# ModaLens: Measuring Image Sensitivity in Report-Conditioned Medical VLMs

arXiv: https://arxiv.org/abs/2609.15635 · HTML: https://mlsanity.com/paper/2609.15635/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 24 of its 33 references that are in the map.
- First posted on arXiv 14 Sep 2026.

## Builds on (most cited first, 24 of 24)

- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Locating and Editing Factual Associations in GPT](https://mlsanity.com/paper/2202.05262/) (2022)
- [Making the V in VQA Matter: Elevating the Role of Image Understanding in Visual Question Answering](https://mlsanity.com/paper/1612.00837/) (2016)
- [Gemma 3 Technical Report](https://mlsanity.com/paper/2503.19786/) (2025)
- [Evaluating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2305.10355/) (2023)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Understanding intermediate layers using linear classifier probes](https://mlsanity.com/paper/1610.01644/) (2016)
- [Inference-Time Intervention: Eliciting Truthful Answers from a Language Model](https://mlsanity.com/paper/2306.03341/) (2023)
- [Steering Llama 2 via Contrastive Activation Addition](https://mlsanity.com/paper/2312.06681/) (2023)
- [Steering Language Models With Activation Engineering](https://mlsanity.com/paper/2308.10248/) (2023)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [Eyes Wide Shut? Exploring the Visual Shortcomings of Multimodal LLMs](https://mlsanity.com/paper/2401.06209/) (2024)
- [The Geometry of Truth: Emergent Linear Structure in Large Language Model Representations of True/False Datasets](https://mlsanity.com/paper/2310.06824/) (2023)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [Object Hallucination in Image Captioning](https://mlsanity.com/paper/1809.02156/) (2018)
- [Eliciting Latent Predictions from Transformers with the Tuned Lens](https://mlsanity.com/paper/2303.08112/) (2023)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [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)
- [Don't Just Assume; Look and Answer: Overcoming Priors for Visual Question Answering](https://mlsanity.com/paper/1712.00377/) (2017)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [TorchXRayVision: A library of chest X-ray datasets and models](https://mlsanity.com/paper/2111.00595/) (2021)
- [Vision-language models for chest radiography do not always need the image](https://mlsanity.com/paper/2606.17710/) (2026)
- [Loud or Silent? A Reusable Framework for Per-Modality Failure Analysis in Multimodal Clinical AI](https://mlsanity.com/paper/2608.01462/) (2026)

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

- [Unmentioned Checklist Findings Change How Reinforcement Learning Appears to Improve Chest Radiograph Report Checking](https://mlsanity.com/paper/2610.05425/) (2026)

## Abstract (arXiv)

A radiology report can already answer a clinical question, so it is hard to tell whether a vision-language model also uses the image. ModaLens, a paired image-swap audit, measures how report availability changes image sensitivity: MedGemma-27B on 3,199 paired MIMIC-CXR cases from 293 patients, all 14 questions per case (13 finding-specific and one composite), each image replaced by one from another study, usually of the same patient, with question and report fixed. Under an explicit answer instruction, the model's generated answer changes on 4.26 percent of trials with the report and 20.94 percent without it, a paired increase of 16.7 points (patient-clustered 95 percent CI 15.6 to 17.7), so report availability reduces image-swap sensitivity under this protocol; the original prompt with a lowercase first-token readout gives 4.70 percent against 17.07 percent, and substitutions also move continuous answer scores where the binary prediction does not change. The labels are derived from reports, which limits conclusions about visual correctness; the direction replicates in two further model lineages. Code, the exact prompts and a run record for every number are at https://github.com/criticaldata/MODALENS.