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.

Sep 27, 2026

FOCUS: Benchmarking Retinal Model Generalization from Foundation Vision Encoders to Multimodal LLMs

Progress in AI-based retinal image analysis has accelerated with the adoption of foundation models, yet evaluating their real-world reliability remains challenging. Performance reported on a single dataset does not capture how models behave under dataset shift, across clinical definitions, or for different patient subgroups. This limitation is particularly critical in medical imaging, where robustness, calibration, and fairness are essential for safe deployment. We introduce FOCUS (Foundation Ophthalmic Cross-Dataset Understanding under Shift), a cross-dataset benchmark evaluating retinal fundus models across vision-only encoder models (VM), vision-language dual-encoder models (VLM), and multimodal large language models (MLLM). FOCUS harmonizes binary diabetic retinopathy, referable diabetic retinopathy, and glaucomatous optic neuropathy tasks across ten public datasets spanning diverse geographies, acquisition conditions, and label protocols. The benchmark evaluates models through a unified analysis layer that measures ranking performance, calibration, subgroup disparities, and image-quality robustness. We present a large-scale evaluation covering 532 base configurations and 228 MLLM configurations adapted via LoRA fine-tuning. Results show no model family consistently dominates across tasks and datasets: general VM encoders achieve the strongest average ranking performance, medical MLLMs are competitive but variable, and dual-encoder VLMs benefit substantially from lightweight adaptation. Fine-tuning improves in-domain performance but exhibits heterogeneous transfer to external datasets, particularly in calibration. FOCUS provides a practical framework and public benchmark to assess generalization, reliability, and robustness beyond single-dataset leaderboards.

David Restrepo, Chenwei Wu, Luis Filipe Nakayama +4

CentraleSupélec, Université Paris-Saclay, France · Cancer Data Science Unit, IHU PRISM, Université Paris-Saclay, CentraleSupélec, Gustave Roussy, INSERM, France · University of Michigan, USA +4

Fairness in Medical Image ClassificationOphthalmic Image AnalysisMedical Image AnalysisCross-Dataset GeneralizationMedical Image BenchmarksMedical Image Classification+2
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Sep 26, 2026

ReVision3D: Attribution-Guided Recursive Self-Improvement for 3D Medical Perception

Recursive self-improvement (RSI) offers a promising path for overcoming the limited visual capability of current medical imaging agents. Yet applying RSI to volumetric imaging remains difficult: failures can arise from acquisition, perception, training recipe, or downstream inference, while self-generated feedback and logged trajectories provide little guidance on which component should change. We introduce ReVision3D, an RSI system that leverages 3D volumes with spatially grounded annotations to determine where visual evidence is lost and recursively improve the corresponding visual capability. A frozen language-model designer proposes revisions to acquisition, perception, training, or inference, while the verifier and system-level objective remain fixed. Our key insight is that an annotated volume forms an exact replay world for view rendering and spatial verification: unvisited views can be rendered on demand, and localized predictions can be checked directly against reference masks. This grounded feedback directs targeted revision, while only changes that improve beyond measured seed noise are retained. Each accepted change triggers renewed attribution, allowing the dominant bottleneck to shift across rounds. On abdominal CT, attribution identifies perception as the dominant remaining limitation. Revising that level enables ReVision3D to achieve 79% liver recall and 83% kidney recall at under 0.4 false positives per patient, outperforming the evaluated frozen multimodal foundation models, with the largest gains on small lesions. Our framework is public available with interactive demo in this project page: https://leeh43.github.io/ReVision3D/

Ho Hin Lee, Yuyin Zhou, Yannan Yu +2

Vanderbilt University · University of California, Santa Cruz · University of California, San Francisco +2

Medical Image Analysis3D Medical ImagingRecursive Self-Improvement
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Sep 26, 2026

Learning When to Recur: Token-Adaptive Recursion for Imbalanced Ophthalmic Domain Incremental Learning

Domain incremental learning is essential for adapting ophthalmic deep learning models to sequential clinical domains while preserving diagnostic expertise. Existing domain incremental learning methods predominantly address the domain shift induced by style variations. However, they often overlook the severe class imbalance inherent in real-world clinical scenarios, such as clinical referral systems. Institutions in these systems encounter drastic fluctuations in class priors, resulting in label distribution shift, a critical form of domain shift that triggers severe catastrophic forgetting. To address these challenges, we propose ToRe, a rehearsal-free and parameter-efficient framework that leverages frozen ophthalmic foundation models for robust incremental adaptation. ToRe employs a parameter isolation strategy to decouple domain-specific optimization paths, thereby helping mitigate catastrophic forgetting driven by both label distribution shift and style variations. Simultaneously, it introduces token-adaptive recursion that adaptively allocates additional computational depth across tokens, allowing simple tokens to exit the recursion loop early while subjecting complex tokens, such as those associated with lesions, to deeper recursive processing. This mechanism enhances the feature representations for minority classes, thereby supporting generalization throughout the domain incremental learning process. Extensive evaluations on nine heterogeneous datasets demonstrate that ToRe consistently outperforms state-of-the-art methods in overall performance across the three benchmarks, while maintaining near-zero forgetting. Together, these results support the applicability of ToRe to dynamic and imbalanced clinical environments. The code is available at https://github.com/Nancyolo/ToRe

Nanxi Yu, Kang Li, Ye Du +3

School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Sichuan, China · Department of Biomedical Engineering and Sports Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China · School of Future Technology, South China University of Technology, Guangdong, China +1

Ophthalmic Image AnalysisDomain-Incremental LearningMedical Image AnalysisClass-Imbalanced LearningVision Foundation Model AdaptationConditional Computation
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Sep 25, 2026

CG-HAF: An Interpretable Global-Local Lesion-Burden Fusion Framework for Ordinal Acne Severity Grading in Agentic Skincare Support

Ordinal acne severity grading requires distinguishing visually similar neighboring grades while jointly weighing holistic facial appearance and localized lesion burden - evidence that most existing approaches collapse into a single opaque representation. We introduce CG-HAF, a global-local fusion framework that instead keeps this evidence explicit: averaged holistic severity probabilities from independently trained classifiers are combined with structured lesion-burden descriptors from an object detector (lesion count, detection confidence, lesion area) into a compact representation, from which a lightweight, interpretable classifier produces the final grade. On a widely used benchmark, this fusion yields a clear, statistically supported improvement over global-evidence-only baselines, with the largest gains on the most severe cases. Testing on an independent dataset with a different grading standard shows that strong within-dataset performance does not transfer automatically, and a follow-up diagnostic attributes much of this gap to mismatched grading criteria rather than detection failure alone. These findings support interpretable global-local fusion as an effective strategy for ordinal acne grading while highlighting criterion alignment as key to cross-dataset portability, with a further illustration of how the resulting severity signal can support transparent, non-diagnostic decision-making in skincare applications.

Muhammad Muhtasim Shahriar, Md. Naimur Asif Borno, Saad Aloteibi +1

Department of Computer Science, International Islamic University Chittagong (IIUC), Chittagong, Bangladesh · Department of Mechatronics, Rajshahi University of Engineering and Technology (RUET), Rajshahi, Bangladesh · Department of Computer Science and Engineering, College of Applied Studies, King Saud University, Riyadh, 11437, Saudi Arabia +3

Medical Image AnalysisExplainable Medical Image AnalysisMedical DiagnosisFeature FusionSkin Lesion ClassificationOrdinal Regression
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Sep 23, 2026

NV-Reason-CT: 3D Visual Language Model for CT Analysis

We present NV-Reason-CT, a generative vision--language model for chest and abdominal CT combining native 3D visual encoding with radiologist-guided reasoning. The model couples a native 3D vision transformer with a language model, passing all visual tokens and their explicit 3D coordinates into language decoding without further spatial token merging. This retains volumetric spatial information within the vision encoder and through the language model's positional encoding during joint processing with text. We train on a curated corpus of approximately 550,000 multimodal instruction examples from 70,111 unique CT image inputs, combining standardized reports, abnormality-focused and anatomy-specific questions, multi-turn interactions, and radiologist-authored reasoning from recorded and transcribed expert CT interpretations. Expert annotations provide direct supervision and guide additional report-grounded synthetic reasoning. End-to-end supervised fine-tuning (SFT) is followed by Group Relative Policy Optimization (GRPO), with verifiable rewards over chest and abdominal abnormality sets. The model supports abnormality classification, report generation, and interactive reasoning with reviewable observations, differential diagnoses, and uncertainty. Evaluation spans public CT benchmarks and a held-out NIH cohort. On CT-RATE, NV-Reason-CT achieves a macro-F1 of 0.614 and macro-AUROC of 0.871 without a task-specific classification head; generated reports achieve a report-derived macro-F1 of 0.592. In a preliminary study with expert radiologists, AI-assisted review received favorable confidence ratings and was associated with a 50% reduction in average reported interpretation and reporting time. We release the model and training code to support reproducible research on explainable AI for volumetric medical imaging.

Andriy Myronenko, Dong Yang, Yucheng Tang +15

NVIDIA, Santa Clara, CA · NIH, Bethesda, MD · University of Oxford, Oxford, UK +4

Radiology Report GenerationRadiology VLMsMedical Image AnalysisVLM Reasoning3D VLMsCT Report Generation
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Sep 22, 2026

Radiomics--Foundation Fusion for Interpretable RCC Classification: Internal Benchmarking and Exploratory External Transfer

Accurate preoperative subtype classification of renal cell carcinoma (RCC) from contrast-enhanced CT remains clinically challenging because clear cell RCC (ccRCC) and non-clear cell RCC often show overlapping imaging appearances. This study evaluates whether foundation representations reduce reliance on handcrafted radiomics, or whether radiomics remains complementary for interpretable tumour characterisation. We compared radiomics, conventional CNN features, MedicalNet-pretrained features, MedVAE representations, and fusion variants for binary ccRCC classification on KiTS23, reporting area under the receiver operating characteristic curve (AUC) with bootstrap confidence intervals and average precision (AP) as a complementary class-imbalance-sensitive metric. We further assessed branch-removal ablation, TCGA/AIMI external transfer, and interpretability using radiomics permutation importance and gate-level analysis. Internally, 3D MedVAE gated fusion achieved the best performance, with an AUC of 82.7% and AP of 92.2%. On the external TCGA cohort, the same model achieved an AUC of 79.5% and AP of 98.9%, although specificity remains uncertain because only two external non-ccRCC cases were available. Gate analysis showed a radiomics-dominant fusion regime, suggesting that foundation representations acted as case-dependent refinement signals rather than replacements for structured tumour descriptors. These findings support radiomics as a complementary and clinically interpretable component of CT-based RCC characterisation in the foundation-model era.

Yuan Liang, Fangyijie Wang, Kathleen M. Curran +3

Research Ireland Centre for Research Training in Machine Learning · School of Computer Science, University College Dublin, Dublin, Ireland · School of Medicine, University College Dublin, Dublin, Ireland +1

Medical Image AnalysisRadiomicsMedical Imaging Foundation ModelsOncologyComputed Tomography
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Sep 22, 2026

Gaze responses to false-positive computer-aided detection prompts during colonoscopy: a paired-video and real-time eye-tracking study

False-positive computer-aided detection (CADe) prompts may divert endoscopists' attention during colonoscopy, yet the attentional impact of individual prompts remains unclear. We used event-locked eye tracking to quantify gaze attraction and attention occupation in complementary retrospective and prospective studies. In a retrospective paired-video experiment, 3 senior and 2 novice endoscopists viewed 60 colonoscopy videos with and without CADe. The prospective study recorded gaze during 42 real-time CADe-assisted colonoscopies performed by 9 senior endoscopists. Screened CADe prompts outside expert-annotated lesion windows were classified as false-positive artifact events. False-positive prompts attracted gaze in 48.6% (68/140) of retrospective observations and 65.2% (533/817) of prospective events. Among attraction events with complete recovery, median attention occupation lasted 1000 ms in the retrospective study and 1100 ms in the prospective study. Corresponding median prompt durations were 33 ms and 267 ms, with median time amplifications of 17.55-fold and 5.15-fold, respectively. In paired retrospective comparisons, visible artifact prompts drew gaze closer to the prompted region than did the same-coordinate unassisted reference. Secondary retrospective analyses showed high lesion gaze recognition without and with CADe (98.0% versus 99.0%). First gaze entry into lesion regions occurred 147.8 ms earlier with CADe. Across controlled and real-time clinical settings, false-positive CADe prompts frequently captured gaze, with attention persisting beyond prompt visibility. These findings support considering prompt-related attentional burden in CADe evaluation and design.

Te Luo, Yan Zhu, Peiyao Fu +5

Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China · Shanghai Key Laboratory of MICCAI, Shanghai, China · Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China +4

EndoscopyMedical Image Analysis
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Sep 21, 2026

Combinatorial Network-Based Manifold Topological Deep Learning for Image Analysis

Medical image analysis remains fundamentally challenging because of the intricate geometric and topological structures present in medical data. Conventional convolutional neural networks model images as regular Euclidean grids, limiting their ability to preserve geometric relationships and higher-order structural information. Recently, manifold topological deep learning (MTDL) has emerged as a promising paradigm that integrates deep learning with geometric and topological representations. Nevertheless, existing methods have not yet fully exploited discrete manifold structures within combinatorial complex neural networks. To bridge this gap, we introduce CNMTDL, a MTDL framework that integrates Hodge decomposition with a combinatorial attention mechanism. In our approach, medical images are represented as discrete manifolds and decomposed into three Hodge components. Features extracted from these components are concatenated and embedded into a combinatorial complex architecture, enabling enhanced higher-order message passing between 00-cells and 22-cells through attention-based blocks. We evaluate CNMTDL on six two-dimensional and three-dimensional datasets from the MedMNIST v2 benchmark, demonstrating its effectiveness for medical image analysis.

Alice Wachira, Xiang Liu, Zhe Su +3

Department of Mathematics, University of Georgia, Athens, GA 30602, USA. · Department of Mathematics and Statistics, Auburn University, AL, 36849, USA. · Department of Computer Science and Engineering, Michigan State University, MI 48824, USA. +2

Medical Image Analysis
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Sep 21, 2026

Applications of Neural Cellular Automata: State of the Art, Challenges and Opportunities

Neural Cellular Automata (NCAs) are a new type of neural network architecture which enable accurate and robust inference at extremely small model sizes. Recently, NCAs have advanced to become interesting low-resource alternatives to convolution- and attention-based architectures for various tasks such as image analysis, synthetic image generation, and simulation. The rapid development and increased research interest necessitate a comprehensive review of the emerging technology. This review provides an overview of the fundamentals of NCAs, applications to medical imaging, as well as insights into the state of the art. We analyze recent modifications to the originally proposed NCA architecture with respect to their efficiency and accuracy. Furthermore, we review practical applications in real-world scenarios with a focus on medical image analysis, segmentation, classification, registration, depth estimation, and image synthesis. Finally, we identify several advantages of NCAs, research gaps, and conclude with an analysis of future opportunities for NCAs in medical applications in confined settings or areas that have particular demands for robustness or efficient data processing.

Nick Lemke, Niklas Ihm, John Kalkhof +11

Technical University of Darmstadt, Darmstadt, Germany · ImFusion GmbH, Munich, Germany · Inria Center at University Cˆote d’Azur, Sophia Antipolis, France +9

Neural Cellular AutomataMedical Image AnalysisMedical Image ClassificationMedical Image SegmentationMedical Image Synthesis
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Sep 21, 2026

Representation-guided in-context learning for medical image interpretation with multimodal large language models

Medical image interpretation is central to diagnosis and care, yet adapting general-purpose multimodal large language models (MLLMs) often requires resource-intensive domain-specific fine-tuning. Here we introduce representation-guided in-context learning (RG-ICL), a training-free inference framework that retrieves query-aligned demonstrations using frozen encoders, without task-specific parameter updates. Across eight datasets spanning histopathology, radiology and retinal fundoscopy, RG-ICL improved classification (mean gain 20 percentage points) and visual question answering (VQA) (mean gain 13 percentage points) over no-context and conventional ICL, approaching or exceeding training-based comparators. Which cases were retrieved mattered more than how many: 6 query-aligned cases outperformed up to 32 randomly selected ones, whereas fixed or random cases often reduced accuracy below baseline. For VQA, aligning reference cases with both image content and question intent produced further gains. These findings indicate that for medical image interpretation, curating which reference cases an MLLM sees is a practical alternative to retraining it.

Minda Zhao, Fangyu Hu, Yan Luo +8

Harvard AI and Robotics Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA · Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA · Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan +6

Medical Image AnalysisMultimodal Large Language ModelsMedical VQAIn-Context LearningRetrieval-Augmented ICL
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Sep 21, 2026

WebMRIQC: A Web-Based Implementation of MRIQC for Accessible MRI Image Quality Assessment in Resource-Constrained Settings

Reliable quality control (QC) of magnetic resonance imaging (MRI) is essential for reliable diagnostic neuroimaging, yet standard manual assessment is subjective and time-consuming. MRIQC has established standardized automated extraction of image-quality metrics (IQMs), but its reliance on local computational imaging skills and capacity including high-performance computing, limits its adoption in resource-constrained settings (RCS). We present WebMRIQC (webmriqc.mailab.io), an open-source browser-based platform that wraps the validated MRIQC engine behind a zero-installation web interface. WebMRIQC automates the DICOM-to-BIDS conversion of de-identified MRI scans, executes the unmodified containerized MRIQC pipeline on a shared compute node governed by a fair-share job queue, and returns an interactive in-browser dashboard. The dashboard grounds every IQM in published quality thresholds, benchmarks each scan against the normative distribution of high-resource open datasets, and supports cross-site multicentre implementation of optimized scan protocols in RCS.We describe the system architecture and a validation framework establishing measurement equivalence between WebMRIQC and native MRIQC across thirteen IQMs on the BraTS-Africa and BraTS 2021 datasets. Preliminary results indicate strong agreement for contrast-, signal and noise-based metrics, demonstrating that web-based implementation lowers the barrier to standardized MRI QC and provides a foundation for harmonized, regionally adapted quality benchmarks across RCS imaging sites. The code is publicly available here https://github.com/CAMERA-MRI/WebMRIqc.

Philip Nkwam, Ifeoluwa Oladeji, Sekinat Zurakat-Aderibigbe +9

Department of Radiography, Faculty of Health Professions, College of Medicine, University of Lagos, Nigeria. · Medical Artificial Intelligence Laboratory, Crestview Radiology Ltd., Lagos, Nigeria. · Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada. +3

Medical Image AnalysisMagnetic Resonance ImagingImage Quality AssessmentBrain MRIMedical Image Quality Assessment
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Sep 20, 2026

Modeling Clinical Workflow for SYNTAX Scoring from Coronary Angiography Videos

The SYNTAX score is a clinically established tool for assessing anatomical lesion complexity in coronary artery disease and guiding subsequent treatment. However, automated SYNTAX scoring is commonly formulated as a direct regression problem from coronary angiography videos to patient-level scores. In this work, we reformulate SYNTAX scoring as a vessel segment identity-preserving anatomical reasoning problem and propose a hierarchical modeling framework that explicitly aligns learning with the clinical workflow. Our approach maintains vessel segment identity across frames and views, estimates stenosis severity at the segment level, and aggregates evidence hierarchically according to coronary anatomy. Simultaneously, to address the scarcity of domain-specific data, we integrate and complete multiple public coronary angiography datasets, constructing a large-scale resource featuring completed vessel segmentation and derived structural annotations. Experiments demonstrate that vessel segment-level stenosis embedding enhances explanatory power and reduces prediction variability compared to baseline models, with the R^2 score improving by 0.201 and dev STD decreasing by 18.4%. These results highlight the necessity of structure-aligned modeling for reliable and stable automated SYNTAX scoring from multi-view coronary angiography videos. The GitHub link is https://github.com/VersaceSu7/SYNTAX_score_777.

Suzhong Fu, Jingqi Dong, Xuan Ding +4

FNii-Shenzhen, The Chinese University of Hong Kong, Shenzhen, China · School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen, China

Coronary AngiographyMedical Image Analysis
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Sep 17, 2026

A Dual-Stream Regulated Reconstruction and Segmentation Network with Hierarchical Artifact-Prior Modeling for Ultra-Low-Field Pediatric Neuroimaging

Automated quality assessment, enhancement, and segmentation of multiple structures in 0.064 T0.064\,\mathrm{T} ultra-low-field pediatric MRI are limited by a low signal-to-noise ratio, weak anatomical boundaries, and frequent artifacts. We present a unified framework for the LISA 2026 Challenge that performs all three tasks together within one inference pipeline. A network with two coupled streams, built on a 3D U-Net, first reconstructs an enhanced uLF volume and then combines the original and enhanced images for subcortical segmentation. To improve boundary stability, we add an auxiliary class covering brain tissue outside the target structures, derived from whole brain masks. A head conditioned on an artifact graph predicts the seven artifact ratings from reconstruction residuals and frozen segmentation features. We address the scarcity of dense annotations using diffeomorphic registration from atlas to target for label propagation and to regularize anatomical reconstruction. We report validation results across all three tasks.

Bahram Jafrasteh, Leo Milecki, Qingyu Zhao

Department of Radiology, Weill Cornell Medicine, New York, NY, USA

Medical Image AnalysisImage ReconstructionMedical Image Quality AssessmentMagnetic Resonance ImagingMedical Image Segmentation3D Medical Image Segmentation
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Sep 15, 2026

MUMINS: Metadata-conditioned Uncertainty-aware Medical Image Next-state Synthesis

Forecasting anatomical changes such as tumor growth and neurodegeneration is a challenging generative vision task. Morphological evolution is subtle relative to static anatomy, highly patient-specific, and inherently stochastic. Existing methods struggle with several issues: deterministic networks ignore biological stochasticity, while standard diffusion models require computationally prohibitive multi-pass sampling to quantify uncertainty. We propose MUMINS (Metadata-conditioned Uncertainty-aware Medical Image Next-state Synthesis), an efficient diffusion framework that jointly diffuses a baseline scan and its follow-up residual, summed to synthesize the follow-up scan, while concurrently predicting a spatial uncertainty map, in a single reverse diffusion process. Conditioned on the time interval and relevant metadata, it preserves fine-grained anatomy by dynamically re-injecting the baseline as a soft anchor at every denoising step, and a negative-log-likelihood head learns the uncertainty map to explicitly flag error-prone regions. Designed without organ-specific heuristics, the same architecture is reused across anatomies via separate, dataset-specific retraining. Extensive evaluations demonstrate that dataset-specific retraining of MUMINS matches or outperforms dedicated, domain-specific state-of-the-art methods on lung CT (PNG) and brain MRI (OASIS-3). Project page: https://aolivtous.github.io/publications/mumins.html.

Anna Oliveras, Roger Marí, Rafael Redondo +7

Eurecat, Centre Tecnol`ogic de Catalunya, Barcelona, Spain · Dept. de Matem`atiques i Inform`atica, Universitat de Barcelona, Barcelona, Spain · Barcelona Supercomputing Center (BSC), Barcelona, Spain +1

Medical Image AnalysisLongitudinal Medical Image AnalysisMedical Image SynthesisConditional Diffusion Models
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Sep 15, 2026

Lesion-centered 3D mapping of colonoscopy procedures: validation of a hierarchical ensemble pipeline on public benchmark videos

Background and Objective: Colonoscopy recording practice preserves text reports and still photographs, while the spatial information already present in the recorded video - where the scope traveled, where a lesion was observed, and whether the same lesion was seen again - is discarded when the procedure ends. This study determines whether a lesion-centered spatial record can be assembled and validated without full-colon 3D reconstruction. Methods: A four-layer hierarchical pipeline was assembled - (1) a global topological map, (2) lesion-level spatio-temporal tracks, (3) on-demand local 3D reconstruction, and (4) persistent lesion identity across repeated observations - and ran end to end on four public videos (two C3VDv2 sequences with ground-truth depth and two full REAL-Colon procedures; 40,245 frames). All components are published, individually validated methods; the contribution is their lesion-centered assembly, linking rules, and evaluation. Results: Revisits, impossible under forward-only mapping by construction, were detected by entry-map Bayesian localization: 5,614 and 4,043 revisit events (56 and 68 distinct nodes) in the two full procedures. Lesion-identity merging at the adopted threshold 0.5 maintained ground-truth purity 1.0 while auto-merging 20 of 231 candidate pairs. The endoscopy-specific geometry engine outperformed a general-purpose foundation model on all metrics (overall absolute relative error (AbsRel) 0.2276 vs. 0.3523). Conclusions: The results are partial but establish a concrete near-term path: revisit detection, lesion identity, and local 3D each returned quantitative, reproducible output without waiting for complete geometric reconstruction; validating the record on clinical data is the next step.

Hyunjun Kim, Hyeonwoo Na, Jaewoo Lee

School of Computing, KAIST, Daejeon, Republic of Korea · Clinical Imaging Research Institute, Seoul, Republic of Korea · Division of Mechanical and Space Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan +1

Endoscopy3D ReconstructionMedical Image AnalysisEndoscopic 3D Reconstruction
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Sep 14, 2026

Authority-Preserving Evaluation of Medical Vision-Language Assistants

Medical vision-language models can propose how urgently a skin lesion should be reviewed, but the local service retains authority to accept or replace that proposal under referral policy, capacity, and locally held patient context. Proposal quality and selected-action quality are therefore distinct evaluation targets, and benchmark evidence transfers between them only when local review preserves the expected action score. We introduce AuthEval, a logging and evaluation framework that records both actions, scores the selected action under declared local criteria, and, where feasible, scores the declined proposal under the same rule. It reports the resulting authority gap only when the record supports it. Because the gap is the product of the proposal-change rate and the mean score change on changed cases, that rate alone determines neither its magnitude nor its sign. On ISIC 2019, with MedGemma and simulated local review, two constraint regimes with similar change rates produced an optimistic image-equal gap under capacity (+0.744+0.744 simulator units) but no detectable gap under safety. The declared evaluation unit also mattered: under mixed constraints the gap reversed from +0.374+0.374 to −0.206-0.206 when weighting shifted from image to lesion-aware cluster. AuthEval thus clarifies whether a study's records support claims about the model, the workflow, or both.

Flint Xiaofeng Fan, Cheston Tan, Yew-Soon Ong +1

ETH Zurich, Zurich, Switzerland · Agency for Science, Technology and Research (A*STAR), Singapore, Singapore

VLM EvaluationHuman Oversight of AIMedical VLMsMedical Image Analysis
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Sep 14, 2026

MedVA: An End-to-End Neuro-Symbolic Agentic System for Medical Volume Visualization

Medical volume visualization requires selecting regions of interest (ROIs) and carefully controlling their relative visual emphasis according to a given clinical intent. Implementing these decisions in conventional workflows demands substantial clinical and visualization expertise and often involves trial-and-error optimization. Recent agentic systems have introduced natural-language interaction and autonomous visualization operations but largely rely on MLLM-based inference throughout the workflow. Although MLLMs encode broad medical knowledge and provide strong reasoning capabilities, such inference may be suboptimal for medical volume visualization, potentially leading to clinically incomplete interpretations of user requests and unreliable ROI identification and visualization optimization. In this work, we present MedVA, an end-to-end neuro-symbolic agentic system for medical volume visualization that addresses these limitations through three complementary agents. The neuro-symbolic intent formulation agent refines MLLM-based interpretations of natural-language requests through symbolic reasoning over established clinical knowledge, which provides more complete, clinically grounded ROI specifications than MLLM-only reasoning. The multi-model ROI identification agent directly identifies semantically specified ROIs in the original volume by leveraging complementary large-scale pretrained medical segmentation models. The objective-driven visualization optimization agent explicitly evaluates ROI visibility and occlusion in the original volume using a volume-based visibility objective. Extensive agent-level and system-level evaluations across diverse medical datasets and interaction scenarios support the effectiveness of the individual agents. A formative user study further indicates high usability and practical value among users with different levels of expertise.

Haill An, Suhyeon Kim, Minjun Kang +4

Institute of Translational Medicine, National Center for Translational Medicine, Shanghai Jiao Tong University, Minhang, Shanghai, China

Medical Image AnalysisTool-Using Vision-Language Agents
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Sep 13, 2026

Mobile CT Services for Rural, Regional, and Remote Areas: Current Practice and Future Integration with Telehealth and Regulatory-Authorised AI

Computed tomography (CT) plays an essential role in clinical workflow to improve patient outcomes. However, access to CT imaging and specialist interpretation remains limited, particularly in rural, regional, remote (RRR), and other resource-limited settings. Recent advances in mobile CT, telehealth, and artificial intelligence (AI) provide opportunities to extend advanced imaging services to populations in RRR settings. This review examines: 1) mobile CT systems deployed in trucks, trailers, ambulances, and other mobile platforms; 2) telehealth technologies supporting CT-based healthcare; and 3) AI for CT that has received regulatory authorisation or is currently deployed in clinical practice. Applications are evaluated across four clinical functions: screening and diagnosis, patient monitoring, risk prediction, and intervention or therapeutic decision support. The review covers neurological, thoracic, cardiovascular, abdominal, oncological, musculoskeletal, and interventional imaging, with particular attention to stroke, cancer, and other image-guided treatment. Other factors such as regulatory status, deployment status, and estimated technology readiness (TRL) level are compared. Current evidence indicates that mobile CT, telehealth, and AI for conventional CT are individually relatively mature, but fully integration of these technologies remains less widely deployed and validated in the clinical settings. Key barriers include regulatory variation, domain shift, connectivity requirements, cost, workflow integration, cybersecurity, and limited evidence of patient-level benefit. Future research should prioritise prospective, multicentre evaluation of integrated CT systems in real-world and underserved clinical settings.

Zhicheng Lu, Md Zahid Islam, M Mamun Huda +6

Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia · Artificial Intelligence and Cyber Futures Institute, Charles Sturt University, Bathurst, NSW 2795, Australia · School of Rural Medicine, Charles Sturt University, Orange, NSW 2800, Australia +3

Computed TomographyHealthcareMedical Image Analysis
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Sep 11, 2026

A Dual Cross-Attention Framework for Colposcopic CIN Grading and Swede Score Prediction Using a New Multi-Center Dataset

Cervical cancer is a major global health challenge, with disease burden falling disproportionately on low- and middle-income countries (LMICs) due to a shortage of trained specialists and the subjective nature of colposcopy-based screening. To address this challenge, we propose a novel deep learning framework for the automated grading of Cervical Intraepithelial Neoplasia (CIN) and the prediction of clinical Swede scores. We also introduce the BUET Multi-Center Colposcopy Dataset, a novel, multi-center cohort designed and annotated for Swede score prediction and CIN grading. Our proposed dual-stream cross-attention architecture mimics the visual reasoning of an expert colposcopist by explicitly fusing paired multimodal cervigrams to evaluate comparative tissue responses. Furthermore, we introduce a custom composite loss function to address severe class imbalances and scoring inconsistencies across the five Swede score components. The proposed framework achieved 71.85% accuracy and an 86.23% AUC-ROC for three-class CIN grading, outperforming existing methods. For Swede score component prediction, the architecture achieved AUC-ROC values ranging from 75.7% to 88.4%, with the composite loss function yielding consistent F1-score improvements. Finally, the total predicted Swede Score, which ranges between 0 and 10, shows a Mean Absolute Error (MAE) of 1.489. The results show that the proposed method can pave the way towards developing AI-assisted colposcopy screening tools to support risk-based triage in resource-limited healthcare settings. The dataset and source code are publicly available(url: https://github.com/mHealthBuet/BUET-colposcopy)

Dania Khan, Nuzhat Aisha Shaikh, Asfina Hassan Juicy +3

mHealth lab, Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh · Dhaka Medical College, Dhaka, Bangladesh · Center for Bioengineering Innovation and Design (CBID), Johns Hopkins University, Baltimore, Maryland, USA

Medical ImagingCross-AttentionMedical Image AnalysisMedical Image Classification
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Sep 11, 2026

Automated Distinction of Intimal and Medial Intracranial Arterial Calcification from CT Head

Intracranial arterial calcifications (IACs) are a common finding on clinical non-contrast enhanced head CT scans and are associated with neurovascular disease. Calcifications can occur in the intimal or medial layer of the arterial wall, subtypes that differ in aetiology and may have distinct clinical relevance. These subtypes can be visually distinguished by radiologists based on the shape of the calcifications. We investigate three automated approaches for subtype classification of IAC from head CT-derived segmentation masks: (1) an automated adaptation of the established radiological visual score, (2) a sphericity-based method, and (3) a method based on shape embeddings extracted by a medical shape foundation model. All approaches use the same lightweight classification pipeline on top of the features they compute and are evaluated using 5-fold cross-validation. The three methods achieved comparable performance, with the embedding-based approach yielding the best overall results with a weighted F1 (mean ±\pm SD) of up to 71.5 ±\pm 3.7 for a single artery and 59.8 ±\pm 1.7 for the joint artery classification. Performance was largely preserved when using automated instead of manual IAC segmentation masks, and we found the difference in weighted F1 not significant. Our results show that fully automated IAC subtype quantification from head CT is feasible and remains robust to the use of manual and automated IAC segmentation masks. Code at https://github.com/bjin96/iac-subtyping.

Benjamin Jin, Maria del C. Valdés Hernández, Richard Bortsov +3

Institute for Neuroscience and Cardiovascular Research, University of Edinburgh, United Kingdom · Department of Epidemiology, Erasmus MC, The Netherlands · UK Dementia Research Institute, University of Edinburgh, United Kingdom +2

Medical Image AnalysisMedical Image ClassificationComputed Tomography
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Sep 9, 2026

Artificial Intelligence Algorithms for the Detection of Pathologies Related to Lung Cancer through Image Analysis using Convolutional Neural Networks and Data Augmentation: a systematic mapping of the literature

Lung cancer is one of the leading causes of death worldwide, and its early diagnosis is crucial to improving patients prognosis and quality of life. However, the process of interpreting medical images for the detection of lung cancer is complex and requires trained experts. In this context, artificial intelligence (AI) and deep learning (DL) emerge as potential tools to automate and optimize image analysis. The objective of this work is to review the most recent and relevant applications of AI and DL in the field of radiology for the detection of lung cancer. To this end, an exhaustive search was carried out in scientific databases such as PubMed,IEEEXPLORE, Scopus and Web of Science, and 96 articles published from 2015 to the present addressing the use of AI and DL in biomedical engineering were selected. Emphasis is placed on the use of convolutional neural networks (CNN) with transfer learning and Data Augmentation as promising techniques to improve the accuracy and efficiency of the image interpretation process. The results show that the use of AI and DL can offer an effective alternative for the early diagnosis of lung cancer, with high sensitivity and specificity. However, current limitations and challenges that must be addressed to guarantee its responsible and safe application in clinical practice are also identified, such as the lack of standardized data, the ex plainability of the models, patient privacy, and the ethical and social implications. It is concluded that the use of AI and DL can have a positive impact on the care of patients with lung cancer, but further research and regulation are required to ensure its quality and reliability.

Pablo Ramirez Amador

Universidad Abierta Interamericana. Faculty of Computer Technology. Center for Advanced Studies in Computer Technology. Buenos Aires, Argentina.

Medical Image AnalysisMedical Image ClassificationConvolutional Neural Networks
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Sep 9, 2026

From Few-Shot Segmentation to Clinician-in-the-Loop Medical Image Analysis

Few-shot medical image segmentation (FSMIS) seeks to delineate unseen structures from a small support set, but its standard formulation fixes task-defining evidence before inference. This assumption is fragile under acquisition shift, atypical pathology, ambiguous boundaries, and poor image quality. Adding clinician interaction and rapid adaptation is not sufficient: the binding constraint is deciding when asking or changing is warranted. We therefore reframe FSMIS as a three-layer sequential decision problem. First, decidable self-assessment separates errors that a bounded intervention can repair from those that no admissible intervention can reach. We formalize this distinction through a correctable set defined by the update operator and remaining interaction budget. Second, selective interaction allocates a distinct expert-attention budget by response-conditioned net expected value of information, yielding explicit accept, query, and defer actions. Third, bounded adaptation emphasizes reversibility and independent safety reassessment rather than speed. A complementary cross-case memory stores reproducible correction priors over failure modes instead of disease-specific mask priors. This structure links sparse support representation, cross-domain robustness, multi-level risk estimation, clinician feedback, and governed experience transfer. We state six hypotheses with an explicit dependency order and propose a minimal pilot that can falsify the foundational self-assessment claim before a clinician study. The central claim is not that interaction resolves domain shift, but that scarce expert attention should be used only when a bounded intervention is expected to reach a clinically better outcome.

Yazhou Zhu

Interactive Medical Image SegmentationSelective PredictionMedical Image AnalysisFew-Shot Medical Image SegmentationSegmentation Uncertainty Estimation
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Sep 9, 2026

Myocardial Strain Drift Correction in Deep Learning Based Ultrasound Tracking

Myocardial strain from echocardiography is a key biomarker for cardiac function. Recent deep learning methods show strong performance for myocardial motion tracking but often lack physiological constraints, leading to temporal drift across the cardiac cycle. Consequently, tracked points may not return to their relative initial positions at the end of each cardiac cycle, producing inaccurate strain estimates and even divergence in some cases. We propose a deep learning framework that compensates for drift during myocardial tracking. We extend a state-of-the-art echocardiographic tracking method (TAS-Net) with persistent memory tokens that share information across sliding windows over full cardiac cycles. A teacher-student fine-tuning strategy on real echocardiographic data then enforces physiologically consistent cyclic motion while preserving tracking accuracy. Experiments show reduced global and regional strain drift, improved agreement with clinical references, and better test-retest reproducibility, supporting more reliable myocardial strain estimation in clinical practice.

Thierry Judge, Nicolas Duchateau, Andreas Østvik +6

Dept. of Computer Science, University of Sherbrooke, Sherbrooke, Canada. · INSA, Université Lyon 1, CNRS UMR 5220, Inserm U1206, CREATIS, Villeurbanne, France. · Institut Universitaire de France (IUF). +4

Medical Image AnalysisEchocardiographyTemporal Consistency
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Sep 3, 2026

Tensor-based Brain Surface Modeling and Analysis

We present a unified computational approach to tensor-based morphometry in detecting the brain surface shape differences between two clinical groups based on magnetic resonance images. Our approach is novel in a sense that we combined surface modeling, surface data smoothing and statistical analysis in a coherent unified mathematical framework. The cerebral cortex has the topology of a 2D highly convoluted sheet. Between two different clinical groups, the local surface area and curvature of the cortex may differ. It is highly likely that such surface shape differences are not uniform over the whole cortex. By computing how such surface metrics differ, the regions of the most rapid structural differences can be localized. To increase the signal to noise ratio, diffusion smoothing based on the explicit estimation of Laplace-Beltrami operator has been developed and applied to the surface metrics. As an illustration, we demonstrate how this new tensor-based surface morphometry can be applied in localizing the cortical regions of the gray matter tissue growth and loss in the brain images longitudinally collected in the group of children.

Moo K. Chung, Keith J. Worsley, Steve Robbins +1

Department of Statistics, Department of Biostatistics and Medical Informatics Keck Laboratory for Functional Brain Imaging and Behavior University of Wisconsin-Madison Madison, WI 53706. USA · Montreal Neurological Institute, McGill University, Canada

Medical Image AnalysisLongitudinal Medical Image AnalysisNeuroimaging
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Sep 2, 2026

Improving Clinical Target Volume Segmentation Accuracy using Anatomical Priors and Active Learning for the AGITG TOPGEAR Clinical Trial

Training deep learning-based medical image segmentation models is challenging with limited curated datasets. For AGITG TOPGEAR, a gastric cancer trial, the Clinical Target Volume (CTV) is complex and defined by multiple anatomical landmarks, making upfront training data preparation difficult for an automated contour QA segmentation model. We investigate anatomical priors, derived from surrounding organ segmentations, to provide spatial context and improve TOPGEAR CTV segmentation accuracy. We also evaluate active learning, iteratively expanding the training dataset by selecting cases expected to improve performance. One hundred TOPGEAR CT scans were retrospectively analyzed. An initial set of 10 expert-contoured cases was used to train an nnU-Net model. TotalSegmentator generated a voxel-wise anatomical prior map from surrounding structures as an additional input channel. Active learning was simulated over four iterations, selecting cases by model uncertainty and segmentation performance. All models used five-fold cross-validation for an ensemble uncertainty measure. Evaluation used a hold-out testing set of 50 cases. The anatomical prior improved CTV segmentation accuracy, increasing mean Dice Similarity Coefficient (DSC) from 0.84 to 0.86. Active learning similarly improved performance to 0.86, with greatest benefit in the final round. Combining the anatomical prior with active learning achieved the highest accuracy, with a DSC of 0.87. Model uncertainty correlated with DSC, supporting its use in identifying suboptimal predictions and guiding active learning. Anatomical priors and active learning each improved CTV segmentation accuracy and generalizability, with their combination achieving the best performance, supporting integration into segmentation model development for automated contour QA in radiotherapy clinical trials.

Phillip Chlap, Mark Lee, Trevor Leong +11

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia · Ingham Institute for Applied Medical Research, Sydney, Australia · Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia +8

Medical Image AnalysisActive LearningMedical Image Segmentation
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Sep 2, 2026

LoFi RADIO: A Distilled In-Domain Backbone Applied for Artifact-Severity Grading of Ultra-Low-Field Neonatal Brain MR

Ultra-low-field MRI makes neonatal brain imaging deploy- able in low-resource settings, but its low SNR, lack of shielding, and long scan duration make it especially prone to acquisition artifacts, motivating automated quality control. We address the LISA 2026 Task 1a challenge: multi-label severity grading (0/1/2) of seven common image artifacts on ULF T2 weighted volumes. We identify that a number of backbones may be successfully paired with a classification MLP, but that no single backbone is uniformly best across artifacts. To improve performance, we evaluate routing complementary foundation model teachers through a per-artifact gate, as well as distilling the teachers into a single in-domain ViT-S student (LoFi RADIO) over an unlabeled low-field MRI corpus. Both of these strategies improve the weighted composite. The distilled backbone matches or exceeds the gate and has the added advantage of not requiring deployment of multiple large foundation models at infer- ence.

Jonathan B. Martin, Yashwant Kurmi, Charlotte R. Sappo

Vanderbilt University Institute of Imaging Science, Nashville, TN, USA

Medical Image Quality AssessmentMedical Image AnalysisMagnetic Resonance ImagingBrain MRIVision TransformerKnowledge Distillation
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Sep 2, 2026

Learning from Scarce Labels: Multi-View Echocardiography for Ejection Fraction Prediction

We present, to the best of our knowledge, the first publicly available resource for predicting left ventricular ejection fraction (EF) from parasternal long-axis (PLAX) echocardiography. Because no PLAX-EF datasets previously existed, our work focuses on an innovative data generation strategy to overcome this scarcity. By leveraging a time-based correlation between clinical notes and echocardiographic videos, combined with fine-tuning view classifiers and proxy labeling, we created a labeled dataset of over 25,000 PLAX videos. This enables us to train the first reproducible PLAX EF model, achieving a mean absolute error (MAE) of 6.86%. Given that apical four-chamber (A4C) methods, the clinical standard, report MAE values of 6%-7%, our results demonstrate that EF estimation from PLAX views is both feasible and clinically relevant. This surpasses the performance of existing methods and provides a clinically relevant solution for situations where apical views may not be feasible. Going further, we demonstrate that combining PLAX and A4C predictions via simple unweighted late fusion improves both single-view baselines to a 6.37% MAE, underscoring the value of multi-view integration. To promote continued research, we release the dataset labels, trained models, and runnable demos on GitHub, Hugging Face, and Google Colab: https://github.com/Jeffrey4899/PLAX_EF_Labels_202509

Zhiyuan Gao, Dominic Yurk, Yaser S. Abu-Mostafa

Electrical Engineering Department, California Institute of Technology, Pasadena, CA 91125, USA · Asari AI, San Francisco, CA 94131, USA

Left Ventricular Ejection Fraction EstimationMedical Image AnalysisEchocardiography
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Sep 2, 2026

ORB-SVM : An Innovative Hybrid Framework for Efficient Brain Tumor Detection from MRI Scans

Brain cancer remains one of the most significant challenges in modern medicine, where the accuracy of early stage diagnosis is a decisive factor in patient survival and treatment efficacy. Although Magnetic Resonance Imaging (MRI) is the established gold standard for visualizing neurological structures, the interpretation of these high dimensional scans is often complicated by subjective variability among practitioners and the inherent noise present in complex medical images. While contemporary approaches frequently rely on high parameter deep learning architectures, such models often involve significant computational costs and require extensive data for effective training. This study introduces a hybrid framework that utilizes the Oriented FAST and Rotated BRIEF (ORB) algorithm for precise feature extraction and a Support Vector Machine (SVM) for classification [1], [2]. The proposed approach achieves a sub- stantial data reduction of approximately 99.5%, which effectively minimizes the influence of non informative background data while preserving critical diagnostic patterns essential for tumor identification. By balancing feature sparsity with a robust kernel based classifier, this methodology addresses the limitations of over parameterized systems while maintaining high diagnostic integrity. Experimental evaluations conducted on the Br35H dataset demonstrate that the framework attains a classification accuracy of 97.5%. The findings suggest that the integration of localized feature representation and optimized classification provides a reliable and resource efficient alternative for medical image analysis, offering a structured solution that maintains per- formance without the need for extensive computational overhead.

Amirhosein Azarpour

Department of Computer Science Shahid Beheshti University Tehran, Iran

Medical Image AnalysisBrain MRI
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Aug 31, 2026

MR-JEPA: A General Purpose Video Foundation Model for Cardiac MRI

Cardiac magnetic resonance imaging (CMR) produces rich sequential data such as temporal cine videos and spatial LGE/mapping stacks, yet most deep learning approaches process individual 2D slices, discarding this context. We present MR-JEPA, a self-supervised video foundation model for CMR that extends LeJEPA to 3D spatiotemporal inputs through tubelet tokenization, spatiotemporal masking augmentation, and initialization from a 2D CMR foundation model. Unlike prior CMR video models limited to cine data, MR-JEPA is pretrained on multi-sequence data (cine, LGE, mapping) from 10,505 patients across two centers without annotations. We evaluate the frozen encoder on six downstream tasks using a unified multi-view gated attention architecture: LV ejection fraction, RV ejection fraction, three myocardial strains (GLS, GCS, GRS), and four-class disease detection. MR-JEPA outperforms other compared methods on all five regression tasks, including both a domain-specific CMR model pretrained on more data with text supervision and a natural-video foundation model, achieving an LV EF MAE of 4.79% (r =0.764) and a GLS MAE of 1.87 (r=0.805), with 21-27% MAE reductions over baselines on strain tasks. For disease detection, MR-JEPA achieved a macro AUG of 0.868, remaining competitive with the domain-specific baseline despite using a fully self-supervised pretraining objective. These results demonstrate the potential of a unified video encoder for robust, multi-view utilization of diverse CMR sequences in clinical cardiac quantification and diagnosis.

Athira J. Jacob, Puneet Sharma, Dorin Comaniciu +1

Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA · Chair for Al in Healthcare and Medicine, Technical University of Munich (TUM) · TUM University Hospital, Munich, Germany +1

Medical Imaging Foundation ModelsSelf-Supervised Pre-TrainingMedical Image AnalysisMedical DiagnosisVideo Representation LearningCardiac MRI
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Aug 31, 2026

Co-Annotator: Expert-Distilled ViT and VLM for Visual and Documentation Guidance in Age-Related Macular Degeneration

Clinical AI often optimizes predictive performance without engaging how clinicians decide where to look and what to write. We present Co-Annotator, which distills expert gaze and dictation into two guidance components: a gaze-aligned Vision Transformer producing fixation-aligned areas of interest (AOIs), and an ontology-bounded vision-language model (VLM) that pre-fills editable biomarker summaries for retinal optical coherence tomography (OCT). We first collect expert gaze and dictations (US1) to train the models, significantly improving diagnostic accuracy and biomarker generation. We then deploy the system with ophthalmology residents: a controlled resident study (US2) confirmed each modality is safe and independently beneficial, with AOI guidance producing lasting perceptual efficiency gains through post-guidance carryover and VLM guidance more than doubling biomarker documentation breadth. In a combined deployment across two academic institutions (US3), providing both modalities simultaneously produced efficiency gains that substantially exceeded either modality alone: correct diagnoses per minute increased by 40% and comment editing time fell by 67%, without compromising diagnostic accuracy. Notably, neither modality improved efficiency during guidance in US2, which makes the in-guidance efficiency gain under combined guidance in US3 the more striking result. Expert-distilled multimodal guidance can remove two distinct clinical workflow bottlenecks at once (visual search overhead and documentation burden) without compromising the diagnostic accuracy clinicians already achieve.

Ziheng "Leo" Li, Benjamin Freeman, Akshay Raman +5

Columbia University

Medical Report GenerationMedical Image AnalysisMedical VLMsOphthalmologyOphthalmic Image Analysis
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