Confident but Unreliable: A Behavioral Safety Audit of Vision-Language Models on Brain MRI

Vision-language models (VLMs), including medical specialists, are increasingly proposed for medical imaging, yet their stated confidence is rarely evaluated separately from correctness. We use brain MRI as a controlled, high-stakes testbed for a broader failure mode in frontier multimodal systems: models can appear competent while lacking reliable self-knowledge. We present an automatically graded behavioral audit and pilot study of six instruction-tuned VLMs (five general-purpose and one medical specialist) on 4,102 images (4,032 axial/coronal/sagittal MRI slices from 250 subjects plus 70 non-brain/noise controls), with labels derived from public metadata and released expert segmentation masks rather than new human annotation. Across models, answer coverage is near-complete, but verbalized-confidence calibration is poor: ECE ranges from 0.27 to 0.40, mean confidence on incorrect answers ranges from 0.82 to 0.97, and 33-46% of answered items are high-confidence errors. The most accurate model is also the most confident on its errors, while a base/specialist family contrast suggests that medical adaptation improves tumor-presence detection without improving confidence reliability. Open-ended diagnostics further show that hallucination and abstention vary separately from multiple-choice accuracy. These findings argue that medical-image VLM evaluation should report verbalized-confidence reliability, confident error, hallucination, and abstention alongside accuracy.

Adaptive Confidence-weighted Expansion for Trustworthy Multi-Omics Multimodal Fusion

Multimodal learning is a robust approach to improve predictive performance in applications such as medical prognosis. However, the clinical applicability of models that use multimodal learning is hampered by their poor performance under noisy or uninformative data streams. Present fusion approaches often lack robust mechanisms for the dynamic assessment of data quality and for the provision of a trustable confidence score on the final prediction. This dissuades their deployment in safety-critical settings. To address these limitations, we introduce Adaptive Confidence-weighted Expansion (ACE), a novel framework to enhance the trustworthiness of multimodal fusion models. ACE first enhances the multimodal space by generating new, complementary modalities from intra-modality correlations. It then employs a dual-level confidence mechanism that (1) adaptively reweighs all modalities by their reliability before fusion and (2) estimates a global trust score over the fused, final decision. To evaluate ACE, we used four challenging multi-omics datasets (BRCA, KIPAN, LGG, and ROSMAP). ACE significantly outperforms existing state-of-the-art algorithms in both classification performance and confidence calibration. Our framework provides a more stable and robust data fusion method that facilitates the use of multimodal learning in addressing high-stakes problems.

Calibrated Hybrid CNN-Transformer for Retinal OCT Classification

Deep models for retinal optical coherence tomography (OCT) classification report high accuracy but rarely report whether their confidence can be trusted -- a gap that matters when a wrong-but-confident reading delays sight-saving treatment. We pair a hybrid convolutional-Transformer encoder with a gradient-boosting (XGBoost) classification head and a three-part clinical safety layer: confidence calibration, out-of-distribution (OOD) rejection, and per-prediction uncertainty flagging. On four-class OCT (84,495 scans) the model reaches 95.4% accuracy while cutting calibration error twelve-fold (expected calibration error, ECE = 0.0024), so the confidence it reports tracks its true accuracy. To our knowledge this is the first OCT classifier to validate all three safety mechanisms jointly, with public weights and reproducible multi-seed evaluation.

Confidence Calibration for Multimodal LLMs: An Empirical Study through Medical VQA

Multimodal Large Language Models (MLLMs) show great potential in medical tasks, but their elicited confidence often misaligns with actual accuracy, potentially leading to misdiagnosis or overlooking correct advice. This study presents the first comprehensive analysis of the relationship between accuracy and confidence in medical MLLMs. It proposes a novel method that combines Multi-Strategy Fusion-Based Interrogation (MS-FBI) with auxiliary expert LLM assessment, aiming to improve confidence calibration in Medical Visual Question Answering (VQA). Experiments demonstrate that our method reduces the Expected Calibration Error (ECE) by an average of 40\% across three Medical VQA datasets, significantly enhancing MLLMs' reliability. The findings highlight the importance of domain-specific calibration for MLLMs in healthcare, offering a more trustworthy solution for AI-assisted diagnosis.