analiza aiqbench
This research addresses a critical flaw in clinical AI adaptation where standard accuracy metrics fail on imbalanced medical data, potentially masking useless models. The authors introduce Ranking-PE, a prompt optimization method that directly optimizes for AUROC by leveraging pairwise instance ordering rather than simple correctness counts. This approach successfully reverses the degradation of ranking performance seen in accuracy-focused pipelines without requiring additional model inference costs.
Ranking-Aware Prompt Optimization for Multimodal Clinical Diagnosis
arXiv:2609.40361v1 Announce Type: cross Abstract: Multimodal large language models (MLLMs) are rapidly advancing clinical diagnosis, yet their adaptation pipelines remain anchored to accuracy-based objectives. Clinical data are heavily class-imbalanced: a constant-majority predictor can score above 90% accuracy while being clinically useless. We therefore evaluate and optimize for AUROC, a threshold-free score that ranks positives above negatives and is invariant to class balance. We focus on prompt optimization in MLLMs. Reflective methods such as GEPA use a binary scores matrix with one row per evaluation instance and one column per candidate prompt; cells record per-instance correctness, so the column average is accuracy and drives candidate selection. We introduce pair-level Pareto prompt evolution (Ranking-PE), which replaces each correctness row with a pairwise-ordering row over (positive, negative) instance pairs: the cell is 1 if the candidate scores the positive higher than the paired negative. The column average then equals empirical AUROC (by the Wilcoxon-Mann-Whitney identity). We apply this swap at all three layers the prompt evolution search reads from - the scores matrix that decides Pareto dominance, the per-example feedback to the reflection LM, and final candidate selection - at no extra model calls and with no surrogate loss. Across three diseases on MIMIC, accuracy-based prompt evolution can degrade ranking; Ranking-PE reverses this, beating the accuracy-based recipe by +5.8 AUROC pp on fine-tuned Qwen3-VL-8B and +16.2 pp on MedGemma-4B. Ablations examine each design component and show that a medical-grade visual backbone - via vision-encoder-tuned SFT or medical pretraining - is a prerequisite that prompt search cannot replace - our recipe extends reflective prompt evolution from text-only data to multimodal clinical decision-making.
Abstract:Multimodal large language models (MLLMs) are rapidly advancing clinical diagnosis, yet their adaptation pipelines remain anchored to accuracy-based objectives. Clinical data are heavily class-imbalanced: a constant-majority predictor can score above 90% accuracy while being clinically useless. We therefore evaluate and optimize for AUROC, a threshold-free score that ranks positives above negatives and is invariant to class balance. We focus on prompt optimization in MLLMs. Reflective methods such as GEPA use a binary scores matrix with one row per evaluation instance and one column per candidate prompt; cells record per-instance correctness, so the column average is accuracy and drives candidate selection. We introduce pair-level Pareto prompt evolution (Ranking-PE), which replaces each correctness row with a pairwise-ordering row over (positive, negative) instance pairs: the cell is 1 if the candidate scores the positive higher than the paired negative. The column average then equals empirical AUROC (by the Wilcoxon-Mann-Whitney identity). We apply this swap at all three layers the prompt evolution search reads from - the scores matrix that decides Pareto dominance, the per-example feedback to the reflection LM, and final candidate selection - at no extra model calls and with no surrogate loss. Across three diseases on MIMIC, accuracy-based prompt evolution can degrade ranking; Ranking-PE reverses this, beating the accuracy-based recipe by +5.8 AUROC pp on fine-tuned Qwen3-VL-8B and +16.2 pp on MedGemma-4B. Ablations examine each design component and show that a medical-grade visual backbone - via vision-encoder-tuned SFT or medical pretraining - is a prerequisite that prompt search cannot replace - our recipe extends reflective prompt evolution from text-only data to multimodal clinical decision-making.
Machine Learning (cs.LG); Computation and Language (cs.CL); Computer Vision and Pattern Recognition (cs.CV)
arXiv:2609.40361 [cs.LG]
(or arXiv:2609.40361v1 [cs.LG] for this version)
https://doi.org/10.48550/arXiv.2609.40361 Focus to learn more arXiv-issued DOI via DataCite (pending registration)
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
Text integral sub licența deschisă a publicației · 367 cuvinte
Subiecte conexe
[AINews] Quasi-Riemann-Hypothesis: OpenAI publishes 722 math papers solving 90 of the top 500 open math problems; “the most significant moment” in >100 years of mathematics
Latent Space · 7 oct. 2026
Are Prompt Optimizers Blind? Cross-Modal Visual Feedback for Automatic Prompt Optimization
arXiv · 28 iul. 2026
Vertical Advantage: Transforming Industries with Lakebase and Agentic AI
Databricks · 27 aug. 2026
[AINews] High Taste Testers Ep. 1
Latent Space · 17 oct. 2026