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Jun 13

CheXGenBench: A Unified Benchmark For Fidelity, Privacy and Utility of Synthetic Chest Radiographs

We introduce CheXGenBench, a rigorous and multifaceted evaluation framework for synthetic chest radiograph generation that simultaneously assesses fidelity, privacy risks, and clinical utility across state-of-the-art text-to-image generative models. Despite rapid advancements in generative AI for real-world imagery, medical domain evaluations have been hindered by methodological inconsistencies, outdated architectural comparisons, and disconnected assessment criteria that rarely address the practical clinical value of synthetic samples. CheXGenBench overcomes these limitations through standardised data partitioning and a unified evaluation protocol comprising over 20 quantitative metrics that systematically analyse generation quality, potential privacy vulnerabilities, and downstream clinical applicability across 11 leading text-to-image architectures. Our results reveal critical inefficiencies in the existing evaluation protocols, particularly in assessing generative fidelity, leading to inconsistent and uninformative comparisons. Our framework establishes a standardised benchmark for the medical AI community, enabling objective and reproducible comparisons while facilitating seamless integration of both existing and future generative models. Additionally, we release a high-quality, synthetic dataset, SynthCheX-75K, comprising 75K radiographs generated by the top-performing model (Sana 0.6B) in our benchmark to support further research in this critical domain. Through CheXGenBench, we establish a new state-of-the-art and release our framework, models, and SynthCheX-75K dataset at https://raman1121.github.io/CheXGenBench/

CXReasonBench: A Benchmark for Evaluating Structured Diagnostic Reasoning in Chest X-rays

Recent progress in Large Vision-Language Models (LVLMs) has enabled promising applications in medical tasks, such as report generation and visual question answering. However, existing benchmarks focus mainly on the final diagnostic answer, offering limited insight into whether models engage in clinically meaningful reasoning. To address this, we present CheXStruct and CXReasonBench, a structured pipeline and benchmark built on the publicly available MIMIC-CXR-JPG dataset. CheXStruct automatically derives a sequence of intermediate reasoning steps directly from chest X-rays, such as segmenting anatomical regions, deriving anatomical landmarks and diagnostic measurements, computing diagnostic indices, and applying clinical thresholds. CXReasonBench leverages this pipeline to evaluate whether models can perform clinically valid reasoning steps and to what extent they can learn from structured guidance, enabling fine-grained and transparent assessment of diagnostic reasoning. The benchmark comprises 18,988 QA pairs across 12 diagnostic tasks and 1,200 cases, each paired with up to 4 visual inputs, and supports multi-path, multi-stage evaluation including visual grounding via anatomical region selection and diagnostic measurements. Even the strongest of 10 evaluated LVLMs struggle with structured reasoning and generalization, often failing to link abstract knowledge with anatomically grounded visual interpretation. The code is available at https://github.com/ttumyche/CXReasonBench

CheXagent: Towards a Foundation Model for Chest X-Ray Interpretation

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats

Since the release of the original CheXpert paper five years ago, CheXpert has become one of the most widely used and cited clinical AI datasets. The emergence of vision language models has sparked an increase in demands for sharing reports linked to CheXpert images, along with a growing interest among AI fairness researchers in obtaining demographic data. To address this, CheXpert Plus serves as a new collection of radiology data sources, made publicly available to enhance the scaling, performance, robustness, and fairness of models for all subsequent machine learning tasks in the field of radiology. CheXpert Plus is the largest text dataset publicly released in radiology, with a total of 36 million text tokens, including 13 million impression tokens. To the best of our knowledge, it represents the largest text de-identification effort in radiology, with almost 1 million PHI spans anonymized. It is only the second time that a large-scale English paired dataset has been released in radiology, thereby enabling, for the first time, cross-institution training at scale. All reports are paired with high-quality images in DICOM format, along with numerous image and patient metadata covering various clinical and socio-economic groups, as well as many pathology labels and RadGraph annotations. We hope this dataset will boost research for AI models that can further assist radiologists and help improve medical care. Data is available at the following URL: https://stanfordaimi.azurewebsites.net/datasets/5158c524-d3ab-4e02-96e9-6ee9efc110a1 Models are available at the following URL: https://github.com/Stanford-AIMI/chexpert-plus

BaxBench: Can LLMs Generate Correct and Secure Backends?

The automatic generation of programs has long been a fundamental challenge in computer science. Recent benchmarks have shown that large language models (LLMs) can effectively generate code at the function level, make code edits, and solve algorithmic coding tasks. However, to achieve full automation, LLMs should be able to generate production-quality, self-contained application modules. To evaluate the capabilities of LLMs in solving this challenge, we introduce BaxBench, a novel evaluation benchmark consisting of 392 tasks for the generation of backend applications. We focus on backends for three critical reasons: (i) they are practically relevant, building the core components of most modern web and cloud software, (ii) they are difficult to get right, requiring multiple functions and files to achieve the desired functionality, and (iii) they are security-critical, as they are exposed to untrusted third-parties, making secure solutions that prevent deployment-time attacks an imperative. BaxBench validates the functionality of the generated applications with comprehensive test cases, and assesses their security exposure by executing end-to-end exploits. Our experiments reveal key limitations of current LLMs in both functionality and security: (i) even the best model, OpenAI o1, achieves a mere 60% on code correctness; (ii) on average, we could successfully execute security exploits on more than half of the correct programs generated by each LLM; and (iii) in less popular backend frameworks, models further struggle to generate correct and secure applications. Progress on BaxBench signifies important steps towards autonomous and secure software development with LLMs.

LongGenBench: Long-context Generation Benchmark

Current long-context benchmarks primarily focus on retrieval-based tests, requiring Large Language Models (LLMs) to locate specific information within extensive input contexts, such as the needle-in-a-haystack (NIAH) benchmark. Long-context generation refers to the ability of a language model to generate coherent and contextually accurate text that spans across lengthy passages or documents. While recent studies show strong performance on NIAH and other retrieval-based long-context benchmarks, there is a significant lack of benchmarks for evaluating long-context generation capabilities. To bridge this gap and offer a comprehensive assessment, we introduce a synthetic benchmark, LongGenBench, which allows for flexible configurations of customized generation context lengths. LongGenBench advances beyond traditional benchmarks by redesigning the format of questions and necessitating that LLMs respond with a single, cohesive long-context answer. Upon extensive evaluation using LongGenBench, we observe that: (1) both API accessed and open source models exhibit performance degradation in long-context generation scenarios, ranging from 1.2% to 47.1%; (2) different series of LLMs exhibit varying trends of performance degradation, with the Gemini-1.5-Flash model showing the least degradation among API accessed models, and the Qwen2 series exhibiting the least degradation in LongGenBench among open source models.