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Beyond Visual Forensics: Auditing Multimodal Robustness for Synthetic Medical Image Detection

With the rapid adoption of generative AI, synthetic medical images pose growing risks, including diagnostic deception and insurance fraud. Although prior work has explored vision-language model (VLM)-based synthetic image detection, these evaluations typically consider images in isolation. In clinical practice, however, images are interpreted alongside structured records and metadata, and VLMs are increasingly deployed under joint image-record inputs. We uncover a previously underexamined multimodal vulnerability: when given both modalities, VLMs may overweight record context in authenticity judgments, such that the same image receives different predictions solely due to changes in its accompanying text. This raises concerns about robustness in real-world deployment. To systematically characterize this effect, we reformulate synthetic medical image detection as an audit of multimodal robustness at the image-record interface and introduce a paired benchmark that holds the image fixed while swapping controlled metadata variants. Across multiple imaging modalities, we evaluate diverse open-weight and frontier API VLMs and quantify how metadata alone shifts authenticity predictions. Our benchmark provides a standardized tool for assessing and improving multimodal robustness beyond image-only settings. The code is available at https://github.com/chiuhaohao/Beyond-Visual-Forensics.

Revealing Training Data Exposure in Vision Language Large Models via Parameter Gradients

Vision-Language Large Models (VLLMs) trained on massive crawled corpora raise pressing copyright and data-provenance concerns. These concerns are particularly acute in healthcare, where patient medical images paired with clinical reports demand rigorous privacy safeguards. However, existing training data detection methods either fail in cross-modal scenarios or rely on superficial output signals with insufficient discriminative power. We introduce GradAudit, a gradient-based auditing framework that examines internal optimization dynamics rather than treating VLLMs as black boxes. Our approach builds on a key observation: model parameters converge to regions where gradients on training samples become stable and well-aligned, whereas gradients on non-training samples remain noisy and inconsistent. By analyzing these gradient signatures, GradAudit achieves strong separability and detects genuine image-text associations learned during training, not merely individual modality membership. Empirically, across both medical and general-domain datasets, GradAudit substantially outperforms state-of-the-art baselines in both pretraining and fine-tuning VLLMs. In a case study employing copyrighted content, we show that existing training data detection methods not only underestimate the extent of unauthorized data usage, but that this underestimation becomes more pronounced as models become more recent and more advanced.