Medical Image Analysis

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Overview

Medical image analysis develops methods to detect disease, segment anatomy, track changes over time, reconstruct images, and estimate clinically useful measurements from modalities such as CT, MRI, X-rays, ultrasound, and retinal imaging. Common approaches include U-Net-style segmentation, transformers, self-supervised and foundation-model learning, multimodal vision-language systems, and methods that incorporate anatomical or physical constraints. Models are tested on tasks and benchmarks such as BraTS for brain tumors, ACDC for cardiac MRI, and EchoNet for echocardiography, with growing attention to external-site testing, calibration, and clinical workflow. A central challenge is that strong benchmark results may not transfer across scanners, hospitals, patient groups, or acquisition protocols, so reliable deployment requires better validation, uncertainty estimates, and safeguards against bias and privacy risks.

Latest papers

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292 papers27 papers in the last four weeks, down 13% on the four weeks before. 0.2% of all new papers.

Feb 25, 2026

Following the Diagnostic Trace: Visual Cognition-guided Cooperative Network for Chest X-Ray Diagnosis

Computer-aided diagnosis (CAD) has significantly advanced automated chest X-ray diagnosis but remains isolated from clinical workflows and lacks reliable decision support and interpretability. Human-AI collaboration seeks to enhance the reliability of diagnostic models by integrating the behaviors of controllable radiologists. However, the absence of interactive tools seamlessly embedded within diagnostic routines impedes collaboration, while the semantic gap between radiologists' decision-making patterns and model representations further limits clinical adoption. To overcome these limitations, we propose a visual cognition-guided collaborative network (VCC-Net) to achieve the cooperative diagnostic paradigm. VCC-Net centers on visual cognition (VC) and employs clinically compatible interfaces, such as eye-tracking or the mouse, to capture radiologists' visual search traces and attention patterns during diagnosis. VCC-Net employs VC as a spatial cognition guide, learning hierarchical visual search strategies to localize diagnostically key regions. A cognition-graph co-editing module subsequently integrates radiologist VC with model inference to construct a disease-aware graph. The module captures dependencies among anatomical regions and aligns model representations with VC-driven features, mitigating radiologist bias and facilitating complementary, transparent decision-making. Experiments on the public datasets SIIM-ACR, EGD-CXR, and self-constructed TB-Mouse dataset achieved classification accuracies of 88.40%, 85.05%, and 92.41%, respectively. The attention maps produced by VCC-Net exhibit strong concordance with radiologists' gaze distributions, demonstrating a mutual reinforcement of radiologist and model inference. The code is available at https://github.com/IPMI-NWU/VCC-Net.

Shaoxuan Wu, Jingkun Chen, Chong Ma +3

College of Computer Science, Northwest University, Xi’an, China, 710127 · Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom · School of Computing and Artificial Intelligence, Southwest Jiaotong University, Chengdu 611756, China +1

Medical Image AnalysisChest X-Ray ClassificationHuman-AI CollaborationExplainable Medical Image AnalysisMedical Image Localization
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Feb 24, 2026

Mask-HybridGNet: Graph-based segmentation with emergent anatomical correspondence from pixel-level supervision

Graph-based medical image segmentation represents anatomical structures using boundary graphs, providing fixed-topology landmarks and inherent population-level correspondences. However, their clinical adoption has been hindered by a major requirement: training datasets with manually annotated landmarks that maintain point-to-point correspondences across patients rarely exist in practice. We introduce Mask-HybridGNet, a framework that trains graph-based models directly using standard pixel-wise masks, eliminating the need for manual landmark annotations. Our approach aligns variable-length ground truth boundaries with fixed-length landmark predictions by combining Chamfer distance supervision and edge-based regularization to ensure local smoothness and regular landmark distribution, further refined via differentiable rasterization. A significant emergent property of this framework is that predicted landmark positions become consistently associated with specific anatomical locations across patients without explicit correspondence supervision. This implicit atlas learning enables temporal tracking, cross-slice reconstruction, and morphological population analyses. Beyond direct segmentation, Mask-HybridGNet can extract correspondences from existing segmentation masks, allowing it to generate stable anatomical atlases from any high-quality pixel-based model. Experiments across chest radiography, cardiac ultrasound, cardiac MRI, and fetal imaging demonstrate that our model achieves competitive results against state-of-the-art pixel-based methods, while ensuring anatomical plausibility by enforcing boundary connectivity through a fixed graph adjacency matrix. This framework leverages the vast availability of standard segmentation masks to build structured models that maintain topological integrity and provide implicit correspondences.

Nicolás Gaggion, Maria J. Ledesma-Carbayo, Stergios Christodoulidis +2

APOLO Biotech, Ciudad Autónoma de Buenos Aires, Argentina · Departamento de Computación, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina · Instituto de Ciencias de la Computación (ICC), CONICET-Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina +4

Medical Image SegmentationMedical Image AnalysisTopology-Preserving Image Segmentation
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Feb 24, 2026

MIP Candy: A Modular PyTorch Framework for Medical Image Processing

Medical image processing demands specialized software that handles high-dimensional volumetric data, heterogeneous file formats, and domain-specific training procedures. Existing frameworks either provide low-level components that require substantial integration effort or impose rigid, monolithic pipelines that resist modification. We present MIP Candy (MIPCandy), a freely available, PyTorch-based framework designed specifically for medical image processing. MIPCandy provides a complete, modular pipeline spanning data loading, training, inference, and evaluation, allowing researchers to obtain a fully functional process workflow by implementing a single method, \texttt{build_network}, while retaining fine-grained control over every component. Central to the design is LayerT\texttt{LayerT}, a deferred configuration mechanism that enables runtime substitution of convolution, normalization, and activation modules without subclassing. The framework further offers built-in kk-fold cross-validation, dataset inspection with automatic region-of-interest detection, deep supervision, exponential moving average, multi-frontend experiment tracking (Weights & Biases, Notion, MLflow), training state recovery, and validation score prediction via quotient regression. An extensible bundle ecosystem provides pre-built model implementations that follow a consistent trainer--predictor pattern and integrate with the core framework without modification. MIPCandy is open-source under the Apache-2.0 license and requires Python~3.12 or later. Source code and documentation are available at https://github.com/ProjectNeura/MIPCandy.

Tianhao Fu, Yucheng Chen

University of Toronto, Toronto, ON, Canada · Vector Institute, Toronto, ON, Canada · Project Neura, Toronto, ON, Canada +2

Medical ImagingMedical Image Analysis
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Feb 23, 2026

Efficient endometrial carcinoma screening via cross-modal synthesis and gradient distillation

Early detection of myometrial invasion is critical for the staging and life-saving management of endometrial carcinoma (EC), a prevalent global malignancy. Transvaginal ultrasound serves as the primary, accessible screening modality in resource-constrained primary care settings; however, its diagnostic reliability is severely hindered by low tissue contrast, high operator dependence, and a pronounced scarcity of positive pathological samples. Existing artificial intelligence solutions struggle to overcome this severe class imbalance and the subtle imaging features of invasion, particularly under the strict computational limits of primary care clinics. Here we present an automated, highly efficient two-stage deep learning framework that resolves both data and computational bottlenecks in EC screening. To mitigate pathological data scarcity, we develop a structure-guided cross-modal generation network that synthesizes diverse, high-fidelity ultrasound images from unpaired magnetic resonance imaging (MRI) data, strictly preserving clinically essential anatomical junctions. Furthermore, we introduce a lightweight screening network utilizing gradient distillation, which transfers discriminative knowledge from a high-capacity teacher model to dynamically guide sparse attention towards task-critical regions. Evaluated on a large, multicenter cohort of 7,951 participants, our model achieves a sensitivity of 99.5%, a specificity of 97.2%, and an area under the curve of 0.987 at a minimal computational cost (0.289 GFLOPs), substantially outperforming the average diagnostic accuracy of expert sonographers. Our approach demonstrates that combining cross-modal synthetic augmentation with knowledge-driven efficient modeling can democratize expert-level, real-time cancer screening for resource-constrained primary care settings.

Dongjing Shan, Yamei Luo, Jiqing Xuan +7

School of Medical Information and Engineering, Southwest Medical University, Luzhou 646000, Sichuan, China · School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China · Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China +8

Medical Image AnalysisOncologyUltrasound ImagingMedical Image Synthesis
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Feb 23, 2026

CT-Flow: Orchestrating CT Interpretation Workflow with Model Context Protocol Servers

Recent advances in Large Vision-Language Models (LVLMs) have shown strong potential for multi-modal radiological reasoning, particularly in tasks like diagnostic visual question answering (VQA) and radiology report generation. However, most existing approaches for 3D CT analysis largely rely on static, single-pass inference. In practice, clinical interpretation is a dynamic, tool-mediated workflow where radiologists iteratively review slices and use measurement, radiomics, and segmentation tools to refine findings. To bridge this gap, we propose CT-Flow, an agentic framework designed for interoperable volumetric interpretation. By leveraging the Model Context Protocol (MCP), CT-Flow shifts from closed-box inference to an open, tool-aware paradigm. We curate CT-FlowBench, the first large-scale instruction-tuning benchmark tailored for 3D CT tool-use and multi-step reasoning. Built upon this, CT-Flow functions as a clinical orchestrator capable of decomposing complex natural language queries into automated tool-use sequences. Experimental evaluations on CT-FlowBench and standard 3D VQA datasets demonstrate that CT-Flow achieves state-of-the-art performance, surpassing baseline models by 41% in diagnostic accuracy and achieving a 95% success rate in autonomous tool invocation. This work provides a scalable foundation for integrating autonomous, agentic intelligence into real-world clinical radiology.

Yannian Gu, Xizhuo Zhang, Linjie Mu +4

Qing Yuan Research Institute, Shanghai Jiao Tong University, Shanghai, China · Sensetime Research, Shanghai, China · Shanghai Innovation Institute, Shanghai, China

Medical Image AnalysisMedical VLMsComputed TomographyVLM Reasoning3D VQA
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Feb 20, 2026

From Global Radiomics to Parametric Maps: A Unified Workflow Fusing Radiomics and Deep Learning for PDAC Detection

Radiomics and deep learning both offer powerful tools for quantitative medical imaging, but most existing fusion approaches only leverage global radiomic features and overlook the complementary value of spatially resolved radiomic parametric maps. We propose a unified framework that first selects discriminative radiomic features and then injects them into a radiomics-enhanced nnUNet at both the global and voxel levels for pancreatic ductal adenocarcinoma (PDAC) detection. On the PANORAMA dataset, our method achieved AUC = 0.96 and AP = 0.84 in cross-validation. On an external in-house cohort, it achieved AUC = 0.95 and AP = 0.78, outperforming the baseline nnUNet; it also ranked second in the PANORAMA Grand Challenge. This demonstrates that handcrafted radiomics, when injected at both global and voxel levels, provide complementary signals to deep learning models for PDAC detection. Our code can be found at https://github.com/briandzt/dl-pdac-radiomics-global-n-paramaps

Zengtian Deng, Yimeng He, Yu Shi +4

Cedars-Sinai Medical Center, Los Angeles, CA, USA · University of California, Los Angeles, Los Angeles, CA, USA

Medical Image AnalysisRadiomicsOncologyConvolutional Neural Networks
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Feb 17, 2026

Imaging-Derived Coronary Fractional Flow Reserve: Advances in Physics-Based, Machine Learning, and Physics-Informed Methods

Purpose of Review Imaging derived fractional flow reserve (FFR) is rapidly evolving beyond conventional computational fluid dynamics (CFD) based pipelines toward machine learning (ML), deep learning (DL), and physics informed approaches that enable fast, wire free, and scalable functional assessment of coronary artery stenosis. This review synthesizes recent advances in computed tomography (CT)- and angiography-based FFR measurement, with particular emphasis on emerging physics-informed neural networks and neural operators (PINNs and PINOs), as well as key considerations for their clinical translation. Recent Findings ML/DL approaches have markedly improved automation and computational speed, enabling prediction of pressure and FFR from anatomical descriptors or angiographic contrast dynamics. However, their real-world performance and generalizability can remain variable and sensitive to domain shift, due to multi-center heterogeneity, interpretability challenges, and differences in acquisition protocols and image quality. Physics informed learning introduces conservation structure and boundary condition consistency into model training, improving generalizability and reducing dependence on dense supervision while maintaining rapid inference. Recent evaluation trends increasingly highlight deployment oriented metrics, including calibration, uncertainty quantification, and quality control gatekeeping, as essential for safe clinical use. Summary The field is converging toward imaging derived FFR methods that are faster, more automated, and more reliable. While ML/DL offers substantial efficiency gains, physics informed frameworks such as PINNs and PINOs may provide a more robust balance between speed and physical consistency. Prospective multi center validation and standardized evaluation will be critical to support broad and safe clinical adoption.

Tanxin Zhu, Emran Hossen, Chen Zhao +4

Department of Applied Computing, Michigan Technological University, Houghton, MI, USA · Department of Computer Science, Kennesaw State University, Marietta GA, USA · Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA +3

Medical Image AnalysisPhysics-Informed MLPhysics-Informed Neural OperatorsComputational Fluid Dynamics
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Feb 17, 2026

Effective and Robust Multimodal Medical Image Analysis

Multimodal Fusion Learning (MFL), leveraging disparate data from various imaging modalities (e.g., MRI, CT, SPECT), has shown great potential for addressing medical problems such as skin cancer and brain tumor prediction. However, existing MFL methods face three key limitations: a) they often specialize in specific modalities, and overlook effective shared complementary information across diverse modalities, hence limiting their generalizability for multi-disease analysis; b) they rely on computationally expensive models, restricting their applicability in resource-limited settings; and c) they lack robustness against adversarial attacks, compromising reliability in medical AI applications. To address these limitations, we propose a novel Multi-Attention Integration Learning (MAIL) network, incorporating two key components: a) an efficient residual learning attention block for capturing refined modality-specific multi-scale patterns and b) an efficient multimodal cross-attention module for learning enriched complementary shared representations across diverse modalities. Furthermore, to ensure adversarial robustness, we extend MAIL network to design Robust-MAIL by incorporating random projection filters and modulated attention noise. Extensive evaluations on 20 public datasets show that both MAIL and Robust-MAIL outperform existing methods, achieving performance gains of up to 9.34% while reducing computational costs by up to 78.3%. These results highlight the superiority of our approaches, ensuring more reliable predictions than top competitors. Code: https://github.com/misti1203/MAIL-Robust-MAIL.

Joy Dhar, Nayyar Zaidi, Maryam Haghighat

Indian Institute of Technology Ropar, Rupnagar, Punjab, India · Deakin University, Melbourne, Victoria, Australia · Queensland University of Technology, Brisbane, QLD, Australia

Medical Image AnalysisMultimodal FusionEfficient Multimodal InferenceMultimodal RobustnessCross-Attention
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Feb 17, 2026

Foundation Models for Medical Imaging: Status, Challenges, and Directions

Foundation models (FMs) are rapidly reshaping medical imaging, shifting the field from narrowly trained, task-specific networks toward large, general-purpose models that can be adapted across modalities, anatomies, and clinical tasks. In this review, we synthesize the emerging landscape of medical imaging FMs along three major axes: principles of FM design, applications of FMs, and forward-looking challenges and opportunities. Taken together, this review provides a technically grounded, clinically aware, and future-facing roadmap for developing FMs that are not only powerful and versatile but also trustworthy and ready for responsible translation into clinical practice.

Chuang Niu, Pengwei Wu, Bruno De Man +1

Biomedical Imaging Center, Center for Computational Innovations, Center for Biotechnology & Interdisciplinary Studies, Department of Biomedical Engineering, School of Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA · GE HealthCare Technology & Innovation Center, Niskayuna, NY, USA

Medical Imaging Foundation ModelsMedical ImagingMedical Image Analysis
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Feb 16, 2026

A Generative AI Approach for Reducing Skin Tone Bias in Skin Cancer Classification

Skin cancer is one of the most common cancers worldwide and early detection is critical for effective treatment. However, current AI diagnostic tools are often trained on datasets dominated by lighter skin tones, leading to reduced accuracy and fairness for people with darker skin. The International Skin Imaging Collaboration (ISIC) dataset, one of the most widely used benchmarks, contains over 70% light skin images while dark skins fewer than 8%. This imbalance poses a significant barrier to equitable healthcare delivery and highlights the urgent need for methods that address demographic diversity in medical imaging. This paper addresses this challenge of skin tone imbalance in automated skin cancer detection using dermoscopic images. To overcome this, we present a generative augmentation pipeline that fine-tunes a pre-trained Stable Diffusion model using Low-Rank Adaptation (LoRA) on the image dark-skin subset of the ISIC dataset and generates synthetic dermoscopic images conditioned on lesion type and skin tone. In this study, we investigated the utility of these images on two downstream tasks: lesion segmentation and binary classification. For segmentation, models trained on the augmented dataset and evaluated on held-out real images show consistent improvements in IoU, Dice coefficient, and boundary accuracy. These evalutions provides the verification of Generated dataset. For classification, an EfficientNet-B0 model trained on the augmented dataset achieved 92.14% accuracy. This paper demonstrates that synthetic data augmentation with Generative AI integration can substantially reduce bias with increase fairness in conventional dermatological diagnostics and open challenges for future directions.

Areez Muhammed Shabu, Mohammad Samar Ansari, Asra Aslam

University of Sheffield, UK · University of Chester, UK

Medical Image AnalysisSynthetic Data AugmentationSkin Lesion ClassificationMedical Image Synthesis
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Feb 12, 2026

Confidence-Uncertainty Boundary Calibration for Bayesian Deep Learning in Medical Image Analysis

In critical decision support systems based on medical imaging, the reliability of AI-assisted decision-making is as relevant as predictive accuracy. Although deep learning models have demonstrated significant accuracy, they frequently suffer from miscalibration, manifested as overconfidence in erroneous predictions. To facilitate clinical acceptance, it is imperative that models quantify uncertainty in a manner that correlates with prediction correctness, allowing clinicians to identify unreliable outputs for further review. To address this necessity, this paper proposes a probabilistic optimization framework grounded in Bayesian deep learning. Specifically, the Confidence-Uncertainty Boundary Curve (CUBC) is first explored as an intermediate operational target. Grounded in this target, a novel Confidence-Uncertainty Boundary Loss (CUB-Loss) is proposed to regularize the alignment between prediction confidence and uncertainty estimates during training, imposing penalties on high-certainty errors and low-certainty correct predictions. Upon completion of training optimization, a Boundary Curve Calibration Error (BCCE) metric is further introduced to measure the degree of boundary alignment in the calibrated model. Building on this measurement, a Dual Temperature Scaling (DTS) strategy is devised to perform post-hoc refinement, further adjusting the posterior predictive distribution across different confidence-uncertainty regions. The proposed framework is validated on three distinct medical imaging tasks: automatic screening of pneumonia, diabetic retinopathy detection, and identification of skin lesions. Empirical results demonstrate that the proposed approach improves uncertainty calibration across diverse modalities, maintains robust performance in data-scarce scenarios, and remains effective on severely imbalanced datasets, underscoring its potential for real clinical deployment.

Hua Xu, Julián D. Arias-Londoño, Juan I. Godino-Llorente

Escuela Técnica Superior de Ingenieros de Telecomunicación Universidad Politécnica de Madrid 28040, Madrid, Spain

Bayesian Neural NetworksPost-Hoc CalibrationMedical Image AnalysisMedical Image ClassificationUncertainty Calibration
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Feb 9, 2026

retinalysis-vascx: An explainable software toolbox for the extraction of retinal vascular biomarkers

Automatic extraction of retinal vascular biomarkers from color fundus images (CFI) is crucial for large-scale studies of the retinal vasculature. We present VascX, an open-source Python toolbox that extracts biomarkers from CFI artery-vein segmentations. VascX starts from vessel segmentation masks, extracts their skeletons, builds undirected and directed vessel graphs, and resolves vessel segments into longer vessels. A comprehensive set of biomarkers is derived, including vascular density, central retinal equivalents (CREs), and tortuosity. Spatially localized biomarkers may be calculated over grids placed relative to the fovea and optic disc. VascX is released via GitHub and PyPI with comprehensive documentation and examples. Our test-retest reproducibility analysis on repeat imaging of the same eye by different devices shows that most VascX biomarkers have moderate to excellent agreement (ICC > 0.5), with important differences in the level of robustness of different biomarkers. Our analyses of biomarker sensitivity to image perturbations and heuristic parameter values support these differences and further characterize VascX biomarkers. Ultimately, VascX provides an explainable and easily modifiable feature-extraction toolbox that complements segmentation to produce reliable retinal vascular biomarkers. Our graph-based biomarker computation stages support reproducible, region-aware measurements suited for large-scale clinical and epidemiological research. By enabling easy extraction of existing biomarkers and rapid experimentation with new ones, VascX supports oculomics research. Its robustness and computational efficiency facilitate scalable deployment in large databases, while open-source distribution lowers barriers to adoption for ophthalmic researchers and clinicians.

Jose D. Vargas Quiros, Michael J. Beyeler, Sofia Ortin Vela +5

Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands · Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands · 5Dept. of Computational Biology, University of Lausanne, Lausanne, Switzerland +4

Medical Image AnalysisFundus ImagingExplainable Medical Image AnalysisOphthalmic Image AnalysisOphthalmology
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Jan 21, 2026

Tracing 3D Anatomy in 2D Strokes: A Multi-Stage Projection Driven Approach to Cervical Spine Fracture Identification

Cervical spine fractures require rapid and accurate diagnosis, yet automatic CT interpretation remains challenging as subtle injuries must be assessed across large 3D volumes. We ask whether full 3D vertebra segmentation is necessary for automated fracture recognition, or whether vertebra masks approximated from 2D projections can preserve sufficient diagnostic context. We propose an end-to-end pipeline that localizes the cervical spine, estimates C1-C7 vertebra masks from optimized 2D projections, and uses the resulting vertebra-level volumes for downstream fracture classification. A YOLOv8 detector first localizes spine regions of interest from multi-view variance projections, achieving a 3D mean Intersection over Union of 94.45%. Multi-label vertebra segmentation is then performed with a DenseNet121-Unet on energy-based sagittal and coronal projections, attaining a mean Dice score of 87.86%. The predicted 2D masks are back-projected and fused into approximate 3D masks for each vertebra to extract volumes of interest from the original CT. These volumes are analyzed by an ensemble of 2.5D spatio-sequential CNN-Transformer models, yielding vertebra-level and patient-level F1 scores of 68.15 and 82.26, area under the receiver operating characteristic curve of 91.62 and 90.95, and area under the precision-recall curve of 75.60 and 92.00, respectively. The projection-derived volumes achieved fracture-recognition performance comparable to a full 3D-segmentation baseline, while shifting the vertebra segmentation stage into a lower-dimensional domain. Saliency-based explainability and interobserver variability analysis further examine interpretability and reliability. Overall, the results indicate that projection-based mask approximation is a viable proxy for full 3D vertebra segmentation in cervical fracture recognition.

Fabi Nahian Madhurja, Rusab Sarmun, Muhammad E. H. Chowdhury +3

Department of Computer Science and Engineering, BRAC University, Dhaka 1212, Bangladesh · Department of Electrical and Electronic Engineering, University of Dhaka, Dhaka 1000, Bangladesh · Department of Electrical Engineering, Qatar University, Doha 2713, Qatar +1

Image SegmentationMedical Image AnalysisMedical Image SegmentationComputed Tomography
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Sep 17, 2025

Invisible Yet Detected: PelFANet with Attention-Guided Anatomical Fusion for Pelvic Fracture Diagnosis

Pelvic fractures pose significant diagnostic challenges, particularly in cases where fracture signs are subtle or invisible on standard radiographs. To address this, we introduce PelFANet, a dual-stream attention network that fuses raw pelvic X-rays with segmented bone images to improve fracture classification. The network employs Fused Attention Blocks (FABlocks) to iteratively exchange and refine features from both inputs, capturing global context and localized anatomical detail. Trained in a two-stage pipeline with a segmentation-guided approach, PelFANet demonstrates superior performance over conventional methods. On the AMERI dataset, it achieves 88.68% accuracy and 0.9334 AUC on visible fractures, while generalizing effectively to invisible fracture cases with 82.29% accuracy and 0.8688 AUC, despite not being trained on them. These results highlight the clinical potential of anatomy-aware dual-input architectures for robust fracture detection, especially in scenarios with subtle radiographic presentations.

Siam Tahsin Bhuiyan, Rashedur Rahman, Sefatul Wasi +4

Center for Computational & Data Sciences, Independent University, Bangladesh · Department of Computer Science and Engineering, Independent University, Bangladesh · Advanced Medical Engineering Research Institute, University of Hyogo, Japan +1

Medical Image AnalysisMedical Image ClassificationMultimodal Fusion
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Aug 22, 2025

Bridging the Gap in Ophthalmic AI: MM-Retinal-Reason Dataset and OphthaReason Model toward Dynamic Multimodal Reasoning

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities under reinforcement learning (RL) paradigm. However, most existing multimodal medical reasoning models focus on basic reasoning, which refers to shallow inference based on visual feature matching. In contrast, real-world clinical diagnosis extends beyond basic reasoning, demanding complex reasoning that integrates heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, an ophthalmic multimodal dataset covering the full spectrum of perception and reasoning. Specifically, it is the first dataset in ophthalmology to encompass both basic and complex reasoning tasks with Chain-of-Thought (CoT) trajectories, aiming to enhance visual-centric reasoning and emulate realistic clinical decision-making. Building upon MM-Retinal-Reason, we propose OphthaReason, the first RL-enhanced ophthalmic multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we further introduce Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates exploration depth through a shaped advantage mechanism. Comprehensive experiments demonstrate the effectiveness of our model on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 15.47%. Project Page: link.

Ruiqi Wu, Yuang Yao, Na Su +11

School of Computer Science and Engineering, Southeast University, Nanjing, China · Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China · School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China

RL for VLMsMedical Image AnalysisMultimodal ReasoningOphthalmic Image AnalysisMedical VLMsMultimodal CoT Reasoning+1
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Jul 15, 2025

Trexplorer Super: Topologically Correct Centerline Tree Tracking of Tubular Objects in CT Volumes

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

Roman Naeem, David Hagerman, Jennifer Alvén +2

Chalmers University of Technology, 412 96 Gothenburg, Sweden

Medical Image Analysis3D Medical ImagingMedical Image Benchmarks
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Jul 10, 2025

ArteryX: A Reliable End-to-End Toolbox for Standardized Intracranial Artery Feature Extraction from 3D TOF-MRA

Cerebrovascular research heavily relies on quantitative analysis of intracranial arteries from time-of-flight magnetic resonance angiography, yet existing processing pipelines remain limited by inconsistent artery labeling and a high manual correction burden. We present ArteryX, a toolbox for extracting features that standardizes artery classification across proximal and distal vascular territories. It integrates segmentation handling, isotropic processing, vessel-fused graph construction, and constrained landmark-based classification within a unified artery-specific feature reporting and reproducible workflow. The toolbox extracts morphological, topological, and complexity features including total length, mean radius, volume, surface area, branch count, tortuosity, and fractal dimensionality for standardized artery-segments. Test-and-validation were performed using three complementary datasets: (1)TopBrain-Challenge benchmarking with annotated arteries, (2)synthetic known-reference validation, and (3)exploratory in-vivo cohort of cerebral small vessel disease. In TopBrain analyses, ArteryX with supervised nnUnet segmentation showed minimal bias, while iCafe showed the highest bias and a large limit-of-agreement. ArteryX consistently demonstrated robust downstream quantification performance across segmentation sources (unsupervised/supervised). Agreement analyses showed minimal bias for radius and good sensitivity of extent-dependent metrics throughout the noisier segmentations compared to the state-of-the-art iCafe-toolbox. Furthermore, a stage-wise human-in-the-loop protocol showed lower intervention time than iCafe. In an in-vivo-cohort (48CSVD+, 20CSVD-), ArteryX-derived distal and territory-level features showed group-level differences, not evident with iCafe. To facilitate adoption-and-reproducibility, ArteryX is designed with versioned builds, tutorials, and documentation.

Abrar Faiyaz, Nhat Hoang, Giovanni Schifitto +1

Department of Neurology, University of Rochester, Rochester, NY 14642, USA · Department of Physics, University of Rochester, Rochester, NY 14627, USA · Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA +2

Medical Image AnalysisMagnetic Resonance Imaging
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Jun 24, 2025

Online camera-pose-free stereo endoscopic tissue deformation recovery with tissue-invariant vision-biomechanics consistency

Tissue deformation recovery based on stereo endoscopic images is crucial for tool-tissue interaction analysis and benefits surgical navigation and autonomous soft tissue manipulation. Previous research suffers from the problems raised from camera motion, occlusion, large tissue deformation, lack of tissue-specific biomechanical priors, and reliance on offline processing. Unlike previous studies where the tissue geometry and deformation are represented by 3D points and displacements, the proposed method models tissue geometry as the 3D point and derivative map and tissue deformation as the 3D displacement and local deformation map. For a single surface point, 6 parameters are used to describe its rigid motion and 3 parameters for its local deformation. The method is formulated under the camera-centric setting, where all motions are regarded as the scene motion with respect to the camera. Inter-frame alignment is realized by optimizing the inter-frame deformation, making it unnecessary to estimate camera pose. The concept of the canonical map is introduced to optimize tissue geometry and deformation in an online approach. Quantitative and qualitative experiments were conducted using in vivo and ex vivo laparoscopic datasets. With the inputs of depth and optical flow, the method stably models tissue geometry and deformation even when the tissue is partially occluded or moving outside the field of view. Results show that the 3D reconstruction accuracy in the non-occluded and occluded areas reaches 0.37±\pm0.27 mm and 0.39±\pm0.21 mm in terms of surface distance, respectively. The method can also estimate surface strain distribution during various manipulations as an extra modality for mechanical-based analysis.

Jiahe Chen, Naoki Tomii, Ichiro Sakuma +1

School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan

Endoscopy3D ReconstructionMedical Image AnalysisDynamic Scene ReconstructionDeformable Shape ReconstructionStereo Vision+1
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Apr 22, 2025

Clinician-Friendly Foundation Models for Ophthalmic Image Diagnostics without Fine-Tuning or Technical Barriers

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We developed GlobeReady, a deployment-oriented platform powered by the RetiGlobe foun- dation model and local feature augmentation. RetiGlobe was pretrained in two stages: 1) self-supervised learning using DINOv2 on 38 million synthetic ophthalmic images, and 2) contrastive learning using CLIP on 475,845 real image-text pairs spanning diverse ethnicities, imaging devices, and geographic regions worldwide. We evaluate GlobeReady on 488,448 ophthalmic images, including color fundus photographs (CFPs) and optical coherence tomography scans, from multi-centres in China, Singapore, Vietnam and the UK. Prospective testing included usability assessment with 31 ophthalmologists. Exploratory analyses evaluated domain generalisability, Bayesian uncertainty quantification, out-of-distribution (OOD) detection, and feature-based case retrieval.

Meng Wang, Tian Lin, Qingshan Hou +69

Medical Imaging Foundation ModelsOphthalmic Image AnalysisMedical Image AnalysisMedical VLMsFundus ImagingOphthalmology
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Apr 8, 2025

WoundAmbit: Bridging State-of-the-Art Semantic Segmentation and Real-World Wound Care

Chronic wounds affect a large population, particularly the elderly and diabetic patients, who often exhibit limited mobility and co-existing health conditions. Automated wound monitoring via mobile image capture can reduce in-person physician visits by enabling remote tracking of wound size. Semantic segmentation is key to this process, yet wound segmentation remains underrepresented in medical imaging research. To address this, we benchmark state-of-the-art deep learning models from general-purpose vision, medical imaging, and top methods from public wound challenges. For a fair comparison, we standardize training, data augmentation, and evaluation, conducting cross-validation to minimize partitioning bias. We also assess real-world deployment aspects, including generalization to an out-of-distribution wound dataset, computational efficiency, and interpretability. Additionally, we propose a reference object-based approach to convert AI-generated masks into clinically relevant wound size estimates and evaluate this, along with mask quality, for the five best architectures based on physician assessments. Overall, the transformer-based TransNeXt showed the highest levels of generalizability. Despite variations in inference times, all models processed at least one image per second on the CPU, which is deemed adequate for the intended application. Interpretability analysis typically revealed prominent activations in wound regions, emphasizing focus on clinically relevant features. Expert evaluation showed high mask approval for all analyzed models, with VWFormer and ConvNeXtS backbone performing the best. Size retrieval accuracy was similar across models, and predictions closely matched expert annotations. Finally, we demonstrate how our AI-driven wound size estimation framework, WoundAmbit, is integrated into a custom telehealth system.

Vanessa Borst, Timo Dittus, Tassilo Dege +2

Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany · University Hospital Würzburg, 97070 Würzburg, Germany

Medical Image AnalysisMedical Image SegmentationExplainable Medical Image Analysis
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Mar 21, 2025

Echo-E3^3Net: Efficient Endocardial Spatio-Temporal Network for Ejection Fraction Estimation

Left ventricular ejection fraction (LVEF) is a primary marker of cardiac function. However, routine estimation from endocardial measurements requires manual delineation at end-diastole (ED) and end-systole (ES), a process that is time-consuming and subject to inter-observer variability. Reliable automation is especially valuable for point-of-care ultrasound (POCUS), where computational resources are limited and acquisition quality varies. We propose Echo-E3^3Net, an anatomy-guided spatio-temporal network that explicitly embeds cardiac anatomy into LVEF prediction. A dual-phase Endocardial Border Detector (E2^2CBD) uses phase-specific cross-attention to localize ED/ES endocardial landmarks and produce phase-aware landmark embeddings, while an Endocardial Feature Aggregator (E2^2FA) fuses these embeddings with global statistical descriptors of deep feature maps to refine EF regression. Training is guided by a lightweight geometric loss that uses ED and ES endocardial landmarks to regularize EF prediction. On EchoNet-Dynamic and a PSAX subset of EchoNet-Pediatric, Echo-E3^3Net attains competitive performance using only 1.55M parameters and 8.05 GFLOPs, an order-of-magnitude compute reduction versus recent baselines, supporting real-time deployment. Our code is publicly available at https://github.com/moeinheidari7829/Echo-E3Net.

Moein Heidari, Afshin Bozorgpour, AmirHossein Zarif-Fakharnia +5

University of British Columbia, Vancouver, BC, Canada · University of Regensburg, Regensburg, Germany · Iran University of Science and Technology, Tehran, Iran +1

Efficient Neural Network InferenceLeft Ventricular Ejection Fraction EstimationMedical Image AnalysisEchocardiographyUltrasound ImagingMedical Image Localization
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Oct 19, 2024

MultiViewDx: Evidence-Linked Multi-View Clinical Diagnosis

Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. MultiViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence -> findings -> differential discussion -> diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond MedVQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.

Junda Wang, Zonghai Yao, Yujan Ting +5

United Imaging Intelligence, MA, USA · Manning College of Information and Computer Sciences, University of Massachusetts Amherst, MA, USA · Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA +1

HealthcareMedical Image AnalysisMedical VQAMedical Image GroundingMultimodal Foundation ModelsMultimodal Instruction Tuning+1
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