3D Medical Imaging

Self-supervised pretraining has become the mainstream approach for learning MRI representations from unlabeled scans. However, most existing objectives still treat each scan primarily as static aggregations of slices, patches or volumes. We ask whether there exists an intrinsic form of self-supervision signal that is different from reconstructing the masked patches, through transforming the 3D volumes into controllable 2D rendered sequences: by rendering slices at continuous positions, orientations, and scales, a 3D volume can be converted into dense video-action sequences whose controls are the action trajectories. We study this formulation with an action-conditioned pretraining objective, where a tokenizer encodes slice observations and a latent dynamics model predicts the evolution of latent features. Across representative anatomical and spatial downstream tasks, the proposed pretraining is evaluated against standard static-volume baselines, tokenizer-only pretraining, and dynamics variants without aligned actions. These results suggest that controllable MRI slice navigation provides a useful complementary pretraining interface for learning anatomical and spatial representations from large unlabeled MRI collections.

Computed tomography (CT) is indispensable for clinical diagnosis and image-guided interventions but exposes patients to ionizing radiation, motivating the development of safer imaging alternatives. Ultrasound (US) is non-ionizing and widely accessible; however, it is highly operator dependent and lacks quantitative tissue characterization, often leading to diagnostic uncertainty and unnecessary CT examinations. This work presents a 3D ultrasound-derived pseudo-CT (UD-pCT) framework that generates CT-like anatomical reference volumes inferred from US, without aiming to reproduce physically accurate Hounsfield Units. Paired 3D kidney US and CT volumes from the TRUSTED dataset are first spatially aligned using a landmark-based multimodal registration pipeline, creating high-quality paired inputs for supervised training of an adversarial framework. The proposed Bottleneck Transformer Residual U-Net3D (BT-ResUNet3D) model employs a 3D residual encoder-decoder generator augmented with a transformer bottleneck, enabling effective modeling of fine-grained local anatomical structures as well as long-range volumetric dependencies, while a 3D Conditional PatchGAN discriminator enforces local structural realism in the synthesized pseudo-CT volumes. Quantitative evaluation using PSNR and SSIM demonstrates that the proposed method outperforms established baselines in structural fidelity and perceptual image quality. The UD-pCT volumes provide real-time anatomical reference for operator guidance, potentially reducing acquisition variability and unnecessary CT use. A limitation of this study is the relatively small paired dataset, which may limit the generalizability of the proposed model.

Today, advances in medical technology extensively utilize 3D volume data for accurate and efficient diagnostics. However, sharing these data across networks in telemedicine poses significant security risks of data tampering and unauthorized copying. To address these challenges, this paper proposes a novel reversible-zero watermarking approach, termed Vol-Mark, for medical volume data to protect their ownership and authenticity in telemedicine. The proposed Vol-Mark method offers two key benefits: 1) it designs a volume data feature extractor that leverages contrastive learning to efficiently extract discriminative and stable volumetric features, ensuring robustness against 3D attacks; 2) it introduces the cubic difference expansion (c-DE) technique, which leverages the 3D integer wavelet transform to embed watermark bits into neighboring voxels within cubes at low-frequency coefficients. The voxel differences within each cube are expanded to create embedding space, and a majority voting mechanism is employed during extraction to enhance reliability. The embedding process incurs low distortion and supports lossless removal, thereby preserving the integrity and diagnostic accuracy of medical volume data. Through these two benefits, Vol-Mark enables both integrity verification and ownership verification. Integrity verification is first performed, and ownership verification through hypothesis testing is further conducted to enhance reliability, particularly under data tampering or watermark removal attacks. Comprehensive experimental results show the effectiveness of the proposed method and its superior robustness against conventional, geometric, and hybrid attacks on medical volume data. In particular, through multiple tasks evaluations, Vol-Mark consistently achieves an ACC above 0.90 in most attack scenarios, outperforming existing methods by a clear margin.

Magnetic Resonance Imaging (MRI) acquisition remains a time-intensive and patient-straining process, as prolonged scan dura- tions increase the likelihood of motion artifacts, which degrade image quality and frequently require repeated scans. To address these chal- lenges, we propose a novel framework with two models MK-ResRecon and IdentityRefineNet3D to reconstruct high-fidelity 3D MRI volumes from sparsely sampled 2D slices-requiring only 12.5% of the axial slices for full resolution 3D reconstruction. MK-ResRecon predicts missing in- termediate 2D slices using a multi-kernel texture-aware loss, preserving fine anatomical details. IdentityRefineNet3D refines the predicted slices and the original sparse slices as a single 3D volume to obtain a smooth anatomical structure. We train the models on a large T1-sequence POST- contrast brain MRI dataset and evaluate on a large heterogeneous brain MRI cohort. The work provides accurate, hallucination-free, generaliz- able and clinically validated framework for 3D MRI reconstruction from highly sparse inputs and enables a clinically viable path towards faster and more patient-friendly MRI imaging.

Vision-language models (VLMs) have shown potential for automated radiology report generation, yet existing approaches rely on global embedding compression of volumetric data, often leading to hallucinated findings and limited anatomical grounding in 3D CT imaging. We introduce MedScribe, a hypothesis-driven framework that reformulates report generation as an iterative evidence acquisition process rather than a single-pass encoding task. MedScribe models reporting as a sequential decision process in which a large language model dynamically invokes pathology-specific diagnostic tools to extract localized volumetric features. These structured features are used to query a multidimensional retrieval space aligned with pathology-specific textual evidence. By explicitly accumulating quantitative evidence prior to synthesis, the framework enforces fine-grained grounding and reduces unsupported claims. Without task-specific fine-tuning, MedScribe improves clinical accuracy, factual consistency, and interpretability on CT-RATE and RadChestCT compared to state-of-the-art 2D and 3D VLMs, demonstrating the value of hypothesis-driven reasoning for reliable medical image reporting.

Analyzing human vasculature and vessel-like, tubular structures, such as airways, is crucial for disease diagnosis and treatment. Current methods often rely on small sub-regions or simplified tree-like structures, rendering analysis of entire organ-level networks at clinical resolution computationally challenging. To this end, we propose VAEsselSparse, an efficient encoder-decoder model to obtain a meaningful yet compact representation of the entire organ-level vascular network at sub-millimeter resolution. VAEsselSparse leverages the inherent sparsity of 3D vascular structures via sparse convolutions and attention mechanisms, achieving substantial spatial compression rates of 8 x 8 x 8. We demonstrate superior reconstruction performance compared to dense counterparts and previous methods. Importantly, the resulting latent space retains clinically relevant discriminative features readily usable for classification tasks, such as aneurysm/stenosis or subvariants of the circle of Willis. Moreover, the compact latent space of VAEsselSparse serves as an effective representation for learning vessel-specific priors through generative models, enabling the synthesis of realistic vasculature.

Blood vessel segmentation and -tracing are essential tasks in many medical imaging applications. Although numerous methods exist, the prevailing segment-then-fix paradigm is fundamentally limited regarding its suitability for modeling the task of complete and topologically accurate vascular network reconstruction. Here, we propose an approach to extract topologically more accurate vascular graphs from 3D image data, building upon highly successful ideas from the related biomedical tasks of cell segmentation and -tracking. Our approach first predicts voxel-wise vessel direction vectors joint with standard vessel segmentation masks. Second, to extract the vascular graph from these predictions, we introduce a direction-vector-guided extension of the TEASAR algorithm. Our approach achieves state-of-the-art performance on three benchmark datasets, spanning both synthetic and real imagery. We further demonstrate the applicability of our approach to challenging 3D micro-CT scans of rat heart vasculature. Finally, we propose meaningful and interpretable measures of topological error, namely false splits and false merges for graphs. Overall, our approach substantially improves the topological accuracy of reconstructed vascular graphs, being able to separate closely apposed vessel segments and handle multiple vascular trees within a single volume.

Surgical training involves didactic teaching, mentor-led learning, surgical skills laboratories, and direct exposure to surgery; however, increasing clinical pressures have limited operating room (OR) exposure. This work leverages virtual reality (VR) to provide a safe and immersive training environment. Existing VR training is often based on standardized scenarios not tailored to individual clinical cases. This study addresses this limitation using artificial intelligence (AI) based computer vision methods to generate patient-specific simulations from computed tomography (CT) and magnetic resonance imaging (MRI). This study focuses on patient-specific spinal decompression simulation for spinal stenosis in a virtual operating room. The objectives were (1) automatic creation of 3D anatomical models and (2) VR simulation of spinal decompression procedures including laminectomy, disc resection, and foraminotomy. Model construction required multimodal fusion (registration) of CT and MRI and segmentation of relevant structures. Segmentation was evaluated using the Dice Similarity Coefficient (DSC), and registration accuracy using Target Registration Error (TRE). Qualitative feedback was obtained from surgeons and trainees. High-fidelity patient-specific 3D models were generated efficiently (approximately 2.5 minutes per case, N = 15). Segmentation accuracy was high, with a DSC of 0.95 (+/- 0.03) for vertebral bone and 0.895 (+/- 0.02) for soft tissue structures. Registration accuracy showed a mean TRE of 1.73 (+/- 0.42) mm. Semi-structured interviews indicated improved spatial understanding, increased procedural confidence, and strong perceived educational value. This platform significantly reduced the time and costs of patient-specific modelling, thereby facilitating pre-operative planning, post-procedural assessments, and comprehensive surgical simulation.

Chest computed tomography (CT) is central to the detection and management of thoracic disease, yet the growing scale and complexity of volumetric imaging increasingly exceed what can be addressed by scan-level prediction alone. Clinically useful AI for CT must not only recognize disease across the whole volume, but also localize abnormalities and provide interpretable visual evidence. Existing vision-language foundation models typically compress scans and reports into global image-text representations, limiting their ability to preserve spatial evidence and support clinically meaningful interpretation. Here we developed EXACT, an explainable anomaly-aware foundation model for three-dimensional chest CT that learns spatially resolved representations from paired clinical scans and radiology reports. EXACT was pre-trained on 25,692 CT-reports pairs using anatomy-aware weak supervision, jointly learning organ segmentation and multi-instance anomaly localization without manual voxel-level annotations. The resulting organ-specific anomaly-aware maps assign each voxel a disease-specific anomaly score confined to its corresponding anatomy, jointly encoding lesion extent and organ-level context. In retrospective multinational and multi-center evaluations, EXACT showed broad and consistent improvements across clinically relevant CT tasks, spanning multi-disease diagnosis, zero-shot anomaly localization, downstream adaptation, and visually grounded report generation, outperforming existing three-dimensional medical foundation models. By transforming routine clinical CT scans and free-text reports into explainable voxel-level representations, EXACT establishes a scalable paradigm for trustworthy volumetric medical AI.

Diffusion models produce high-quality synthetic data but suffer from slow inference. We propose 3D Variable-Step Denoising Diffusion Probabilistic Model (VS-DDPM) a framework engineered to maintain generative quality while accelerating inference by several factors. We tested our approach on four tasks (missing MRI, tumor removal, MRI-to-sCT, and CBCT-to-sCT) within the BraTS2025 and SynthRAD2025 challenges. Designed for high efficiency under hardware and time constrains imposed by both challenges. VS-DDPM achieved state-of-the-art (SOTA) performance in missing MRI synthesis, yielding Dice scores of 0.80, 0.83, and 0.88 for the enhancing tumor, tumor core, and whole tumor regions, respectively, alongside a structural similarity index (SSIM) of 0.95. For MRI tumor removal, the model attained a root mean squared error (RMSE) of 0.053, a peak signal-to-noise ratio (PSNR) of 26.77, and an SSIM of 0.918. While the framework demonstrated competitive performance in MRI-to-sCT and CBCT-to-sCT tasks, it did not reach SOTA benchmarks, potentially due to sensitivities in data pre and post-processing pipelines or specific loss function configurations. These results demonstrate that VS-DDPM provides a robust and tunable solution for high-fidelity 3D medical image synthesis. The code is available in https://github.com/andre-fs-ferreira/SynthRAD_by_Faking_it.

Computed Tomography (CT) is a widely used imaging modality in medical and industrial applications. To limit radiation exposure and measurement time, there is a growing interest in sparse-view CT, where the number of projection views is significantly reduced. Deep neural networks have shown great promise in improving reconstruction quality in sparse-view CT, especially generative diffusion models. However, these methods struggle to scale to large 3D volumes due to several reasons: (i) the high memory and computational requirements of 3D models, (ii) the lack of large 3D training datasets, and (iii) the inconsistencies across slices when using 2D models independently on each slice. We overcome these limitations and scale diffusion-based sparse-view CT reconstruction to large 3D volumes by combining conditional diffusion with explicit data consistency. We propose Conditional Diffusion Posterior Alignment (CDPA) to enable scalable 3D sparse-view CT reconstruction. A 2D U-Net diffusion model is conditioned on an initial 3D reconstruction to improve inter-slice consistency, combined with data-consistency alignment to match measured projections. Experiments on synthetic and real Cone Beam CT (CBCT) data show state-of-the-art performance, with ablations that confirm the synergistic effects of the proposed pipeline. Finally, we show that the same principles also strengthen fast denoising U-Nets, yielding near-diffusion quality at a fraction of the computational cost.

Conditional medical image generation plays an important role in many clinically relevant imaging tasks. However, existing methods still face a fundamental challenge in balancing inference efficiency, patient-specific fidelity, and distribution-level plausibility, particularly in high-dimensional 3D medical imaging. In this work, we propose GDM, a generative drifting framework that reformulates deterministic medical image prediction as a multi-objective learning problem to jointly promote distribution-level plausibility and patient-specific fidelity while retaining one-step inference. GDM extends drifting to 3D medical imaging through an attractive-repulsive drift that minimizes the discrepancy between the generator pushforward and the target distribution. To enable stable drifting-based learning in 3D volumetric data, GDM constructs a multi-level feature bank from a medical foundation encoder to support reliable affinity estimation and drifting field computation across complementary global, local, and spatial representations. In addition, a gradient coordination strategy in the shared output space improves optimization balance under competing distribution-level and fidelity-oriented objectives. We evaluate the proposed framework on two representative tasks, MRI-to-CT synthesis and sparse-view CT reconstruction. Experimental results show that GDM consistently outperforms a wide range of baselines, including GAN-based, flow-matching-based, and SDE-based generative models, as well as supervised regression methods, while improving the balance among anatomical fidelity, quantitative reliability, perceptual realism, and inference efficiency. These findings suggest that GDM provides a practical and effective framework for conditional 3D medical image generation.

Accurate cardiac anatomy modeling requires the model to be able to handle intricate interrelations among structures. In this paper, we propose VecHeart, a unified framework for holistic reconstruction and generation of four-chamber cardiac structures. To overcome the limitations of current feed-forward implicit methods, specifically their restriction to single-object modeling and their neglect of inter-part correlations, we introduce Hybrid Part Transformer, which leverages part-specific learnable queries and interleaved attention to capture complex inter-chamber dependencies. Furthermore, we propose Anatomical Completion Masking and Modality Alignment strategies, enabling the model to infer complete four-chamber structures from partial, sparse, or noisy observations, even when certain anatomical parts are entirely missing. VecHeart also seamlessly extends to 3D+t dynamic mesh sequence generation, demonstrating exceptional versatility. Experiments show that our method achieves state-of-the-art performance, maintaining high-fidelity reconstruction across diverse challenging scenarios. Code is available at https://github.com/Scalsol/VecHeart.

Three-dimensional (3D) medical image enhancement, including denoising and super-resolution, is critical for clinical diagnosis in CT, PET, and MRI. Although diffusion models have shown remarkable success in 2D medical imaging, scaling them to high-resolution 3D volumes remains computationally prohibitive due to lengthy diffusion trajectories over high-dimensional volumetric data. We observe that in conditional enhancement, strong anatomical priors in the degraded input render dense noise schedules largely redundant. Leveraging this insight, we propose a sparse voxel-space diffusion framework that trains and samples on a compact set of uniformly subsampled timesteps. The network predicts clean data directly on the data manifold, supervised in velocity space for stable gradient scaling. A lightweight Structure-aware Trajectory Modulation (STM) module recalibrates time embeddings at each network block based on local anatomical content, enabling structure-adaptive denoising over the shared sparse schedule. Operating directly in voxel space, our framework preserves fine anatomical detail without lossy compression while achieving up to $10\times$ training acceleration. Experiments on four datasets spanning CT, PET, and MRI demonstrate state-of-the-art performance on both denoising and super-resolution tasks. Our code is publicly available at: https://github.com/mirthAI/sparse-3d-diffusion.

Spatial reasoning and visual grounding are core capabilities for vision-language models (VLMs), yet most medical VLMs produce predictions without transparent reasoning or spatial evidence. Existing benchmarks also evaluate VLMs on isolated 2D images, overlooking the volumetric nature of clinical imaging, where findings can span multiple frames or appear on only a few slices. We introduce Spatially Grounded MRI Visual Question Answering (SGMRI-VQA), a 41,307-pair benchmark for multi-frame, spatially grounded reasoning on volumetric MRI. Built from expert radiologist annotations in the fastMRI+ dataset across brain and knee studies, each QA pair includes a clinician-aligned chain-of-thought trace with frame-indexed bounding box coordinates. Tasks are organized hierarchically across detection, localization, counting/classification, and captioning, requiring models to jointly reason about what is present, where it is, and across which frames it extends. We benchmark 10 VLMs and show that supervised fine-tuning of Qwen3-VL-8B with bounding box supervision consistently improves grounding performance over strong zero-shot baselines, indicating that targeted spatial supervision is an effective path toward grounded clinical reasoning.

While specialized Medical Vision-Language Models (VLMs) have achieved remarkable success in interpreting 2D and 3D medical modalities, their deployment for 3D volumetric data remains constrained by significant computational inefficiencies. Current architectures typically suffer from massive anatomical redundancy due to the direct concatenation of consecutive 2D slices and lack the flexibility to handle heterogeneous information densities across different slices using fixed pruning ratios. To address these challenges, we propose MedPruner, a training-free and model-agnostic hierarchical token pruning framework specifically designed for efficient 3D medical image understanding. MedPruner introduces a two-stage mechanism: an Inter-slice Anchor-based Filtering module to eliminate slice-level temporal redundancy, followed by a Dynamic Information Nucleus Selection strategy that achieves adaptive token-level compression by quantifying cumulative attention weights. Extensive experiments on three 3D medical benchmarks and across three diverse medical VLMs reveal massive token redundancy in existing architectures. Notably, MedPruner enables models such as MedGemma-1.5 to maintain or even exceed their original performance while retaining fewer than 5% of visual tokens, thereby reducing visual-token overhead and validating the necessity of dynamic token selection for practical clinical deployment. Our code is available at https://github.com/CUHK-AIM-Group/MedPruner.

Accurate 3D reconstruction of vertebral anatomy from ultrasound is important for guiding minimally invasive spine interventions, but it remains challenging due to acoustic shadowing and view-dependent signal variations. We propose an occupancy-based shape completion method that reconstructs complete 3D anatomical geometry from partial ultrasound observations. Crucially for intra-operative applications, our approach extracts the anatomical surface directly from the image, avoiding the need for anatomical labels during inference. This label-free completion relies on a coupled latent space representing both the image appearance and the underlying anatomical shape. By leveraging a Neural Implicit Representation (NIR) that jointly models both spatial occupancy and acoustic interactions, the method uses acoustic parameters to become implicitly aware of the unseen regions without explicit shadowing labels through tracking acoustic signal transmission. We show that this method outperforms state-of-the-art shape completion for B-mode ultrasound by 80% in HD95 score. We validate our approach both in-silico and on phantom US images with registered mesh models from CT labels, demonstrating accurate reconstruction of occluded anatomy and robust generalization across diverse imaging conditions. Code and data will be released on publication.

Self-supervised learning (SSL) and diffusion models have respectively advanced representation learning and generative modeling for high-dimensional 3D visual data, yet they are often developed as separate paradigms. Their unification remains challenging under multi-source heterogeneity, as anatomical content must be preserved for analysis while acquisition-related style varies across centers and affects synthesis. In this paper, we propose MeDUET, a 3D Medical image Disentangled UnifiEd PreTraining framework in the variational autoencoder latent space. MeDUET formulates unified pretraining as an empirical factor identifiability problem, aiming to learn domain-invariant content factors for anatomy and domain-specific style factors for appearance. To improve factor separation, MeDUET first uses token demixing with a standard adversarial domain regularizer to establish basic content-style specialization, and further introduces Mixed Factor Token Distillation and Swap-invariance Quadruplet Contrast to reduce mixed-region factor leakage and organize factor spaces with factor-wise invariance and discriminability. With these learned factors, MeDUET transfers effectively to both synthesis and analysis, yielding higher fidelity, faster convergence, and better controllability for synthesis, while achieving competitive or superior domain generalization and label efficiency on diverse datasets, tasks, and modalities. Overall, MeDUET shows that multi-source heterogeneity can serve as useful supervision, with disentanglement providing an effective interface for unifying 3D medical image synthesis and analysis. Our code is available at https://github.com/JK-Liu7/MeDUET.

This work introduces MedForj, a suite of 3D foundational generative priors based on diffusion models. The MedForj models were trained on $72{,}659$ 1~mm isotropic 3D $T_1$-weighted MRI human brain image volumes from $38{,}174$ subjects, drawn from a curated corpus of $80{,}675$ volumes from $42{,}506$ subjects spanning $38$ publicly available datasets. These training images were manually inspected to exclude those with poor quality and excessive pathology, and otherwise were minimally processed. The models include six different diffusion training strategies: rectified flow, latent diffusion rectified flow, flow matching, velocity prediction, clean prediction, and noise prediction. Image samples produced by each of these models were compared to each other and against real, ground truth data under downstream segmentation distributions, FID, five inverse problems, and blind human inspection in an observer study. Flow matching was the strongest strategy overall, achieving the best inverse problem solving results at $28.80$~dB PSNR and $0.874$ SSIM averaged over the five forward problems, the highest rate of reconstructions judged real by blind human raters at $72.6\%$, and the closest per-structure match to real segmented anatomy in a permutation test. It was not best everywhere: rectified flow produced the most convincing unconditional samples in the observer study and the best FID, and the latent rectified-flow model achieved the smallest joint distributional distance to real anatomy. No other strategy, however, performed consistently well across all four evaluations. We therefore recommend flow matching as the default MedForj prior, while releasing every strategy so that the choice can be revisited per application. All model weights and corresponding code are publicly available at https://github.com/piksl-research/medforj.

Managing chronic wounds remains a major healthcare challenge, with clinical assessment often relying on subjective and time-consuming manual documentation methods. Although 2D digital videometry frameworks have aided wound measurement, these approaches struggle with perspective distortion, a limited field of view, and an inability to capture wound depth, especially in anatomically complex or curved regions. To overcome these limitations, we present Wound3DAssist, a practical framework for 3D wound assessment using monocular consumer-grade videos. Our framework generates 3D wound models from short handheld recordings captured using consumer-grade devices, enabling non-contact, automatic measurements from reconstructed multi-view surfaces. We integrate 3D reconstruction, wound segmentation, tissue classification, and periwound analysis into a modular workflow. We evaluate Wound3DAssist across digital models with known geometry, silicone phantoms, and real patients. Results show that the framework supports high-quality wound bed visualization, approximately millimeter-scale surface reconstruction accuracy in the evaluated clinical cases, and multi-view wound-tissue composition analysis. Full assessments are completed in under 20 minutes, demonstrating feasibility for a research framework intended for future clinical workflow evaluation.

Endoscopic depth estimation is a critical technology for improving the safety and precision of minimally invasive surgery. It has attracted considerable attention from researchers in medical imaging, computer vision, and robotics. Over the past decade, a large number of methods have been developed. Despite the existence of several related surveys, a comprehensive overview focusing on recent deep learning-based techniques is still limited. This paper endeavors to bridge this gap by comprehensively reviewing the state-of-the-art literature. Specifically, we provide a thorough survey of the field from three key perspectives: data, methods, and applications. Firstly, at the data level, we describe the acquisition process of publicly available datasets. Secondly, at the methodological level, we introduce both monocular and stereo deep learning-based approaches for endoscopic depth estimation. Thirdly, at the application level, we identify the specific challenges and corresponding solutions for the clinical implementation of depth estimation technology, situated within concrete clinical scenarios. Finally, we outline potential directions for future research, such as domain adaptation, real-time implementation, and the synergistic fusion of depth information with sensor technologies, thereby providing a valuable starting point for researchers to engage with and advance the field toward clinical translation.

Tubular tree structures, such as blood vessels and airways, are essential in human anatomy and accurately tracking them while preserving their topology is crucial for various downstream tasks. Trexplorer is a recurrent model designed for centerline tracking in 3D medical images but it struggles with predicting duplicate branches and terminating tracking prematurely. To address these issues, we present Trexplorer Super, an enhanced version that notably improves performance through novel advancements. However, evaluating centerline tracking models is challenging due to the lack of public datasets. To enable thorough evaluation, we develop three centerline datasets, one synthetic and two real, each with increasing difficulty. Using these datasets, we conduct a comprehensive evaluation of existing state-of-the-art (SOTA) models and compare them with our approach. Trexplorer Super outperforms previous SOTA models on every dataset. Our results also highlight that strong performance on synthetic data does not necessarily translate to real datasets. The code and datasets are available at https://github.com/RomStriker/Trexplorer-Super.

Current CT report generation frameworks predominantly rely on global feature representations, often failing to capture region-specific details and potentially missing certain abnormalities. To overcome this limitation, we propose MedRegion-CT, a region-focused multimodal large language model framework featuring three key innovations. First, we revisit the SlowFast strategy to jointly model global and fine-grained information and adapt it to the medical domain via a Region-based SlowFast Tokenizer that extracts tokens guided by clinically meaningful regions. Second, generated pseudo-masks guide the model to attend to diagnostically important anatomical regions, facilitating a systematic understanding of the overall scan context. Third, quantitative lesion information, including size, diameter, and spatial location, is encoded as structured textual prompts, enabling context-aware and clinically informed report generation. To enable rigorous evaluation, we validate our framework on multi-institutional structured report generation benchmarks. Experimental results demonstrate that MedRegion-CT achieves state-of-the-art performance, outperforming existing approaches in both linguistic quality and clinical accuracy. All code is publicly available at: https://github.com/babbu3682/MedRegion-CT.

Photorealistic volumetric rendering of CT scans greatly benefits clinical workflows, yet neural approaches such as Neural Radiance Fields (NeRF) and 3D Gaussian Splatting (3DGS) require prohibitive per-scan optimization (hours for NeRF, about 30 minutes for 3DGS), making them impractical in clinical settings. We propose Render-FM, a feedforward model that eliminates this bottleneck by directly regressing 6D Gaussian Splatting (6DGS) parameters from a CT volume in a single 2.8-second forward pass, a 500x speedup over per-scan optimization. To bridge the domain gap between natural scene reconstruction and medical volumetric rendering, we introduce Anatomy-Guided Priming (AGP), which incorporates segmentation masks and transfer functions as structural and appearance priors, information that existing Gaussian splatting methods overlook. Built on an nnU-Net-inspired 3D U-Net trained on diverse CT scans, Render-FM predicts per-voxel 6DGS parameters and supports immediate real-time rendering. Unlike per-scan methods, it generalizes to unseen anatomies, novel transfer functions, and enables compositional organ visualization with zero additional preparation time. Optional 89-second fine-tuning further improves quality, surpassing per-scan optimized baselines. Project page: https://gaozhongpai.github.io/renderfm/.

Acute ischemic stroke (AIS) requires time-critical decision-making, where inaccurate interpretation of neuroimaging findings can lead to irreversible disability. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps from magnetic resonance imaging (MRI) are central to detecting acute infarction, yet generating factually reliable radiology reports directly from 3D MRI remains challenging due to the difficulty of learning robust cross-modal alignments between volumetric images and clinical text. We propose paired image-domain retrieval and text-domain augmentation (PIRTA), a retrieval-augmented generation framework that improves report factuality by avoiding explicit image-text alignment. PIRTA retrieves clinically similar 3D DWI/ADC volumes using a pretrained 3D vision encoder and leverages their paired clinician-authored reports to ground large language model (LLM)-based report generation. Experiments on multi-institutional in-house data, a held-out external privacy-preserving cohort, and the public ISLES benchmark demonstrate that PIRTA achieves strong image-domain retrieval performance and consistently improves ischemic-territory accuracy, a clinically grounded surrogate for report factuality, compared to direct image-to-text baselines. These results indicate that retrieval-grounded generation provides a scalable and reliable paradigm for producing factually consistent radiology reports from complex 3D brain MRI. Source code is available at https://github.com/jhlee0619/PIRTA.

Digital Subtraction Angiography (DSA) is one of the gold standards for vascular disease diagnosis. With the help of a contrast agent, time-resolved 2D DSA images deliver comprehensive blood flow information and can be utilized to reconstruct 3D vessel structures for medical assessment. Current commercial DSA systems typically require hundreds of scanning views to perform reconstruction, resulting in substantial radiation exposure. In this study, we propose a neural rendering-based optimization framework tailored for high-quality sparse-view DSA reconstruction to reduce radiation dosage. Our approach, termed vessel probability guided attenuation learning, represents DSA imaging as a complementary weighted combination of static and dynamic attenuation fields, with the weights derived from the time-independent vessel probability field. Functioning as a foreground mask, vessel probability provides proper gradients for both static and dynamic fields adaptive to different scene types. This mechanism enables self-supervised decomposition between static backgrounds and dynamic contrast agent flow, and significantly improves reconstruction quality. Our model is trained by minimizing the discrepancy between synthesized projections and real captured DSA images. We further employ two training strategies to improve reconstruction quality: (1) coarse-to-fine progressive training for better geometry and (2) temporal perturbed rendering loss for temporal consistency. Experimental results have demonstrated high-quality 3D vessel reconstruction and 2D DSA image synthesis.

Computed Tomography (CT) is essential for diagnosing pediatric craniofacial abnormalities, yet poses radiation risks to developing anatomies. Reconstructing 3D CT from sparse bi-planar X-rays offers a low-dose alternative but is severely ill-posed. Existing methods employ geometry-agnostic feature lifting, naively projecting 2D features into 3D without explicit spatial modeling, causing depth ambiguity and degraded osseous boundaries. We present PSCT-Net, a geometry-aware framework with differentiable back-projection. Differentiable back-projection establishes a spatially faithful volumetric prior, alleviating depth ambiguity. An Attention-Guided Projection (AGP-3D) module then learns non-linear voxel-wise correspondences between 2D regions and 3D locations. A Bidirectional Mamba (BiM-3D) module captures long-range volumetric dependencies with linear complexity. We further curate a private institutional pediatric skull CT cohort, PedSkull-CT, comprising normal and pathological cases for internal evaluation, addressing the gap in adult-centric, trunk-focused datasets. Project page and code are available at https://dydevelop.github.io/PSCT-Net/.