# MC-CXR: A Multi-Context Chest X-ray Benchmark for Context-Induced Disruption in Vision-Language Models

arXiv: https://arxiv.org/abs/2608.24118 · HTML: https://mlsanity.com/paper/2608.24118/

## 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 23 of its 41 references that are in the map.
- First posted on arXiv 25 Aug 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, 23 of 23)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Shortcut Learning in Deep Neural Networks](https://mlsanity.com/paper/2004.07780/) (2020)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Towards Understanding Sycophancy in Language Models](https://mlsanity.com/paper/2310.13548/) (2023)
- [Beyond Accuracy: Behavioral Testing of NLP models with CheckList](https://mlsanity.com/paper/2005.04118/) (2020)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Phi-4-Mini Technical Report: Compact yet Powerful Multimodal Language Models via Mixture-of-LoRAs](https://mlsanity.com/paper/2503.01743/) (2025)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Learning the Difference that Makes a Difference with Counterfactually-Augmented Data](https://mlsanity.com/paper/1909.12434/) (2019)
- [Making Retrieval-Augmented Language Models Robust to Irrelevant Context](https://mlsanity.com/paper/2310.01558/) (2023)
- [Generating Radiology Reports via Memory-driven Transformer](https://mlsanity.com/paper/2010.16056/) (2020)
- [Entity-Based Knowledge Conflicts in Question Answering](https://mlsanity.com/paper/2109.05052/) (2021)
- [Adaptive Chameleon or Stubborn Sloth: Revealing the Behavior of Large Language Models in Knowledge Conflicts](https://mlsanity.com/paper/2305.13300/) (2023)
- [Learning to Exploit Temporal Structure for Biomedical Vision-Language Processing](https://mlsanity.com/paper/2301.04558/) (2023)
- [TieNet: Text-Image Embedding Network for Common Thorax Disease Classification and Reporting in Chest X-rays](https://mlsanity.com/paper/1801.04334/) (2018)
- [Chest ImaGenome Dataset for Clinical Reasoning](https://mlsanity.com/paper/2108.00316/) (2021)
- [Retrieval-Augmented Generation with Conflicting Evidence](https://mlsanity.com/paper/2504.13079/) (2025)
- [FaithfulRAG: Fact-Level Conflict Modeling for Context-Faithful Retrieval-Augmented Generation](https://mlsanity.com/paper/2506.08938/) (2025)
- [ReXVQA: A Large-scale Visual Question Answering Benchmark for Generalist Chest X-ray Understanding](https://mlsanity.com/paper/2506.04353/) (2025)
- [Lunguage: A Benchmark for Structured and Sequential Chest X-ray Interpretation](https://mlsanity.com/paper/2505.21190/) (2025)
- [MI-CXR: A Benchmark for Longitudinal Reasoning over Multi-Interval Chest X-rays](https://mlsanity.com/paper/2605.15574/) (2026)

## Abstract (arXiv)

Vision-language models (VLMs) are increasingly used in clinical pipelines where a chest X-ray is interpreted alongside retrieved reports, preliminary notes, or prior imaging. Existing benchmarks measure whether models answer correctly in isolation, but not whether they preserve a correct image-only decision when plausible context conflicts with the image. We introduce Multi-Context Chest X-ray (MC-CXR), a benchmark of 240 cases expanded into 2,522 instances that isolates context-induced disruption through paired perturbation. Each case fixes the current image and target finding while presenting matched reliable and misleading context across text and prior CXR, with visual overlays where available. MC-CXR defines three task families and two paired metrics, the switch-to-wrong rate and the context-aligned error rate. We evaluate ten VLMs spanning open-source general, medical-domain, and closed-source systems. Image-only accuracy is necessary but insufficient. Mean switch rates range from 45.6-78.1% across misleading textual sources and 35.7-61.7% across misleading visual sources. Among switched predictions, 74.6% align with the misleading label for text versus 17.6% for visual context, a 57.0-point gap (95% CI 50.9-62.8). This text-visual asymmetry is observed under the standardized direct-answer protocol. The dataset is available on PhysioNet.