MC-CXR: A Multi-Context Chest X-ray Benchmark for Context-Induced Disruption in Vision-Language Models

Vision-language models (VLMs) are increasingly used in clinical pipelines where a chest X-ray is interpreted alongside retrieved reports, preliminary notes, or prior imaging. Existing benchmarks measure whether models answer correctly in isolation, but not whether they preserve a correct image-only decision when plausible context conflicts with the image. We introduce Multi-Context Chest X-ray (MC-CXR), a benchmark of 240 cases expanded into 2,522 instances that isolates context-induced disruption through paired perturbation. Each case fixes the current image and target finding while presenting matched reliable and misleading context across text and prior CXR, with visual overlays where available. MC-CXR defines three task families and two paired metrics, the switch-to-wrong rate and the context-aligned error rate. We evaluate ten VLMs spanning open-source general, medical-domain, and closed-source systems. Image-only accuracy is necessary but insufficient. Mean switch rates range from 45.6-78.1% across misleading textual sources and 35.7-61.7% across misleading visual sources. Among switched predictions, 74.6% align with the misleading label for text versus 17.6% for visual context, a 57.0-point gap (95% CI 50.9-62.8). This text-visual asymmetry is observed under the standardized direct-answer protocol. The dataset is available on PhysioNet.

Learning When to Trust via Selective Context Preference Optimization

Language models increasingly condition their answers on external signals, and a single misleading one can turn a correct answer wrong. The obvious remedy, training models to resist such signals, hides a failure mode: a model that ignores all context looks robust yet is useless when the context is worth trusting. We recast the problem as selective trust and introduce MIST, a human-annotated benchmark that renders each reasoning item under four matched conditions (clean, misleading, correct-context, and irrelevant-context), together with SC2W, a paired metric counting how often a misleading signal flips a clean-correct answer to wrong. Across a comprehensive benchmark study, we observe that such a susceptibility is universal. We then propose SCOPE, which mines clean-correct/misleading-wrong failures and optimizes a standard Direct Preference Optimization (DPO) objective over matched preference pairs balanced equally across all four conditions, rather than over misleading items alone. Our approach substantially reduces SC2W on popular open-sourced models while preserving accuracy when the added context is clean, correct, or irrelevant. With this work, we argue that models should be judged on selective trust, not on resistance alone.

ContextShift: A Controlled Benchmark for Context Dependence in Object Detection

Modern object detectors achieve strong performance on standard benchmarks, yet their robustness to contextual variation remains insufficiently understood. Prior evaluations largely rely on aggregate metrics such as AP on uncontrolled distribution shifts, which can obscure how performance degrades under context change. We introduce ContextShift, a controlled benchmark that systematically manipulates object--context relationships while preserving object appearance. Built on COCO 2017, it isolates context as an independent variable through geometric transformations and synthetic and natural background substitutions, including a continuous compatibility axis based on normalized pointwise mutual information (NPMI). Across diverse detector architectures, we observe a consistent degradation pattern: false negatives increase by up to 227% and prediction volume decreases by up to 44%, while false positives remain stable or decline. This suppression behavior is not captured by aggregate metrics such as AP, which can mask substantial recall loss and changes in prediction dynamics. Further analysis suggests that degradation is driven less by reduced confidence than by a reduced formation of valid detection candidates. Moreover, performance along the statistical compatibility axis is non-monotonic, peaking at intermediate NPMI and degrading toward both extremes, indicating that statistical co-occurrence does not correlate linearly with effective visual context. Finally, we show that context-aware augmentation improves robustness: every augmented variant outperforms the dataset-only baseline on both original and manipulated test images, partially recovering performance lost to prediction-suppression failures by exposing models to object--context decoupling during training.