Gelei Xu
Publications
Beyond Visual Forensics: Auditing Multimodal Robustness for Synthetic Medical Image Detection
With the rapid adoption of generative AI, synthetic medical images pose growing risks, including diagnostic deception and insurance fraud. Although prior work has explored vision-language model (VLM)-based synthetic image detection, these evaluations typically consider images in isolation. In clinical practice, however, images are interpreted alongside structured records and metadata, and VLMs are increasingly deployed under joint image-record inputs. We uncover a previously underexamined multimodal vulnerability: when given both modalities, VLMs may overweight record context in authenticity judgments, such that the same image receives different predictions solely due to changes in its accompanying text. This raises concerns about robustness in real-world deployment. To systematically characterize this effect, we reformulate synthetic medical image detection as an audit of multimodal robustness at the image-record interface and introduce a paired benchmark that holds the image fixed while swapping controlled metadata variants. Across multiple imaging modalities, we evaluate diverse open-weight and frontier API VLMs and quantify how metadata alone shifts authenticity predictions. Our benchmark provides a standardized tool for assessing and improving multimodal robustness beyond image-only settings. The code is available at https://github.com/chiuhaohao/Beyond-Visual-Forensics.
How Coding Agents Fail Their Users: A Large-Scale Analysis of Developer-Agent Misalignment in 20,574 Real-World Sessions
AI coding agents increasingly act directly within software environments, yet existing analyses of their failures rely on benchmark trajectories that miss how developers actually experience misalignment. We present an observational study of 20,574 coding-agent sessions from 1,639 repositories across IDE and CLI workflows. We operationalize misalignment as a breakdown made visible through developer pushback, and annotate each episode along four axes: form, cause, cost, and resolution. We identify seven recurring forms, spanning how agents read projects, interpret developer intent, follow rules, bound their actions, implement and execute code, and report progress. 90.50\% of episodes impose effort and trust costs rather than irreversible system damage, yet 91.49\% of visible resolutions still require explicit user correction. Misalignment patterns also differ across IDE and CLI settings, persist across adjacent sessions, and shift over time: while overall rates decline, constraint violations and inaccurate self-reporting grow in share. Our findings inform the design of training, evaluation, and interfaces for keeping coding agents aligned with real developer workflows.
An Empirical Study of Agent Skills for Healthcare: Practice, Gaps, and Governance
Healthcare automation is shaped by local procedures and organizational constraints, so agent capabilities rarely transfer unchanged across settings. Agent skills, self-contained directories that package reusable procedures for AI agents, are emerging as a procedural layer for adapting healthcare agents across diverse healthcare settings. We present the first empirical analysis of healthcare agent skills, drawing on 557 healthcare-related skills filtered from 58,159 public skills on ClawHub and annotated along ten dimensions covering function, deployment context, autonomy, and safety. We find that public healthcare skills emphasize patient-facing workflow automation and monitoring rather than the diagnostic and treatment-oriented tasks foregrounded in healthcare-agent research; coverage of the healthcare lifecycle and specialized clinical inputs remains uneven; and general technical risk does not reliably capture clinical risk. These findings position healthcare skills as a procedural layer not yet addressed by current benchmarks and risk frameworks.