# CARES: A Comprehensive Benchmark of Trustworthiness in Medical Vision Language Models

arXiv: https://arxiv.org/abs/2406.06007 · HTML: https://mlsanity.com/paper/2406.06007/

## Key facts

- Cited by 64 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 58 of its 99 references that are in the map.
- First posted on arXiv 10 Jun 2024.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 58)

- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [MMMU: A Massive Multi-discipline Multimodal Understanding and Reasoning Benchmark for Expert AGI](https://mlsanity.com/paper/2311.16502/) (2023)
- [Evaluating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2305.10355/) (2023)
- [MME: A Comprehensive Evaluation Benchmark for Multimodal Large Language Models](https://mlsanity.com/paper/2306.13394/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [ShareGPT4V: Improving Large Multi-Modal Models with Better Captions](https://mlsanity.com/paper/2311.12793/) (2023)
- [SEED-Bench: Benchmarking Multimodal LLMs with Generative Comprehension](https://mlsanity.com/paper/2307.16125/) (2023)
- [Are We on the Right Way for Evaluating Large Vision-Language Models?](https://mlsanity.com/paper/2403.20330/) (2024)
- [BeaverTails: Towards Improved Safety Alignment of LLM via a Human-Preference Dataset](https://mlsanity.com/paper/2307.04657/) (2023)
- [Yi: Open Foundation Models by 01.AI](https://mlsanity.com/paper/2403.04652/) (2024)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [HallusionBench: An Advanced Diagnostic Suite for Entangled Language Hallucination and Visual Illusion in Large Vision-Language Models](https://mlsanity.com/paper/2310.14566/) (2023)
- [DecodingTrust: A Comprehensive Assessment of Trustworthiness in GPT Models](https://mlsanity.com/paper/2306.11698/) (2023)
- [Catastrophic Jailbreak of Open-source LLMs via Exploiting Generation](https://mlsanity.com/paper/2310.06987/) (2023)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Analyzing and Mitigating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2310.00754/) (2023)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [TrustLLM: Trustworthiness in Large Language Models](https://mlsanity.com/paper/2401.05561/) (2024)
- [Detecting and Preventing Hallucinations in Large Vision Language Models](https://mlsanity.com/paper/2308.06394/) (2023)
- [LVLM-eHub: A Comprehensive Evaluation Benchmark for Large Vision-Language Models](https://mlsanity.com/paper/2306.09265/) (2023)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Surgical Fine-Tuning Improves Adaptation to Distribution Shifts](https://mlsanity.com/paper/2210.11466/) (2022)
- [Aligning Modalities in Vision Large Language Models via Preference Fine-tuning](https://mlsanity.com/paper/2402.11411/) (2024)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)

## Built on by (most cited first, 30 of 64)

- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [MMed-RAG: Versatile Multimodal RAG System for Medical Vision Language Models](https://mlsanity.com/paper/2410.13085/) (2024)
- [A Survey of Attacks on Large Vision-Language Models: Resources, Advances, and Future Trends](https://mlsanity.com/paper/2407.07403/) (2024)
- [MDocAgent: A Multi-Modal Multi-Agent Framework for Document Understanding](https://mlsanity.com/paper/2503.13964/) (2025)
- [MMedAgent-RL: Optimizing Multi-Agent Collaboration for Multimodal Medical Reasoning](https://mlsanity.com/paper/2506.00555/) (2025)
- [QoQ-Med: Building Multimodal Clinical Foundation Models with Domain-Aware GRPO Training](https://mlsanity.com/paper/2506.00711/) (2025)
- [AutoTrust: Benchmarking Trustworthiness in Large Vision Language Models for Autonomous Driving](https://mlsanity.com/paper/2412.15206/) (2024)
- [MMIE: Massive Multimodal Interleaved Comprehension Benchmark for Large Vision-Language Models](https://mlsanity.com/paper/2410.10139/) (2024)
- [MediConfusion: Can you trust your AI radiologist? Probing the reliability of multimodal medical foundation models](https://mlsanity.com/paper/2409.15477/) (2024)
- [Scaling and Beyond: Advancing Spatial Reasoning in MLLMs Requires New Recipes](https://mlsanity.com/paper/2504.15037/) (2025)
- [MMedPO: Aligning Medical Vision-Language Models with Clinical-Aware Multimodal Preference Optimization](https://mlsanity.com/paper/2412.06141/) (2024)
- [Uni-Med: A Unified Medical Generalist Foundation Model For Multi-Task Learning Via Connector-MoE](https://mlsanity.com/paper/2409.17508/) (2024)
- [A Survey on Trustworthiness in Foundation Models for Medical Image Analysis](https://mlsanity.com/paper/2407.15851/) (2024)
- [Exploring Typographic Visual Prompts Injection Threats in Cross-Modality Generation Models](https://mlsanity.com/paper/2503.11519/) (2025)
- [Localizing Before Answering: A Hallucination Evaluation Benchmark for Grounded Medical Multimodal LLMs](https://mlsanity.com/paper/2505.00744/) (2025)
- [EndoBench: A Comprehensive Evaluation of Multi-Modal Large Language Models for Endoscopy Analysis](https://mlsanity.com/paper/2505.23601/) (2025)
- [TP-DRSeg: Improving Diabetic Retinopathy Lesion Segmentation with Explicit Text-Prompts Assisted SAM](https://mlsanity.com/paper/2406.15764/) (2024)
- [CLIMB: Data Foundations for Large Scale Multimodal Clinical Foundation Models](https://mlsanity.com/paper/2503.07667/) (2025)
- [MVTamperBench: Evaluating Robustness of Vision-Language Models](https://mlsanity.com/paper/2412.19794/) (2024)
- [Beyond the Hype: A dispassionate look at vision-language models in medical scenario](https://mlsanity.com/paper/2408.08704/) (2024)
- [Anyprefer: An Agentic Framework for Preference Data Synthesis](https://mlsanity.com/paper/2504.19276/) (2025)
- [CLINIC: Evaluating Multilingual Trustworthiness in Language Models for Healthcare](https://mlsanity.com/paper/2512.11437/) (2025)
- [A Multimodal Multi-Agent Framework for Radiology Report Generation](https://mlsanity.com/paper/2505.09787/) (2025)
- [CityLens: Evaluating Large Vision-Language Models for Urban Socioeconomic Sensing](https://mlsanity.com/paper/2506.00530/) (2025)
- [MedHallTune: An Instruction-Tuning Benchmark for Mitigating Medical Hallucination in Vision-Language Models](https://mlsanity.com/paper/2502.20780/) (2025)
- [Med-VCD: Mitigating Hallucination for Medical Large Vision Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2512.01922/) (2025)
- [MedPAIR: Measuring Physicians and AI Relevance Alignment in Medical Question Answering](https://mlsanity.com/paper/2505.24040/) (2025)
- [CBVLM: Training-free Explainable Concept-based Large Vision Language Models for Medical Image Classification](https://mlsanity.com/paper/2501.12266/) (2025)
- [Uncertainty-Driven Expert Control: Enhancing the Reliability of Medical Vision-Language Models](https://mlsanity.com/paper/2507.09209/) (2025)
- [X-Ray-CoT: Interpretable Chest X-ray Diagnosis with Vision-Language Models via Chain-of-Thought Reasoning](https://mlsanity.com/paper/2508.12455/) (2025)

## Abstract (arXiv)

Artificial intelligence has significantly impacted medical applications, particularly with the advent of Medical Large Vision Language Models (Med-LVLMs), sparking optimism for the future of automated and personalized healthcare. However, the trustworthiness of Med-LVLMs remains unverified, posing significant risks for future model deployment. In this paper, we introduce CARES and aim to comprehensively evaluate the Trustworthiness of Med-LVLMs across the medical domain. We assess the trustworthiness of Med-LVLMs across five dimensions, including trustfulness, fairness, safety, privacy, and robustness. CARES comprises about 41K question-answer pairs in both closed and open-ended formats, covering 16 medical image modalities and 27 anatomical regions. Our analysis reveals that the models consistently exhibit concerns regarding trustworthiness, often displaying factual inaccuracies and failing to maintain fairness across different demographic groups. Furthermore, they are vulnerable to attacks and demonstrate a lack of privacy awareness. We publicly release our benchmark and code in https://cares-ai.github.io/.