arXiv subjects

Krishnaram Kenthapadi

Publications and source records attributed to Krishnaram Kenthapadi.

At least 19 recordsLinked to original sources

arXiv2026

CheXmix: Unified Generative Pretraining for Vision Language Models in Medical Imaging

Recent medical multimodal foundation models are built as multimodal LLMs (MLLMs) by connecting a CLIP-pretrained vision encoder to an LLM using LLaVA-style finetuning. This two-stage, decoupled approach introduces a projection layer that can distort visual features. This is especially concerning in medical imaging where subtle cues are essential for accurate diagnoses. In contrast, early-fusion generative approaches such as Chameleon eliminate the projection bottleneck by processing image and text tokens within a single unified sequence, enabling joint representation learning that leverages the inductive priors of language models. We present CheXmix, a unified early-fusion generative model trained on a large corpus of chest X-rays paired with radiology reports. We expand on Chameleon's autoregressive framework by introducing a two-stage multimodal generative pretraining strategy that combines the representational strengths of masked autoencoders with MLLMs. The resulting models are highly flexible, supporting both discriminative and generative tasks at both coarse and fine-grained scales. Our approach outperforms well-established generative models across all masking ratios by 6.0% and surpasses CheXagent by 8.6% on AUROC at high image masking ratios on the CheXpert classification task. We further inpaint images over 51.0% better than text-only generative models and outperform CheXagent by 45% on the GREEN metric for radiology report generation. These results demonstrate that CheXmix captures fine-grained information across a broad spectrum of chest X-ray tasks. Our code is at: https://github.com/StanfordMIMI/CheXmix.

cs.CV↗

arXiv2026

From Attribution to Abstention: Training-Free Attention-Based Auditing for Clinical Summarization

Deploying multimodal large language models (MLLMs) for clinical summarization demands not only fluent generation but also transparency about where each statement originates-and a mechanism to flag when statements lack evidential support. We present ClinTrace, a training-free framework that extracts two clinically useful signals from the decoder attention weights that every transformer-based MLLM already produces during generation: (i) fine-grained source attributions linking each output sentence to supporting text spans or images, and (ii) per-sentence groundedness scores that identify poorly supported claims as candidate hallucinations. Both signals are derived from the same attention tensors in a single pass, requiring no retraining, no auxiliary models, and no additional inference cost. We evaluate on two clinical summarization tasks: doctor-patient dialogue summarization (CliConSummation) and radiology report summarization (MIMIC-CXR) using a general-purpose MLLM (Qwen3-8B) and a medical-finetuned model (HuatuoGPT-Vision-7B). For source attribution, ClinTrace achieves over 92% text F1 on radiology and 88% on dialogue summarization, substantially outperforming embedding-based and self-attribution baselines. For hallucination detection, groundedness scores achieve 0.77 AUROC with the medical-finetuned model: competitive with embedding-based confidence at zero additional cost, and enable an abstention mechanism that improves faithfulness from 61.7% to 72.6% by withholding the least: grounded 20% of output for clinician review. Notably, medical finetuning substantially improves the reliability of attention-based hallucination detection, suggesting that domain adaptation produces more semantically structured attention patterns amenable to self-auditing.

cs.CL↗

arXiv2025

Balancing Safety and Helpfulness in Healthcare AI Assistants through Iterative Preference Alignment

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.

cs.AI↗

arXiv2025

OG-Rank: Learning to Rank Fast and Slow with Uncertainty and Reward-Trend Guided Adaptive Exploration

Clinicians need ranking systems that work in real time and still justify their choices. Motivated by the need for a low-latency, decoder-based reranker, we present OG-Rank, a single-decoder approach that pairs a pooled first-token scoring signal with an uncertainty-gated explanation step. The model scores all candidates in one pass and generates a brief, structured rationale only when the list is genuinely ambiguous, keeping latency predictable. Trained with a curriculum that concentrates effort on hard cases, OG-Rank delivers strong effectiveness on encounter-scoped order selection (fast path: Recall@1~0.45, nDCG@20~0.625) and improves further when the gate activates (Recall@1~0.56, nDCG@20~0.699 at a 45\% gate rate), while compact backbones show similar gains under the same policy. Encoder baselines trail in both effectiveness and flexibility. The result is a practical recipe: rank fast by default and explain when it helps, a pattern that applies broadly to decision tasks where selective generation buys accuracy at acceptable cost. The single-policy design simplifies deployment and budget planning, and the curriculum principle (spend more on the hard cases, less on the easy ones) readily transfers beyond clinical order selection.

cs.AI↗

arXiv2025

JEDA: Query-Free Clinical Order Search from Ambient Dialogues

Clinical conversations mix explicit directives (order a chest X-ray) with implicit reasoning (the cough worsened overnight, we should check for pneumonia). Many systems rely on LLM rewriting, adding latency, instability, and opacity that hinder real-time ordering. We present JEDA (Joint Embedding for Direct and Ambient clinical orders), a domain-initialized bi-encoder that retrieves canonical orders directly and, in a query-free mode, encodes a short rolling window of ambient dialogue to trigger retrieval. Initialized from PubMedBERT and fine-tuned with a duplicate-safe contrastive objective, JEDA aligns heterogeneous expressions of intent to shared order concepts. Training uses constrained LLM guidance to tie each signed order to complementary formulations (command only, context only, command+context, context+reasoning), producing clearer inter-order separation, tighter query extendash order coupling, and stronger generalization. The query-free mode is noise-resilient, reducing sensitivity to disfluencies and ASR errors by conditioning on a short window rather than a single utterance. Deployed in practice, JEDA yields large gains and substantially outperforms its base encoder and recent open embedders (Linq Embed Mistral, SFR Embedding, GTE Qwen, BGE large, Embedding Gemma). The result is a fast, interpretable, LLM-free retrieval layer that links ambient context to actionable clinical orders in real time.

cs.AI↗

arXiv2025

Optimizing Long-Form Clinical Text Generation with Claim-Based Rewards

Automating clinical documentation with large language models requires precise alignment with priorities such as completeness and factual grounding. We present an evaluation-integrated reinforcement learning framework for long-form clinical text generation that couples Group Relative Policy Optimization (GRPO) with DocLens, a claim-level evaluator that provides deterministic, dialogue-grounded rewards. Our method directly optimizes factual grounding and completeness without training a separate reward model or relying on human-authored references. Empirically, the approach improves clinical note quality and reduces training cost via a simple reward-gating strategy. An independent GPT-5 qualitative evaluation further supports these gains, showing higher preference for GRPO outputs in factuality, completeness, and brevity, with fewer omissions and hallucinations. Because the benchmarks are relatively clean and the base model already well aligned, these improvements likely represent a conservative lower bound. The framework is scalable to real-world settings and can incorporate custom objectives such as guideline adherence or billing preferences.

cs.CL↗

arXiv2025

RadAgents: Multimodal Agentic Reasoning for Chest X-ray Interpretation with Radiologist-like Workflows

Agentic systems offer a potential path to solve complex clinical tasks through collaboration among specialized agents, augmented by tool use and external knowledge bases. Nevertheless, for chest X-ray (CXR) interpretation, prevailing methods remain limited: (i) reasoning is frequently neither clinically interpretable nor aligned with guidelines, reflecting mere aggregation of tool outputs; (ii) multimodal evidence is insufficiently fused, yielding text-only rationales that are not visually grounded; and (iii) systems rarely detect or resolve cross-tool inconsistencies and provide no principled verification mechanisms. To bridge the above gaps, we present RadAgents, a multi-agent framework that couples clinical priors with task-aware multimodal reasoning and encodes a radiologist-style workflow into a modular, auditable pipeline. In addition, we integrate grounding and multimodal retrieval-augmentation to verify and resolve context conflicts, resulting in outputs that are more reliable, transparent, and consistent with clinical practice.

cs.MA↗

arXiv2025

Permissioned LLMs: Enforcing Access Control in Large Language Models

In enterprise settings, organizational data is segregated, siloed and carefully protected by elaborate access control frameworks. These access control structures can completely break down if an LLM fine-tuned on the siloed data serves requests, for downstream tasks, from individuals with disparate access privileges. We propose Permissioned LLMs (PermLLM), a new class of LLMs that superimpose the organizational data access control structures on query responses they generate. We formalize abstractions underpinning the means to determine whether access control enforcement happens correctly over LLM query responses. Our formalism introduces the notion of a relevant response that can be used to prove whether a PermLLM mechanism has been implemented correctly. We also introduce a novel metric, called access advantage, to empirically evaluate the efficacy of a PermLLM mechanism. We introduce three novel PermLLM mechanisms that build on Parameter Efficient Fine-Tuning to achieve the desired access control. We furthermore present two instantiations of access advantage--(i) Domain Distinguishability Index (DDI) based on Membership Inference Attacks, and (ii) Utility Gap Index (UGI) based on LLM utility evaluation. We demonstrate the efficacy of our PermLLM mechanisms through extensive experiments on five public datasets (GPQA, RCV1, SimpleQA, WMDP, and PubMedQA), in addition to evaluating the validity of DDI and UGI metrics themselves for quantifying access control in LLMs.

cs.CR↗

arXiv2025

RedactOR: An LLM-Powered Framework for Automatic Clinical Data De-Identification

Ensuring clinical data privacy while preserving utility is critical for AI-driven healthcare and data analytics. Existing de-identification (De-ID) methods, including rule-based techniques, deep learning models, and large language models (LLMs), often suffer from recall errors, limited generalization, and inefficiencies, limiting their real-world applicability. We propose a fully automated, multi-modal framework, RedactOR for de-identifying structured and unstructured electronic health records, including clinical audio records. Our framework employs cost-efficient De-ID strategies, including intelligent routing, hybrid rule and LLM based approaches, and a two-step audio redaction approach. We present a retrieval-based entity relexicalization approach to ensure consistent substitutions of protected entities, thereby enhancing data coherence for downstream applications. We discuss key design desiderata, de-identification and relexicalization methodology, and modular architecture of RedactOR and its integration with the Oracle Health Clinical AI system. Evaluated on the i2b2 2014 De-ID dataset using standard metrics with strict recall, our approach achieves competitive performance while optimizing token usage to reduce LLM costs. Finally, we discuss key lessons and insights from deployment in real-world AI- driven healthcare data pipelines.

cs.AI↗

arXiv2025

Towards Trustworthy Retrieval Augmented Generation for Large Language Models: A Survey

Retrieval-Augmented Generation (RAG) is an advanced technique designed to address the challenges of Artificial Intelligence-Generated Content (AIGC). By integrating context retrieval into content generation, RAG provides reliable and up-to-date external knowledge, reduces hallucinations, and ensures relevant context across a wide range of tasks. However, despite RAG's success and potential, recent studies have shown that the RAG paradigm also introduces new risks, including robustness issues, privacy concerns, adversarial attacks, and accountability issues. Addressing these risks is critical for future applications of RAG systems, as they directly impact their trustworthiness. Although various methods have been developed to improve the trustworthiness of RAG methods, there is a lack of a unified perspective and framework for research in this topic. Thus, in this paper, we aim to address this gap by providing a comprehensive roadmap for developing trustworthy RAG systems. We place our discussion around five key perspectives: reliability, privacy, safety, fairness, explainability, and accountability. For each perspective, we present a general framework and taxonomy, offering a structured approach to understanding the current challenges, evaluating existing solutions, and identifying promising future research directions. To encourage broader adoption and innovation, we also highlight the downstream applications where trustworthy RAG systems have a significant impact.

cs.CL↗

arXiv2024

Mastering the Craft of Data Synthesis for CodeLLMs

Large language models (LLMs) have shown impressive performance in \emph{code} understanding and generation, making coding tasks a key focus for researchers due to their practical applications and value as a testbed for LLM evaluation. Data synthesis and filtering techniques have been widely adopted and shown to be highly effective in this context. In this paper, we present a focused survey and taxonomy of these techniques, emphasizing recent advancements. We highlight key challenges, explore future research directions, and offer practical guidance for new researchers entering the field.

cs.SE↗

arXiv2024

Grounding and Evaluation for Large Language Models: Practical Challenges and Lessons Learned (Survey)

With the ongoing rapid adoption of Artificial Intelligence (AI)-based systems in high-stakes domains, ensuring the trustworthiness, safety, and observability of these systems has become crucial. It is essential to evaluate and monitor AI systems not only for accuracy and quality-related metrics but also for robustness, bias, security, interpretability, and other responsible AI dimensions. We focus on large language models (LLMs) and other generative AI models, which present additional challenges such as hallucinations, harmful and manipulative content, and copyright infringement. In this survey article accompanying our KDD 2024 tutorial, we highlight a wide range of harms associated with generative AI systems, and survey state of the art approaches (along with open challenges) to address these harms.

cs.CL↗

arXiv2023

Measuring Distributional Shifts in Text: The Advantage of Language Model-Based Embeddings

An essential part of monitoring machine learning models in production is measuring input and output data drift. In this paper, we present a system for measuring distributional shifts in natural language data and highlight and investigate the potential advantage of using large language models (LLMs) for this problem. Recent advancements in LLMs and their successful adoption in different domains indicate their effectiveness in capturing semantic relationships for solving various natural language processing problems. The power of LLMs comes largely from the encodings (embeddings) generated in the hidden layers of the corresponding neural network. First we propose a clustering-based algorithm for measuring distributional shifts in text data by exploiting such embeddings. Then we study the effectiveness of our approach when applied to text embeddings generated by both LLMs and classical embedding algorithms. Our experiments show that general-purpose LLM-based embeddings provide a high sensitivity to data drift compared to other embedding methods. We propose drift sensitivity as an important evaluation metric to consider when comparing language models. Finally, we present insights and lessons learned from deploying our framework as part of the Fiddler ML Monitoring platform over a period of 18 months.

cs.CL↗

arXiv2023

Designing Closed-Loop Models for Task Allocation

Automatically assigning tasks to people is challenging because human performance can vary across tasks for many reasons. This challenge is further compounded in real-life settings in which no oracle exists to assess the quality of human decisions and task assignments made. Instead, we find ourselves in a "closed" decision-making loop in which the same fallible human decisions we rely on in practice must also be used to guide task allocation. How can imperfect and potentially biased human decisions train an accurate allocation model? Our key insight is to exploit weak prior information on human-task similarity to bootstrap model training. We show that the use of such a weak prior can improve task allocation accuracy, even when human decision-makers are fallible and biased. We present both theoretical analysis and empirical evaluation over synthetic data and a social media toxicity detection task. Results demonstrate the efficacy of our approach.

cs.HC↗

arXiv2022

Towards the Use of Saliency Maps for Explaining Low-Quality Electrocardiograms to End Users

When using medical images for diagnosis, either by clinicians or artificial intelligence (AI) systems, it is important that the images are of high quality. When an image is of low quality, the medical exam that produced the image often needs to be redone. In telemedicine, a common problem is that the quality issue is only flagged once the patient has left the clinic, meaning they must return in order to have the exam redone. This can be especially difficult for people living in remote regions, who make up a substantial portion of the patients at Portal Telemedicina, a digital healthcare organization based in Brazil. In this paper, we report on ongoing work regarding (i) the development of an AI system for flagging and explaining low-quality medical images in real-time, (ii) an interview study to understand the explanation needs of stakeholders using the AI system at OurCompany, and, (iii) a longitudinal user study design to examine the effect of including explanations on the workflow of the technicians in our clinics. To the best of our knowledge, this would be the first longitudinal study on evaluating the effects of XAI methods on end-users -- stakeholders that use AI systems but do not have AI-specific expertise. We welcome feedback and suggestions on our experimental setup.

cs.LG↗

arXiv2022

Visual Auditor: Interactive Visualization for Detection and Summarization of Model Biases

As machine learning (ML) systems become increasingly widespread, it is necessary to audit these systems for biases prior to their deployment. Recent research has developed algorithms for effectively identifying intersectional bias in the form of interpretable, underperforming subsets (or slices) of the data. However, these solutions and their insights are limited without a tool for visually understanding and interacting with the results of these algorithms. We propose Visual Auditor, an interactive visualization tool for auditing and summarizing model biases. Visual Auditor assists model validation by providing an interpretable overview of intersectional bias (bias that is present when examining populations defined by multiple features), details about relationships between problematic data slices, and a comparison between underperforming and overperforming data slices in a model. Our open-source tool runs directly in both computational notebooks and web browsers, making model auditing accessible and easily integrated into current ML development workflows. An observational user study in collaboration with domain experts at Fiddler AI highlights that our tool can help ML practitioners identify and understand model biases.

cs.HC↗

arXiv2022

A Human-Centric Take on Model Monitoring

Predictive models are increasingly used to make various consequential decisions in high-stakes domains such as healthcare, finance, and policy. It becomes critical to ensure that these models make accurate predictions, are robust to shifts in the data, do not rely on spurious features, and do not unduly discriminate against minority groups. To this end, several approaches spanning various areas such as explainability, fairness, and robustness have been proposed in recent literature. Such approaches need to be human-centered as they cater to the understanding of the models to their users. However, there is a research gap in understanding the human-centric needs and challenges of monitoring machine learning (ML) models once they are deployed. To fill this gap, we conducted an interview study with 13 practitioners who have experience at the intersection of deploying ML models and engaging with customers spanning domains such as financial services, healthcare, hiring, online retail, computational advertising, and conversational assistants. We identified various human-centric challenges and requirements for model monitoring in real-world applications. Specifically, we found the need and the challenge for the model monitoring systems to clarify the impact of the monitoring observations on outcomes. Further, such insights must be actionable, robust, customizable for domain-specific use cases, and cognitively considerate to avoid information overload.

cs.LG↗

arXiv2022

Are Two Heads the Same as One? Identifying Disparate Treatment in Fair Neural Networks

We show that deep networks trained to satisfy demographic parity often do so through a form of race or gender awareness, and that the more we force a network to be fair, the more accurately we can recover race or gender from the internal state of the network. Based on this observation, we investigate an alternative fairness approach: we add a second classification head to the network to explicitly predict the protected attribute (such as race or gender) alongside the original task. After training the two-headed network, we enforce demographic parity by merging the two heads, creating a network with the same architecture as the original network. We establish a close relationship between existing approaches and our approach by showing (1) that the decisions of a fair classifier are well-approximated by our approach, and (2) that an unfair and optimally accurate classifier can be recovered from a fair classifier and our second head predicting the protected attribute. We use our explicit formulation to argue that the existing fairness approaches, just as ours, demonstrate disparate treatment and that they are likely to be unlawful in a wide range of scenarios under US law.

cs.LG↗