Longitudinal radiology report generation (LRRG) requires identifying both current findings and their changes relative to a prior study. Existing methods jointly model diagnosis, attribute estimation, temporal comparison, and language generation within implicit representations, which can cause task interference, obscure the evidence underlying each decision, and limit error traceability. They also model progression states as independent labels, ignoring their ordered structure and thus treating missed changes and direction reversals equally. We present STRIVE, Multi-Agent Structured Temporal Reasoning with Integrated Verification for LRRG, which decomposes clinical reasoning into specialized Diagnosis, Attribute, and Temporal Change Agents that produce explicit intermediate evidence. In particular, the Temporal Change Agent is further post-trained using Progression-Aware GRPO, a verifiable, shaped reward that assigns partial credit to direction-preserving errors while scoring direction reversals lowest. STRIVE performs verification at two stages: a deterministic Consistency Gate reconciles the agent outputs before report generation, and a Validation Agent checks whether the generated report is supported by the aggregated clinical evidence. On Longitudinal-MIMIC, STRIVE attains the best clinical efficacy among recent methods and more than doubles Longitudinal Change Concordance (LCC), a measure of temporal agreement with the reference report, over the strongest baseline.
While multimodal large language models (MLLMs) excel in medical applications, most of them favor static images or short-term signals. In the critical field of dynamic electrocardiograms (ECG), models struggle with complex temporal reasoning and diagnostic report generation due to a lack of high-quality datasets and benchmarks. To address this, we introduce (i) Holtercare-23K, a large-scale multimodal dynamic ECG dataset comprising 22,980 QA pairs derived from 788 clinical Holter records and featuring a novel signal-video-text tri-modal alignment. Based on this dataset, we present (ii) Holtercare-Bench, a multimodal benchmark that evaluates models on temporal localization, clinical diagnosis, and global summarization. Zero-shot evaluations of leading MLLMs reveal a significant performance gap in processing ultra-long pathological sequences. However, fine-tuning representative models yields substantial improvements. This work illuminates the limitations of current MLLMs in electrophysiology and provides a foundational benchmark for long-term medical MLLMs. Our project is available at https://github.com/ZJU4HealthCare/Holtercare-Bench.
Chengyang He, Tahreem Arif, Marko Zivkovic +3cs.CL cs.AI cs.IR
Understanding the temporal progression of symptoms in clinical narratives is critical for disease monitoring, safety surveillance, and causality assessment. Clinical narratives, however, rarely provide explicit temporal anchors. Current approaches to temporal information reasoning focus predominantly on pairwise relation classification across multi-visit and timestamp-rich records, leaving the reconstruction of structured symptom trajectories from individual anchor-sparse reports largely unaddressed. We propose CRAFT, an LLM framework that pairs a generator with a constraint-based verifier to iteratively produce and refine stage-wise symptom timelines through targeted feedback. We conduct evaluation on MedTempo, a new benchmark of 5,347 vaccine adverse-event narratives spanning three COVID-19 vaccine types, with expert-validated temporal stage annotations for 3,166 reports. Experiments across four LLM backbones demonstrate that CRAFT consistently improves temporal ordering accuracy, with ablation analysis isolating the contribution of generator and verifier components across model capability levels.
OFM Riaz Rahman Aranya, Peyman Najafirad, Kevin Desaics.CV
Radiologists routinely compare current and prior chest X-rays to track disease progression, producing follow-up reports that describe multiple findings, each localised to an anatomical region and annotated with a temporal change status. Existing automated methods either generate reports from a single image without modelling temporal context, or incorporate temporal information but do not ground their outputs spatially. The few approaches that combine temporal reasoning with spatial grounding are restricted to single-finding descriptions, leaving multi-finding reports with mixed change directions unaddressed. We present GRCD, a framework for grounded report generation from chest X-ray pairs in the multi-finding setting. We first construct a rigorously cleaned dataset of temporal chest X-ray pairs by identifying and correcting two systematic labelling errors in the source annotations. We then introduce a Region-Guided Change Token module that encodes per-region temporal change across anatomical structures and injects this signal into a language model through a dual-pathway strategy combining prepended spatial tokens with gated cross-attention. On a multi-finding test set, GRCD outperforms existing baselines on text generation and clinical accuracy metrics, with gains in change detection. Ablation studies confirm that the dual-pathway design outperforms either integration strategy in isolation on text and clinical metrics, and that region-level change encoding is necessary for multi-finding generation. Code is available at https://github.com/UTSA-VIRLab/GRCD
Existing medical video benchmarks primarily evaluate whether a model produces the correct answer, but rarely assess whether it answers at the right time. In real clinical settings, AI systems must decide not only what to predict, but also when to answer, defer judgment, or proactively raise alerts. This creates a critical gap between benchmark evaluation and deployment requirements. We present MedStreamBench, a benchmark for time-aware medical video understanding. MedStreamBench integrates 22 medical datasets and 5,419 QA instances across four temporal settings: retrospective, present, future, and proactive. Unlike conventional benchmarks that assume full-video access, MedStreamBench restricts models to temporally bounded evidence windows and supports both single-turn and streaming evaluation. We further introduce a proactive monitoring setting that requires models to determine whether and when clinically relevant alerts should be triggered. Beyond answer correctness, MedStreamBench evaluates temporal behavior through responsiveness and post-evidence stability. Experiments on leading general-purpose and medical vision-language models reveal a substantial gap between offline recognition and temporally grounded decision-making, with performance dropping markedly in streaming and proactive settings. Our benchmark is available at https://huggingface.co/datasets/Venn2024/MedStreamBench.
Large language models (LLMs) are increasingly used for everyday health questions, including whether a user can safely take another dose of an over-the-counter (OTC) medication. Yet this common safety-relevant setting remains underexplored in existing medical QA evaluations, where correct answers require tracking dose timing, computing rolling 24-hour intake, following product-label constraints, and handling incomplete medication histories. We introduce DOSEBENCH, a focused benchmark of 81 curated OTC dosing scenarios focused on adult acetaminophen and ibuprofen use, with manually annotated gold references. We evaluate four LLMs across repeated runs using metrics for decision correctness, consistency, explanation verifiability, failure types, and confidence-related signals, resulting in 1,620 model responses. Our results show that models frequently struggle with rolling-window reasoning and ambiguity-sensitive cases and that stable or confident-looking responses can still violate dosing constraints. These findings suggest that OTC dosing QA provides a narrow yet practical testbed for evaluating temporal reasoning, constraint following, and safety-relevant uncertainty handling in medical QA.
Biomedical knowledge graphs (KGs) treat disease associations as static facts, but temporal information is crucial for clinical reasoning, e.g., a symptom diagnostic of one disease at age 3 may imply a different disease at age 13. Existing KGs such as PrimeKG, Hetionet, and iKraph do not encode when a finding becomes clinically relevant over the course of a disease. This limits their usefulness for longitudinal clinical reasoning and retrieval augmentation. We introduce ChronoMedKG, a temporal biomedical knowledge graph that contains 460,497 evidence-linked triples (filtered from 13M raw extractions) covering 13,431 diseases. Each association is tied to temporal components like onset window or progression stage, which are backed by PMID-traceable evidence and a multi-signal credibility score. The graph is constructed through a disease-autonomous multi-agent pipeline in which multiple frontier LLMs independently extract knowledge from PubMed and PMC literature. Only those relations are kept that are supported by multi-model consensus, survive credibility filtering, as well as ontology alignment. ChronoMedKG scored 92.7% agreement against Orphadata and adds temporal grounding for 6,250 diseases absent from HPOA, Orphadata, and Phenopackets, including 1,657 Orphanet-coded rare diseases. We further introduce ChronoTQA, a benchmark of 3,341 questions across eight task types (six temporal plus two static controls), with a 12-question supplementary probe. Frontier LLMs lose roughly 30 points moving from static to temporal questions; ChronoMedKG retrieval rescues 47-65% of their long-tail failures, against 17-29% for HPOA-RAG. As such, ChronoMedKG provides a crucial temporal axis for retrieval-augmented clinical systems that was previously absent.