Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

Agentic AI systems have gained significant attention for their ability to autonomously perform complex tasks. However, their reliance on well-prepared tools limits their applicability in the medical domain, which requires to train specialized models. In this paper, we make three contributions: (i) We present M3Builder, a novel multi-agent system designed to automate machine learning (ML) in medical imaging. At its core, M3Builder employs four specialized agents that collaborate to tackle complex, multi-step medical ML workflows, from automated data processing and environment configuration to self-contained auto debugging and model training. These agents operate within a medical imaging ML workspace, a structured environment designed to provide agents with free-text descriptions of datasets, training codes, and interaction tools, enabling seamless communication and task execution. (ii) To evaluate progress in automated medical imaging ML, we propose M3Bench, a benchmark comprising four general tasks on 14 training datasets, across five anatomies and three imaging modalities, covering both 2D and 3D data. (iii) We experiment with seven state-of-the-art large language models serving as agent cores for our system, such as Claude series, GPT-4o, and DeepSeek-V3. Compared to existing ML agentic designs, M3Builder shows superior performance on completing ML tasks in medical imaging, achieving a 94.29% success rate using Claude-3.7-Sonnet as the agent core, showing huge potential towards fully automated machine learning in medical imaging.

This paper introduces a novel, entity-aware metric, termed as Radiological Report (Text) Evaluation (RaTEScore), to assess the quality of medical reports generated by AI models. RaTEScore emphasizes crucial medical entities such as diagnostic outcomes and anatomical details, and is robust against complex medical synonyms and sensitive to negation expressions. Technically, we developed a comprehensive medical NER dataset, RaTE-NER, and trained an NER model specifically for this purpose. This model enables the decomposition of complex radiological reports into constituent medical entities. The metric itself is derived by comparing the similarity of entity embeddings, obtained from a language model, based on their types and relevance to clinical significance. Our evaluations demonstrate that RaTEScore aligns more closely with human preference than existing metrics, validated both on established public benchmarks and our newly proposed RaTE-Eval benchmark.

In the recent literature, large language models (LLMs) have demonstrated great promise in healthcare, for example, closed-source models such as GPT-4 [1] and MedPalm-2 [38] have shown remarkable performance, and successfully passed the United States Medical Licensing Examination (USMLE). Concurrently, open-source models like Llama 2 have also facilitated the development of specialized language models for medicine, such as MEDITRON, PMC-LLaMA, MedAlpaca, and ChatDoctors [48, 11, 25, 6], gradually bridging the performance gap with their closed-source peers. Despite these advancements, the primary focus on English-language applications by these sophisticated medical language models has constrained their potential reach, limiting the benefits to a wider, linguistically diverse audience. In the realm of open-source multilingual Large Language Models (LLMs), exemplified by BLOOM [37] and the more recent InternLM 2 [42], a notable challenge persists despite their training on diverse multilingual corpora, that is, they exhibit unsatisfactory performance on medical queries in non-English languages, a discrepancy primarily attributed to the under-representation of medical content in these general datasets. This paper endeavors to bridge this gap by developing an open-source, multilingual language model for healthcare. As shown by Figure 1, our contribution is threefold: firstly, we gather a multilingual medical corpus designed for auto-regressive training, this aims to lay a robust foundation that accurately reflects the linguistic diversity and complexity of the medical domain; secondly, to monitor the progress, we introduce a new comprehensive multilingual medical question-answering (QA) benchmark, enabling the evaluation on multi-choice QA and rationale ability of different language models under both zero-shot and fine-tuning settings; lastly, we have tested a wide spectrum of existing language models, together with those that have undergone auto-regressive pre-training on our corpus. Through this comprehensive evaluation, we aim to provide valuable insights into the models' capabilities and fostering a deeper understanding of the intricacies involved in multilingual medical query processing. For auto-regressive training, we have developed a large-scale Multilingual Medical Corpus (MMedC), amassing over 25.5 billion medical-related tokens across six primary languages: English, Chinese, Japanese, French, Russian, and Spanish. This diverse dataset was compiled from four distinct sources: (i) we devised an automatic pipeline to filter medical-related content from the broad multilingual corpus, ensuring a focused and relevant dataset, (ii) we curated an extensive collection of medical textbooks in various languages, and converted them into texts with carefully designed pre-processing, e.g., Optical Character Recognition (OCR), heuristic data filtering, etc.

Driven by the large foundation models, the development of artificial intelligence has witnessed tremendous progress lately, leading to a surge of general interest from the public. In this study, we aim to assess the performance of OpenAI's newest model, GPT-4V(ision), specifically in the realm of multimodal medical diagnosis. Our evaluation encompasses 17 human body systems, including Central Nervous System, Head and Neck, Cardiac, Chest, Hematology, Hepatobiliary, Gastrointestinal, Urogenital, Gynecology, Obstetrics, Breast, Musculoskeletal, Spine, Vascular, Oncology, Trauma, Pediatrics, with images taken from 8 modalities used in daily clinic routine, e.g., X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Digital Subtraction Angiography (DSA), Mammography, Ultrasound, and Pathology. We probe the GPT-4V's ability on multiple clinical tasks with or without patent history provided, including imaging modality and anatomy recognition, disease diagnosis, report generation, disease localisation. Our observation shows that, while GPT-4V demonstrates proficiency in distinguishing between medical image modalities and anatomy, it faces significant challenges in disease diagnosis and generating comprehensive reports. These findings underscore that while large multimodal models have made significant advancements in computer vision and natural language processing, it remains far from being used to effectively support real-world medical applications and clinical decision-making.

In this study, we aim to initiate the development of Radiology Foundation Model, termed as RadFM. We consider the construction of foundational models from three perspectives, namely, dataset construction, model design, and thorough evaluation. Our contribution can be concluded as follows: (i), we construct a large-scale Medical Multi-modal Dataset, MedMD, which consists of 16M 2D and 3D medical scans with high-quality text descriptions or reports across various data formats, modalities, and tasks, covering over 5000 distinct diseases. To the best of our knowledge, this is the first large-scale, high-quality, medical visual-language dataset, with both 2D and 3D scans; (ii), we propose an architecture that enables visually conditioned generative pre-training, i.e., allowing for integration of text input with 2D or 3D medical scans, and generate responses for diverse radiologic tasks. The model was initially pre-trained on MedMD and subsequently fine-tuned on the domain-specific dataset, which is a radiologic cleaned version of MedMD, containing 3M radiologic visual-language pairs, termed as RadMD; (iii), we propose a new evaluation benchmark, RadBench, that comprises five tasks, including modality recognition, disease diagnosis, visual question answering, report generation and rationale diagnosis, aiming to comprehensively assess the capability of foundation models in handling practical clinical problems. We conduct both automatic and human evaluation on RadBench, in both cases, RadFM outperforms existing multi-modal foundation models, that are publicaly accessible, including Openflamingo, MedFlamingo, MedVInT and GPT-4V. Additionally, we also adapt RadFM for different public benchmarks, surpassing existing SOTAs on diverse datasets. All codes, data, and model checkpoint will all be made publicly available to promote further research and development in the field.

Magnetic resonance imaging~(MRI) have played a crucial role in brain disease diagnosis, with which a range of computer-aided artificial intelligence methods have been proposed. However, the early explorations usually focus on the limited types of brain diseases in one study and train the model on the data in a small scale, yielding the bottleneck of generalization. Towards a more effective and scalable paradigm, we propose a hierarchical knowledge-enhanced pre-training framework for the universal brain MRI diagnosis, termed as UniBrain. Specifically, UniBrain leverages a large-scale dataset of 24,770 imaging-report pairs from routine diagnostics. Different from previous pre-training techniques for the unitary vision or textual feature, or with the brute-force alignment between vision and language information, we leverage the unique characteristic of report information in different granularity to build a hierarchical alignment mechanism, which strengthens the efficiency in feature learning. Our UniBrain is validated on three real world datasets with severe class imbalance and the public BraTS2019 dataset. It not only consistently outperforms all state-of-the-art diagnostic methods by a large margin and provides a superior grounding performance but also shows comparable performance compared to expert radiologists on certain disease types.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

In this paper, we consider enhancing medical visual-language pre-training (VLP) with domain-specific knowledge, by exploiting the paired image-text reports from the radiological daily practice. In particular, we make the following contributions: First, unlike existing works that directly process the raw reports, we adopt a novel triplet extraction module to extract the medical-related information, avoiding unnecessary complexity from language grammar and enhancing the supervision signals; Second, we propose a novel triplet encoding module with entity translation by querying a knowledge base, to exploit the rich domain knowledge in medical field, and implicitly build relationships between medical entities in the language embedding space; Third, we propose to use a Transformer-based fusion model for spatially aligning the entity description with visual signals at the image patch level, enabling the ability for medical diagnosis; Fourth, we conduct thorough experiments to validate the effectiveness of our architecture, and benchmark on numerous public benchmarks, e.g., ChestX-ray14, RSNA Pneumonia, SIIM-ACR Pneumothorax, COVIDx CXR-2, COVID Rural, and EdemaSeverity. In both zero-shot and fine-tuning settings, our model has demonstrated strong performance compared with the former methods on disease classification and grounding.

Foundation models trained on large-scale dataset gain a recent surge in CV and NLP. In contrast, development in biomedical domain lags far behind due to data scarcity. To address this issue, we build and release PMC-OA, a biomedical dataset with 1.6M image-caption pairs collected from PubMedCentral's OpenAccess subset, which is 8 times larger than before. PMC-OA covers diverse modalities or diseases, with majority of the image-caption samples aligned at finer-grained level, i.e., subfigure and subcaption. While pretraining a CLIP-style model on PMC-OA, our model named PMC-CLIP achieves state-of-the-art results on various downstream tasks, including image-text retrieval on ROCO, MedMNIST image classification, Medical VQA, i.e. +8.1% R@10 on image-text retrieval, +3.9% accuracy on image classification.