Tomography

Recent innovations in deep learning have significantly enhanced the diagnosis of medical images, although they are based on the use of centralized data storage that pose severe threats to patient privacy and medical data security. To address this issue, this research proposes a Federated Learning (FL) model that is coupled with an optimized YOLOv8 network to detect the kidney stones on a computed tomography (CT) image and at the same time, protect privacy of the patients. The suggested system can help various medical organizations to jointly train a common model without exchanging the information about the patients. This is to ensure that data protection laws like GDPR and HIPAA are adhered to. The residual feature fusion and DropBlock regularization among other architectural improvements are also included in YOLOv8 to enhance detection robustness and minimize overfitting. Experimental analysis carried out on a distributed CT dataset demonstrated that the federated YOLOv8 model has a mAP at 50 of 0.733 and is able to keep the data confidential. Moreover, its lean design facilitates fast edge deployment and real-time inference across a clinical setting. Altogether, these findings indicate that Federated Learning is a safe and efficient solution to AI-assisted diagnosis in contemporary healthcare when combined with the use of sophisticated object detection models.

Detector response nonuniformity introduces systematic projection errors and ring artifacts in photon-counting detector computed tomography (PCD-CT). In measured PCD-CT data, residual stripe amplitudes vary slowly with projection angle, which fixed-bias models cannot adequately capture. We propose TRACE, a two-stage unsupervised sinogram decomposition method for estimating and correcting these response-related errors. TRACE represents stripes as a fixed bias plus low-order discrete cosine transform (DCT) components, using a small number of coefficients to describe angular variations at each detector element. A learnable analysis--synthesis architecture represents the ideal projections, while two-stage optimization separates them from fixed and then dynamic stripes. An angular-gradient soft orthogonality constraint suppresses correlated variations within the shared DCT gradient subspace, reducing the leakage of object structures into the artifact estimate. All parameters are optimized directly on the measured sinogram without paired training data. Experiments on measured QRM mouse phantom and porcine trotter data show that TRACE suppresses ring artifacts and improves image uniformity while preserving edge sharpness, soft-tissue texture, and trabecular detail.

Robust medical image segmentation across imaging modalities is challenging because of large differences in appearance and intensity distributions. Models trained on a single modality often show substantial performance drops when applied to unseen domains. In this work, we develop a unified 3D pancreas segmentation framework that applies domain-adversarial learning to 4,604 heterogeneous CT and MRI scans to learn anatomical representations. A shared nnU-Net encoder-decoder is trained for whole-pancreas segmentation, with a latent domain discriminator encouraging CT-MRI feature alignment. The learned encoder is subsequently transferred to pancreatic head-body-tail segmentation using limited MRI-only subregion annotations. An average Dice score of 87.31% on the in-distribution test set and Dice scores ranging from 84.20% to 88.09% across external OOD datasets were achieved in whole pancreas segmentation. Dice scores of 80.53% on MRI and 83.05% on CT were achieved for downstream subregion segmentation, without using CT subregion annotations. These results demonstrate that a unified anatomical representation can support both cross-modality pancreas segmentation and label-efficient downstream transfer.

We determine the optimal sample complexity of low-rank quantum state tomography when each measurement may act jointly on at most $t$ samples. For sufficiently small $\varepsilon$, estimating an unknown state on $\mathbb{C}^d$ of rank at most $r$ to trace norm error $\varepsilon$ with constant success probability requires, and is achievable with, $Θ\left( \frac{dr}{\varepsilon^2} \max\left\{1,\frac r{\sqrt t}\right\} \right)$ samples. The lower bound allows the protocol to choose each joint measurement adaptively using all previous classical outcomes; the matching upper bound is nonadaptive. Thus joint measurements on at most $t$ samples improve the complexity of algorithms making single-sample measurements by at most a factor $\sqrt t$. Further, measuring order $r^2$ samples jointly is necessary and sufficient to attain the unrestricted collective rate. For the lower bound, we vary the support of a state with fixed uniform spectrum and bound the Fisher information trace of every joint measurement on $t$ samples. The adaptive Fisher chain rule and the van Trees inequality then give the trace norm lower bound. For the upper bound, we construct and analyze a nonadaptive tomography protocol based on a Gaussian joint measurement. An explicit second moment identity and a conditional Gaussian law outside the state's support give a rank-dependent error analysis, yielding the matching rate.

Reconstructing volumetric Computed Tomography (CT) from a single 2D chest radiograph (CXR) is an ill-posed inverse problem, further complicated by the scarcity of paired CXR-CT training data. Prior approaches address this by training on Digitally Reconstructed Radiographs (DRRs), which are synthetic projections derived from CT volumes. However, the domain gap between DRRs and real CXRs limits generalization, often resulting in coarse or anatomically inconsistent reconstructions when applied to clinical images. To address this challenging problem, this study introduces a Multi-Pass Multi-View Blended Learning framework for synthesizing high-fidelity volumetric CT directly from real chest X-ray (CXR) images. The proposed approach progressively decomposes the synthesis task into two distinct, complementary learning stages. Stage 1 is an unsupervised CXR-to-DRR Domain Adaptation, while Stage 2 includes three passes, namely, (a) supervised DRR-to-CT Transformation, (b) unsupervised Multi-View Slice Refinement, followed by (c) Progressive Transfer Learning (PTL). With such a blended learning paradigm, the proposed approach mitigates the synthetic-to-real domain gap while enhancing both the structural integrity and anatomical detail of the final output. On the LIDC-IDRI dataset, where paired DRR-CT ground truth is available for quantitative evaluation, the proposed method improves upon prior methods by up to 14% in PSNR and 7.6% in SSIM. The framework successfully generates structurally consistent and anatomically realistic high-fidelity CT volumes from real CXRs, marking a significant advancement toward clinical viability of CT reconstruction from standard radiographic images.

Malocclusion skeletal grading is a fundamental task in orthodontics, critical for diagnosis and treatment planning. Traditionally, cone-beam computed tomography (CBCT) is used for visual measurement, and the reconstructed lateral cephalograms are handed over to expert dentists for diagnosis. However, manual review is time-consuming, labor-intensive, and subject to inter-operator variability. Therefore, an automatic CBCT-based system is needed for reliable malocclusion skeletal grading. In this case, we develop TeethGNN, a novel graph-based framework designed to combine CBCT image features with morphological information for accurate and efficient malocclusion grading. TeethGNN utilizes a decoupled learnable decoder to directly predict key morphological indicators from CBCT images, eliminating the need for manual measurements. These morphological features are then fused with image features using a graph neural network (GNN), which effectively models the relationships between the modalities. To further enhance robustness and calibration, we introduce a collaborative calibration strategy. This strategy combines multi-scale graph adversarial perturbation for explicit calibration and nonlinear topological graph calibration for implicit confidence adjustment. Extensive experiments and ablation studies on our collected clinical dataset demonstrate that our malocclusion measurement system achieves 77.08% in accuracy and 89.61% in AUC, outperforming the compared state-of-the-art methods. These results validate the effectiveness of graph-based multimodal fusion and collaborative calibration in improving malocclusion grading performance. Our system shows strong potential for advancing computer-aided orthodontic diagnosis, providing an accurate and reliable solution for vision-based clinical measurement and diagnosis.

Purpose: Accurate CT protocol selection is critical for diagnostic quality and patient safety, yet the current process is manual, time-consuming, and prone to inconsistencies. Prior Machine Learning methods using keywords or bag-of-words lack contextual understanding and perform poorly on rare protocols. We propose a decision support system using large language model (LLM) features to recommend protocols from free-text clinical indications, capturing clinical nuance and phrasing variation for more consistent, efficient selection. Methods: In this REB-approved retrospective study, 285,123 chest CT imaging requests from a large academic medical center (2017-2024) were split into training (228,099, 80%) and held-out test (57,024, 20%) sets. Each request included procedure names, clinical indication, HIS comments, and the selected protocol. Clinical text was embedded using a fine-tuned LLM, Meta's LLaMA-3.1-70B; these features input a logistic regression classifier predicting 18 protocol labels (e.g., PE, LDCT). Results: The pipeline achieved a weighted precision of 0.84, weighted F1-score of 0.81, and overall accuracy of 79% across 18 CT protocols. On 300 independent cases with expert consensus, the LLM reached an overall accuracy of 80% versus 83% for radiologists, with no significant difference (p = 0.263). Performance was comparable across most classes, with the LLM exceeding radiologists for some challenging categories, and entropy analyses indicated more balanced protocol use, suggesting reduced variability. Conclusion: An LLM-based recommendation system can leverage general knowledge from a large natural-text corpus to accurately assign chest CT protocols from free-text imaging requests, and may serve as a viable foundation for protocol recommendation tools where inputs require language understanding.

Weak gravitational lensing shear and convergence trace the distribution of baryonic and dark matter across space, making them a powerful probe of cosmic structure. Inferring shear and convergence from images is a challenging inverse problem. The prevailing approach to this task estimates shear from weighted averages of galaxy ellipticities, calibrates these estimates to account for systematic biases, and transforms them to reconstruct convergence, a multistage procedure that requires substantial computational resources and meticulous handling of statistical uncertainties. As an alternative, we propose a probabilistic approach to field-level weak lensing inference in which we train a deep neural network to directly map a multiband image to a variational distribution over the underlying tomographic shear and convergence fields. This neural posterior estimation (NPE) procedure implicitly marginalizes over nuisance variables in the cosmological forward model and does not require evaluating the likelihood function. It is also amortized, so it enables rapid posterior inference for astronomical surveys once the neural network is trained. When evaluated on synthetic images from the LSST-DESC DC2 Simulated Sky Survey, NPE produces well-calibrated variational distributions for shear and convergence that are consistent with the ground truth. We describe how maps sampled from these variational distributions could be used in a subsequent simulation-based inference procedure to approximate the posterior distribution over cosmological parameters.

Parameterised graph theory studies how the complexity of graph-theoretic problems depends on structural parameters of the input graph. This perspective has proved useful in analysing tensor-network simulation (Markov and Shi, 2008). Its implications for tensor-network representations and tomography are less well understood. In particular, which graph parameters determine whether a tensor-network state (TNS) admits a tractable matrix product state (MPS) or tree tensor network (TTN) representation, and which control the complexity of learning the state? We address these questions using parameterised graph theory. First, we show that cutwidth and tree-cutwidth bound the bond dimension overhead required to represent a TNS as an MPS or TTN. In the TTN case, tree-cutwidth also bounds the local dimension of the grouped subsystems. The proofs are based on entanglement rerouting, a tensor-network analogue of rerouting information in a classical network. Second, we derive graph-dependent upper bounds on the sample and computational complexity of realisable TNS tomography, with exponents that depend on cutwidth, tree-cutwidth, and a new graph parameter, learning complexity, which we bound in terms of degree and treewidth. We obtain these results by extending the disentangling MPS learner of (Cramer et al., 2010), as analysed further in (Bakshi et al., 2025; Lin et al., 2025), to TTNs and to tensor networks on arbitrary known graphs. Finally, we extend the framework beyond the realisable setting. For an arbitrary input state, our agnostic learner outputs a pure state whose fidelity is within additive error $ε$ of the optimum over tensor-network states on the given graph with a given bond dimension, with explicit graph-dependent bounds on sample and computational complexity.

The joint interpretation of metabolic function and anatomical structure is essential for clinical diagnosis in whole-body PET/CT. Although recent advances in 3D medical vision-language models have demonstrated remarkable progress, current efforts are limited to regional CT imaging, leaving a critical void in comprehensive whole-body PET/CT analysis. In this work, we introduce MetaStructAtlas, a large-scale dataset for grounded whole-body PET/CT interpretation that synthesizes multimodal imaging with integrated anatomical, metabolic, and semantic annotations. MetaStructAtlas provides 490 co-registered 3D PET and CT volumes with 50,470 organ-level segmentation masks and grounded radiology reports. To facilitate interactive reasoning, we further developed MetaStructVQA, a standardized 3D grounded visual question-answering benchmark containing 100,565 QA pairs. This framework explicitly links diagnostic queries to visual evidence across modalities, encompassing anatomical, morphological, and metabolic characteristics. Finally, we evaluate state-of-the-art 3D medical VLMs on MetaStructVQA, establishing a robust foundation for multimodal representation learning and integrated whole-body reasoning in nuclear medicine.

Digital volume correlation (DVC) provides three-dimensional full-field displacement measurements from volumetric images, but how the internal resolution of a machine-learning-based DVC model affects accuracy and operating range remains poorly understood. Here, we present RAFT-DVC, a resolution-aware family of recurrent all-pairs field transforms (RAFT)-based DVC solvers with encoder downsampling factors s = 2, 4, and 8. Using a matched design, we find that the three solvers localize displacement to approximately 0.017 feature-grid voxel, giving an empirical raw-volume error scaling of approximately 0.017s voxel. The solvers exhibit complementary operating regimes governed jointly by displacement reach and volumetric-texture compatibility. Synthetic benchmarks show that RAFT-DVC achieves errors of the same order as tuned classical DVC under fine-texture, small-to-moderate-displacement conditions and becomes competitive or advantageous under coarse-texture, large-displacement conditions. Frequency-swept tests quantify deformation spatial resolution, while tiled inference enables dense estimation on large volumes. Evaluation on confocal volumetric images acquired during indentation illustrates the importance of matching solver operating regime to deformation magnitude and image texture. Tests on micro-CT images of elastomeric foam, despite training only on particle-labeled synthetic data, provide evidence of cross-texture transfer. We also identify coordinate-order inconsistencies in three-dimensional RAFT correlation sampling and introduce a non-cubic impulse test to verify sampler geometry independently of network training. Correcting the sampler improves native-input accuracy and generalization to unseen volume dimensions. Together, these results establish RAFT-DVC as a fast, resolution-aware framework for dense DVC with characterized accuracy and operating regimes.

Automated lesion segmentation in whole-body PET/CT is complicated by the variety of physiological tracer uptake patterns and by the differing appearance of lesions across tracers. The autoPET/CT V challenge addresses this by making segmentation interactive: user scribbles marking foreground and background are supplied alongside the image, and the algorithm is expected to exploit them. We present our submission, a scribble-conditioned residual encoder U-Net operating on four input channels: CT, PET, and a sparse scribble map for each of foreground and background. The network is initialised from the autoPET-III winning weights and extended from two to four input channels, with the two scribble channels zero-initialised so that the pretrained representation is preserved exactly at initialisation. Every model is fine-tuned per fold from the corresponding autoPET-III fold checkpoint, so that no validation case is seen during pretraining. PET intensities are normalised against a per-scan aorta blood-pool reference derived from a CT segmentation, which removes tracer- and centre-specific scaling without requiring lesion labels. At inference the five fold models are ensembled by averaging their softmax outputs per sliding-window patch, before Gaussian-weighted stitching. On the challenge's five-fold split, with each fold evaluated on its own validation cases, mean Dice is 0.554 and mean lesion-level F1 is 0.528 without scribbles, rising to 0.751 and 0.733 after five correction rounds. About 85% of that gain follows the first scribble, and the spread between fold models narrows five-fold over the same rounds, so interaction largely compensates for how well or badly a given model segments unaided.

Non-destructive X-ray and computed tomography (CT) testing are essential for ensuring the dimensional accuracy of manufactured components with complex internal structures, such as the cooling channels in gas turbine blades, which directly affect thermal performance and service life. This study presents a multipart 3D-2D rigid registration approach for aligning CAD models with X-ray projections as an alternative to CT reconstruction for part inspection and measurement. A greedy registration algorithm sequentially aligns the blade's exterior before registering its internal components by maximizing the mutual information between simulated and acquired X-ray images. This stepwise approach reduces problem complexity and improves alignment accuracy. View angles are optimized using a greedy method that iteratively selects angles to minimize dimensional measurement errors. The results indicate that a small number of oblique views provides the best accuracy, although a broad range of angles yields acceptable results. The method achieves subpixel registration accuracy, with errors below one-fifth of the magnified detector-pixel pitch. Image noise and defects reduce registration precision, but direct registration in projection space mitigates these effects compared with CT reconstruction. Appropriate view selection can therefore preserve acceptable subpixel accuracy in the presence of image noise and defects.

Low-dose computed tomography (LDCT) measurements contain mixed Poisson-Gaussian noise. However, most self-supervised methods rely on generic image statistics and do not explicitly model this noise, which may limit their ability to effectively suppress realistic LDCT noise. To address this issue, we propose a physics-driven framework with cross-domain iteration for self-supervised LDCT denoising. The proposed framework proceeds in three main steps. First, a learned sinogram prior and the LDCT noise model guide posterior inference of photon counts, enabling separation of the Poisson and Gaussian components. Second, the separated Poisson and Gaussian components are respectively processed by binomial thinning and Gaussian data thinning to construct two branches, and residual scaling matches each branch's noise level to that of the observation, yielding a training pair with approximately independent noise realizations from one low-dose measurement. Finally, the pair is used to train an image-domain network whose forward-projected outputs update the prior. Through cross-domain iteration, the prior and the training pair are progressively refined while maintaining consistency with CT acquisition physics. Experiments on simulated data from AAPM, LIDC-IDRI, and LoDoPaB-CT and on real LDCT data show consistent gains over the evaluated self-supervised baselines across dose levels, with performance comparable to the evaluated supervised baseline.

Accurate 3D abnormality segmentation in chest CT requires dense spatial supervision, but obtaining expert voxel-level labels is costly. Radiology reports, however, are routinely generated during clinical interpretation and contain instance-specific descriptions that can provide additional guidance without new dense annotation. Existing vision-language grounding methods typically require report-derived findings at inference, making localization dependent on paired text and limiting each forward pass to a queried finding. We propose Instance-Guided Report Anchoring (IGRA), a model-agnostic module that preserves the correspondence between each annotated abnormality instance and the report finding that describes it. IGRA pools each instance representation and anchors it to the corresponding finding embedding during training; all text-related components are discarded at inference. We further reformulate free-text grounding on ReXGroundingCT as multi-label volumetric segmentation by merging same-category instances, allowing all abnormality categories to be predicted in one image-only forward pass. IGRA improves Dice by 22.5% over the strongest image-only baseline (30.93 vs. 25.25) and is comparable to VoxTell on the single-finding subset (30.29 vs. 30.43). Applied unchanged to four standard 3D segmentation backbones, IGRA improves Dice and hit rate across all architectures. Zero-shot evaluation on LIDC-IDRI, PleThora, and a private in-house dataset further shows consistent gains over image-only baselines.

Background: Patient details and acquisition metadata are important for clinical decisions, image quality control, and automated research pipelines, but may be missing or unreliable in imaging archives. Purpose: To develop and evaluate a fast open-source model that predicts patient and acquisition characteristics directly from CT and MR images. Materials and Methods: Separate 3D ResNet-10 ensembles for CT and MR were trained on 57,291 and 43,200 clinical examinations acquired from 2011 to 2025. Both predicted weight, height, age, sex, contrast presence, vertebral coverage, and image noise. The CT model additionally predicted scanner manufacturer, tube voltage, tube current, convolution kernel, and post-injection time; the MR model predicted sequence class. Performance was evaluated on internal CT (n=501) and MR (n=636) test sets and an external CT dataset (n=54). Results: Internal CT MAEs were 3.90 kg, 3.68 cm, and 4.42 years for weight, height, and age, with sex F1=0.990; corresponding MR results were 4.34 kg, 4.62 cm, 7.13 years, and F1=0.970. The CNN outperformed a segmentation-derived XGBoost baseline for all four core targets in both modalities (adjusted P<=.042). F1 scores were 0.963 for CT contrast, 0.953 for MR sequence, and 0.823 for MR contrast. External CT MAEs were 4.45 kg, 4.05 cm, and 5.17 years, with sex F1=0.971. CPU inference required 20 seconds for CT and 12 seconds for MR. Conclusion: One 3D multitask model per modality can rapidly recover patient and acquisition characteristics from heterogeneous CT and MR examinations. Models are available in TotalSegmentator: https://github.com/wasserth/TotalSegmentator

Cone-beam computed tomography (CBCT) enables volumetric reconstruction from X-ray projections, but suffers from severe artifacts--especially beam hardening--when imaging materials with high attenuation such as metals. These artifacts arise from the polychromatic nature of X-rays and are not properly addressed by conventional monochromatic reconstruction algorithms. While recent neural representation-based methods offer improved reconstruction quality, they are computationally expensive and often impractical for deployment. We propose a novel physics-inspired, self-calibrating metal artifact reduction method that efficiently reconstructs 3D CBCT volumes while correcting beam hardening artifacts. Our method integrates a polychromatic X-ray projection model, material-dependent attenuation profiles, and system response modeling into a Gaussian Splatting framework. Unlike prior work, we eliminate the need for manual metal masks or strong prior assumptions, and we optimize both reconstruction parameters and X-ray spectral characteristics jointly during training. We further introduce a high-fidelity synthetic CBCT dataset generation pipeline validated on Monte-Carlo x-ray simulation toolbox and release new datasets with severe metal-induced artifacts to support the community. This is the first splat-based method for reducing beam hardening in CBCT. Extensive experiments on both synthetic and real-world datasets demonstrate that our method outperforms state-of-the-art approaches in artifact suppression and reconstruction accuracy.

Clinical intelligence requires estimating a patient's underlying condition from incomplete observations rather than learning isolated mappings from scans to answers. Volumetric medical images provide dense observations of anatomy, attenuation, and lesions, whereas clinical language provides sparse but complementary semantic observations. We formulate CT-centered intelligence as inference over a shared latent patient state, under which readout, reconstruction, and simulation all become state-dependent prediction problems. To operationalize this view, we introduce HounsBench, a computed tomography (CT) centric patient-state benchmark that unifies these three task families with patient-disjoint splits and per-family metrics, and HounsWorld, a 3B multimodal world model that treats volumetric scans and language as observations of the shared state through Joint Understanding-Generation Learning. A shared transformer forms an implicit patient-state estimate and supports three outputs: query-conditioned answers that read out the state, reports and captions that reconstruct it in language, and condition-specific CT volumes for low-dose denoising, virtual contrast enhancement, and anatomy-constrained text-and-mask-to-volume generation. Zero-initialized CT adapters preserve pretrained multimodal mappings, while condition-explicit Hounsfield-unit window sampling exposes clinically meaningful density observations. HounsWorld shows strong performance across all three task families while consistently improving CT understanding through clinically structured completion. Our project is available at https://github.com/byhwhite/HounsWorld.git

In medical imaging, the clinical value of Computed Tomography (CT) lies not only in depicting current disease status, but crucially in enabling longitudinal comparison of serial scans to determine disease evolution, a process that underpins response assessment, recurrence detection, and ongoing patient management. Yet, despite this central role of temporal comparison in clinical decision-making, existing medical foundation models remain largely confined to single-study understanding, leaving temporally grounded cross-examination insufficiently addressed. To address this gap, we study longitudinal imaging difference reporting, a task in which a model takes two temporally separated scans from the same patient and generates a clinically meaningful report describing interval changes between them. We introduce CT-$Δ$Bench, a dedicated benchmark for this task with patient-level splitting to prevent information leakage. To better evaluate this task beyond surface-level text similarity, we further develop change-aware metrics specifically designed to capture clinically meaningful longitudinal changes, and conduct an independent physician validation to assess the reliability of the synthesized references and event extraction pipeline. We also compare direct paired-CT reasoning with an indirect two-stage pipeline that first generates single-timepoint reports and then performs textual differencing. Finally, we propose DeltaMed, a baseline model for direct paired-CT difference reporting, and train it on the benchmark training set. Together, these contributions lay the groundwork for temporally aware medical foundation models that better reflect real-world longitudinal clinical reasoning.

Automated lesion segmentation in whole-body PET/CT imaging can assist clinicians with cancer detection, staging, and treatment planning across radiotracers and cancer types. However, training lesion segmentation models that capture variations in lesion size, distribution, and appearance requires large annotated datasets, whose creation is both time- and expertise-intensive. As a result, models trained on limited labeled PET/CT data often lack the accuracy and generalizability needed for clinical use. We present FEEDS (Foundation model-Enabled Efficient Data Sampling), a label- and compute-efficient learning strategy that uses vision foundation model embeddings to select the most informative and diverse unlabeled cases for expert annotation. Unlike unsupervised, semi-supervised, and active learning approaches, FEEDS is a one-step training paradigm requiring only a limited, representative training set, making it label- and compute-efficient. We train and validate FEEDS using the AutoPET-III dataset. We test its accuracy and generalizability on three held-out sets: AutoPET-III, DeepPSMA, and an internal Dartmouth-Hitchcock Medical Center dataset. We evaluate clinical utility at the voxel, lesion, and anatomic region level to assess performance in high-risk areas and treatment planning utility. FEEDS outperforms random-sampling-based labeling, pseudolabel-based semi-supervised learning, and training with limited labeled data alone. It generalizes across all three test sets, FDG and PSMA tracers, and multiple diseases, matching fully-labeled (100%) training performance with 70% less annotation burden. FEEDS addresses the challenge of label scarcity in an automatic lesion segmentation framework by providing a practical approach for constructing representative and diverse annotation queues from large, unannotated clinical repositories.

While deep learning-based denoising has become widely adopted in low-dose CT, conventional models use generic architectures designed for natural images, failing to account for non-stationary and spatially correlated CT noise characteristics. To address this, we propose an Efficient Noise COntext-aware REpresentation (ENCORE) framework that explicitly leverages CT noise characteristics and anatomical features. First, we reformulate the noise synthesis procedure based on a realistic noise distribution beyond the conventional Gaussian approximation, establishing a rigorous foundation for training pair generation. Next, we extract local noise power and correlation contexts to guide the denoising process. To fully leverage the potential of noise context, we propose a FlyingConv module, which adaptively changes convolution weights for each local image region. Notably, our approach demonstrates substantial gains in both denoising quality and computational efficiency. Furthermore, manipulating the intensity of the noise context maps at inference time enables zero-shot conditional denoising, allowing for dynamic control over the output image texture. The entire pipeline is available at https://github.com/minwoo-yu/ENCORE.git

Most radiotherapy dose-prediction models use only CT images and anatomical structures, although intensity-modulated proton therapy (IMPT) dose also depends strongly on beam geometry and available clinical datasets are often small. We present DoseBridge, a denoising diffusion bridge model that uses the patient CT as a structured bridge endpoint and encodes plan-specific beam geometry in a spatially aligned beam mask. Multiscale fusion combines CT, target, organ-at-risk, and beam-mask representations with 1.95% additional parameters. DoseBridge was retrospectively evaluated on single-institution CT images and treatment plans from 52 patients with advanced-stage lung cancer treated with 60 Gy in 30 fractions; 42 cases were used for training and 10 for testing. Performance was assessed using image-similarity, dose-volume, and Lyman-Kutcher-Burman normal-tissue complication probability (NTCP) metrics and compared with two deep-learning models. On the test cohort, DoseBridge achieved a mean absolute error of 4.170 Gy, peak signal-to-noise ratio of 23.06 dB, and structural similarity index of 0.798, outperforming both comparison models on these metrics. Clinical target volume D95 differed from the reference dose by 0.62 +/- 1.6 Gy; signed organ-at-risk mean-dose differences ranged from -0.32 to 0.24 Gy, and NTCP differences were -0.40 +/- 2.2 and 0.52 +/- 3.4 percentage points for acute esophagitis and radiation pneumonitis, respectively. Changing only the beam mask redirected predicted low-dose entrance regions while preserving the high-dose target region. To our knowledge, DoseBridge is the first denoising diffusion bridge model for radiotherapy dose prediction. These results support its feasibility as a beam-aware planning prior for lung IMPT, pending evaluation in larger external cohorts.

During standard radiotherapy planning, repeated CT acquisitions are often required for patient registration, verification, and adaptive planning, resulting in increased cumulative X-ray dose. To mitigate this, low-dose cone-beam CT (CBCT) is routinely acquired during treatment delivery. However, CBCT image quality remains insufficient for accurate dose calculation and adaptive radiotherapy planning due to increased scatter, noise, beam hardening, and reconstruction related artifacts. This study develops a supervised deep learning based CBCT to CT synthesis framework using a conditional denoising diffusion probabilistic model (DDPM), where the generation of a CT-based planning for accurate positioning and dose calculation is obtained using generative models with low dose CBCT imaging. Beyond demonstrating CBCT to CT synthesis, the primary objective is to investigate how the representation of CBCT input data, either standard clinical DICOM CBCT images or filtered back-projection (FDK) reconstructions from raw projection data, affects the performance of diffusion based CT synthesis. The overarching aim is to assess whether physics aware CBCT representations better support CT-equivalent image quality while maintaining reduced imaging dose in radiotherapy workflows.

Hierarchical Phase-Contrast Tomography (HiP-CT) is a synchrotron based X-ray imaging technique that enables non-destructive, volumetric imaging of intact organs with multi-resolutions bridging 20 $μm$/voxel for whole organs to near-cellular resolution ($\sim$0.8 $μm$/voxel) in local regions. This offers the opportunity to bring volumetric whole-organ context to histology. However, nonlinear registration between H&E histology and HiP-CT volumes is challenging due to the differences in feature representations of different colour spaces. Synthesis-before-registration methods have shown strong results in histology-to-MRI and histology-to-CT alignment. However, existing approaches either rely on manual anatomical contours or are trained from scratch without semantic constraints, limiting their generalisability to soft tissue organs and novel modalities. We propose LoRCA (LoRA Cycle Adaptation), a cycle consistent style translation framework built on a shared frozen DINOv3 with modality-specific LoRA adapters, learning modality-specific representations that are decoded and adversarially trained. LoRCA enables structure-preserving translation without requiring paired training data. The frozen backbone is intended to be a structural anchor that prevents content drift by preserving pretrained semantic-extraction capability. We evaluate translation quality using Fréchet Inception Distance (FID) and structural fidelity via mutual information and Canny edge preservation. LoRCA outperforms CycleGAN in both translation quality and structural consistency. As a preliminary indicator of downstream registration utility, we find that style-translated images yield increased feature correspondences under MatchAnything on manually aligned HiP-CT and histology test pairs, suggesting that LoRCA-style translation is a promising step towards 2D histological sections to 3D HiP-CT volumes registration.

Registration between cone-beam computed tomography (CBCT) and intraoral scans (IOS) is essential for patient-specific surgical planning. However, disparate imaging modalities, limited overlap, and large pose offsets make automated registration unreliable. Consequently, clinical registration remains dependent on conventional geometry pipelines and manual clinician adjustment. To address these challenges, we propose APCReg, an anatomical-prior-guided coarse-to-fine framework for global registration and reliability-controlled residual correction. Specifically, multi-view anatomical coarse registration (MACR) performs ordered orthogonal projection alignment (buccal, proximal, and occlusal) to decompose the six-degree-of-freedom search before three-dimensional refinement. Overlap-aware residual registration (OARR) combines shared KPConv features, a folded arch-length cue, overlap-gated cross-attention, and Sinkhorn matching. Finally, dental-arch-structured hypothesis selection evaluates diverse poses on held-out reliable correspondences, while a ground-truth-free coarse-retention guard conditionally retains a geometrically reliable coarse pose. On 60 held-out jaw pairs, APCReg achieves a submillimeter mean Chamfer distance of 0.87 mm and a Hausdorff distance of 2.92 mm under this evaluation protocol, and ranks first across the six reported metrics among the evaluated open-source baselines.

Mandibular reconstruction restores facial continuity and oral function after segmental resection. Patient-specific cutting guides transfer a computed tomography (CT)-based plan to the operating room with three-dimensional information, but printed guides add cost and lead time, cannot adapt after fabrication, and may interrupt surgery if sterility is lost. We investigate a markerless augmented reality (AR) alternative that registers a virtual cutting guide to the exposed mandible from surface geometry. The method extends surface-based registration for the transoral setting, where teeth form the most distinctive visible surface. After camera calibration, a HoloLens 2 time-of-flight camera captures a partial intraoperative point cloud. The user supplies a rough head-based alignment only to crop the region of interest. A teeth-weighted global stage computes correspondences and solves a truncated least-squares rigid alignment. An asymmetric point-to-plane iterative closest point (ICP) stage refines the complete CT mandible against the partial depth cloud target. The guide-to-mandible transform places the guide in the HoloLens world frame, while pose updates and interpolation follow target motion. We define a blinded phantom protocol with 30 target registration error (TRE) points under full, intermediate, and teeth-only exposure, plus a motion-to-display latency test. Our median TRE is 4.05, 6.10, and 7.10 mm respectively, and median latency is 0.805 s. These values support the feasibility of using AR to replace physical prints. The workflow removes mounted fiducials and manual landmark selection and provides a testable path toward transoral cutting guidance.

Routine CT interpretation is inherently comprehensive, capturing incidental findings across the entire scan volume. 3D CT foundation models could assist this process by providing generalizable representations of anatomy and pathology. To evaluate their diagnostic breadth, we benchmark ten frozen CT encoders across three cohorts of thoracic CT scans, including an unseen internal clinical dataset, using $k$-nearest neighbors, zero-shot prompting, and linear probing. We find no universal state-of-the-art, with rankings fluctuating significantly depending on the evaluation context. While models combining fine-grained image tokenization with vision-language alignment generally perform best, a lightweight supervised encoder remains highly competitive, demonstrating that explicit labels can effectively substitute for scale. Crucially, rather than model architecture, we observe that the primary determinant of performance is a physical bottleneck: a finding's detectability scales with its contrast against surrounding tissue and its spatial extent. Through controlled within-organ comparisons, we empirically demonstrate that widespread or high-contrast abnormalities, such as devices and effusions, are reliably recovered. Conversely, small, low-contrast focal lesions remain a persistent challenge across all evaluated encoders. We attribute this to the inherent limitations of globally pooled embeddings, suggesting that accurately representing small, low-contrast structures will require region- or lesion-level pretraining.

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.

Computed tomography (CT) is widely used for clinical diagnosis and longitudinal follow-up, yet automatically generating accurate and complete radiology reports from three-dimensional (3D) CT remains challenging. Existing methods improve fine-grained correspondence between images and text by modeling anatomical regions, but remain centered on the current examination. Consequently, patient-specific longitudinal changes within individual regions remain insufficiently modeled. Meanwhile, interval changes are often distributed across multiple anatomical regions, complicating a coherent assessment of the overall longitudinal state. We propose Anatomically Localized Temporal Evidence Representation (ALTER) to address these limitations. Global Prior Integration (GPI) incorporates the prior CT and report to establish historical context for the current examination. Regional Proxy Differencing (RPD) enables each current anatomical region to retrieve a historical proxy from a single shared encoding of the prior volume and to derive localized interval evidence. Interval Change Fusion (ICF) further combines current abnormality states with region-distributed differences, converting their joint representation into change-aware soft prompts that guide report generation. ALTER achieves state-of-the-art results on most evaluation metrics across the RadGenome-ChestCT validation and CTRG-Chest-548K test sets. Code and data preprocessing details are available at https://github.com/peytonkarlie/ALTER/tree/main.

The emergence of medical deepfakes, i.e., medical images manipulated by deep generative models, poses a significant threat to clinical workflows. However, existing detectors suffer from two critical limitations: poor generalization to unseen generative architectures for manipulation detection and lack of interpretability. In this context, we present HexMIL (Hierarchical EXplainable Multiple Instance Learning), a mask-free medical deepfake detector that simultaneously addresses both limitations using only binary volume-level supervision. HexMIL decomposes each CT volume into a two-level hierarchy of patches and slices, aggregated via independent Gated Attention modules whose weights are directly combined into a full-resolution 3D attention volume that localizes the manipulated sub-region without any pixel-level annotation. Unlike post-hoc methods such as Grad-CAM, HexMIL's attention weights constitute the exact forward computation driving the classification decision, providing ante-hoc and structurally faithful spatial attribution. We evaluate HexMIL on M3DSynth and CT-GAN datasets under a rigorous cross-generator generalization protocol, training on a single generative architecture and testing on unseen ones. HexMIL outperforms all baselines by $+9.1$ AUC and $+9.4$ F1 in out-of-domain classification, and achieves the best average IoU and Pointing Game score in localization. Project page: opontorno.github.io/hexmil.

X-ray computed tomography (CT) suffers from severe metal artifacts when high-attenuation objects such as dental fillings or orthopedic implants are present. These artifacts originate from the polychromatic nature of X-rays, where attenuation varies strongly with photon energy and material composition, breaking the monochromatic assumption used by conventional reconstruction algorithms. Recent neural rendering approaches attempt to address this mismatch through differentiable polychromatic projection models, but they still struggle with smoothness bias, loss of fine structures, and prohibitive computation when extended to large-scale cone-beam CT. We introduce a splat-based metal artifact reduction framework that incorporates a physically grounded polychromatic forward model into a continuous Gaussian representation for cone-beam CT. Each Gaussian encodes the energy-dependent attenuation of the underlying material using a compact material parameterization, which enables efficient joint optimization of geometric and material properties without relying on a metal mask. This compact attenuation formulation captures the essential variation across biological tissues and metallic implants, allowing our model to explain metal-induced nonlinearity while preserving high-frequency structure. Experiments on simulated and real cone-beam CT scans show that our method converges significantly faster and suppresses metal artifacts more effectively than existing reconstruction and neural field-based approaches.

X-ray computed tomography (CT) reconstructs volumetric representations of objects from projection images obtained by transmitting X-rays through a target. Recent splat-based tomography, which represents a volume as a continuous distribution of 3D Gaussians, has demonstrated both high reconstruction quality and fast convergence in cone-beam sparse-view CT. However, when deployed in real CT systems with limited and non-uniform view distributions, we observe distinctive streak and strip artifacts that are far more pronounced than in conventional reconstruction methods. Through detailed analysis, we show that these artifacts primarily originate from pose inaccuracies in the acquisition geometry rather than from view sparsity itself. We revisit pose sensitivity in the splatting formulation and derive a stable gradient-based framework that jointly refines geometric parameters during reconstruction. Our study not only identifies how pose perturbations propagate through the differentiable projection operator but also reveals why splat-based CT is particularly vulnerable to geometric misalignment. The resulting formulation remains lightweight and easily integrable into existing pipelines while substantially improving reconstruction fidelity under real-world sparse-view conditions.

Four-dimensional cone beam CT (4D CBCT) is important for image-guided radiation therapy of thoracic cancers, but its use is limited by long scan times, causing high patient dose and motion/sparse-sampling artifacts. We propose a deep learning method for motion-resolved 4D CBCT reconstruction from conventional free-breathing scans, without a respiratory signal or explicit projection binning. Our CNN takes free-breathing 3D CBCT projections as input and predicts a static volume at maximum inhalation plus ten displacement vector fields (DVFs) spanning a breathing cycle. The network extends U-Net: the encoder acts on filtered projection stacks, the decoder acts in the volume domain, and skip connections are replaced with non-trainable back-projection functions at multiple resolutions to transfer features between domains. The model is trained on simulated CBCT scans and evaluated on 11 unseen simulated patients and 13 clinical free-breathing scans. Two additional models (60 s and 6 s scans) were evaluated by clinical experts on three and two scans, comparing single phases of our 4D reconstruction to reference 3D SART-TV images for tumor and esophagus visibility. Experts preferred our method for tumor visibility (59% vs. 36% no preference, 5% reference) and esophagus visibility (47% vs. 42%, 11%). On simulated data, image quality matched SART-TV (mean RMSE: -1.19 HU, PSNR: +0.09 dB, SSIM: -0.009) while enabling 4D reconstruction. On clinical scans, our method showed sharper dynamic structures (e.g., diaphragm) and fewer motion streak artifacts than traditional reconstruction. This non-patient-specific CNN predicts static volumes and full 4D respiratory motion models from a single free-breathing scan, without a respiratory surrogate or projection binning, reducing motion artifacts while adding motion-modeling capability.

Precise 3D characterization of nanomaterials is essential for unlocking structure-property relationships. However, standard electron tomography is fundamentally limited by the missing wedge problem. Consequently, conventional algorithms suffer from severe geometric distortions, a challenge further complicated by pervasive noise interference. Current learning-based methods either rely on physics-blind post-processing or employ end-to-end architectures constrained by local receptive fields, failing to capture complex 3D topologies. We propose NanoMorph-3D, a unified end-to-end framework grounded in a comprehensive Nanomorphological Taxonomy. Powered by a large-scale synthetic dataset explicitly modeling non-linear electron attenuation, we design a Physics-Driven Unrolled Network mapping proximal gradient descent into a learnable architecture. To capture complex internal topologies, we formulate a hierarchical attention mechanism with Physics-Normalization for long-range 3D dependencies and scale invariance. Crucially, our Dual-Domain strategy leverages Sinusoidal Attention to explicitly model physical projection trajectories, enforcing strict sinogram consistency to mitigate missing wedge artifacts. Finally, an unsupervised dual-stream mechanism bridges the simulation-to-reality gap. Experiments demonstrate NanoMorph-3D reconstructs diverse topologies with superior fidelity and speed.

Head-and-neck (HN) proton therapy is highly sensitive to anatomical change over a 4-to-6-week course, as tumor shrinkage, weight loss, and setup variation can misposition the Bragg peak near critical organs such as the parotids, oral cavity, brainstem, and spinal cord, leading to target underdosing or organ-at-risk overdosing. Online adaptive proton therapy replans on the anatomy of the day, yet standard workflows rely on offline replanning that requires repeated CT acquisition and roughly a week of preparation, adding burden, cost, and delay. We investigate whether a patient's treatment-day anatomy can be predicted before image acquisition by transferring longitudinal change from a population database. We propose a digital-twin framework built on a pretrained foundation-model deformable registration network used without patient-specific training. A first registration aligns a prior patient's planning CT to the target and carries the prior's during-treatment quality assurance CT (QACT) into the target frame; a second registration estimates the prior's planning-to-QACT change, which is then applied to the target's own planning CT to synthesize predicted CTs (pdCTs) with propagated contours. Using 88 HN patients, each with a planning CT and three QACTs, we show that pdCTs better match treatment-day anatomy than the static planning CT. Compared with the planning CT alone, normalized cross-correlation improves by 22.8%, Dice for organs-at-risk by 20.2%, and CT-number error decreases by 23.4%. Gains are largest for patients with major anatomical change and negligible when anatomy is stable. This cross-patient motion transfer leverages the digital-twin concept to anticipate treatment-day anatomy, enabling personalized online adaptive proton therapy without repeated imaging.

A 3D CT scan entering a vision-language model produces a long sequence of visual tokens, often thousands to tens of thousands per volume, and this sequence must be compressed before a language model can consume it. Token compression is well studied in general vision, but little of it targets 3D CT specifically. A common baseline is grid average, which pools regular grid cells and can blend distinct anatomy, lesion, and air into one token. We present \textbf{ORCA} (ORgan-Centroid Aggregation), a token compressor for 3D CT. It merges adjacent tokens with organ guidance and adds a sinusoidal encoding of each region's centroid to preserve spatial layout. This preserves the anatomical information a downstream model needs. ORCA is training-free and plug-and-play, producing an adjustable token set without any model change or text query. We evaluate it across two datasets (CT-RATE and Merlin) and five encoders. The evaluation spans two task types: attribute prediction over five families (size, density, location, texture, and disease) and text generation (visual question answering and report generation). At matched token budgets, ORCA improves consistently over existing compression methods. It shrinks the visual context $64\times$ and its KV-cache $50\times$, and is $31\times$ faster to process each volume. Code released at https://github.com/renjie-liang/ORCA-3DCT.

Volumetric CT vision-language pretraining learns 3D representations from scan-report pairs, but global and anatomy-aware objectives supervise only correspondence: they establish what is present and leave how much unconstrained. Nothing separates a mild from an extensive case of the same finding along a consistent direction, so the graded burden language in reports collapses into a present/absent signal. Longitudinal supervision would supply this order, but patient-matched CT pairs are scarce at scale; cross-sectional cohorts already encode weak burden cues across different patients. We introduce Spectrum, an anatomy-conditioned framework that represents each study at whole-study and organ scopes. For each organ-mapped pathology, a rule-based scorer mines confidence-filtered lower-to-higher pairs of different patients, and Burden-Direction Alignment (BDA) aligns the pathology-conditioned image delta with the report delta at each scope, separating that direction from its reverse. Because the endpoints are different people, a target-conditioned aligner first makes them comparable, so the delta reflects burden rather than between-patient variation. BDA further separates the selected direction from its reverse, anchors it to the observed higher-burden endpoint, and enforces consistency across ordered triplets. Since every pair is drawn within a single pathology, BDA is designed to constrain intra-class structure that image-report contrast alone never touches. Spectrum attains 85.6 zero-shot AUROC on CT-RATE and 72.7 on external RAD-ChestCT, with consistent gains in linear probing and retrieval. Weak cross-patient order is thus a scalable complement to anatomy-aware correspondence, yielding burden-aware CT representations without longitudinal data.

Medical image quality plays a critical role in diagnostic accuracy, especially in X-ray-based imaging modalities such as cone-beam computed tomography (CBCT), where image quality must be balanced against radiation dose. While expert visual evaluation remains the clinical standard for image quality evaluation, it is time-consuming, subjective and affected by inter-observer variability, emphasizing the need for reliable quantitative image quality assessment (IQA) methods. However, the development and validation of such IQA methods have been limited by the lack of publicly available CBCT datasets with expert image quality annotations. In this study, we provide the first open-access CBCT IQA dataset containing 1,764 annotated image slices acquired using systematic variations in image acquisition and reconstruction parameters. Three clinical experts graded the overall image quality and a predefined regions of interest (ROI) using a four-level scoring scheme. In addition, we benchmark 26 full reference- and no reference-based IQA measures against expert annotations and introduce an exploratory IQA measure-based ranking capable of distinguishing subtle image quality differences. This dataset introduced a standardized benchmark for future CBCT IQA research and provides a valuable resource for the development and validation of new IQA methods, enabling reproducible research and advancing CBCT IQA.

Transcranial focused ultrasound (tFUS) is a non-invasive technique that delivers focused acoustic energy through the skull for neuromodulation and therapeutic applications. However, the heterogeneous structure of the skull induces complex, patient-specific phase and amplitude aberrations that distort the acoustic focus and deviate it from the intended target, compromising therapeutic efficacy and safety. Conventional time-reversal (TR) simulations can correct these aberrations but rely on computationally expensive full-wave solvers, making them impractical for real-time use and iterative treatment planning. We propose a few-shot deep surrogate framework that predicts per-element phase and amplitude corrections for a 96-element 3D phased-array transducer from patient CT images. A geometry-aware encoder extracts skull-path features shared across dedicated phase classification and amplitude regression branches, where phase periodicity is handled via circular expectation decoding. The framework is pretrained on diverse skull geometries and fine-tuned with only ten target points, enabling rapid adaptation to unseen patients without full patient-specific simulation. Evaluated via leave-one-out cross-validation across 12 skulls, it achieves a mean phase CMAE of 0.155 rad and amplitude rMAE of 9.089%, a focal centroid error of 0.467 mm, Dice score of 94.422%, and peak pressure ratio of 92.332%, with an approximately 2,535 times speedup over TR simulation. The code is available at https://github.com/Minju-Seol/fewshot-tfus-correction.

This paper proposes an automated classification method of COVID-19 chest CT volumes using improved 3D MLP-Mixer. Novel coronavirus disease 2019 (COVID-19) spreads over the world, causing a large number of infected patients and deaths. Sudden increase in the number of COVID-19 patients causes a manpower shortage in medical institutions. Computer-aided diagnosis (CAD) system provides quick and quantitative diagnosis results. CAD system for COVID-19 enables efficient diagnosis workflow and contributes to reduce such manpower shortage. In image-based diagnosis of viral pneumonia cases including COVID-19, both local and global image features are important because viral pneumonia cause many ground glass opacities and consolidations in large areas in the lung. This paper proposes an automated classification method of chest CT volumes for COVID-19 diagnosis assistance. MLP-Mixer is a recent method of image classification using Vision Transformer-like architecture. It performs classification using both local and global image features. To classify 3D CT volumes, we developed a hybrid classification model that consists of both a 3D convolutional neural network (CNN) and a 3D version of the MLP-Mixer. Classification accuracy of the proposed method was evaluated using a dataset that contains 1205 CT volumes and obtained 79.5% of classification accuracy. The accuracy was higher than that of conventional 3D CNN models consists of 3D CNN layers and simple MLP layers.

This paper proposes an automated classification method of chest CT volumes based on likelihood of COVID-19 cases. Novel coronavirus disease 2019 (COVID-19) spreads over the world, causing a large number of infected patients and deaths. Sudden increase in the number of COVID-19 patients causes a manpower shortage in medical institutions. Computer-aided diagnosis (CAD) system provides quick and quantitative diagnosis results. CAD system for COVID-19 enables efficient diagnosis workflow and contributes to reduce such manpower shortage. This paper proposes an automated classification method of chest CT volumes for COVID-19 diagnosis assistance. We propose a COVID-19 classification convolutional neural network (CNN) that has a 2D/3D hybrid feature extraction flows. The 2D/3D hybrid feature extraction flows are designed to effectively extract image features from anisotropic volumes such as chest CT volumes for diagnosis. The flows extract image features on three mutually perpendicular planes in CT volumes and then combine the features to perform classification. Classification accuracy of the proposed method was evaluated using a dataset that contains 1288 CT volumes. An averaged classification accuracy was 83.3%. The accuracy was higher than that of a classification CNN which does not have 2D and 3D hybrid feature extraction flows.

In X-ray CT, metallic objects cause beam hardening, photon starvation, and scattering, leading to projection inconsistency, streaks, dark bands, and structural distortions that compromise clinical diagnosis and quantitative analysis. Existing metal artifact reduction (MAR) methods remain limited: optimization-based methods may leave residual artifacts or blur structures, regression networks may generalize poorly across scenarios, and generative models without sample-specific structural guidance and physical constraints may produce anatomically inconsistent structures. Flow Matching learns a continuous-time velocity field that deterministically transports a source distribution to a target distribution, providing a flexible MAR prior. However, standard unconditional Flow Matching does not exploit sample-specific structure, spatially nonuniform metal-induced degradation, or measured projections. To address these limitations, we propose SCMA, a structure-conditioned and metal-aware Flow Matching framework. First, a linear-interpolation-corrected image is fed into the velocity network with the intermediate state as a sample-specific structural condition, guiding inference toward artifact-free CT images while preserving anatomy. Second, time-varying spatial weights from the metal mask and its distance transform are incorporated into the Flow Matching loss to emphasize severe degradation within and around metal regions. Finally, conditional Flow Matching updates alternate with projection-consistency correction during inference, allowing reliable measurements outside metal traces to constrain predictions. Experiments on simulated and real CT data demonstrate that SCMA more effectively suppresses metal artifacts, preserves local anatomical structures, and reduces hallucination-like structures inconsistent with projection measurements than representative MAR methods.

We present a novel technique for predicting the imaging quality of anomalies such as cancer cells located inside organic tissues. This technique is useful for evaluating and designing RF tomography sensors.

Time-varying implicit neural representations (INRs) provide a compact representation of scientific volumes and, for modalities such as dynamic X-ray computed tomography (CT), are often the only practical way to represent the data. However, interactive volume rendering of INRs is challenging, as cheap memory lookups are replaced by expensive neural inferences, hindering the performance. Therefore, conventional volume rendering methods such as ray marching with dense sampling are often impractical. While resampling, caching, and retraining can mitigate this cost, they compromise convenience and accuracy and become impractical for time-varying data. We tackle these challenges using a query-efficient stochastic volume rendering framework based on delta tracking. Our system employs a four-stage pipeline that exploits heterogeneous parallelism, using ray tracing cores for traversal and tensor cores for batched neural evaluation. Furthermore, we present strategies to reduce INR queries via ray budgeting and query pruning, thereby increasing per-frame performance. Using our renderer, many time-varying INRs can be rendered directly from their original representation. The system achieves ~30-40 FPS at 1024x1024 resolution on an RTX 4090 GPU and converges to high-fidelity images. Moreover, the system enables interactive temporal exploration of the continuous domain, with timestep updates taking approximately 1-2 ms.

The rapid emergence of 3D CT foundation models has opened new avenues for predictive modeling from CT imaging, offering a compelling alternative to traditional radiomics which is known to suffer from reproducibility issues and sensitivity to acquisition protocol variations. Yet, as these models grow in availability, a critical need arises to evaluate how well their learned representations generalize across diverse clinical settings and whether adaptation to specific downstream tasks is necessary to unlock their full potential. To address these questions, we benchmarked several 3D CT foundation models for predicting recurrence-free survival in head and neck cancer across two public datasets totaling 3,644 patients, evaluating various adaptation strategies and modality fusion mechanisms. Our findings reveal persistent difficulty in identifying features that generalize consistently across different imaging distributions, as evidenced by significant performance drops on external validation cohorts. Ultimately, the integration of imaging features with clinical data remains the most accurate approach for prognostic prediction, though achieving universal generalization across varied clinical contexts continues to represent a substantial challenge for the current generation of models.

Self-supervised pretraining is central to 3D medical image analysis, where unlabeled CT volumes are abundant but expert annotations are scarce. Yet existing volumetric encoders often fail to preserve the coarse spatial and geometric structure that downstream reasoning depends on, limiting their performance on organ disentanglement, abnormality detection, and spatial understanding when paired with language models. We introduce Rad-JEPA 3D, a joint-embedding predictive framework that learns volumetric CT representations by predicting the latent features of a complete scan from a masked view. At its core is a hybrid H-Mamba encoder that fuses a Mamba state-space branch, which models inter-slice continuity through sequential scanning, with a grouped-query attention branch, which captures cross-plane spatial context, combined through a lightweight per-token router. To improve the quality of intermediate representations, we further propose Hidden States Orthogonal Regularization (HSOR), which aligns student-teacher hidden states and reduces feature redundancy throughout the encoder. This layer-wise regularization produces more consistent and discriminative volumetric representations, leading to improved performance on organ recognition and spatial reasoning tasks. Pretrained on approximately 120,000 CT scans, Rad-JEPA 3D attains state-of-the-art results despite its compact size: with only 4.0B total parameters, it achieves competitive results with state-of-the-art on closed-ended VQA and the best average spatial-reasoning score on the Spatial-Med benchmark. Ablation studies confirm that the hybrid block and HSOR contribute complementary gains, and that the induced spatial structure can substitute for raw language-model scale on volumetric reasoning tasks.

We introduce a method for training a text-conditioned segmentation model for CT scans, which combines voxel-level supervision with coarse but scalable slice-level supervision from reports. We extract, from a large database of scan-report pairs, descriptions of findings with indices of slices where those findings occur. We then finetune a general-purpose 2D image segmentation model, SAM3, with standard segmentation losses from strongly labeled data and with a slice-level classification loss from the extracted weak supervision. Our results on the ReXGroundingCT dataset illustrate that this strategy improves the segmentation dice score: from an 8% relative gain when there are 1000 fully labeled volumes to 22% when there are 250 fully labeled volumes.

A CT examination captures multiple organs, but many biomedical questions concern abnormalities, prognosis, or longitudinal change in a specific organ. These questions require a separate representation for each organ within the same CT volume. Existing CT foundation models commonly produce a single volume-level representation, while recent anatomy-aware methods either encode pre-separated organ volumes or explicitly disentangle images into organ token groups. The former may remove clinically relevant surrounding context, while the latter does not condition a shared encoder on a selected organ before its features are formed. We introduce OrganLens for organ-specific representation learning through self-supervision. An organ identity conditions a shared CT encoder, while organ-specific distillation and anatomy-mask supervision shape features for anatomy-weighted pooling into organ-specific representations. At inference, the shared model produces 11 organ-specific representations without external segmentation masks. We evaluate OrganLens on CT-RATE, RAD-ChestCT, INSPECT, and NLST across diverse acquisitions and downstream evaluations. Relative to CT-pretrained DINOv2, heart representations raise CT-RATE cardiomegaly AUROC from 0.910 to 0.953, while lung representations improve the Harrell C-index for NLST lung-cancer mortality by 14.2%. The global representation reaches INSPECT Recall@10 of 33.09% and 32.04% for text-to-image and image-to-text retrieval, respectively. Across organ-related tasks, anatomically matched representations provide stronger task-relevant signal, while the global representation retains broad utility. OrganLens offers a scalable approach to organ-specific CT representation learning with a shared encoder. More broadly, it provides the medical research community with a reusable framework for studying organ-specific disease across cohorts and clinical endpoints.

Intraoperative 2D/3D registration aligns preoperative CT volumes with intraoperative X-ray or fluoroscopic images and is essential for image-guided interventions. Recent learning-based and differentiable registration methods have shown promising accuracy, especially in patient-specific settings where abundant digitally reconstructed radiographs (DRRs) can be synthesized from the target CT. However, training a separate patient-specific model from scratch for every new patient is computationally inefficient and limits practical deployment. In this work, we propose an efficient patient-specific 2D/3D registration framework based on patient-agnostic synthetic pretraining and spherical similarity learning. The model is first pretrained on synthetic DRRs generated from multiple CT volumes to learn transferable pose-sensitive representations, and is then adapted to a new patient using only a limited number of synthetic projections from the target CT. To improve synthetic-to-real robustness without requiring anatomical labels, we introduce a segmentation-free domain randomization strategy that perturbs image intensity, projection physics, field-of-view, occlusion, and fluoroscopic artifacts. The adapted model provides an initial pose estimate, which is further refined using spherical similarity learning and differentiable Levenberg-Marquardt optimization. Experiments on multiple anatomical datasets evaluate whether patient-agnostic synthetic pretraining can improve the efficiency of patient-specific registration, with particular focus on the trade-off between adaptation cost and registration accuracy. The results demonstrate that patient-agnostic synthetic pretraining can significantly reduce patient-specific training requirements while preserving accurate intraoperative 2D/3D registration.

Longitudinal medical imaging captures temporal evolution of lesions, yet extracting the underlying dynamical parameters governing this evolution remains challenging. We propose an inverse Bayesian framework for inferring lesion dynamics from longitudinal spectral CT. We decompose spectral feature ($x$) evolution into three components: \begin{equation*} \frac{dx_i}{dt} = A_i x_i + B \cdot n + C \cdot Δx_{\text{sat}} \end{equation*} where $A_i$ captures intrinsic dynamics (lesion-autonomous evolution), $B$ captures local environment tumour burden (organ tumour burden through satellite count coupling), and $C$ captures environment/satellite state change (i.e., whether surrounding lesions move similarly or not). We demonstrate the framework on photon-counting NSCLC CT data from metastases, recovering distinct dynamical regimes: lung lesions exhibit significant satellite count coupling ($B=-0.34$, $p<0.05$) suggesting competitive dynamics, while liver lesions show synergistic satellite behaviour coupling ($C\approx+1.0$, $p<0.05$). Synthetic validation confirms parameter recovery, and cross-coupling analysis validates that our method detects non-zero coupling when present. This work establishes inverse dynamical inference as a principled methodology for extracting interpretable parameters from longitudinal imaging, moving beyond static feature extraction toward mechanistic characterisation of lesion behaviour. The code and data are available at: https://github.com/lukasf98/inverse-bayesian-inference

Comparing CT reconstruction methods fairly is labor-intensive and largely manual, and many benchmarks use idealized data. We ask whether a large language model (LLM) agent can do the labor of reconstruction research on its own, and whether a ranking measured on ideal data predicts behavior under realistic noise. We built an agentic loop: the agent edits a solver, runs a short cluster job, reads one frozen metric, and revises. The metric is a calibrated headroom score against the FBP baseline, inside the field of view; every method shares the same differentiable fan-beam projector. We benchmarked 26 methods on Mayo low-dose CT (noise-limited) and a 128-view sparse-view breast task from the noiseless DL-Sparse-View Challenge, with validation-selected iterations scored on a held-out test set. Every trained breast model was then re-scored on noisy inputs (I_0 = 10^5 photons) without retraining, and separately retrained on matched noise. The agent independently implemented, tuned, and benchmarked all 26 methods, and recombined them into a compact solver of 969 parameters that ties the top Mayo tier at the 1% level using 0.4% of the champion's parameters. Benchmarking gives a tier of statistically indistinguishable top methods, not one winner. Mild input noise nearly inverts the breast ranking: the noiseless champion (a supervised image denoiser, hr 0.89) collapses to 0.00, while a learned primal-dual method rises to champion (0.72 to 0.93). An ideal-data leaderboard therefore does not predict robustness. The inversion is a transfer effect, not a permanent deficit: retraining on matched noise restores much of the clean ranking (Spearman rho 0.04 to 0.61). Noise is only the easiest confounder in an open-ended set (beam hardening, scatter, anatomy, disease), so no single-factor challenge certifies generality. Benchmarks should model a broad spectrum of realistic factors at once.

Recovering the 6-DoF pose of the knee bones from a plain radiograph, given the patient's segmented pre-operative CT, turns a routine low-dose image into a quantitative measurement of joint geometry, without the added dose of a repeat CT or a fixed biplanar rig. Classic solutions align a rendered bone silhouette to image edges; recent alternatives refine pose by backpropagating an image-similarity loss through a differentiable X-ray renderer. Both operate one patient at a time and are fragile under a single view. Silhouettes are depth-ambiguous, and differentiable-rendering refinement has a narrow capture range at substantial per-iteration cost. We instead learn an amortized, subject-agnostic dense 2D-3D correspondence, supervised solely by projection geometry. One shared-weight model per bone, trained across 758 patients, registers patients unseen during training. The pose then follows in closed form from a global, initialization-free, render-free PnP+RANSAC solve. Because X-ray formation is transmissive, our correspondence target is transmission-aware rather than tied to a single surface. Though trained only to register, the representation is anatomically semantic: a simple classifier reads a landmark's anatomical region from its embedding across held-out patients, and the same features separate the knee's bones into a 2D-3D-consistent identity learned without any bone label. On a large single-institution cohort the model generalizes well to held-out patients.

18F-FDG PET/CT plays a central role in staging, treatment planning, and response assessment for head and neck cancer by providing functional information that complements anatomical CT imaging. However, PET acquisition requires radiotracer administration, specialized infrastructure, and additional cost, limiting its availability for repeated imaging. We present a proof of concept deep learning framework for synthesizing PET like images directly from routine CT scans with the goal of providing complementary metabolic information that may support imaging triage and clinical decision support rather than replace diagnostic PET. Forty-four patients from the publicly available QIN-HEADNECK dataset were retrospectively analyzed using five fold cross-validation. We propose a fully three dimensional dual path architecture consisting of (i) a regression U-Net optimized for voxel-wise quantitative SUV estimation and (ii) a conditional generative adversarial network optimized for realistic PET texture. Their outputs are integrated using hotspot guided Laplacian pyramid blending, allowing quantitative information from the regression pathway to be preserved within metabolically active regions while leveraging adversarial texture synthesis elsewhere. The proposed framework achieved a mean absolute error of 0.00395, PSNR of 39.19 dB, and SSIM of 0.9634 on reconstructed three dimensional PET volumes. Qualitative evaluation demonstrated accurate localization of many FDG-avid lesions while producing anatomically realistic background texture. Consistent with previous CT to PET synthesis studies, the principal limitation was systematic underestimation of SUV within highly metabolically active tumor regions.

Metal artifacts generated by dental implants significantly degrade cone-beam computed tomography (CBCT) volumes, obscuring critical anatomical structures and compromising diagnostic precision. To address this, an unsupervised deep learning framework has been proposed for Metal Artifact Reduction (MAR) utilizing a Cycle-Consistent Adversarial Network (CycleGAN) optimized for high-fidelity restoration. Unlike supervised methods that rely on unattainable voxel-aligned paired datasets, the proposed approach leverages an unpaired dataset of approximately 4,000 images, curated from the public ToothFairy dataset. The architecture integrates U-Net-based generators and PatchGAN discriminators, specifically tuned to mitigate generative hallucinations and preserve morphological integrity. Quantitative benchmarking on a held-out test set demonstrates a 34.6% improvement in the Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE) score, a substantial reduction in Fréchet Inception Distance (FID) from 207.03 to 157.04, and a superior Structural Similarity Index Measure (SSIM) of 0.9105. The framework achieves real-time efficiency with a 3.03 ms inference time per slice, effectively suppressing artifacts while preserving anatomical detail. Expert validation confirms high fidelity; however, to ensure reliability in extreme cases, the architecture is recommended as a clinical decision-support tool under human-in-the-loop oversight. By enhancing diagnostic clarity via a scalable software pipeline, this study provides a robust solution for high-fidelity dental implant imaging.

We present a privacy-preserving framework for synthetic lung CT slice generation developed for the Image-CLEFmed GANs 2026 challenge. The approach combines Optimal Transport Conditional Flow Matching with privacy-oriented training and a post-generation "Supervisor" pipeline that filters generated candidates in learned geometric latent spaces using autoencoder embeddings, Determinantal Point Processes, and Stein Kernel Thinning. Official results show a strong realism-privacy trade-off, with the best-performing model achieving a Privacy Preservation Score of 0.549 and competitive visual fidelity with an FID of 0.3290. While the proposed geometric filtering substantially reduces nearest-neighbor memorization and membership-inference leakage, persistent patient re-identification scores indicate that preventing direct image copying is not sufficient to remove deeper patient-specific anatomical identity, highlighting an important frontier for future privacy-preserving medical image generation.

Purpose: To develop and validate a deep learning ensemble for estimating adult sex, age, height, and weight from coronal digitally reconstructed radiographs (DRRs) generated from diagnostic CT. Materials and Methods: This retrospective study included 128,621 CT examinations from 80,004 adults at nine institutions in Japan. Three multitask models-ConvNeXt-Base, ViT-Base/16, and MaxViT-Base-were fine-tuned using coronal DRRs and combined by weighted averaging. Data were split by institution into training (114,147 examinations; seven institutions), tuning (4,305; one institution), and test (10,169; one institution) sets; generalizability was assessed on two non-Japanese datasets. Accuracy and mean absolute error (MAE) were used to evaluate sex classification and age, height, and weight regression, respectively. Body surface area (BSA)-corrected heart and liver volume trends were compared using true versus estimated height and weight. Results: In the test set (median age, 69.9 years; 4,899 of 10,169 [48.2%] male), overall sex-classification accuracy was 0.997 (95% CI, 0.996-0.998), and MAEs were 3.57 years (3.51-3.63), 2.59 cm (2.54-2.64), and 3.40 kg (3.34-3.47) for age, height, and weight, respectively. In examinations covering the chest through pelvis, accuracy was 1.000, and MAEs were 3.15 years, 2.28 cm, and 3.18 kg, respectively. BSA calculated from estimated values reproduced age-related heart and liver volume trends obtained using true values. On non-Japanese datasets, height error increased but was reduced by continued fine-tuning. Conclusion: The ensemble estimated adult sex, age, height, and weight from CT-derived DRRs, with generally lower errors in examinations with broader anatomical coverage.

3D CT vision-language models (VLMs) classify abnormalities from text prompts in a zero-shot manner, enabling cross-institution deployment where labels are scarce and clinical tasks shift faster than supervised models can be retrained. A real CT scan, however, typically contains several co-occurring abnormalities, and the reliability of zero-shot multi-label prediction under distribution shift remains poorly understood. Test-time adaptation (TTA) updates a model on unlabeled target scans without source data or target annotations, yet existing TTA methods target multi-class softmax prediction on natural images or 2D medical segmentation, and none addresses unsupervised multi-label adaptation for zero-shot 3D CT VLMs. We study when TTA helps zero-shot 3D CT VLMs. A controlled diagnostic analysis shows that TTA is conditional: the volumetric input must preserve the encoder's depth structure, and the base representation must transfer to the target cohort, with depth reduction alone lowering internal AUROC by more than 0.12. We then focus on the regime where the base model already separates present from absent abnormalities. We introduce CARVE (Cardinality-Aware Retained-View Entropy), the first TTA method for this setting. CARVE estimates a sample-specific positive-label cardinality $\hat{k}$, optimizes a top-$\hat{k}$ objective to preserve co-occurring abnormalities, and performs memory-efficient multi-view adaptation by scoring weak 3D views without gradients before updating on a retained subset. Across contrastive CT-CLIP and anatomy-aware fVLM, CARVE provides the most consistent improvements across multi-label, three-class, and binary CT tasks when the base model is already discriminative. These results establish multi-label TTA for zero-shot 3D CT VLMs as a distinct problem and CARVE as a cardinality-aware solution.

Computed Tomography (CT) carries significant ionizing radiation risks, driving the need for sparse-view reconstruction. Implicit scene representations (ISRs) address this by recovering continuous volumetric attenuation fields directly from sparse projections, and recent geometry-aware extensions jointly model surface geometry alongside attenuation to improve fidelity and enable clean tissue segmentation without manual thresholding. However, these methods remain limited by manually tuned attenuation bounds and rigid two-material constraints. This paper proposes $K$-NeAS, a unified and scalable architecture for automated, multi-material surface reconstruction. We replace independent material networks with a shared latent backbone and introduce a fully differentiable $K$-material sequential soft selector to model an arbitrary number of overlapping tissues. To eliminate manual tuning, we automate attenuation bounding using a Gaussian Mixture Model (GMM) and implement a scheduled auxiliary floater loss to mitigate geometric hallucinations common under extreme sparsity. Evaluated across four clinical Cone-Beam CT (CBCT) datasets, $K$-NeAS successfully scales to arbitrary material counts, achieving superior 3D volumetric fidelity at $K=3$ materials on complex multi-tissue regions such as the Abdomen ($33.28\text{ dB}$ 3D PSNR vs. $31.40\text{ dB}$ single-material NeAS baseline, a $+1.88\text{ dB}$ improvement). Furthermore, our model exhibits enhanced robustness under sparse-sampling conditions, outperforming baseline 3D PSNR by up to $1.17\text{ dB}$ under 5- and 10-view constraints.

Automated chest CT report generation remains challenging because clinically faithful reporting requires both whole-volume understanding and accurate description of localized anatomical findings. Here we developed and retrospectively evaluated MonteRET, a region-aware retrieval-enhanced framework for generating chest CT findings sections. MonteRET integrates global CT features with region-level anatomical representations, retrieves clinically relevant knowledge using predicted medical conditions and region-level vision-language alignment, and refines initial reports through a knowledge-guided report rewriting agent. We trained our model on a public cohort with 24,128 CT scans from RadGenome-ChestCT. We evaluated MonteRET on the public RadGenome-ChestCT test set of 1,564 CT scans and an external cohort of 82 CT scans from NewYork-Presbyterian/Weill Cornell Medical Center. MonteRET improved report quality, semantic similarity, and clinical efficacy compared with a matched baseline and several state-of-the-art methods. Gains were most pronounced for recall, suggesting fewer omitted findings. Human expert evaluation by radiology residents also favored MonteRET.

Computed tomography (CT) vision-language pretraining from paired volumes and radiology reports is a scalable yet challenging task. Existing methods commonly adopt global scan-report contrast, which is scalable but obscures heterogeneous organ evidence. Meanwhile, direct organ-level alignment remains coarse, since the same anatomy can exhibit multiple distinct radiological appearances. Therefore, pretraining requires a finer alignment unit: the organ-conditioned radiological pattern. In this work, we propose OCP-CT, an organ-conditioned pattern-token alignment framework for CT vision-language pretraining. Specifically, OCP-CT preserves a stable global CT-report contrastive branch and introduces an organ pattern interface: sparse Mixture-of-Experts (MoE) routes image and text tokens according to latent radiological patterns, learnable slots query the routed tokens into continuous pattern tokens, and paired token contrast aligns image-text pattern tokens with structured soft targets built from report-derived clinical similarity. On the publicly available CT-RATE and RAD-ChestCT benchmarks, OCP-CT achieves average AUROCs of 84.5% and 69.9% for zero-shot abnormality diagnosis, respectively. Compared with the strongest prior reported results, these results yield absolute AUROC gains of 6.7 and 0.8 percentage points.