Vision-language models don't always need images for chest X-ray accuracy
A causal audit shows that text-only models match multimodal models in chest radiography accuracy. Across nine systems, a text-only model performs within 5.7 points of the best multimodal model, and a 119-billion-parameter model is indistinguishable from a 7-billion-parameter text-only baseline. Grounding audits, not accuracy, should determine clinical deployment.