Conservative AI for Safety-Sensitive Medical Image Restoration: Residual-Bounded CT-CTA Enhancement for Intracranial Aneurysm-Relevant Signal Recovery

Automated detection of intracranial aneurysms (IAs) from CT angiography (CTA) is severely hindered by high false-positive rates. Convolutional neural networks (CNNs) rely on local pixel intensities, causing systematic confusion between saccular aneurysms and vascular bifurcations - a problem especially acute for small lesions (<3 mm), where detection sensitivity falls below 60%. We propose a plug-and-play, topology-aware false-positive reduction framework evaluating the Smooth Euler Characteristic Transform (SECT) - a directional representation encoding global 3D vascular geometry independently of intensity - against persistence-based summaries (Persistence Images and Landscapes), tested on a stratified subset of the RSNA 2025 dataset. SECT achieves an AUC of 0.943, substantially outperforming direction-agnostic methods (AUC ~0.68), and exhibits a clinical performance inversion: it excels on the sub-3 mm cohort, maintaining 0.943 AUC and 78.5% sensitivity at 95% specificity. The representation is also scanner-agnostic, achieving 0.927 mean AUC under leave-one-scanner-out (LOGO) validation across four manufacturers. By capturing asymmetric geometric invariants rather than intensity profiles, SECT reliably resolves the primary structural confounder in IA detection, positioning it as a robust downstream filter for hybrid deep-learning diagnostic pipelines.

Anisotropic volumetric acquisitions are common in clinical MRI and volume electron microscopy (vEM), where sparse through-plane sampling creates thick slices or sections that degrade orthogonal reformats and downstream analysis. We present CRIS, a cross-plane self-supervised framework for isotropic restoration without paired isotropic ground truth. CRIS casts 3D restoration as 2D stripe completion on orthogonal reformats of an isotropic grid: high-resolution in-plane slices are synthetically degraded and periodically masked for training, while at inference blank slices define the isotropic grid, two orthogonal reformats are restored, and predictions are fused by multi-view averaging. We evaluate CRIS on two MRI cohorts and two microscopy benchmarks up to 8x anisotropy. On brain MRI, CRIS achieves 32.921 +/- 0.436 dB PSNR and 0.963 +/- 0.003 SSIM, outperforming interpolation, ECLARE, SMORE4, SIMPLE, SA-INR, and ATME, and gives the best segmentation consistency (Dice 0.940 +/- 0.004, ASSD 0.245 +/- 0.014 mm, HD99 1.275 +/- 0.061 mm). On reference-free abdominal MRI, CRIS reduces FID/KID to 48.71/0.023, outperforming interpolation, ECLARE, SMORE4, and SIMPLE. On vEM, CRIS achieves 29.100 dB/0.830 3D PSNR/SSIM at 4x and 26.874 dB/0.722 at 8x on EPFL, and 21.935 +/- 0.437 dB/0.696 +/- 0.024 on noisy hemibrain data. In a dedicated robustness experiment, one variable-gap CRIS model evaluated across gap factors 3-7 and coronal, axial, and sagittal degradations maintained higher PSNR/SSIM than interpolation (36.36-31.14 dB and 0.977-0.932 vs. 33.07-27.85 dB and 0.951-0.853). These results support CRIS as a modality-flexible route to isotropic restoration without paired isotropic targets or configuration-specific retraining. Code is available at https://github.com/adi-hatav/CRIS.

Industrial inspection pipelines often restore a measured image before a detector acts on it, yet restoration can suppress detector-supported defect structure or create clean-region activations. We formulate restoration as a selective action problem over the measured display, five restored candidates, and review. SafeRestore ranks candidates with action-specific fitted scores, chooses a gate on threshold-tuning data, and evaluates the fixed gate on a disjoint certification sample with two one-sided exact binomial bounds: one for the positive-conditional evidence-loss incident rate and one for the all-accepted excess-activation incident rate. The guarantee is marginal for one policy fixed before its certification outcomes are observed, under an image-level i.i.d. working model. In a retrospective split-sample study of 4,591 public Carinthia-S images, the protocol yields auditable risk-coverage behavior. The primary all-action policy passes in one of five training repetitions (12.0% +/- 26.9% pass-gated test coverage when failures count as zero), whereas fixed bicubic and reduced-complexity variants pass more often. On reserved morphologies, evidence-loss incidence rises to 81.1-90.3%, and KolektorSDD lacks both detector competence and enough positive certification images for the stated target. The contribution is therefore an auditable, detector-relative framework for deciding when a transformed image may be returned automatically and when review remains necessary -- not a claim that adaptive routing outperforms simpler policies on the present evidence.