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MedCORE advances medical AI by embedding explicit clinical reasoning structures into vision-language models, directly addressing the "black box" problem in diagnostic imaging. This approach improves interpretability and safety by localizing specific pathological criteria and weighting evidence based on confidence levels across multiple imaging modalities. The framework demonstrates that aligning model outputs with established clinical workflows yields superior performance over standard deep learning baselines.
MedCORE: Criteria-Grounded Clinical Reasoning for Interpretable Medical Image Diagnosis
arXiv:2610.08528v1 Announce Type: cross Abstract: Clinical diagnosis is inherently a structured reasoning process, yet existing deep learning models often bypass this structure by mapping image features directly to disease labels without explicitly interrogating the morphological and textural criteria that clinicians systematically evaluate. This limits diagnostic transparency and may compromise safe clinical deployment. We present MedCORE (Medical Criteria-Oriented Reasoning and Evidence), a structured diagnostic framework that operationalizes clinical reasoning within a vision-language architecture. For each input image, MedCORE decomposes the diagnostic process into clinically defined criteria, spatially localizes each criterion to diagnostically relevant image regions, encodes evidence through multi-scale representations that capture macro-structural and micro-textural pathological characteristics, and refines criterion representations using a Graph Attention Network that explicitly models inter-criteria dependencies. Criterion representations are further aligned with clinical text descriptors, reinforced through class-wise visual prototypes, and aggregated using uncertainty-calibrated weighting that proportionally discounts low-confidence diagnostic evidence. MedCORE is validated across three clinically heterogeneous imaging modalities, including dermoscopic lesion classification on ISIC 2018, breast ultrasound lesion characterization on BUSI, and diabetic retinopathy grading on IDRiD. Quantitatively, MedCORE achieves 89.2% accuracy, 85.7% macro-F1, and 96.4% AUC on ISIC 2018; 96.1% accuracy, 95.2% macro-F1, and 98.4% AUC on BUSI; and 84.3% accuracy, 80.2% macro-F1, and 92.8% AUC on IDRiD. These results demonstrate consistent improvements over strong CNN, transformer, biomedical vision-language, concept-based, and prototype-based baselines.
Abstract:Clinical diagnosis is inherently a structured reasoning process, yet existing deep learning models often bypass this structure by mapping image features directly to disease labels without explicitly interrogating the morphological and textural criteria that clinicians systematically evaluate. This limits diagnostic transparency and may compromise safe clinical deployment. We present MedCORE (Medical Criteria-Oriented Reasoning and Evidence), a structured diagnostic framework that operationalizes clinical reasoning within a vision-language architecture. For each input image, MedCORE decomposes the diagnostic process into clinically defined criteria, spatially localizes each criterion to diagnostically relevant image regions, encodes evidence through multi-scale representations that capture macro-structural and micro-textural pathological characteristics, and refines criterion representations using a Graph Attention Network that explicitly models inter-criteria dependencies. Criterion representations are further aligned with clinical text descriptors, reinforced through class-wise visual prototypes, and aggregated using uncertainty-calibrated weighting that proportionally discounts low-confidence diagnostic evidence. MedCORE is validated across three clinically heterogeneous imaging modalities, including dermoscopic lesion classification on ISIC 2018, breast ultrasound lesion characterization on BUSI, and diabetic retinopathy grading on IDRiD. Quantitatively, MedCORE achieves 89.2% accuracy, 85.7% macro-F1, and 96.4% AUC on ISIC 2018; 96.1% accuracy, 95.2% macro-F1, and 98.4% AUC on BUSI; and 84.3% accuracy, 80.2% macro-F1, and 92.8% AUC on IDRiD. These results demonstrate consistent improvements over strong CNN, transformer, biomedical vision-language, concept-based, and prototype-based baselines.
Computer Vision and Pattern Recognition (cs.CV); Artificial Intelligence (cs.AI)
arXiv:2610.08528 [cs.CV]
(or arXiv:2610.08528v1 [cs.CV] for this version)
https://doi.org/10.48550/arXiv.2610.08528 Focus to learn more arXiv-issued DOI via DataCite (pending registration)
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