Retrieval-Augmented Multimodal Language Model with Heterogeneous Evidence Integration for Clinical Prognosis
1mo
- Published
- Collected
Clinical prognosis requires integrating structured measurements, physiological waveforms, longitudinal history, and population context. We introduce PRISM (Population-Retrieved Inference for Structured Multimodal Prognosis), a multimodal language model that combines per-feature numerical tokenization, recency-weighted aggregation of longitudinal ECGs, and a dual-modality population memory bank. Retrieval operates in representation space: the model receives mean-pooled embeddings of similar training-cohort encounters, while no individual retrieved record enters the prompt. On the 1,443-task MDS-ED benchmark, PRISM achieves AUROCs of 86.2% for diagnosis, 93.1% for deterioration, 91.8% for ICU admission, and 92.8% for mortality. These results use a 96-hour pre-arrival window unavailable to reported baselines. With benchmark-window inputs only, PRISM reaches 0.8895 AUROC, compared with 0.8937 for UniPACT and 0.8889 for MDS-ED. A matched-input compact fusion model using the same five evidence streams and frozen encoders reaches 0.7652 AUROC, versus 0.9092 for PRISM. Replacing numerical EHR encoding with text serialization reduces AUROC by 3.66 points; removing pre-arrival history reduces it by 1.97 points; and zeroing retrieval reduces it by 0.99 points. Genuine retrieval outperforms random-neighbor retrieval by 0.97 macro-average points, although a paired task-level sign test does not establish a uniform advantage (p=0.067). On the external MC-MED cohort, supervised fine-tuning reaches 0.8611 AUROC, compared with 0.8227 for locally trained gradient boosting and 0.7841 for source-only PRISM. These results support structure-aware multimodal integration and supervised external adaptation.
Authors
Hamza Shafiq, Jialu Tang, Ting Dang, Jun Hu, Aaqib Saeed
Categories
overfeed.news indexes and links. We publish a short excerpt — the full article stays at arXiv AI Papers.
More from arXiv AI Papers
Log in to follow this source
Medical Image Segmentation: Foundation Model Adaptation versus Task-Specific Training
Foundation models pretrained on large natural-image collections are increasingly adapted for medical image segmentation, in the expectation that they will replace models trained for each task. Most comparisons, however, use data from the training distribution and a single task-specific baseline whose configuration is rarely justified, and therefore provide limited evidence of performance at new clinical sites. It also remains unclear how much of a foundation model must be adapted, and what determines this. We adapted a foundation model, DINOv2, with strategies ranging from tuning only its bias terms to full fine-tuning, and compared it with U-Nets and ResU-Nets trained from scratch. Experiments covered colonoscopy, breast ultrasound and dermoscopy, with testing on held-out data from the training source and on independent datasets from other institutions. The adapted foundation model generalised better on every external dataset. Within the training distribution, the task-specific models remained competitive when training data were abundant, and delineated boundaries more precisely, while the foundation model more often missed small lesions. Only a small fraction of the foundation model required adaptation, and the capacity needed was determined by the imaging domain rather than by the adaptation method. A widely used polyp test set was also found to duplicate images from another benchmark. Foundation-model adaptation is therefore warranted where models must work across sites, with capacity selected on the target domain.
Toward Foundation Detection Models via Example-Based Grounding in EM-DETR
DeepLearning (DL)-based Computer-Aided Diagnostic (CAD) systems have shown great promise in supporting clinicians, but their performance heavily depends on the availability of large, well-annotated datasets. In medical lesion detection, the scarcity of comprehensive, stan dardized annotations and the heterogeneity of existing datasets limit the development of robust foundation models. In this work, we introduce a novel approach to building a multi-domain foundation model for le sion detection by integrating diverse medical image datasets annotated for both anatomical structures and abnormalities. We first propose a student-teacher training strategy to effectively combine datasets with heterogeneous label spaces, mitigating catastrophic forgetting, and im proving feature learning. In addition, building on our previously pro posed example-based EM-DETR framework, we adapt it to jointly learn from multiple domain-specific datasets, enabling fine-grained, example driven detection across modalities. Our model achieves state-of-the-art (SOTA) results, with image-level AUC scores exceeding previous SOTA by 1% point on four key findings in CXRs. We achieve a leading mAP50 in CXRs and mammography, surpassing EM-DETR trained on a single dataset by 2-3% points. This approach paves the way for scalable foundation models in medical imaging that leverage heterogeneous data while maintaining robust and generalizable performance.
TorchCurves: Differentiable Parametric Curves
We present TorchCurves, a PyTorch library that treats vector-valued parametric curves as learnable primitives. Its central operation maps batches of scalar inputs to points on curves represented in B-spline or Legendre polynomial bases, with differentiation through both inputs and coefficients. Curve coefficients can be optimized jointly with the surrounding model or produced by another network. The library provides trainable modules, reusable basis modules, and a functional interface, supporting applications ranging from continuous feature embeddings to Kolmogorov-Arnold networks and functional regression. Its implementation combines classical evaluation algorithms with vectorized PyTorch operations, emphasizing readability and maintainability without custom hardware kernels. Timing experiments compare curve evaluation against NumPy and SciPy and KAN training against EfficientKAN across a range of problem sizes. The results illustrate where this generality remains computationally practical and where overhead is substantial. Library is available on GitHub at https://github.com/alexshtf/torchcurves.
AutoScaffold: AI-Guided Scaffolding for Reinforcement Learning of Language Models
Reinforcement learning with verifiable rewards (RLVR) produces rich training experience, yet outcome rewards reduce each attempt to a single number and leave most of this information unused. Training-time scaffolds, such as strategies or hints added to the prompt during training, offer a natural way to turn this information into guidance, but their design and adaptation are largely left to humans and tailored to specific domains. We introduce AutoScaffold, a unified AI-for-AI framework that turns a student's training experience into adaptive scaffolds, with minimal domain-specific information and no human intervention during training. A frozen teacher periodically examines this experience, diagnoses bottlenecks, and designs scaffolds in two forms: (i) strategies shared across a class of tasks and (ii) hints for individual hard tasks, adjusting the content and amount of support as the student learns. The scaffolds are removed at evaluation. We apply the same framework to ALFWorld, search-based QA, mathematical reasoning, and GPU kernel generation. When evaluated without scaffolds, students trained with AutoScaffold outperform those trained with the corresponding RL baselines in all four domains, with gains of 7.2 points in ALFWorld success and 4.0 points in average QA exact match. On GPU kernel generation, AutoScaffold increases the fraction of tasks with a correct kernel that runs faster than the PyTorch reference by up to 5.0 points. On math, our student surpasses QuestA's reported accuracy using approximately one-third as many student training steps. Analyses show that the teacher identifies a different failure in each task class and shifts its scaffolds from step-by-step workflows to targeted fixes as the student improves, and that its revised scaffolds help the student learn more than keeping the previous scaffold or using no scaffold.