Medical Image Analysis

Vision-language models (VLMs) are increasingly being evaluated for medical imaging, but many available benchmarks emphasize disease classification, report generation, or broad visual question answering rather than the spatial and anatomical reasoning required for radiology. We developed the Spatial Perception and Anatomical Reasoning in Clinical Radiology (SPARC-Rad) Benchmark, a manually curated multimodal benchmark dataset and evaluation pipeline for assessing these capabilities in radiology VLMs. SPARC-Rad includes 300 image-question pairs derived from healthy control imaging studies in The Cancer Imaging Archive (TCIA), spanning CT, MRI, and radiography across the abdomen, chest, breast, neuro, and musculoskeletal categories. Radiology trainees manually designed and annotated questions to evaluate anatomical identification, localization, laterality, regional recognition, device identification, and inter-structure spatial relationships. The evaluation pipeline supports standardized prompting, structured output collection, response normalization, LLM-as-judge grading, human quality review, binary correctness scoring, and subgroup analysis by modality, anatomy, and reasoning type. SPARC-Rad provides a reusable framework for evaluating whether VLMs can provide reasoning for radiologic anatomy as a spatial system, supporting future model development, failure-mode analysis, and pre-deployment assessment.

Radiomics and imaging foundation models promise non-invasive biomarkers of tumour biology, yet predictive signatures may reflect tumour volume or acquisition artifacts rather than meaningful image structure. We introduce READII-2-ROQC, an open-source framework that uses volume-preserving negative controls to assess whether radiomic and deep imaging features capture independent spatial signals. READII-2-ROQC generates voxel-perturbed images across tumour, background and whole-image regions using configurable randomization strategies, then compares feature behaviour and model performance between original and control images. Applied to three public cancer imaging cohorts, the framework processed 3,552 tumour volumes and extracted PyRadiomics and foundation-model features from original images and nine matched controls. Reproducing published survival and HPV-status signatures, we show that multiple models retain performance after spatial structure is destroyed, revealing volume-driven or contextual confounding, whereas others show perturbation-sensitive signal. READII-2-ROQC provides a scalable quality-control strategy for developing interpretable, biologically grounded imaging biomarkers and reproducible radiomics workflows.

Numerous unsupervised domain adaptation (UDA) algorithms exist, but for clinical practice, selecting the best-suited one along with proper hyperparameters often remains unclear, as the unlabeled deployment (target) domain prevents direct evaluation. We propose a label-free criterion that jointly selects the algorithm and hyperparameters for UDA. Given a pool of candidate models from multiple algorithms trained with different hyperparameters, our approach scores each candidate against an agreement reference, and selects the one with the highest score. The agreement reference is constructed in two levels without using target labels. First, we leverage multiple label-free selection signals, using each to nominate a model within every algorithm. Second, the nominated models are aggregated across algorithms to form a reference prediction for each unlabeled target sample. The candidate whose predictions agree most with this reference is then selected for deployment. Experimental results on four brain MRI and four chest X-ray datasets across seven clinically relevant transfer scenarios show that our method achieves better selection performance than other methods and remains effective across different algorithm pools. Our approach takes a step towards practical, label-free algorithm selection for clinical deployment of UDA.

We describe the DS@GT submissions to the ImageCLEFmedical Caption 2026 challenge, which continues a long-running benchmark on the ROCOv2 dataset with two tracks: Concept Detection (Task 1), assigning UMLS Concept Unique Identifiers (CUIs) to radiology images, and Caption Prediction (Task 2), generating natural-language captions. For Task 1, our primary submission was a three-way late-fusion ensemble of ConvNeXt-V2, BiomedCLIP ViT-B/16, and DenseNet-169 with a regularized ''Honest Threshold Tuning'' procedure designed to avoid validation overfitting on rare concepts; this submission ranked first on the official submission with a primary $F_1$ of $0.5790$ and a secondary $F_1$ of $0.9657$. In parallel, we submitted a training-free KNN retrieval pipeline over frozen BiomedCLIP embeddings, which reached a primary $F_1$ of $0.5780$ and a secondary $F_1$ of $0.9599$-essentially matching the fine-tuned ensemble on the primary track at a fraction of the cost. For Task 2, our submissions included a fine-tuned Gemma-3 27B model (overall $0.3571$, ranking third in the official submission), a fully fine-tuned BLIP pipeline with custom Vizwins merging ($0.3564$), and a zero-shot MedGemma-4B run with a PubMed-style prompt ($0.3186$), spanning a wide range of model scales and training costs. Code: https://github.com/dsgt-arc/imageclef-caption-2026.

When asked to describe a medical image that was never attached, frontier vision-language models do not abstain: they confabulate a diagnosis. We show that this confabulation is not random. It is structured by who the patient is said to be. Across chest X-ray, brain MRI, and dermatology, Claude Opus-4.7, GPT-5.4, and Gemini-3.1-Pro are each queried with only a demographic descriptor and no image, and changing the descriptor systematically shifts the diagnosis returned. Claude concentrates sharply: a 65-year-old white man asking about a skin mole receives Melanoma in nearly every response, and a 32-year-old Black woman asking about her chest X-ray receives a Sarcoidosis diagnosis whose reasoning reads "suspected, based on demographics and classic pattern.'' GPT-5.4's effect is broader, fabricating across every demographic cell we test, most conspicuously naming Sarcoidosis for young Black patients on chest X-ray. Two structural findings sharpen the problem. A hedged regime appears in which the prose acknowledges the missing image while the structured diagnosis field nevertheless names a disease, a dissociation invisible to prose-only audits. And Claude's dermatology effect collapses entirely when 'skin mole' is swapped for 'skin lesion' while GPT-5.4's is preserved, indicating that mirage is a family of distinct failure modes rather than a single phenomenon. Trustworthy VLM deployment in clinical pipelines requires auditing the structured output channel directly, and probe-word sensitivity should be treated as a first-class evaluation dimension

Breast DCE-MRI AI is increasingly being explored for breast-level classification of no-lesion, benign, and malignant findings, beyond conventional lesion-centered diagnosis. Within this broader diagnostic scope, however, patient-specific background variability remains a major source of imaging confounding across classification tasks. Existing approaches predominantly focus on unilateral or lesion-centric analysis, whereas bilateral methods offer limited explicit modeling of spatially adaptive cross-breast correspondence. We propose PRISM-Net, a registration-free bilateral framework that leverages contralateral breast features as patient-specific references for background-aware representation learning. PRISM-Net integrates bilateral feature matching and asymmetry-aware attention to establish adaptive inter-breast correspondence and enhance representations of discriminative asymmetric patterns. On ODELIA, Macro AUC, Micro AUC, and quadratic weighted kappa were $84.11 \pm 2.33$, $90.64 \pm 1.61$, and $60.94 \pm 5.64$ on the in-distribution test set, and $68.51 \pm 4.54$, $80.74 \pm 2.68$, and $43.45 \pm 7.10$ on the held-out institution, respectively, outperforming the evaluated baseline methods across the primary evaluation metrics. PRISM-Net further demonstrated performance on independent institutional and background-complexity evaluations. Ablation experiments revealed that both bilateral relation modeling and asymmetry-aware reweighting contributed to improved classification performance. These findings highlight patient-specific bilateral reference modeling as a clinically grounded strategy for DCE-MRI interpretation, improving asymmetric pattern discrimination through explicit modeling of background complexity.

Biomedical image analysis spans diverse modalities and tasks, yet real-world deployment is hindered by severe distribution shifts across scanners, protocols, and patient populations. High-performing models consequently require repeated domain-specific fine-tuning, which is a costly cycle that becomes impractical when labels are scarce or privacy constraints limit data sharing. We propose OPERA (Offline Policy-guided Expert Routing and Adaptation), a multi-agent ensemble framework that addresses this deployment bottleneck by treating expert weight assignment as an offline policy learning problem: a routing policy is learned from a small validation set without gradient updates to any expert agent, then deployed with test-time adaptation to handle distribution shift. OPERA coordinates heterogeneous specialist agents through complementary mechanisms. The expert profiling module learns selection policies offline, enabling informed allocation of expertise. Each agent undergoes confidence calibration through temperature adjustment, ensuring more reliable probabilistic outputs. OPERA also incorporates distribution aware adaptation, where class weights are dynamically adjusted at the batch level using statistics derived from unlabeled test data. Instance level routing assigns each sample to the most suitable expert by leveraging inter model agreement and predictive entropy. We evaluate OPERA on 9 datasets covering fundus photography, chest X-ray, CT, MRI, and multimodal diagnostic benchmarks, comparing against 30+ baselines across classification, segmentation, and multimodal settings. OPERA consistently improves performance and calibration quality, demonstrating that offline policy-guided expert agents coordination is a practical path to deployable biomedical AI without retraining. Code is on GitHub.

Color Fundus Photography (CFP) is a primary non-invasive imaging modality for large-scale screening of ophthalmic and systemic diseases. Existing surveys mainly summarize task-specific algorithms, datasets, or preprocessing techniques independently, lacking a unified perspective on their co-evolution with modern artificial intelligence. This review provides an integrated overview of CFP AI through the interplay of dataset evolution, preprocessing paradigms, and modeling frameworks. We show that CFP datasets have evolved from small single-center collections with task-specific labels to large multi-center resources featuring multimodal pairings and longitudinal clinical records. Preprocessing has progressed from conventional image enhancement to neural data-engineering pipelines, hardware-aware token optimization, and self-supervised imputation for incomplete electronic health records (EHRs). Meanwhile, modeling has advanced from convolutional neural networks (CNNs) to vision foundation models, state space models (SSMs), and multimodal expert architectures. At the multimodal frontier, CFP is increasingly integrated with EHRs and longitudinal patient information, enabling more comprehensive clinical reasoning beyond isolated image analysis. We conclude that future progress depends on the collaborative optimization of datasets, preprocessing, and multimodal modeling, providing a roadmap toward robust clinical deployment, improved cross-domain generalization, and resource-efficient edge intelligence.

In this paper, we propose a method for predicting bone volume fraction (BVF) and fracture position by constructing a random forest model based on multichannel S-parameters. A nine-antenna microwave scanning system is designed and fabricated to acquire the multichannel S-parameter data. Bone-mimicking phantoms are developed, and corresponding experiments are conducted to validate the effectiveness of the proposed approach. Both synthetic and experimental results demonstrate the validity of the method.

Vascular segmentation is a standard procedure for clinical diagnosis, yet the specific visual features determining model decisions remain poorly understood. This paper investigates the visual cues Convolutional Neural Networks (CNNs) use to segment blood vessels across two distinct imaging domains: fluorescence microscopy and retinal fundus photography. We employ a series of experiments to quantify the influence of shape, texture, and receptive field on segmentation performance. First, we isolate texture and intensity by evaluating performance on patches subjected to pixel shuffling and normalization. Second, we assess global shape relevance by training models on sparse contours and centerlines. Lastly, we quantify the required spatial context by systematically varying the network's theoretical and effective receptive fields. Within the scope of the evaluated datasets, we found that pixel intensity is more relevant than texture, though networks maintain surprisingly high accuracy even when both cues are removed. Furthermore, CNNs struggle to extrapolate full vessel geometry from shape cues alone, typically relying on a relatively small effective receptive field of around 20 pixels, though global context provides a modest benefit for fundus images. While specific to the modalities studied, this methodology offers a quantitative foundation to audit and refine deep learning systems in vascular imaging.

Training deep learning models on radiological images requires integrating heterogeneous datasets across different sources, file formats, directory layouts, label schemas, and annotation types. We present RadHarmony, an open-source Python library that provides a unified API for loading, harmonizing, and augmenting radiological datasets, with a primary focus on chest radiographs and early support for computed tomography (CT) and magnetic resonance imaging (MRI). RadHarmony standardizes metadata from 24 public datasets into a single tabular format, wraps MONAI's map-style datasets for deep-learning-ready sample delivery with optional on-disk caching, and supports classification labels, segmentation masks, bounding boxes, and radiology report text through a single interface, with an interactive visualization tool for dataset exploration and verification. To lower the barrier for integrating new datasets, RadHarmony introduces an AI-agent skill that guides the full integration workflow from raw data inspection through code generation and testing. We demonstrate the library's utility by pretraining RadHarmony-ViT, a reference vision transformer baseline that combines three heterogeneous chest radiograph datasets with no dataset-specific code. The code and pretrained model weights are available at https://github.com/f10409/RadHarmony.

Robust out-of-the-box performance is essential for the clinical deployment of deep learning models in medical imaging. An important but underexplored factor affecting model generalisability is intensity normalisation, particularly for magnetic resonance imaging (MRI), where image intensities vary across scanners and protocols. In this study, we systematically compared seven normalisation methods and their impact on the performance of a 3D U-Net model for meniscus segmentation from knee MRI. The methods included standard scaling approaches, histogram-based techniques, and a Gaussian Mixture Model (GMM)-based method. Models were trained on the IWOAI 2019 dataset and evaluated on both internal and external test sets (SKM-TEA) to assess generalisability. Performance was similar internally but differences were significant on external data, with Z-score, Nyúl histogram matching, and CLAHE showing greater robustness than other methods. However, these differences were small compared to the significant performance drop observed between datasets. Overall, while intensity normalisation had a measurable effect on model generalisability, its impact was limited relative to the effects of domain shift, highlighting the need for complementary strategies for robust deployment.

Automated grading of Lumbar Disc Degeneration is essential for the objective quantification of structural changes associated with low back pain. Observing that baseline models underperformed on our data, we propose a framework designed to overcome these limitations. First, we present the Cross-sequence Attention Spine (CrossSpine) framework, a novel architecture that employs a cross-sequence attention mechanism to adaptively fuse features from different MRI sequences at multiple spa- tial scales. Second, we contribute a meticulously curated dataset aimed at automated Pfirrmann grading. Finally, we introduce an IVD-aware classification technique that integrates anatomical disc-level information, enabling the model to learn level-specific degeneration priors. Our experi- ments demonstrate the superiority of this approach: CrossSpine achieved a relative improvement exceeding 125% in the Macro F1 score, while boosting the Mean AUPRC by 99% and the Mean AUROC by 36% com- pared to the baseline.

Optical coherence tomography (OCT) imaging is essential for the diagnosis and treatment of retinal diseases. Although multimodal large language models (MLLMs) have demonstrated considerable potential in medical image analysis, existing benchmarks largely reduce OCT understanding to coarse-grained disease classification or isolated visual question answering, leaving the complete cognitive process from visual perception to clinical reasoning insufficiently evaluated. To address this limitation, we introduce OCT-Bench, a comprehensive benchmark dedicated to OCT image understanding. OCT-Bench comprises 10,076 high-quality multiple-choice questions constructed from 4,137 OCT images across seven public datasets. Following the real-world clinical interpretation workflow, we establish a hierarchical capability taxonomy consisting of 20 fine-grained tasks across three dimensions: Perception, Cognition, and Reasoning. These tasks cover a broad range of capabilities, including imaging attributes, retinal anatomy, lesion characteristics, spatial relationships, disease assessment, therapeutic decision-making, and prognostic management. We systematically evaluate 20 representative MLLMs, including proprietary models, open-source general-purpose models, and medical-domain models. Experimental results demonstrate that current models remain substantially short of reliable OCT understanding. Moreover, neither medical-domain adaptation nor increased model scale consistently improves performance across capability levels. OCT-Bench enables comprehensive and fine-grained evaluation of MLLMs, providing a foundation for identifying capability bottlenecks and advancing clinically grounded OCT understanding.

Background and Objective: Deep video models estimate left-ventricular ejection fraction (EF) from echocardiography with near-expert accuracy, and post-hoc attribution (Chefer relevance for transformers, Grad-CAM for CNNs) is increasingly used to certify that models "look at the right place." Yet whether these explanations are faithful both spatially and temporally is unaudited. Because EF is defined by the end-systolic (ES) and end-diastolic (ED) frames, a faithful explanation must localize the left ventricle (space) and the decisive frames (time). Methods: We fine-tune two distinct EF regressors on EchoNet-Dynamic -- a self-supervised VideoMAE transformer and a Kinetics-pretrained R(2+1)D CNN -- and audit each with architecture-matched attribution along three axes: intersection-over-relevance (IoR) against LV masks, deletion AUC, and a temporal localization index on ES/ED frames, each relative to chance with per-case 95% CIs over 50 studies. A tubelet-occlusion probe separates attribution failure from model behavior. Results: Both models are anatomically faithful -- IoR 2.91x (VideoMAE) and 1.98x (R(2+1)D) above chance -- yet temporally blind: temporal localization is indistinguishable from chance (0.97--1.00) and no better than random attribution. Occlusion shows the models do not preferentially rely on ES/ED (0.90x chance), so temporal blindness reflects model behavior, not an attribution artifact. Conclusions: Spatial faithfulness does not imply temporal faithfulness. Attribution can certify anatomical grounding while masking that a model ignores the clinically decisive frames -- a caution for XAI-based validation of video diagnostic models and a call for temporally-aware training and evaluation.

Life-limiting congenital anomalies require accurate prenatal diagnosis for appropriate clinical decision-making. Prenatal ultrasound (US) examinations involve multiple anatomical planes, and diagnosis depends on identifying anatomical planes and selecting diagnostically relevant planes for each anomaly. Existing automated methods either rely on plane-level annotations or aggregate heterogeneous images without explicitly modeling these diagnostic capabilities. We propose AnomExpert, a prototype-driven framework for prenatal US anomaly diagnosis using only case-level supervision. AnomExpert introduces learnable plane prototypes to organize unordered images into latent representations corresponding to anatomical planes without requiring plane annotations. A disease-aware sparse selection mechanism further selects diagnostically relevant planes for each anomaly. Experiments on a multi-center dataset of 3,654 cases show that AnomExpert consistently outperforms nine representative multi-instance learning methods. Using a ViT-small backbone, it achieves 86.9% accuracy and 84.2% F1-score while maintaining parameter efficiency. These findings indicate that modeling anatomical plane identification and disease-specific plane selection improves weakly supervised multi-plane prenatal US anomaly classification. The code is available at https://github.com/TIanCat/AnomExpert.

ThinPrep Cytologic Test (TCT) enables early cervical cancer screening, but manual reading is time-consuming and yields inconsistent diagnostic results among cytopathologists. Existing AI detection models perform poorly under real clinical conditions, primarily restricted by two key constraints: unbalanced spatial distribution of cell populations in TCT slides, and limited high-quality annotated cytology data relying on professional pathologist labeling. To address these limitations, we propose a Cell-Distribution Normalization (C-Norm) method. By decoupling abnormal and normal cells from the original TCT images and re-synthesizing them, this method ensures a uniform distribution of cell populations, thereby mitigating generalization degradation caused by distribution bias. Building upon this, we integrate the YOLOv12 framework with a DINOv3 module. This hybrid architecture leverages the advanced detection capability of YOLO models and the superior feature representations of DINOv3 to capture subtle morphological nuances essential for precise recognition of TCT images. Extensive experiments demonstrate that our proposed method achieves state-of-the-art performance, significantly outperforming mainstream detection algorithms. The complete implementation is available at: https://github.com/ddw2AIGROUP2CQUPT/Cell-Norm

Biomedical imaging data exhibit substantial acquisition variability, where identical biological structures can appear markedly different due to differences in imaging devices, acquisition protocols, sites, and reconstruction settings. Consequently, learned representations often entangle underlying biological information with acquisition-dependent appearance, limiting interpretability, generalisation, and clinical deployment. We show that these sources of variation can be disentangled by jointly modelling medical images and acquisition metadata. Using large-scale clinical brain MRI data as a case study, we learn representations that disentangle anatomical structure from contrast-dependent appearance. The resulting framework enables the organisation of heterogeneous imaging protocols, sequence understanding, the detection of image-metadata inconsistencies and imaging artifacts, while preserving biologically relevant anatomical features across diverse acquisitions. Building on these disentangled representations, it further supports generative and translational capabilities, performing both metadata-conditioned synthesis of realistic 3D brain MRIs and anatomy-preserving harmonisation for cross-modality and cross-site adaptation. Our findings demonstrate that acquisition variability is a structured component of the imaging process that can be modeled, audited, synthesised, and controlled, establishing a foundation for acquisition-aware representation learning in large-scale biomedical imaging.

Medical imaging generates high-resolution images posing significant storage, transmission, and computational challenges. While low-rank matrix approximation (LoRMA) techniques offer efficient compression by exploiting structural redundancy, global approaches often fail to preserve local details critical for diagnosis. This paper focuses on clustering techniques that exploit non-local self-similarity to identify structurally similar regions in medical images. These clusters can be used for post-processing tasks such as adaptive image compression. We evaluate five clustering techniques: k-means, mini-batch k-means, agglomerative hierarchical clustering, balanced iterative reducing and clustering using hierarchies (BIRCH), and bisecting k-means across MRI, ultrasound, and chest X-ray modalities. All clustering techniques were optimised using random search, and cluster quality was assessed using the Silhouette score, the Davies-Bouldin (DB) index, and the Calinski-Harabasz (CH) index. Results demonstrate that standard k-means and bisecting k-means generally achieve strong cluster cohesion and separation across modalities. However, they tend to form a small number of clusters with high intra-cluster variability, limiting their effectiveness for post-processing tasks such as adaptive compression. Agglomerative clustering outperformed other techniques for MRI and ultrasound in terms of intra-cluster homogeneity, making it more suitable for preserving fine diagnostic details. For chest X-rays, mini-batch k-means achieved the best balance between clustering quality and intra-cluster compactness. BIRCH consistently underperformed across all modalities.

Mechanical thrombectomy (MT) is a time-critical intervention for acute ischemic stroke; however, access remains limited due to a shortage of neuroradiologists and specialized centers. Reinforcement learning (RL) offers potential to automate endovascular navigation and improve accessibility, yet current models lack standardized frameworks to assess navigation difficulty for model training and evaluation. This study aims to identify vascular metrics associated with navigation difficulty and to develop an automated pipeline for quantitative vascular feature extraction, enabling future complexity grading. Vascular trees were segmented from computed tomography angiograms from 61 patients, and vascular metrics including aortic arch type, presence of bovine arch, vessel length, tortuosity, take-off angle, number of reverse curves, were measured using a custom pipeline. A Soft Actor-Critic RL algorithm was used for 120 s autonomous navigation. Outcomes were analyzed using both mixed effects linear and logistic regression. On the left side, the presence of a bovine arch and aortic arch type II/III increased navigation time by 30.19 s and 37.92 s, respectively, while greater tortuosity (\b{eta} = 118.20) further prolonged the procedure and reduced success probability. On the right side, type II/III arches extended procedure time by 45.94 s, while each additional reverse curve was associated with 3.96 s longer navigation time and lower probability of success. These findings demonstrate for the first time that MT agent navigation difficulty is strongly influenced by vascular geometry. The proposed automated pipeline enables objective and quantitative characterization of vascular features, providing a foundation for future development of standardized complexity grading and RL model evaluation, without aiming to demonstrate clinically generalizable autonomous navigation.

Medical imaging models are often deployed without the demographic, acquisition, and quality metadata needed for subgroup auditing. Once those metadata disappear, clinically critical failure modes can be masked by strong aggregate performance, and many robust-learning methods lose the group structure they rely on. We present CAPRA, a calibrated proxy-axis framework for hidden subgroup analysis under missing metadata. CAPRA predicts image-derived semantic axes, calibrates axis posteriors on a small metadata-labeled split via patient-level cross-fitting, and organizes those posteriors into a calibrated subgroup interface that supports both deployment-time failure analysis and downstream robust learning without requiring subgroup labels at deployment. Across fundus, dermoscopy, and chest radiography, CAPRA reveals disparity patterns missed by metadata-only slicing, remains informative under dataset shift, and produces subgroup partitions that align more closely with explicit failure axes than image-only or latent-slice baselines. The same interface can also be reused by downstream robust learners, although those gains are domain-dependent. Overall, CAPRA turns hidden subgroup analysis under missing metadata into a calibrated, interpretable, and reusable subgroup interface for deployment-time analysis and robust transfer.

The privacy requirements of medical data and its substantial variations across organs and modalities hinder the clinical implementation of medical AI. Federated learning (FL) is a feasible approach to overcome these challenges. Due to the continuous emergence of FL algorithms and the highly heterogeneous nature of medical data, objectively evaluating their performance in real-world clinical settings remains difficult. Therefore, a comprehensive federated medical imaging benchmark, serving as a unified evaluation standard, is crucial for advancing the technology toward reliable clinical application. Existing federated medical imaging benchmarks have not yet adequately incorporated state-of-the-art algorithms, are limited to data from single organs or modalities, and overly emphasize model accuracy, making it difficult to comprehensively assess the overall efficacy of FL in real-world medical environments. To address these challenges, we developed the MobenFL benchmark. This benchmark integrates 20 cutting-edge FL algorithms and 22 medical imaging datasets, covering 12 critical organs across the human body, surpassing existing benchmark in breadth. In terms of evaluation dimensions, MobenFL not only assesses performance but also systematically incorporates key metrics such as algorithmic efficiency and privacy protection capabilities. Additionally, it conducts specialized evaluations for complex real-world clinical scenarios involving different diseases, devices, and imaging modalities, thereby providing a comprehensive and in-depth evaluation framework for the clinical application of FL in the medical field.

Background: Automated 3D segmentation of muscles and adipose tissue from CT is vital for body composition analysis, but multi-source data heterogeneity and high CPU memory demands hinder clinical deployment. Methods: We propose a coarse-to-fine hierarchical framework to segment ten tissue structures. Efficiency is optimized using Dynamic Spacing and Anisotropic Patching, a Group Inference mechanism for low-memory sliding-window processing, and Topology-Aware Asymmetric Resampling for fast post-processing. Results: The framework was trained on 1,558 CT volumes from seven public and two private datasets, and evaluated on an independent test cohort (N=105), per-structure Dice coefficients ranged from 0.924 to 0.982. Eight major structures met the +-10% relative error clinical acceptance limit. On a 12-core CPU workstation, the GPU-free pipeline averaged 44.5 seconds per volume with 4.73 GB peak memory. Conclusion: This framework balances accuracy and efficiency, enabling robust, large-scale body composition analysis on standard CPU workstations.

Squint and cataract are major ocular disorders that majorly affect visual perception and interaction capability. This paper proposes a real-time video-based automated detection system for squint and cataract detection based on computer vision and image processing methods. The proposed system uses a media-pipe face-mesh (a 478-point facial landmark detection model) to extract geometric ocular features for multi-class squint classification. Simultaneously, The presence and severity cataract is estimated through grayscale intensity and histogram-based lens opacity analysis. The system records short video sequences with standard laptop or mobile cameras, which can be deployed at low costs and on a large scale. The experimental performance has shown great accuracy in the detection of squint (98.39%) and classification of cataract (96.90%). Besides automatic ocular analysis, the proposed framework is also made accessible for visual impairment inference which will be integrated with future adaptive user interface and Web accessibility systems for people with visual impairment.

Despite rapid advances in chest X-ray (CXR) foundation models, most radiology report generation (RRG) systems still rely on heavily downsampled inputs (e.g., 256x256) due to the fixed visual token budgets of pretrained vision encoders, suppressing subtle yet clinically important cues present in native-resolution images. However, enabling high-resolution (high-res) perception remains challenging: naive tiling causes prohibitive token inflation, while global compression suppresses subtle lesions and degrades diagnostic fidelity. Inspired by radiologists' workflow, localizing suspicious regions before detailed high-res assessment. We propose Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Reporting (LePaX), the first RRG framework that enables efficient high-res CXR perception (up to 1920x1920) without increasing the vision-token count. LePaX formulates high-res perception as a constrained spatial resolution allocation problem under a fixed token budget and introduces two key components: Learnable Spatial Resolution Allocation (LSRA), which learns a spatial utility map that adaptively allocates limited high-res capacity to diagnostically relevant regions, enabling targeted extraction of high-res patches from native CXRs; and Global-Regional Fusion (GRF), which performs token-preserving region-to-global refinement by projecting high-resolution regional evidence back onto the global feature grid through spatially aligned resolution write-back, avoiding token inflation. Experiments on multiple CXR benchmarks demonstrate that LePaX consistently improves both clinical and linguistic metrics while enabling native-resolution CXR perception with over 10x fewer visual tokens than naive high-res tiling.

Multi-view reasoning in coronary X-ray angiography is inherently a cross-projection geometric problem, yet automated report generation in this setting remains largely unexplored. The 3D vascular topology leads to projection-dependent branch overlap and foreshortening, rendering single-view modeling fundamentally incomplete and unstable for lesion localization and stenosis grading. Although multi-view fusion appears promising, learning anatomically consistent fusion from real angiograms is impeded by a critical limitation: cross-view alignment is unobservable and cannot be explicitly supervised. Consequently, conventional fusion relies on implicit correlations rather than verified anatomical correspondence. We address this by reformulating multi-view stenosis reporting as an alignment-constrained aggregation problem. A controllable synthetic angiography generation strategy is introduced to expose geometry-derived patch-level correspondence supervision unavailable in real data. An anatomy-correspondence module learns cross-view correspondence matrices that explicitly align auxiliary features within the main-view coordinate space prior to fusion, thereby constraining evidence aggregation to anatomically consistent regions. Experiments on synthetic data and zero-shot transfer to real angiograms show that this alignment-constrained design improves correspondence consistency and structured stenosis reporting compared to single-view modeling and conventional multi-view fusion methods. The code will be publicly available upon publication.

Glaucoma is a leading cause of irreversible blindness worldwide, yet most automated diagnosis systems rely on opaque deep-learning models that offer little clinical interpretability. We present GlaKG, a biomarker-centric fundus knowledge graph that integrates structural biomarkers, clinically grounded rules, and image features to produce traceable reasoning for glaucoma diagnosis and risk stratification. GlaKG encodes six entity types (Fundus Image, Optic Disc, Neural Rim, Pathology, Diagnosis, Risk Level), eight relation types, and 11 clinically validated rules into a unified graph, so that every prediction is accompanied by an explicit reasoning chain linking biomarker evidence to activated clinical rules. To keep knowledge-based reasoning strictly separate from label information, we adopt a post-processing fusion framework that combines ResNet50 image embeddings with a normalized KG reasoning-chain score via a tunable weight alpha, with all fitting confined to the training split. On a publicly available, AI-annotated fundus dataset, GlaKG reaches F1 = 0.9953 for binary glaucoma classification and 0.930 accuracy with 0.922 weighted F1 for four-class risk stratification; we report openly that the dataset's biomarker annotations are highly label-correlated, and therefore frame these figures as an upper bound attainable with clean structured biomarkers rather than as leakage-free image-only performance. Feature-importance analysis shows KG-derived and biomarker features contributing near-equally (51.1% vs. 48.9%), and the reasoning chain flags borderline cases by exposing low chain scores rather than failing silently. GlaKG's central contribution is therefore a clinically auditable reasoning framework that complements raw predictive performance by explicitly exposing the biomarker evidence and rule activations behind each decision.

Radiologists routinely compare current and prior chest X-rays to track disease progression, producing follow-up reports that describe multiple findings, each localised to an anatomical region and annotated with a temporal change status. Existing automated methods either generate reports from a single image without modelling temporal context, or incorporate temporal information but do not ground their outputs spatially. The few approaches that combine temporal reasoning with spatial grounding are restricted to single-finding descriptions, leaving multi-finding reports with mixed change directions unaddressed. We present GRCD, a framework for grounded report generation from chest X-ray pairs in the multi-finding setting. We first construct a rigorously cleaned dataset of temporal chest X-ray pairs by identifying and correcting two systematic labelling errors in the source annotations. We then introduce a Region-Guided Change Token module that encodes per-region temporal change across anatomical structures and injects this signal into a language model through a dual-pathway strategy combining prepended spatial tokens with gated cross-attention. On a multi-finding test set, GRCD outperforms existing baselines on text generation and clinical accuracy metrics, with gains in change detection. Ablation studies confirm that the dual-pathway design outperforms either integration strategy in isolation on text and clinical metrics, and that region-level change encoding is necessary for multi-finding generation. Code is available at https://github.com/UTSA-VIRLab/GRCD

Therapy-induced cardiotoxicity is the leading non-oncological cause of treatment interruption in breast cancer patients, yet early, automated risk stratification from routine cardiac imaging remains an unsolved problem. We present EchoRisk, the first curated, multicentre, longitudinal echocardiography dataset with explicit cardiotoxicity labels, released as the primary technical reference for the EchoRisk-MICCAI 2026 challenge. The dataset comprises 422 patients enrolled in the EU-funded CARDIOCARE prospective study across five European sites, yielding 2,159 echocardiography videos across 1,123 clinical exams acquired at up to five longitudinal timepoints, alongside a dedicated cohort of 280 patients with baseline imaging for early cardiotoxicity prediction. Three clinically grounded tasks are defined: automated estimation of left ventricular ejection fraction from cine video (Task 1), classification of LV dysfunction from longitudinal imaging (Task 2), and early prediction of therapy-induced cardiotoxicity from pre-therapy baseline echocardiography alone (Task 3). For each task we specify the evaluation protocol, primary and secondary metrics, and ranking procedure. We establish baseline performance using an R(2+1)D video backbone with LSTM aggregation trained from Kinetics-400 pretrained weights, demonstrating strong discriminative performance for cardiac functional assessment and LV dysfunction classification, while early cardiotoxicity prediction from a single pre-therapy video remains a significant open problem for the community. The dataset, evaluation code, and baseline implementations are publicly available to serve as a benchmark for further collaboration, comparison, and the creation of task-specific architectures in cardio-oncology.

Implicit neural representations (INRs) are well suited to cardiac motion estimation, providing continuous, compact representations of motion fields. However, fitting an INR to each image sequence is time-consuming and sensitive to the optimisation trajectory. Learned priors can help guide optimisation towards plausible motion fields and enable faster adaptation, but learning priors for cardiac motion INRs remains under-explored. In this work, we compare four strategies for learning cardiac motion priors, including a population prior learned by joint optimisation, a consensus prior obtained by weight averaging, auto-decoders, and meta-learning. Using short-axis tagged cardiac magnetic resonance images from the UK Biobank, we evaluate their impact on tracking accuracy, motion behaviour, and adaptation trajectory. All learned priors substantially improved early adaptation performance compared with random initialisation. While the simple consensus prior was effective, auto-decoders recovered large deformations faster during early adaptation. Meta-learning achieved strong early performance and maintained the best adaptation trajectory over 50 iterations.