SMMILE

How subjects answered

• Claude 3.7 Sonnet correct

  This chest X-ray shows left lower lobe pneumonia with a small left pleural effusion. The findings include:

  1. Consolidation in the left lower lung field with air bronchograms
  2. Blunting of the left costophrenic angle consistent with a small pleural effusion
  3. Slight leftward mediastinal shift due to volume loss in the left lower lobe
  4. The right lung appears clear

  This pattern is consistent with left lower lobe pneumonia, which is an infection causing inflammatory consolidation of the lung parenchyma. The small pleural effusion is a common accompanying finding with pneumonia.

• Llama-3.3-70B-Instruct (text-only) correct

  To accurately determine a diagnosis, I would need more specific information regarding the patient's symptoms, medical history, and any relevant test results (e.g., imaging studies like X-rays or CT scans). However, based on the examples provided:

  1. Hydropneumothorax, right - This condition involves the presence of both air (pneumothorax) and fluid (pleural effusion) in the pleural space on the right side.
  2. Pneumothorax, right - This refers to air in the pleural space on the right side, which can lead to a lung collapse.
  3. Pleural effusion, right - This involves an accumulation of fluid in the pleural space on the right side.

  Without specific patient details or test …

• MedGemma-4B-Multimodal correct

  Based on the image, the diagnosis is left-sided pleural effusion. The significant opacity in the left hemithorax suggests fluid accumulation in the pleural space.

• Qwen2.5-VL-3B incorrect

  Pleural effusion, right

• Qwen2.5-VL-72B incorrect

  The chest X-ray shows signs of cardiomegaly (enlarged heart) and possible pulmonary edema, as indicated by the increased opacity in the lung fields. There may also be evidence of pleural effusion, particularly on the right side, given the blunting of the costophrenic angle and elevation of the hemidiaphragm.

  Key Observations:

  1. Cardiomegaly: The heart appears enlarged, occupying more than half of the thoracic cavity.
  2. Pulmonary Edema: There is increased interstitial and alveolar markings, suggesting fluid accumulation in the lungs.
  3. Possible Pleural Effusion: Blunting of the costophrenic angles and elevation of the hemidiaphragm suggest fluid accumulation in the …
• Qwen2.5-VL-7B incorrect

  Pleural effusion, left

How subjects answered

• Qwen2.5-VL-32B correct

  Small right pneumothorax

• Qwen2.5-VL-72B correct

  The X-ray image shows a chest radiograph with no obvious signs of major abnormalities such as pneumothorax, pleural effusion, or large masses. The lung fields appear relatively clear, and the heart size seems normal. However, there are some subtle areas of increased opacity in the lower lung fields, which could be indicative of mild interstitial changes or early stages of pulmonary fibrosis. It's important to note that a definitive diagnosis should be made by a qualified radiologist who can interpret the image in the context of the patient's clinical history and other diagnostic findings.

• LLaVA-NeXT-7B correct

  The X-ray shows a pneumothorax, which is a medical condition where air accumulates in the pleural space between the lungs and the chest wall. This can occur due to a variety of reasons, such as trauma, medical procedures, or certain medical conditions. The air in the pleural space can cause the lung to collapse, which can be life-threatening if not treated. The X-ray is a lateral chest X-ray, which is a type of X-ray that is taken from the side of the body.

• LLaVA-OneVision-7B incorrect

  Large right pneumothorax

• Qwen2.5-VL-3B incorrect

  Right-sided tension pneumothorax

• Qwen2.5-VL-7B incorrect

  Moderate left pneumothorax

How subjects answered

• Claude 3.7 Sonnet correct

  In this chest X-ray, there is atelectasis in the right middle lobe. The white arrows are pointing to the area of increased opacity with volume loss in the right mid-lung zone, which is characteristic of right middle lobe atelectasis. This appears as a wedge-shaped density extending from the hilum toward the right lateral chest wall.

• Llama-3.2-Vision-90B correct

  Left middle lobe

• LLaVA-v1.5-13B correct

  Right middle lobe

• Qwen2.5-VL-3B incorrect

  Right upper lobe

• Qwen2.5-VL-72B incorrect

  The atelectasis appears to be in the right lower lobe of the lung. The arrows on the image point to areas of increased opacity and blunting of the costophrenic angle, which are consistent with right lower lobe atelectasis.

• Qwen2.5-VL-7B incorrect

  Left lower lobe

How subjects answered

• MedVLM-R1 correct

  Yes, hyperdense left MCA

• LLaVA-OneVision-0.5B correct

  Yes, hyperdense right MCA

• LLaVA-NeXT-7B correct

  Yes, there is a visible pathology on the image. It appears to be a hyperdense left MCA, which is a type of stroke. The hyperdense area is the darker region on the left side of the brain, which is the middle cerebral artery (MCA) territory. This type of stroke is characterized by a dense, hyperdense area on the CT scan, which is the result of a blockage in the blood vessel.

• LLaVA-OneVision-7B incorrect

  Yes, hyperdense right MCA

• MedGemma-4B-Multimodal incorrect

  Yes, hyperdense right MCA

• Qwen2.5-VL-32B incorrect

  Yes, hyperdense right MCA

How subjects answered

• Llama-3.2-Vision-90B correct

  Type V

• GPT-4o correct

  Type VI

• LLaVA-OneVision-0.5B correct

  Type VI

• Qwen2.5-VL-3B incorrect

  Type III

• Qwen2.5-VL-72B incorrect

  The person in the image appears to have a skin tone that could be classified as Type IV or V on the Fitzpatrick scale. This classification indicates skin that tans easily and rarely burns, with moderate sensitivity to the sun. The exact type would depend on how the individual's skin reacts to sunlight, but based on the visible skin tone, it falls within this range.

• Qwen2.5-VL-7B incorrect

  Type III

How subjects answered

• Qwen2.5-VL-32B correct

  Sickle cells

• Qwen2.5-VL-72B correct

  The image shows a blood smear with several red blood cell (RBC) abnormalities that suggest the presence of schistocytes. Schistocytes are fragmented RBCs that can be seen as irregularly shaped, often crescent-shaped or triangular pieces of RBC membranes. These findings are typically associated with microangiopathic hemolytic anemia (MAHA), which can occur in conditions such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and other microangiopathies.

  Key features in the image:

  • Fragmented RBCs (schistocytes)
  • Irregular shapes and sizes of RBCs

  These characteristics point towards a pathology involving mechanical …

• MedGemma-4B-Multimodal correct

  Sickle cells

• LLaVA-NeXT-7B incorrect

  Sickle cells

• LLaVA-OneVision-7B incorrect

  Sickle cells

• Qwen2.5-VL-7B incorrect

  Sickle cells

How subjects answered

• Claude 3.7 Sonnet correct

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• GPT-4o correct

  Yes, the image shows a joint deformity consistent with Charcot's foot. Charcot's foot is a condition often associated with neuropathy, particularly in individuals with diabetes. It is characterized by the weakening of bones in the foot, which can lead to fractures and dislocations, resulting in a deformed appearance. The image shows a prominent arch and swelling, which are typical signs of this condition.

• Llama-3.2-Vision-90B correct

  Yes, Charcot´s foot, right.

• LLaVA-OneVision-0.5B incorrect

  No

• LLaVA-NeXT-7B incorrect

  Yes, the image shows a foot with Charcot's foot, which is a type of joint deformity. It is characterized by the collapse of the arch in the foot, often accompanied by dislocation of the joints. This condition can be caused by a variety of factors, including diabetes, alcoholism, and other systemic diseases.

• Qwen2.5-VL-72B incorrect

  No

How subjects answered

• MedVLM-R1 correct

  No. Pneumoperitoneum indicative of gastrointestinal perforation.

• Claude 3.7 Sonnet correct

  Yes, this chest X-ray appears normal. The lung fields are clear without evidence of pneumonia, pneumothorax, or effusion. The cardiac silhouette is of normal size and contour. The diaphragm is well-defined with normal costophrenic angles. The bony structures appear intact without obvious fractures. The mediastinum is not widened.

  Assuming the patient's clinical presentation is consistent with this normal radiographic finding (no concerning symptoms such as severe chest pain, respiratory distress, or hemodynamic instability), and vital signs are stable, it would be reasonable to discharge the patient home with appropriate follow-up instructions.

  However, it's important to note that …

• Llama-3.2-Vision-90B correct

  Yes, normal Chest X-ray.

• LLaVA-NeXT-7B incorrect

  No. Pneumoperitoneum indicative of gastrointestinal perforation.

• Qwen2.5-VL-3B incorrect

  No. Pneumoperitoneum indicative of gastrointestinal perforation.

• Qwen2.5-VL-72B incorrect

  No. Pneumoperitoneum indicative of gastrointestinal perforation.

How subjects answered

• MedVLM-R1 correct

  MRI of the brain without contrast

• Claude 3.7 Sonnet correct

  This is an MRI of the brain with contrast (T1-weighted with gadolinium). The image shows an axial (horizontal) cross-section through the brain at the level of the temporal lobes and orbits. The contrast enhancement allows for better visualization of blood vessels, tumors, inflammation, or breakdown of the blood-brain barrier. The bright areas in the image represent structures that have taken up the contrast agent.

• Llama-3.2-Vision-90B correct

  MRI of the brain with contrast

• Qwen2.5-VL-3B incorrect

  MRI of the brain with contrast

• Qwen2.5-VL-72B incorrect

  This is an MRI (Magnetic Resonance Imaging) scan of the brain. The image appears to be a T1-weighted axial view, which is commonly used to assess brain structures and detect abnormalities such as tumors, bleeding, or other pathologies. The contrast in the image helps differentiate between different types of tissues.

• Qwen2.5-VL-7B incorrect

  MRI of the brain with contrast

How subjects answered

• Claude 3.7 Sonnet correct

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• GPT-4o correct

  The histopathologic diagnosis is squamous cell carcinoma. The image shows keratin pearls and atypical squamous cells, which are characteristic features of this type of carcinoma.

• Llama-3.2-Vision-90B correct

  Squamous cell carcinoma.

• LLaVA-OneVision-7B incorrect

  Squamous cell carcinoma.

• Qwen2.5-VL-3B incorrect

  Squamous cell carcinoma.

• Qwen2.5-VL-7B incorrect

  Squamous cell carcinoma.

How subjects answered

• Claude 3.7 Sonnet correct

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• GPT-4o correct

  This ECG shows ventricular tachycardia. Several features suggest this diagnosis:

  1. Wide QRS Complexes: The QRS complexes are broad, which is typical of ventricular tachycardia. While supraventricular tachycardia with aberrancy can also present with wide QRS complexes, the morphology here is more consistent with VT.

  2. AV Dissociation: If present, AV dissociation is a hallmark of ventricular tachycardia. Although not clearly visible in this ECG, the absence of clear P waves suggests the possibility of AV dissociation.

  3. QRS Morphology: The morphology of the QRS complexes, particularly the presence of a monophasic or biphasic pattern, is more typical of VT.

  4. **Extreme Axis …

• Llama-3.3-70B-Instruct (text-only) correct

  Supraventricular tachycardia with aberrancy.

• LLaVA-OneVision-7B incorrect

  supraventricular tachycardia with aberrancy

• LLaVA-OneVision-0.5B incorrect

  supraventricular tachycardia with aberrancy

• Qwen2.5-VL-32B incorrect

  Ventricular Tachycardia (VT)

  Reasoning:

  1. Rhythm Analysis:

     • The rhythm is regular, which can be seen in both VT and supraventricular tachycardia (SVT) with aberrancy.
     • The heart rate appears to be rapid, consistent with tachycardia.

  2. QRS Complex Morphology:

     • The QRS complexes are wide (>120 ms), which is a hallmark of VT or SVT with aberrancy.
     • In this case, the QRS morphology is bizarre and irregular, suggesting multiple morphologies. This is more characteristic of VT rather than SVT with aberrancy, as SVT with aberrancy typically shows a consistent QRS morphology due to a single conduction pathway being affected.

  3. Axis Deviation:

     • The …

How subjects answered

• Claude 3.7 Sonnet correct

  Yes, bronchiectasis is present in this coronal CT image of the chest.

  The image shows several characteristic findings of bronchiectasis:

  1. Dilated bronchi that appear wider than their accompanying pulmonary vessels (the "signet ring" sign)
  2. Lack of normal bronchial tapering as they extend toward the periphery
  3. Visible bronchi in the peripheral third of the lung fields
  4. Thickened bronchial walls

  These findings are particularly evident in the lower lobes bilaterally. The bronchiectatic changes appear to be cylindrical/tubular in morphology. There also appears to be some volume loss in the lower lobes, which is a common finding in chronic bronchiectasis.

  This pattern is consistent …

• Llama-3.2-Vision-90B correct

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• LLaVA-v1.5-13B correct

  Yes

• LLaVA-NeXT-7B incorrect

  Yes, the image appears to show a chest X-ray with a pattern that could be indicative of bronchiectasis. Bronchiectasis is a condition where the airways in the lungs become damaged or enlarged, causing the air to flow through them more quickly than normal. This can lead to the buildup of mucus and bacteria, which can cause recurring infections. The pattern of the airways in the image looks dilated, which is a common characteristic of bronchiectasis. However, it's important to note that a definitive diagnosis would require a medical professional to review the image and consider other factors such as the patient's medical history and symptoms.

• MedGemma-4B-Multimodal incorrect

  Yes, bronchiectasis is present. The image shows dilated and thickened airways, which are characteristic features of bronchiectasis.

• Qwen2.5-VL-3B incorrect

  Yes