Medical image re-identification (MedReID) enables longitudinal patient linkage but remains vulnerable to shortcut learning and often produces decisions that clinicians cannot audit against named anatomy. We propose Graph-of-Differences (GoD), which grounds identity comparisons in explicit anatomical structure. Each image is represented as an anatomy graph whose nodes correspond to named anatomical regions; given an image pair, soft node correspondence is established, and differences are computed over matched anatomy. A graph-level difference alignment objective ties these anatomy-matched differences to the global backbone difference, ensuring the retrieval signal is anchored in homologous structures rather than arbitrary spatial tokens. Explanations are defined over named graph nodes and quantitatively audited via node insertion/deletion tests, replacing unstable pixel heatmaps with verifiable structure-level evidence. On internal benchmarks, GoD improves Rank-1 by +7.1 pp on fundus and +3.1 pp on CXR over a strong frozen-backbone baseline, with further gains on zero-shot external transfers confirming that anatomy grounding improves both accuracy and generalization. Code is available at https://github.com/GenMI-Lab/GoD.git.
Medical landmark detection usually requires accurate expert annotations, which are laborious and difficult to scale across anatomical regions. In this work, we study an extreme annotation-efficient setting where only a single annotated template image is available. We propose SGB-Match, a structure-guided coarse-to-fine self-supervised matching framework for one-shot medical landmark detection. The framework first learns dense anatomical correspondence from unlabeled augmented image pairs, and then transfers the landmark definition from the annotated template to each target image through feature matching. Different from standard contrastive correspondence learning, where negative candidates are penalized by a structure-agnostic rule, we introduce a structure-guided bias into the contrastive objective. The bias is constructed from relative distance and edge-aware anatomical cues, and explicitly reweights the negative gradients: nearby structure-relevant candidates are weakly repelled, while distant or structure-irrelevant negatives are strongly suppressed. As a result, the learned feature space better preserves local anatomical structures around template landmarks and reduces confusing responses from repeated textures. We further adopt a global-to-local design, where a global encoder provides coarse landmark localization and a local encoder refines the prediction in a cropped region. Extensive experiments on four 2D radiological landmark datasets demonstrate that SGB-Match achieves strong one-shot performance across both public and newly collected datasets and consistently benefits from both structure-guided bias and two-stage refinement.
Medical images are routinely de-identified---names, dates, and other metadata removed---and then shared for research, teaching, and public benchmarks under the assumption that this renders them anonymous. Such de-identification protects the metadata but not the pixels, and---apart from scans that directly contain facial structures---whether the image content itself identifies the patient has received little scrutiny. We investigate this question by learning a cycle-consistent correspondence between a cross-sectional medical image and a non-medical, patient-identifying image, using a pair of coupled, cycle-consistent variational autoencoders. From a held-out scan, the model recovers a recognisable likeness of the patient (identity-region MAE = 0.163); conversely, it synthesises a scan from such an image. These results indicate that a de-identified medical scan remains identifying---it is, in effect, a photograph of the patient---and that imaging data should be governed as biometric data rather than as anonymisable records. To support reproducibility, the code and trained models are shared at https://github.com/attilasimko/public-repository.
Medical imaging artificial intelligence has achieved strong performance in isolated image interpretation, but remains poorly aligned with radiological practice, where diagnosis and follow-up rely on comparison across prior studies and analogous reference cases. Here we formulate radiological comparison as an entity-aware cross-image reasoning problem and introduce a framework that supports both reference-case retrieval and temporal comparative interpretation. We construct MedReCo-DB, a large-scale comparative imaging resource derived from routine image-report pairs, comprising more than 690,000 images from over 160,000 patients across eight institutions, four countries and seven imaging modalities. Reports are decomposed into anatomical structures, abnormal findings and pathological conditions to provide supervision for entity-conditioned retrieval and comparative visual question answering. Using this resource, we develop MedReCo, an entity-aware visual encoder for controllable retrieval of clinically analogous cases, and MedReCo-VLM, a vision--language extension for generative interpretation of interval change. Across internal, external and cross-center evaluations, MedReCo achieved the highest Recall@1 in all 12 internal retrieval settings and improved external retrieval by a mean of 6.0 percentage points. In clinically confusable differential groups, it consistently outperformed the strongest baselines. MedReCo-VLM achieved the best performance across all comparative generation evaluations and improved longitudinal follow-up accuracy by 14.5-46.5 percentage points on chest radiographs and 13.0-27.9 percentage points on CT. These findings suggest that entity-aware comparative reasoning can be learned from routine clinical data at scale and may provide a more clinically aligned foundation for medical imaging AI.