Do Medical Vision Models Reason About Anatomy? Probing the Spatial Inductive Biases of Learned Visual Representations

Interpreting a CT scan means comparing structures on either side, judging how far apart organs sit, and knowing where each one belongs. Medical vision encoders are evaluated on diagnostic accuracy, or through assembled multimodal systems where a failure is hard to attribute, so it remains unclear whether their representations support any of this. We construct SPAR-Bench, eight probes over multi-organ abdominal CT that separate coordinate localization, relational reasoning, and spatial queries, and apply them to five architectural configurations and three medical foundation models, frozen and finetuned. Probes that ask for a comparison within the slice stay at chance, and neither pretraining scale, finetuning, nor architecture closes the gap. Probes that appear solved in domain fall to chance under zero-shot transfer, indicating that their accuracy reflects recall of canonical anatomy rather than computation over the image. Reading the same frozen features with a pooled head rather than the full set of tokens moves relational recovery from 0.7% to 67.8%, so pooled probing understates what a representation holds. Questions the encoders answer well are answered at chance by four open-weight MLLMs. Our results suggest these encoders carry a map of where organs usually lie, and little of the machinery for comparing structures within a particular patient. Code and data will be available at https://spar-bench.github.io.

FRAME: separating sampling variation from representational cause in medical imaging fairness

Subgroup performance differences are the standard evidence for fairness bias in medical imaging, and the usual response removes the demographic information that a model encodes. Here we introduce Fair-model Reference And Mechanism Evaluation (FRAME), a two-step framework for auditing such a claim. The first step derives a fair-model reference, the distribution of the difference under exact fairness at the observed subgroup sizes. In the second step, we test the remainder with two operators in representation space. One operator cannot change a within-group ranking by construction. Across 702,206 images and 36 encoders, the reference accounts for a median 41% of the reported race difference and 22% of the age difference. Injecting demographic decodability leaves the remainder unchanged, while entangling the group with the disease direction raises the race difference from 0.077 to 0.118. No intervention we tested changes the remainder more than a change of random seed does. Those interventions reduce a difference at the operating point and leave the within-group ranking difference at a median of 0.000. Applied to 89 differences in 9 published studies across 6 medical imaging modalities, the reference accounts for a median 25% of a rate difference and 70% of a difference in the area under the receiver operating characteristic curve. Image-text pretraining instead raises worst-group performance by about 0.05. Applying FRAME before choosing an intervention could distinguish differences that need a mechanistic explanation from differences compatible with sampling variation at the current cohort sizes.

ECG-InterpBench: Benchmarking the Interpretability of ECG Foundation Models with Matched-Scale Sparse Autoencoders

Existing benchmarks for electrocardiogram foundation models primarily evaluate downstream predictive performance, providing limited insight into whether their internal representations can be faithfully decomposed, clinically interpreted, or reproduced across independent analyses. We introduce ECG-InterpBench, a benchmark designed to systematically evaluate the interpretability of ECG foundation-model representations. ECG-InterpBench uses sparse autoencoders as standardized measurement instruments and matches their capacity across models to enable controlled comparisons. We evaluate six frozen ECG foundation models across five standardized encoder depths, five matched dictionary widths, and three random seeds, producing a 450-cell interpretability atlas comprising 75 exactly matched six-model comparison blocks. The benchmark evaluates complementary dimensions of representation interpretability, including sparse reconstruction fidelity, single-feature accessibility and coverage of 49 clinically meaningful ECG measurements, and cross-seed feature reproducibility. The evaluation further quantifies patient-sampling uncertainty, depth- and seed-dependent variation, and sensitivity to the sparsity parameterization. The benchmark reveals that ECG foundation models exhibit distinct interpretability profiles. A matched replication on MIMIC-IV-ECG confirms that reconstruction fidelity and clinical accessibility identify different leading models. The benchmark is accompanied by executable evaluation code, standardized manifests, cell-level metrics, and reproducibility audits. ECG-InterpBench complements performance-centered ECG benchmarks by providing a capacity-controlled and reproducible framework for comparing ECG foundation models across distinct dimensions of representation interpretability.

Causal-Adversarial Probing of Clinical Covariates for Prostate MRI Grading

Deep learning models for prostate MRI-based cancer grading may encode clinical covariates that either reflect useful disease-related signal or non-generalising shortcut information, but their role is usually assumed. We propose a causal-reasoning framework for probing covariate dependence in MRI-based International Society of Urological Pathology (ISUP) Grade Group prediction. Rather than treating mpMRI as a direct cause of grade, we model MRI appearance and ISUP grade as observations of latent tumour pathology, and test whether candidate clinical variables act as nuisance correlates, disease-related proxies, or irrelevant covariates in the learned representation. We implement this using an adversarial framework that suppresses the decodability of individual clinical covariate at a time while preserving MRI-based grade prediction. The approach is developed and evaluated on 2,903 prostate MRI examinations, with external validation on 576 patients. We report a set of interesting and previously under-explored imaging-to-clinical-variable interactions in the context of deep learning generalisation. For examples, in binary ISUP Grade Group $\geq2$ classification, suppressing age, BMI, and alcohol use improved AUC by 1.23%, 0.84%, and 1.42%, respectively (all p < 0.05), suggesting reduced non-generalising covariate information; In contrast, suppressing PSA and prostate volume degraded AUC by 1.91% and 7.61% (all p < 0.001), indicating that these variables carried task-relevant signal. These findings show that adversarial covariate suppression can provide a practical representation-level analysis for distinguishing potentially harmful dependence from informative signal in prostate MRI grading models.

Viral Proteins Reveal Geometry of Protein Language Models

Protein language models are trained on highly imbalanced datasets, raising the question of how they represent underrepresented biological sequences. Using viral proteins as a case study across ESM model families, we identify a dominant nativeness axis in embedding space, aligned with masked reconstruction perplexity, that orders sequences from well-modeled cellular proteins through viral proteins to shuffled and random sequences. Scaling contracts this axis unevenly across viral families. Despite this, protein language model embeddings retain viral-specific signal: viral proteins remain linearly separable beyond zero-shot perplexity and shallow sequence features. Together, these results suggest that pLM representations are structured by a general notion of nativeness while preserving information specific to distinct biological groups.

Beyond Accuracy: Interpreting Topic Representation in Suicide Ideation Detection Models

Suicide ideation detection models are typically evaluated using aggregate performance metrics, yet little is known about how they internally represent psychologically meaningful risk factors. In high-stakes mental health applications, understanding these internal representations is essential for safety, transparency, and responsible deployment. In this work, we move beyond accuracy and analyze how suicide detection models trained on original and topic-augmented datasets encode psychological risk factors in their internal representation space. Using visualization and geometric analysis, we examine the coherence and separability of topic-related features. Our results show that topic-aware augmentation increases the clarity and distinctness of underrepresented psychosocial risk factors such as immigration, family issues, and financial crisis. These findings suggest that augmentation not only improves model performance but also leads to more structured and interpretable internal representations.

The Identity Trap in EEG Foundation Models: A Diagnostic Audit

Objective. EEG foundation models (FMs) report strong accuracy on clinical resting-state EEG. However, high accuracy under subject-disjoint cross-validation remains ambiguous: it can reflect a genuine clinical biomarker, or subject-identity features that correlate with the label. We name this the Identity Trap and ask whether it can be diagnosed at the representation level before fine-tuning. Approach. We propose FMScope, a frozen-representation protocol packaging five diagnostics: variance decomposition, subject-axis erasure, aperiodic 1/f ablation, layer-wise label probing, and within-subject direction consistency. We apply it to three pretrained FMs (LaBraM, CBraMod, REVE) across four datasets in a 2x2 layout: subject relation of label x presence of a consensus cross-subject EEG marker. Main results. (i) The Identity Trap is universal: frozen subject-variance is 13-89x a random null in 12/12 pairs, rising in all 12 under fine-tuning (+10 to +63 pp). This dominance is a removable linear axis: erasing it improves label decoding where the label varies within subject (+6 to +12 pp in primary cells; +4 to +27 pp across external cohorts). (ii) Aperiodic 1/f is one subject carrier: removing it drops the subject probe by 9-19 pp on LaBraM and CBraMod. REVE saturates subject identity without measurable aperiodic dependence. (iii) Fine-tuning amplifies label-variance only in cells with a literature-established cross-subject marker. Significance. The Identity Trap is a physically-grounded instance of shortcut learning: the preferred cue has a measurable physiological component, and subject-disjoint splitting alone cannot rule it out. FMScope separates gains reflecting a biological marker from those reflecting subject identity.