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A specialized reasoning large language model for accelerating rare disease diagnosis: a randomized AI physician assistance trial

Rare diseases affect millions of individuals worldwide, yet timely diagnosis remains a major public health challenge due to scarcity of specialized clinical expertise. While large language models (LLMs) show promise to support rare disease diagnosis, current models are constrained by insufficient clinical deployability, limited clinically grounded evidence, and scarcity of training data. Here we present RaDaR (Rare Disease navigatoR), an open-source, compact reasoning LLM (32B parameters) for rare disease diagnosis. RaDaR was trained with 49,170 publicly available free-text cases and 104,666 synthetic cases with reasoning-enhanced training. RaDaR showed the strongest performance among evaluated open-source models, including the 671B DeepSeek-R1, across public benchmarks and four external validation centers. In a retrospective cohort, RaDaR prioritized the final diagnosis before documented clinical suspicion in 61.06 percent of cases, corresponding to a potential lead time of 1.87 months and 50.18 percent of the within-center interval. In a randomized physician-assistance trial, RaDaR assistance improved physicians' rare-disease diagnostic accuracy by 21.44 percentage points compared with internet search alone. Synthetic-data ablations suggested that phenotype-anchored narratives provide useful training signal for long-tail rare diseases, with a monotonic scaling trend within the tested data range. Together, RaDaR and its development and validation framework provide a deployable rare-disease reasoning model and a reproducible development framework for diagnostic AI under data scarcity.

Timage: A Generative Text-in-Image Paradigm for Fine-Tuning Vision-Language Models

Multimodal Large Language Models (MLLMs) often lose track of the right image regions during fine-grained spatial reasoning, because a textual query rarely carries any explicit geometric anchor into the pixel domain. Prevailing remedies either rewire the model's weights or pad the prompt with verbose instructions, yet neither reliably pins the language to the correct visual coordinates without eroding the backbone's general competence. We introduce Timage, a paradigm that recasts multimodal understanding as an alignment problem solved at the input: the query is drawn, as a typeset overlay, onto the image itself. The placement and appearance of this overlay are produced by a Constrained Schrödinger Bridge (cSB), an entropic optimal-transport sampler that factorizes layout synthesis into two coupled stochastic stages. The first stage, Region Search, transports noise toward query-aligned image zones while obeying a hard occlusion barrier that protects salient foreground content; the second stage, Appearance Shaping, sizes the glyphs through an ``ink-budget'' regularizer so that the rendered text stays legible and visually balanced. The resulting overlay behaves as an explicit attention beacon that channels the model's focus along spatial semantics. On the VMCBench suite, Timage paired with a modest 7B backbone clearly overtakes far larger proprietary systems as well as parameter-tuned baselines. The study positions deliberate input reconstruction as a powerful, architecture-neutral lever for strengthening multimodal reasoning.

Understanding Cross-Sensor Feature Variations for Generalizable 3D Perception

Radar-camera BEV perception often suffers from degraded performance when evaluated across datasets, as changes in driving scenes, sensor configurations, and environmental conditions can alter both the input observations and the internal fused representations. This work studies this issue from the perspective of source-domain variation modeling, aiming to improve the robustness of BEV-based 3D detectors without relying on target-domain samples. We introduce a framework that characterizes visual scene variations in the frequency domain and uses them to synthesize diverse source-domain views. By comparing the resulting fused BEV representations, the framework further captures how image-level variations influence multi-modal BEV features. These variation patterns are then used to regularize the detector, encouraging the learned fusion space to remain stable under latent scene changes. The proposed method is applied only during training and leaves the inference pipeline unchanged. Experiments on cross-dataset radar-camera 3D detection between View-of-Delft and TJ4DRadSet demonstrate consistent improvements over multiple BEV fusion backbones, and the gains remain effective when a small amount of target-domain data is available.