Medical Imaging

Multimodal medical imaging fuses complementary anatomical and functional information, yet modalities frequently disagree in pathologically heterogeneous regions. Current segmentation models handle this in one of two inadequate ways: deterministic fusion that averages away disagreement, or post-hoc uncertainty estimation decoupled from the fusion process that produces it. Both obscure the clinically critical question: why is this prediction unreliable? We present EnTrust, a framework that treats inter-modal conflict as the primary source of predictive uncertainty. Our EnFuse module decomposes multimodal features into three disentangled components: shared anatomical consensus (F_c), modality-specific cues (F_{u,m}), and spatially localized conflict signals (F_{cf}), with independence enforced via a cross-covariance objective. This structured decomposition conditions SegDiff, a diffusion-based generative segmentation model whose sampled hypotheses diverge specifically in regions of modal disagreement. TrustMap then translates this hypothesis divergence into calibrated, pixel-wise uncertainty using ensemble entropy, conflict-guided perturbation probing, and a learned calibration head, enabling clinicians to understand not only where predictions are uncertain, but why. Across four benchmarks spanning brain, cardiac, lesion, and oncology domains, EnTrust achieves state-of-the-art segmentation accuracy while reducing calibration error by 40% compared to the strongest baseline. Notably, it outperforms 5x deep ensembles using a single model at roughly half the memory footprint. Code and checkpoints are available at https://github.com/GenMI-Lab/EnTrust.git.

Attention-based Multiple Instance Learning aggregators in medical imaging are prone to attention concentration, producing overconfident and unstable predictions. We introduce QG-MIL, a gated transformer aggregator that addresses this through four synergistic architectural components: RMSNorm-based pre-normalization, per-head QK normalization, fine-grained attention output gating, and SwiGLU-style feed-forward modules. Together, these design choices stabilize training and distribute attention more uniformly across instances without auxiliary losses, masking, or multi-stage regularization. We evaluate QG-MIL across six benchmarks spanning whole-slide pathology and cell-level hematology, covering two fundamentally different MIL scales. The best-performing QG-MIL variants outperform leading baselines on all six benchmarks, with an average improvement of +6.1 mean macro F1 points. Attention overlays and attention mass analysis confirm more distributed instance weighting. Ablation studies show that while individual components can match the full model on specific datasets, the QG-MIL design provides the most consistent cross-domain performance and tightest variance when compared to selected baselines. We release a configurable implementation to support reproducibility at: https://github.com/unica-visual-intelligence-lab/QG-MIL

Accurate segmentation of thin, tortuous anatomical structures, such as retinal vessels, cerebral vasculature, and facial wrinkles, remains challenging due to low contrast, frequent discontinuities, and severe class imbalance. Although recent convolutional and Transformer-based models have improved performance, they often yield fragmented predictions and fail to recover fine branches. We propose CSWinUNETR, a general-purpose backbone for 2D and 3D thin-structure segmentation. It employs cross-shaped stripe self-attention to model long-range principal-axis context and incorporates cyclic shifts to enhance information exchange across stripes. To better preserve fine-grained details, we further introduce a detail-enhanced multi-scale self-attention module that aggregates contextual features from multi-resolution representations. In addition, we propose sparse-control dynamic snake convolution, which reconstructs reliable dense curvilinear kernels from sparsely predicted control points to better follow tortuous geometry. Extensive experiments on four benchmarks across ophthalmology, neurovascular imaging, and dermatology demonstrate that CSWinUNETR consistently outperforms state-of-the-art methods without task-specific post-processing or topology-aware losses. The code is available at https://github.com/labhai/CSWinUNETR.

Artificial intelligence has driven rapid progress in medical imaging research, producing increasingly sophisticated algorithms and steady improvements on benchmark tasks. However, this algorithm-centric trajectory has also revealed a growing imbalance: while computational methods advance rapidly, the conceptual foundations that define imaging tasks, evaluation metrics, and clinical meaning sometimes remain underexamined. In this Perspective, we distinguish algorithmic innovation, which focuses on improving computational implementations and performance within a fixed problem definition, from conceptual innovation, which reframes what problems are posed, how success is measured, and why an approach is clinically relevant. We argue that prevailing incentive structures, training pathways, and publication norms disproportionately reward algorithmic novelty, particularly for early-career researchers, while at times undervaluing conceptual contributions that are essential for scientific maturation and clinical translation. Through representative examples from medical imaging AI, we show how insufficient conceptual grounding can lead to misaligned objectives, fragile generalization, and limited real-world impact. We conclude with actionable recommendations for researchers, mentors, reviewers, and journals to better recognize, support, and integrate conceptual innovation alongside algorithmic advances.

A vision-language model can answer a question about a medical image fluently and confidently while barely using the image, leaning instead on language priors. In medicine this is the failure that matters most, because the answer looks trustworthy and is not, and the only protection is a confidence score reliable enough to tell the system when to abstain. We ask a deployment question rather than an accuracy one: how much imaging work a model can safely handle alone, and which confidence signal makes that possible. We evaluate seven confidence estimators across five open-weight LVLMs and three medical visual-question-answering datasets spanning broad clinical imaging, radiology, and pathology, with every probe trained only on natural images and applied without adaptation. Recast as bounded selective prediction (automate a case only when confidence clears a threshold, defer the rest), the comparison is cautionary. The standard metrics are poor guides: discrimination barely separates the methods, and the weak calibration of a cheap self-report is cheaply removed by off-domain temperature scaling without changing deployable yield. What distinguishes a usable estimator is the high-confidence region a clinician acts on: the weakest baselines are confidently wrong on 41 to 45 percent of their errors against 1 to 4 percent for the best probe, and no estimator is reliably best across domains or models. Safe handoff is governed at two levels: base-model competence sets a ceiling, so a well-calibrated score recovers roughly a third of radiology cases at a 20 percent error tolerance but almost none of pathology; the confidence layer then decides how much of that ceiling is reachable. The usable role today is calibrated triage, not autonomy: automate the cases a calibrated score marks safe, route the rest to a clinician. We release all outputs, correctness judgments, and confidence scores, with code.

AI systems are being deployed across medical imaging faster than their failure modes are understood. At this point in time, the failure of greatest clinical concern is hallucination: clinically plausible but factually incorrect outputs, including fabricated anatomical structures, missed findings, incorrect laterality, and invented measurements in generated reports, with direct consequences, for example, for biopsy decisions, staging, and treatment planning. This structured narrative synthesizes peer-reviewed studies, benchmark datasets, and FDA regulatory guidance across five imaging modalities to produce a cross-modality analysis of hallucination taxonomy, etiology, detection, and mitigation. Specifically, we address three questions in this study: (1) how can existing taxonomies be unified across modalities?, (2) how do medical-specialized foundation models hallucinate less than general-purpose ones?, and (3) which mitigation strategies are effective and compatible with FDA lifecycle oversight? We note that three taxonomic frameworks together cover the imaging pipeline in a way no single framework does alone. We also highlight that general-purpose foundation models outperform medical-specialized models on hallucination-specific benchmarks, indicating that narrow domain fine-tuning can introduce overfitting-induced confabulation. At the same time, the oversight of radiologists remains essential; for instance, a very high percentage of of AI-generated flags required expert correction before clinical use. Physics-informed architectural constraints, Chain-of-Thought prompting, and human-in-the-loop safeguards each address different failure modes and is effective when combined. All findings are mapped to the FDA's Total Product Lifecycle and Predetermined Change Control Plan frameworks, which treat hallucination management as a lifecycle obligation rather than a pre-deployment checklist.

Large Vision-Language Models (LVLMs) have achieved strong performance across medical imaging tasks, yet they remain prone to factual inconsistencies, poor visual grounding, and misalignment with clinically meaningful feedback. Existing post-training alignment approaches, including Direct Preference Optimization (DPO) and its variants, face three critical limitations in the medical domain: (1) sequence-level reward signals treat clinically critical tokens identically to generic filler text; (2) reliance on static supervised fine-tuning references as preferred responses introduces an off-policy distribution shift, steering optimization toward stylistic artifacts over clinical correctness; and (3) alignment objectives lack explicit visual grounding constraints, leaving models insensitive to subtle yet diagnostically decisive pathological features. Our method leverages a bidirectional token-wise KL regularizer alongside a visual-contrastive grounding objective that pairs clean and lesion-corrupted images to penalize responses generated without adequate visual evidence. Together, these components form a fine-grained, on-policy alignment framework that constructs preference pairs by minimally editing model-generated outputs, correcting only clinically erroneous spans while preserving the original linguistic style. Extensive experiments across medical imaging tasks and clinical text generation benchmarks validate the effectiveness of our approach.

Modulation recognition systems rely on heterogeneous signal representations. 2D signal-image modalities such as time-frequency and cyclostationary maps capture structural patterns, while 1D statistical descriptors such as higher-order power spectra encode complementary cues. Under distribution shift, these modalities degrade unevenly, making robust fusion a central challenge for practical deployment. Progress is further limited by the lack of a unified evaluation protocol that systematically separates different shift types. This paper addresses both challenges through a joint benchmark-and-model study in underwater acoustic modulation recognition. UAMR-ShiftBench is the first benchmark to jointly cover in-distribution, low-SNR, unseen-environment, unseen-communication-parameter, and measured sea-trial evaluation under a single matched protocol, with two independent real-world subsets collected during two sea-trial campaigns conducted in March and November in the South China Sea. SCP-TriCA fuses STFT, cyclostationary, and P2/P4 (second- and fourth-order power spectra) modalities hierarchically: the two 2D modalities are first aligned through bidirectional cross-attention, and the 1D statistical modality is then incorporated through a sample-adaptive selective gate. On UAMR-ShiftBench, SCP-TriCA achieves 95.33% in-distribution accuracy and 74.59% simulated OOD average, outperforming the strongest baseline by 5.12 percentage points, and reaches 91.14% and 94.86% on the two sea-trial subsets, exceeding the best baseline by 15.71 and 23.00 percentage points respectively. Ablation results confirm that the gains stem from modality complementarity and the hierarchical fusion design. Code and models are available at https://github.com/ronglaiqian/UAMR-ShiftBench.

Medical image segmentation is often framed as a search for stronger architectures, but this can obscure a more fundamental question: what does the dataset require from the model? In medical imaging, this requirement is shaped by foreground occupancy, morphology, boundary ambiguity, topology sensitivity, annotation quality, acquisition variation, and operating point. This paper introduces the Medical Segmentation Dataset Knowledge Card (MS-DKC), a framework for making these factors explicit. MS-DKC records dataset evidence through image/acquisition, morphology, supervision, context-dependence, and deployment-risk descriptors. These descriptors are mapped to failure modes, design priors, and risk-aligned criteria, making segmentation design more traceable than architecture-first comparison. We evaluate MS-DKC on DRIVE, ISIC2018, and ACDC, representing distinct regimes. DRIVE contains sparse, thin, branching vessels, favoring detail-preserving models, sensitivity-aware optimization, threshold analysis, and topology-aware metrics. DKC-TNet-v2 achieved Dice 0.8044 and IoU 0.6730 with 35103 parameters, while SA-UNetv2-DKC-AmbRef reached Dice 0.8141, IoU 0.6865, sensitivity 0.8265, specificity 0.9804, and AUC 0.9853. ISIC2018 involves compact but appearance-variable lesions; validation-constrained score-function selection on Att-Next-Topo/ATTNext produced MS-DKC-AttNextTopo-VCSF-NoAug with Dice 0.8872, IoU 0.8214, precision 0.9173, Boundary F1 0.4878, and ASSD 4.13, while plausible additions failed to improve the risk-aligned profile. ACDC provides a multi-class cardiac case, where MS-DKC recommends four-class softmax segmentation, class-balanced Dice/CE supervision, and class-wise surface evaluation. Overall, the results support dataset-conditioned design: different datasets require different priors, operating points, and evidence before a model can be judged appropriate.

Breast cancer remains a leading cause of cancer-related mortality among women. Its clinical management requires multimodal reasoning across a clinical workflow that spans \textit{screening}, \textit{diagnosis} and \textit{treatment planning}, where each stage involves distinct imaging modalities, task objectives, and reasoning patterns. However, constrained by data scarcity and model versatility, existing medical MLLMs are typically evaluated on isolated modalities or narrow task families, limiting their ability to support workflow-level clinical reasoning. In this work, we first introduce \textbf{BreastStage}, a workflow-aligned breast imaging instruction corpus comprising 1.86M instruction-following pairs curated from 17 sub-datasets across 5 imaging modalities and 136 task templates. Its held-out split, \textbf{BreastStage-Bench}, provides a comprehensive benchmark for evaluating multimodal reasoning across the breast cancer care continuum. Building on this corpus, we propose \textbf{BreastGPT}, a unified MLLM equipped with a dual-branch visual encoder and concept-preserving token compression to bridge the scale gap between standard radiology and gigapixel pathology. On BreastStage-Bench, BreastGPT achieves 75.66% closed-ended accuracy and 89.92% open-ended score, outperforming both general-purpose and medical-specific MLLMs across clinical stages and task formats. These results suggest that workflow-aligned data and cross-scale visual modeling are critical for clinically grounded medical MLLMs. All data, code, and model checkpoints are released at https://yangyy-liu.github.io/BreastGPT.io.

Semantic segmentation in medical imaging is a critical yet challenging task due to data scarcity and high variability across modalities. While foundation models like the Segment Anything Model (SAM) show promise, they often struggle with medical images without specific adaptation. Moreover, point prompts, despite being the most natural form of user interaction, provide insufficient spatial context for reliable segmentation, particularly when target structures are irregular or poorly contrasted. In this paper, we propose an enhanced segmentation framework that integrates a lightweight Box Predictor module into the MedSAM architecture. The Box Predictor estimates an approximate bounding box from a single user click using localized image embedding features, providing spatial guidance that reduces the ambiguity of point prompts, while introducing only 1.6M additional parameters and negligible inference overhead. We introduce a two-stage training pipeline where the Box Predictor is trained independently before being integrated into MedSAM. To validate the generalization capability of our method, we conduct extensive evaluations on four diverse datasets (FLARE22, BRISC, BUSI, LungSegDB) spanning distinct imaging modalities, including CT, MRI, and Ultrasound. Our method improves segmentation accuracy and robustness across varied anatomical structures and imaging domains, achieving Dice scores of 0.89 (BUSI), 0.93 (FLARE22), 0.88 (BRISC), and 0.98 (LungSegDB). Code is available at https://github.com/Amirhosseinmovahedi/MedSAM-BoxPredictor

Measuring the angle between bone structures is a routine task in medical image analysis and provides a key quantitative parameter for diagnosis and treatment planning. Automated methods can reduce time and cost while improving reproducibility. In this work, we address automatic bone pose estimation using a learning-based point candidate proposal followed by a line model to extract axis parameters. Since conventional line models such as least squares are sensitive to outliers, we incorporate false-positive reduction strategies and robust fitting techniques, such as RANSAC and Hough transforms, to improve robustness. We evaluate our method on three clinically relevant paediatric angle estimation tasks: fracture fragment assessment in radiographs and ultrasound and developmental dysplasia of the hip evaluation in ultrasound using the Graf method. Our approach achieves mean errors of $4.1^\circ$, $5.4^\circ$, and $5.51^\circ$, respectively, not only remaining within the expected clinical observer variability, but also significantly outperforming landmark-based methods. Our code and annotations for fracture angle assessment in radiographs are publicly available on GitHub.

Self-supervised learning has enabled large-scale pre-training on 2D natural images, producing general-purpose visual representations that transfer effectively across tasks. However, many medical imaging modalities, such as CT scans, are inherently three-dimensional and differ fundamentally from natural images in both structure and semantics. Volumetric modalities capture spatial continuity, organ anatomy, and intensity-based tissue properties (e.g., Hounsfield Units), which are not adequately modeled by 2D pre-training. To bridge this gap, we introduce CoralBay, a self-distillation framework that extends DINO by using a hierarchical 3D Swin backbone and applying self-distillation to concatenated multi-scale features, enabling data-efficient self-supervised learning of rich spatial representations that encode both global semantics and fine-grained local structure. As a result, CoralBay transfers effectively to a wide range of downstream radiological tasks, demonstrating strong and consistent performance across diverse anatomical targets. In addition, we contribute to the open-source \eva framework by introducing a public, reproducible 3D radiology leaderboard that unifies multiple datasets and establishes a standardized benchmark for evaluating volumetric representation learning methods.

Entropy minimization (EM) is the dominant objective for test-time adaptation, yet its failure mode, model collapse, remains poorly understood. In this work, we show that distribution shifts can cause feature clusters corresponding to distinct classes in the model's representation space to merge, while the decision boundary remains fixed. This induces a systematic skew in the predicted class distribution, referred to as prediction bias. Prediction bias refers to a shift in the predicted class distribution, with some classes overrepresented and others suppressed. We show that entropy minimization amplifies this prediction bias by tightening the existing clusters, reinforcing the incorrect groupings until all predictions collapse to a trivial solution. Next, to demonstrate the significance of prediction bias and mitigate it, we further propose Distribution Shift Bias Reduction (DSBR), a bias-correcting objective that specifically targets this failure mode by equalizing the contribution of each predicted class to the unsupervised entropy minimization loss. To study this failure mode, we design suitable adaptation settings using four medical-imaging datasets and additionally evaluate on ImageNet-C. We find that DSBR consistently stabilizes test-time adaptation, prevents model collapse, and matches or outperforms state-of-the-art methods. Moreover, DSBR operates solely at test-time.

Generative models for volumetric medical images have found many applications in medical imaging, ranging from data augmentation to serving as priors for inverse problems. For these applications, generating high-resolution 3D images with strong controllability is essential but remains highly challenging. Existing approaches typically control generation either through radiology reports used as text prompts or through full image segmentation. While text-based prompting is flexible, it provides limited spatial control over the location, shape, and boundary of abnormalities. In contrast, segmentation-based methods receive precise spatial guidance but are restrictive in requiring full-organ annotations. In this work, we propose a flexible multimodal framework for controllable volumetric image generation that supports input from radiology reports and segmentation prompts (both optional). Our approach allows users to provide segmentation of a specific anatomy or abnormality without requiring full-organ annotations. The semantic meaning of the segmentation mask is specified through an accompanying text description, resulting in a highly flexible and scalable conditioning mechanism. We develop a memory-efficient architecture based on a modified diffusion transformer that jointly processes image and segmentation tokens. The model further incorporates gated attention to effectively attend to long radiology reports. Experiments demonstrate that our method achieves state-of-the-art perceptual and semantic scores (e.g., 24% relative improvement in mean FID), generates high-resolution anatomically consistent CT volumes, and improves data efficiency when used for data augmentation. Radiologists' evaluation further confirms strong alignment between generated and real medical images.

Accurate brain tumor classification from magnetic resonance imaging (MRI) is a key requirement for early diagnosis and clinical decision-making. Vision Transformers (ViTs) have shown strong performance in medical image analysis by learning global contextual representations, but they often fail to capture intrinsic structural and topological patterns present in tumor regions. To address this limitation, we propose a fusion framework that combines Topological Data Analysis (TDA) features with pretrained Vision Transformer representations for four-class brain tumor classification. In the proposed method, TDA is used to extract complementary topological descriptors that capture geometric structure, connectivity, and shape information from MRI images. In parallel, a pretrained ViT model learns high-level semantic representations from the same images. These two feature spaces are then fused to form a unified and more discriminative representation for classification. The model is evaluated on the BRISC2025 dataset, which contains four brain tumor classes: glioma, meningioma, pituitary tumor, and non-tumor cases. Experimental results show that combining topological and transformer-based features significantly improves performance compared to using either approach alone. The proposed TDA-ViT fusion model achieves an accuracy of 99.10%, precision of 99.27%, recall of 99.15%, F1-score of 99.21%, and an AUC of 99.98%. It also outperforms several state-of-the-art models, including ResNet50, ResNet101, EfficientNetB2, and standalone Vision Transformers. These results demonstrate that topological features provide valuable complementary information that enhances deep representation learning, leading to a robust and highly accurate framework for automated brain tumor classification.

Compact Vision Transformers are attractive for medical imaging in low-data and resource-constrained settings, but most existing variants assume that Euclidean latent geometry is sufficient for organizing image representations. We introduce hZACH-ViT, a family of curved-geometry extensions of ZACH-ViT, a compact zero-token Vision Transformer that removes positional embeddings and the class token and relies on global average pooling over patch representations. To isolate the role of geometry, we preserve the verified ZACH-ViT backbone and modify only the final representation space and prototype-based classifier head, enabling a controlled comparison between Euclidean, hyperbolic, and spherical latent geometries. We evaluate Poincaré, Klein, and spherical hZACH-ViT heads on seven MedMNIST datasets under an identical few-shot protocol with 50 samples per class and five random seeds. The completed benchmark contains 770 training runs spanning seven datasets, three non-Euclidean geometries, seven curvature magnitudes, and a Euclidean baseline. Across all seven datasets, the best non-Euclidean hZACH-ViT configuration improves over Euclidean ZACH-ViT, with an average gain of +0.021 in the dataset-specific primary metric and the largest improvement on OCTMNIST (+0.055 MacroF1). Fixed low-curvature configurations retain positive gains on the majority of datasets, and low curvature values (c = 0.1 or 0.2) account for six of the seven dataset-level winners. Rather than identifying a universally optimal manifold, our results establish geometry and curvature as dataset-dependent model-selection variables, with fixed low-curvature analyses confirming that gains persist beyond exhaustive per-dataset tuning.

Multi-omics data provide complementary molecular characterizations of disease phenotypes and play an important role in disease diagnosis and subtype classification in precision medicine. However, acquiring complete multi-omics profiles is expensive and time-consuming, while most existing deep learning methods assume full modality availability during inference, resulting in substantial redundancy and limited practicality in clinical settings. To address this issue, we propose SDM-Q, a reinforcement learning framework for adaptive and cost-aware multi-omics classification. Specifically, multi-omics diagnosis is reformulated as a finite-horizon sequential decision problem, where the currently acquired omics modalities define the diagnostic state at each stage. An action--value function determines whether to acquire an additional modality or terminate the decision process and output the final prediction. To balance diagnostic utility and acquisition cost, the reward is defined only at the terminal stage and jointly determined by classification correctness and cumulative modality acquisition cost. A backward stage-wise optimization strategy is introduced to improve policy consistency and training stability. Experiments on four public multi-omics datasets, including ROSMAP, LGG, BRCA, and KIPAN, demonstrate that SDM-Q effectively reduces redundant modality acquisition while maintaining competitive classification performance compared with methods using complete multi-omics inputs. In the BRCA and KIPAN datasets, more than 99% and 95% of subjects, respectively, achieve accurate classification using only a single omics modality, while the average number of acquired modalities remains below two for ROSMAP and LGG. These results suggest that cost-aware sequential decision-making provides an effective paradigm for improving the efficiency of precision medicine workflows.

Medical image analysis models can exhibit performance disparities across patient subgroups, threatening clinical safety and fairness. Existing methods typically address this issue by optimizing accuracy and fairness metrics for visible demographic attributes (e.g., sex or age) considered in isolation. This strategy not only overlooks potentially more informative latent stratifications, which may reveal deeper sources of model error and inequity, but also fails to scale when multiple demographic attributes are considered simultaneously due to the resulting sparsity of training data within each subgroup. We deal with these issues by introducing the label-free hidden-cohort fairness (LHCF) training paradigm that instead of maximizing fairness over visible demographic attributes, it optimizes fairness across latent subpopulations discovered from image appearance. By clustering images into K appearance-based cohorts and applying fairness optimization over them, LHCF uncovers underlying sources of model error and avoids the combinatorial sparsity of multi-demographic attributes, reducing disparities across both single and multiple demographic attributes. We demonstrate on our proposed fairness benchmark, HIDFairBench, that LHCF provides state-of-the-art fairness results on single and multiple demographic attributes, despite never using demographic labels for training. Our results position hidden-cohort fairness as a practical, scalable, and robust alternative to demographic-based fairness optimization for trustworthy medical image analysis.

Task-based assessment of image quality (IQ) is critically important for the design and optimization of medical imaging systems. Ideal observers, including the Bayesian Ideal Observer (IO) and the ideal linear observer, i.e., the Hotelling observer (HO), provide objective figures of merit (FOMs) that quantify system performance on signal detection tasks. However, the application of ideal observers to high-dimensional image data is often computationally intractable. Channel mechanisms provide an effective framework for dimensionality reduction that can facilitate the computation of ideal observers. This work presents a conjugate gradient (CG)-based method to construct efficient channels for approximating the IO and HO performance.

Masked autoencoders (MAE) have shown great promise in medical image classification. However, the random masking strategy employed by traditional MAEs may overlook critical areas in medical images, where even subtle changes can indicate disease. To address this limitation, we propose a novel approach that utilizes a multifractal measure (Renyi entropy) to optimize the masking strategy. Our method, termed Multifractal-Optimized Masked Autoencoder (MO-MAE), employs a multifractal analysis to identify regions of high complexity and information content. By focusing the masking process on these areas, MO-MAE ensures that the model learns to reconstruct the most diagnostically relevant features. This approach is particularly beneficial for medical imaging, where fine-grained inspection of tissue structures is crucial for accurate diagnosis. We evaluate MO-MAE on several medical datasets covering various diseases, including MedMNIST and COVID-CT. Our results demonstrate that MO-MAE achieves promising performance, surpassing other basiline and state-of-the-art models. The proposed method also adds minimum computational overhead as the computation of the proposed measure is straightforward. Our findings suggest that the multifractal-optimized masking strategy enhances the model's ability to capture and reconstruct complex tissue structures, leading to more accurate and efficient medical image representation. The proposed MO-MAE framework offers a promising direction for improving the accuracy and efficiency of deep learning models in medical image analysis, potentially advancing the field of computer-aided diagnosis.

In biomedical and neurodegenerative disorders, accurate and early disease identification remains challenging due to the scarcity of labeled data and the complexity of imaging patterns. To address these challenges, we introduce ARMA-C3, a unified unsupervised and semi-supervised graph learning framework for node classification based on contrastive learning and graph-cut regularization to learn structurally meaningful and discriminative representations. By modeling samples or images as graph nodes and exploiting inter-sample relationships, the proposed framework captures subject-level dependencies that conventional machine learning methods typically overlook. We conduct extensive binary classification experiments across five clinically relevant datasets: the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Neuroimaging in Frontotemporal Dementia (NIFD) dataset, and three medical imaging benchmarks (BreastMNIST, PneumoniaMNIST, and a liver ultrasound dataset). Experimental results demonstrate that ARMA-C3 achieves competitive and frequently superior performance compared to classical clustering techniques, state-of-the-art machine learning models, and existing graph-based deep learning approaches across multiple evaluation settings, particularly under limited supervision and severe class imbalance. The proposed framework further demonstrates robust representation learning and strong cross-modal generalization across diverse biomedical imaging modalities.

Vision Transformer (ViT) models, utilizing self-attention mechanisms, have demonstrated robust generalization capabilities across various vision tasks, including image classification. However, these models, typically pretrained on general public datasets, often lack the specialized domain knowledge necessary for medical imaging applications. In this study, we investigate the adaptation of ViT models, specifically for cardiac magnetic resonance (MR) images, using an in-house dataset. We found that pretrained ViT features do not effectively transfer to the cardiac MR domain. To overcome this limitation, we introduce an adaptation strategy that utilizes image-based self-supervised contrastive learning, demonstrating superior performance compared to traditional supervised training approaches. Moreover, our adapted ViT model exhibits strong generalization to external MR datasets such as BraTS and ADNI. Through ablation studies, we further investigate the impact of batch size and dataset scale on performance. Ultimately, our adapted model achieves classification AUC exceeding 0.75 across the four most common cardiac MR sequences.

Federated learning is used in medical imaging where privacy prohibits centralizing data. Standard federated algorithms assume homogeneous hardware, identical architectures, and centralized aggregation, which fails when hospitals have unequal compute resources. We propose capacity-aware coordination: measure each hospital's throughput, assign capacity-appropriate architectures (MobileNetV3-Small, EfficientNet-B0, ResNet-50), and combine predictions via weighted ensemble. Weak and strong hospitals can participate without forcing uniform architectures. We separate on-chain policy from off-chain learning. A Solidity contract stores hospital registration, benchmark hashes, metrics, and weights. Hospitals train locally and submit only hashes and scalars (not parameters). Weighted ensemble inference is computed off-chain. Experiments on PneumoniaMNIST and DermaMNIST (5 seeds, 3 non-IID levels) show our method achieves lower or equal calibration error versus equal-weight ensemble and competitive accuracy versus FedAvg, FedProx, and FedMD. Communication overhead is 224 bytes per round, a reduction of over 912,000x compared to FedAvg.

Deep learning models have shown strong performance in medical image analysis, but deploying them in low-resource clinical environments remains difficult due to computational, memory, and power constraints. This paper presents a multi-strategy compression framework for brain tumor classification from MRI, encompassing quantization-aware training, knowledge distillation from a DenseNet-101 teacher to a compact DenseNet-32 student with low-bit post-training quantization, and Float16 post-training quantization on a lightweight MobileNetV2 backbone. Using a multi-class brain tumor MRI dataset containing glioma, meningioma, pituitary tumors, and healthy controls, we provide full experimental validation of the MobileNetV2-based pipeline, training the classifier through a three-stage transfer learning process and applying Float16 quantization via TensorFlow Lite. The DenseNet-based distillation and quantization-aware training strategies are described as complementary compression approaches within the framework, with their complete empirical evaluation reserved for future work. Experimental results on the MobileNetV2 pipeline show that the quantized model achieves 82.37 percent validation accuracy compared to the 82.20 percent full-precision baseline, reducing model size from 35.34 MB to 5.76 MB, a 6.14x compression ratio with no meaningful accuracy loss. Per-class evaluation confirms that quantization preserves diagnostic performance uniformly across all four tumor categories. These findings demonstrate that lightweight quantized models can deliver clinically viable brain tumor screening in resource-constrained healthcare settings.

Medical foundation models have achieved remarkable clinical performance, yet their robustness under real-world perturbations remains underexplored. We present a robustness benchmark comprising 40 perturbation types (12 base, 28 medical-specific) across eight imaging modalities, evaluating five VLMs (LLaVA-Med, MedGemma, MedGemma-1.5, Gemini-2.5-flash and GPT-4o-mini) on VQA, visual grounding, and captioning, alongside two segmentation models (MedSAM, SAM-Med2D) with five fine-tuning strategies. Our findings reveal: (1) Fine-tuning strategy dominates robustness, with LoRA exhibiting nearly double the degradation of full fine-tuning, while SAM-Med2D's Adapter offers favorable efficiency-robustness trade-off. (2) Medical-specific perturbations disproportionately damage segmentation, with 9 of 15 top corruptions being domain-specific. (3) LoRA-tuned visual grounding drops over 40 points, whereas zero-shot captioning remains stable (<7% drop). Zero-shot VQA shows model-dependent robustness--medical models drop under 20% while Gemini-2.5-flash drops 54%. General-purpose VLMs achieve higher VQA accuracy but fail on grounding; among medical VLMs, MedGemma demonstrates the best overall stability. These results provide deployment guidelines and underscore the necessity of domain-specific robustness evaluation for medical AI. Our code is available at: https://abnerai.github.io/MedFM-Robust.

Self-supervised learning (SSL) is increasingly used in medical image analysis to reduce dependence on costly expert annotations by learning transferable representations from unlabeled data. However, SSL performance depends not only on model architecture, but also on whether the pretext task preserves information required by the downstream clinical objective. This review presents a task-oriented synthesis of SSL methods for medical imaging, focusing on how pretext-task design interacts with imaging modality, label availability, and downstream performance. We analyze 75 studies published from 2017 to 2025 and organize them into four paradigms: contrastive learning, non-contrastive and predictive learning, generative and reconstruction-based learning, and hybrid learning. Rather than cataloging methods chronologically, we examine how these paradigms support classification, segmentation, detection, reconstruction, and regression. The evidence suggests that no SSL strategy is universally optimal. Contrastive objectives generally encourage global discriminative representations and are well aligned with classification, but may underrepresent subtle or localized pathology. Spatial prediction, masked modeling, and reconstruction-based objectives better preserve anatomical structure and are often more suitable for segmentation and dense prediction. Hybrid methods can provide balanced representations, although they increase training complexity. Across modalities, SSL is most beneficial in low-label and few-shot regimes, but its effectiveness depends on modality-aware augmentation, pathology-preserving corruption, and clinically meaningful evaluation. We conclude with practical design guidelines and identify open challenges, including pathology-aware pretext tasks, resource-efficient training for high-dimensional data, and standardized evaluation protocols.

Vision-Language Models (VLMs) facilitate medical visual question answering (MedVQA) by jointly interpreting images and text. However, existing models typically depend on large architectures and closed-set answers, which limits their efficiency and potential clinical applicability. To overcome these shortcomings, we introduce RoiMAM, an efficient VLM. It integrates a training-free ROI Generation Module with Semantic Selective Suppression to focus on lesion-relevant regions, alongside a Text Prompt Enhancer module that provides modality-specific context without introducing training parameters. Compared to the widely used MedVInT-TD model, our design achieves efficient and accurate diagnosis at less than 20% of the model size, while improving accuracy by approximately 2% on SLAKE and 4.6% on PMC-VQA.

Self-supervised pre-training methods in medical imaging typically treat each individual as an isolated instance, learning representations through augmentation-based objectives or masked reconstruction. They often do not adequately capitalize on a key characteristic of physiological features: anatomical structures maintain consistent spatial relationships across individuals (instances), such as the thalamus being medial to the basal ganglia, regardless of variations in brain size, shape, or pathology. We propose leveraging this cross-instance topological consistency as a supervisory signal. The challenge arises from the inherent variability in medical imaging, which can differ significantly across instances and modalities. To tackle this, we focus on two alignment regimes. (i) Intra-instance: with pixel-level correspondences available, a cross-modal triplet objective explicitly preserves local neighborhood topology. (ii) Inter-instance: without such supervision, we derive pseudo-correspondences to control partial neighborhood alignment and prevent topology collapse across modalities. We validate our approach across 7 downstream multi-modal tasks, achieving average improvements of 1.1% and 5.94% in segmentation and classification tasks, respectively, and demonstrating significantly better robustness when modalities are missing at test time.

Feature sharing via split inference offers a lightweight alternative to federated learning for resource-constrained hospitals, but transmitted features still leak patient identity information and lack practical mechanisms for controlled feature sharing. We propose Keyed Nonlinear Transform (KNT), a drop-in feature transformation that applies key-conditioned obfuscation to intermediate representations. KNT reduces re-identification AUC from 0.635 to 0.586, corresponding to a 36% reduction in above-chance identity signal, while introducing only 0.15 ms CPU overhead, without backbone retraining, and preserving classification performance within 1.0 pp. Our analysis shows that KNT's nonlinear transform prevents closed-form inversion and shifts recovery to iterative gradient-based optimization under full key compromise, substantially increasing inversion difficulty. The same transform generalizes to dense prediction tasks, incurring only a 4.4 pp Dice reduction on skin-lesion segmentation without retraining. These results position KNT as a practical and efficient privacy layer for split inference deployments.

Medical image-to-image (I2I) translation enables virtual scanning, i.e. the synthesis of a target imaging modality from a source one without additional acquisitions. Despite growing interest, most proposed methods operate on 2D slices, are evaluated on isolated tasks with different experimental set-ups and lack clinical validation. The primary contribution of this work is a reproducible, standardized comparative evaluation of 3D I2I translation methods in oncological imaging, designed to standardize preprocessing, splitting, inference, and multi-level evaluation across heterogeneous clinical tasks. Within this framework, we compare seven generative models, three Generative Adversarial Networks (GANs: Pix2Pix, CycleGAN, SRGAN) and four latent generative models (Latent Diffusion Model, Latent Diffusion Model+ControlNet, Brownian Bridge, Flow Matching), across eleven datasets spanning three anatomical regions (head/neck, lung, pelvis) and four translation directions (cone-beam CT to CT, MRI to CT, CT to PET, MRI T2-weighted to T2-FLAIR), for a total of 77 experiments under uniform training, inference, and evaluation conditions. The results show that GANs outperform latent generative models across all tasks, with SRGAN achieving statistically significant superiority. Our lesion-level analysis reveals that all models struggle with small lesions and that, in CT to PET synthesis, models reproduce lesion shape more reliably than absolute uptake-related intensity. We also performed a Visual Turing test administered to 17 physicians, including 15 radiologists, which shows near-chance classification accuracy (56.7%), confirming that synthetic volumes are largely indistinguishable from real acquisitions, while exposing a dissociation between quantitative metrics and clinical preference.

Zero-shot anomaly detection aims to identify defects in unseen categories without target-specific training. Existing methods usually apply the same feature transformation to all samples, treating normal and anomalous data uniformly despite their fundamentally asymmetric distributions, compact normals versus diverse anomalies. We instead exploit this natural asymmetry by proposing AVA-DINO, an anomaly-aware vision-language adaptation framework with dual specialized branches for normal and anomalous patterns that adapt frozen DINOv3 visual features. During training on auxiliary data, the two branches are learned jointly with a text-guided routing mechanism and explicit routing regularization that encourages branch specialization. At test time, only the input image and fixed, predefined language descriptions are used to dynamically combine the two branches, enabling an asymmetric activation. This design prevents degenerate uniform routing and allows context-specific feature transformations. Experiments across nine industrial and medical benchmarks demonstrate state-of-the-art performance, achieving 93.5% image-AUROC on MVTec-AD and strong cross-domain generalization to medical imaging without domain-specific fine-tuning. https://github.com/aqeeelmirza/AVA-DINO

We propose a novel spectral vision transformer architecture for efficient tokenization in limited data, with an emphasis on medical imaging. We outline convenient theoretical properties arising from the choice of basis including spatial invariance and optimal signal-to-noise ratio. We show reduced complexity arising from the spectral projection compared to spatial vision transformers. We show equitable or superior performance with a reduced number of parameters as compared to a variety of models including compact and standard vision transformers, convolutional neural networks with attention, shifted window transformers, multi-layer perceptrons, and logistic regression. We include simulated, public, and clinical data in our analysis and release our code at: \verb+github.com/agr78/spectralViT+.

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

Deep learning models in medical imaging often fail when deployed in new clinical environments due to distribution shifts in demographics, scanner hardware, or acquisition protocols. A central challenge is underspecification, where models with similar validation performance exhibit divergent real-world failure modes. Although stress testing has emerged as a tool to assess this, current methods typically rely on simple, uninformed perturbations (e.g., brightness or contrast changes), which fail to capture clinically realistic variation and can overestimate robustness. In this work, we introduce a counterfactual stress testing framework based on causal generative models that create realistic "what if" images by intervening on attributes such as scanner type and patient sex while preserving anatomical identity, enabling controlled and semantically meaningful evaluation under targeted distribution shifts. Across two imaging modalities (chest X-ray and mammography), three model architectures, and multiple shift scenarios, we show that counterfactual stress tests provide a substantially more accurate proxy for real out-of-distribution performance than classical perturbations, capturing the direction and relative magnitude of performance changes as well as model ranking. These results suggest that causal generative models can serve as practical simulators for robustness assessment, offering a more reliable basis for evaluating medical AI systems prior to deployment.

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

Large vision-language models (VLMs) demonstrate strong performance in medical image understanding, but frequently generate clinically plausible yet incorrect statements, raising significant safety concerns. Existing medical hallucination benchmarks primarily focus on 2D imaging with one-shot diagnostic questions, offering limited insight into whether predictions are grounded in correct localization and abnormality identification, allowing critical reasoning errors to remain hidden behind seemingly correct diagnoses. We introduce Med-StepBench, the first large-scale benchmark for step-wise hallucination detection in 3D oncological PET/CT, comprising over 12,000 images and more than 1,000,000 image-statement pairs across volumetric and multi-view 2D data, which decomposes clinical reasoning into four expert-designed diagnostic stages. Using clinician-verified annotations, we perform the first step-level evaluation of general-purpose and medical VLMs, revealing systematic failure modes obscured by aggregate accuracy metrics. Furthermore, we show that current VLMs are highly susceptible to adversarial yet clinically plausible intermediate explanations, which significantly amplify hallucinations despite contradictory visual evidence. Together, our findings highlight fundamental limitations in grounding multi-step clinical reasoning and establish Med-StepBench as a rigorous benchmark for developing safer and more reliable medical VLMs.

Multi-modal medical imaging enables comprehensive diagnostics, yet current foundation models process 2D (e.g. X-ray) and 3D (e.g. CT) data with separate, dimensionality-specific architectures. We present MultiMedVision, a unified framework for joint 2D/3D representation learning built on a Sparse Vision Transformer. Our model uses 3D Rotary Positional Embeddings and variable-length sequence packing to process mixed-modality batches natively within a shared latent space, without modality-specific adapters or treating 3D volumes as 2D slice sequences. Trained with a self-supervised objective on chest X-rays (MIMIC-CXR) and CT scans (CT-RATE), and using a single shared encoder with 5x less data, MultiMedVision achieves competitive performance on both 2D benchmarks (Macro AUROC 0.82 on MIMIC, 0.84 on CheXpert) and 3D tasks (0.85 on CT-RATE). Analysis of the learned representations reveals coexisting modality-specific and shared feature subspaces, demonstrating that unified cross-dimensional representation learning is feasible without sacrificing modality-specific performance.

Federated learning enables hospitals to collaboratively train segmentation models without sharing patient data. However, current evaluation protocols report only average performance across clients, masking failures at individual sites. In clinical deployment, a model that fails consistently at one hospital is a real safety risk that a good mean score can hide entirely. We introduce MedFL-Stress, a controlled stress-testing framework that exposes exactly this failure mode. Using 2D axial slices from BraTS 2020 distributed across four simulated hospital clients, we apply graded MRI appearance shifts (gamma contrast, scale-shift, and noise-plus-blur) reflecting scanner and acquisition variability in real multi-site deployments. Three federated baselines are evaluated: FedAvg, FedProx, and FedBN. Worst-hospital Dice and inter-hospital disparity are treated as primary metrics, not supplementary observations. FedAvg achieves the highest global mean Dice (0.8159) but conceals a 0.0850 gap between its best and worst-performing hospital. FedBN closes that gap by 41% (0.0850 to 0.0503) while sacrificing less than half a Dice point in mean accuracy (0.8159 to 0.8109), and the weakest hospital gains 3.5 Dice points outright (0.7309 to 0.7656). These findings demonstrate that robustness-oriented evaluation protocols are essential for reliable federated medical imaging deployment.

Body composition assessment (BCA) provides detailed information about the distribution of different tissue types in the body, enabling more precise characterization of individuals than BMI or weight alone. Consistent and frequent BCA would be valuable for personalized medicine, but the gold standard methods for BCA, such as CT and MRI, are only practical for opportunistic monitoring of patients with clinical indications for imaging and are not suitable for routine use in the general population. Here, we consider an imaging modality which is not currently used in medical applications: millimeter wave (mmWave) radar. Commonly used in security settings, mmWave scans enable fast, non-intrusive, and privacy-preserving reconstruction of full body shape without the need to remove clothing. To demonstrate the feasibility of fast and convenient BCA from mmWave scans, we present a method for BCA value regression using a multi-task learning strategy that leverages synthetic mmWave-like point clouds derived from clinical imaging and parametric human models. We evaluate the model on a pilot cohort of real mmWave scans with bioimpedance-derived body fat measurements, supporting the feasibility of estimating VAT and body fat percentage (BFP) from mmWave data acquired through clothing in a standing posture. We find that the model can predict VAT and BFP with a mean absolute error of 1.0 L and 3.2%, respectively, demonstrating the potential of mmWave scanning for routine BCA in a wide range of settings.

Vision foundation models are increasingly moving beyond 2D to volumetric domains such as 3D medical imaging, where unified pretraining across different imaging modalities (i.e. CT, MRI, and PET) could provide foundational models for diverse clinical tasks. However, training such models requires mixing heterogeneous imaging domains, and current mixture strategies remain largely heuristic. In this work, we observe that different medical imaging domains scale at variable rates during pretraining, and knowledge transfer between domains is strongly asymmetric: training on one domain can substantially improve another, but the reverse may be much weaker. Interestingly, both MAE reconstruction loss and cross-domain transfer follow predictable power-law trends with domain-specific behaviors. Motivated by these findings, we formulate data allocation as a scaling-law optimization problem. The derived allocations reveal an interpretable hub-and-island structure: highly transferable domains emerge as hubs that benefit many others and deserve strategic allocation, while isolated domains act as islands requiring direct investment. Empirically, transfer-aware allocation outperforms data-proportional sampling by up to 58% and generalizes well to unseen budgets with r=0.989. Downstream validation on disease classification and organ/lesion segmentation further confirms that the derived transfer-aware mixtures provide stronger pretrained representations for clinical 3D medical imaging tasks.

The opaque nature of deep learning models remains a significant barrier to their clinical adoption in medical imaging. This paper presents a multimodal explainability framework that bridges the gap between convolutional neural network (CNN) predictions and clinically actionable insights for brain tumor classification, leveraging large language models (LLMs) to deliver human-interpretable diagnostic narratives. The proposed framework operates through three coupled stages. First, nine CNN architectures are extended with a dual-output hybrid formulation that simultaneously optimises a classification head and a segmentation head, enabling spatially richer feature learning. Second, visual saliency attribution methods, namely Grad-CAM, Grad-CAM++, and ScoreCAM, are applied to generate class-discriminative heatmaps, which are subsequently refined into binary tumor masks via an adaptive percentile thresholding pipeline. Third, the resulting masks are mapped onto the Harvard-Oxford cortical atlas to translate pixel-level evidence into named neuroanatomical structures, and the extracted findings are encoded into a structured JSON file that conditions three LLMs (Grok3, Mistral, and LLaMA) to generate coherent, radiological-style diagnostic reports. Evaluated on a dataset of 4,834 contrast-enhanced T1-weighted brain MRI images spanning three tumor classes, InceptionResNetV2 achieved the highest classification performance and Grad-CAM++ yielded the best segmentation overlap. Among the language models, Grok3 led in lexical diversity and coherence, while LLaMA achieved the highest readability score. By integrating visual, anatomical, and linguistic modalities into a unified pipeline, the framework produces explanations that are technically grounded and meaningfully interpretable, advancing the transparency and clinical accountability of artificial intelligence assisted brain tumor diagnosis.

Addressing missing modalities is an important challenge in multimodal image analysis and often relies on complex architectures that do not transfer easily to different datasets without architectural modifications or hyperparameter tuning. While most existing methods tackle this problem in feature space by engineering representations that are robust to missing inputs, we instead operate in weight space. We propose LARGO, a hypernetwork that compresses the $2^N-1$ dedicated missing-modality models into a single network by modelling the convolutional weights using the Canonical Polyadic (CP) tensor decomposition. Extensive experimental validation on BraTS 2018 (4 modalities, 15 scenarios) and ISLES 2022 (3 modalities, 7 scenarios) shows that our method ranks first in 47 out of 52 configurations, achieving average Dice improvements of +0.68$\%$ and +2.53$\%$ over state-of-the-art baselines (mmFormer, M$^{3}$AE, ShaSpec, SimMLM). A proof-of-concept experiment on avMNIST suggests that LARGO may extend beyond medical imaging to heterogeneous non-medical modalities.

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

Anomaly detection in medical images is a challenging task, since anomalies are not typically available during training. Recent methods leverage a single pretext task coupled with a large-scale pre-trained model to reach state-of-the-art performance. Instead, we propose to learn multiple self-supervised and pseudo-labeling tasks from scratch, using a joint model based on Mixture-of-Experts (MoE). By carefully integrating multiple proxy tasks, the joint model effectively learns a robust representation of normal anatomical structures, so that anomaly scores can be derived based on how well the multi-task learner (MTL) solves each task during inference. We perform comprehensive experiments on BMAD, a recent benchmark that comprises a broad range of medical image modalities. The empirical results indicate that our multi-task learner is an effective anomaly detector, outperforming all state-of-the-art competitors on BMAD. Moreover, our model produces interpretable anomaly maps, potentially helping physicians in providing more accurate diagnoses.

Zero-shot anomaly localisation via vision-language models (VLMs) offers a compelling approach for rare pathology detection, yet its performance is fundamentally limited by the absence of healthy anatomical context. We reformulate zero-shot localisation as a comparative inference problem in which anomalies are identified through structured comparison against reference distributions of normal anatomy. We introduce WALDO, a training-free framework grounded in optimal transport theory that enables comparative reasoning through: (i) entropy-weighted Sliced Wasserstein distances for anatomically-aware reference selection from DINOv2 patch distributions, (ii) Goldilocks zone sampling exploiting the non-monotonic relationship between reference similarity and localisation accuracy, and (iii) self-consistency aggregation via weighted non-maximum suppression. We theoretically analyse the Goldilocks effect through distributional divergence, and show that references with moderate similarity minimize a bias-variance trade-off in comparative visual reasoning. On the NOVA brain MRI benchmark, WALDO with Qwen2.5-VL-72B achieves $43.5_{\pm1.6}\%$ mAP@30 (95% CI: [40.4, 46.7]), representing a 19% relative improvement over zero-shot baselines. Cross-model evaluation shows consistent gains: GPT-4o achieves $32.0_{\pm6.5}\%$ and Qwen3-VL-32B achieves $32.0_{\pm6.6}\%$ mAP@30. Paired McNemar tests confirm statistical significance ($p<0.01$). Source code is available at https://github.com/bkainz/WALDO_MICCAI26_demo .

Ascription of an image gives insights into the objects that influence the classification of the whole image or its pixels towards a specific category. These insights help radiologists to visualize deformities in medical imaging. Most of the existing visualization techniques are based on discriminative models and highlight regions of the input image participating in the decision-making of a classifier. However, these approaches do not take all noticeable objects into account as their objective is to classify the input by using a minimal set of discriminative features. To overcome the issue, a counterfactual explanation (CX) based class-oriented feature attribution method is proposed. A counterfactual explanation (CX) explicates a causal reasoning process of the form: "if X had not happened, then Y would not have happened". The method is built on generative adversarial networks (GANs) with a cyclical-consistent loss function. We evaluate our method on three datasets: synthetic, tuberculosis and BraTS. All experiments confirm the efficacy of the proposed method. This study also highlighted the limitations of existing counterfactual explanation techniques in producing plausible counterfactual instances (CIs). Accompanying CXs with believable CIs thus provides self-explanatory analogy-based explanations. To this end, a CI generation method is proposed. Also, a novel technique is used to evaluate the quality of CI. The baseline results are produced on the BraTS dataset.

Implicit neural representations (INRs) have emerged as a powerful paradigm for medical imaging via physics-informed unsupervised learning. Classical INRs optimize an entire network from scratch for each subject, leading to inefficient training and suboptimal imaging quality. Recent initialization-based approaches attempt to inject population priors into pre-trained networks, yet they rely on high-quality images and often suffer from catastrophic forgetting during fine-tuning. We present DisINR, a novel INR framework that explicitly disentangles shared and subject-specific representations. DisINR introduces a shared encoder-decoder pair and subject-specific encoders, whose features are jointly decoded for image reconstruction. By integrating differentiable forward models, it pre-trains the shared modules directly from limited raw measurements, removing the need for pre-acquired high-quality images. During test-time adaptation, only the subject-specific encoder is optimized, while the shared pair remains frozen, effectively preserving learned priors. Extensive evaluations on three representative medical imaging tasks show that DisINR significantly outperforms state-of-the-art INRs in both reconstruction accuracy and efficiency.

Mirroring its ubiquity in popular media and all human activities, the use of deep learning (DL) is rapidly growing in scientific imaging modalities. However, unlike everyday RGB pictures, pixels encode precise physicochemical properties in scientific imaging across potentially thousands of channels. While DL is well validated on human-centric RGB perceptual tasks, its effectiveness for scientific imaging remains uncertain. Here, we show that the naive application of DL frameworks to scientific images can lead to critical failures. We evaluate the use of DL for pathology, comparing RGB images of stained tissue with the quantitative and information-rich biochemical signatures of infrared (IR) imaging. Despite this informational advantage, DL models trained on IR data paradoxically underperform. We investigate this discrepancy to find that IR data priors interact poorly with the simplicity bias of DL, causing models to collapse to one-dimensional predictions. This constitutes a catastrophic DL failure because the model's representational capacity remains largely unused, while furthermore raising AI safety concerns and undermining the advantages of such scientific modalities. Notably, this problem persists even with state-of-the-art DL robustification strategies, which are primarily designed and validated for RGB imagery and thus inherit the same prior-bias mismatch. This work establishes a framework for understanding the limitations of generic DL in science and advocates for the study of modality-specific failure modes to guide the development of specialized, safe AI algorithms.

Medical image super-resolution (MedSR) is essential for improving diagnostic precision across diverse imaging modalities such as MRI, CT, X-ray, Ultrasound, and Fundus imaging. Despite rapid advances in deep learning, challenges remain in preserving anatomical accuracy, maintaining perceptual quality, and generalizing across medical domains. This paper presents MedSR-Vision, a novel unified deep learning framework for evaluating and comparing super-resolution models across five modalities: Brain MRI, Chest X-ray, Renal Ultrasound, Nephrolithiasis CT, and Spine MRI, at magnification scales of $\times2$, $\times3$, and $\times4$. Three representative models namely SRCNN, SwinIR, and Real-ESRGAN are benchmarked using multiple quantitative metrics encompassing fidelity, perceptual realism, and sharpness. Experimental analysis demonstrates that Real-ESRGAN achieves superior perceptual quality and edge recovery at higher scales, SwinIR excels in preserving structural and diagnostic features, and SRCNN provides efficient and stable performance at lower magnifications. The results establish domain-specific insights and practical guidelines for model selection in clinical imaging workflows, offering a standardized evaluation framework for future medical image super-resolution research and deployment.

Deep learning-based medical image segmentation is increasingly used to support clinical diagnosis and develop new treatment strategies. However, model performance remains limited by the scarcity of high-quality annotated data and insufficient generalization across imaging protocols. This limitation is particularly evident in MRI and CT, where models are typically trained on a single acquisition sequence and exhibit reduced robustness when applied to unseen sequences or contrasts. Although data augmentation is widely used to improve general robustness on medical images, its impact on cross-modality generalization has not been quantitatively explored. In this work, we study a targeted set of data augmentation techniques designed to improve cross-modality transfer. We train three spine segmentation models, each on a single-modality/sequence dataset, and evaluate them across seven out-of-distribution datasets (spanning CT and MRI), reflecting a realistic single-sequence training and multi-sequence/contrast/modality deployment scenario. Our results demonstrate substantial performance gains on unseen domains (average Dice gain of 155 %) while preserving in-domain accuracy (average Dice decrease of 0.008 %), including effective transfer between CT and MRI. To mitigate the computational cost typically associated with strong data augmentation, we implement GPU-optimized augmentations that maintain, and even improve, training efficiency by approximately 10 %. We release our approach as an open-source toolbox, enabling seamless integration into commonly used frameworks such as nnUNet and MONAI. These augmentations significantly enhance robustness to heterogeneous clinical imaging scenarios without compromising training speed.

Chest radiography is a widely used imaging modality for thoracic disease diagnosis, yet its conventional interpretation remains time-consuming and heavily dependent on expert knowledge. While deep learning has improved diagnostic efficiency through automated feature extraction, challenges such as class imbalance and the localization of multiple co-existing pathologies remain unsolved. In this paper, inspired by the strength of Convolutional Block Attention Module (CBAM) in feature refinement and the capability of CNN blocks in feature extraction, we propose a strategy to integrate CBAM into traditional CNN blocks to enhance performance in multi-label classification tasks. Our method achieves a mean AUC of 0.8695 on ChestXray14 dataset, outperforming several state-of-the-art baselines.Our source code is available at: https://github.com/NNNguyenDuyyy/FETC_CBAM_Enhanced_CNN.git

With the development of deep learning, medical image processing has been widely used to assist clinical research. This paper focuses on the denoising problem of low-dose computed tomography using deep learning. Although low-dose computed tomography reduces radiation exposure to patients, it also introduces more noise, which may interfere with visual interpretation by physicians and affect diagnostic results. To address this problem, inspired by Cycle-GAN for unsupervised learning, this paper proposes an end-to-end unsupervised low-dose computed tomography denoising framework. The proposed framework combines a U-Net structure for multi-scale feature extraction, an attention mechanism for feature fusion, and a residual network for feature transformation. It also introduces perceptual loss to improve the network for the characteristics of medical images. In addition, we construct a real low-dose computed tomography dataset and design a large number of comparative experiments to validate the proposed method, using both image-based evaluation metrics and medical evaluation criteria. Compared with classical methods, the main advantage of this paper is that it addresses the limitation that real clinical data cannot be directly used for supervised learning, while still achieving excellent performance. The experimental results are also professionally evaluated by imaging physicians and meet clinical needs.

Federated Unlearning (FU) is an emerging paradigm in Federated Learning (FL) that enables participating clients to fully remove their contributions from a trained global model, driven by data protection regulations that mandate the right to be forgotten. However, existing FU methods mostly rely on synchronous coordination. This requirement forces the entire federation to halt and wait for stragglers to complete erasure, creating significant delays due to device heterogeneity. Furthermore, these methods often face the problem that the influence of erased data is merely suppressed temporarily and resurfaces during subsequent training, rather than being genuinely removed. To overcome these limitations, this paper proposes Asynchronous Federated Unlearning with Invariance Calibration (AFU-IC), a novel framework for medical imaging that decouples the erasure process from the global training workflow. This enables the target client to perform unlearning asynchronously without interrupting global training. Meanwhile, a server-side invariance calibration mechanism prevents the model from relearning the erased data. Extensive experiments on three medical benchmarks demonstrate that AFU-IC achieves unlearning efficacy and model fidelity comparable to gold-standard retraining while significantly reducing wall-clock latency compared to synchronous baselines. AFU-IC ensures efficient, compliant and reliable FL in cross-silo medical environments.

Machine learning models for medical image analysis often exhibit subgroup-dependent performance, which impacts how decisions should be allocated between automated systems and human experts under limited resources. Prior work on AI fairness and human-AI cooperation, including learning to defer (L2D) and learning to complement (L2C), typically addresses these problems in isolation. We propose People-Centred Medical Image Analysis (PecMan), a framework for fairness-aware human-AI co-operative classification that jointly models subgroup-dependent reliability, decision allocation, and collaborative prediction. PecMan combines subgroup-specialised predictors with a gating and consolidation mechanism that dynamically assigns cases to automated models, human experts, or their combination, without requiring sensitive attributes at test time. We also introduce the FairHAI benchmark for evaluating trade-offs between predictive accuracy, subgroup equity, and human involvement. In addition, we provide a theoretical analysis of multi-agent gating via selection regret and characterise fairness-coverage trade-offs under input-dependent allocation. Experiments across multiple medical imaging datasets demonstrate that PecMan achieves consistently improved trade-offs compared to methods that address fairness or human-AI cooperation separately.

Foundation segmentation models such as the Segment Anything Model (SAM) have demonstrated strong generalization across natural images; however, their robustness under clinically realistic medical imaging domain shifts remains insufficiently quantified. We present a systematic slice-level robustness audit of SAM (ViT-B) for spleen segmentation in abdominal CT using 1,051 nonempty slices from 41 volumes in the Medical Segmentation Decathlon. A standardized ground-truth-derived bounding-box protocol was used to isolate encoder robustness from prompt uncertainty. Controlled perturbations simulating inter-scanner variability, including Gaussian noise, blur, contrast scaling, gamma correction, and resolution mismatch, were applied across ten conditions. The clean baseline achieved a mean Dice score of 0.9145 (95% CI: [0.909, 0.919]) with a failure rate of 0.67%. Across all perturbations, the absolute mean ΔDice remained below 0.01. Paired Wilcoxon signed-rank tests with Benjamini-Hochberg false discovery rate correction identified statistically significant but small-magnitude changes under selected conditions, while McNemar analysis showed no significant increase in failure probability. These findings indicate that SAM exhibits stable segmentation behavior under moderate CT domain shifts, supporting its role as a robust foundation baseline for medical image segmentation research. As health digital twins increasingly incorporate foundation segmentation models for anatomical modeling and organ-level monitoring, formal characterization of robustness under real-world imaging variability is a necessary step toward trustworthy deployment.

Federated learning enables collaborative model training across medical institutions without sharing raw data, but its performance is often limited by domain heterogeneity across clients. Existing approaches to address this challenge fall into two main paradigms: model-side personalization, which adapts model parameters to each client, and data-side harmonization, which reduces inter-client variation at the input level. Despite their widespread use, these strategies have not been systematically compared. In this work, we conduct a comprehensive study across six medical imaging settings-colon polyp, skin lesion, and breast tumor segmentation, and tuberculosis CXR, brain tumor, and breast tumor classification-covering diverse types of domain shift. We evaluate a broad set of state-of-the-art harmonization and personalization methods under a unified framework. Our results reveal a conditional trade-off driven by the nature of heterogeneity: harmonization is more effective when variation is primarily appearance-based (e.g., CXR classification), while personalization performs better when differences are structural (e.g., colon polyp segmentation). When inter-client variation is limited, both strategies perform similarly. These findings demonstrate that the effectiveness of adaptation in federated medical imaging depends on the type and magnitude of domain shift rather than the strategy alone. We provide practical guidelines for selecting between harmonization and personalization and highlight directions for future hybrid approaches that combine both paradigms. Code is available at https://github.com/ChamaniS/WhenToAdapt.

We propose SparseContrast, a new framework that merges dynamic sparse attention with contrastive learning for medical imaging, with a focus on chest X-ray disease detection in low-data settings. Traditional contrastive learning methods rely on dense attention mechanisms, which are computationally expensive and often process redundant regions in medical images. To resolve this, SparseContrast introduces a sparse attention mechanism that selectively concentrates on diagnostically pertinent areas, markedly decreasing computational burden without compromising accuracy. The framework adaptively trims attention maps in the training phase, directed by a compact saliency predictor which concurrently optimizes sparsity and feature quality. This method not only speeds up training and inference by as much as 40% relative to dense attention benchmarks but also boosts diagnostic accuracy by focusing on areas of clinical importance. Moreover, the approach remains indifferent to the selection of backbone architecture, which permits its application to both convolutional and transformer-based models. Experiments show SparseContrast attains comparable or better performance in disease identification tasks with greater efficiency relative to current approaches. The proposed framework delivers a practical approach for implementing contrastive learning in medical imaging settings with limited resources, where computational efficiency and diagnostic accuracy are paramount.

Accurate biomedical image classification under low-resource conditions remains challenging due to limited annotations, subtle inter-class visual differences, and complex disease semantics. While vision--language models offer a promising foundation for mitigating data scarcity, their effective adaptation in biomedical settings is constrained by the need for parameter-efficient tuning alongside fine-grained and semantically consistent representation learning. In this work, we propose Multi-View Synergistic Learning (MVSL), a unified framework that addresses these challenges by jointly considering adaptation paradigms, representation granularity, and disease semantic relationships. MVSL decouples the adaptation of visual and textual encoders to respect their distinct representational characteristics, enabling more stable and effective parameter-efficient fine-tuning. It further introduces multi-granularity contrastive learning to explicitly model both global image semantics and localized lesion-level evidence, improving fine-grained discrimination for visually similar disease categories. In addition, MVSL preserves disease-level semantic structure by incorporating structured supervision derived from large language models, which constrains textual representations at the class level and indirectly regularizes visual embeddings through cross-modal alignment. Together, these components enable more stable cross-modal alignment and improved discrimination under limited supervision. Extensive experiments on $11$ public biomedical datasets spanning $9$ imaging modalities and $10$ anatomical regions demonstrate that MVSL consistently outperforms state-of-the-art methods in few-shot and zero-shot classification settings.

Convolutional neural networks (CNNs) have become increasingly difficult to deploy in resource-constrained environments due to their large memory and computational requirements. Although low-rank compression methods can reduce this burden, most existing approaches compress spatial and channel redundancy independently and therefore do not fully exploit the localised structure within convolutional feature maps. This paper proposes a hierarchical spatio-channel low-rank compression framework for CNNs that exploits redundancy across spatial regions and channel activations. Unlike conventional methods, which apply a uniform decomposition across an entire layer, the proposed approach first partitions feature maps into spatial regions, then groups channels according to their co-activation patterns within each region, and finally applies rank-adaptive SVD to each resulting spatio-channel cluster. The method is evaluated on an AlexNet-based brain tumour MRI classification model and compared with Global SVD and Tucker decomposition under $3\times$ and $6\times$ compression budgets. Our method outperforms both baselines, reducing FLOPs from $8.21\,\mathrm{G}$ to $1.55\,\mathrm{G}$ ($81.1\%$ reduction), achieving a $1.38\times$ inference speed-up, and increasing classification accuracy from $87.76\%$ to $89.80\%$. The method also improves the macro $F_1$-score and performance on challenging classes such as meningioma. A hyper-parameter trade-off analysis demonstrates that the framework provides Pareto-optimal configurations, enabling control over the balance between compression and predictive performance. Moderate clustering with adaptive rank selection yields strong results. Bootstrap standard errors are reported for all classification metrics.