{"id":"https://openalex.org/W7204446176","doi":"https://doi.org/10.64898/2026.08.21.26360755","title":"Expert-Guided Visual Correction for Characterizing Diagnostic Performance and Error Patterns of Multimodal Large Language Models Using Periodontal In-Service Examination Images","display_name":"Expert-Guided Visual Correction for Characterizing Diagnostic Performance and Error Patterns of Multimodal Large Language Models Using Periodontal In-Service Examination Images","publication_year":2026,"publication_date":"2026-08-27","ids":{"openalex":"https://openalex.org/W7204446176","doi":"https://doi.org/10.64898/2026.08.21.26360755"},"language":"en","primary_location":{"id":"doi:10.64898/2026.08.21.26360755","doi":"https://doi.org/10.64898/2026.08.21.26360755","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.21.26360755","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/27/2026.08.21.26360755.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/27/2026.08.21.26360755.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5028060326","display_name":"Prita Abhay Dhaimade","orcid":"https://orcid.org/0000-0002-6037-0260","observed_orcids":["https://orcid.org/0000-0002-6037-0260"]},"institutions":[{"id":"https://openalex.org/I186335123","display_name":"East Carolina University","ror":"https://ror.org/01vx35703","country_code":"US","type":"education","lineage":["https://openalex.org/I186335123"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Prita Abhay Dhaimade","raw_affiliation_strings":["Clinical Assistant Professor Division of Periodontology Department of Surgical Sciences School of Dental Medicine East Carolina University Greenville, North Carolina, USA"],"raw_orcid":"https://orcid.org/0000-0002-6037-0260","affiliations":[{"raw_affiliation_string":"Clinical Assistant Professor Division of Periodontology Department of Surgical Sciences School of Dental Medicine East Carolina University Greenville, North Carolina, USA","institution_ids":["https://openalex.org/I186335123"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5064338439","display_name":"Robin Henderson","orcid":"https://orcid.org/0009-0002-1688-1626","observed_orcids":["https://orcid.org/0009-0002-1688-1626"]},"institutions":[{"id":"https://openalex.org/I49332381","display_name":"University of Oklahoma Health Sciences Center","ror":"https://ror.org/0457zbj98","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I49332381"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Robin Henderson","raw_affiliation_strings":["Associate Professor Division of Periodontics College of Dentistry University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Associate Professor Division of Periodontics College of Dentistry University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA","institution_ids":["https://openalex.org/I49332381"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5028060326"],"corresponding_institution_ids":["https://openalex.org/I186335123"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9940999746322632,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9940999746322632,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11714","display_name":"Multimodal Machine Learning Applications","score":0.0027000000700354576,"subfield":{"id":"https://openalex.org/subfields/1707","display_name":"Computer Vision and Pattern Recognition"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T11363","display_name":"Dental Radiography and Imaging","score":0.0010000000474974513,"subfield":{"id":"https://openalex.org/subfields/3504","display_name":"Oral Surgery"},"field":{"id":"https://openalex.org/fields/35","display_name":"Dentistry"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/multimodal-large-language-models","display_name":"multimodal large language models","score":0.9990000128746033},{"id":"https://openalex.org/keywords/periodontal-disease-diagnosis","display_name":"periodontal diagnosis","score":0.8999999761581421},{"id":"https://openalex.org/keywords/diagnostic-error-analysis","display_name":"diagnostic error analysis","score":0.4699999988079071},{"id":"https://openalex.org/keywords/vision-correction","display_name":"vision correction","score":0.6349999904632568},{"id":"https://openalex.org/keywords/perceptual-errors","display_name":"perceptual errors","score":0.8730000257492065},{"id":"https://openalex.org/keywords/cognitive-errors","display_name":"cognitive errors","score":0.9829999804496765},{"id":"https://openalex.org/keywords/ai-diagnostic-accuracy","display_name":"AI diagnostic accuracy","score":0.3930000066757202},{"id":"https://openalex.org/keywords/histopathological-images","display_name":"histopathological images","score":0.7639999985694885},{"id":"https://openalex.org/keywords/clinical-images","display_name":"clinical photographs","score":0.7239999771118164},{"id":"https://openalex.org/keywords/ai-benchmarking","display_name":"AI benchmarking","score":0.5130000114440918},{"id":"https://openalex.org/keywords/clinical-reasoning","display_name":"clinical reasoning","score":0.3840000033378601},{"id":"https://openalex.org/keywords/dental-education","display_name":"dental education","score":0.640999972820282}],"concepts":[{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.6635000109672546},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.578499972820282},{"id":"https://openalex.org/C2781067378","wikidata":"https://www.wikidata.org/wiki/Q17027399","display_name":"Interpretability","level":2,"score":0.5600000023841858},{"id":"https://openalex.org/C144374066","wikidata":"https://www.wikidata.org/wiki/Q938196","display_name":"Periodontology","level":2,"score":0.5587999820709229},{"id":"https://openalex.org/C43214815","wikidata":"https://www.wikidata.org/wiki/Q7310987","display_name":"Reliability (semiconductor)","level":3,"score":0.4440000057220459},{"id":"https://openalex.org/C26760741","wikidata":"https://www.wikidata.org/wiki/Q160402","display_name":"Perception","level":2,"score":0.42289999127388},{"id":"https://openalex.org/C2776401178","wikidata":"https://www.wikidata.org/wiki/Q12050496","display_name":"Feature (linguistics)","level":2,"score":0.40860000252723694},{"id":"https://openalex.org/C169900460","wikidata":"https://www.wikidata.org/wiki/Q2200417","display_name":"Cognition","level":2,"score":0.4018000066280365},{"id":"https://openalex.org/C204321447","wikidata":"https://www.wikidata.org/wiki/Q30642","display_name":"Natural language processing","level":1,"score":0.40139999985694885},{"id":"https://openalex.org/C153180895","wikidata":"https://www.wikidata.org/wiki/Q7148389","display_name":"Pattern recognition (psychology)","level":2,"score":0.3912000060081482},{"id":"https://openalex.org/C178253425","wikidata":"https://www.wikidata.org/wiki/Q162668","display_name":"Visual perception","level":3,"score":0.38260000944137573},{"id":"https://openalex.org/C103088060","wikidata":"https://www.wikidata.org/wiki/Q1062839","display_name":"Error detection and correction","level":2,"score":0.3763999938964844},{"id":"https://openalex.org/C16345878","wikidata":"https://www.wikidata.org/wiki/Q107472979","display_name":"Orientation (vector space)","level":2,"score":0.3682999908924103},{"id":"https://openalex.org/C36464697","wikidata":"https://www.wikidata.org/wiki/Q451553","display_name":"Visualization","level":2,"score":0.35989999771118164},{"id":"https://openalex.org/C170130773","wikidata":"https://www.wikidata.org/wiki/Q216378","display_name":"Usability","level":2,"score":0.3472999930381775},{"id":"https://openalex.org/C2909411463","wikidata":"https://www.wikidata.org/wiki/Q938196","display_name":"Periodontist","level":2,"score":0.3075999915599823},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.3046000003814697},{"id":"https://openalex.org/C31972630","wikidata":"https://www.wikidata.org/wiki/Q844240","display_name":"Computer vision","level":1,"score":0.28859999775886536},{"id":"https://openalex.org/C27158222","wikidata":"https://www.wikidata.org/wiki/Q5532422","display_name":"Generalizability theory","level":2,"score":0.2863999903202057},{"id":"https://openalex.org/C146849305","wikidata":"https://www.wikidata.org/wiki/Q370766","display_name":"Ground truth","level":2,"score":0.2833999991416931},{"id":"https://openalex.org/C3020132585","wikidata":"https://www.wikidata.org/wiki/Q2671652","display_name":"Diagnostic accuracy","level":2,"score":0.28060001134872437},{"id":"https://openalex.org/C31601959","wikidata":"https://www.wikidata.org/wiki/Q931309","display_name":"Medical imaging","level":2,"score":0.2786000072956085},{"id":"https://openalex.org/C66024118","wikidata":"https://www.wikidata.org/wiki/Q1122506","display_name":"Computational model","level":2,"score":0.2768999934196472},{"id":"https://openalex.org/C111370547","wikidata":"https://www.wikidata.org/wiki/Q7451120","display_name":"Sensory cue","level":2,"score":0.2754000127315521},{"id":"https://openalex.org/C115961682","wikidata":"https://www.wikidata.org/wiki/Q860623","display_name":"Image (mathematics)","level":2,"score":0.26579999923706055},{"id":"https://openalex.org/C2777601683","wikidata":"https://www.wikidata.org/wiki/Q6499736","display_name":"Vocabulary","level":2,"score":0.25279998779296875}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.08.21.26360755","doi":"https://doi.org/10.64898/2026.08.21.26360755","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.21.26360755","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/27/2026.08.21.26360755.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.08.21.26360755","doi":"https://doi.org/10.64898/2026.08.21.26360755","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.21.26360755","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/08/27/2026.08.21.26360755.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":0.428600013256073,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7204446176.pdf","grobid_xml":"https://content.openalex.org/works/W7204446176.grobid-xml"},"referenced_works_count":33,"referenced_works":["https://openalex.org/W2033266691","https://openalex.org/W2143428226","https://openalex.org/W2901466771","https://openalex.org/W4390919701","https://openalex.org/W4391620736","https://openalex.org/W4392120599","https://openalex.org/W4399295615","https://openalex.org/W4400838583","https://openalex.org/W4400921803","https://openalex.org/W4402155831","https://openalex.org/W4402582321","https://openalex.org/W4404356490","https://openalex.org/W4405596328","https://openalex.org/W4405673884","https://openalex.org/W4406302098","https://openalex.org/W4408866688","https://openalex.org/W4408968357","https://openalex.org/W4409283601","https://openalex.org/W4409480408","https://openalex.org/W4410344546","https://openalex.org/W4411079791","https://openalex.org/W4411422294","https://openalex.org/W4413312755","https://openalex.org/W4414142358","https://openalex.org/W4414248865","https://openalex.org/W4414448155","https://openalex.org/W4414984189","https://openalex.org/W7124142608","https://openalex.org/W7125774901","https://openalex.org/W7128508677","https://openalex.org/W7139953235","https://openalex.org/W7141770846","https://openalex.org/W7160633353"],"related_works":["https://openalex.org/W7165926307","https://openalex.org/W7207758400","https://openalex.org/W7155080817","https://openalex.org/W7163889640","https://openalex.org/W7149974363","https://openalex.org/W7117785196","https://openalex.org/W7161024458","https://openalex.org/W7160233929","https://openalex.org/W7165741016","https://openalex.org/W7155095356"],"abstract_inverted_index":{"Abstract":[0],"Multimodal":[1],"large":[2],"language":[3],"models":[4,107,216,275],"(MLLMs)":[5],"are":[6],"increasingly":[7,359],"applied":[8,101],"to":[9,103,116,124,289,338,348,361],"image-based":[10,51],"clinical":[11,64,253,377],"reasoning,":[12,163],"yet":[13],"their":[14,26],"diagnostic":[15,119,162,228,323,342,352],"reliability":[16],"in":[17,81,98,224,354],"periodontal":[18],"image":[19,132,218,283,324],"interpretation,":[20],"and":[21,46,71,93,114,140,190,193,200,209,217,304,307,364,382,387],"the":[22,56,246],"underlying":[23],"source":[24],"of":[25,59,161,233,242,248,259,271],"errors,":[27,166,175],"remain":[28],"poorly":[29],"characterized.":[30],"This":[31],"study":[32],"evaluated":[33],"six":[34],"architecturally":[35],"distinct":[36,257,301],"MLLMs":[37,315,357],"(Claude":[38],"Sonnet":[39],"4.5,":[40],"GPT-5.0,":[41],"Gemini":[42],"2.5,":[43],"GLM-4.6,":[44],"Sonar,":[45],"Grok":[47],"4.1)":[48],"using":[49,152],"50":[50],"multiple-choice":[52],"questions":[53,104],"drawn":[54],"from":[55,158,168,173,177,369],"American":[57],"Academy":[58],"Periodontology":[60],"In-Service":[61],"Examination,":[62],"spanning":[63],"photographs,":[65],"histopathology,":[66],"radiographs,":[67],"cardiac":[68],"rhythm":[69],"strips,":[70],"anatomical":[72],"illustrations.":[73],"A":[74],"sequential":[75],"two-phase":[76],"experimental":[77],"design":[78],"was":[79,134],"used:":[80],"Phase":[82,99,225],"1,":[83],"each":[84,88],"model":[85,160,380],"independently":[86,141],"described":[87],"image,":[89],"selected":[90],"an":[91,110],"answer,":[92],"provided":[94],"a":[95,137,144,153,231,239,256,334],"supporting":[96],"citation;":[97],"2,":[100],"only":[102],"answered":[105],"incorrectly,":[106],"were":[108,150],"given":[109],"expert-validated":[111],"visual":[112,122,170,222,249,265,328],"description":[113],"asked":[115],"re-answer,":[117],"allowing":[118],"improvement":[120],"through":[121],"correction":[123,329],"be":[125,317],"measured":[126],"directly.":[127],"Expert":[128],"ground":[129],"truth":[130],"for":[131,230,313,322,374],"content":[133],"established":[135],"by":[136,143],"board-certified":[138,146],"periodontist":[139],"validated":[142],"second":[145],"periodontist.":[147],"Model":[148],"outputs":[149],"classified":[151],"dual-process":[154],"error":[155,210],"taxonomy":[156],"adapted":[157],"Norman\u2019s":[159],"distinguishing":[164,367],"perceptual":[165,272,290,306,368],"arising":[167,176],"inaccurate":[169,205,221,282],"feature":[171],"extraction,":[172],"cognitive":[174,184,308,370],"flawed":[178],"reasoning":[179,202,287],"despite":[180,262,280],"accurate":[181,263],"perception,":[182],"with":[183],"errors":[185,243,260,309],"further":[186],"subdivided":[187],"into":[188],"correctable":[189],"persistent":[191],"subtypes,":[192],"additional":[194],"categories":[195],"capturing":[196],"compound":[197],"perceptual-cognitive":[198],"failures":[199,269],"compensatory":[201,286],"that":[203,238,295,305,344],"overcame":[204],"perception.":[206],"Diagnostic":[207],"accuracy":[208,229,297],"type":[211],"distribution":[212],"varied":[213],"significantly":[214],"across":[215],"modality.":[219],"Correcting":[220],"descriptions":[223],"2":[226],"improved":[227,321],"subset":[232,258],"previously":[234],"incorrect":[235],"responses,":[236],"indicating":[237,267],"meaningful":[240],"share":[241],"originated":[244],"at":[245],"level":[247],"perception":[250],"rather":[251],"than":[252],"reasoning;":[254],"conversely,":[255],"persisted":[261],"corrected":[264],"input,":[266],"reasoning-level":[268],"independent":[270],"accuracy.":[273],"Some":[274],"also":[276],"reached":[277],"correct":[278],"answers":[279],"generating":[281],"descriptions,":[284],"reflecting":[285],"resilient":[288],"error.":[291],"These":[292],"findings":[293],"show":[294],"aggregate":[296],"scores":[298],"conflate":[299],"mechanistically":[300],"failure":[302,371],"modes,":[303],"carry":[310],"different":[311],"implications":[312],"how":[314],"might":[316],"safely":[318],"deployed":[319],"or":[320],"interpretation.":[325],"The":[326],"expert-guided":[327],"framework":[330],"introduced":[331],"here":[332],"provides":[333],"generalizable,":[335],"mechanism-based":[336],"approach":[337],"benchmarking":[339],"multimodal":[340],"AI":[341],"performance":[343],"extends":[345],"beyond":[346],"periodontics":[347],"other":[349],"visually":[350],"driven":[351],"domains":[353],"medicine.":[355],"As":[356],"become":[358],"accessible":[360],"clinicians,":[362],"residents,":[363],"dental":[365,385],"educators,":[366],"is":[372],"essential":[373],"guiding":[375],"responsible":[376],"use,":[378],"targeting":[379],"refinement,":[381],"informing":[383],"AI-augmented":[384],"education":[386],"competency":[388],"assessment.":[389]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-08-28T00:00:00"}
