Medical Image Classification

Automated malaria diagnosis from stained blood-smear microscopy is dominated by deep convolutional neural networks that are accurate but computationally expensive, poorly interpretable, and rarely validated with patient-level rigor. We present EMFE (Efficient Mathematical Feature Extraction), a five-feature framework for classifying single red-blood-cell images as parasitized or uninfected using Gray World color normalization, adaptive green-channel thresholding, morphological spot detection, and classical machine learning. Using the NIH LHNCBC malaria dataset (27,558 images from 200 patients), we evaluate Random Forest, Histogram Gradient Boosting, and Support Vector Machine classifiers under patient-grouped nested cross-validation (K_outer=20, K_inner=3), ensuring that cells from each patient remain within a single fold. The optimized Random Forest achieves 94.6% pooled out-of-fold accuracy (95% CI [93.6, 95.7]), corroborated by an untouched 40-patient holdout test (94.3%) and a patient-level permutation test (p<0.001, 1,000 permutations). Ablation experiments quantify the contribution of individual features and pipeline stages. Hardware-matched comparisons with retrained DenseNet121, ResNet50, and MobileNetV2 models assess the accuracy-efficiency trade-off. Synthetic perturbations characterize three failure modes, while explainability analysis identifies spot saturation as the dominant discriminative feature. Patient-level aggregation further quantifies sensitivity-specificity trade-offs and false-positive accumulation. These results demonstrate a statistically rigorous, interpretable, and computationally lightweight alternative to deep learning, while explicitly quantifying its limitations.

Retinal fundus photography is widely used for screening and monitoring ocular diseases, but many modern classification pipelines rely on deep latent representations and provide limited interpretability. This study develops an interpretable fundus image classification framework based on a ring-structured representation of the retinal vasculature centered on the optic disc. The method quantifies vessel geometry, color appearance, oxygenation-related vascular appearance, and vessel--background entropy within concentric retinal regions. These physiologically motivated descriptors are derived from vessel masks, image intensities, and optical-density measurements and aggregated across rings to capture spatial variation in vascular properties. Using only quantitative vascular descriptors, the proposed method achieved strong classification performance across three public fundus datasets. On HRF, it achieved 91.1% accuracy using automatically generated vessel masks, matching RETFound, a vision transformer pretrained on large-scale retinal fundus image data, under the same evaluation setting. Additional analyses suggest that pretrained image models are sensitive to acquisition-related spatial cues, including fundus scale and retinal position within the field of view, as well as broader non-vessel image characteristics. This framework may support interpretable disease classification, quantitative retinal phenotyping, and retinal biomarker discovery without requiring large task-specific training datasets.

Pretrained image encoders are central to medical image classification, where expert annotation is costly and task-specific cohorts are often limited. As the model space expands from general-purpose to broad-medical and specialty-specific encoders, selecting the representation becomes a substantive modeling decision. Clean-test discrimination alone is insufficient for this purpose: encoders with similar AUROC can differ in calibration, label efficiency, and stability under acquisition perturbations or distribution shift. We introduce CRS-Bench, a controlled benchmark for multi-objective medical encoder selection. CRS-Bench evaluates 15 pretrained encoder families across dermatology, ophthalmology, and radiology using ISIC 2019, APTOS 2019, and CheXpert, with CheXpert-to-MIMIC-CXR as an observed institutional shift, yielding 17,575 controlled run records and 3,515 seed-aggregated metric rows. Each encoder is characterized along four operational reliability dimensions: discrimination, calibration, label efficiency, and robustness. We summarize these dimensions using the Clinical Reliability Score (CRS), a Pareto-aware, reference-relative score combining dominance, profile balance, and worst-axis performance. AUROC and CRS are positively associated but not decision-equivalent: 21 of 105 pairwise orderings reverse, with a mean absolute rank displacement of 1.87. Paired-seed bootstrap analysis identifies PanDerm, MedSigLIP, and MedGemma as a stable leading reliability tier rather than a statistically resolved single leader. CRS-Bench provides a controlled framework for selecting medical image encoders from multi-axis reliability profiles rather than clean-test AUROC alone.

Oral cancer is a leading cause of mortality in low-to-middle-income countries, where a shortage of specialists delays diagnosis. While point-of-care screening via smartphones offers a scalable solution, developing robust AI for resource-constrained settings poses significant challenges, including class imbalance in training data, variable data quality, and computational constraints on edge devices. In this paper, we present the optimisation of lightweight deep learning models for smartphone-based oral cancer screening. Using a diverse, multi-centre retrospective dataset of approximately 30,000 images acquired over a decade, we systematically evaluate state-of-the-art convolutional, transformer, and hybrid architectures. Through rigorous pipeline ablation, we demonstrate that directly optimising hybrid architectures for the edge strictly outperforms computationally heavy paradigms, such as large models or knowledge distillation. Furthermore, interpretability analysis and simulated noise-stress tests revealed that the system anchors on clinical features and remains robust to unstructured sensor noise, despite vulnerabilities to impulse bit errors. In the held-out test set, our optimised MobileViTv2 models achieved an average sensitivity of 83.2 $\pm$ 1.5% and an average specificity of 86.0 $\pm$ 0.8%, with the best model exhibiting 87.4% sensitivity, 86.5% specificity, and a critical negative predictive value of 97.2% with reference to specialist labels. These results confirm that with targeted architectural selection and streamlined optimisation, interpretable and robust lightweight AI models exhibit high potential for edge deployment to enable automated triage in primary care settings.

Background: Multimodal fracture classifiers may benefit from patient and anatomical metadata, but they can also become brittle when contextual information is missing or mismatched. Methods: We studied 1493 radiographs from the Bangladeshi OrthoFrac-XR dataset using leakage-safe age, sex, bone type, and laterality. A ConvNeXt image encoder was combined with a clinical multilayer perceptron through concatenation, late fusion, reliability-gated residual fusion, and a hierarchical state-location formulation. We additionally introduced an anatomy-consistency gate that attenuates metadata corrections when an image-side anatomical prediction disagrees with the reported bone type. Results: Across five folds and three seeds, hierarchical residual fusion achieved a macro-F1 of 0.6046 +/- 0.0279, compared with 0.5727 +/- 0.0270 for image-only learning, while improving the Brier score from 0.5239 to 0.4948. In a five-fold robustness experiment, anatomy-consistency fusion reduced the macro-F1 loss under shuffled metadata from 0.0567 to 0.0203 relative to ordinary residual fusion, although its clean-data macro-F1 was lower. Without bone type at inference, auxiliary anatomy supervision improved macro-F1 from 0.5620 +/- 0.0330 to 0.5899 +/- 0.0289. Conclusions: Structured context improves fracture classification, and consistency-aware gating limits harm from mismatched metadata. The observed clean-performance-robustness trade-off and the absence of patient-level identifiers motivate external and prospective validation.

Breast ultrasound diagnosis relies on clinically meaningful semantic concepts, yet most deep learning methods adopt end-to-end image-to-label paradigms that lack interpretability and robustness. While concept-based approaches offer a promising alternative, they often assume complete annotations or require multimodal inputs at inference, which significantly limits their real-world applicability. To tackle these issues, we propose Training-time Report-guided and Clinically Ordered Concept Editing (TRACE), a training-time report-guided framework that leverages structured radiology reports as privileged concept supervision while enabling image-only diagnosis at test time. TRACE refines image-derived concepts through a teacher-guided editing mechanism within a malignancy-aware ordered concept space. To address incomplete annotations, we introduce Strategic Concept Missing Training (SCMT) and train an image-only self-editor via edit distillation for autonomous concept refinement. Besides, we introduce BUSC, a concept-enriched benchmark linking images, labels, and structured attributes. Experiments across multiple datasets demonstrate that TRACE achieves superior performance and improved cross-domain robustness compared to existing methods.

Domain shift across clinical centers using different imaging hardware or acquisition protocols remains a fundamental barrier to deploying deep learning models for prostate cancer (PCa) detection. Existing test-time adaptation (TTA) methods address distribution shift through entropy minimization or augmentation-based self-supervision, correcting for statistical differences in image appearance but ignoring the anatomical structure of the target domain. We propose ANT, a segmentation-guided TTA framework that adapts a pretrained cancer detection encoder to the target domain by solving an auxiliary prostate segmentation task at test time, supervised by pseudo-masks from a frozen pretrained segmentation network. By aligning encoder representations to prostate anatomy in the target domain, ANT corrects domain-specific feature drift while preserving cancer-discriminative structure. The model was trained on 693 patients imaged with an earlier-generation micro-ultrasound scanner in a multi-center clinical trial, and evaluated on 118 patients acquired with a newer-generation system across two centers in another clinical trial. Under a leave-one-center-out protocol with identical evaluation conditions across all methods, ANT improves mean AUC by 2.9% and 3.6% at the biopsy-core and patient levels, respectively, over no adaptation, outperforming TTA baselines. Code is available at: https://github.com/ObedDzik/ant.git.

Women's health remains substantially under-resourced in medical imaging research, with pelvic pathologies such as polycystic ovary syndrome (PCOS) and pelvic fracture both suffering from a scarcity of public, well-annotated benchmark data despite their clinical importance. We introduce PelviNeXt, a modality-agnostic hybrid architecture combining a dense convolutional feature extractor, hierarchical channel-spatial attention (H-CBAM), a multi-scale fusion module (MSFM), and talking-heads multi-head self-attention (TH-MHSA), applied without modification to both pelvic ultrasound and X-ray inputs. While benchmarking PelviNeXt on PCOSGen, the only gynaecologist-annotated public PCOS ultrasound dataset, we identified extensive exact and near-duplicate contamination within and across the dataset. We audit this contamination via perceptual hashing, publicly release a deduplicated version of the dataset, and establish the first integrity-audited evaluation protocol and baseline for PCOSGen under 5-fold cross-validation. On the only publicly available pelvic fracture X-ray dataset (PXR150), PelviNeXt exceeds previously reported state-of-the-art results across accuracy, recall, specificity, and AUROC. Ablation studies confirm that each architectural component contributes to performance on both tasks. Our results demonstrate that a single architecture, applied without task-specific modification, can serve as a reliable foundation for pelvic imaging across modalities in data-scarce, under-researched areas of women's health.

Digital subtraction angiography (DSA) is the reference standard for leptomeningeal collateral (LMC) assessment, providing critical prognostic insights to guide secondary treatment strategies, neurorehabilitation planning, and retrospective stroke research. However, clinical LMC grading via the ASITN/SIR scale relies on manual, highly variable visual inspection. We introduce X-LMC, a spatiotemporal framework for automated collateral scoring from time-resolved biplane DSA. The proposed architecture encodes spatial frame representations through a DINOv2 backbone, fuses orthogonal projections via a token-level cross-view attention module, and models representations of contrast bolus dynamics using a recurrent network architecture. We evaluate our framework on a multicenter dataset of 134 patients with M1-segment occlusions. In a 5-fold cross-validation setting, X-LMC yields higher point estimates than static architectures and spatiotemporal baselines adapted from related angiographic tasks, achieving a Quadratic Weighted Kappa (QWK) of 0.398 (vs. 0.322) and a dichotomized macro-F1 score of 0.711 (vs. 0.663) against the best-performing baseline. X-LMC performance also aligns with the observed clinical inter-rater agreement (QWK: 0.314). As the first DSA study attempting to automate LMC scoring, we demonstrate that multi-view temporal deep learning can capture collateral-specific contrast kinetics. Ultimately, these benchmarks delineate the clinical ambiguities and achievable performance boundaries of automated ASITN/SIR grading, establishing a reproducible foundation for objective hemodynamic phenotyping in stroke cohorts. Code is available at https://github.com/maedehafezi/X-LMC.

Hardware shifts, color variations, and changing patient characteristics between development and deployment routinely break trained medical image classifiers. Existing remedies fall short: standard color jittering provides insufficient diversity, while deep generative style transfer algorithms hallucinate features, destroy clinically relevant structures, and waste massive compute resources. To address this, we revisit classical statistical color matching and repurpose it as Colorist, a highly efficient data augmentation strategy that applies global mean-standard deviation matching directly in the RGB color space. We demonstrate that this training-free, fully interpretable approach safely generates structurally intact domain variations, outperforming deep generative models in structural fidelity and color alignment. Across out-of-distribution histopathology, peripheral blood, dermatology, and retinal datasets, it improves balanced accuracy by up to +9% over state-of-the-art domain generalization regularizers and by +13% over an unaugmented baseline. Moreover, by avoiding neural networks in the augmentation loop, Colorist preserves anatomical structure, minimizes carbon footprint, and integrates seamlessly into standard dataloaders. Together, these findings establish statistical matching as a safe, interpretable, yet overlooked alternative to deep architectures for clinical robustness. Source code is available at https://github.com/sdoerrich97/colorist.

Appendicitis is one of the most common abdominal emergencies worldwide and requires prompt diagnosis and treatment to prevent life-threatening conditions. However, accurately differentiating complicated cases, such as perforation or abscess formation, from uncomplicated appendicitis remains a significant clinical challenge. Among other methods, ultrasound is a safer and more cost-efficient diagnostic technique because of the lack of radiation exposure. In this research, an advanced system capable of automatically detecting complicated appendicitis from ultrasound images was developed. A dataset consisting of 4679 ultrasound images with 5 classes, namely perforated, abscess, acute, appendicolith, and normal, was used for the proposed model training and testing. Four pretrained deep learning models, DenseNet201, InceptionV3, ConvNextTiny, and VGG19, have been employed for detecting and classifying complicated appendicitis. In the initial configuration, InceptionV3 achieved the second highest accuracy, with a value of 69.21%. Owing to suboptimal performance with raw images, further optimization techniques, including image preprocessing, hyperparameter tuning, model fine-tuning, and image sharpening, were applied. These enhancements significantly improved the model's performance, with an accuracy of 95.58% for InceptionV3. The model performance is then explained with gradient-weighted class activation mapping (Grad-CAM), which creates a heatmap of the regions responsible for the model's prediction of the infected areas. This could make crosschecking with experts much easier.

Dynamic contrast-enhanced (DCE) imaging is the gold standard technique for the detection and characterization of breast cancer using magnetic resonance imaging (MRI). However, DCE-MRI requires long acquisition times and the administration of contrast into the bloodstream, which can cause allergic reactions. Alternatively, diffusion-weighted MRI (DW-MRI) is a standard complementary technique for breast MRI that does not require contrast, has shorter acquisition times, and enables calculation of apparent diffusion coefficient (ADC) maps that correlate with tumor cellularity. Yet, despite these technical advantages, deep learning research has focused on DCE-based models and has barely explored the tumor detection performance of DW-MRI and ADC maps either in combination with DCE-MRI or as standalone alternatives. Here, we evaluate the application of different state-of-the-art deep learning techniques for detection and segmentation of breast cancer using ADC-only images. This is, to our knowledge, the first comprehensive evaluation of ADC-only breast cancer pipelines for classification, detection, and segmentation tasks.

Retinal diseases are a leading cause of irreversible vision impairment, making early and accurate diagnosis essential for effective treatment. Optical Coherence Tomography (OCT) serves as a critical imaging modality for this purpose, yet its automated analysis is hindered by inherent speckle noise, varying lesion scales, and subtle inter-class similarities. To address these challenges, we propose a novel framework, RetiWave-Mamba, which integrates spatial-frequency domain learning with state-of-the-art state space models. The framework utilizes Discrete Wavelet Transform (DWT) to decompose OCT images into low- and high-frequency streams, enabling decoupled processing of structural context and fine-grained details. For the low-frequency branch, we design a Multi-scale Contextual Localization Module (MCLM), which synergizes multi-scale dilation with spatial attention to expand the global receptive field and precisely localize lesion regions. For the high-frequency branch, we introduce an Attention-Guided High-Resolution Network (AG-HRNet) equipped with an intelligent gating mechanism to suppress noise propagation during multi-scale interactions. Furthermore, a Feature-Adaptive Mamba Projector (FAMP) is incorporated to form complementary channel-wise feature paths and adaptively reweight them using Mamba-generated gates. Extensive experiments on the OCT-C8 dataset demonstrate that our approach achieves a state-of-the-art (SOTA) classification accuracy of 98.38, surpassing existing methods. These results highlight the effectiveness of RetiWave-Mamba in identifying retinal pathologies and support its potential for computer-aided OCT image analysis.

Despite the rapid progress of deep neural networks in visual recognition, their adoption in high-risk medical applications remains limited due to reliability and robustness concerns. Models may exploit spurious correlations, particularly in medical imaging, where devices or treatment artifacts often co-occur with pathology. In small or imbalanced datasets, such cues further reduce worst-group performance and undermine clinical trust. To solve these issues, two major challenges should be addressed: identifying dataset-specific spurious cues, which typically require domain knowledge, and mitigating reliance on them. To tackle both, we propose SpurCon, a lightweight framework based on a novel supervised contrastive loss formulation that leverages available metadata and predicted spurious labels to enhance robustness. We introduce a fast few-shot procedure, without network training, to estimate spurious labels using a small number of expert-annotated samples. We then propose a weighted supervised contrastive objective, WtSupCon, that reshapes the representation geometry by assigning sample-specific weights that depend on the [pathology, spurious, metadata] combination. For example, the highest weight is assigned to samples that differ only in their spurious label. This yields highly similar representations for images with the same metadata and pathology, differing only in the predicted spurious label. Our method operates on pretrained image encoders (such as BiomedCLIP) and trains only a lightweight projection head. We evaluate SpurCon on a synthetic setting and on Waterbirds, CheXpert, a chest X-ray classification dataset, and ISIC 2020, a skin cancer classification dataset. Our approach delivers the best spurious-mitigation performance, balancing well worst-group and overall accuracy on multiple datasets.

Intra-tumoural heterogeneity (ITH) reflects spatial variation in tumour biology and is an important determinant of tumour behaviour, prognosis, and treatment response. Radiomics and deep learning have shown promise for tumour classification from multiparametric MRI (mp-MRI), but radiomics relies on handcrafted features, while most deep learning methods use whole-tumour representations or manually defined sub-regions, limiting scalable modelling of tumour heterogeneity. We propose a Heterogeneity-Aware Deep Learning Classification (HA-DLC) framework that explicitly models imaging-derived tumour sub-regions for lesion-type diagnosis and molecular-status prediction. HA-DLC consists of: (1) a Heterogeneous Sub-region Generation (HSG) module that produces initial pseudo-labelled sub-regions via unsupervised clustering, followed by Cross-Patient Sub-region Alignment (CPSA), which maps cluster-derived regions to a shared label space using soft assignments; and (2) a Dual-Stream Feature Extraction (DSFE) module that integrates local heterogeneity-aware features with global tumour representations. Given the initial clustering masks, CPSA, segmentation, feature extraction, and classification are jointly optimized end-to-end using soft-target segmentation and classification objectives. We evaluate HA-DLC on the LLD-MMRI2023 liver lesion dataset and the RSNA-ASNR-MICCAI 2021 Radiogenomic Brain Tumour dataset. HA-DLC consistently outperforms state-of-the-art radiomics and deep learning baselines, demonstrating the value of cross-patient sub-region alignment and dual-stream heterogeneity modelling for tumour classification from mp-MRI.

CBCT (Cone Beam Computed Tomography) scans provide detailed three-dimensional images, widely used in dentistry for diagnostic and treatment planning tasks. While invaluable, analyzing and documenting these scans is labor-intensive, prompting efforts to automate key steps like the classification and segmentation of anatomical structures to identify tooth types and associated pathologies. In this article, we propose an approach to automation that leverages persistent homology, a framework from topological data analysis that studies the shape of data by identifying features like connected components, holes, and voids across multiple scales. Persistent homology, together with a support vector machine, allows us to classify teeth in a CBCT scan and to perform diagnostics. Our method advances the state of the art, reaching average accuracy scores of 97.67% for tooth-labeling and 96.77% for diagnostic tasks, outperforming a CNN trained on the same data with accuracy of 70.27% and 86.67%, respectively.

The advanced retinal disease diagnosing imaging modality, optical coherence tomography (OCT), encounters a lack of automation because of the high expenses for annotations performed by specialists. The use of SSL solves the problem of insufficient annotations using unlabeled B-scans; however, most of the current techniques for generating pseudo-labels are based on prediction confidence without considering the asymmetry between different types of errors. This paper proposes TRIAGE, a risk-controlled semi-supervised framework for OCT scans classification, which uses the concept of a patient-level conformal risk controller with an asymmetric cost matrix. TRIAGE unites three crucial modules: a hierarchical classifier that is capable of working with partially abnormal supervision of the disease subtypes, a patient-grouped conformal risk controller with primal-dual coverage control, and a context-aware Transformer teacher for cross-slice verification. On the dataset from Noor Eye Hospital (16,822 B-scans, 161 patients, and 554 volumes) with a test set of unseen patients, TRIAGE demonstrates 89.66% scan-level accuracy, 0.8805 macro-F1, 0.9641 macro-AUC, and an 8.34% under-grading rate when using only 20% of the labeled data. With only 5% of the labeled data, TRIAGE keeps 76.88% accuracy and a 0.1656 under-grading rate. Compared with the other six state-of-the-art semi-supervised methods, TRIAGE significantly outperforms them with ablation study demonstrating the contribution of each module in the overall framework performance (by 42.7% in terms of under-grading rate comparing to fixed threshold methods). TRIAGE demonstrates 98.00% accuracy for 3-class classification with 1% labeled data and 95.94% accuracy for 8-class classification with 10% labeled data on the OCT-C8 dataset.

Ultrasound is the primary imaging modality for assessing thyroid nodules, and the ACR TI-RADS framework standardizes diagnosis through five ultrasound feature categories that are aggregated into five risk levels (TR1-TR5). Although widely adopted in clinical practice, most deep learning approaches focus on binary malignancy classification, while multi-class prediction and explicit utilization of feature-level supervision remain underexplored, largely due to limited annotated data. In this study, we introduce the STN dataset of 600 thyroid nodules with paired transverse and longitudinal ultrasound images, bounding box annotations, and complete labels for all five TI-RADS feature categories. Following the clinical decision process, we investigate how structured feature information can guide representation learning during training while requiring only images at inference. We demonstrate that text embeddings derived from standardized feature descriptions form a stable surrogate representation for TI-RADS risk levels. Based on this observation, we propose CMCNet, which aligns image embeddings to fixed textual embeddings via a Center-Margin Contrastive Loss that simultaneously promotes intra-class compactness and inter-class separation. Experimental results show that this embedding alignment strategy is more data-efficient and robust than direct multitask learning, and consistently outperforms InfoNCE, center loss, a strong multitask baseline, and a VQA-style multimodal model, particularly in imbalanced settings. The dataset is freely available at doi: 10.5281/zenodo.19125693 and the source code is available at: https://www.healthinformaticslab.org/supp/.

Concept bottleneck models (CBMs) can improve the transparency of cancer image diagnostic prediction by expressing predictions through radiological concepts. However, their dependence on instance-level concept annotations limits practical applicability. We propose a prior-guided hybrid CBM that integrates limited concept annotations, class-conditional concept distribution matching on unannotated patients, and prior initialization of the concept-to-diagnosis head. We evaluate the method on CBIS-DDSM mammographic masses and calcifications and LIDC-IDRI pulmonary nodules across 0-100% concept annotation. In the clinically relevant 0-20% annotation regime, the hybrid CBM consistently improves mean concept AUC over a matched standard CBM, while maintaining diagnostic performance close to black-box models. At 10% annotation specifically, concept AUC increases from 0.619 to 0.741 for masses, from 0.650 to 0.787 for calcifications, and from 0.597 to 0.642 for pulmonary nodules. Ablation experiments identify prior initialization as the main component contributing to improved concept detection, likely by stabilizing the concept-to-diagnosis head. Zero-shot VLMs remain insufficient for reliable fine-grained tumor-level concept prediction. These findings suggest that structured priors can substantially reduce the annotation burden of interpretable cancer imaging models.

Worldwide, millions of senior citizens are suffering from Alzheimer disease abbreviated as AD, a well- versed form of dementia. AD is featured by amnesia, intellectual disability, and difficulty with consciousness. DL and ML models are undoubtedly explored to identify AD related patterns on large dimensional neuroimaging data but they need global optimization and are suffering from overfitting issue that might yield dissatisfactory result in testing data set. DL overcomes the issue by convolution of input image with kernel but any sudden change in the MRI image or human manipulation, limited pre- processing of the images can mislead CNN in achieving highly accurate detection. Transfer Learning (TL) has proved itself in AD diagnosis by utilizing pre-trained models on large data sets to guide novice model in a new neuroimaging dataset. This review provides an inclusive glimpse of TL implication in classification, identification including the conversion of AD. Keeping in view, we have assessed the strengths and limitations of TL in improvising diagnostic accuracy even with limited data. The uniqueness of the present review is the incorporation of explainable AI in TL based AD diagnosis system. Finally, it can be claimed that the review will guide the new re-searchers in the area of TL induced neurodegenerative disease detection.

Thyroid ultrasound diagnosis requires coordinated lesion localization, measurement, risk stratification and reporting, yet most AI systems address these tasks in isolation and provide limited support for clinical review. We present ThyroidXAgent, a clinician-interactive agentic AI system that coordinates specialized diagnostic tools and stores their outputs as an auditable case-level evidence record. The system was developed using OpenThyroidDB, a multicentre, multitask resource integrating approximately 0.3 million ultrasound images and 24,000 paired reports, and was evaluated on 28,458 non-overlapping test cases, including 8,721 cases from 35 centres in the private NHC-MISD-TUS cohort. Across heterogeneous datasets, ThyroidXAgent achieved a mean Dice score of 87.21 percent for nodule segmentation and a mean AUROC of 0.9466 for benign-malignant classification. The same workflow supported lymph-node metastasis prediction and follicular versus papillary thyroid carcinoma classification, with AUROCs of 0.864 and 0.805, respectively. For report generation, evidence-grounded assembly outperformed multimodal language-model baselines across three cohorts. ThyClinScore, a lesion-level clinical semantic metric introduced here, showed the strongest correlation with a location-aware language-model judge. ThyroidXAgent improved physician classification accuracy, increased report diagnostic consistency from 70.3 percent to 86.2 percent, and reduced segmentation and reporting time by 35.9 percent and 27.4 percent, respectively. These findings support auditable, clinician-correctable agentic AI for thyroid ultrasound diagnosis and reporting.

Skin cancer diagnosis from dermoscopic images remains challenging due to high intra-class variability, inter-class similarity, class imbalance, and the limited interpretability of deep learning models. This paper proposes an uncertainty-aware and explainable deep learning framework for multi-class skin lesion classification. The framework combines a vision transformer model (MaxViT-Tiny) with CNN-based models (ConvNeXt-Tiny and EfficientNetV2-B0) through deep ensemble learning. Monte Carlo (MC) Dropout estimates predictive uncertainty and identifies unreliable predictions, while Grad-CAM++, an explainable AI (XAI) technique, provides visual explanations by highlighting lesion regions that influence model decisions. Evaluated on the HAM10000 dataset, the framework achieves 96% accuracy and 99% ROC-AUC under uncertainty-aware filtering (entropy < 1.0, confidence >= 0.7), with macro-average precision, recall, and F1-score of 94%, 95%, and 95%, respectively, and 96% weighted-average scores across all three metrics. The results demonstrate accurate, interpretable, and uncertainty-aware skin lesion classification for trustworthy computer-aided diagnosis.

Leukemia cell image classification is challenged by real-world domain shifts from acquisition, staining, illumination, and site protocols, causing single-dataset models to generalize poorly in real clinical scenarios. This work presents a robust framework for leukemia classification across multiple heterogeneous datasets using a two-stage pipeline with a pretrained vision foundation model. Stage 1 performs binary classification (leukemia vs. non-leukemia) and is trained using 122,167 single-cell images. Stage 2 is conditionally applied to Stage 1 positives to perform subtype classification into Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML), trained using 69,400 single-cell images. Labels are harmonized across five heterogeneous datasets to enable cross-dataset training, and performance is evaluated on a held-out dataset protocol to assess domain-shift generalization. Within this pipeline, three encoders are benchmarked (DinoBloom, pretrained on single-cell images; BiomedCLIP, pretrained on biomedical data; and CLIP as a general-purpose model) under linear probing, Low-Rank Adaptation (LoRA), and a Retrieval-Augmented Classification (RAC) module that retrieves the top-k most similar cell images to provide cytomorphological grounding. The objective is to quantify how much domain-specific pretraining contributes to performance under domain shift, and whether cost-effective adaptation and retrieval can be a viable alternative to expensive domain-specialized pretraining. The held-out protocol additionally serves as a diagnostic tool, revealing when classification performance is attributable to dataset-specific artifacts rather than to cytomorphological features.

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, predominantly arising from precancerous polyps. Accurate detection, segmentation, and endoscopic and histological classification of colorectal polyps are crucial for timely clinical intervention. In this study, we present PolypVision, a three-stage hierarchical deep learning framework that sequentially performs: (Stage 1) binary classification of polyps as adenomatous or hyperplastic, with simultaneous Paris and JNet classification, using EfficientNetV2-M with Focal Loss; (Stage 2) polyp segmentation with recommended resection method using a UNet++ decoder with the Stage 1 backbone as encoder, optimized with Dice and BCE losses; and (Stage 3) adenoma subtype classification (tubular, tubulovillous, villous) using EfficientNetV2-M with transfer learning from Stage 2. Evaluated on three public datasets -- PolypGen, Kvasir-SEG, and CVC-ClinicDB -- PolypVision achieves an AUC of approximately 0.99 for frame classification and a detection mAP@50 of 94.4% on Kvasir-SEG, outperforming or matching state-of-the-art methods. Gradient-weighted Class Activation Maps (Grad-CAM) confirm that the model attends to clinically relevant lesion features. The framework is device-independent, operating across diverse endoscopic imaging systems without hardware-specific adaptation. These results demonstrate that a hierarchical, transfer-learning-driven pipeline with task-specific loss functions offers a robust, device-independent, and clinically meaningful approach to automated colorectal polyp analysis. PolypVision is freely available as a web application at https://polypvision.com, a DataBioX initiative, with a free usage tier open to all users.

Breast density classification is a critical component of breast cancer risk assessment, yet AI models often struggle to generalize across clinical sites due to vendor-specific acquisition styles. In this work, we introduce two new datasets, BreastMammo and DenseMammo, to facilitate robust multi-view mammography research. We propose a domain generalization framework that utilizes a foreground-only histogram matching protocol to resolve the domain shift issue arising from disparate clinical sources. Internal evaluation using a 5-fold cross-validation protocol demonstrates the efficacy of our approach, with the Swin Transformer backbone achieving a peak AUC of 98.32% for density classification. External evaluation on the TNMammo and LUMINA datasets demonstrates that the proposed approach consistently reduces domain shift, significantly outperforming prominent domain generalization paradigms, including MixStyle and Discrete-Fourier-Transform-based frameworks.

Joint exam-level prediction and candidate-region localization may improve the usefulness of AI support in mammography. We study this setting using a multi-task DETR framework, where shared representations support both image-level malignancy prediction and lesion localization, and evaluate its performance on OPTIMAM and a biopsy-confirmed SGM1k cohort. Across both datasets, modern backbones consistently outperformed older ResNet-style features, with ConvNeXtV2 and DINOv3 giving the strongest overall results, whereas MambaVision was less competitive. On OPTIMAM, ConvNeXtV2 achieved the best overall performance, reaching 97.96% AUC, 99.89% sensitivity, 25.08% [email protected], and 74.38% [email protected]. On SGM1k, DINOv3 gave the strongest overall results, with 90.97% AUC, 86.28% sensitivity, 82.00% specificity, 27.04% [email protected], and 77.32% [email protected]. These findings suggest that backbone quality is a critical factor in effective multi-task mammography, with ConvNeXtV2 emerging as a particularly strong and well-matched CNN backbone for mammography in this framework.

Retinal fundus images frequently exhibit multiple co-occurring pathologies, yet standard deep learning classifiers apply static, identical computation to every image regardless of the underlying disease distribution. We propose a novel architecture that resolves this via sparse conditional computation, pairing a Guided Context Gating (GCG) spatial attention front-end with a sparsely-routed Mixture-of-Experts (MoE) block operating over feature tokens. Crucially, this routing yields an interpretable, data-driven decomposition. Expert allocation is significantly disease-dependent (p < 0.001), with the healthy Normal state and morphologically distinct pathologies (e.g., ERM, AMD) isolating to dedicated experts. On a five-class, patient-disjoint 5-fold cross-validation benchmark, our model achieves 0.912 +/- 0.008 macro AUC and 0.653 +/- 0.014 macro F1. Furthermore, Grad-CAM++ and post-MoE t-SNE visualizations confirm that expert routing aligns with localized lesions and geometrically maps co-occurring cases between their constituent clusters, positioning sparse MoE as an interpretable approach to multi-disease retinal screening.

Diabetic retinopathy (DR) remains a leading cause of vision loss among working-age adults worldwide, making reliable severity grading clinically important. Despite strong performance, most deep models formulate DR grading as image-level classification and do not explicitly model clinically grounded evidence, such as lesion types and spatial relations. In this paper, we propose PARAGraph, a Pathology-Anatomy-Aware Hierarchical Graph framework for DR grading. PARAGraph represents each image as a three-level hierarchical graph with lesion-level nodes, intermediate category and region nodes, and global anatomical and semantic nodes. To incorporate medical priors into nodes, we construct an optic disc-fovea-anchored coordinate frame that provides a scale- and rotation-normalized retinal reference system. Within this frame, lesion nodes are encoded with category, normalized area, and anatomical coordinates. To mitigate noisy lesion segmentation, PARAGraph uses a dual-fusion strategy that introduces global visual context into a graph semantic node and a decision-level prediction branch, improving robustness when lesion evidence is unreliable. Extensive experiments on Messidor-2, APTOS, and DDR show that PARAGraph achieves consistent DR grading performance over state-of-the-art methods. Interpretability and robustness analyses further demonstrate that its predictions are clinically grounded, closely associated with lesion evidence and robust to lesion segmentation noise.

Large language models (LLMs) show promise in medical image interpretation but suffer from hallucination, limited accuracy, and run-to-run inconsistency. We developed and validated an agentic AI framework integrating LLMs with specialized deep learning tools for glaucoma detection from fundus photography. The workflow had three steps: (1) LLM initial assessment; (2) function calling to invoke specialized tools for image quality (QAModel, FundaQ-8), glaucoma classification (SwinV2-Tiny), and optic disc/cup segmentation (SegFormer-B0); and (3) LLM reflection integrating the initial impression with tool outputs. Two LLMs (Gemini 2.5 Flash, GPT-5.4 mini) were evaluated on two public datasets (ORIGA, n=100; RIM-ONE-v3, n=100) under uncropped and cropped fields of view; all images were independently graded by a masked fellowship-trained glaucoma specialist. The agentic workflow improved classification accuracy by 16 to 47 percentage points across all conditions, reaching within 6 points of the specialist; on RIM-ONE-v3 the best configurations matched the specialist accuracy of 88%. LLM-alone approaches failed in two ways: GPT-5.4 mini showed positive bias (sensitivity 95-100%, specificity 0-5%), while Gemini 2.5 Flash varied stochastically between runs; the agentic workflow corrected both. Cup-to-disc ratio error fell 15-50% (MAE 0.156-0.228 to 0.104-0.132), and correlation with specialist grading rose from weak (r=0.12-0.39) to moderate-strong (r=0.59-0.84). Run-to-run consistency rose from near-random (kappa as low as -0.01) to near-perfect (kappa up to 0.96). Integrating LLMs with specialized tools addressed key limitations of LLM-alone approaches, including over-diagnosis and run-to-run variability. Gains held for both LLMs, suggesting generalizability across backbones, and may signal a shift from monolithic models toward orchestrated multi-agent systems in medical AI.

Recent advances in machine learning have greatly improved breast cancer detection, enabling more accurate and timely diagnosis. Deep learning (DL) models show strong potential for medical image analysis; however, as their architectural complexity increases, their environmental impacts are becoming a growing concern. In this paper, we present a comparative analysis of seven DL models for breast cancer detection on two medical datasets: Breast Ultrasound and BreakHis 400X. The evaluated architectures range from Convolutional Neural Networks (CNNs) and transformers to hybrid models. In addition to performance metrics, we assess CO2 emissions during both training and inference. Our results show that EfficientNet and ResNet consistently deliver strong performance, although with higher CO2 emissions. The selected transformers, such as DeiT-Tiny, perform competitively on both datasets, whereas DenseNet121 achieves lower accuracy. On the Breast Ultrasound Dataset, DeiT provides the most favourable balance between accuracy and energy consumption, whereas on the BreakHis dataset, the ViT and Swin models achieve the best results. Overall, our findings indicate that no single architecture category from the evaluated ones consistently dominates across the two selected datasets. Our results highlight the importance of jointly considering performance, emissions, and dataset characteristics when selecting models for medical applications.