairs and lack explicit supervision for modeling longitudinal change. We introduce CheXTemporal, a dataset for temporally grounded reasoning in chest radiography consisting of paired prior-current chest X-rays (CXR) with finding-level temporal and spatial annotations. The dataset includes a five-class progression taxonomy (new, worse, stable, improved, resolved), localized spatial supervision of pathology, explicit spatial-temporal alignment across paired studies, and multi-source coverage for cross-domain evaluation. We additionally construct a 280K-pair silver dataset with automatically derived temporal and anatomical supervision for large-scale evaluation under weaker supervision. Using these resources, we evaluate multiple state-of-the-art vision-language CXR models on grounding and progression-classification tasks in a zero-shot setting. Across both gold and silver evaluations, current models exhibit consistent limitations in spatial grounding, fine-grained temporal reasoning, and robustness under distribution shift. In particular, models perform substantially better on salient progression categories such as worse than on temporally subtle states such as stable and resolved, suggesting limited modeling of longitudinal disease evolution in chest radiography.

cs.CV↗
arXiv2026

Activation Matters: Test-time Activated Negative Labels for OOD Detection with Vision-Language Models

Out-of-distribution (OOD) detection aims to identify samples that deviate from in-distribution (ID). One popular pipeline addresses this by introducing negative labels distant from ID classes and detecting OOD based on their distance to these labels. However, such labels may present poor activation on OOD samples, failing to capture the OOD characteristics. To address this, we propose \underline{T}est-time \underline{A}ctivated \underline{N}egative \underline{L}abels (TANL) by dynamically evaluating activation levels across the corpus dataset and mining candidate labels with high activation responses during the testing process. Specifically, TANL identifies high-confidence test images online and accumulates their assignment probabilities over the corpus to construct a label activation metric. Such a metric leverages historical test samples to adaptively align with the test distribution, enabling the selection of distribution-adaptive activated negative labels. By further exploring the activation information within the current testing batch, we introduce a more fine-grained, batch-adaptive variant. To fully utilize label activation knowledge, we propose an activation-aware score function that emphasizes negative labels with stronger activations, boosting performance and enhancing its robustness to the label number. Our TANL is training-free, test-efficient, and grounded in theoretical justification. Experiments on diverse backbones and wide task settings validate its effectiveness. Notably, on the large-scale ImageNet benchmark, TANL significantly reduces the FPR95 from 17.5\% to 9.8\%. Codes are available at \href{https://github.com/YBZh/OpenOOD-VLM}{YBZh/OpenOOD-VLM}.

cs.CV↗
arXiv2026

A Generalizable Deep Learning System for Cardiac MRI

Cardiac MRI allows for a comprehensive assessment of myocardial structure, function and tissue characteristics. Here we describe a foundational vision system for cardiac MRI, capable of representing the breadth of human cardiovascular disease and health. Our deep-learning model is trained via self-supervised contrastive learning, in which visual concepts in cine-sequence cardiac MRI scans are learned from the raw text of the accompanying radiology reports. We train and evaluate our model on data from four large academic clinical institutions in the United States. We additionally showcase the performance of our models on the UK BioBank and two additional publicly available external datasets. We explore emergent capabilities of our system and demonstrate remarkable performance across a range of tasks, including the problem of left-ventricular ejection fraction regression and the diagnosis of 39 different conditions such as cardiac amyloidosis and hypertrophic cardiomyopathy. We show that our deep-learning system is capable of not only contextualizing the staggering complexity of human cardiovascular disease but can be directed towards clinical problems of interest, yielding impressive, clinical-grade diagnostic accuracy with a fraction of the training data typically required for such tasks.

eess.IV↗
arXiv2026

Learning Generalizable 3D Medical Image Representations from Mask-Guided Self-Supervision

Foundation models have transformed vision and language by learning general-purpose representations from large-scale unlabeled data, yet 3D medical imaging lacks analogous approaches. Existing self-supervised methods rely on low-level reconstruction or contrastive objectives that fail to capture the anatomical semantics critical for medical image analysis, limiting transfer to downstream tasks. We present MASS (MAsk-guided Self-Supervised learning), which treats in-context segmentation as the pretext task for learning general-purpose medical imaging representations. MASS's key insight is that automatically generated class-agnostic masks provide sufficient structural supervision for learning semantically rich representations. By training on thousands of diverse mask proposals spanning anatomical structures and pathological findings, MASS learns what semantically defines medical structures: the holistic combination of appearance, shape, spatial context, and anatomical relationships. We demonstrate effectiveness across data regimes: from small-scale pretraining on individual datasets (20-200 scans) to large-scale multi-modal pretraining on 5K CT, MRI, and PET volumes, all without annotations. MASS demonstrates: (i) few-shot segmentation on novel structures, (ii) matching full supervision with only 20-40\% labeled data while outperforming self-supervised baselines by over 20 in Dice score in low-data regimes, and (iii) frozen-encoder classification on unseen pathologies that matches full supervised training with thousands of samples. Mask-guided self-supervised pretraining captures broadly generalizable knowledge, opening a path toward 3D medical imaging foundation models without expert annotations. Code is available: https://github.com/Stanford-AIMI/MASS.

cs.CV↗
arXiv2026

GazeXPErT: An Expert Eye-tracking Dataset for Interpretable and Explainable AI in Oncologic FDG-PET/CT Scans

[18F]FDG-PET/CT is a cornerstone imaging modality for guiding oncology therapies, yet human expert shortages necessitate more efficient diagnostic aids. While standalone AI models for automatic lesion detection exist, clinical translation remains hindered by AI explainability, reliability, and workflow integration. Meanwhile, human-computer-interaction in radiology remain limited to keyboard, mouse and voice, ignoring experts' faster, natural gaze signal. We present GazeXPErT, a 4D eye-tracking dataset with annotated expert decision windows for tumor detection and measurement on 346 dual-read FDG-PET/CTs. The dataset contributes 9,030 gaze-to-lesion trajectories derived from 3,948 minutes of 60 Hz eye-tracking data, rendered in COCO-style format. GazeXPErT captures experts' visual reasoning patterns when adjudicating suspicious lesions. It aims to facilitate development of trusted, explainable and interactive AI models through understanding expert gaze patterns. Baseline feasibility experiments suggest salient signal is extractable from routinely collected expert gaze (3D nnU-Net Dice: 0.6819 versus 0.6008 without), that gaze-trained vision transformers may aid dynamic lesion localization (74.95% predicted gaze closer to tumor), and that experts' intent may be predictable from raw gaze (Accuracy 67.53%, AUROC 0.747).

eess.IV↗
arXiv2026

Attention Head Entropy of LLMs Predicts Answer Correctness

Large language models (LLMs) often generate plausible yet incorrect answers, posing risks in safety-critical settings such as medicine. Human evaluation is expensive, and LLM-as-judge approaches risk introducing hidden errors. Recent white-box methods detect contextual hallucinations using model internals, focusing on the localization of the attention mass, but two questions remain open: do these approaches extend to predicting answer correctness, and do they generalize out-of-domains? We introduce Head Entropy, a method that predicts answer correctness from attention entropy patterns, specifically measuring the spread of the attention mass. Using sparse logistic regression on per-head 2-Renyi entropies, Head Entropy matches or exceeds baselines in-distribution and generalizes substantially better on out-of-domains, it outperforms the closest baseline on average by +8.5% AUROC. We further show that attention patterns over the question/context alone, before answer generation, already carry predictive signal using Head Entropy with on average +17.7% AUROC over the closest baseline. We evaluate across 5 instruction-tuned LLMs and 3 QA datasets spanning general knowledge, multi-hop reasoning, and medicine.

cs.LG↗
arXiv2026

MedVAL: Toward Expert-Level Medical Text Validation with Language Models

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LLM-as-a-judge" paradigm offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. We propose MedVAL, a novel, self-supervised, data-efficient distillation method that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset of 840 physician-annotated outputs across 6 diverse medical tasks capturing real-world challenges. Across 10 state-of-the-art LMs spanning open-source and proprietary models, MedVAL distillation significantly improves (p < 0.001) alignment with physicians across seen and unseen tasks, increasing average F1 scores from 66% to 83%. Despite strong baseline performance, MedVAL improves the best-performing proprietary LM (GPT-4o) by 8% without training on physician-labeled data, demonstrating a performance statistically non-inferior to a single human expert on a subset annotated by multiple physicians (p < 0.001). To support a scalable, risk-aware pathway towards clinical integration, we open-source: 1) Codebase (https://github.com/StanfordMIMI/MedVAL), 2) MedVAL-Bench (https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench), 3) MedVAL-4B (https://huggingface.co/stanfordmimi/MedVAL-4B). Our benchmark provides evidence of LMs approaching expert-level ability in validating AI-generated medical text.

cs.CL↗
arXiv2026

RadDiff: Describing Differences in Radiology Image Sets with Natural Language

Understanding how two radiology image sets differ is critical for generating clinical insights and for interpreting medical AI systems. We introduce RadDiff, a multimodal agentic system that performs radiologist-style comparative reasoning to describe clinically meaningful differences between paired radiology studies. RadDiff builds on a proposer-ranker framework from VisDiff, and incorporates four innovations inspired by real diagnostic workflows: (1) medical knowledge injection through domain-adapted vision-language models; (2) multimodal reasoning that integrates images with their clinical reports; (3) iterative hypothesis refinement across multiple reasoning rounds; and (4) targeted visual search that localizes and zooms in on salient regions to capture subtle findings. To evaluate RadDiff, we construct RadDiffBench, a challenging benchmark comprising 57 expert-validated radiology study pairs with ground-truth difference descriptions. On RadDiffBench, RadDiff achieves 47% accuracy, and 50% accuracy when guided by ground-truth reports, significantly outperforming the general-domain VisDiff baseline. We further demonstrate RadDiff's versatility across diverse clinical tasks, including COVID-19 phenotype comparison, racial subgroup analysis, and discovery of survival-related imaging features. Together, RadDiff and RadDiffBench provide the first method-and-benchmark foundation for systematically uncovering meaningful differences in radiological data.

cs.CV↗
arXiv2025

TRoVe: Discovering Error-Inducing Static Feature Biases in Temporal Vision-Language Models

Vision-language models (VLMs) have made great strides in addressing temporal understanding tasks, which involve characterizing visual changes across a sequence of images. However, recent works have suggested that when making predictions, VLMs may rely on static feature biases, such as background or object features, rather than dynamic visual changes. Static feature biases are a type of shortcut and can contribute to systematic prediction errors on downstream tasks; as a result, identifying and characterizing error-inducing static feature biases is critical prior to real-world model deployment. In this work, we introduce TRoVe, an automated approach for discovering error-inducing static feature biases learned by temporal VLMs. Given a trained VLM and an annotated validation dataset associated with a downstream classification task, TRoVe extracts candidate static features from the dataset and scores each feature by (i) the effect of the feature on classification errors as well as (ii) the extent to which the VLM relies on the feature when making predictions. In order to quantitatively evaluate TRoVe, we introduce an evaluation framework consisting of 101 trained temporal VLMs paired with ground-truth annotations for learned static feature biases. We use this framework to demonstrate that TRoVe can accurately identify error-inducing static feature biases in VLMs, achieving a 28.6% improvement over the closest baseline. Finally, we apply TRoVe to 7 off-the-shelf VLMs and 2 temporal understanding tasks, surfacing previously-unknown static feature biases and demonstrating that knowledge of learned biases can aid in improving model performance at test time. Our code is available at https://github.com/Stanford-AIMI/TRoVe.

cs.CV↗
arXiv2025

Improving the Performance of Radiology Report De-identification with Large-Scale Training and Benchmarking Against Cloud Vendor Methods

Objective: To enhance automated de-identification of radiology reports by scaling transformer-based models through extensive training datasets and benchmarking performance against commercial cloud vendor systems for protected health information (PHI) detection. Materials and Methods: In this retrospective study, we built upon a state-of-the-art, transformer-based, PHI de-identification pipeline by fine-tuning on two large annotated radiology corpora from Stanford University, encompassing chest X-ray, chest CT, abdomen/pelvis CT, and brain MR reports and introducing an additional PHI category (AGE) into the architecture. Model performance was evaluated on test sets from Stanford and the University of Pennsylvania (Penn) for token-level PHI detection. We further assessed (1) the stability of synthetic PHI generation using a "hide-in-plain-sight" method and (2) performance against commercial systems. Precision, recall, and F1 scores were computed across all PHI categories. Results: Our model achieved overall F1 scores of 0.973 on the Penn dataset and 0.996 on the Stanford dataset, outperforming or maintaining the previous state-of-the-art model performance. Synthetic PHI evaluation showed consistent detectability (overall F1: 0.959 [0.958-0.960]) across 50 independently de-identified Penn datasets. Our model outperformed all vendor systems on synthetic Penn reports (overall F1: 0.960 vs. 0.632-0.754). Discussion: Large-scale, multimodal training improved cross-institutional generalization and robustness. Synthetic PHI generation preserved data utility while ensuring privacy. Conclusion: A transformer-based de-identification model trained on diverse radiology datasets outperforms prior academic and commercial systems in PHI detection and establishes a new benchmark for secure clinical text processing.

cs.CL↗
arXiv2025

STARC-9: A Large-scale Dataset for Multi-Class Tissue Classification for CRC Histopathology

Multi-class tissue-type classification of colorectal cancer (CRC) histopathologic images is a significant step in the development of downstream machine learning models for diagnosis and treatment planning. However, existing public CRC datasets often lack morphologic diversity, suffer from class imbalance, and contain low-quality image tiles, limiting model performance and generalizability. To address these issues, we introduce STARC-9 (STAnford coloRectal Cancer), a large-scale dataset for multi-class tissue classification. STARC-9 contains 630,000 hematoxylin and eosin-stained image tiles uniformly sampled across nine clinically relevant tissue classes (70,000 tiles per class) from 200 CRC patients at the Stanford University School of Medicine. The dataset was built using a novel framework, DeepCluster++, designed to ensure intra-class diversity and reduce manual curation. First, an encoder from a histopathology-specific autoencoder extracts feature vectors from tiles within each whole-slide image. Then, K-means clustering groups morphologically similar tiles, followed by equal-frequency binning to sample diverse morphologic patterns within each class. The selected tiles are subsequently verified by expert gastrointestinal pathologists to ensure accuracy. This semi-automated process significantly reduces manual effort while producing high-quality, diverse tiles. To evaluate STARC-9, we benchmarked convolutional neural networks, transformers, and pathology-specific foundation models on multi-class CRC tissue classification and segmentation tasks, showing superior generalizability compared to models trained on existing datasets. Although we demonstrate the utility of DeepCluster++ on CRC as a pilot use-case, it is a flexible framework that can be used for constructing high-quality datasets from large WSI repositories across a wide range of cancer and non-cancer applications.

cs.CE↗
arXiv2025

Evaluating and Improving the Effectiveness of Synthetic Chest X-Rays for Medical Image Analysis

Purpose: To explore best-practice approaches for generating synthetic chest X-ray images and augmenting medical imaging datasets to optimize the performance of deep learning models in downstream tasks like classification and segmentation. Materials and Methods: We utilized a latent diffusion model to condition the generation of synthetic chest X-rays on text prompts and/or segmentation masks. We explored methods like using a proxy model and using radiologist feedback to improve the quality of synthetic data. These synthetic images were then generated from relevant disease information or geometrically transformed segmentation masks and added to ground truth training set images from the CheXpert, CANDID-PTX, SIIM, and RSNA Pneumonia datasets to measure improvements in classification and segmentation model performance on the test sets. F1 and Dice scores were used to evaluate classification and segmentation respectively. One-tailed t-tests with Bonferroni correction assessed the statistical significance of performance improvements with synthetic data. Results: Across all experiments, the synthetic data we generated resulted in a maximum mean classification F1 score improvement of 0.150453 (CI: 0.099108-0.201798; P=0.0031) compared to using only real data. For segmentation, the maximum Dice score improvement was 0.14575 (CI: 0.108267-0.183233; P=0.0064). Conclusion: Best practices for generating synthetic chest X-ray images for downstream tasks include conditioning on single-disease labels or geometrically transformed segmentation masks, as well as potentially using proxy modeling for fine-tuning such generations.

eess.IV↗
arXiv2025

From Detection to Mitigation: Addressing Bias in Deep Learning Models for Chest X-Ray Diagnosis

Deep learning models have shown promise in improving diagnostic accuracy from chest X-rays, but they also risk perpetuating healthcare disparities when performance varies across demographic groups. In this work, we present a comprehensive bias detection and mitigation framework targeting sex, age, and race-based disparities when performing diagnostic tasks with chest X-rays. We extend a recent CNN-XGBoost pipeline to support multi-label classification and evaluate its performance across four medical conditions. We show that replacing the final layer of CNN with an eXtreme Gradient Boosting classifier improves the fairness of the subgroup while maintaining or improving the overall predictive performance. To validate its generalizability, we apply the method to different backbones, namely DenseNet-121 and ResNet-50, and achieve similarly strong performance and fairness outcomes, confirming its model-agnostic design. We further compare this lightweight adapter training method with traditional full-model training bias mitigation techniques, including adversarial training, reweighting, data augmentation, and active learning, and find that our approach offers competitive or superior bias reduction at a fraction of the computational cost. Finally, we show that combining eXtreme Gradient Boosting retraining with active learning yields the largest reduction in bias across all demographic subgroups, both in and out of distribution on the CheXpert and MIMIC datasets, establishing a practical and effective path toward equitable deep learning deployment in clinical radiology.

cs.CV↗
arXiv2025

LieRE: Lie Rotational Positional Encodings

Transformer architectures rely on position encodings to model the spatial structure of input data. Rotary Position Encoding (RoPE) is a widely used method in language models that encodes relative positions through fixed, block-diagonal, rotation matrices applied to key-query interactions. We hypothesize that this inductive bias limits their RoPE's effectiveness for modalities with high dimensional structure. Lie Relative Encodings (LieRE) introduce a principled generalization of RoPE, aimed at increasing the representational capacity of positional encodings in transformers. Instead of fixed 2D rotations, LieRE learns dense skew-symmetric matrices (Lie algebra elements), which are then differentiable mapped to form high-dimensional rotation matrices (Lie group elements). This results in richer, learnable, and continuous, encodings of both relative and absolute positional information. We demonstrate the effectiveness of LieRE on 2D and 3D vision tasks, showing that it generalizes well to higher input resolutions while maintaining computational efficiency. The code and checkpoints are publicly available at https://github.com/StanfordMIMI/LieRE.

cs.CV↗
arXiv2025

CheXalign: Preference fine-tuning in chest X-ray interpretation models without human feedback

Radiologists play a crucial role in translating medical images into actionable reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning. Meanwhile, additional preference fine-tuning in the post-training pipeline has become standard practice in the general domain. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback at scale. To address this challenge, we propose an automated pipeline for preference feedback, focusing on chest X-ray radiology report generation (RRG). Specifically, our method leverages publicly available datasets containing pairs of images and radiologist-written reference reports with reference-based metrics, or Judges, eliminating the need for additional radiologist feedback. We investigate reward overoptimization via length exploitation in this setting and introduce a length-controlled version of the GREEN score. Our best-performing setup achieves state-of-the-art CheXbert scores on the MIMIC-CXR dataset for the RRG task while on average maintaining robust performance across six additional image perception and reasoning tasks.

cs.CV↗