Beyond Diagnosis: Evaluating Multimodal LLMs for Pathology Localization in Chest Radiographs
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| Autores principales: | , , , , , , |
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| Formato: | Preprint |
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2025
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| _version_ | 1866917091439804416 |
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| author | Gosai, Advait Kavishwar, Arun McNamara, Stephanie L. Samineni, Soujanya Umeton, Renato Chowdhury, Alexander Lotter, William |
| author_facet | Gosai, Advait Kavishwar, Arun McNamara, Stephanie L. Samineni, Soujanya Umeton, Renato Chowdhury, Alexander Lotter, William |
| contents | Recent work has shown promising performance of frontier large language models (LLMs) and their multimodal counterparts in medical quizzes and diagnostic tasks, highlighting their potential for broad clinical utility given their accessible, general-purpose nature. However, beyond diagnosis, a fundamental aspect of medical image interpretation is the ability to localize pathological findings. Evaluating localization not only has clinical and educational relevance but also provides insight into a model's spatial understanding of anatomy and disease. Here, we systematically assess two general-purpose MLLMs (GPT-4 and GPT-5) and a domain-specific model (MedGemma) in their ability to localize pathologies on chest radiographs, using a prompting pipeline that overlays a spatial grid and elicits coordinate-based predictions. Averaged across nine pathologies in the CheXlocalize dataset, GPT-5 exhibited a localization accuracy of 49.7%, followed by GPT-4 (39.1%) and MedGemma (17.7%), all lower than a task-specific CNN baseline (59.9%) and a radiologist benchmark (80.1%). Despite modest performance, error analysis revealed that GPT-5's predictions were largely in anatomically plausible regions, just not always precisely localized. GPT-4 performed well on pathologies with fixed anatomical locations, but struggled with spatially variable findings and exhibited anatomically implausible predictions more frequently. MedGemma demonstrated the lowest performance on all pathologies, but showed improvements when provided examples through few shot prompting. Our findings highlight both the promise and limitations of current MLLMs in medical imaging and underscore the importance of integrating them with task-specific tools for reliable use. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2509_18015 |
| institution | arXiv |
| publishDate | 2025 |
| record_format | arxiv |
| spellingShingle | Beyond Diagnosis: Evaluating Multimodal LLMs for Pathology Localization in Chest Radiographs Gosai, Advait Kavishwar, Arun McNamara, Stephanie L. Samineni, Soujanya Umeton, Renato Chowdhury, Alexander Lotter, William Computer Vision and Pattern Recognition Artificial Intelligence Recent work has shown promising performance of frontier large language models (LLMs) and their multimodal counterparts in medical quizzes and diagnostic tasks, highlighting their potential for broad clinical utility given their accessible, general-purpose nature. However, beyond diagnosis, a fundamental aspect of medical image interpretation is the ability to localize pathological findings. Evaluating localization not only has clinical and educational relevance but also provides insight into a model's spatial understanding of anatomy and disease. Here, we systematically assess two general-purpose MLLMs (GPT-4 and GPT-5) and a domain-specific model (MedGemma) in their ability to localize pathologies on chest radiographs, using a prompting pipeline that overlays a spatial grid and elicits coordinate-based predictions. Averaged across nine pathologies in the CheXlocalize dataset, GPT-5 exhibited a localization accuracy of 49.7%, followed by GPT-4 (39.1%) and MedGemma (17.7%), all lower than a task-specific CNN baseline (59.9%) and a radiologist benchmark (80.1%). Despite modest performance, error analysis revealed that GPT-5's predictions were largely in anatomically plausible regions, just not always precisely localized. GPT-4 performed well on pathologies with fixed anatomical locations, but struggled with spatially variable findings and exhibited anatomically implausible predictions more frequently. MedGemma demonstrated the lowest performance on all pathologies, but showed improvements when provided examples through few shot prompting. Our findings highlight both the promise and limitations of current MLLMs in medical imaging and underscore the importance of integrating them with task-specific tools for reliable use. |
| title | Beyond Diagnosis: Evaluating Multimodal LLMs for Pathology Localization in Chest Radiographs |
| topic | Computer Vision and Pattern Recognition Artificial Intelligence |
| url | https://arxiv.org/abs/2509.18015 |