Machine unlearning (MU) is essential for enforcing the right to be forgotten in machine learning systems. A key challenge of MU is how to reliably audit whether a model has truly forgotten specified training data. Membership Inference Attacks (MIAs) are widely used for unlearning auditing, where samples that evade membership detection are often regarded as successfully forgotten. After carefully revisiting the reliability of MIA, we show that this assumption is flawed: failed membership inference does not imply true forgetting. We theoretically demonstrate that MIA-based auditing, when formulated as a binary classification problem, inevitably incurs statistical errors whose magnitude cannot be observed during the auditing process. This leads to overly optimistic evaluations of unlearning performance, while incurring substantial computational overhead due to shadow model training. To address these limitations, we propose Statistical Membership Inference Attack (SMIA), a novel training-free and highly effective auditing framework. SMIA directly compares the distributions of member and non-member data using statistical tests, eliminating the need for learned attack models. Moreover, SMIA outputs both a forgetting rate and a corresponding confidence interval, enabling quantified reliability of the auditing results. Extensive experiments show that SMIA provides more reliable auditing with significantly lower computational cost than existing MIA-based approaches. Notably, the theoretical guarantees and empirical effectiveness of SMIA suggest it as a new paradigm for reliable machine unlearning auditing.

With the rapid advancement of retrieval-augmented vision-language models, multimodal medical retrieval-augmented generation (MMed-RAG) systems are increasingly adopted in clinical decision support. These systems enhance medical applications by performing cross-modal retrieval to integrate relevant visual and textual evidence for tasks, e.g., report generation and disease diagnosis. However, their complex architecture also introduces underexplored adversarial vulnerabilities, particularly via visual input perturbations. In this paper, we propose Medusa, a novel framework for crafting cross-modal transferable adversarial attacks on MMed-RAG systems under a black-box setting. Specifically, Medusa formulates the attack as a perturbation optimization problem, leveraging a multi-positive InfoNCE loss (MPIL) to align adversarial visual embeddings with medically plausible but malicious textual targets, thereby hijacking the retrieval process. To enhance transferability, we adopt a surrogate model ensemble and design a dual-loop optimization strategy augmented with invariant risk minimization (IRM). Extensive experiments on two real-world medical tasks, including medical report generation and disease diagnosis, demonstrate that Medusa achieves over 90% average attack success rate across various generation models and retrievers under appropriate parameter configuration, while remaining robust against four mainstream defenses, outperforming state-of-the-art baselines. Our results reveal critical vulnerabilities in the MMed-RAG systems and highlight the necessity of robustness benchmarking in safety-critical medical applications. The code and data are available at https://anonymous.4open.science/r/MMed-RAG-Attack-F05A.