# CRS-Bench: A Reference-Relative Reliability Benchmark for Medical Image Encoders

arXiv: https://arxiv.org/abs/2608.22059 · HTML: https://mlsanity.com/paper/2608.22059/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 23 of its 34 references that are in the map.
- First posted on arXiv 22 Aug 2026.

## Builds on (most cited first, 23 of 23)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Sigmoid Loss for Language Image Pre-Training](https://mlsanity.com/paper/2303.15343/) (2023)
- [Benchmarking Neural Network Robustness to Common Corruptions and Perturbations](https://mlsanity.com/paper/1903.12261/) (2019)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [A Large-scale Study of Representation Learning with the Visual Task Adaptation Benchmark](https://mlsanity.com/paper/1910.04867/) (2019)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [Causality matters in medical imaging](https://mlsanity.com/paper/1912.08142/) (2019)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [ELEVATER: A Benchmark and Toolkit for Evaluating Language-Augmented Visual Models](https://mlsanity.com/paper/2204.08790/) (2022)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [A Multimodal Vision Foundation Model for Clinical Dermatology](https://mlsanity.com/paper/2410.15038/) (2024)
- [FairMedFM: Fairness Benchmarking for Medical Imaging Foundation Models](https://mlsanity.com/paper/2407.00983/) (2024)
- [A Large-scale Medical Visual Task Adaptation Benchmark](https://mlsanity.com/paper/2404.12876/) (2024)

## Abstract (arXiv)

Pretrained image encoders are central to medical image classification, where expert annotation is costly and task-specific cohorts are often limited. As the model space expands from general-purpose to broad-medical and specialty-specific encoders, selecting the representation becomes a substantive modeling decision. Clean-test discrimination alone is insufficient for this purpose: encoders with similar AUROC can differ in calibration, label efficiency, and stability under acquisition perturbations or distribution shift. We introduce CRS-Bench, a controlled benchmark for multi-objective medical encoder selection. CRS-Bench evaluates 15 pretrained encoder families across dermatology, ophthalmology, and radiology using ISIC 2019, APTOS 2019, and CheXpert, with CheXpert-to-MIMIC-CXR as an observed institutional shift, yielding 17,575 controlled run records and 3,515 seed-aggregated metric rows. Each encoder is characterized along four operational reliability dimensions: discrimination, calibration, label efficiency, and robustness. We summarize these dimensions using the Clinical Reliability Score (CRS), a Pareto-aware, reference-relative score combining dominance, profile balance, and worst-axis performance. AUROC and CRS are positively associated but not decision-equivalent: 21 of 105 pairwise orderings reverse, with a mean absolute rank displacement of 1.87. Paired-seed bootstrap analysis identifies PanDerm, MedSigLIP, and MedGemma as a stable leading reliability tier rather than a statistically resolved single leader. CRS-Bench provides a controlled framework for selecting medical image encoders from multi-axis reliability profiles rather than clean-test AUROC alone.