CPR: Chained Perceptual Refinement for Coarse-to-Fine Medical Image Classification

Medical image super-resolution (MedSR) is essential for improving diagnostic precision across diverse imaging modalities such as MRI, CT, X-ray, Ultrasound, and Fundus imaging. Despite rapid advances in deep learning, challenges remain in preserving anatomical accuracy, maintaining perceptual quality, and generalizing across medical domains. This paper presents MedSR-Vision, a novel unified deep learning framework for evaluating and comparing super-resolution models across five modalities: Brain MRI, Chest X-ray, Renal Ultrasound, Nephrolithiasis CT, and Spine MRI, at magnification scales of $\times2$, $\times3$, and $\times4$. Three representative models namely SRCNN, SwinIR, and Real-ESRGAN are benchmarked using multiple quantitative metrics encompassing fidelity, perceptual realism, and sharpness. Experimental analysis demonstrates that Real-ESRGAN achieves superior perceptual quality and edge recovery at higher scales, SwinIR excels in preserving structural and diagnostic features, and SRCNN provides efficient and stable performance at lower magnifications. The results establish domain-specific insights and practical guidelines for model selection in clinical imaging workflows, offering a standardized evaluation framework for future medical image super-resolution research and deployment.

Despite rapid advances in chest X-ray (CXR) foundation models, most radiology report generation (RRG) systems still rely on heavily downsampled inputs (e.g., 256x256) due to the fixed visual token budgets of pretrained vision encoders, suppressing subtle yet clinically important cues present in native-resolution images. However, enabling high-resolution (high-res) perception remains challenging: naive tiling causes prohibitive token inflation, while global compression suppresses subtle lesions and degrades diagnostic fidelity. Inspired by radiologists' workflow, localizing suspicious regions before detailed high-res assessment. We propose Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Reporting (LePaX), the first RRG framework that enables efficient high-res CXR perception (up to 1920x1920) without increasing the vision-token count. LePaX formulates high-res perception as a constrained spatial resolution allocation problem under a fixed token budget and introduces two key components: Learnable Spatial Resolution Allocation (LSRA), which learns a spatial utility map that adaptively allocates limited high-res capacity to diagnostically relevant regions, enabling targeted extraction of high-res patches from native CXRs; and Global-Regional Fusion (GRF), which performs token-preserving region-to-global refinement by projecting high-resolution regional evidence back onto the global feature grid through spatially aligned resolution write-back, avoiding token inflation. Experiments on multiple CXR benchmarks demonstrate that LePaX consistently improves both clinical and linguistic metrics while enabling native-resolution CXR perception with over 10x fewer visual tokens than naive high-res tiling.

Dense prediction is a fundamental requirement for many medical vision tasks such as medical image restoration, registration, and segmentation. The most popular vision model, Convolutional Neural Networks (CNNs), has reached bottlenecks due to the intrinsic locality of convolution operations. Recently, transformers have been widely adopted for dense prediction for their capability to capture long-range visual dependence. However, due to the high computational complexity and large memory consumption of self-attention operations, transformers are usually used at downsampled feature resolutions. Such usage cannot effectively leverage the tissue-level textural information available only at the full image resolution. This textural information is crucial for medical dense prediction as it can differentiate the subtle human anatomy in medical images. In this study, we hypothesize that Multi-layer Perceptrons (MLPs) are superior alternatives to transformers in medical dense prediction where tissue-level details dominate the performance, as MLPs enable long-range dependence at the full image resolution. To validate our hypothesis, we develop a full-resolution hierarchical MLP framework that uses MLPs beginning from the full image resolution. We evaluate this framework with various MLP blocks on a wide range of medical dense prediction tasks including restoration, registration, and segmentation. Extensive experiments on six public well-benchmarked datasets show that, by simply using MLPs at full resolution, our framework outperforms its CNN and transformer counterparts and achieves state-of-the-art performance on various medical dense prediction tasks.