Agentic AI-powered flexible fiber-bundle endoscopy for high-resolution NIR-II fluorescence imaging in vivo
Authors: Yanzhao Shi, Yuanhua Liu, Sixin Xu, Wayne Jason Li, Yuyuan Chen, Danyang Xu, Zhisheng Wu, Hanze Yu, +5 more
Organizations: Department of Electrical and Computer Engineering, School of Biomedical Engineering, The University of Hong Kong, Hong Kong SAR, China. · Materials Innovation Institute for Life Sciences and Energy (MILES), The University of Hong Kong Shenzhen Institute of Research and Innovation (HKU-SIRI), Shenzhen 518045, China. · Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China. · Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. · JC STEM Lab of Nanoscience and Nanomedicine, Department of Chemistry and School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China. · School of Computing and Data Science, The University of Hong Kong, Hong Kong SAR, China.
Fiber-bundle endoscopy offers a compact and flexible route for clinical fluorescence imaging through natural human orifices, but since its first report in the 1950s, it has remained limited by low spatial resolution, honeycomb artifacts, and inter-core crosstalk. The crosstalk becomes more pronounced at near-infrared-II wavelengths (NIR-II, 1000-3000 nm), a spectral window that offers superior contrast, resolution, and tissue penetration depth for biomedical imaging. Here, we present an AI-powered flexible endoscopy platform that overcomes these constraints through optical-computational co-design: optimizing ultrathin fiber bundles to mitigate crosstalk-induced image blur and enable high-fidelity image transmission across the visible-to-NIR-II spectral range, and developing an Agent-Guided Mixture-of-Experts (GAME) pipeline for honeycomb-artifact removal and image restoration. GAME provides a single restoration entry point for diverse biomedical images acquired with our endoscope, spanning cell, mouse and human samples. It dynamically routes each input to suitable restoration experts via a vision-language model, facilitating image reconstruction with a fourfold resolution improvement beyond the NyquistShannon sampling limit. The utility of our endoscope is demonstrated through in vivo NIR-II imaging of anatomical structures in mice, as well as imaging of the digital micromirror device (DMD)-projected human gastric tube and lymphatic system, paving the way for future clinical translation.
Vision-language models (VLMs) and agentic AI have shown strong performance on semantic visual tasks, but it remains unclear whether they can handle the physics and inverse problems that underlie computational imaging. We present ImagingBench, a benchmark of 20 computational imaging tasks spanning five categories: ray and wave optics, image signal processing, inverse reconstruction, computational sensing, and calibration. ImagingBench evaluates three complementary settings: Expert, fixed expert-guided inverse reconstruction; Planner, planner-guided inverse reconstruction; and Forward, forward-system simulation for consistency checking. We benchmark leading proprietary and open-source image-centric multimodal systems, including Gemini, GPT, and Qwen, and compare them with representative task-specific non-agentic baselines. Across tasks, agentic models remain consistently weaker than specialized methods, especially on computational sensing problems such as lensless imaging, event-based reconstruction, time-of-flight imaging, and holography. Planner guidance provides only modest and inconsistent gains over the fixed-prompt Expert baseline. Although the models often generate visually plausible outputs, their reference-based fidelity remains poor, revealing a substantial gap between semantic visual competence and physically grounded imaging performance. ImagingBench provides a unified testbed for measuring this gap and tracking progress in agentic AI for computational imaging.
Lissajous confocal laser endomicroscopy (CLE) is a promising solution for high speed in vivo optical biopsy for handheld scenarios. However, Lissajous scanning traces a resonant trajectory and samples only the visited pixels per frame; at high frame rates, many pixels remain unvisited, creating structured holes. In this work, we introduce the first benchmark for high-rate Lissajous CLE, consisting of low-quality video clips paired with high-quality reference images. The reference images are wide-FOV mosaics obtained by stitching stabilized, slow-scan frames of the same tissue, enabling temporally aligned supervision. Using this dataset, we propose MIRA, a lightweight recurrent framework for Lissajous CLE restoration that iteratively aggregates temporal context through feature reuse and displacement alignment. Our experiments demonstrate that MIRA outperforms both lightweight and high-complexity baselines in restoration quality while maintaining a favorable computational efficiency suitable for clinical deployment.
Endoscopic diagnosis is an iterative process in which clinicians acquire, compare, and verify local visual evidence before reaching a conclusion. Current AI systems do not adequately support this process because fine-grained evidence acquisition and multi-step reasoning remain weakly coupled, complicating reconciliation of image-derived findings with their textual interpretations. This gives rise to two failure modes, hallucinated evidence and uncorrected error accumulation, that undermine diagnostic reliability. We propose EndoCogniAgent, a closed-loop agentic framework that formulates endoscopic diagnosis as a controlled state update process for integrating complementary visual and textual evidence. At each reasoning round, a central planner selects an evidence acquisition action, specialized expert tools extract spatial and semantic observations as structured textual evidence, and a self-consistency validation mechanism examines this evidence along two dimensions, knowledge consistency against the input image and temporal consistency with prior validated findings, before updating the diagnostic state. Validated observations are admitted into the evolving state to condition subsequent planning, while insufficiently supported or conflicting findings are retained with corrective feedback that redirects the planner toward additional verification. We further introduce EndoAgentBench, a workflow-oriented benchmark comprising 6,132 question-answer pairs from 11 endoscopic datasets, to evaluate diagnostic agents across a comprehensive diagnostic chain, from fine-grained visual perception to high-level diagnostic reasoning. EndoCogniAgent achieves 85.23% overall accuracy on perception tasks and 71.13% clinical acceptance rate on reasoning tasks. Blinded clinician evaluation further shows consistent improvements in diagnostic response quality over the evaluated baselines.