Lung Nodule Detection

Healthcare institutions routinely accumulate high-dimensional computed tomography (CT) volumes, but only a fraction can be annotated by experts. We present L2GSSL, a local-to-global self-supervised learning framework that leverages unlabeled volumes by decomposing pretraining into intra-slice and inter-slice representation spaces. A slice encoder learns view-invariant local features, and a global encoder aggregates the resulting tokens to model volumetric context. The stop-gradient isolates the local space from the global objective, while slice-wise execution and a three-phase schedule support training under constrained GPU memory. On LIDC-IDRI lung nodule malignancy classification, L2GSSL reaches $0.9229$ AUROC with only $10\%$ of the labels and $0.9377$ with $25\%$, exceeding the volume-level VICReg by $0.0229$ and $0.0294$, respectively. With all labels, the strongest supervised baseline exceeds L2GSSL by only $0.0044$ AUROC, consistent with self-supervised pretraining providing its greatest value when annotations are limited. Without adaptation to the external LNDb cohort, a model fine-tuned on $25\%$ of LIDC-IDRI obtains $0.8138$ AUROC and $0.7589$ AUPRC, improving over the strongest evaluated self-supervised baseline by $0.1130$ and $0.0954$. Experiments across data sources, thoracic and abdominal anatomy, downstream tasks, and two backbones examine healthcare-data variety, while lesion-slice masking shows that the predictions depend on lesion-bearing content.

Low dose Computed Tomography (CT) is the standard imaging modality for lung cancer screening. On CT scans, lung cancer typically manifests as pulmonary nodules, whose manual identification is time-consuming and prone to observer variability, image quality limitations, and suboptimal reading conditions. Moreover, subtle temporal changes are often difficult to quantify reliably in CT scans from the same patient across follow-up examinations. Deep learning-based approaches for the automatic detection and segmentation of lung nodules have demonstrated improved accuracy and efficiency. However, most existing approaches provide only coarse region-of-interest localisation, rely on prior lesion annotations or human supervision, or treat detection and segmentation as separate tasks. In this work, we present NoduleFlow, a framework for lung nodule detection, classification, and segmentation directly from series of CT volumes. Our proposal consists of four interconnected modules and operates in an automated manner at inference time, without requiring prior lesion annotations, manual initialisation, or region-of-interest pre-selection. We further investigate whether nodule localization benefits from the propagation of candidate regions across follow-up scans through inter-scan registration fields, as opposed to conventional independent per-scan analysis. The generalisability of the framework is systematically evaluated across four independent datasets. The results underscore the potential of automated pipelines for lung nodule analysis in screening and diagnostic settings.

In this work, we present an uncertainty-driven training framework for three-dimensional computed tomography (CT) lung nodule classification, where validation-based uncertainty estimates guide loss reweighting to enhance predictive performance and probability calibration. Two Uncertainty Quantification (UQ) methods are considered: Monte Carlo Dropout (MCD) and Evidential Deep Learning (EDL). Both provide per-class uncertainty estimates that modulate the loss and encourage focus on hard or unreliable classes. The framework is evaluated with ResNet, DenseNet, EfficientNet, Vision Transformer (ViT), and Swin Transformer backbones on two datasets: the clinical LIDC-IDRI cohort and the NoduleMNIST3D benchmark. Uncertainty-driven training achieves classification performance similar to conventional training while substantially improving calibration, with an expected calibration error (ECE) reduced by up to 65% on LIDC-IDRI. EDL attains competitive performance on shallower architectures with single-pass inference, whereas MCD is more robust on deeper networks. Analysis across architectural families reveals that uncertainty-driven training benefits convolutional backbones more consistently than transformer-based architectures: EDL in particular degrades on ViT, suggesting that the Dirichlet evidence parameterisation may interact unfavourably with attention-based architectures at lower input resolutions. A posteriori temperature scaling proves highly effective across all configurations, indicating that a simple scalar calibration can be competitive even without explicit uncertainty-aware training. Our results indicate that integrating UQ into the training loop can significantly improve probabilistic calibration and support more trustworthy deployment of three-dimensional medical imaging models.

Foundation models have recently demonstrated strong capabilities across a wide range of medical imaging tasks. However, their performance in structured clinical interpretation settings remains insufficiently explored. In lung cancer screening, interpretative variability persists despite standardized frameworks such as Lung-RADS. In this study, we evaluate MedGemma, a medical general-purpose foundation model derived from Gemini and its fine-tuned version adapted for lung cancer detection and diagnosis, compared against radiologists performing Lung-RADS v2022 assessment on the NLST dataset. Twelve radiologists independently evaluated each case in a multi-reader design, enabling quantification of inter-reader variability. Radiologists achieved a mean AUC of 0.90, with substantial variability across readers (range: 0.80-0.94). The native foundation model achieved an AUC of 0.70, failing to reach clinically relevant performance. In contrast, fine-tuning significantly improved performance to an AUC of 0.83, placing the model within the lower range of individual radiologists performance. These findings highlight a trade-off between peak accuracy and prediction consistency. Unlike radiologists, under fixed conditions, the model produces deterministic outputs, removing inter-run variability under identical inputs, in contrast to inter-reader variability observed among radiologists. This supports the role of fine-tuned foundation models potential complementary tools for clinical decision support, particularly in settings with limited expertise. However, evaluation is performed on a case-enriched cohort from NLST and does not account for real-world prevalence or external validation, limiting direct clinical generalization.

Lung cancer causes more deaths than any other malignancy, and low-dose CT screening is the main pathway to early diagnosis. That pathway hinges on the smallest lesions, yet nodules below six millimeters remain hard to detect, because most methods treat a nodule as a generic object and ignore the imaging physics behind its appearance. We show that this appearance is highly regular. Intensity peaks at the geometric center of a nodule and decays radially in a Gaussian pattern, and a fit to 18,218 annotated lesions from three public benchmarks yields a mean radial coefficient of determination above 0.86 in every dataset and size stratum. A square convolution samples both axes uniformly and is mismatched to this radial signal, most severely for small nodules. Guided by this evidence, we propose GRIPNet (Gaussian Radial Intensity Prior Network), a detector in which every module maps to a measurable property of the intensity distribution. Pinwheel convolutions decompose radial gradients, a dual-frequency module separates boundary detail from structural context, dilated masked attention matches the decay extent, and an adaptive loss reweights samples by conspicuity. GRIPNet raises [email protected] to 95.3, 91.6 and 97.9 percent on KanserSet, LUNA16 and Lung-PET-CT-Dx while sharpening high-IoU localization at real-time speed.

We propose NoduLoCC2026, a challenge on lung nodule detection and localization in chest X-ray images. We have provided a dataset for both tasks and received submissions from 5 international teams. The participating teams' solutions are presented in this work along with results on an external dataset used for testing. Proposed methods show good performance on the classification task. The best method shows a balanced accuracy score of 0.72 and AUC-ROC of 0.79. We highlight the limitations of current approaches for the localization task, with the best approach having predicted the correct number of nodules on 53% of the test images with a median distance of 12.83mm, showing that it is a more challenging task than the first one. The challenge website is available via https://gt-i2mdp.github.io/website/nodule_challenge.html.

AI governance for medical imaging is formalizing: the 2026 ACR-SIIM Practice Parameter recommends local acceptance testing and ongoing drift monitoring, and the ACR Assess-AI registry monitors AI outputs using DICOM metadata for context. We argue that a necessary, currently unmonitored layer sits beneath output metrics: whether incoming studies remain within the acquisition envelope a model was validated on. Using a LUNA16-trained MONAI RetinaNet lung-nodule detector, we test whether acquisition state behaves as a structured, measurable variable. On real paired CT differing only in reconstruction kernel (NLST B30f vs B80f), kernel alone shifted AI-measured diameter and flipped a Fleischner size category in 5.2% (8 of 155) of nodules at fixed patient and acquisition, while detection confidence was unchanged (Wilcoxon p=0.22). Under controlled LIDC-IDRI perturbations the effects dissociated by axis: the noise axis degraded detection confidence (p=5.9e-32, concentrated in nodules under 6 mm) but not measurement, while the frequency/kernel axis corrupted measurement (p=8.6e-13) but not detection. A 4-feature pixel fingerprint recovered reconstruction identity (patient-level AUC about 0.95 on real CT, 0.995 on a QIBA phantom) where the ConvolutionKernel DICOM tag was uninformative (identical labels across reconstructions). The kernel axis transported across four manufacturers (leave-one-vendor-out AUC 0.94-0.98, matching the within-vendor ceiling). Acquisition state thus maps to distinct AI failure modes, frequency content to measurement reliability and noise to detection sensitivity, and is not recoverable from metadata. Acquisition-aware, input-side validation is the missing layer for the acceptance-testing and drift-monitoring requirements now entering imaging-AI accreditation.

Background: Sensitivity of AI-assisted lung nodule detection systems is known to vary with CT acquisition parameters including radiation dose, reconstruction kernel, and slice thickness. However, the dependence of detection probability on nodule position within the reconstruction cycle -- the z-phase -- has not, to the author's knowledge, been characterized for deep learning-based detection systems. Methods: A retrospective analysis was performed using the LIDC-IDRI dataset. Detection results from a previously validated 154-case perturbation study were re-analyzed. For each consensus nodule (>=4-reader agreement), z-phase was defined as the fractional position of the nodule center within the reconstruction cycle, folded to [0, 0.5]. Detection sensitivity was stratified by z-phase bin, reconstruction interval (1mm, 3mm, 5mm), and by the ratio of reconstruction interval to nodule diameter (d/D). Results: At 5mm reconstruction interval, sensitivity was 71.6% vs 84.8% at 1mm baseline. Within the 5mm condition, sensitivity varied by 17.6 percentage points across z-phase bins. Stratified by d/D ratio, sensitivity was 92.4% for d/D < 0.5, 78.0% for 0.5 <= d/D < 1.0, and 61.4% for d/D >= 1.0, with a systematic z-phase effect present only in the d/D >= 1.0 stratum. Conclusions: AI detection sensitivity depends on the ratio of reconstruction interval to nodule diameter. When this ratio approaches or exceeds 1.0 -- as occurs for 3-6mm nodules at 5mm reconstruction -- z-phase becomes the dominant source of per-study detection variance. This stochastic effect is invisible to protocol-level quality metrics and not reflected in AI confidence scores.

Background: Artificial intelligence (AI) assisted lung nodule detection systems are increasingly deployed in clinical settings without site-specific validation. Performance reported under benchmark conditions may not reflect real-world behavior when acquisition parameters differ from training data. Purpose: To propose and demonstrate a physics-guided framework for evaluating the sensitivity of a deployed lung nodule detection model to systematic variation in CT acquisition parameters. Methods: Twenty-one cases from the publicly available LIDC-IDRI dataset were evaluated using a MONAI RetinaNet model pretrained on LUNA16 (fold 0, no fine-tuning). Five imaging conditions were tested: baseline, 25% dose reduction, 50% dose reduction, 3 mm slice thickness, and 5 mm slice thickness. Dose reduction was simulated via image-domain Gaussian noise; slice thickness via moving average along the z-axis. Detection sensitivity was computed at a confidence threshold of 0.5 with a 15 mm matching criterion. Results: Baseline sensitivity was 45.2% (57/126 consensus nodules). Dose reduction produced slight degradation: 41.3% at 25% dose and 42.1% at 50% dose. The 5 mm slice thickness condition produced a marked drop to 26.2% - a 19 percentage point reduction representing a 42% relative decrease from baseline. This finding was consistent across confidence thresholds from 0.1 to 0.9. Per-case analysis revealed heterogeneous performance including two cases with complete detection failure at baseline. Conclusion: Slice thickness represents a more fundamental constraint on AI detection performance than image noise under the conditions tested. The proposed framework is reproducible, requires no proprietary scanner data, and is designed to serve as the basis for ongoing post-deployment QA in resource-constrained environment.

Early detection of lung cancer in chest radiographs (CXRs) is crucial for improving patient outcomes, yet nodule detection remains challenging due to their subtle appearance and variability in radiological characteristics like size, texture, and boundary. For robust analysis, this diversity must be well represented in training datasets for deep learning based Computer-Assisted Diagnosis (CAD) systems. However, assembling such datasets is costly and often impractical, motivating the need for realistic synthetic data generation. Existing methods lack fine-grained control over synthetic nodule generation, limiting their utility in addressing data scarcity. This paper proposes a novel diffusion-based framework with low-rank adaptation (LoRA) adapters for characteristic controlled nodule synthesis on CXRs. We begin by addressing size and shape control through nodule mask conditioned training of the base diffusion model. To achieve individual characteristic control, we train separate LoRA modules, each dedicated to a specific radiological feature. However, since nodules rarely exhibit isolated characteristics, effective multi-characteristic control requires a balanced integration of features. We address this by leveraging the dynamic composability of LoRAs and revisiting existing merging strategies. Building on this, we identify two key issues, overlapping attention regions and non-orthogonal parameter spaces. To overcome these limitations, we introduce a novel orthogonality loss term during LoRA composition training. Extensive experiments on both in-house and public datasets demonstrate improved downstream nodule detection. Radiologist evaluations confirm the fine-grained controllability of our generated nodules, and across multiple quantitative metrics, our method surpasses existing nodule generation approaches for CXRs.