# A Source-Grounded Framework for Constructing and Evaluating Progressive Multimodal Diagnostic Dialogues from Clinical Case Reports

arXiv: https://arxiv.org/abs/2608.22713 · HTML: https://mlsanity.com/paper/2608.22713/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 15 references that are in the map.
- First posted on arXiv 24 Aug 2026.

## Builds on (most cited first, 7 of 7)

- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (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)
- [Evaluating Step-by-step Reasoning Traces: A Survey](https://mlsanity.com/paper/2502.12289/) (2025)
- [LLMEval-Med: A Real-world Clinical Benchmark for Medical LLMs with Physician Validation](https://mlsanity.com/paper/2506.04078/) (2025)
- [Advancing Conversational Diagnostic AI with Multimodal Reasoning](https://mlsanity.com/paper/2505.04653/) (2025)
- [3MDBench: Medical Multimodal Multi-agent Dialogue Benchmark](https://mlsanity.com/paper/2504.13861/) (2025)

## Abstract (arXiv)

Clinical diagnosis requires progressive integration of patient history, physical examination, laboratory findings, medical images, and diagnostic-informative tests. However, most multimodal medical benchmarks evaluate fixed inputs or endpoint answers, while fully interactive diagnostic agents conflate evidence selection with evidence interpretation. We present a source-grounded framework to construct progressive multimodal diagnostic dialogues from case reports and an evaluation strategy for assessing MLLMs on final diagnosis, diagnostic reasoning, and image-finding interpretation. Evaluation on 24 internal medicine case reports showed that our framework can accurately convert case reports into reference dialogues, achieving a diagnosis F1 of 0.99 and a reasoning-quality score of 4.79 out of 5. Evaluation on two frontier MLLMs (o4-mini and Claude Haiku 4.5) achieved reasoning-quality scores of 2.75 and 2.50, respectively, with substantially lower diagnosis, reasoning, and image-finding F1 scores. The results demonstrate that fluent responses do not necessarily reflect evidence-grounded clinical reasoning and highlight the utility of the proposed framework for evaluating multimodal diagnostic reasoning.