Medical Image Benchmarks

Deep learning models for diabetic foot ulcer (DFU) segmentation routinely report high accuracy, but they are almost always trained and tested on the same dataset, leaving their behaviour on data from a different clinical source largely unmeasured. We benchmark three representative segmentation architectures -- U-Net and DeepLabV3+ (convolutional) and SegFormer-B2 (Transformer) -- under an identical, leakage-screened protocol: training on the combined FUSeg/AZH wound data and evaluating, without fine-tuning, on two independent external datasets (DFUC2022 and Medetec). All models achieve strong in-domain performance (Dice 0.80--0.83) but degrade substantially across datasets. The degradation is, however, architecture-dependent: SegFormer-B2 generalizes best on both external sets (DFUC2022 Dice 0.557, Medetec Dice 0.786), outperforming both convolutional models, while the more complex DeepLabV3+ generalizes worse than the simpler U-Net. Per-image failure analysis on 2,160 images across both external test sets confirms that SegFormer-B2 produces the fewest catastrophic failures on DFUC2022 (31.1%), compared with U-Net (38.5%) and DeepLabV3+ (43.0%). The consistent ranking across two independent external sources, confirmed by Wilcoxon signed-rank tests (p < 0.001 on both datasets), indicates that architecture family, not model complexity, drives cross-hospital generalization.

Causally linking disease-related factors to image-derived biomarkers provides a powerful pathway to understanding disease mechanisms. Despite growing interest in applying causal artificial intelligence (AI) approaches for this task, these methods still need to be adapted for complex medical images, and especially, neuroimaging. However, the lack of ground-truth data presents a barrier to development. To bridge this gap, we developed and tested a method for generating synthetic neuroimages, which adhere to a user-specified causal structure describing the non-image to image variable relationships, permitting the creation of ground-truth neuroimaging datasets. In the simulated T1-weighted magnetic resonance images, anatomical variability is modeled by sampling from a subspace estimated from real data and deforming a template image to create unique simulated subjects. Causal relationships are encoded via precise volumetric changes of any region-of-interest without unwanted global artifacts. We achieved relative volume errors of 0.3-2.66% for the targeted regions-of-interest and demonstrate their statistically significant causal relationships, while maintaining mean absolute errors for non-target brain regions between 0.034-0.397ml. An initial evaluation of causal discovery methods exposes their limited ability to suppress spurious connections, highlighting the need for image-appropriate methods. Our framework is the first to enable the generation of realistic synthetic 3D neuroimages with explicit causal control that can serve as the missing ground-truth data necessary for the objective benchmarking and development of causal AI methods.

Recent advances in large language models and vision-language models have enabled reasoning over multimodal data, offering opportunities for clinical applications such as decision support and triaging. However, existing medical AI benchmarks are fragmented: some support multi-turn dialogues but lack images, while others provide multimodal inputs but focus on single-turn QA tasks. To address this gap, we introduce IMCBench, an image-grounded, multi-turn medical conversation benchmark that pairs real, publicly available clinical images with synthetic patient profiles to simulate realistic patient-clinician interactions. Each conversation is evaluated across three clinical dimensions: safety, accuracy, and appropriate use of uncertainty in diagnosis. We benchmark eight multimodal frontier models across four model families (Claude, GPT, Nova, and Llama), scoring each on a 1-5 scale using LLM-as-Jury scoring calibrated against expert clinician annotations. Our results show that Claude Opus 4.6 achieves the highest overall score (3.61), followed by Claude Sonnet 4.6 (3.30) and GPT-5.2 (3.29), though no model dominates all dimensions and safety degrades for both malignant and rare conditions ($Δ$ = -0.27 each). Ablation studies further reveal that both visual input and EHR context contribute to safe guidance (safety drops of 0.18 and 0.23 on average when each is removed), with stronger models leveraging visual features more effectively. Together, these findings demonstrate that accurate clinical description does not guarantee safe patient guidance, motivating the need for multi-dimensional evaluation frameworks in medical AI.

Large Vision-Language Models (LVLMs) specialized in healthcare are emerging as a promising research direction due to their potential impact in clinical and biomedical applications. However, progress is constrained by the scarcity of high-quality medical multimodal data, concerns about robustness in safety-critical settings, and the narrow and potentially contaminated evaluation benchmarks that limit reliable assessment. To address these issues, the field requires state-of-the-art solutions to be fully open and reproducible systems in which all components can be inspected, evaluated, and improved. This work introduces Aloe-Vision-Data, a large-scale, quality-filtered mixture which integrates both medical and general domains across multimodal and text-only sources, designed for direct use in model fine-tuning. Building on this dataset, we train the Aloe-Vision family of medical LVLMs, openly released with full weights, training recipes and data, in two scales (7B and 72B). Through comprehensive benchmarking, we demonstrate that high quality training mixtures produce balanced LVLMs which yield significant gains over the baseline models without compromising general capabilities, achieving competitive performance with respect to state-of-the-art alternatives. To support reliable evaluation, we introduce CareQA-Vision, a carefully curated vision benchmark derived from MIR and EIR exams, the residency entrance exams for medical and nursing specialists in Spain, offering novel vision questions with low likelihood of contamination. Finally, we show that current LVLMs remain vulnerable to adversarial and misleading inputs, underscoring reliability challenges in clinical contexts.

Reasoning in multimodal large language models (MLLMs) has shown strong promise in medical imaging. However, this reasoning is usually free-form text judged only by its final answer, making it hard to interpret and verify, especially in 3D radiology, where a diagnosis should be traceable to evidence in the scan. Existing chest CT question-answering datasets compound this by reducing expert radiology reports to answer-only pairs, dropping the reasoning that links findings to conclusions and omitting the patient history clinicians rely on. As a result, reasoning-capable 3D chest CT MLLMs remain out of reach, as neither the structured supervision needed to train them nor the protocol needed to verify their reasoning yet exists. We introduce CORTEX (Clinically Organized Reasoning and sTructured EXplanation), a structured reasoning benchmark for 3D chest CT. For each question, CORTEX restores the missing reasoning as a four-stage diagnostic trace mirroring a radiologist's workflow: task understanding, visual observation, diagnostic reasoning, and answer synthesis. We generate these traces using frontier large language models with broad medical and general-domain knowledge, then filter and verify them with a stage-level evaluation protocol combining automated rubric scoring with expert radiologist review. Crucially, both the reasoning structure and evaluation rubrics are designed in close collaboration with clinicians. Built on CT-RATE, a large, publicly available chest CT dataset without reasoning annotations, CORTEX comprises 76,177 validated reasoning traces across open-ended VQA, closed-ended VQA, and report generation, providing both the structured supervision and the stage-level evaluation protocol needed to build and evaluate trustworthy reasoning models for 3D chest CT. Our dataset and evaluation code is available at https://huggingface.co/datasets/aneesurhashmi/cortex

Color fundus photography (CFP) is the most common ophthalmic imaging modality for large-scale screening. However, it is highly susceptible to degradations, making robust fundus image quality assessment (FIQA) crucial. The criteria for what constitutes high-quality at the image level vary across clinical tasks, making FIQA dependent on expert knowledge. This motivated the development of automated methods and datasets. While existing datasets aim to standardize image-level quality, their criteria often differ. Furthermore, image-level labels preclude the quantitative evaluation of localized degradations, which is essential for trustworthy FIQA. We argue that pixel-level FIQA based on anatomical visibility represents a more task-agnostic, explainable approach. In this work, we introduce FunPiQ, the first FIQA benchmark to provide pixel-level quality annotations. In addition, we propose EFIQA-CP, an explainable-by-design (EBD) method that uses quality pseudo-labels based on anatomical visibility to train a CNN via Non-Negative Positive-Unlabeled learning. Extensive evaluations of classification methods with post-hoc explanations, anomaly detection methods, and EBD methods demonstrate the superior performance of the last and, particularly, of EFIQA-CP.

With the rapid adoption of generative AI, synthetic medical images pose growing risks, including diagnostic deception and insurance fraud. Although prior work has explored vision-language model (VLM)-based synthetic image detection, these evaluations typically consider images in isolation. In clinical practice, however, images are interpreted alongside structured records and metadata, and VLMs are increasingly deployed under joint image-record inputs. We uncover a previously underexamined multimodal vulnerability: when given both modalities, VLMs may overweight record context in authenticity judgments, such that the same image receives different predictions solely due to changes in its accompanying text. This raises concerns about robustness in real-world deployment. To systematically characterize this effect, we reformulate synthetic medical image detection as an audit of multimodal robustness at the image-record interface and introduce a paired benchmark that holds the image fixed while swapping controlled metadata variants. Across multiple imaging modalities, we evaluate diverse open-weight and frontier API VLMs and find that changing the metadata context alone can flip authenticity judgments, with accuracy on authentic images dropping by 61.1% on average under an explicit AI-origin tag. We further propose an inference-time mitigation pipeline that detects and neutralizes provenance shortcuts without model retraining, substantially outperforming direct prompt-based suppression on the affected subset. Our benchmark provides a standardized tool for assessing and improving multimodal robustness beyond image-only settings. Code and data will be released upon acceptance.

Vision Language Models (VLMs) have shown promising capabilities in medical image analysis by jointly understanding visual and textual information for tasks such as Visual Question Answering. However, existing hematology vision-language resources remain predominantly English centric, limiting their applicability in multilingual healthcare environments. This challenge is releveant generally to South Asia and specifically to Pakistan, where Urdu is widely used despite healthcare information and digital medical systems being largely dependent on English. To investigate this gap, we conducted a survey among healthcare professionals, which revealed substantial language mismatches between clinical documentation and patient communication, emphasizing the need for multilingual healthcare technologies. To address this limitation, we introduce WBCMor VQA, a clinically validated bilingual English, Urdu morphology aware VQA benchmark for leukemia and normal white blood cell analysis. The benchmark is constructed using morphology-aware annotations from LeukemiaAttri and WBCAtt datasets and supported by a domain specific Urdu hematology dictionary to ensure linguistic consistency and clinical correctness. The final benchmark contains 110K bilingual question answer pairs serving as VQA annotations for 20K leukemic and normal single-cell images. Furthermore, we establish baseline performance by evaluating multiple open-source VLMs on the proposed benchmark. The proposed resource aims to facilitate the development of accessible and clinically relevant AI systems for multilingual healthcare environments.

Artificial intelligence (AI) has achieved remarkable success in medical imaging, but it is widely recognized that these models often perform inconsistently across real-world clinical settings. Such inconsistencies occur when patient demographics and imaging protocols vary, for example, in detecting small tumors, analyzing scans from different contrast phases, or evaluating patients of different ages or sexes. To quantify these inconsistencies, we develop a large-scale, open benchmark of 85,355 CT scans that systematically evaluates 12 tumor-detection AI models across tumor size, location, patient subgroup, and imaging protocol. We leverage large language models (LLMs) to extract and organize subgroup information from clinical data, which makes the analysis both scalable and reproducible. Our benchmark reveals that current state-of-the-art AI models, optimized for average accuracy, perform poorly in rare or underrepresented subgroups, such as young, female African Americans. However, collecting sufficient annotated data for these rare cases is often impractical. The benchmark provides a foundation for building more reliable and robust AI models for tumor detection and highlighting the need for rigorous, subgroup-level evaluation in medical imaging and computer vision. Datasets, code

Automated classification of acute lymphoblastic leukemia (ALL) from peripheral blood smear images has often reported near-perfect performance on the C-NMC 2019 dataset. We show that such results can be inflated by patient-level data leakage caused by random image-level partitioning, where cells from the same subject may appear in both training and test folds. We establish a leakage-aware benchmark under a strict subject-disjoint protocol, comparing LightGBM, RBF-SVM, EfficientNet-B0, EfficientNet-B1, and ViT-Tiny. Models are developed using three subject-disjoint folds from 73 subjects and evaluated on an external preliminary-phase test set of 1,867 images from 28 unseen subjects with zero patient overlap. Beyond discrimination, we assess calibration using expected calibration error, Brier score, and temperature scaling. Under honest evaluation, EfficientNet-B1 achieves the best performance, with AUROC 0.913, sensitivity 0.87, specificity 0.80, and calibrated ECE 0.024. Frozen-feature classifiers and ViT-Tiny show high sensitivity but poor specificity, indicating a tendency to over-predict the malignant class. A random-versus-subject-disjoint ablation shows that random splitting inflates AUROC by about 0.04 even in the conservative frozen-feature setting. These findings caution against image-level evaluation on C-NMC 2019 and provide a reproducible, calibration-aware benchmark for future work.

Deep learning has become an important tool in computational pathology, enabling automated analysis of histopathological images. While convolutional neural networks (CNNs) have traditionally dominated this field, transformer-based and hybrid architectures have recently demonstrated promising performance. However, comprehensive comparisons of these approaches for colorectal histopathology remain limited. This study evaluated twelve ImageNet-pretrained CNN, transformer, and hybrid architectures using the Kather colorectal histopathology dataset containing 5,000 image tiles from eight tissue classes. All models were trained using a standardized transfer-learning and fine-tuning protocol and assessed using multiple performance metrics, including accuracy, precision, sensitivity, specificity, F1-score, ROC-AUC, Cohen's kappa, and Matthews correlation coefficient. All evaluated models achieved high classification performance, with accuracies ranging from 93.2% to 97.1%. EVA-02 achieved the highest overall performance (97.1% accuracy, 97.0% F1-score), closely followed by ViT-B/16. Among CNNs, ResNet34 and ConvNeXt-Tiny demonstrated highly competitive performance, achieving accuracies of 96.4% and 96.3%, respectively. Transformer architectures generally produced the strongest results across evaluation metrics, although the performance gap between the best transformer and CNN models was relatively small. Per-class analysis showed consistently strong classification performance across all tissue categories, with Complex Stroma representing the most challenging class. Overall, transformer-based architectures achieved the highest predictive performance, whereas modern CNNs provided a favorable balance between accuracy and model complexity. These findings provide a comprehensive benchmark of major deep learning paradigms for colorectal histopathology classification.

Purpose: To evaluate whether large language model (LLM)-assisted label cleaning can identify label-report discordance in CT-RATE, a large-scale public chest CT dataset. Materials and Methods: After report-level deduplication, 24,446 unique radiology reports were identified. Twelve reports were excluded from the primary GPT-5.4 analysis because of Microsoft Azure AI Foundry content-safety filtering, leaving 24,434 reports and 439,812 label instances across 18 abnormality categories. GPT-5.4-derived binary labels were generated from report text using structured JSON output and compared with existing CT-RATE labels. Discordant instances were adjudicated by radiologists. In addition, 100 randomly sampled reports were manually annotated to compare CT-RATE labels, individual LLM-derived labels, and multi-LLM majority-vote labels against radiologist-annotated reference labels. Results: Overall agreement between GPT-5.4-derived and CT-RATE labels was 96.4%, with Cohen's kappa of 0.884. Lymphadenopathy showed the lowest agreement and kappa. In discordance review, radiologist adjudication supported GPT-5.4-derived labels in 72 of 97 (74.2%) general discordant instances and 91 of 99 (91.9%) targeted lymphadenopathy discordant instances. Against radiologist-annotated reference labels, multi-LLM majority-vote labels achieved the highest label-macro-averaged F1 score and Cohen's kappa. Conclusion: LLM-assisted label cleaning identified clinically meaningful label-report discordance in CT-RATE and may support scalable quality improvement of public imaging datasets. The cleaned dataset will be made publicly available to support future research.

Gastrointestinal cancers represent a growing health burden in the South Asian region, driven largely by rapid changes in socio-economic conditions & lifestyle habits. However, early diagnosis of such malignancies remains a significant challenge, largely due to a lack of modern equipment, lack of financial support, and a scarcity of GI experts. AI-assisted diagnosis & report generation, show great promise in alleviating this problem by providing low-skill manpower the technical expertise to perform diagnosis. However, almost all open-source, publicly available datasets are predominantly collected from the European region, with no representation from the South Asian region. The lack of open-source GI datasets from diverse geographic regions has made it difficult to assess whether population bias is present in existing models, and to develop geographically inclusive AI tools for automated GI diagnosis. To address this gap, we introduce SAGE: An Expert-Annotated South Asian GI Endoscopy dataset for image captioning, multi-label classification, and visual question answering (VQA) tasks. It consists of 1,300 images, their captions along with hallucination tag, 18 labels and 14,726 question-answer pairs making it well-suited for diverse range of tasks including classification, benchmarking, and fine-tuning large multimodal models (LMMs). We further conducted benchmarking of multi-class classifiers on the effect of population shift in GI imaging AI tasks, and contemporary LMMs on their performance. Our study reveals that task-specific models, such as multi-class classification models, suffer the most, with an average performance drop of 58% when evaluated on the South Asian dataset. For contemporary LMMs, benchmarking reveals a substantial drop in the average GREEN score for anatomical landmark detection (0.308) and abnormality detection (0.410).

In this work, we present SemanticVessel, a dataset for fine-grained brain vessel segmentation in computed tomography angiography scans. Based on the detailed contrast provided by dynamic 4D-CTA scans, we generate segmentation traces for arteries and veins. We then use intensity-guided region growing to obtain segmentations of the majority of vascular territories in the human brain, which are refined and annotated with 20 unique arterial classes by an expert radiologist. Unlike existing datasets, where minor arteries are discarded as background content, we merge these minor arteries into a generic arterial class. Due to the multiple-phase acquisition of dynamic 4D-CTA, labels for a single phase can be re-used for other phases in the same series, greatly increasing the size of our dataset with no additional annotation cost. The results show that models trained with the additional generic artery class produce better fine-grained segmentations across the board. We will make our code, annotation GUI, and model weights available to the scientific community. Code, weights, and data will be made available on https://github.com/alceballosa/robust-vessel-segmentation

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

Medical Vision-Language Models (Med-VLMs) achieve strong expert-level performance, yet their ability to generate patient-accessible descriptions remains underexplored. With the 21st Century Cures Act now mandating immediate patient access to diagnostic imaging results, evaluating whether Med-VLMs can bridge this Expert-Lay Gap is both urgent and clinically consequential for patient education and shared decision-making. To this end, we introduce MedLayXPlain, the first large-scale multimodal benchmark and evaluation framework for Medical Lay Language Generation (MLLG). MedLayXPlain-122K provides 122,789 region-grounded samples across 8 imaging modalities from 12 publicly available source datasets, each comprising a medical image with paired expert and lay captions anchored in a three-level Unified Medical Language System (UMLS) ontology hierarchy spanning 7 semantic groups, 43 semantic types, and 2,411 medical concepts. Lay captions are constructed via Hierarchical Ontology-Verified Refinement (HOVER), a three-step pipeline combining patient-centric vocabulary mapping, LLM-based constrained rewriting, and cross-model visual verification to enforce semantic equivalence while preventing hallucination. We further introduce MedLayEval, a lightweight 3B evaluator distilled from a 27B verifier that scores expert-lay alignment across five clinically grounded attributes, addressing the poor correlation between standard NLG metrics and clinical judgment. Benchmarking 33 VLMs on MedLayXPlain-122K reveals a systematic Expert-Lay Gap: medical VLMs achieve strong expert captioning but suffer significant lay-register degradation, while general-purpose VLMs produce more accessible language yet lack clinical precision, confirming that neither current paradigm adequately serves patient-facing communication.

Mammography is an essential tool for breast cancer detection, with millions of examinations conducted annually. However, publicly available high-quality mammography datasets for AI development remain limited in both scale and annotation richness, particularly regarding pathological subtype coverage and structured diagnostic reasoning annotations. In this paper, we present MammoExpert, the first mammography dataset with Chain-of-Thought reasoning annotations across three diagnostic phases: (i) primal observation, (ii) factual assessment, and (iii) diagnostic synthesis. Comprising 2,379 mammography images covering 67 WHO-classified histopathology subtypes, each exam provides 42 radiographic features annotated by nine senior radiologists. We evaluate its performance on the breast lesion classification task, demonstrating superior accuracy and reasonability compared to existing classification models. Combining public dataset CBIS-DDSM with MammoExpert yields 7.1% classification accuracy improvement, while the training model to learn CoT reasoning achieves another 4% gain on the MammoExpert test set. Similar improvements are observed on INBreast and Vindr datasets, where the full approach yields accuracy gains of 6.9% and 6.7%, respectively. MammoExpert can serve as a benchmark for interpretable breast lesion diagnosis through explicit CoT reasoning.

The evaluation of vision-language models (VLMs) for chest X-ray (CXR) analysis has largely been limited to disease-presence classification without visual grounding. Such evaluations fail to verify the expert-level lesion perception necessary to ensure the clinical reliability of VLMs. To address these limitations, we introduce CheXpercept, a sequential, multi-level perception benchmark that mirrors a radiologist's cognitive workflow across coarse-level detection, fine-level contour evaluation and revision, and semantic-level attribute extraction. To ensure high clinical fidelity at scale, we construct the dataset using a semi-automated generation pipeline paired with a review by six medical experts. CheXpercept contains 10,400 QA items derived from 2,100 CXRs, covering seven clinically critical pulmonary and cardiac lesions. To demonstrate the current landscape of VLM perception, we benchmark 14 general and medical VLMs on CheXpercept. The models achieve adequate performance only at the coarse level, with accuracy degrading precipitously on deeper visual tasks. Notably, medical VLMs show almost no perceptual advantage over their general-domain counterparts, highlighting a systemic flaw in current domain adaptation. The code and dataset will be publicly available.

Gastric intestinal metaplasia (GIM) is a precursor lesion to gastric dysplasia and adenocarcinoma whose early detection is crucial for intervening in the carcinogenesis cascade. Artificial intelligence (AI) holds considerable promise for real-time endoscopic detection and characterization of GIM. However, development of reliable AI models has been constrained by the absence of publicly available, histopathologically validated datasets that combine detailed endoscopic annotations, histological subtype (complete and incomplete), standardized grading systems, and normal mucosal patterns. GIM-ENDO was designed to fill this gap. The dataset comprises demographic data, endoscopic findings, histopathological results, and H. pylori status acquired using the Olympus EVIS X1 system with white-light endoscopy (WLE) and image-enhanced endoscopy (IEE), including narrow-band imaging (NBI) and magnifying NBI (M-NBI), along with images and video clips from 24 patients (22 GIM-positive, 2 normal controls). Annotations cover six primary IEE endoscopic signs -- light blue crest (LBC), marginal turbid band (MTB), white opaque substance (WOS), TV pattern (Fusion), atrophy, and map-like erythema (MLE) -- plus two additional endoscopic findings (AHP and GA) recorded where present. GIM subtypes (complete and incomplete) are annotated for all GIM-positive cases; OLGA and OLGIM staging are provided where complete histological sampling was available. The dataset is publicly accessible at https://doi.org/10.5281/zenodo.20707267. For the latest updates and further information regarding this dataset, readers are referred to the DataBioX website: https://databiox.com A short version of this work has been submitted to MICCAI 2026 Open Data Track.

Head and neck cancers (HNC) represent a significant global health burden, with accurate tumor delineation being essential for effective radiotherapy planning. The complexity of the oropharyngeal anatomy, combined with the heterogeneous appearance of tumors on imaging, makes manual segmentation time-intensive and subject to inter-observer variability. Beyond segmentation, predicting long-term clinical outcomes, such as recurrence-free survival (RFS), and determining human papillomavirus (HPV) status from noninvasive imaging, remain challenging yet clinically valuable goals. The HECKTOR 2025 challenge addresses these needs by establishing a comprehensive benchmark for automated HNC analysis using multimodal PET/CT imaging and electronic health records. Building on previous editions (2020-2022), this challenge features an expanded multi-institutional dataset comprising over 1,100 patients from 10 centers worldwide. Participants were tasked with three complementary objectives: (1) segmenting primary gross tumor volumes (GTVp) and metastatic lymph nodes (GTVn), (2) predicting recurrence-free survival, and (3) classifying HPV status. The challenge attracted 35 registered teams, with 15 final submissions evaluated on a held-out test set. Top-performing algorithms achieved a mean Dice similarity coefficient of 0.75 for segmentation, a concordance index of 0.66 for survival prediction, and a balanced accuracy of 0.56 for HPV classification. This paper presents a comprehensive analysis of the submitted methodologies, evaluates their performance across different lesion characteristics, and discusses their implications for clinical translation in automated oncology workflows and decision support systems.

Medical image classification is often constrained by limited labeled data, motivating generative augmentation; recently, quantum generative models have been proposed for this purpose, frequently reporting accuracy gains. However, such claims are typically based on single training runs, do not match the parameter budgets of the quantum and classical generators, and do not characterize the data regime in which any benefit appears. We present a controlled benchmark that isolates the contribution of a quantum generator to brain-MRI augmentation. Images are encoded into a KL-regularized latent space in which a conditional Wasserstein GAN with gradient penalty is trained using either a variational quantum generator or a classical generator of near-identical parameter count (1648 vs. 1632). Synthetic samples are decoded and used to augment a pretrained classifier across labeled data fractions from 5% to 100%, evaluated over eight random seeds with paired significance testing (with multiple-comparison correction) and with intraset diversity and latent-distribution analyses. Across all fractions, no augmentation variant significantly outperforms real-data-only training, and the quantum and classical generators are statistically indistinguishable. Any low-data benefit behaves as regularization rather than faithful data expansion:synthetic samples are off distribution and severely mode collapsed precisely where data is scarce, and the quantum generator is no more diverse thanits classical counterpart. We release the protocol as a testbed for rigorous evaluation of quantum generative augmentation in medical imaging.

Multiphasic contrast-enhanced CT (CECT) is widely used for abdominal lesion characterization, yet it carries inherent risks of contrast-induced nephropathy, escalates acquisition burden, and heavily contributes to radiologist workload. To address these challenges, we introduce a novel multi-center benchmark for multi-organ abdominal disease diagnosis and automated radiology report generation, which learns to synthesize contrast-enhanced findings from single-phase non-contrast CT (NCCT). To support this, we curated a large-scale dataset of paired NCCT-CECT studies and their corresponding contrast-enhanced radiology reports from two centers, partitioned into internal sets and an external validation cohort. Under a unified evaluation protocol, we benchmarked five contemporary deep learning architectures encompassing chest-specific, abdomen-specific, and general-purpose multimodal domains. Extensive experiments demonstrate that NCCT retains diagnostic signals, achieving an average multi-organ AUC of 69.1% on the internal cohort and 63.1% on the external cohort, respectively. By releasing this dataset and standardized benchmark publicly, this study aims to catalyze future research into safer, resource-efficient, and globally accessible contrast-free abdominal imaging workflows. Code is available at: https://github.com/xmed-lab/TriALS-Report.

While federated learning (FL) enables collaborative medical image segmentation without centralizing sensitive data, real-world deployment is frequently complicated by cross-site label imperfections such as contour disagreement, missing or additional structures, and confused labels. Federated noisy label learning (FNLL) aims to mitigate these effects, yet remains underused in practice as existing evidence is largely based on synthetic noise, simplified settings, and limited real-world noisy evaluation. We address this gap by introducing a benchmark suite that combines diverse real-world noisy datasets, deployment-relevant client-noise scenarios, and label-noise-targeted evaluation to support systematic FNLL assessment and informed method selection. The suite combines curated real-world noisy medical image segmentation datasets from diverse sources with a comprehensive federated segmentation framework including various client-noise scenarios and noise-targeted evaluation. The presented suite provides a realistic and discriminative basis for FNLL evaluation in medical image segmentation and establishes a reusable foundation for fair benchmarking, dataset-specific label-noise characterization, and future method development under realistic federated settings. Code is available at https://github.com/MIC-DKFZ/FedSegNoiseBench.

Medical image segmentation plays a critical role in clinical diagnostics, treatment planning, disease monitoring, and neurological disorder identification. This article presents a comprehensive review of its systematic development, covering widely used public datasets, representative methods built on the U-Net, Transformer, and SAM architectures, and key evaluation metrics with their differences, followed by an analysis of major challenges from multiple perspectives. Unlike surveys that focus on a single model family or a specific clinical application, this review organizes U-Net-, Transformer-, and SAM-based methods within a unified analytical framework, with a particular focus on their effectiveness in improving segmentation accuracy and efficiency. This work aims to guide future research and support clinical translation of medical image segmentation, with all related resources publicly available in our GitHub repository: https://github.com/andrew-pengyu/Awsome_MedSeg/tree/main.

General-purpose large language models (LLMs) are routinely used as baselines when evaluating specialized pathology models on whole-slide images (WSIs). Because WSIs exceed contemporary model context limits, LLM baselines routinely use small, high-magnification patches processed independently via majority voting, without systematic evaluation of seemingly inconsequential design choices such as patch size, patch count, and magnification. Generalist LLMs have consistently underperformed specialized systems, reinforcing the perception that domain-specific training or architectural adaptation is necessary for pathology tasks involving WSIs. Here, we conduct a systematic factorial analysis of four input design factors: inference mode, patch size, magnification, and patch count. We demonstrate that prior studies have overstated the gap between specialized models and general-purpose LLMs by choosing non-optimized input configurations. On the MultiPathQA benchmark, switching to a single balanced configuration (large patches at lower magnification, processed jointly) raises GPT-5 from 15.1% to 39.5% on cancer-type classification (TCGA) and from 38.1% to 62.9% on organ classification (GTEx). Per-task optimization yields further gains up to 43.9% (TCGA) and 71.6% (GTEx). The same configuration generalizes to two other models and to a fully held-out CPTAC cohort, where it improves Gemini 3 Flash by 23.4 percentage points without any task-specific tuning.

Hematoxylin and eosin (H&E) staining is the cornerstone of histopathology, yet scalable, quantitative analysis of H&E whole-slide images (WSIs) remains a central challenge in computational pathology. We present Atlas H&E-TME, an AI-based system built on the Atlas family of pathology foundation models that predicts tissue quality, tissue region, and cell type labels across multiple cancer types, yielding over 4,500 quantitative readouts per slide at cell-level resolution. A key challenge to validating such systems is overcoming morphological ambiguity inherent to H&E-only ground truth and the limited scalability of more informed references drawing on modalities such as immunohistochemistry (IHC). We address this with a dual validation framework combining biologically grounded depth with technical and morphological breadth. For depth, we propose an IHC-informed multi-pathologist consensus protocol that substantially improves inter-rater agreement over conventional H&E-only annotation. This yields a molecularly grounded reference against which we compare Atlas H&E-TME and pathologists working from H&E alone. For breadth, we benchmark Atlas H&E-TME on over 200,000 high-confidence H&E-only pathologist annotations across 1,500+ cases spanning eight cancer types and their most common metastatic sites, with subtypes covering >90% of clinical cases per cancer type, drawn from 25+ sources and 8+ scanner models. Benchmarked against the IHC-informed consensus, Atlas H&E-TME matches or exceeds pathologist H&E-only performance and generalizes consistently and robustly across this broad morphological and technical scope. In doing so, Atlas H&E-TME turns the H&E slide -- the most ubiquitous data in pathology -- into a scalable, quantitative window into the tumor and its microenvironment, laying a foundation for the next generation of tissue-based biomarkers in translational and clinical research.

High-stakes clinical use of large vision-language models (LVLMs) requires reasoning that is grounded in visual evidence and clinical knowledge, not just correct final answers. We introduce OpenMedReason, a large-scale, open multimodal medical reasoning corpus comprising approximately 450K image-question-answer instances whose reasoning traces are primarily derived from curated biomedical, human-authored scientific articles. OpenMedReason provides high-fidelity supervision beyond synthetic chains of thought, covering diverse medical domain vision modalities such as radiological scans, microscopic images, visible light photographs, charts, and others. We complement it with OpenMedReason-Bench, a held-out benchmark that allows fine-grained evaluation of LVLMs along three complementary axes of capability, including perception, medical knowledge, and rationale, enabling diagnostic evaluation beyond final-answer accuracy. OpenMedReason is a rich training resource that exhibits its effectiveness in both supervised fine-tuning (SFT) and reinforcement-based alignment. Training with OpenMedReason yields a 20% average improvement in VQA accuracy over the base model and achieves performance within 4.2% of the strongest comparable-scale medical LVLMs. Fine-grained performance analysis confirms that the gains are not concentrated in any single axis: OpenMedReason improves perception, medical knowledge, and rationale jointly, and its reasoning traces are preferred over those of the base model in 86.1% of pairwise comparisons. We release the code and dataset at huggingface.co/datasets/neginb/OpenMedReason.

Foundation Models (FMs) have recently redefined the state-of-the-art in histopathology by providing robust representations for whole-slide image (WSI) analysis. However, selecting the optimal foundation model (FM) for a specific clinical cohort currently requires multiple preprocessing steps, followed by computationally expensive feature extraction and the training of a Multiple Instance Learning (MIL) aggregator for every model. In this work, we investigate whether efficient tile-level linear probing can serve as a reliable proxy for slide-level performance, reducing the need to run full slide-level pipelines for every candidate encoder. We benchmark 19 state-of-the-art FMs on 42 slide-level and 16 tile-level tasks, comparing tile probing metrics against slide-level outcomes using ABMIL and Mean Pooling aggregations. We observe a high correlation between tile and slide performance across varying task difficulties, indicating that encoder representation quality is the primary determinant of WSI success. Sensitivity analyses show that transferability is stable across models and is more influenced by cohort sizes and numbers of tiles per slide than by average task difficulty. We also measure the agreement in best performing models between tile and slide-level tasks, showing tile benchmarks reliably shortlist strong candidates. Overall, our study indicates that tile-level benchmarking provides an efficient and practical first step for narrowing down candidate models, while slide-level evaluation remains essential for final validation on clinical tasks.

Medical vision-language models (VLMs) are evaluated on public benchmarks whose images and question-answer pairs have been freely downloadable for years, yet reported accuracy assumes these examples were absent from pretraining. We audit open VLMs on SLAKE-En, PathVQA, VQA-RAD, and an auxiliary public OmniMedVQA mirror using four detector families: image-side near-neighbour overlap against PMC-OA-beta, canonical-order exchangeability, cohort-relative Min-K%++ tail enrichment, and cross-model top-K overlap. We find measurable image-side source overlap on SLAKE-En: 19.8% of images are flagged under SigLIP-B-16 and 4.2% under SigLIP-SO400M, while out-of-domain controls produce 0/2000 flags. Manual adjudication shows same-modality, same-projection matches to different patients rather than verified pixel-level duplicates, so we interpret this as source or distributional overlap rather than confirmed per-image memorization. On the text side, Qwen2.5-VL on SLAKE-En shows a canonical-order exchangeability signal that survives ordering ablation and external non-medical baselines. On the OmniMedVQA mirror, exchangeability fires for five medical and general VLMs while BLIP-2 remains clean. In contrast, cohort-relative Min-K%++ tail enrichment and cross-model top-K overlap collapse under an external pre-domain baseline: BLIP-2 reproduces the apparent positive signals despite lacking plausible medical-VQA exposure. We conclude that these cohort-relative detectors are unreliable as standalone membership-inference signals on small medical-VLM cohorts.

3D reconstruction could improve colonoscopy by estimating mucosal coverage and alerting clinicians to missed regions during screening. However, algorithm development is limited as no current datasets provide both a realistic in vivo appearance and dense, time-resolved 3D ground truth, especially under non-rigid deformation. We present C3VD-DEFCOL, a framework and dataset for evaluating deformable colonoscopy reconstruction with paired geometry and realistic texture. Starting from C3VD/C3VDv2 colon meshes and camera trajectories, we generate controlled deformations of the colon surface, including peristaltic waves and centerline motion, and render per-frame depth, surface normals, optical flow, camera poses, and time-stamped 3D meshes. We then use the rendered geometry, primarily depth, to condition an LTX-2.3-based sim-to-real translation model that produces RGB clips with in vivo-like mucosal color, texture, vasculature, and specular appearance while preserving the underlying 3D scene structure. The resulting dataset contains 110 videos from 11 unique colon mesh geometries, with varying camera trajectories, appearances, and parameterized deformation regimes, including three peristaltic severity levels that serve as controlled evaluation axes. We evaluate the generated videos using appearance realism, geometric consistency, and temporal consistency metrics, and use the paired ground truth to benchmark the downstream task of pose estimation in deformable 3D reconstruction. Our experiments show how pose estimation error increases with increasing deformation severity, providing a controlled stress test that is not possible with existing in vivo datasets. Overall, C3VD-DEFCOL is designed as a reproducible, quantitative evaluation platform for testing deformable 3D reconstruction algorithms, with the goal of reducing the domain gap between synthetic datasets and in vivo colonoscopy.