Cross-Modality

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.

Estimating reliable cross-modality association is crucial to unsupervised visible-infrared person re-ID. While optimal transport is shown to be a practical solution for cross-modality association, it suffers from the rigidness of hard label assignment without considering the impact of cluster noise. Moreover, enforcing only cross-modality contrast is also suboptimal, as it fails to jointly optimize the similarity relation within and across modality. In this paper, we propose a novel framework for cross-modality learning by well exploitation of prototypes: First, instead of contrasting with cross-modality prototypes, we show that modality-unified prototypical contrast facilitates better modality invariance by jointly and simultaneously optimizing similarity relation within and across-modality. Taking self-prototype as a steady teacher, we further refine the instance-prototype online relation through prototype-guided self-distillation. The two components are optimized in a unified framework, leading to a simple yet effective model. On standard VI-ReID benchmarks, we perform extensive comparison and analysis, validating the effectiveness of our proposed method. Code is available at: https://github.com/Terminator8758/PoSeD.

Magnetic resonance images of the same subject look markedly different across field strengths, which complicates the comparison and pooling of data across sites. We address cross-field brain-MRI translation for the MRIxFields2026 challenge, and in particular its Task~3: a single model that translates between any directed pair of the five field strengths and across three contrasts. We phrase the problem as a conditional flow matching path: because the source and target volumes are spatially registered, we learn a velocity field that carries the source slice directly to the target slice, rather than starting from noise. To learn this mapping from only three paired subjects, the unified model is trained in three stages: a degradation-bridge pretraining that distills a restoration prior from the abundant unpaired retrospective cohort, a cross-field finetuning over all directed pairs on the paired cohort, and an adversarial refinement that sharpens the output. At inference, we integrate the learned velocity with a second-order Heun solver in a handful of steps. A restoration prior learned without any paired data already reaches a mean SSIM of 0.837, and each subsequent training stage improves on it. A single 6.3M-parameter model thereby covers all 60 field-pair and contrast combinations, with inference in five solver steps per slice. On the challenge evaluation set the model reaches a mean SSIM of 0.909, averaged over the three contrasts, outperforming regression and diffusion baselines built on the identical network on all three challenge metrics.

Whole-heart segmentation (WHS) in computed tomography (CT) and magnetic resonance imaging (MRI) is affected by acquisition shifts and heterogeneous cardiac annotations. Existing WHS systems combine architectural design, transfer learning, and generic spatial or intensity augmentation. We investigate whether changes to data augmentation and training supervision can improve cross-modality WHS while the segmentation architecture is held constant. We present LISynSeg, a data-centric approach that augments real-image nnU-Net training with label-to-image synthesis. Synthetic volumes are generated from cardiac label maps using contrast and acquisition perturbations calibrated to the training cohort, then mixed with real images to retain thoracic context absent from the labels (and thus the synthesized images). We model cardiac label variation through controlled changes in myocardial wall thickness and partial supervision of uncertain vessel endpoints. On the CARE Whole-Heart benchmark, synthetic-only training performs worse than the real-image nnU-Net baseline, whereas calibrated real-synthetic training improves cross-modality segmentation without changing the architecture; the improvement is larger for MRI than for CT. The results show that modifying the training data strategy can benefit model development for heterogeneous cardiac data. Code and trained weights will be released at https://github.com/MedICL-VU/Care26_LISynSeg.

Multi-modal learning combining medical images and clinical text is promising for disease diagnosis. However, standard multi-modal training leads to shortcut learning: models exploit the easier modality (e.g., diagnostic cues in text) while neglecting harder-to-learn features (e.g., subtle visual patterns). We propose UniMod, a framework that mitigates shortcut learning by requiring each modality to predict the diagnosis on its own. It supervises image-only, text-only, and multi-modal classification simultaneously, so each modality must extract diagnostic features. We add cross-modality alignment for knowledge transfer and within-modality supervised contrastive alignment over same-diagnosis patients. On Harvard-Glaucoma, UniMod reaches 0.850 AUC, outperforming OGM-GE and Gradient Blending by 1.6-1.8%; on CheXpert Plus, it reaches 0.966 AUC, surpassing them by over 5%. UniMod also extends to 5-class multi-label diagnosis without architectural change, improving mean AUC by 0.097 over CGGM.

Cross-modality medical image translation can reduce the burden of multi-modal acquisitions, yet the field remains constrained by two coupled limitations: methods operate on 2D slices or 3D patches rather than whole volumes, and train a separate model for each translation task. Both stem from a single cause, the absence of a sufficiently strong volumetric prior, which forces generative models to learn anatomical appearance and cross-modality mapping simultaneously, an ill-posed problem at the scale of available paired datasets. We propose to decouple these objectives. A large-scale pretrained 3D variational autoencoder provides a compact latent representation of volumetric appearance, reducing translation to a conditional flow-matching problem. This compression makes whole-volume processing tractable, while a resolution-aware sampling strategy preserves native anatomical scale. We train a single model jointly across inter-modality (MRI$\to$CT, CBCT$\to$CT) and intra-modality (MRI$\to$MRI) tasks over three multi-center datasets. Across all tasks, whole-volume processing outperforms its patch-based counterpart, and the multi-task model matches task-specific baselines while replacing $N$ networks with one. Crucially, joint training unlocks capabilities inaccessible to task-specific approaches: zero-shot generalization to anatomical regions unseen during training, within 0.15 SSIM of the fully supervised model, and compositional cross-dataset translation along paths never directly supervised. These results suggest that combining a strong volumetric prior with multitask training is a scalable route toward synthesis systems that generalize beyond their training distribution. Code is available at https://github.com/arco-group/Whole-Volume-Latent-FM.

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.

We test whether a parameterized quantum circuit (PQC) improves a hybrid quantum-classical model's performance on classical datasets, using an interface-matched classical map as the control while holding all other components fixed. Our architecture, Quantum-Embedded Attention (QEA), uses a learnable projector to compress backbone features into an $n_q$-dimensional angle vector, a shallow PQC to map those angles to one- and two-qubit Pauli expectations, and a classical attention decoder to produce class logits. We hypothesized the PQC would improve accuracy or seed-to-seed stability over a classical map with matched input/output dimensions. We test this with an interface-matched $2\times2$ factorial on Breast Cancer Wisconsin at $n_q\in\{4,8\}$, independently swapping the PQC for a classical map and the attention decoder for a linear head, across five paired seeds per cell. Three of four paired quantum-minus-classical $95\%$ confidence intervals include zero; the fourth, a $+1.63$ percentage-point contrast for the attention decoder at $n_q=4$, reverses sign at $n_q=8$ and does not survive correction across the four contrasts. The experiment thus shows no consistent PQC contribution and cannot establish equivalence. A five-dataset cross-modality grid shows comparable accuracy on AG~News, Breast Cancer Wisconsin, and BirdCLEF but a large deficit on CIFAR-10; these cells are not interface-matched and are interpreted descriptively. We report all planned canonical runs, distinguish current Pauli-readout results from legacy probability-readout experiments, and analyze bottleneck, simulation, finite-shot, and noise limitations. The results do not establish a quantum advantage; they demonstrate why controlled component attribution is necessary before crediting a hybrid model's performance to its quantum layer.

Human-interpretable computer-aided diagnosis is crucial for clinical decision making. Concept-based models excel by providing transparent reasoning and enabling post-hoc, clinician-in-the-loop interventions. However, their rigid dataset-specific adaptation inherently restricts cross-site generalization. Applying them across diverse modalities, such as dermoscopic and clinical photographs, is challenging due to heterogeneous concept taxonomies varying in availability, granularity, and semantics across cohorts. Consequently, adapting Foundation Vision-Language Models (FVLMs) demands costly label engineering and repeated post-training. Existing intervention mechanisms remain rigidly tied to predefined concepts, lacking adaptability and hindering scalable dermatology CAD deployment. To address these bottlenecks, we propose UniCon, an open-linguistic unified concept learning framework for multimodal interpretable vision-language diagnosis. UniCon resolves these challenges through three contributions: (1) A shared semantic representation space via a unified concept prototype codebook, seamlessly coordinating heterogeneous concept systems across modalities without dataset-specific retraining. (2) Open-linguistic based multi-faceted semantic specifications to overcome sparse textual label limitations, improving boundary sensitivity in uncertain clinical contexts. (3) A robust, cross-site adjustable intervention interface powered by reliability-gated bottleneck aggregation, enabling consistent reasoning and transferable clinician corrections. Extensive experiments demonstrate that beyond securing top-tier diagnostic accuracy, UniCon successfully bridges disparate clinical taxonomies, unlocking unprecedented cross-site intervention capabilities. Code is available at https://github.com/wuchengyu123/UniCon.

Learning transferable representations from CT-report pairs requires combining whole-volume context with anatomy-specific evidence. Existing methods typically emphasize either global CT-report alignment or fine-grained anatomy-level correspondence. Global alignment preserves broad study context but leaves the contribution of localized evidence implicit, whereas anatomy-level alignment explicitly grounds local findings but does not specify how independently represented evidence should interact, acquire study-level meaning, and contribute to a global CT representation. To address this gap, we propose SCOPE (Semantic Calibration Of comPosed Evidence), a framework for semantically calibrated evidence composition in CT vision-language learning. Under organ-specific report supervision, mask-guided queries with fixed anatomical identities extract context-aware organ evidence from shared, uncropped volumetric features, while an unrestricted global query retains access to whole-volume context. The global query then drives Local-Global Coupling to compose the organ evidence into a unified evidence representation. The composed evidence is subsequently calibrated using the diagnostic summary, providing study-level semantic supervision beyond local organ descriptions, and is finally integrated as a controlled residual into a context-preserving whole-volume representation aligned with the complete report. This progressive pathway connects localized evidence with study-level semantics without reducing the CT representation to a predefined set of organs. On CT-RATE and RadChestCT, SCOPE achieves macro AUCs of 85.0 and 72.2, respectively, outperforming the previous SOTA by 7.2 and 4.2, while also yielding substantial gains in linear probing and cross-modal retrieval. These results demonstrate the effectiveness of semantically calibrated evidence composition.

Medical vision-language models (VLMs) can retain high observed marginal coverage after clinical shift while substantially under-covering an individual disease class. The affected class varies with acquisition protocol and backbone geometry, so source prevalence does not reliably reveal the failure. Existing localized and tail-aware conformal methods respectively adapt to test neighborhoods and source-frequency tails, leaving held-out class-wise coverage failure unmodeled. We introduce Class-Tail Adaptive Localized Conformal Deferral (CALCoDe), a post-hoc reliability layer for frozen medical VLMs. Cross-fitted validation predictions identify classes at risk of undercoverage, and a disjoint calibration split estimates their class-conditional tail thresholds. CALCoDe combines each protected threshold with a localized conformal threshold using a one-sided maximum. The resulting set contains every label admitted by the localized rule, with additional protection confined to validation-identified classes. An independently calibrated support audit defers cases with insufficient inlier support. Under exchangeability among accepted examples within each protected class, CALCoDe provides finite-sample coverage at the prespecified guard level and contains the corresponding localized conformal sets; coverage on shifted external cohorts is evaluated empirically. Among standard conformal baselines and recent VLM-specific conformal methods evaluated across two dermatology shifts (HAM10000 to ISIC 2019 and HAM10000 to PAD-UFES-20) and four frozen VLM backbones (BiomedCLIP, OpenAI CLIP ViT-B/32, PubMedCLIP ViT-B/32, and MedSigLIP-448), CALCoDe is the only approach whose observed marginal and worst-class accepted coverage both reach 0.95 in all eight settings. On HAM10000 to ISIC 2019, its average worst-class accepted coverage is 0.970, compared with 0.926 for sTACP and 0.864 for LCP-VLM.

Cross-modal knowledge distillation can transfer diagnostic knowledge from a strong but costly teacher modality to a cheaper and more deployable student modality. In medical image analysis, however, the two modalities are often unpaired: they are collected from different patient cohorts and occupy geometrically incompatible feature spaces. This makes instance-level distillation invalid and direct feature matching unreliable. To address these challenges, we propose Shared Semantic Codebook Distillation (SSCD), which compares teacher and student representations through a shared discrete codebook. Each image is represented as a distribution over a common, modality-agnostic vocabulary, and knowledge is transferred by aligning these distributions across modalities, both globally and class-conditionally, without requiring paired samples or directly comparable raw features. The codebook is evolved online by exponential moving average and kept diverse through entropy regularization and dead-code restart. At inference, all teacher-side and codebook modules are discarded, leaving only the student encoder and classifier. On two heterogeneous unpaired settings, OCT-to-fundus retinal disease classification and CT-to-chest-X-ray pneumonia classification, SSCD improves the student from 64.5 to 70.2 macro-F1 and from 73.8 to 76.3 macro-F1, respectively, outperforming all evaluated distillation baselines on both settings. Code and pretrained models are available at https://github.com/DillanImans/SSCD-unpaired-distillation

Medical world models aim to learn a latent state of patient or organ physiology and a transition function that forecasts how that state evolves under interventions, supporting downstream tasks from imaging-based diagnosis to digital-twin treatment planning. Two failure modes threaten the reliability of such models in clinical deployment: (i)\emph{covariate shift}, because training data are fragmented across hospitals, scanners, and time, so the feature distribution seen by the latent-dynamics predictor differs across fragments and from the distribution at deployment; and (ii)\emph{confidence misalignment}, because multi-step forecasts are often overconfident exactly where clinical risk is highest. We argue that both problems admit a unified treatment via a single lightweight regularisation objective, \textbf{CalTwin}, which combines a Fisher-Information-based shift penalty adapted from our prior work on fragmented covariate-shift remediation~\cite{khan2025mitigating,khan2025causal} with a Confidence Misalignment Penalty adapted from our prior work on calibrated vision-language classification~\cite{khan2025confidence}, applied here to a GRU-based medical world model's latent transition predictor. We derive the combined objective, establish which proof steps transfer from the classification setting without modification and which require adaptation, and evaluate it on the PhysioNet 2019 Sepsis Challenge, treating the two hospital systems as sequential training fragments and the unseen system as an out-of-distribution test. CalTwin reduces OOD next-step latent-state MSE by 9.1% relative to the no-penalty baseline (FIM penalty alone accounts for 7.0%); the ECE reduction from the Confidence Misalignment Penalty is real but small (0.7% for CalTwin, 1.3% for CMP alone).

Histopathological examination primarily relies on hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining. Although IHC provides critical molecular information, it is costly and requires specialized expertise. Stain transfer provides an efficient alternative by computationally generating IHC from H&E images, but remains challenged by unified and interpretable modeling for heterogeneous biomarkers under pixel-unaligned supervision. We propose DMCoStain, a novel Data-Model Co-optimization framework for Stain transfer. It iteratively co-refines training data and model capability, improving staining accuracy and interpretability in both pathological and structural consistency. To refine training data in a clinically meaningful manner, it incorporates the Multimodal Expert-Guided Finer Selection (MEGFS) strategy, built upon a pioneering IHC-positive-expression (IPE) vision-language model (VLM) that emulates pathologist reasoning. To support MEGFS, we construct ImmunoInstruction, the first large-scale IPE instruction-following dataset with 150K VQA samples. Extensive experiments on multiple tissues and biomarkers demonstrate that DMCoStain achieves state-of-the-art (SOTA) accuracy. This paradigm offers strong practical value, and MEGFS also functions as a specialized evaluation tool for future model development. Dataset, code, and more details are in https://github.com/SikangSHU/DMCoStain.

Infrared image super-resolution (IISR) mitigates the limitations imposed by low spatial resolution. Existing methods have recognized that IISR should preserve consistency in global distribution and structural information while enhancing image clarity. However, these methods are either insufficient or overly intrusive, a problem that becomes even more pronounced in diffusion-based models. To address these issues, we propose a dual-path diffusion-based framework for IISR, termed Shift-IISR. The proposed method is designed to improve the consistency of IISR results while preserving the generative capacity of diffusion models. Specifically, we develop a Global Representation Modulation (GRM) module to extract modality-specific information from infrared imagery and guide the global distribution of the diffusion model toward the ground truth. In addition, we introduce a Local Structure Refinement (LSR) module to encourage the model to focus on structural information at each step of the iterative denoising process. Extensive experiments demonstrate that the proposed method effectively improves distributional and structural consistency while maintaining competitive super-resolution performance. The source code of the proposed Shift-IISR can be available at https://github.com/Assassink8/Shift-IISR.

Medical image encoders from different groups are increasingly treated as interchangeable, on the assumption that scale and clinical supervision concentrate their representations onto a shared structure. Whether this convergence is real, what produces it, and whether it is clinically usable are untested, and the similarity measures behind such claims are fragile. We present a controlled dissection across 18 image and 7 text encoders, all open-weight and run locally, spanning 7M to 27B parameters and five imaging modalities, including 650,982 chest radiographs from six datasets. To isolate cause, we train encoders that vary only the objective under fixed data, architecture, and scale, and reproduce the effect in a synthetic model. Convergence is modest but above a random floor, driven by the self-supervised objective, not clinical supervision: matched self-supervised encoders aligned most (40.4% on chest radiography), with label-supervised (21.1%) and image-text (3.3%) far lower, and did not grow with size (Spearman 0.302, p=0.223) or capability. It is within-modality, does not reach clinical language, and does not reproduce how radiologists judge case similarity. Yet a linear classifier transfers across encoders and to five held-out hospitals, retaining about 85% of within-encoder performance. Convergence in medical imaging is therefore set by the pretraining objective, not inherited from scale or clinical supervision. Interoperability is accordingly something to design for through that objective, and to validate where the shared geometry is weakest, across patient subgroups and against clinical judgment.

Goal-directed visual processing is a hallmark of human visual intelligence, resulting in representations that support downstream tasks such as categorization or search. Though vision-language models (VLMs) are often faced with these same tasks, their ability to recode visual representations when presented with goal-directed language remains poorly characterized. Indeed, prior work largely treats visual representations in VLMs as static repositories of visual information that are manipulated by language representations. In the present work, we provide evidence for two concrete instances of language-induced recoding of visual representations. First, we identify an abstract reference representation that denotes which objects are goal-relevant under a natural language prompt. We extract contrastive steering vectors corresponding to this reference representation and demonstrate that they are causally implicated in model predictions. These reference representations are abstract in that they generalize to different objects, different task contexts, and even from synthetic to naturalistic images. Second, we demonstrate language-induced attribute modulation: later layers selectively amplify goal-relevant attributes in visual representations of objects. We demonstrate this phenomenon across a range of different prompts. Finally, we provide a causal intervention that demonstrates that attribute modulation mediates a VLM's response distribution. Together, our results support a more dynamic account of cross-modality processing in VLMs -- rather than vision tokens serving as static repositories of information, they are modulated to support queries articulated in language.

Building foundation models for medical imaging requires pooling data across institutions, yet privacy regulations prohibit centralized aggregation. Existing Federated Foundation Models either fine-tune natural-image models with poor medical-domain transfer, or train from scratch within a single modality, lacking the flexibility to unify tasks. We identify an under-explored challenge, Imaging Modality Heterogeneity, where clients operate under two structural regimes: Overlapped (shared modalities with heterogeneous label distributions) and Non-overlapped (fully disjoint modalities per client). We propose FM$^2$, a unified framework that trains the core backbone from scratch to preserve medical domain fidelity while optionally incorporating biomedical pretrained encoders for vision-language alignment. FM$^2$ equips each client with dual Mixture-of-Experts modules (a Class-wise MoE for personalized category knowledge and a Domain-wise MoE for shared cross-modality representations), coupled with a Heterogeneous Modality Alignment (HMA) regularizer that explicitly aligns modality-specific expert parameters, admitting provable $O(1/\sqrt{T})$ convergence and generalization guarantees. FM$^2$ further incorporates Caption-Enhanced Learning (CEL), where locally retained GPT-4o-generated captions serve as a textual semantic bridge enabling representation transfer across clients with disjoint modalities, and demonstrates extensibility to Federated Medical VQA. Experiments on our MIMH benchmark (classification and CEL) and real-world medical VQA datasets confirm consistent superiority over state-of-the-art federated baselines and strong out-of-modality generalization across all three tasks.

Magnetic resonance imaging exhibits substantial acquisition variability, where identical anatomy can appear markedly different across scanners and imaging protocols. Consequently, learned representations entangle biological structure with acquisition-dependent appearance, limiting interpretability, generalisation, and clinical deployment. We show that these sources of variation can be separated by jointly modelling MRI images and DICOM metadata. Using large-scale clinical brain MRI data, we learn representations that separate anatomical structure from contrast-dependent appearance. Resulting contrast representations organise heterogeneous acquisitions, support sequence understanding, and detect image--metadata inconsistencies, whereas anatomical representations suppress acquisition-specific variation while preserving biologically relevant information. Building on these disentangled representations, we introduce a unified anatomy-preserving harmonisation model for cross-modality and cross-site adaptation, conditioned on image or acquisition metadata. Our findings suggest that acquisition variability is a structured component of the imaging process that can be modelled, audited, and controlled, providing a foundation for acquisition-aware representation learning in large-scale medical imaging.

We present Spectral Consistent Flow (SC-Flow), a 3D medical image translation framework with a single function evaluation (1-NFE) in the latent space. This approach reformulates medical image translation as a stochastic Brownian bridge process that directly constructs a mapping between source and target modalities by predicting the support regularized mean velocity field. To mitigate modality entanglement, over-smoothing, and artifacts induced by the implicit low-pass modulation of the latent average velocity, we introduce a Spectral Consistency Corrector that dynamically regularizes the evolution of the power spectral density via learnable frequency-domain gain modulation. This mechanism establishes an explicit bridge between spatial textures and spectral energy flow, enabling the model to recover fine-grained anatomical fidelity while maintaining global structural coherence. Extensive experiments on four datasets demonstrate that SC-Flow delivers significantly more accurate, consistent, and robust performance across various translation scenarios.

A synthetic measurement of model competence is useful only if it survives the move to real data, yet the real labels that would verify it are exactly what medical imaging lacks. We ask whether transfer can be predicted in advance, label-free, and answer with a mechanism: on synthetic digital twins, competence that is donor-driven (a property of the transplanted nodule) survives the synthetic to real change of host, while host-driven competence (a property of the surrounding anatomy) need not. We test this on three lung CT vision-language tasks chosen to span that axis, across five public VLMs, four guidance conditions, and seven real datasets. The prediction holds in every case: presence and size orderings transfer (R2 >= 0.96), lobe does not; the split survives leave-source-out calibration, and the diagnostic names that boundary before any real label. TrialCouncil, a training-free council calibrated only on synthetic CT, confirms it by matching the best fixed model exactly where transfer is predicted. The contribution is not the router but the finding that transfer itself is predictable, label-free, from synthetic data alone.

Few-Shot Medical Image Segmentation (FSMIS) offers a powerful solution to data scarcity but struggles to generalize across different imaging modalities. This performance collapse stems primarily from the drastic texture discrepancies between domains, which mislead models trained on source-specific intensity distributions. While existing methods attempt to align frequency or local texture features, they often fail to decouple semantic structure from domain-specific appearance. To address this, we identify a critical invariance: despite distinct imaging physics, the position and geometric shape of organs remain robustly consistent across modalities. Therefore, we propose a novel framework that harnesses Position and Shape Priors (PSP) for cross-domain FSMIS. Specifically, PSP first introduces a Position Coordinate Embedding (PCE) module to inject relative spatial coordinates for rapid organ localization. Subsequently, a Shape Prototype Modulation (SPM) module constructs domain-invariant structural prototypes via explicit shape priors, effectively filtering out texture noise. Furthermore, the Hybrid-Prototype Prediction (HPP) module adaptively calibrates the support prototype to the query feature distribution, mitigating feature misalignment. Extensive experiments on two public medical imaging datasets demonstrate that PSP significantly outperforms state-of-the-art methods.

Cross-domain diagnosis remains a major challenge in cervical cell pathology due to pronounced domain shifts across institutions and the subtle visual differences among disease stages, which jointly impair model generalization. To address these issues, this paper proposes a two-stage framework for cross-domain cervical cell detection. In the first stage, we propose the Spatially-Continuous Unpaired Neural Schrödinger Bridge (SC-UNSB), which constructs a synthetic intermediate domain to mitigate cross-domain distribution shifts by modeling image translation as an entropy-regularized optimal transport process. In the second stage, we propose a dual-level feature alignment strategy within a knowledge distillation, which progressively aligns shallow structural features and deep semantic representations to facilitate the transfer of domain-invariant knowledge from the source to the target model. Experimental results demonstrate that the proposed method effectively mitigates domain shift and category ambiguity, improving the cross-domain detection performance.

Large Language Models (LLMs) possess broad conceptual knowledge acquired through large-scale text pretraining, yet their potential to supervise models in other modalities remains underexplored. In this work, we propose LaViD--Language-to-Visual Knowledge Distillation--a simple and effective framework for transferring high-level semantic knowledge from a language-only teacher to a vision-only student model. Instead of relying on paired multimodal data, LaViD elicits conceptual signals from an LLM by prompting it to generate multiple-choice questions (MCQs) that probe semantic distinctions between visual classes. Each class is mapped to a soft label distribution over these MCQs, forming a rich conceptual signature that guides the student through an auxiliary distillation loss. Notably, despite using a language-only teacher without access to image data, LaViD consistently outperforms recent methods like MaKD that distill from vision-language models across multiple fine-grained benchmarks. It also achieves competitive or superior performance compared to state-of-the-art visual distillation methods such as DKD and MLKD, with further gains when combined with logit standardization. On the Waterbirds dataset, LaViD substantially improves worst-group accuracy, demonstrating enhanced robustness to spurious correlations with distillation. Code is available at https://github.com/lliangthomas/lavid.

High-resolution (HR) MRI acquisition is often hampered by scan time constraints, resulting in anisotropic or low-resolution scans (e.g., thick-slice FLAIR) that limit diagnostic accuracy. While deep learning-based super-resolution (SR) methods show promise, they often hallucinate anatomical details, which can compromise brain structural integrity. To mitigate this limitation, we introduce MR-DiffuSR, a Multi-Resolution Diffusion-based Super-Resolution framework that incorporates HR T1w structural image priors to guide the restoration of thick-slice FLAIR scans and operates in the 3D latent space. Our architecture introduces cross-modality structural swin-attention, which derives structural attention maps from the HR T1w and applies them to the low-resolution FLAIR latent features. This design disentangles anatomical structure from modality-specific contrast, effectively preventing hallucinations. Furthermore, we employ a mixed-scale degradation strategy, training the model on a continuum of downsampling factors to ensure robustness to varying slice thicknesses, while optimizing with a DINOv3-based perceptual loss to preserve high-frequency semantic details. Evaluated on the ADNI-4 dataset, MR-DiffuSR surpasses both CNN and 2D diffusion approaches, achieving an average PSNR of 32.46dB, SSIM of 0.97, and LPIPS of 0.07 across all downsampling factors. In downstream white matter hyperintensity segmentation, our model demonstrates exceptional robustness. While baseline performance collapses at 10x down-sampling (Dice: 0.51), MR-DiffuSR maintains a Dice score of 0.63, preserving utility even at 7mm equivalent slice thickness.

AI-assisted clinical documentation tools increasingly summarize, standardize, and reformat radiology reports using large language models (LLMs). We present a controlled measurement of the resulting information degradation. Using 450 chest X-ray reports from the Indiana University dataset, we generate synthetic versions via three realistic LLM rewriting tasks: EHR summarization, standardized rewriting, and teaching case preparation. We measure entity erosion (via medical NER), hedging collapse (loss of clinical uncertainty language), and cross-modal alignment degradation (via BiomedCLIP image-text similarity). Our central finding is a dissociation between information loss and cross-modal fidelity. EHR summarization is the most destructive at the content level, eroding 51.4% of clinical entities and 43.7% of hedging language, yet it preserves image-text alignment almost entirely (a 2.5% drop). The two tasks meant to produce cleaner training data, standardized rewriting and teaching case preparation, do the reverse: they preserve more entities (26.8% and 29.3% eroded) but cause 14.9-16.5% alignment drops, six to seven times those of EHR summarization. We term this the slop paradox: rewriting that makes clinical text look cleaner for multimodal training is precisely what pulls it away from the image. Contrary to our pre-specified hypothesis, rare pathologies were not preferentially degraded: across nine rare-versus-common comparisons, no difference survived multiple-comparison correction, and nominal differences ran in the opposite direction (common > rare), so contamination is invisible to condition-specific monitoring. The dominant determinant of degradation is the type of AI rewriting task, not the clinical content. These findings bear on multimodal medical AI dataset construction and the governance of AI-assisted clinical documentation.

Early and highly accurate prediction of colorectal polyps, as an important sign of one of the most dangerous types of cancer, will result in saving more lives. Despite the advancements in colorectal polyp classification, many challenges remain in obtaining an automated polyp prediction system that is able to diagnose the difficult-to-predict polyps accompanied by different features in real scenarios, where the model can handle imbalanced data, label distribution shift, and cross-modality generalization successfully. In this study, we propose Polyp-D2ATL, a novel framework accompanied by a specific training strategy, which mitigates these limitations and effectively predicts the different classes of polyps belonging to the NICE classification. Our extensive experiments on the PICCOLO validation and test sets demonstrate that the proposed Polyp-D2ATL significantly outperforms existing state-of-the-art models across various reliable metrics, achieving an accuracy of 82.38%, a Macro-F1 of 77.49%, and a specificity of 87.47% on the validation set, alongside consistent improvements on the held-out test set which demonstrates the generalization capacity and clinical applicability of the proposed approach.

AI systems are being deployed across medical imaging faster than their failure modes are understood. At this point in time, the failure of greatest clinical concern is hallucination: clinically plausible but factually incorrect outputs, including fabricated anatomical structures, missed findings, incorrect laterality, and invented measurements in generated reports, with direct consequences, for example, for biopsy decisions, staging, and treatment planning. This structured narrative synthesizes peer-reviewed studies, benchmark datasets, and FDA regulatory guidance across five imaging modalities to produce a cross-modality analysis of hallucination taxonomy, etiology, detection, and mitigation. Specifically, we address three questions in this study: (1) how can existing taxonomies be unified across modalities?, (2) how do medical-specialized foundation models hallucinate less than general-purpose ones?, and (3) which mitigation strategies are effective and compatible with FDA lifecycle oversight? We note that three taxonomic frameworks together cover the imaging pipeline in a way no single framework does alone. We also highlight that general-purpose foundation models outperform medical-specialized models on hallucination-specific benchmarks, indicating that narrow domain fine-tuning can introduce overfitting-induced confabulation. At the same time, the oversight of radiologists remains essential; for instance, a very high percentage of of AI-generated flags required expert correction before clinical use. Physics-informed architectural constraints, Chain-of-Thought prompting, and human-in-the-loop safeguards each address different failure modes and is effective when combined. All findings are mapped to the FDA's Total Product Lifecycle and Predetermined Change Control Plan frameworks, which treat hallucination management as a lifecycle obligation rather than a pre-deployment checklist.

Multi-Modality Spatio-Temporal Forecasting (MoSTF) extends traditional spatio-temporal forecasting by incorporating diverse traffic modalities. Despite significant recent strides in spatio-temporal modeling, existing approaches often fail to explicitly model the coupling relationships between different modality variables. Accurate MoSTF is challenging, as it requires modeling (1) temporal dynamic heterogeneity under exogenous influences and (2) heterogeneous spatial dependencies alongside complex cross-variable couplings. To address these challenges, we propose the Dual-Domain Spectral Filtering Network (DSFNet). Our framework employs dual-domain spectral filtering to capture heterogeneous spatial patterns and explicitly model the relationships between variables. Unlike graph-based message passing or dense attention over node-modality pairs, DSFNet factorizes space-modality interactions into feature-domain and spatial-domain spectral operators, enabling scalable modeling of nonlocal dependencies and cross-modality couplings. Furthermore, we introduce an external gating mechanism to adaptively regulate temporal dynamics under external influences. We validate our method through extensive experiments on five representative real-world traffic datasets. Compared with the second-best baselines, DSFNet reduces MAE by 3.21%-10.16% across these datasets. The results demonstrate that DSFNet significantly outperforms existing state-of-the-art baselines in accuracy while exhibiting efficiency and robustness.

Despite the success of audio-visual large-language models (LLMs), they can produce plausible but ungrounded outputs, termed hallucination. Existing benchmarks focus on environmental sounds (e.g., dog barking) to indicate event occurrence. In contrast, human speech carries fundamentally different, rich semantics and temporal structures, yet it remains unexplored whether current models can accurately align speech content with corresponding visual signals. In this work, we show that speech content can induce hallucinations in audio-visual LLMs. To systematically study this, we introduce SVHalluc, the first comprehensive benchmark for evaluating speech-vision hallucination in audio-visual LLMs. Our benchmark diagnoses speech-vision hallucinations from two critical and complementary aspects: semantic and temporal. Experimental results demonstrate that state-of-the-art open-source audio-visual LLMs struggle with aligning speech content with corresponding visual signals, with a near-random accuracy on multiple tasks. In contrast, Gemini 2.5 Pro significantly outperforms the open-source models. Our analysis suggests that their failures stem from limited ability in cross-modality understanding, despite strong performance in single-modality perception. Our work uncovers a new and fundamental limitation of current audio-visual LLMs and highlights the need for speech-grounded video comprehension. Project page: https://chenshuang-zhang.github.io/projects/svhalluc/.

Models for AI-based skin cancer screening suffer a severe performance drop when shifting from expert dermoscopic (source) images to consumer-grade clinical (target) images, hindering real-world deployment. Existing domain adaptation methods often ignore crucial semantic invariants, such as clinical concepts. While new foundation models like MONET can provide this semantic information as dense, probabilistic scores, this metadata is unavailable at test time, creating a deployment paradox for practical image-only screening tools. We address this gap by proposing CoFiDA-M, a privileged information framework that learns from concepts at training time but deploys as an image-only model. Our method trains a teacher network that uses MONET concept probabilities to guide a FiLM modulator, transforming visual features into a semantically edited" feature space. A lightweight, image-only student is then trained to reproduce this edited representation, not just the teacher's final predictions. This distillation bakes" the clinical reasoning into the student's weights. On a challenging multi-dataset benchmark, our image-only student significantly outperforms state-of-the-art approaches, especially in melanoma recall. Our work provides a practical and generalizable framework for leveraging noisy, probabilistic metadata as privileged information, demonstrating strong cross-dataset robustness and potential for real-world deployment beyond dermatology. Implementation code is available at: https://github.com/mmu-dermatology-research/CoFiDA.git

Vision-Language Models (VLMs) achieve outstanding performance, yet their huge model size severely hinders deployment on edge devices with limited resources. As an efficient model compression technique, vector quantization (VQ) excels in ultra-low-bit representation, which maps model weights to discrete codewords in a compact codebook to cut memory consumption and transmission overhead while preserving model capability. Direct VQ application to VLMs still has two core limitations. First, cross-modality weight distribution differences brought by visual and textual inputs cannot be well fitted by a single unified codebook. Second, current second-order error compensation ignores first-order gradient information, causing weight deviation from pre-trained optimal states, gradient drift and biased compensation results. This work proposes MGVQ, a novel vector quantization framework integrating multi-dimensional sensitivity perception and gradient-Hessian fusion. It consists of two core modules: sensitivity-guided structured mixed-precision quantization dynamically assigns different bit-widths according to channel sensitivity via combined global and local sensitivity analysis for refined resource allocation; gradient-aware second-order error compensation embeds first-order gradients into error correction, and adopts Kronecker and Block-LDL decomposition to ensure low computational cost. Extensive experiments on mainstream VLMs including LLaVA-onevision, InternVL2 and Qwen2-VL verify the effectiveness of MGVQ. In 2-bit quantization settings, MGVQ surpasses existing advanced post-training quantization methods significantly, achieving a maximum accuracy improvement of 4.9 points (71.4% vs 67.0% on InternVL2-26B). The proposed method realizes stable and efficient ultra-low-bit VLM quantization, greatly promoting the practical deployment of multimodal large models in resource-limited environments.

Finding correspondences is a fundamental and extensively researched problem in computer vision and graphics. In this work, we examine the underexplored task of estimating segmentation-to-segmentation correspondence between images in the wild and untextured 3D shapes. This task is highly challenging due to substantial differences in appearance, geometry, and viewpoint. Our approach bridges the cross-modality gap by linking pixels in the image segment to vertices in the corresponding semantic part of the 3D shape. To achieve this, we first distill deep visual features from a 2D vision model onto the 3D shape surface, allowing for the computation of feature similarity between image pixels and shape vertices. Then, we identify Best Segmentation Buddies, vertices whose most similar image pixel lies within the image segmentation region, enabling the reliable discovery of vertices in semantically corresponding shape parts. Finally, we leverage distilled 3D features from the 2D image segmentation model to segment the shape directly in 3D, bootstrapping the correspondence process. We demonstrate the generality and robustness of our approach across a wide range of image-shape pairs, showcasing accurate and semantically meaningful correspondences. Our project page is at https://threedle.github.io/bsb/.

Deploying multi-sequence magnetic resonance imaging (MRI) segmentation models to new clinical environments is challenging due to variations in scanners and acquisition protocols. Although existing TTA methods handle basic per-modality shifts, they often fail under a fundamental dual-shift problem, as their adaptation signals fail to capture modality-interaction shifts that disrupt inter-sequence consistency. To address this, we propose Variance-gated Inter-Sequence Test-time Adaptation (VISTA), a source-free framework that tackles modality-interaction shifts. First, we design an Inter-Sequence Intervention Generator (ISIG) that generates a set of consistency probes by swapping low-frequency spectra and entropy-localized patches across sequences, preserving anatomical semantics while challenging inter-sequence dependencies. Second, we introduce Cross-View Disagreement-Aware Pseudo Labeling (CDPL), which establishes a voxel-wise reliability metric using cross-view disagreement variance to dynamically gate self-training and enforce interventional consistency, encouraging the network to rely on robust anatomical semantics. Extensive experiments adapting from standard adult MRI (BraTS-GLI-Pre) to African low-field (BraTS-SSA) and pediatric (BraTS-PED) cohorts show improved performance over competing methods under clinical shifts, achieving absolute Dice improvements of +1.89% (SSA) and +2.82% (PED) over the source model. The code is available at https://github.com/dzp2095/VISTA.

Different from existing cross-modality identification tasks (e.g., heterogeneous face recognition, sketch re-identification, etc.), we introduce a novel yet practical setting for these related identification tasks, named \textbf{sketch biometric identification}, which aims to continually train a unified model across different data domains, even diverse identification tasks. Sketch biometric identification faces challenges, including scarce real sketch data, high annotation costs, privacy risks, and insufficient generalization ability of cross-task models. Existing methods usually rely on limited real data or single-task optimization, making it difficult to effectively address the joint challenges of cross-modality and cross-task. This paper proposes a unified framework that integrates efficient synthetic sketch generation and task-sequential continual learning. First, we design an efficient pipeline to generate a large-scale and high-quality synthetic person and face sketch data, which significantly reduces costs and avoids privacy risks. Meanwhile, we enhance the model's robustness by fusing real data. Second, we construct a universal unified framework for sketch biometric identification, which adopts a task-sequential training strategy: the model first completes sketch person re-identification learning on the person dataset; subsequently, it maintains the acquired person recognition capability through a trusted sample replay technique and seamlessly performs incremental training on the face dataset. This enables a single model to simultaneously handle the cross-task capabilities of multiple sketch biometric identification tasks. To support the study of the mentioned sketch biometric identification, we built a new large-scale benchmark, SketchUnified-BioID, with several practical evaluation protocols.

Cross-modality recognition has many important applications in science, law enforcement and entertainment. Popular methods to bridge the modality gap include reducing the distributional differences of representations of different modalities, learning indistinguishable representations or explicit modality transfer. The first two approaches suffer from the loss of discriminant information while removing the modality-specific variations. The third one heavily relies on the successful modality transfer, could face catastrophic performance drop when explicit modality transfers are not possible or difficult. To tackle this problem, we proposed a compact encoder-decoder neural module (cmUNet) to learn modality-agnostic representations while retaining identity-related information. This is achieved through cross-modality transformation and in-modality reconstruction, enhanced by an adversarial/perceptual loss which encourages indistinguishability of representations in the original sample space. For cross-modality matching, we propose MarrNet where cmUNet is connected to a standard feature extraction network which takes as inputs the modality-agnostic representations and outputs similarity scores for matching. We validated our method on five challenging tasks, namely Raman-infrared spectrum matching, cross-modality person re-identification and heterogeneous (photo-sketch, visible-near infrared and visible-thermal) face recognition, where MarrNet showed superior performance compared to state-of-the-art methods. Furthermore, it is observed that a cross-modality matching method could be biased to extract discriminant information from partial or even wrong regions, due to incompetence of dealing with modality gaps, which subsequently leads to poor generalization. We show that robustness to occlusions can be an indicator of whether a method can well bridge the modality gap.

Cross-modal 3D medical image analysis requires voxelwise representations that remain anatomically consistent across imaging contrasts, scanners, and acquisition protocols. Recent work has shown that frozen 2D Vision Transformer (ViT) foundation models can support such representations, but typical pipelines extract features along a single anatomical axis and adapt those features inside a registration solver for one image pair at a time, leaving complementary viewing directions unused and producing representations that do not transfer to new volumes. We introduce VoxCor, a training-free fit--transform method for reusable volumetric feature representations from frozen 2D ViT foundation models. During an offline fitting phase, VoxCor combines triplanar ViT inference with a compact closed-form weighted partial least squares (WPLS) projection that uses fitting-time voxel correspondences to select modality-stable anatomical directions in the triplanar feature space. At transform time, new volumes are mapped by triplanar ViT inference and linear projection alone, without fine-tuning or registration. Voxel correspondences can then be queried directly by nearest-neighbor search. We evaluate VoxCor on intra-subject Abdomen MR--CT and inter-subject HCP T2w--T1w tasks using deformable registration, voxelwise k-nearest-neighbor segmentation, and segmentation-center landmark localization. VoxCor improves the hardest cross-subject, cross-modality transfer settings, reduces encoder sensitivity for dense correspondence transfer, and yields registration performance competitive with handcrafted descriptors and learned 3D features. This positions VoxCor as a reusable feature layer for downstream multimodal analysis beyond pairwise registration. Code, configuration files, and implementation details are publicly available on GitHub at \href{https://github.com/guneytombak/VoxCor}{guneytombak/VoxCor}.

Medical image-to-image (I2I) translation enables virtual scanning, i.e. the synthesis of a target imaging modality from a source one without additional acquisitions. Despite growing interest, most proposed methods operate on 2D slices, are evaluated on isolated tasks with different experimental set-ups and lack clinical validation. The primary contribution of this work is a reproducible, standardized comparative evaluation of 3D I2I translation methods in oncological imaging, designed to standardize preprocessing, splitting, inference, and multi-level evaluation across heterogeneous clinical tasks. Within this framework, we compare seven generative models, three Generative Adversarial Networks (GANs: Pix2Pix, CycleGAN, SRGAN) and four latent generative models (Latent Diffusion Model, Latent Diffusion Model+ControlNet, Brownian Bridge, Flow Matching), across eleven datasets spanning three anatomical regions (head/neck, lung, pelvis) and four translation directions (cone-beam CT to CT, MRI to CT, CT to PET, MRI T2-weighted to T2-FLAIR), for a total of 77 experiments under uniform training, inference, and evaluation conditions. The results show that GANs outperform latent generative models across all tasks, with SRGAN achieving statistically significant superiority. Our lesion-level analysis reveals that all models struggle with small lesions and that, in CT to PET synthesis, models reproduce lesion shape more reliably than absolute uptake-related intensity. We also performed a Visual Turing test administered to 17 physicians, including 15 radiologists, which shows near-chance classification accuracy (56.7%), confirming that synthetic volumes are largely indistinguishable from real acquisitions, while exposing a dissociation between quantitative metrics and clinical preference.

Intracranial electrocorticography (ECoG) offers high-signal-to-noise access to cortical activity for brain-computer interfaces, yet limited per-patient data has led most prior work to rely on small, subject-specific decoders that neglect information shared across patients. We investigate whether large pretrained scalp-EEG foundation models (EEG FMs) can be adapted to ECoG, enabling cross-patient learning and competitive decoding performance while calibrating to a held-out patient in 10-30 minutes on a single GPU. We introduce CORTEG, a cross-modality transfer framework that combines a pretrained EEG FM backbone, an electrode-aware KNNSoftFourier spatial adapter, a dual-stream tokenizer for low-frequency and high-gamma activity, and a leave-one-subject-out fine-tuning strategy. We evaluate CORTEG on two challenging regression tasks: public finger trajectory regression (n=9) and private audio envelope regression (n=16). CORTEG matches or exceeds the strongest task-specific baselines on both tasks: it reaches the highest mean correlation among compared methods on the public finger benchmark (gain not statistically significant on n=9 subjects), with larger and statistically significant gains on the audio task and in low-data per-patient calibration. Feature analyses align with neurophysiology, and latent manifolds capture low-dimensional finger-movement structure. CORTEG provides systematic evidence that scalp-EEG pretraining can be repurposed for ECoG decoding, enabling data-efficient intracranial BCIs that can adapt to new patients.

Vision foundation models are increasingly moving beyond 2D to volumetric domains such as 3D medical imaging, where unified pretraining across different imaging modalities (i.e. CT, MRI, and PET) could provide foundational models for diverse clinical tasks. However, training such models requires mixing heterogeneous imaging domains, and current mixture strategies remain largely heuristic. In this work, we observe that different medical imaging domains scale at variable rates during pretraining, and knowledge transfer between domains is strongly asymmetric: training on one domain can substantially improve another, but the reverse may be much weaker. Interestingly, both MAE reconstruction loss and cross-domain transfer follow predictable power-law trends with domain-specific behaviors. Motivated by these findings, we formulate data allocation as a scaling-law optimization problem. The derived allocations reveal an interpretable hub-and-island structure: highly transferable domains emerge as hubs that benefit many others and deserve strategic allocation, while isolated domains act as islands requiring direct investment. Empirically, transfer-aware allocation outperforms data-proportional sampling by up to 58% and generalizes well to unseen budgets with r=0.989. Downstream validation on disease classification and organ/lesion segmentation further confirms that the derived transfer-aware mixtures provide stronger pretrained representations for clinical 3D medical imaging tasks.

Although self-supervised pretraining is expected to learn broadly transferable representations, its effectiveness across imaging modalities substantially different from the pretraining domain, and on complex tumor-segmentation tasks, remains understudied. Evaluating CT-pretrained transformers on MRI rectal cancer segmentation, we identified two interacting failure modes in CT-to-MRI transfer: (a) inefficient token usage caused by zero-padding to match pretrained input dimensions, and (b) ineffective feature adaptation. We investigated these vulnerabilities using two primary CT-pretrained hierarchical shifted-window transformer backbones, SMIT and Swin UNETR, together with VoCo as a large-scale-pretrained supporting benchmark; these models differ in pretraining objectives and datasets. Mechanistic analysis leveraged an attention dilution index (ADI), an entropy-based metric quantifying attention diverted toward uninformative padding tokens, and centered kernel alignment (CKA) to measure feature reuse during MRI adaptation. ADI increased with zero-padding, while high feature reuse did not necessarily translate to improved downstream accuracy. To mitigate these issues, we introduced two interventions: a tumor-aware augmentation strategy to expand tumor appearance heterogeneity coverage, and an anisotropic cropping strategy to restore token efficiency. Fine-tuning with these strategies on identical rectal MRI datasets yielded detection rates of 91.1% (225/247) and 88.7% (219/247) for the primary SMIT and Swin UNETR backbones, with the supporting VoCo benchmark reaching 90.3% (223/247), demonstrating significantly improved robustness under CT-to-MRI transfer. This study is among the first to examine when pretrained transformers fail to transfer across imaging modalities and demonstrates how targeted mitigation strategies can systematically overcome cross-modality transfer limitations.

Automated glaucoma detection is critical for preventing irreversible vision loss and reducing the burden on healthcare systems. However, ensuring fairness across diverse patient populations remains a significant challenge. In this paper, we propose FairEnc, a fair pretraining method for vision-language models (VLMs) that enables simultaneous debiasing across multiple sensitive attributes. FairEnc jointly mitigates biases in both textual and visual modalities with respect to multiple sensitive attributes, including race, gender, ethnicity, and language. Specifically, for the textual encoder, we leverage a large language model to generate synthetic clinical descriptions with varied sensitive attributes while preserving disease semantics, and employ a contrastive alignment objective to encourage demographic-invariant representations. For the visual encoder, we propose a dual-level fairness strategy that combines mutual information regularization to reduce statistical dependence between learned features and demographic groups, with multi-discriminator adversarial debiasing. Comprehensive experiments on the publicly available Harvard-FairVLMed dataset demonstrate that FairEnc effectively reduces demographic disparity as measured by DPD and DEOdds while achieving strong diagnostic performance under both zero-shot and linear probing evaluations. Additional experiments on the private FairFundus dataset show that FairEnc consistently preserves fairness advantages under cross-domain and cross-modality settings and maintains diagnostic performance within a competitive range. These results highlight FairEnc's ability to generalize fairness under distribution shifts, supporting its potential for more equitable deployment in real-world clinical settings. Our codebase and synthetic clinical notes are available at https://github.com/Mohamed-Elhabebe/FairEnc

Deep learning-based medical image segmentation is increasingly used to support clinical diagnosis and develop new treatment strategies. However, model performance remains limited by the scarcity of high-quality annotated data and insufficient generalization across imaging protocols. This limitation is particularly evident in MRI and CT, where models are typically trained on a single acquisition sequence and exhibit reduced robustness when applied to unseen sequences or contrasts. Although data augmentation is widely used to improve general robustness on medical images, its impact on cross-modality generalization has not been quantitatively explored. In this work, we study a targeted set of data augmentation techniques designed to improve cross-modality transfer. We train three spine segmentation models, each on a single-modality/sequence dataset, and evaluate them across seven out-of-distribution datasets (spanning CT and MRI), reflecting a realistic single-sequence training and multi-sequence/contrast/modality deployment scenario. Our results demonstrate substantial performance gains on unseen domains (average Dice gain of 155 %) while preserving in-domain accuracy (average Dice decrease of 0.008 %), including effective transfer between CT and MRI. To mitigate the computational cost typically associated with strong data augmentation, we implement GPU-optimized augmentations that maintain, and even improve, training efficiency by approximately 10 %. We release our approach as an open-source toolbox, enabling seamless integration into commonly used frameworks such as nnUNet and MONAI. These augmentations significantly enhance robustness to heterogeneous clinical imaging scenarios without compromising training speed.

We propose a unified cross-domain transfer learning framework that leverages knowledge from multiple heterogeneous medical imaging datasets to improve performance across segmentation, classification, and object detection tasks. Our approach employs a teacher-student paradigm in which a joint teacher model aggregates domain-invariant representations learned from diverse source datasets, while a task-specific student model is trained via multi-level knowledge distillation. Originally developed for medical image segmentation, the framework is extended to support image-level classification and object-level detection, enabling a general multi-task formulation for medical image analysis. We evaluate our method on a broad suite of datasets, including six segmentation benchmarks, BrainMetShare, ISLES, BraTS (MRI) and Lung MSD, LiTS, KiTS (CT), as well as multiple classification datasets for pulmonary disease and dementia, and detection datasets with native bounding-box annotations. Across all tasks and modalities, the proposed approach yields consistent improvements over strong dataset-specific and multi-head baselines, demonstrating enhanced robustness to distributional shifts and superior generalization. These findings highlight the potential of multi-dataset knowledge distillation as a scalable and task-agnostic approach for enhancing segmentation, classification, and object detection performance across heterogeneous medical imaging domains.

Vision-Language Models (VLMs) have enhanced traditional LLMs with visual capabilities through the integration of vision encoders. While recent works have explored various combinations of vision encoders and LLMs, there still lacks a principled understanding of what makes a vision encoder suitable for VLM alignment. In this paper, we systematically investigate this question via comprehensive experiments on a curated collection of 19 pre-trained vision encoders from diverse sources. We first demonstrate that common practices, such as choosing encoders with the largest size or highest zero-shot accuracy, consistently fail to identify optimal models. In fact, these metrics show only weak to moderate correlation with VLM performance. This intriguing finding begs a fundamental question: What factors of vision-encoders matter in VLM? Through comprehensive analysis, we identify that the structural similarity across modalities plays a crucial but previously overlooked role in vision-encoder selection, which we measure using the Gromov-Wasserstein distance as a proxy. From a theoretical perspective, we show that the learnability of cross-modality mapping can be provably associated with the Gromov-Wasserstein distance. Empirical verification on 60+ full VLM training runs shows that our proposed inference-only metric performs significantly better than alternative model selection strategies and exhibits a much stronger correlation with final VLM performance, thereby enabling efficient and effective prediction of VLM performance before full training.

Frozen Gemma 4 31B weights pretrained exclusively on text, unmodified, transfer through a thin trainable interface to non-text modalities the substrate has never processed. On the L24--L29 slice (192 attention heads), an English-text TxtCopy attention probe (95 sentences) and per-head ablation impact on four non-language token-pattern tasks (binary copy, associative recall, 1D cellular automaton Rule 90, binary addition) jointly classify four heads -- L26.28, L27.28, L27.2, L27.3 -- as top-tier on both signals. The slice-level joint coincidence is significant under hypergeometric null ($P = 0.0013$, $N=192$, $K=38$, $n=4$) and survives multiplicity-aware permutation tests ($P_{V4} = 0.013$). Pretrained Gemma L26 reaches 60.22% on OGBench cube-double-play-task1 vs ~1% for random-init Gemma ($+59$pt at $n=3$); a FrozenRandom-GPT2 control with correct $1/\sqrt{d_k}$ scaling also fails. Head-level causal validation: zeroing L26.28 in the trained cube-task1 IQL agent drops success $63.3\% \to 10.0\%$ vs $46.7\%$ for a layer-matched low-TxtCopy negative control ($3.2\times$ specificity at $n=30$; $n=5$ paired-$t$ $p=0.039$). A full L26 sweep places L26.28 at rank 4 of 32. Honest negatives: within-L26 Spearman $ρ(\text{TxtCopy, drop}) = +0.37$ (opposite of within-layer causal reading); single-head activation patching does not transfer the matching variable; the 4 named heads alone do not suffice on any task; Walker2d-DT and scene-task1 recruit L24 outside the named slice and show null head-ablation specificity. We frame the contribution as a cross-distribution importance fingerprint at the slice level plus head-level causal evidence on one cross-modality target.

Integrating molecular, morphological, and clinical data is essential for basic and translational biomedical research, yet systematic frameworks for jointly modeling these modalities remain limited. Here we present Haiku, a tri-modal contrastive learning model trained on multiplexed immunofluorescence (mIF). It comprises 26.7 million spatial proteomics patches from 3,218 tissue sections across 1,606 patients spanning 11 organ types, with matched hematoxylin and eosin (H&E) histology and clinical metadata aligned in a shared embedding space. Haiku enables three-way cross-modal retrieval, improves downstream classification and clinical prediction tasks over unimodal baselines, and supports zero-shot biomarker inference through fusion retrieval conditioned on clinical metadata-only text descriptions. Across tasks, Haiku outperforms competing approaches, achieving cross-modal retrieval (Recall@50 up to 0.611 versus near-zero baseline), survival prediction (C-index 0.737, +7.91% relative improvement), and zero-shot biomarker inference (mean Pearson correlation 0.718 across 52 biomarkers). Furthermore, we introduce a counterfactual prediction framework in which modifying only clinical metadata while fixing tissue morphology surfaces niche-specific molecular shifts associated with breast cancer stage progression and lung cancer survival outcomes. In a lung adenocarcinoma case study, the counterfactual analysis recovers niche-specific shifts characterized by increased CD8 and granzyme B, reduced PD-L1, and decreased Ki67, broadly consistent with patterns reported for favorable outcomes. We present these counterfactual results as exploratory, hypothesis-generating signals rather than mechanistic claims. These capabilities demonstrate that tri-modal alignment via Haiku enables integrative analysis of spatial biology, bridging molecular measurements with clinical context for biological exploration.

Hyperspectral imaging (HSI) semantic segmentation typically relies on in-domain training, but limited data availability often restricts model performance in real-world applications. Current approaches to leverage foundation models in proximal sensing use cross-modality techniques, bridging RGB and HSI to exploit vision foundation models. However, these methods either discard spectral information or introduce architectural complexity. We propose cross-domain transfer as an alternative, reusing HSI foundation models - originally trained in remote sensing - for proximal sensing applications. By eliminating the need to bridge modality gaps, our approach preserves spectral information while maintaining a simple architecture. Using the HS3-Bench benchmark, we systematically evaluate and compare conventional in-domain, in-modality training, cross-modality transfer and cross-domain transfer strategies. Our results demonstrate that cross-domain transfer achieves large performance improvements over in-domain, in-modality training, reduces the performance gap to cross-modality approaches and maintains strong performance in limited data settings. Thus, this work advances more effective HSI semantic segmentation in diverse applications.

We present CRC-SAM, a unified framework for colorectal cancer segmentation across colonoscopy, CT, and histopathology images. Unlike prior single-modality methods, CRC-SAM provides consistent, modality-agnostic segmentation throughout the clinical workflow. Built on MedSAM, it incorporates low-rank adaptation (LoRA) layers into a frozen encoder, enabling efficient domain transfer to underrepresented modalities with minimal trainable parameters. Experiments on MSD-Colon, CVC-ClinicDB, and EBHI-Seg demonstrate superior performance across modalities, outperforming state-of-the-art baselines and highlighting the effectiveness of lightweight LoRA adaptation for foundation-model-based colorectal cancer analysis.

Pretrained biomedical vision-language models (VLMs) such as BioMedCLIP perform well on average but often degrade on challenging modalities where inter-class margins are small and acquisition-specific variations are pronounced, especially under few-shot supervision and when modality priors differ from pretraining corpora substantially. We propose BioVLM, a prompt-learning framework that improves cross-domain generalization without extensive backbone fine-tuning. BioVLM learns a diverse prompt bank and introduces dynamic prompt selection: for each input, it selects the most discriminative prompts via a low-entropy criterion on the predictive distribution, effectively coupling sparse few-shot evidence with rich LLM semantic priors. To strengthen this coupling, we distill high-confidence LLM-derived attributes and enforce robust knowledge transfer through strong/weak augmentation consistency. At test time, BioVLM adapts by choosing modality-appropriate prompts, enabling transfer to unseen categories and domains, while keeping training lightweight and inference efficient. On 11 MedMNIST+ 2D datasets, BioVLM achieves new state of the art across three distinct generalization settings. Codes are available at https://github.com/mainaksingha01/BioVLM.

Recent advances in unsupervised video object segmentation have highlighted the potential of two-stream architectures that integrate appearance and motion cues. However, fully leveraging these complementary sources of information requires effectively modeling their interdependencies. In this paper, we introduce cross-modality token modulation, a novel approach designed to strengthen the interaction between appearance and motion cues. Our method establishes dense connections between tokens from each modality, enabling efficient intra-modal and inter-modal information propagation through relation transformer blocks. To improve learning efficiency, we incorporate a token masking strategy that addresses the limitations of relying solely on increased model complexity. Our approach achieves state-of-the-art performance across all public benchmarks, outperforming existing methods.

Purpose: Developing generalizable medical image segmentation models is challenging because imaging data are distributed across institutions and differ in modality and acquisition protocol. Federated learning (FL) enables collaborative training without centralizing raw medical images, but cross-modality domain shifts between computed tomography (CT) and magnetic resonance imaging (MRI) can substantially reduce model performance. This study investigates augmentation-driven cross-modality FL for abdominal organ and whole-heart segmentation. Methods: We evaluate convolution-based spatial augmentation, frequency-domain argumentation, domain-specific normalization, and global intensity nonlinear (GIN) augmentation for multimodal segmentation. Abdominal organ segmentation and whole-heart segmentation are first evaluated using a 2D U-Net framework. For whole-heart segmentation, we additionally perform native 3D experiments using a self-configuring nnU-Net architecture on the CARE-WHS 2026 dataset, enabling evaluation of whether the observed cross-modality FL behavior persists when moving from slice-based 2D segmentation to volumetric 3D segmentation. Results: GIN provides the most consistent cross-modality performance among the evaluated approaches in the original 2D experiments. For pancreas segmentation, the Dice similarity coefficient (DSC) improved from 0.073 to 0.437 when CT data were incorporated through federated cross-modality training. In 3D whole-heart segmentation, FedGIN improved mean DSC over FedAvg from 0.8696 to 0.8901 on the unseen CT center and from 0.7160 to 0.7956 on the unseen MRI center. Relative to centralized GIN training, FedGIN retained 92.4% of performance on unseen CT data and achieved comparable performance on unseen MRI data (0.7956 versus 0.7937).