S. Ostmeier
Publications
Symbal: Detecting Systematic Misalignments in Model-Generated Captions
Multimodal large language models (MLLMs) often introduce errors when generating image captions, resulting in misaligned image-text pairs. Our work focuses on a class of captioning errors that we refer to as systematic misalignments, where a recurring error in MLLM-generated captions is closely associated with the presence of a specific visual feature in the paired image. Given a vision-language dataset with MLLM-generated captions, our aim in this work is to detect such errors, a task we refer to as systematic misalignment detection. As our first key contribution, we present Symbal, which utilizes a structured, dual-stage setup with off-the-shelf foundation models to identify systematic misalignments and summarize results in natural language. As our second key contribution, we introduce SymbalBench, a benchmark designed to evaluate automated methods on our proposed task. SymbalBench consists of 1.7 million image-text pairs from two domains (natural and medical images), organized into 420 vision-language datasets with annotated systematic misalignments. Symbal exhibits strong performance on this benchmark, correctly identifying systematic misalignments in 63.8% of datasets, a nearly 4x improvement over the closest baseline. We supplement our evaluations on SymbalBench with real-world evaluations, showing that (1) Symbal can accurately surface systematic misalignments in captions generated by four MLLMs and (2) Symbal is a powerful tool for auditing off-the-shelf image-caption datasets. Ultimately, our novel task, method, and benchmark can aid users with auditing MLLM-generated captions and identifying critical errors, without requiring access to the underlying MLLM. Code is available at https://github.com/Stanford-AIMI/Symbal.
A Reasoning-Enabled Vision-Language Foundation Model for Chest X-ray Interpretation
Chest X-rays (CXRs) are among the most frequently performed imaging examinations worldwide, yet rising imaging volumes increase radiologist workload and the risk of diagnostic errors. Although artificial intelligence (AI) systems have shown promise for CXR interpretation, most generate only final predictions, without making explicit how visual evidence is translated into radiographic findings and diagnostic predictions. We present CheXOne, a reasoning-enabled vision-language model for CXR interpretation. CheXOne jointly generates diagnostic predictions and explicit, clinically grounded reasoning traces that connect visual evidence, radiographic findings, and these predictions. The model is trained on 14.7 million instruction and reasoning samples curated from 30 public datasets spanning 36 CXR interpretation tasks, using a two-stage framework that combines instruction tuning with reinforcement learning to improve reasoning quality. We evaluate CheXOne in zero-shot settings across visual question answering, report generation, visual grounding and reasoning assessment, covering 17 evaluation settings. CheXOne outperforms existing medical and general-domain foundation models and achieves strong performance on independent public benchmarks. A clinical reader study demonstrates that CheXOne-drafted reports are comparable to or better than resident-written reports in 55% of cases, while effectively addressing clinical indications and enhancing both report writing and CXR interpretation efficiency. Further analyses involving radiologists reveal that the generated reasoning traces show high clinical factuality and provide causal support for the final predictions, offering a plausible explanation for the performance gains. These results suggest that explicit reasoning can improve model performance, interpretability and clinical utility in AI-assisted CXR interpretation.