Xihe Qiu
Publications
From Answers to Arguments: Toward Trustworthy Clinical Diagnostic Reasoning with Toulmin-Guided Curriculum Goal-Conditioned Learning
The integration of Large Language Models (LLMs) into clinical decision support is critically obstructed by their opaque and often unreliable reasoning. In the high-stakes domain of healthcare, correct answers alone are insufficient; clinical practice demands full transparency to ensure patient safety and enable professional accountability. A pervasive and dangerous weakness of current LLMs is their tendency to produce "correct answers through flawed reasoning." This issue is far more than a minor academic flaw; such process errors signal a fundamental lack of robust understanding, making the model prone to broader hallucinations and unpredictable failures when faced with real-world clinical complexity. In this paper, we establish a framework for trustworthy clinical argumentation by adapting the Toulmin model to the diagnostic process. We propose a novel training pipeline: Curriculum Goal-Conditioned Learning (CGCL), designed to progressively train LLM to generate diagnostic arguments that explicitly follow this Toulmin structure. CGCL's progressive three-stage curriculum systematically builds a solid clinical argument: (1) extracting facts and generating differential diagnoses; (2) justifying a core hypothesis while rebutting alternatives; and (3) synthesizing the analysis into a final, qualified conclusion. We validate CGCL using T-Eval, a quantitative framework measuring the integrity of the diagnosis reasoning. Experiments show that our method achieves diagnostic accuracy and reasoning quality comparable to resource-intensive Reinforcement Learning (RL) methods, while offering a more stable and efficient training pipeline.
VIVID-Med: LLM-Supervised Structured Pretraining for Deployable Medical ViTs
Vision-language pretraining has driven significant progress in medical image analysis. However, current methods typically supervise visual encoders using one-hot labels or free-form text, neither of which effectively captures the complex semantic relationships among clinical findings. In this study, we introduce VIVID-Med, a novel framework that leverages a frozen large language model (LLM) as a structured semantic teacher to pretrain medical vision transformers (ViTs). VIVID-Med translates clinical findings into verifiable JSON field-state pairs via a Unified Medical Schema (UMS), utilizing answerability-aware masking to focus optimization. It then employs Structured Prediction Decomposition (SPD) to partition cross-attention into orthogonality-regularized query groups, extracting complementary visual aspects. Crucially, the LLM is discarded post-training, yielding a lightweight, deployable ViT-only backbone. We evaluated VIVID-Med across multiple settings: on CheXpert linear probing, it achieves a macro-AUC of 0.8588, outperforming BiomedCLIP by +6.65 points while using 500x less data. It also demonstrates robust zero-shot cross-domain transfer to NIH ChestX-ray14 (0.7225 macro-AUC) and strong cross-modality generalization to CT, achieving 0.8413 AUC on LIDC-IDRI lung nodule classification and 0.9969 macro-AUC on OrganAMNIST 11-organ classification. VIVID-Med offers a highly efficient, scalable alternative to deploying resource-heavy vision-language models in clinical settings.
PRISM: Festina Lente Proactivity -- Risk-Sensitive, Uncertainty-Aware Deliberation for Proactive Agents
Proactive agents must decide not only what to say but also whether and when to intervene. Many current systems rely on brittle heuristics or indiscriminate long reasoning, which offers little control over the benefit-burden tradeoff. We formulate the problem as cost-sensitive selective intervention and present PRISM, a novel framework that couples a decision-theoretic gate with a dual-process reasoning architecture. At inference time, the agent intervenes only when a calibrated probability of user acceptance exceeds a threshold derived from asymmetric costs of missed help and false alarms. Inspired by festina lente (Latin: "make haste slowly"), we gate by an acceptance-calibrated, cost-derived threshold and invoke a resource-intensive Slow mode with counterfactual checks only near the decision boundary, concentrating computation on ambiguous and high-stakes cases. Training uses gate-aligned, schema-locked distillation: a teacher running the full PRISM pipeline provides dense, executable supervision on unlabeled interaction traces, while the student learns a response policy that is explicitly decoupled from the intervention gate to enable tunable and auditable control. On ProactiveBench, PRISM reduces false alarms by 22.78% and improves F1 by 20.14% over strong baselines. These results show that principled decision-theoretic gating, paired with selective slow reasoning and aligned distillation, yields proactive agents that are precise, computationally efficient, and controllable. To facilitate reproducibility, we release our code, models, and resources at https://prism-festinalente.github.io/; all experiments use the open-source ProactiveBench benchmark.
Curiosity Driven Knowledge Retrieval for Mobile Agents
Mobile agents have made progress toward reliable smartphone automation, yet performance in complex applications remains limited by incomplete knowledge and weak generalization to unseen environments. We introduce a curiosity driven knowledge retrieval framework that formalizes uncertainty during execution as a curiosity score. When this score exceeds a threshold, the system retrieves external information from documentation, code repositories, and historical trajectories. Retrieved content is organized into structured AppCards, which encode functional semantics, parameter conventions, interface mappings, and interaction patterns. During execution, an enhanced agent selectively integrates relevant AppCards into its reasoning process, thereby compensating for knowledge blind spots and improving planning reliability. Evaluation on the AndroidWorld benchmark shows consistent improvements across backbones, with an average gain of six percentage points and a new state of the art success rate of 88.8\% when combined with GPT-5. Analysis indicates that AppCards are particularly effective for multi step and cross application tasks, while improvements depend on the backbone model. Case studies further confirm that AppCards reduce ambiguity, shorten exploration, and support stable execution trajectories. Task trajectories are publicly available at https://lisalsj.github.io/Droidrun-appcard/.
SRU-Pix2Pix: A Fusion-Driven Generator Network for Medical Image Translation with Few-Shot Learning
Magnetic Resonance Imaging (MRI) provides detailed tissue information, but its clinical application is limited by long acquisition time, high cost, and restricted resolution. Image translation has recently gained attention as a strategy to address these limitations. Although Pix2Pix has been widely applied in medical image translation, its potential has not been fully explored. In this study, we propose an enhanced Pix2Pix framework that integrates Squeeze-and-Excitation Residual Networks (SEResNet) and U-Net++ to improve image generation quality and structural fidelity. SEResNet strengthens critical feature representation through channel attention, while U-Net++ enhances multi-scale feature fusion. A simplified PatchGAN discriminator further stabilizes training and refines local anatomical realism. Experimental results demonstrate that under few-shot conditions with fewer than 500 images, the proposed method achieves consistent structural fidelity and superior image quality across multiple intra-modality MRI translation tasks, showing strong generalization ability. These results suggest an effective extension of Pix2Pix for medical image translation.