Medical Image Analysis

Bronchoscopy is routinely conducted in pulmonary clinics and intensive care units, but navigating the complex branching of the respiratory tract remains challenging. This paper introduces BronchoLumen, a real-time YOLO-based system for detecting bronchial orifices in video bronchoscopy, aiming to assist navigation and CAD systems. The paper investigates if bronchial orifices can be robustly detected across image domains using state-of-the-art object detection and a limited set of public image data. The study includes the description and comparison of YOLOv8, a widely adopted architecture, and YOLOv12, a more recent architecture integrating attention-based modules to improve spatial reasoning. Both models are trained and tested solely on publicly available datasets comprising different image domains. A comparison of both models is conducted based on the common metrics [email protected] and [email protected]:0.9 with the latter emphasizing localization accuracy. For YOLOv8 we obtained a [email protected] of 0.91 on an in-domain and 0.68 on a cross-domain test set. YOLOv12 achieved 0.84 and 0.68 respectively with slightly better localization accuracy with [email protected]:0.9 of 0.48 and 0.26 compared to YOLOv8 with 0.45 and 0.25. Challenges like motion blur and low contrast occasionally entailed uncertainties but the system demonstrated overall robustness in most scenarios. BronchoLumen is an open-weight, YOLO-based solution for bronchial orifice detection offering high accuracy and efficiency across multiple image domains. While the more recent YOLOv12 achieves better localization accuracy, we observed a slightly worse precision. The models have been made publicly available to foster further research in bronchoscopy navigation.

Medical imaging research has spent a decade getting very good at one thing: producing per-voxel masks. Masks tell us size, volume, and location, and a decade of clinical infrastructure rests on those outputs. Yet the report a radiologist writes contains almost nothing a mask can express. We argue that medical imaging research should adopt medical image parsing as its central output: a structured representation in which entities, attributes, and relationships are emitted together and mutually consistent. Entities are the named structures and findings, present or absent. Attributes describe those entities, capturing things like margin regularity, enhancement pattern, or severity grade. Relationships connect them, naming where one structure sits relative to another, what abuts what, and what has changed since the prior scan. A good parse satisfies three properties, in order: (1) decision (the parse names the right things in the current image), (2) reconstruction (its content is rich enough to regenerate that image), and (3) prediction (its content is rich enough to forecast how the patient state will evolve). Quantitative measurements are derived from this content; they are not predicted alongside it. To test how close the field is to producing such an output, we audit eleven representative systems against the three parsing primitives plus closure. None emits a well-formed parse. Entities are largely solved. Attributes, relationships, and closure remain near-empty. The path forward is not a new architecture. It is a commitment to a richer output, and to training signals that reward it. Segmentation taught models to measure. Parsing asks them to explain.

Existing medical-agent benchmarks deliver imaging as pre-selected samples, never as an environment the agent must navigate. We introduce ABRA, a radiology-agent benchmark in which the agent operates an OHIF viewer and an Orthanc DICOM server through twenty-one function-calling tools that span slice navigation, windowing, series selection, pixel-coordinate annotation, and structured reporting. ABRA contains 655 programmatically generated tasks across three difficulty tiers and eight types (viewer control, metadata QA, vision probe, annotation, longitudinal comparison, BI-RADS reporting, and oracle variants of annotation and BI-RADS reporting), drawn from LIDC-IDRI, Duke Breast Cancer MRI, and NLST New-Lesion LongCT. Each episode is scored along Planning, Execution, and Outcome (Bluethgen et al., 2025) by task-type-specific automatic scorers. Ten current models, five closed-weight and five open-weight, reach at least 89% Execution on real annotation but only 0-25% Outcome; on the paired oracle variant where a simulated detector supplies the finding, Outcome on the same task reaches 69-100% across the models evaluated, localising the bottleneck to perception rather than tool orchestration. Code, task generators, and scorers are released at https://github.com/Luab/ABRA

Out-of-distribution (OOD) detection is essential for building reliable AI systems, as models that produce outputs for invalid inputs cannot be trusted. Although deep learning (DL) is often assumed to outperform traditional machine learning (ML), medical imaging data are typically acquired under standardized protocols, leading to relatively constrained image variability in OOD detection tasks. This motivates a direct comparison between ML and DL approaches in this setting. The two approaches are evaluated on open datasets comprising over 60,000 fundus and non-fundus images across multiple resolutions. Both approaches achieved an AUROC of 1.000 and accuracies between 0.999 and 1.000 on internal and external validation sets, showing comparable detection performance. The ML approach, however, exhibited substantially lower end-to-end latency while maintaining equivalent accuracy, indicating greater computational efficiency. These results suggest that for OOD detection tasks of limited visual complexity, lightweight ML approaches can achieve DL-level performance with significantly reduced computational cost, supporting practical real-world deployment.

Breast density is a key factor that influences mammography interpretation and is a major source of heterogeneity in multicenter datasets. Such heterogeneity poses challenges for collaborative machine learning across institutions, particularly in Federated Learning. This study aims to evaluate the impact of breast density-induced heterogeneity on FL for mammography image classification and to assess the robustness of common FL algorithms in realistic clinical settings. We conducted experiments under two scenarios: (1) a strongly heterogeneous setting where each participating site contributed exclusively low- or high-density cases, based on the BI-RADS density score, and (2) a population-based setting simulating breast density distributions in White and Asian populations. For the strongly heterogeneous setting, we evaluated two configurations: one with 2 clients, where the cases were grouped as BI-RADS A-B and C-D, and one with 4 clients, where each site contained cases of a single BI-RADS density. We compared three FL methods (FedAvg, FedProx, SCAFFOLD) against centralized training, local-only training, and naive aggregation approaches, including ensembling and weight averaging. Across both scenarios, FL achieved performance comparable to centralized training, while local models and naive aggregation approaches underperformed in the presence of strong heterogeneity. Notably, FedAvg achieved accuracy on par with or exceeding centralized training, demonstrating resilience to breast density-induced data imbalance without requiring specialized heterogeneity mitigation algorithms. These findings show that FL can address breast density-related heterogeneity, supporting its feasibility for real-world mammography workflows. The demonstrated robustness of FedAvg underscores the potential for broad clinical deployment of FL, enabling collaborative model development while maintaining data privacy.

Wireless capsule endoscopy (WCE) enables non-invasive visual assessment of the small bowel, but its clinical utility is constrained by the large volume of frames generated per examination and the difficulty of recognising subtle abnormalities under highly variable imaging conditions. Existing learning-based approaches for WCE are predominantly vision-only, often confined to narrow pathology sets, and show limited transfer across datasets and centres. To address these limitations, this study introduces CapCLIP, a domain-specific vision-language representation learning framework for WCE. CapCLIP aligns capsule endoscopy frames with clinically grounded textual descriptions derived from standardised nomenclature and pathology-aware caption templates, thereby learning embeddings that are both semantically informed and transferable. The proposed framework is evaluated against relevant open-source vision and vision-language foundation models under strict zero-shot conditions using unseen WCE datasets. Evaluation covers three downstream tasks: K-nearest neighbour classification, CLIP-style image-text classification, and text-to-image retrieval. Across these settings, CapCLIP consistently outperforms the compared baselines, with particularly strong gains in zero-shot image-text classification and cross-modal retrieval on out-of-distribution datasets. The results indicate that language-guided representation learning can improve both generalisation and semantic interpretability in WCE analysis. These findings position CapCLIP as a step toward foundation models tailored to capsule endoscopy and support the use of language-grounded WCE analysis.

Accurate 3D brain MRI subtype classification benefits from both localized anatomical cues and long-range contextual reasoning. We present AGA3DNet, a report-grounded framework that incorporates brief anatomical phrases extracted from radiology reports as a soft anatomical prior channel and fuses it with a lightweight 3D CNN and multi-view xLSTM aggregation. Specifically, extracted anatomical phrases are mapped to atlas-defined regions and converted into smooth spatial priors using a signed-distance transform followed by Gaussian weighting, providing interpretable, anatomy-grounded guidance without requiring dense voxel annotations. We evaluate AGA3DNet on a retrospective institutional brain MRI cohort for abnormal subtype discrimination and compare against reproducible 3D classification baselines. AGA3DNet achieves improved overall balance across performance metrics and supports clinically interpretable localization through the prior channel. We discuss limitations related to single-cohort evaluation and the lack of large-scale public brain MRI datasets paired with radiology reports under broadly usable terms.

Diabetic Retinopathy (DR) is a leading cause of preventable blindness among working-age adults worldwide, yet most automated screening systems are limited to image-level classification and lack clinically structured reporting. We propose Retina-RAG, a low-cost modular framework that jointly performs DR severity grading, macular edema (ME) detection, and report generation. The architecture decouples a high-performance retinal classifier and a parameter-efficient vision-language model (Qwen2.5-VL-7B-Instruct) adapted via Low-Rank Adaptation (LoRA), enabling flexible component integration. A retrieval-augmented generation (RAG) module injects curated ophthalmic knowledge together with structured classifier outputs at inference time to improve diagnostic consistency and reduce hallucinations. Retina-RAG achieves an F1-score of 0.731 for DR grading and 0.948 for ME detection, substantially outperforming zero-shot Qwen (0.096, 0.732) and MMed-RAG (0.541, 0.641) on a retinal disease detection dataset with captions. For report generation, Retina-RAG attains ROUGE-L 0.438 and SBERT similarity 0.884, exceeding all baselines. The full framework operates on a single consumer-grade GPU, demonstrating that clinically structured retinal AI can be achieved with modest computational resources.

We introduce a hybrid quantum-classical pipeline, based on neutral-atom reservoir computing, for medical image classification, focusing on the binary classification task of polyp detection. To deal effectively with the high dimensionality, we integrate a guided auto-encoder. This pipeline learns compact and discriminative representations of image data that are also well-suited for quantum reservoir computing. A key challenge in such systems is the non-differentiable nature of quantum measurements, which creates a 'gradient barrier' for standard training. We overcome this barrier by incorporating a differentiable surrogate model that emulates the quantum layer, enabling end-to-end backpropagation through the entire system. This guided training process is jointly optimized for classification accuracy and for faithful image recovery from the auto-encoder. The learned latent representations are encoded as pulse detuning parameters within a Rydberg Hamiltonian, and quantum embeddings are subsequently obtained through expectation values. These embeddings are then passed to a linear classifier. Our simulations show that this method outperforms some traditional approaches that use PCA or unguided autoencoders. We also conduct ablation studies to assess the impact of various quantum and training parameters, demonstrating the robustness and flexibility of our proposed pipeline for real-world medical imaging applications, even in the current NISQ era.

Cardiac magnetic resonance (CMR) segmentation underpins quantitative assessment of ventricular structure and function, yet reliable delineation remains difficult due to low tissue contrast, fuzzy boundaries, and inter scan variability. We present CardiacNAS, an evolutionary neural architecture search (NAS) framework that couples a UNet like supernet with a cardiac aware search space spanning depth width, kernel size, filter size, attention, fusion, activation, dropout, and residual scaling. The search is explicitly resource aware, jointly optimizing dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95) versus model size and floating point operations (FLOPs) under fixed compute budgets. Candidate architectures are instantiated from the supernet, trained with proxy budgets, and evolved through crossover, mutation, and elitist selection. We evaluate on the ACDC dataset and compare against six state of the art methods, using qualitative comparisons, learning curve analyses, and design factor correlation studies. The resulting model attains 93.22% average DSC and 4.73 mm HD95 with 3.58M parameters and 14.56 GFLOPs, demonstrating a favorable accuracy efficiency trade off. Analyses indicate that searched attention and fusion choices, together with residual scaling, contribute to improved boundary fidelity and stability. CardiacNAS offers a principled, resource aware approach to deployable CMR segmentation with transparent reporting of architectural complexity and compute budgets.

Multi-rater medical image segmentation captures the inherent ambiguity of clinical interpretation, where diagnostic boundaries vary across experts and imaging devices. Existing approaches often reduce this diversity to consensus labels or treat rater differences as noise, resulting in overconfident and poorly calibrated models. We propose a harmonized probabilistic framework that disentangles acquisition artifacts from genuine annotator variability through adaptive feature conditioning and frequency-domain personalization. A lightweight Harmonizer Network implicitly models scanner-specific artifacts and performs dynamic feature modulation to standardize latent representations, ensuring that uncertainty reflects anatomy rather than noise. To represent rater-specific styles, we introduce a novel High-Frequency Prompt Modules that operate in the spectral domain to encode annotator-dependent boundary precision and textural sensitivity. These prompts adaptively modulate harmonized features to produce personalized yet anatomically consistent segmentations. Furthermore, a Generalized Energy Distance based regularization aligns the generative distribution with empirical annotation variability, promoting diversity where experts disagree and consensus where they converge. Experiments on LIDC-IDRI and NPC-170 show SOTA aggregated and individualized segmentation, with notable GED reductions and improved Dice scores, especially on noisy cases. Beyond accuracy, the model exhibits clinically meaningful uncertainty. Confidence rises in agreement regions and declines in ambiguous areas, supporting its use as a reliable and interpretable tool for multi-expert clinical workflows.

Vision Transformers (ViTs) achieve state-of-the-art segmentation accuracy but require large training datasets because each layer has unique parameters that must be learned independently. We present RD-ViT, a Recurrent-Depth Vision Transformer that adapts the Recurrent-Depth Transformer (RDT) architecture to dense prediction tasks, supporting both 2D and 3D inputs. RD-ViT replaces the deep stack of unique transformer blocks with a single shared block looped T times, augmented with LTI-stable state injection for guaranteed convergence, Adaptive Computation Time (ACT) for spatial compute allocation, depth-wise LoRA adaptation, and optional Mixture-of-Experts (MoE) feed-forward networks for category-specific specialization. We evaluate on the ACDC cardiac MRI segmentation benchmark in both 2D slice-level and 3D volumetric settings with exclusively real experiments executed in Google Colab. In 2D, RD-ViT outperforms standard ViT at 10% training data (Dice 0.774 vs 0.762) and at full data (0.882 vs 0.872). In 3D, RD-ViT with MoE achieves Dice 0.812 with 3.0M parameters, reaching 99.4% of standard ViT performance (0.817) at 53% of the parameter count. MoE expert utilization analysis reveals that different experts spontaneously specialize for different cardiac structures (RV, MYO, LV) without explicit routing supervision. ACT halting maps show higher compute allocation at cardiac boundaries, and the mean ponder time decreases from 2.6 to 1.4 iterations during training, demonstrating learned computational efficiency. Depth extrapolation enables inference with more loops than training without degradation. All code, notebooks, and results are publicly released.

Clinicians trace cephalometric radiographs following a structured anatomical workflow, yet no prior system encodes this into computation. We present a five-phase anatomy-guided pipeline producing confidence-weighted spatial priors that shape HRNet-W32 training, achieving 1.04 mm mean radial error on 25 landmarks across 1,502 radiographs from 7+ imaging devices. A training x inference prior matrix isolates the mechanism: anatomical priors maintain a 1% validation-to-test gap versus 88% without priors (1.94 mm), despite identical validation convergence. The matrix establishes that all trained models are inference-independent, the expanded architecture alone provides no benefit, random priors yield partial but unstable improvement (1.72 mm), and only image-specific anatomically correct priors produce the 1.04 mm result -- functioning as a training-time regularizer requiring no automated prior generation at deployment. Five-fold cross-validation (p=0.0015), patient-level permutation testing (p<0.0001, n=151), quantified Grad-CAM analysis (88% vs. 74% in-zone activation, p<0.001), and clinical measurement validation (skeletal classification kappa=0.79-0.84, zero Class II<->III reversals, ICC>0.95) provide converging evidence. Cross-domain experiments on echocardiography, cervical spine, and hand radiography support the hypothesis that prior effectiveness scales with the spatial entropy of the landmark distribution.

Gliomas are aggressive brain tumors that infiltrate surrounding tissue beyond the visible tumor margins observed on Magnetic Resonance Imaging (MRI). Predicting the spatial extent of this infiltration is essential for surgical planning and radiation therapy, yet existing deep learning approaches focus on segmenting the visible tumor rather than estimating infiltration risk in the surrounding tissue. This paper presents InfiltrNet, a novel dual-branch architecture that combines a convolutional neural network (CNN) encoder with a Swin Transformer encoder through cross-attention fusion modules to predict three-zone infiltration risk maps from multimodal MRI. A label generation strategy based on distance transforms is proposed to derive reproducible infiltration risk zones from standard Brain Tumor Segmentation (BraTS) annotations. InfiltrNet is trained with a combined Dice-CrossEntropy and boundary-aware loss augmented by auxiliary supervision heads at intermediate decoder levels. Extensive experiments on BraTS 2020 and BraTS 2025 demonstrate that InfiltrNet outperforms five established baselines. Explainability analysis using GradCAM++ and Occlusion sensitivity confirms that the model attends to clinically relevant peritumoral regions.

In MRI, variations in scan parameters, sequence, or hardware can lead to discrepancies in image appearance, even for the same subject. These inconsistencies, known as domain shifts, can hinder image analysis and degrade the performance of deep learning models trained on data from specific target domains. MRI image harmonization aims to address these issues by aligning source domain images to the target domain images while preserving biological information such as anatomical structures. However, most existing harmonization approaches require access to both source and target domain data in training or test time. This dependence induces data sharing between institutions, raising concerns about patient privacy and substantially limiting the harmonization approaches that can be practically deployed in clinical settings. To overcome these limitations, we introduce TgtFreeHarmony, the harmonization framework tailored for target-free scenarios, eliminating the need for target domain data and any data sharing, enabling privacy-preserving harmonization directly within the source institution. Our approach estimates the target domain style by searching the manifold of MRI domain style constructed via a disentanglement-based generator using Bayesian optimization guided by the performance of a downstream task model, which is trained on target domain data. We evaluated our method on the brain tissue segmentation task across multiple institutes and demonstrated that it effectively harmonizes source images into target images, leading to improved downstream task performance. By enabling harmonization without any access to target-domain data, TgtFreeHarmony establishes a new direction of harmonization preserving data privacy that can be realistically deployed within clinical environments.

The systemic, metabolic, lifestyle factors have established associations with Alzheimer's Disease (AD) through epidemiologic and AD-specific biomarker studies. Whether colored fundus photography (CFP) contains retinal structural signatures corresponding to these AD-related risk domains remains unclear. To determine whether deep learning (DL) models can predict 12 AD-related risk factors from CFP and to characterize the retinal structures underlying these predictions, thereby assessing whether CFP reflects pathways to AD vulnerability. Using 62,876 CFPs from 44,501 unique participants from the UK Biobank, DL models were trained to predict 12 factors linked to AD incidence: 6 categorical (sex, smoking, sleeplessness, economic status, alcohol use, depression) and 6 continuous (age, age at completing education, BMI, systolic, diastolic blood pressure, HbA1c). Model performance, model saliency, and saliency-derived scores (CAM-Score) were evaluated and compared to retinal morphometry. The scores were also compared between incident-AD cases (average 8.55 years before onset) and matched controls. Performance of DL ranged from AUROC= 0.5654-0.9480 for categorical and R2=-0.0291-0.7620 for continuous factors, outperforming most of the morphometry-machine learning models. Saliency-based score consistently highlighted biologically meaningful regions, particularly the optic nerve head and retinal vasculature. It also aligned with present morphometric variations. Several saliency-based scores differed significantly between incident AD and matched controls, suggesting potential overlap between retinal correlates of risk factors and preclinical AD-associated changes. CFP encodes retinal signatures linked to AD risk factors. Although not diagnostic, DL-derived retinal representations may uncover biologically meaningful risk-related structural changes mirroring the potential AD vulnerability.

Blood vessel segmentation and -tracing are essential tasks in many medical imaging applications. Although numerous methods exist, the prevailing segment-then-fix paradigm is fundamentally limited regarding its suitability for modeling the task of complete and topologically accurate vascular network reconstruction. Here, we propose an approach to extract topologically more accurate vascular graphs from 3D image data, building upon highly successful ideas from the related biomedical tasks of cell segmentation and -tracking. Our approach first predicts voxel-wise vessel direction vectors joint with standard vessel segmentation masks. Second, to extract the vascular graph from these predictions, we introduce a direction-vector-guided extension of the TEASAR algorithm. Our approach achieves state-of-the-art performance on three benchmark datasets, spanning both synthetic and real imagery. We further demonstrate the applicability of our approach to challenging 3D micro-CT scans of rat heart vasculature. Finally, we propose meaningful and interpretable measures of topological error, namely false splits and false merges for graphs. Overall, our approach substantially improves the topological accuracy of reconstructed vascular graphs, being able to separate closely apposed vessel segments and handle multiple vascular trees within a single volume.

The deployment of artificial intelligence in medical imaging is hindered by high computational complexity and resource-intensive processing of volumetric data. Although chest computed tomography (CT) volumes offer richer diagnostic information than projection radiography, their use in AI-based diagnosis remains limited due to the computational burden of processing uncompressed volumetric images (typically stored in NIfTI or DICOM format). Addressing the growing need for low-resource deployment and efficient electronic data transfer, we investigate the utilization of JPEG-compressed chest CT volumes for thoracic abnormality detection. We propose Feature Attention Style Transfer (FAST), a novel distillation framework that transfers both activation patterns and structural relationships from high-fidelity CT representations to a spatiotemporal visual encoder operating on compressed inputs. By combining Gram-matrix-based attention style preservation with dual-attention feature alignment, FAST enables robust feature extraction from degraded volumes. Furthermore, we introduce Structured Factorized Projection (SFP), leveraging Block Tensor Train decomposition as a parameter-efficient alternative to dense projection layers, reducing projection-head parameters by almost half. Our contrastive learning pipeline, CT-Lite, integrates these components with a SigLIP-based multimodal alignment objective. Experiments on CT-RATE, NIDCH, and Rad-ChestCT demonstrate that CT-Lite achieves AUROC within 5-7% of the uncompressed-input baseline across all three datasets, despite operating on compressed inputs with significantly fewer parameters, paving the way for AI-based clinical evaluation under resource constraints.

Bronchoscopic navigation relies on registering endoscopic video to a preoperative CT scan, but respiratory motion deforms the airway by 5-20 mm, creating CT-to-body divergence that limits localization accuracy. In practice, this is mitigated through breath-hold protocols, which attempt to match the intraoperative anatomy to a static CT, but are difficult to reproduce and disrupt clinical workflow. We propose to eliminate the need for breath-hold protocols by leveraging patient-specific respiratory modeling. Paired inhale-exhale CT scans, already acquired for planning, implicitly define the patient-specific deformation space of the breathing airway. By registering these scans, we reduce respiratory motion to a single scalar breathing phase per frame, constraining all reconstructions to anatomically observed configurations. We embed this representation within a mesh-anchored Gaussian splatting framework, where a lightweight estimator infers breathing phase directly from endoscopic RGB, enabling continuous, deformation-aware reconstruction throughout the respiratory cycle without breath-holds or external sensing. To enable quantitative evaluation, we introduce RESPIRE, a physically grounded bronchoscopy simulation pipeline with per-frame ground truth for geometry, pose, breathing phase, and deformation. Experiments on RESPIRE show that our approach achieves geometrically faithful reconstruction, over 20x faster training, and 1.22 mm target localization accuracy (within the 3mm clinically relevant tolerances) outperforming unconstrained single-CT baselines. Please check out our website for additional visuals: https://asdunnbe.github.io/RESPIRE/

Ultrasound interpretation requires both precise lesion localization and holistic clinical reasoning, yet existing methods typically excel at only one of these capabilities: specialized detectors offer strong localization but limited reasoning, whereas multimodal large language models (MLLMs) provide flexible reasoning but weak grounding in specialized medical domains. We present Echo-α, an agentic multimodal reasoning model for ultrasound interpretation that unifies these strengths within an invoke-and-reason framework. Echo-α is trained to coordinate organ-specific detector outputs, integrate them with global visual context, and convert the resulting evidence into grounded diagnostic decisions beyond detector-only inference. This behavior is established through a nine-task supervised curriculum and then refined by sequential reinforcement learning under different reward trade-offs, yielding Echo-α-Grounding for lesion anchoring and Echo-α-Diagnosis for final diagnosis. On multi-center renal and breast ultrasound benchmarks, Echo-α outperforms competitive baselines on both grounding and diagnosis. In particular, on cross-center test sets, Echo-α-Grounding attains 56.73%/43.78% [email protected] and Echo- α-Diagnosis reaches 74.90%/49.20% overall accuracy on renal/breast ultrasound. These results suggest that agentic multimodal reasoning can turn specialized detectors into verifiable clinical evidence, offering a practical route toward ultrasound AI systems that are more accurate, interpretable, and transferable. The repository is at https://github.com/MiliLab/Echo-Alpha.

Surgical resection remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC), and eligibility depends on accurate assessment of vascular invasion (VI), i.e., tumor extension into adjacent critical vessels. Despite its importance for preoperative staging and surgical planning, computational VI assessment remains underexplored. Two major challenges are the lack of public datasets and the diagnostic ambiguity at the tumor-vessel interface, which leads to substantial inter-rater variability even among expert radiologists. To address these limitations, we introduce the CURVAS-PDACVI Dataset and Challenge, an open benchmark for uncertainty-aware AI in PDAC staging based on a densely annotated dataset with five independent expert annotations per scan. We also propose a multi-metric evaluation framework that extends beyond spatial overlap to include probabilistic calibration and VI assessment. Evaluation of six state-of-the-art methods shows that strong global volumetric overlap does not necessarily translate into reliable performance at clinically critical tumor-vessel interfaces. In particular, methods optimized for binary segmentation perform competitively on average overlap metrics, but often degrade in high-complexity cases with low expert consensus, either collapsing in volume or overextending at uncertain boundaries. In contrast, methods that model inter-rater disagreement produce better calibrated probabilistic maps and show greater robustness in these ambiguous cases. The benchmark highlights the limitations of volumetric accuracy as a proxy for localized surgical utility, motivating uncertainty-aware probabilistic models for preoperative decision-making.

Chest X-ray interpretation is one of the most frequently performed diagnostic tasks in medicine and a primary target for AI development, yet current vision-language models are primarily trained on datasets of paired images and reports, not the cognitive processes and visual attention that underlie clinical reasoning. Here, we present CheXthought, a global, multimodal resource containing 103,592 chain-of-thought reasoning traces and 6,609,082 synchronized visual attention annotations across 50,312 multi-read chest X-rays from 501 radiologists in 71 countries. Our analysis reveals clinical reasoning patterns in how experts deploy distinct visual search strategies, integrate clinical context, and communicate uncertainty. We demonstrate the clinical utility of CheXthought across four dimensions. First, CheXthought reasoning significantly outperforms state-of-the-art vision-language model chain-of-thought in factual accuracy and spatial grounding. Second, visual attention data used as an inference-time hint recovers missed findings and significantly reduces hallucinations. Third, vision-language models trained on CheXthought data achieve significantly stronger pathology classification, visual faithfulness, temporal reasoning and uncertainty communication. Fourth, leveraging CheXthought's multi-reader annotations, we predict both human-human and human-AI disagreement directly from an image, enabling transparent communication of case difficulty, uncertainty and model reliability. These findings establish CheXthought as a resource for advancing multimodal clinical reasoning and the development of more transparent, interpretable vision-language models.

High-precision medical diagnosis relies not only on static imaging features but also on the implicit diagnostic memory experts instantly invoke during image interpretation. We pinpoint a fundamental cognitive misalignment in medical VLMs caused by discrete tokenization, leading to quantization loss, long-range information dissipation, and missing case-adaptive expertise. To bridge this gap, we propose ours, a framework for latent diagnostic memory evolution that simulates the experiential invocation of clinicians by dynamically synthesizing implicit diagnostic memories within the model's hidden stream. Specifically, it begins with a Meta Query for Prior Memorization mechanism, where learnable probes retrieve structured priors from an anatomical prior encoder to generate condensed implicit memories. To ensure clinical fidelity, we introduce Causal Counterfactual Refinement (CCR), which leverages reinforcement learning and counterfactual rewards derived from region-level feature masking to quantify the causal contribution of each memory, thereby pruning redundancies and aligning latent representations with diagnostic logic. This evolutionary process culminates in Intrinsic Memory Transition (IMT), a privileged-autonomous dual-branch paradigm that internalizes teacher-branch diagnostic patterns into the student-branch via full-vocabulary divergence alignment. Comprehensive empirical evaluations across multiple datasets demonstrate that ours, by transferring external expertise into endogenous parameters, significantly outperforms existing state-of-the-art methods, particularly chain-of-thought paradigms, in diagnostic accuracy. The code is available at https://github.com/zhcz328/MedSynapse-V.

Accurate intraoperative assessment of glioma infiltration is essential for maximizing tumor resection while preserving functional brain tissue. Fluorescence lifetime imaging (FLIm) offers real-time, label-free biochemical contrast, but its clinical utility is challenged by biological heterogeneity, class imbalance, and variability in histopathological labeling. We present a data-centric AI (DC-AI) framework that integrates confident learning (CL), class refinement, and targeted label evaluation to develop a robust multi-class FLIm classifier for glioblastoma (GBM) resection margins. FLIm data were collected from 192 tissue margins across 31 newly diagnosed IDH-wildtype GBM patients and initially labeled into seven tumor cellularity classes by an expert neuropathologist. CL was applied to quantify FLIm point-level confidence, identify label inconsistencies, and guide iterative class merging into a three-class scheme ("low", "moderate", "high"). The resulting high-fidelity dataset enabled training a model that achieved 96% accuracy in the three-class task. SHAP analysis revealed class-specific FLIm feature importance, highlighting distinct optical signatures across the infiltration spectrum. Targeted FLIm analysis further identified biological (e.g., gray matter composition) and acquisition-related (e.g., blood contamination) contributors to low-confidence predictions. Blinded re-evaluation of margins flagged by CL demonstrated intra-pathologist variability, underscoring the value of selective relabeling rather than exhaustive review. Together, these findings demonstrate that a DC-AI framework can systematically improve data reliability, enhance model robustness, and refine biological interpretation of FLIm signals, supporting the development of clinically actionable optical tools for real-time glioma margin assessment.

As dental caries appear as subtle, low-contrast lesions in intraoral imaging, existing deep learning models face significant challenges in the early detection of caries. While recent Transformer-based detectors have shown promising results in natural images, they often fail to capture the domain-specific anatomical priors crucial for dental caries detection. In this paper, we propose Caries-DETR, a specialized Transformer framework for caries detection in intraoral images. A Tooth Structure-aware Query Initialization (TSQI) is designed, leveraging large-scale intraoral photograph pre-training and a structure perception branch (SPB) to integrate high-frequency structural priors, guiding the model to focus on anatomically significant lesion areas. Furthermore, we design a Lesion-aware Dynamic Loss Refinement (LDLR) to implement quality-driven hard mining through adaptive loss reweighting based on lesion size, anatomical relevance, and prediction quality, optimizing detection for subtle lesions. Extensive experiments on two public datasets (i.e., AlphaDent and DentalAI) demonstrate that Caries-DETR achieves a state-of-the-art performance compared to existing methods and exhibits good generalization and robustness. Code and data at https://github.com/XuefenLiu-SZU/Caries-DETR}{https://github.com/XuefenLiu-SZU/Caries-DETR.

Accurate cardiac anatomy modeling requires the model to be able to handle intricate interrelations among structures. In this paper, we propose VecHeart, a unified framework for holistic reconstruction and generation of four-chamber cardiac structures. To overcome the limitations of current feed-forward implicit methods, specifically their restriction to single-object modeling and their neglect of inter-part correlations, we introduce Hybrid Part Transformer, which leverages part-specific learnable queries and interleaved attention to capture complex inter-chamber dependencies. Furthermore, we propose Anatomical Completion Masking and Modality Alignment strategies, enabling the model to infer complete four-chamber structures from partial, sparse, or noisy observations, even when certain anatomical parts are entirely missing. VecHeart also seamlessly extends to 3D+t dynamic mesh sequence generation, demonstrating exceptional versatility. Experiments show that our method achieves state-of-the-art performance, maintaining high-fidelity reconstruction across diverse challenging scenarios. Code is available at https://github.com/Scalsol/VecHeart.

State-of-the-art large language models (LLMs) show high performance in general visual question answering. However, a fundamental limitation remains: current architectures lack the native 3D spatial reasoning required to directly analyze volumetric medical imaging, such as CT or MRI. Emerging agentic AI offers a new solution, eliminating the need for intrinsic 3D processing by enabling LLMs to orchestrate and leverage specialized external tools. Yet, the feasibility of such agentic frameworks in complex, multi-step radiological workflows remains underexplored. In this work, we present a training-free agentic pipeline for automated brain MRI analysis. Validating our methodology on several LLMs (GPT-5.4, Gemini 3.1 Pro, Claude Sonnet 4.6) with off-the-shelf domain-specific tools, our system autonomously executes complex end-to-end workflows, including preprocessing (skull stripping, registration), pathology segmentation (glioma, meningioma, metastases), and volumetric reasoning. We evaluate our framework across increasingly complex radiological tasks, from single-scan tumor and anatomy analysis to longitudinal response assessment requiring multi-timepoint comparisons. We analyze the impact of architectural design by comparing single-agent models against multi-agent "domain-expert" collaborations. To support rigorous evaluation of future agentic systems, we release a benchmark dataset of image-prompt-answer tuples derived from public data. Our results demonstrate that agentic AI can solve highly neuro-radiological image analysis tasks through tool use without the need for training or fine-tuning.

Motion artifacts present a significant challenge in structural MRI (sMRI), often compromising clinical diagnostics and large-scale automated analysis. While manual quality control (QC) remains the gold standard, it is increasingly unscalable for massive longitudinal studies. To address this, we propose a hybrid CNN-Attention framework designed for robust, site-invariant MRI quality assessment. Our architecture integrates a hierarchical 2D CNN encoder for local spatial feature extraction with a multi-head cross-attention mechanism to model global dependencies. This synergy enables the model to prioritize motion relevant artifact signatures, such as ringing and blurring, while dynamically filtering out site-specific intensity variations and background noise. The framework was trained end-to-end on the MR-ART dataset using a balanced cohort of 200 subjects. Performance was evaluated across two tiers: Seen Site Evaluation on a held-out MR-ART partition and Unseen Site Evaluation using 200 subjects from 17 heterogeneous sites in the ABIDE archive. On seen sites, the model achieved a scan-level accuracy of 0.9920 and an F1-score of 0.9919. Crucially, it maintained strong generalization across unseen ABIDE sites (Acc = 0.755) without any retraining or fine-tuning, demonstrating high resilience to domain shift. These results indicate that attention-based feature re-weighting successfully captures universal artifact descriptors, bridging the performance gap between diverse imaging environments and scanner manufacturers.

Vision-Language Models (VLMs) have demonstrated significant potential in medical image analysis, yet their application in intraoral photography remains largely underexplored due to the lack of fine-grained, annotated datasets and comprehensive benchmarks. To address this, we present MetaDent, a comprehensive resource that includes (1) a novel and large-scale dentistry image dataset collected from clinical, public, and web sources; (2) a semi-structured annotation framework designed to capture the hierarchical and clinically nuanced nature of dental photography; and (3) comprehensive benchmark suites for evaluating state-of-the-art VLMs on clinical image understanding. Our labeling approach combines a high-level image summary with point-by-point, free-text descriptions of abnormalities. This method enables rich, scalable, and task-agnostic representations. We curated 60,669 dental images from diverse sources and annotated a representative subset of 2,588 images using this meta-labeling scheme. Leveraging Large Language Models (LLMs), we derive standardized benchmarks: approximately 15K Visual Question Answering (VQA) pairs and an 18-class multi-label classification dataset, which we validated with human review and error analysis to justify that the LLM-driven transition reliably preserves fidelity and semantic accuracy. We then evaluate state-of-the-art VLMs across VQA, classification, and image captioning tasks. Quantitative results reveal that even the most advanced models struggle with a fine-grained understanding of intraoral scenes, achieving moderate accuracy and producing inconsistent or incomplete descriptions in image captioning. We publicly release our dataset, annotations, and tools to foster reproducible research and accelerate the development of vision-language systems for dental applications.

Early identification and removal of polyps can reduce the risk of developing colorectal cancer. However, the diverse morphologies, complex backgrounds and often concealed nature of polyps make polyp segmentation in colonoscopy images highly challenging. Despite the promising performance of existing deep learning-based polyp segmentation methods, their perceptual capabilities remain biased toward local regions, mainly because of the strong spatial correlations between neighboring pixels in the spatial domain. This limitation makes it difficult to capture the complete polyp structures, ultimately leading to sub-optimal segmentation results. In this paper, we propose a novel adaptive spectrum guidance network, called ASGNet, which addresses the limitations of spatial perception by integrating spectral features with global attributes. Specifically, we first design a spectrum-guided non-local perception module that jointly aggregates local and global information, therefore enhancing the discriminability of polyp structures, and refining their boundaries. Moreover, we introduce a multi-source semantic extractor that integrates rich high-level semantic information to assist in the preliminary localization of polyps. Furthermore, we construct a dense cross-layer interaction decoder that effectively integrates diverse information from different layers and strengthens it to generate high-quality representations for accurate polyp segmentation. Extensive quantitative and qualitative results demonstrate the superiority of our ASGNet approach over 21 state-of-the-art methods across five widely-used polyp segmentation benchmarks. The code will be publicly available at: https://github.com/CSYSI/ASGNet.