# Assessing VLM Reliability for Medical Image Quality Evaluation Under Corruption and Bias

arXiv: https://arxiv.org/abs/2607.01973 · HTML: https://mlsanity.com/paper/2607.01973/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 16 of its 26 references that are in the map.
- First posted on arXiv 2 Jul 2026.

## Placed in

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

## Builds on (most cited first, 16 of 16)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [InternVL3.5: Advancing Open-Source Multimodal Models in Versatility, Reasoning, and Efficiency](https://mlsanity.com/paper/2508.18265/) (2025)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [Justice or Prejudice? Quantifying Biases in LLM-as-a-Judge](https://mlsanity.com/paper/2410.02736/) (2024)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [Vision-Language Models for Medical Report Generation and Visual Question Answering: A Review](https://mlsanity.com/paper/2403.02469/) (2024)
- [Exploring the Frontier of Vision-Language Models: A Survey of Current Methodologies and Future Directions](https://mlsanity.com/paper/2404.07214/) (2024)
- [Interpreting the linear structure of vision-language model embedding spaces](https://mlsanity.com/paper/2504.11695/) (2025)
- [A Survey on Efficient Vision-Language Models](https://mlsanity.com/paper/2504.09724/) (2025)
- [A comprehensive and easy-to-use multi-domain multi-task medical imaging meta-dataset](https://mlsanity.com/paper/2404.16000/) (2024)
- [A General Framework for Producing Interpretable Semantic Text Embeddings](https://mlsanity.com/paper/2410.03435/) (2024)
- [On the Robustness of Medical Vision-Language Models: Are they Truly Generalizable?](https://mlsanity.com/paper/2505.15425/) (2025)
- [MedQ-Bench: Evaluating and Exploring Medical Image Quality Assessment Abilities in MLLMs](https://mlsanity.com/paper/2510.01691/) (2025)

## Abstract (arXiv)

Vision-Language Models (VLMs) are increasingly applied in medical tasks such as pathology description, report generation, and visual question answering. Medical Image Quality Assessment (MIQA) supports diagnostic accuracy and patient safety by determining whether images meet the standards required for clinical decision-making. Automating MIQA with VLMs may reduce workload, but their behavior under real-world conditions, where images may be degraded or textual context may affect judgments, should be further explored before deployment. We benchmark VLMs on medical image quality using the MediMeta-C dataset zero-shot across seven corruption types and five severity levels. We evaluate sensitivity to degradation patterns, the effect of corruptions on embedding geometry, and whether textual attributes (demographics, expertise, infrastructure, institution) alter scores. Across 16 VLMs and seven modalities, pixelation produced the largest score reductions (mean -20.58%, up to -34.4% for OCT), whereas brightness had limited effect (-0.81%). Embedding displacement was associated with score changes. Same-family models showed correlations of 0.67-0.83; some produced increases up to +31% for corrupted mammography. Textual attributes affected scores: institutional prestige raised them +17.15%, and equipment age lowered them -14.7%. The largest changes were +95.62% (InternVL-8B) and -37.7% (MedGemma). Current VLMs show limitations for medical image quality assessment. Pixelation, a privacy-preserving transformation, reduces performance, indicating a trade-off between patient privacy and reliability. Sensitivity to contextual metadata indicates limited objectivity and marks metadata as a privacy and bias source. Privacy protection and objective quality assessment are related requirements for use.