# MI-CXR: A Benchmark for Longitudinal Reasoning over Multi-Interval Chest X-rays

arXiv: https://arxiv.org/abs/2605.15574 · HTML: https://mlsanity.com/paper/2605.15574/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 34 of its 65 references that are in the map.
- First posted on arXiv 15 May 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 30 of 34)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [InternVL3.5: Advancing Open-Source Multimodal Models in Versatility, Reasoning, and Efficiency](https://mlsanity.com/paper/2508.18265/) (2025)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [DeepSeek-VL2: Mixture-of-Experts Vision-Language Models for Advanced Multimodal Understanding](https://mlsanity.com/paper/2412.10302/) (2024)
- [Large Language Models Are Not Robust Multiple Choice Selectors](https://mlsanity.com/paper/2309.03882/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats](https://mlsanity.com/paper/2405.19538/) (2024)
- [Evaluating Step-by-step Reasoning Traces: A Survey](https://mlsanity.com/paper/2502.12289/) (2025)
- [EHRXQA: A Multi-Modal Question Answering Dataset for Electronic Health Records with Chest X-ray Images](https://mlsanity.com/paper/2310.18652/) (2023)
- [Describing and Localizing Multiple Changes with Transformers](https://mlsanity.com/paper/2103.14146/) (2021)
- [HERGen: Elevating Radiology Report Generation with Longitudinal Data](https://mlsanity.com/paper/2407.15158/) (2024)
- [Libra: Leveraging Temporal Images for Biomedical Radiology Analysis](https://mlsanity.com/paper/2411.19378/) (2024)
- [CoMT: Chain-of-Medical-Thought Reduces Hallucination in Medical Report Generation](https://mlsanity.com/paper/2406.11451/) (2024)
- [ReXrank: A Public Leaderboard for AI-Powered Radiology Report Generation](https://mlsanity.com/paper/2411.15122/) (2024)
- [Anchored Answers: Unravelling Positional Bias in GPT-2's Multiple-Choice Questions](https://mlsanity.com/paper/2405.03205/) (2024)
- [Pretraining Vision-Language Model for Difference Visual Question Answering in Longitudinal Chest X-rays](https://mlsanity.com/paper/2402.08966/) (2024)
- [MMXU: A Multi-Modal and Multi-X-ray Understanding Dataset for Disease Progression](https://mlsanity.com/paper/2502.11651/) (2025)
- [PriorRG: Prior-Guided Contrastive Pre-training and Coarse-to-Fine Decoding for Chest X-ray Report Generation](https://mlsanity.com/paper/2508.05353/) (2025)
- [Lunguage: A Benchmark for Structured and Sequential Chest X-ray Interpretation](https://mlsanity.com/paper/2505.21190/) (2025)
- [CXReasonBench: A Benchmark for Evaluating Structured Diagnostic Reasoning in Chest X-rays](https://mlsanity.com/paper/2505.18087/) (2025)
- [MRGAgents: A Multi-Agent Framework for Improved Medical Report Generation with Med-LVLMs](https://mlsanity.com/paper/2505.18530/) (2025)

## Built on by (most cited first, 1 of 1)

- [MC-CXR: A Multi-Context Chest X-ray Benchmark for Context-Induced Disruption in Vision-Language Models](https://mlsanity.com/paper/2608.24118/) (2026)

## Abstract (arXiv)

Longitudinal chest X-ray (CXR) interpretation requires reasoning over disease evolution across multiple patient visits, yet most existing medical VQA benchmarks focus on single images or short-horizon image pairs. We introduce MI-CXR, a benchmark for standardized evaluation of Multi-Interval longitudinal reasoning over multi-visit CXR sequences, without requiring free-form report generation or additional clinical context. MI-CXR comprises five-way multiple-choice questions over five-visit patient timelines and instantiates three complementary task families: Temporal Event Localization, Interval-wise Change Reasoning, and Global Trajectory Summarization, which assess clinically grounded visual reasoning over time. Evaluating 14 state-of-the-art vision-language models (VLMs) shows low overall performance, with an average accuracy of 29.3%, only modestly above random guessing. Using stage-wise diagnostic probing, we find that models often produce locally plausible interval descriptions but fail to enforce temporal constraints or compose evidence into globally consistent decisions over the full timeline. These findings reveal key limitations of current VLMs and establish MI-CXR as a principled benchmark for longitudinal medical reasoning. The benchmark is available at https://github.com/AIDASLab/MI-CXR