Medical Image Classification

Perineural invasion (PNI) is a clinically relevant indicator of tumor aggressiveness and can influence surgical decision-making, motivating interest in reliable preoperative assessment. The subtle MRI features of PNI, however, often resemble nearby anatomy, complicating noninvasive prediction. These fine perineural cues are easily attenuated by routine downsampling or overly global feature aggregation, reducing the effectiveness of conventional volumetric models. We present LoSA-Net, a localized and scale-adaptive architecture for boundary-sensitive PNI prediction in 3D MRI. Talking Neighborhood Attention (TNA) preserves nerve-aligned detail through localized self-attention with head-wise mixing, and Scale-Adaptive Feature Mixing (SAFM) modulates the receptive field using multi-scale depthwise processing. Cross-Scale Refinement and Alignment (CSRA) maintains consistency between semantic context and high-resolution boundaries across stages. In contrast-enhanced MRI scans from 168 patients with cholangiocarcinoma, LoSA-Net achieves an AUC of 0.7567 and outperforms representative convolutional and transformer baselines under matched preprocessing and optimization settings.

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. Non-invasive prediction from 3D MRI is challenging, demanding models that efficiently capture both fine-grained details and global context. We propose the Multi-window Mixture-of-Head Attention Transformer (MMA-Former), a novel end-to-end 3D architecture featuring a Coarse-Fine Transformer (CFT) structure for parallel multi-scale feature extraction. We advance this structure by integrating a novel Window-Specific Mixture-of-Head attention (WS-MoH) mechanism. Unlike standard Multi-Head Self Attention (MSA), WS-MoH generates a representation for each 3D window and dynamically routes the entire window to specialized or common attention heads. This enables spatially adaptive feature extraction tailored to the local context of each window, enhancing specialization and reducing redundancy without increasing parameters. Evaluated on a retrospective dataset of 168 T1-weighted MRI scans, MMA-Former achieved an AUC of 0.752, outperforming other 3D architectures, including the best CNN (AUC of 0.708) and Transformer baselines (AUC of 0.681).

Medical image classification models are ideally expected to identify diagnostically relevant regions while making predictions, yet standard classification losses rarely provide spatial supervision. Explicit supervision via anatomical shape information, such as segmentation masks of task-relevant anatomy, has been shown to guide the network toward regions relevant to the target prediction. However, obtaining such masks incurs substantial manual annotation effort and computational overhead. With the advent of segmentation foundation models that exhibit strong localization of anatomical structures across diverse imaging modalities, we leverage this capability to extract anatomical shape priors without the burden of training a dedicated segmentation model. In this paper, we propose a new framework, Locus, an anatomical attention regularization framework that leverages pretrained segmentation foundation models to guide a classifier's attention toward diagnostically meaningful anatomical structures across diverse imaging modalities. Instead of enforcing pixel-wise alignment with the foundation-model-derived mask, we introduce a regularization term that adaptively balances attention between anatomical (foreground) and background regions, penalizing the classifier when background attention dominates. We validate Locus on eight diverse medical imaging datasets spanning dermoscopy, X-ray, histopathology, and cardiac MRI, showing consistent gains in classification performance alongside improved anatomically grounded attention.

Medical image classifiers are often trained within one source population, yet clinical deployment requires robustness to patients whose appearance, acquisition style, and disease prevalence differ from the source cohort. Existing fairness and robustness methods often require group supervision or treat appearance variation as an undifferentiated nuisance, which is insufficient when population-correlated low-level cues and lesion evidence share edge and texture structure. We study a strict source-only cross-population setting, where external populations are unseen during optimization, validation, scheduling, hyperparameter and model selection. We propose RED-Sphere, a plug-and-play robustness framework for image classification under unseen population shifts. It estimates shortcut-sensitive nuisance responses with an edge and feature energy prior, attenuates dominant responses through residual soft gating, regularizes masked nuisance views with counterfactual-inspired consistency and separation losses, and predicts labels with normalized spherical prototypes. It favours angular semantic evidence over source-correlated activation magnitude while preserving lesion structure. Although demonstrated on 2D Scanning Laser Ophthalmoscopy (SLO) fundus classification for Age-Related Macular Degeneration (AMD) and Diabetic Retinopathy (DR), RED-Sphere is not tied to retinal anatomy: the same principle can be adapted with modality-specific nuisance priors wherever appearance shortcuts and semantic evidence are entangled. Under a strict White-only Harvard-FairVision protocol, RED-Sphere improves held-out macro-F1 across all 20 task and backbone comparisons, with average gains of 1.28 and 2.98 F1 points on AMD and DR. Gains in AUC and PR-AUC, visual diagnostics, ablations, and sensitivity analyses further support stronger external semantic alignment and more stable angular disease geometry.

Foundation models are increasingly used as image feature extractors for mammography, but their robustness under external domain shift remains unclear. We benchmark 15 foundation-model backbones across breast density, BI-RADS severity, and cancer status using a unified frozen-backbone linear-probe protocol, training on 3 source datasets and evaluating on 12 task-compatible out-of-distribution (OOD) datasets after label harmonization. Mammography-specific vision-language models (Mammo-FM and MaMA) provide the strongest mean OOD performance, but robustness is not explained by mammography exposure alone. DINOv3 remains a competitive vision-only baseline, and mammography-adapted pretraining does not consistently improve generalization. Dataset-level analysis further shows that even leading models show heterogeneous performance across datasets. Feature-space inspection reveals that useful representations can preserve clinical signal while retaining dataset and acquisition structure. These findings highlight dataset-level OOD evaluation as a central criterion for assessing mammography representations. Our code is publicly available: https://github.com/biomedia-mira/mammo-ood.

Accurate cervical cytology image classification is a key component of automated cervical cancer screening, where reliable recognition of normal, precancerous, and cancer-associated cellular patterns from Pap smear images can improve screening efficiency and diagnostic consistency. However, this task remains challenging because cervical cells exhibit complex morphology, subtle intra-class variations, and strong inter-class similarities. Existing convolution-based models capture local texture well but have limited ability to model long-range relationships, whereas attention-based models provide broader context but often lack explicit structural guidance. To address these limitations, we propose a geometry-aware classification framework for cervical cancer screening-oriented cytology image analysis, incorporating semantic abstraction and structural priors learned from pre-trained vision-language features. The method uses Gaussian expert modules to generate axis-wise priors from global semantic information, capturing structural regularities such as nuclear alignment and cellular spatial organization. These priors are embedded into an axial self-attention module to modulate similarity computation along horizontal and vertical directions, improving long-range dependency modeling and structure-sensitive feature interaction. Experiments on the Mendeley liquid-based cytology and SIPaKMeD datasets show that the proposed method achieves 99.48% accuracy on the former and 96.08% on the latter, with balanced gains in recall, precision, and overall classification performance. Visual analysis further shows that the learned priors highlight diagnostically relevant cellular regions, demonstrating the potential of the proposed framework as a screening-oriented decision-support tool for cervical cytology.

Breast cancer remains the most commonly diagnosed malignancy among women worldwide, yet accurate detection and characterization of breast masses in mammography remain challenging due to subtle intensity variations, heterogeneous tissue densities, and indistinct lesion boundaries that complicate radiological interpretation. To address these limitations, we propose BiLoG-Net, a deep learning framework that jointly performs breast mass segmentation and malignancy classification through bi-context location-aware feature modeling and segmentation-guided attention mechanisms. Our architecture integrates a novel encoder-decoder paradigm with Fire-based feature extraction, lightweight global and local feature enhancement modules, and adaptive location-aware gating to simultaneously capture long-range contextual dependencies and fine-grained boundary-sensitive details. Unlike conventional multi-stage pipelines, our tightly coupled multi-task design enables mutual reinforcement between pixel-level localization and image-level diagnosis, reducing error propagation while producing spatially grounded malignancy predictions. Evaluated on CBIS-DDSM and INBreast benchmarks, BiLoG-Net achieves state-of-the-art performance with Dice scores of 94.20% and 93.10%, classification accuracies of 95.20% and 93.60%, and AUC values of 97.10% and 96.00%, respectively, substantially outperforming existing CNN and transformer-based baselines. By combining precise boundary delineation with reliable malignancy assessment in a single end-to-end model, this work holds strong potential for clinical computer-aided detection systems, helping radiologists prioritize suspicious cases and improve screening efficiency in busy clinical settings.

Cervical cytology classification models are typically evaluated on curated, class-balanced benchmarks, but real-world liquid-based cytology (LBC) collections are often small and class-imbalanced. This paper presents a class-imbalance-aware and calibration-aware ensemble classification study on the Mendeley LBC dataset, using its native four-class Bethesda taxonomy (NILM, LSIL, HSIL, SCC) rather than a collapsed binary formulation. Three lightweight architectures (Swin-Tiny, TinyViT-5M, DenseNet121) are trained directly on Mendeley LBC using weighted random sampling to counteract class imbalance, and compared against two soft-voting ensembles (Hybrid-2, Hybrid-3). Post-hoc temperature scaling is fit on a held-out calibration subset carved out of the training portion of each cross-validation fold, distinct from both the training data used to fit model weights and the evaluation fold used for final metrics, avoiding the optimistic calibration estimates that result when the same data is used for both purposes. Calibration substantially reduces expected calibration error, Brier score, and negative log-likelihood for every model and ensemble configuration tested, while discrimination metrics (accuracy, macro-F1, macro-AUROC) remain essentially unchanged. Ensemble size shows no consistent additional reliability benefit over the best individual model once all configurations are properly calibrated. Confusion matrices show that all classification errors, across every configuration, are confined to the boundary between high-grade lesions (HSIL) and carcinoma (SCC); no errors involve the negative (NILM) or low-grade (LSIL) categories. These results suggest that, for this dataset, calibration is the dominant lever for reliability, not ensemble size, though this conclusion should be read in light of the dataset's modest size.

Medical images require comprehensive and accurate interpretation to support the diagnosis of diverse clincial conditions. Recent vision-language generalist models offer broad task coverage and promising zero-shot capabilities, yet often lack fine-grained anatomical and lesion awareness for reliable diagnosis and spatial interpretability. In contrast, supervised specialist models achieve strong performance on specific tasks but typically lack generalization across diseases and anatomies. In this work, we present SuG, a Super-Generalist framework that unifies generalist vision-language learning with specialist objectives, enabling both broad generalization and specialist-level diagnostic capability. We perform specialist-enhanced vision-language alignment in SuG by incorporating spatial priors from multiple segmentation experts, including anatomy, class-specific lesion and class-agnostic lesion segmentors that captures lesions beyond anatomies annotated during training. To improve lesion grounding capability, we leverage lesion masks as spatial priors to calibrate text-conditioned visual attention, encouraging disease-related semantics to focus on clinically relevant regions. We evaluate SuG on extensive chest and abdominal CT benchmarks, including CT-RATE, Merlin, MedVL-CT69K, and several in-house tumor datasets. SuG achieves state-of-the-art performance across a wide range of disease diagnosis tasks and surpasses specialist models on several critical tumor diagnosis benchmarks. Furthermore, SuG demonstrates strong lesion grounding capability, including robust generalization to lesion types lacking class-specific supervision.

Microbial density is clinically important for tumor assessment and treatment decision-making, and recent advances in deep learning suggest that it can be non-invasively inferred from multimodal MRI. In this work, MRI-based Microbial Density Stratification (MRI-MDS) is first investigated as a patient-level representation learning task, and Center Heatmap-driven Macro-micro modeling Network (CHM-Net) is introduced for this task. CHM-Net first establishes the link between imaging phenotypes and microbial states through center heatmap-guided small-lesion response localization. Building upon this, it constructs patient-level macro-micro evidence from localized heatmap responses for microbial density prediction. Experiments on the novel GBNPC 2026 dataset constructed for MRI-MDS demonstrate the effectiveness of CHM-Net, achieving superior performance over representative baselines with a 12.06% absolute ACC gain over the strongest competing result. Additionally, auxiliary validation on two 3D medical image datasets further verifies its robustness across volumetric medical image classification scenarios. The project is available at https://anonymous.4open.science/r/CHM-Net-942E/.

Alzheimer's disease (AD) is a common neurodegenerative disorder, and early diagnosis is of great significance for delaying disease progression and enabling timely intervention. Mild cognitive impairment (MCI), which represents an intermediate clinical stage between cognitively normal aging and AD. Structural magnetic resonance imaging (sMRI) provides detailed characterization of anatomical structures and plays an important role in AD-related brain analysis. However, existing sMRI-based brain network methods typically rely on a single graph construction strategy, limiting their ability to jointly capture spatial relationships and morphological similarities between brain regions. To address these issues, this paper proposes an sMRI-based multi-view masked graph neural network model (MVMGNN) for AD diagnosis. A joint node-edge masking mechanism is proposed to simultaneously select radiomics feature dimensions and structural connections, reducing redundancy during graph learning. Furthermore, a patient-level cross-view gated fusion mechanism is proposed to integrate multi-view representations. Experimental results on the ADNI dataset demonstrate that MVMGNN outperforms several competing approaches in AD classification. Interpretability analysis further demonstrates that MVMGNN is able to identify key brain regions associated with AD, providing useful insights into discriminative patterns in sMRI-based brain networks.Our implementation is publicly available at https://github.com/chenzhao2023/MVMGNN_AD

Deformable shape representations have proven to be robust complements to texture features in cardiac image classification, offering geometric priors that are invariant to imaging artifacts and intensity variations. However, existing deep networks perform simple concatenation to combine these distinct feature representations, which neither fully exploits their complementary nature nor learns cross-modal feature dependencies. Furthermore, this results in uniform attention across all timepoints; hence ignoring the varying diagnostic importance across the cardiac phases. In this paper, we propose a novel cardiac video classification model that, for the first time, learns temporal features in an integrated space of deformable shape and image texture representations. In particular, we design a bi-directional cross-attention in the latent space to fuse latent deformable shape and image features, allowing each modality to adaptively weight the other based on spatio-temporal correspondence. In contrast to current methods that apply uniform weighting across all the cardiac phases, our approach learns to dynamically adjust the contributions of shape and texture representations, derived from images, over time. We demonstrate state-of-the-art classification performance on a cine cardiac magnetic resonance (CMR) video dataset, achieving improved interpretability from attention mechanisms that identify diagnostically critical cardiac phases and modality contributions.

Artificial intelligence (AI) analysis of micro-ultrasound ($μ$US) has shown promise for prostate cancer (PCa) detection. However, most existing AI methods focus on the analysis of single $μ$US images in isolation. By contrast, expert $μ$US readers typically assess a full recorded video study, which provides three-dimensional context, to improve PCa detection compared to single-frame analysis. Inspired by this clinical workflow, we propose Compass, a novel AI methodology which models a $μ$US study as a stream of 2D images. Compass jointly integrates rotational sweep videos of the prostate with $μ$US frames acquired at the moment of biopsy, and performs evidence aggregation across the study using a transformer conditioned on the probe's rotational angle. Finally, a decoder head predicts frame-level and study-level risk scores for the patient. The model is trained and evaluated using a multi-center clinical trial dataset of $μ$US studies, including continuous rotational scans of the prostate and videos captured during biopsy acquisition. We compare the proposed method to baseline AI methods from the literature and to risk scores provided by clinical experts. Our framework shows strong performance, highlighting the value of multi-view context for $μ$US PCa detection, and providing a potentially powerful tool to complement human expertise in $μ$US-based PCa diagnosis. Our code is available at: https://github.com/mharmanani/Compass.

Accurate breast cancer classification from mammography requires effective integration of complementary information from craniocaudal (CC) and mediolateral oblique (MLO) views, which provide a more complete characterization of breast abnormalities. However, existing multi-view learning approaches typically rely on feature-level aggregation or single-stage cross-attention, which can entangle view-specific and shared representations and restrict interaction to limited network depths. To address these limitations, we propose a token-centric dual-view learning framework that unifies prompt-based adaptation and cross-view fusion within a frozen vision transformer backbone. The framework reformulates inter-view interaction as structured token-level communication, where dedicated fusion tokens explicitly encode bidirectional information exchange between CC and MLO views via cross-attention, serving as intermediate carriers of cross-view dependencies rather than relying on direct feature fusion. Unlike conventional methods that apply fusion at a single layer, fusion modules are inserted at multiple transformer depths, enabling progressive and repeated interaction across the encoder hierarchy. Fusion tokens are reintegrated into the token sequence and refined by subsequent transformer layers, facilitating hierarchical propagation of complementary information while preserving view-specific structure. Experiments on VinDr-Mammo and CMMD datasets demonstrate consistent improvements over linear probing, prompt-only adaptation, and conventional fusion baselines. On the VinDr-Mammo BI-RADS classification task, the framework achieves 50.40% F1-score and 0.8090 AUC, including a 0.10 AUC improvement over a dual-view fusion baseline in the binary setting. Ablation studies further validate the effectiveness of token-based fusion and multi-depth interaction design.

Existing deep learning methods perform well in medical image classification but struggle with multi-scale morphology and limited annotations due to fixed sampling and data-hungry training. Existing approaches address these challenges in isolation: DCN-based models provide adaptive sampling but lack explicit multi-scale attention fusion and label-efficient regularisation; multi-scale architectures typically rely on static fusion; and semi-supervised methods target label scarcity without jointly modelling adaptive cross-scale representations. We propose MSA-DCNN, a scale-consistent deformable attention learning framework that introduces adaptive multi-scale sampling, within-scale saliency refinement, learned cross-scale fusion, and auxiliary self-distillation within a unified optimisation scheme, with potential to generalise to structurally heterogeneous anatomy. We evaluate on three public benchmarks and an external hold-out set for leukaemia. MSA-DCNN demonstrates competitive and often better performance against ViT baselines, CNN baselines, and a MICCAI semi-supervised baseline under distribution shift and label scarcity in accuracy, F1, and AUC (binary), while using fewer parameters. Ablations confirm complementary component contributions, supporting MSA-DCNN as a practical foundation for data-efficient medical image classification.

Non-invasive prediction of Gleason Grade Group (GGG) in prostate cancer using multiparametric MRI (mpMRI) is clinically vital for reducing unnecessary biopsies. Existing GGG prediction methods face two major limitations. First, they often overlook non-image information critical for GGG prediction, including age, prostate-specific antigen (PSA), and expert priors embedded in radiology reports. Second, they tend to oversimplify GGG as flat categorical labels, failing to account for its intrinsic hierarchy of primary and secondary Gleason patterns. To this end, we propose a novel Knowledge-Driven Ordinal-Aware Learning (KOAL) framework with three synergistic modules. Specifically, the Clinical-Context Modulation (CCM) module uses clinical variables (e.g., age and PSA) to dynamically modulate discriminative image representations. The Knowledge-Guided Prototype Alignment (KGPA) module leverages an LLM to extract group-specific expert knowledge from training radiology reports and clinical guidelines, producing offline semantic anchors describing grade-specific radiological findings without requiring patient-specific reports at inference. Through prototype contrastive alignment, patient-specific mpMRI representations are matched with these anchors to promote pathology-aligned representation learning. The Hierarchical Ordinal-aware Constraints (HOC) module decouples primary and secondary Gleason pattern prediction and maps their probabilistic outputs to GGG via a Differentiable Bio-logic Mapping Layer (DBML), ensuring pathological grading consistency. Experiments on public PI-CAI and in-house datasets demonstrate that KOAL outperforms state-of-the-art methods. Code is available at: https://github.com/Gother-GZ/KOAL.

Background. Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness, with rising burden in low- and middle-income countries where ROP-trained ophthalmologists are scarce. Plus disease, marked by retinal vessel dilation and tortuosity, triggers treatment but is subjective and variable. Automated screening could extend specialist reach, but African evidence remains limited. Methods. We analysed 121 Kenyan preterm infants, covering 237 eyes and 1,635 fundus images graded as No Plus, Pre-Plus or Plus. Vessel annotations from two graders supported segmentation training. Eleven configurations were evaluated for eye-level Plus detection using patient-grouped nested cross-validation, including image classifiers, multiple-instance learning, multi-task segmentation-classification, and segment-then-classify pipelines. Results. Vessel segmentation was feasible, achieving pooled Dice 0.533, IoU 0.368, sensitivity 0.623 and specificity 0.979 on held-out images. RGB classifiers were highly sensitive but over-referred, while segmentation-coupled models were more specific. Combining approaches improved performance: an OR-based screen achieved the highest sensitivity, an AND-based confirmation achieved the highest specificity, and a probability ensemble gave the best balanced performance, with sensitivity 0.692, specificity 0.914 and balanced accuracy 0.803, outperforming the vision classifier alone. Conclusions. Classification and vessel segmentation are complementary for ROP Plus detection in Kenyan data. Classifiers support sensitive case-finding, while segmentation improves specificity and reduces over-referral. African ROP AI systems should use combined workflows and undergo prospective multi-site validation.

Deep learning (DL) has shown strong performance in medical image classification, but its trustworthy deployment remains challenging in safety-critical clinical settings, where prediction errors under perturbations may lead to severe consequences. Existing studies mainly focus on adversarial robustness (AR) from a worst-case perspective; however, such settings may be less representative of real medical applications. In this work, we investigate probabilistic robustness (PR) as a more practical measure of model trustworthiness. To this end, we construct a set of natural corruption settings for medical image classification and systematically evaluate commonly used DL models on MedMNIST v2 dataset. Our study provides a statistically grounded perspective on assessing the trustworthiness of DL models, thereby supporting their more trustworthy deployment in medical imaging applications.

Medical imaging models often degrade when deployed at new clinical sites due to differences in imaging equipment, protocols, and patient populations. Test-time adaptation (TTA) addresses this by updating a pretrained model using only unlabeled target data, without access to source data. However, existing TTA methods were designed for single-label classification on natural image benchmarks, minimizing entropy uniformly across all samples without considering label dependencies. This overlooks a key property of multi-label medical imaging: pathologies do not occur independently but exhibit structured co-occurrence patterns. In this work, we propose Co-occurrence Weighted Adaptation (CoWA), which leverages disease co-occurrence patterns as a reliability signal for adaptation. CoWA estimates label co-occurrence structure from model predictions and downweights samples that deviate from expected patterns, enabling adaptation to rely more on consistent predictions while reducing the impact of noisy ones. We evaluate CoWA on chest X-ray benchmarks under domain shifts and demonstrate consistent improvements over established baselines.

Imaging signatures are quantitative features extracted from medical images that provide clinically meaningful information for tumor diagnosis, characterization, prognosis, and treatment planning. Although deep learning has shown great potential for imaging signature discovery, its limited interpretability remains a major barrier to clinical adoption. Existing approaches often achieve high predictive performance but provide little biological insight into the identified signatures. We propose a unified framework for interpretable imaging signature discovery by integrating deep learning based segmentation, explainable classification, and radiomic analysis. A robust segmentation model is first used to accurately delineate tumors, followed by a Grad-CAM guided pipeline that identifies diagnostically important regions as candidate imaging signatures. A mutual information based adaptive thresholding strategy enables patient-specific signature extraction. The resulting signatures are validated using a downstream deep learning classification model, while radiomic features extracted from the signature regions are evaluated with traditional machine learning models and interpreted using SHAP to identify the most discriminative biomarkers. The proposed framework is evaluated on the public BUSI breast ultrasound, KiTS renal CT, and BraTS brain tumor datasets, as well as a private UF Health renal CT cohort. Compared with conventional whole-tumor radiomics, the proposed signature-based approach achieves improved discriminative performance while providing greater biological interpretability. By converting deep learning attention into reproducible quantitative imaging biomarkers, this framework offers an interpretable and reproducible solution for non-invasive tumor characterization and imaging biomarker discovery.

Glaucoma is a progressive eye disease that can lead to irreversible vision loss if not detected at an early stage. Conventional diagnostic procedures are often time-consuming and rely heavily on expert interpretation, limiting their scalability for large-scale screening. In this study, glaucoma detection is investigated under two evaluation settings: sample-wise, where individual samples are analyzed independently, and patient-wise, where data from each patient are aggregated for final prediction. An automated multimodal framework is proposed that integrates fundus images with clinical data. Under the sample-wise setting, detection is performed using fundus images and clinical features individually, as well as through their multimodal combination. Under the patient-wise setting, predictions are obtained by aggregating multiple fundus image representations with corresponding clinical information for each patient. Deep visual features are extracted using a Vision Transformer (ViT) architecture and classified using classical machine-learning models, with a stacking-based ensemble of the three best-performing classifiers employed to optimize performance. Experiments conducted on the publicly available PAPILA dataset demonstrate strong diagnostic performance, achieving 97.47% accuracy and a 97.50% F1-score for sample-wise multimodal classification, and 98.97% accuracy and F1-score for subject-wise detection. The proposed framework is further deployed as an end-to-end web-based platform to support automated glaucoma screening and clinical decision support.

Ultrasound image classification is essential for computer-aided diagnosis. However, current methods often neglect clinical priors, leading to poor generalization in challenging scenarios and a lack of interpretability that limits clinical adoption. To address these issues, we aim to develop a medical-prior module that can be seamlessly integrated into existing pipelines to enhance both diagnostic performance and interpretability. In this paper, we propose an attribute-guided dual-branch framework for ultrasound classification that introduces domain-agnostic medical attribute priors, improving generalization while offering interpretable evidence. Specifically, a baseline branch follows conventional architectures and predicts image categories via a fully connected classifier. An attribute-guided branch injects domain-agnostic attributes as priors and produces human-interpretable decision cues. Finally, an adaptive decision module fuses the two branches in a data-dependent manner to yield the final prediction. Experiments across diverse ultrasound classification tasks demonstrate that our approach can be integrated into multiple backbones and state-of-the-art methods with low overhead, consistently improving accuracy and interpretability. Code is available at: https://github.com/zhaobo253-crypto/AttrGuide.

Radiomics is the established approach for CT-based lung cancer phenotyping, yet comparisons with foundation models rarely isolate contributions of feature extractor, classification head, and segmentation choice, or test cross-cohort robustness. We benchmark five feature extractors (Curia, Curia-2, DINOv3, Radiomics2D, Radiomics3D), seven classification heads (TabPFN, TabICL, XGBoost, CatBoost, Random Forest, logistic regression, Ridge), and three segmentation regimes on five tasks: tumor volume and stage classification, 2-year survival prediction, histology classification, and age prediction. Models are trained on LUNG1 (n=338) and evaluated on an internal test set (n=84) and the external LUNG2 cohort (n=211), with worst-case cross-cohort performance as the primary metric. The dominant design factor is task-dependent: segmentation drives volume and stage classification, while classifier choice drives survival, histology, and age prediction. Radiomics is competitive for tumor volume, tumor stage and survival (partly due to label-derivation effects for the former); Curia variants reach comparable peak scores for survival; DINOv3 falls slightly short across tasks. Patch and slice aggregation have negligible impact. We recommend Curia with tumor segmentation and a CatBoost head as a safe default, achieving the best mean rank across the three primary clinical tasks, though task-specific selection consistently outperforms any cross-task default. When tumor delineations are unavailable, Curia-2 with lung segmentation and logistic regression offers a competitive alternative. All pipelines use a two-stage design suited to small cohort sizes where end-to-end fine-tuning would risk overfitting.

High resolution medical images contain fine grained, spatially sparse cues that are critical for diagnosis, yet preserving full resolution incurs substantial computational and memory costs. Most deep models process images uniformly, leading to redundant computation or loss of diagnostic detail under downsampling. We propose Chained Perceptual Refinement, CPR, a coarse to fine framework that formulates medical image analysis as a sequential global to local decision process. Starting from a low resolution global view, CPR dynamically predicts the location and spatial extent of refinement regions, extracts high resolution evidence from the original image, and incrementally integrates it with global context. By keeping the backbone input size fixed while contracting the perceptual field, CPR preserves diagnostic fidelity with constant peak GPU memory. Extensive experiments on five medical imaging datasets and multiple backbone architectures demonstrate that CPR consistently outperforms both fixed resolution and multi scale state of the art baselines, achieving improvements of up to 2.27 percentage points over the second best method. It also achieves up to a 19.6 fold reduction in GFLOPs at matched accuracy, establishing a superior accuracy and efficiency trade off for high resolution medical image analysis. The code is available on GitHub.

We present Aegis, a joint-embedding predictive architecture for breast cancer detection and density assessment in mammography. We train three Vision Transformer variants (Small/Base/Large) using self-supervised joint-embedding predictive architecture (JEPA) pre-training on 71,103 studies from 14 clinical sites, followed by supervised fine-tuning with progressive resolution scaling up to 2048x1536. On a curated 785-study test set, our largest model achieves area under the receiver operating characteristic curve (AUC) 0.949 for breast cancer triage with 93% sensitivity and 75% specificity at the optimal operating point. An ensemble combining our model with a U.S. Food and Drug Administration-cleared baseline further improves discrimination to 0.952 AUC. For breast density classification, the model achieves 0.953 AUC for binary (dense vs. non-dense) classification and 62.6% exact accuracy across four Breast Imaging Reporting and Data System (BI-RADS) categories, with 98.8% adjacent accuracy comparable to reported human inter-reader agreement. External validation on the public VinDr-Mammo dataset provides evidence of cross-population transfer under a different reference standard, with the largest model achieving 0.871 AUC for triage in a zero-shot setting.

In this study, we examine learned preprocessing pipelines in the context of triage-oriented orthopedic abnormality detection task using elbow radiographs from MURA dataset. The evaluation focuses on patient-level detection of musculoskeletal abnormalities under a leakage-aware protocol. We compare multiple preprocessing pipelines, with and without a lightweight DnCNN module as a learned preprocessing component, to assess their impact on discrimination and calibration. Performance is assessed using discrimination metrics (AUROC, PR-AUC), calibration measures (ECE, Brier score), and validation-selected operating point analysis targeting high specificity. Results show that differences across preprocessing strategies are modest and configuration-dependent, with no consistent discrimination advantage over the raw-input DenseNet121 baseline. The raw and diverse inputs combined with the DnCNN front-end showed reduced ECE and Brier score, while CLAHE combined with DnCNN did not improve calibration. Overall, the results suggest that under patient-level evaluation, preprocessing gains are modest and configuration-dependent; the raw-input DenseNet121 baseline remains competitive throughout, and no tested preprocessing strategy produced a consistent discrimination advantage across all metrics.

Micro-ultrasound ($μ$US) is a new, emerging, and promising imaging modality for prostate cancer (PCa) detection, but accurate identification of suspicious tissue remains highly dependent on clinical experience, leading to substantial inter-observer variability. Machine-learning assistance can reduce this variability; however, training reliable deep models is challenging because supervision is sparse and noisy -- typically limited to core-level histopathology outcomes (e.g., cancer grade and its percentage in a biopsy core) without pixel-level lesion annotations and under severe class imbalance. We introduce Prost-RL, which reframes $μ$US PCa detection as a spatially aware, policy-driven inference problem by learning where to look before decoding. Prost-RL integrates a lightweight reinforcement-learning policy into a foundation-model encoder-decoder to generate interpretable spatial attention maps that act as soft prompts for both cancer-likelihood heatmap prediction and image-level classification. We further propose Adaptive Policy Optimization (APO) to stabilize hybrid supervised-RL training and a noise-robust objective combining symmetric cross-entropy with negative-entropy regularization to mitigate weak-label noise and encourage sharp localization. On a cohort of 6,607 biopsy cores from 693 patients across five clinical sites, Prost-RL achieves $79.0\pm3.5$ AUROC with $64.6\pm6.3$% sensitivity at 80% specificity for core-level detection (+2.1 AUROC and +4.5 sensitivity points over the strongest baseline), and $79.3\pm5.8$ AUROC for clinically significant cancer classification. The learned policy highlights biopsy-aligned regions, providing transparent, spatially grounded evidence alongside quantitative risk predictions. Code is available at: https://github.com/DeepRCL/Prost-RL.

Prototype-based medical image classifiers present three clinical limitations: they treat findings as independent, silently amplify unsafe physician feedback, and require full retraining whenever a new finding is needed. We present GRAPE (Graph-Augmented Prototype Explanations), a unified architecture that addresses all three challenges. First, a Graph Attention Task Head models anatomical concept co-occurrence, boosting macro-F1 by +13.8,pp over the prototype baseline on TBX11K. Second, a Concept-Mismatch Safety Check - the first such mechanism in prototype-based medical classifiers - warns when the model's dominant finding inside a doctor-drawn region conflicts with the claimed label, catching 85% of erroneous annotations versus 51% for MC-Dropout with no extra inference cost. Third, Open-Vocabulary Prototype Anchoring aligns visual prototypes to clinical text, allowing a new finding to be added from a single labeled image without modifying any other component. On NIH ChestX-ray14, one Effusion example recovers full-supervision localization accuracy; on TBX11K, prototype maps achieve 2.6x better lesion localization than end-to-end baselines. All three capabilities add only +1~ms latency at interactive batch size. The project page is https://github.com/KurbanIntelligenceLab/GRAPE.

Neurological disorders involve diverse pathologies of the brain and nervous system, making early and accurate detection essential. While many deep CNNs have been developed for MRI-based classification of neurological disorders, most are optimized for binary tasks and often fail to capture the multi-class features needed to distinguish subtle anatomical differences across conditions. This study proposes the Enhanced Neurological Disorder Detection Network (End-Net) for multi-class MRI classification of neurological disorders. End-Net includes 24 convolutional layers, beginning with convolutional blocks followed by 21 optimized inception modules. These modules extract multiscale features via parallel 1 x 1, 3 x 3, and factorized 5 x 5 convolutional branches, along with max pooling, enabling the model to capture complementary texture, edge, shape, and contextual information. A global average pooling head, compact fully connected classifier, and dropout reduce parameters, limit overfitting, and improve robustness. End-Net was evaluated on the Multi-Class Neurological Disorder dataset, comprising MRI scans from patients with Alzheimer's disease, brain tumors, multiple sclerosis, and healthy controls. Severe class imbalance was addressed by augmenting minority classes with WGAN-GP and randomly undersampling the majority class. The results show that End-Net outperforms existing architectures in both accuracy and generalization. The model is also integrated into an online system for real-time web-based inference and accessibility.

Jointly learning to segment and classify medical images demands cross-task synergy, yet encoder-sharing architectures limit decoder reconstruction to task-private representations, permanently discarding the boundary cues and semantic priors each branch could supply to the other. This work introduces BTI-Net, which establishes bidirectional communication at every decoder level through two parallel pathways via Task Interaction Modules (TIM). Spatial boundary context is gated into the classification branch, while global semantic priors multiplicatively modulate the decoder, with refined features propagating progressively from coarse semantics to fine boundary detail across all four decoder resolutions. Since cross-task interaction is not equally reliable for every input, Uncertainty Proxy Attention (UPA) gates each TIM output per instance and per level using three signals that capture cross-task alignment, scene complexity, and prediction confidence, without external annotations or additional inference passes. Experiments on three medical benchmarks spanning ultrasound, dermoscopy, and brain MRI demonstrate consistent improvements in segmentation IoU and classification accuracy over both encoder-sharing and decoder-interaction baselines. Ablation confirms adaptive gating contributes +2.36 IoU over fixed bidirectional interaction, and classification accuracy improves by up to +2.26 points over the strongest multi-task baseline. UPA's uncertainty proxies serve as reliable single-pass task-failure signals without the overhead of stochastic sampling. Code: https://github.com/C-loud-Nine/BTI-Net_MTL