Medical Imaging Foundation Models

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24 papers in the last four weeks, up 167% on the four weeks before. 0.2% of all new papers.

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May 4, 2026cs.CV

OphMAE: Bridging Volumetric and Planar Imaging with a Foundation Model for Adaptive Ophthalmological Diagnosis

The advent of foundation models has heralded a new era in medical artificial intelligence (AI), enabling the extraction of generalizable representations from large-scale unlabeled datasets. However, current ophthalmic AI paradigms are predominantly constrained to single-modality inference, thereby creating a dissonance with clinical practice where diagnosis relies on the synthesis of complementary imaging modalities. Furthermore, the deployment of high-performance AI in resource-limited settings is frequently impeded by the unavailability of advanced three-dimensional imaging hardware. Here, we present the Ophthalmic multimodal Masked Autoencoder (OphMAE), a multi-imaging foundation model engineered to synergize the volumetric depth of 3D Optical Coherence Tomography (OCT) with the planar context of 2D en face OCT. By implementing a novel cross-modal fusion architecture and a unique adaptive inference mechanism, OphMAE was pre-trained on a massive dataset with of 183,875 paired OCT images derived from 32,765 patients. In a rigorous benchmark encompassing 17 diverse diagnostic tasks with 48,340 paired OCT images from 8,191 patients, the model demonstrated state-of-the-art performance, achieving an Area Under the Curve (AUC) of 96.9% for Age-related Macular Degeneration (AMD) and 97.2% for Diabetic Macular Edema (DME), consistently surpassing existing single-modal and multimodal foundation models. Crucially, OphMAE exhibits robust engineering adaptability: it maintains high diagnostic accuracy, such as 93.7% AUC for AMD, even when restricted to single-modality 2D inputs, and demonstrates exceptional data efficiency by retaining 95.7% AUC with as few as 500 labeled samples. This work establishes a scalable and adaptable framework for ophthalmic AI, ensuring robust performance across different tasks.

Tienyu Chang, Zhen Chen, Renjie Liang +9

Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN · Department of Biomedical Informatics and Data Science, Yale University, New Haven, CT · Department of Data Science and Artificial Intelligence, The Hong Kong Polytechnic University, Hong Kong +5

Medical Imaging Foundation ModelsMasked AutoencodersMedical DiagnosisMedical Image ClassificationMultimodal FusionMedical Image Representation Learning
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May 4, 2026cs.CV

Representation learning from OCT images

Optical Coherence Tomography (OCT) has become one of the most used imaging modality in ophthalmology. It provides high-resolution, non-invasive visualization of retinal microarchitecture. The automated analysis of OCT images through representation learning has emerged as a central research frontier. This has mainly been driven by the clinical need to process large acquisition volumes. The objective is to reduce the reliance on expert annotation, and improve diagnostic consistency across devices and populations. This survey provides a comprehensive and structured review of representation learning methods for retinal OCT image analysis. It covers the period from early deep learning approaches to the most recent developments in foundation models and vision-language systems. We organize the literature along a principled taxonomy of learning paradigms, encompassing supervised learning with CNN-based and transformer-based architectures, self-supervised and semi-supervised methods, generative approaches, as well as 3D volumetric modeling, multimodal representation learning, and large-scale pretrained foundation models. For each paradigm, we analyze the core methodological contributions, identify persistent limitations, and trace the connections between successive approaches. We further provide a structured overview of publicly available OCT datasets, discuss evaluation protocol considerations, and present a unified problem formulation that situates each learning paradigm within a common mathematical framework. Building on this analysis, we identify and discuss the most pressing open research directions emerging in the literature. This includes volumetric foundation model pretraining, uncertainty-aware representation learning, federated and privacy-preserving training, fairness and bias mitigation, concept-based interpretability,...

Hedi Tabia, Désiré Sidibé, Nawres Khlifa +6

IBISC Univ. Evry Université Paris-Saclay · University of Tunis El Manar · ESIEE Paris - Université Gustave Eiffel +2

Medical ImagingMedical Imaging Foundation ModelsOptical Coherence Tomography3D Representation LearningMedical Image Representation LearningSelf-Supervised Visual Representation Learning+1
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May 3, 2026cs.CV

GeoSAE: Geometric Prior-Guided Layer-Wise Sparse Autoencoder Annotation of Brain MRI Foundation Models

Brain MRI foundation models learn rich representations of anatomy, but interpreting what clinical information they encode remains an open problem. Standard sparse autoencoders (SAEs) suffer from severe feature collapse in deep transformer layers, and in Alzheimer's disease (AD) research, aging confounds nearly every clinical variable, making naive annotation unreliable. We propose GeoSAE, a geometry-guided SAE framework that uses the foundation model's learned manifold structure to prevent feature collapse and annotates each surviving feature via age-deconfounded partial correlations. Applied to ~14k T1-weighted MRI scans from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the Australian Imaging biomarkers and Lifestyle (AIBL) datasets, GeoSAE identifies a compact, fully interpretable feature set that predicts mild cognitive impairment (MCI)-to-AD conversion (AUC 0.746) using only 2% of the embedding dimensions, while comorbidity-annotated features achieve only chance-level performance. The identified features replicate across cohorts without retraining (r=0.97) and localize to neuroanatomically distinct regions consistent with Braak staging. This shows that geometry-guided SAEs can extract interpretable, biomarkers from frozen brain MRI foundation models.

Favour Nerrise, Lucy Yin, Mohammad H. Abbasi +2

Stanford University · Stanford University, CA

Alzheimer's DiseaseMedical Imaging Foundation ModelsClinical Outcome PredictionGeometric Representation LearningSparse AutoencodersAlzheimer's Disease Classification+3
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Apr 30, 2026cs.LG

BrainDINO: A Brain MRI Foundation Model for Generalizable Clinical Representation Learning

Brain MRI underpins a wide range of neuroscientific and clinical applications, yet most learning-based methods remain task-specific and require substantial labeled data. Here we show that a single self-supervised representation can generalize across heterogeneous brain MRI endpoints. We trained BrainDINO, a self-distilled foundation model, on approximately 6.6 million unlabeled axial slices from 20 datasets encompassing broad variation in population, disease, and acquisition setting. Using a frozen encoder with lightweight task heads, BrainDINO supported transfer across tumor segmentation, neurodegenerative and neurodevelopmental conditions classification, brain age estimation, post-stroke temporal prediction, molecular status prediction, MRI sequence classification, and survival modeling. Across tasks and supervision regimes, BrainDINO consistently equaled or exceeded natural-image and MRI-specific self-supervised baselines, with particularly strong advantages under label scarcity. Representation analyses further showed anatomically organized and pathology-sensitive feature structure in the absence of task-specific supervision. Our findings indicate that large-scale slice-wise self-supervised learning can yield a unified brain MRI representation that supports diverse neuroimaging tasks without volumetric pretraining or full-network fine-tuning, establishing a scalable foundation for robust and data-efficient brain imaging analysis. Code is available at https://github.com/mclwu22/BrainDINO

Yizhou Wu, Shansong Wang, Yuheng Li +5

Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA. · Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA. · Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. +2

Medical Imaging Foundation ModelsSelf-Supervised Pre-TrainingMedical Image Representation LearningBrain MRI
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Apr 28, 2026eess.IV

Robustness Evaluation of a Foundation Segmentation Model Under Simulated Domain Shifts in Abdominal CT: Implications for Health Digital Twin Deployment

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.

Sanghati Basu

Healthcare Informatics, University of Illinois Springfield

Distribution Shift RobustnessImage SegmentationMedical Imaging Foundation ModelsImage Corruption RobustnessMedical Image SegmentationComputed Tomography+1
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Apr 27, 2026cs.CV

DiffuSAM: Diffusion-Based Prompt-Free SAM2 for Few-Shot and Source-Free Medical Image Segmentation

Segmentation models such as Segment Anything Model (SAM) and SAM2 achieve strong prompt-driven zero-shot performance. However, their training on natural images limits domain transfer to medical data. Consequently, accurate segmentation typically requires extensive fine-tuning and expert-designed prompts. We propose DiffuSAM, a diffusion-based adaptation of SAM2 for prompt-free medical image segmentation. Our framework synthesizes SAM2-compatible segmentation mask-like embeddings via a lightweight diffusion-prior from off-the-shelf frozen SAM2 image features. The generated embeddings are integrated into SAM2's mask decoder to produce accurate segmentations, thereby eliminating the need for user prompts. The diffusion prior is further conditioned on previously segmented slices, enforcing spatial consistency across volumes. Evaluated on the BTCV and CHAOS datasets for CT and MRI under Source-Free Unsupervised Domain Adaptation (SF-UDA) and Few-Shot settings, DiffuSAM achieves competitive performance with efficient training and inference. Code is available upon request from the corresponding author.

Tal Grossman, Noa Cahan, Lev Ayzenberg +1

School of Electrical Engineering, Tel Aviv University, Israel · School of Biomedical Engineering, Tel Aviv University, Israel

Source-Free Domain AdaptationImage SegmentationMedical Imaging Foundation ModelsMedical Image SegmentationFew-Shot Medical Image SegmentationDiffusion Models
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Apr 27, 2026cs.CV

EXACT: an explainable anomaly-aware vision foundation model for analysis of 3D chest CT

Chest computed tomography (CT) is central to the detection and management of thoracic disease, yet the growing scale and complexity of volumetric imaging increasingly exceed what can be addressed by scan-level prediction alone. Clinically useful AI for CT must not only recognize disease across the whole volume, but also localize abnormalities and provide interpretable visual evidence. Existing vision-language foundation models typically compress scans and reports into global image-text representations, limiting their ability to preserve spatial evidence and support clinically meaningful interpretation. Here we developed EXACT, an explainable anomaly-aware foundation model for three-dimensional chest CT that learns spatially resolved representations from paired clinical scans and radiology reports. EXACT was pre-trained on 25,692 CT-reports pairs using anatomy-aware weak supervision, jointly learning organ segmentation and multi-instance anomaly localization without manual voxel-level annotations. The resulting organ-specific anomaly-aware maps assign each voxel a disease-specific anomaly score confined to its corresponding anatomy, jointly encoding lesion extent and organ-level context. In retrospective multinational and multi-center evaluations, EXACT showed broad and consistent improvements across clinically relevant CT tasks, spanning multi-disease diagnosis, zero-shot anomaly localization, downstream adaptation, and visually grounded report generation, outperforming existing three-dimensional medical foundation models. By transforming routine clinical CT scans and free-text reports into explainable voxel-level representations, EXACT establishes a scalable paradigm for trustworthy volumetric medical AI.

Xuguang Bai, Mingxuan Liu, Tongxi Song +6

School of Biomedical Engineering, Tsinghua University, Beijing, China. · Department of Radiology, Mianyang Central Hospital, Mianyang, China. · Center for Biomedical Imaging Research, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing, China, 100084

Medical Imaging Foundation ModelsRadiology VLMs3D Medical ImagingMedical Image Anomaly DetectionExplainable Medical Image AnalysisComputed Tomography
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Apr 27, 2026cs.CV

SemiSAM-O1: How far can we push the boundary of annotation-efficient medical image segmentation?

Semi-supervised learning (SSL) has become a promising solution to alleviate the annotation burden of deep learning-based medical image segmentation models. While recent advances in foundation model-driven SSL have pushed the boundary to extremely limited annotation scenarios, they fail to maintain robust competitive performance in complex imaging modalities. In this paper, we propose SemiSAM-O1, an annotation-efficient framework using only one annotated template image for segmentation. SemiSAM-O1 extends the specialist-generalist collaborative learning framework to the extreme one-label setting by fully exploiting the foundation model's feature representation capability beyond its prompting interface. SemiSAM-O1 operates in two stages. In the first stage, the foundation model's encoder extracts dense features from all volumes, and class prototypes derived from the single annotated template are propagated to the unlabeled pool via feature similarity to produce coarse initial pseudo-labels. In the second stage, an iterative training-and-refinement loop progressively improves both the segmentation model and the pseudo-labels over multiple rounds, where each round trains the model from scratch on current pseudo-labels and generates updated predictions with voxel-wise uncertainty estimates. An uncertainty-guided refinement step further leverages the foundation model's global feature space to correct high-uncertainty regions by aggregating labels from their most similar confident neighbors, establishing a virtuous cycle of mutual improvement. Extensive experiments on a wide range of segmentation tasks across different modalities and anatomical targets demonstrate that SemiSAM-O1 significantly narrows the performance gap between one-label semi-supervised learning and full supervision, while significantly reducing the computational overhead of online foundation model inference.

Yichi Zhang, Le Xue, Bichun Xu +6

Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, China. · Shanghai Academy of Artificial Intelligence for Science, Shanghai, China. · Department of Radiotherapy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. +2

Image SegmentationMedical Imaging Foundation ModelsSemi-Supervised Medical Image SegmentationMedical Image SegmentationFew-Shot Medical Image SegmentationSemi-Supervised Learning
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Apr 25, 2026eess.IV

CRC-SAM: SAM-Based Multi-Modal Segmentation and Quantification of Colorectal Cancer in CT, Colonoscopy, and Histology Images

We present CRC-SAM, a unified framework for colorectal cancer segmentation across colonoscopy, CT, and histopathology images. Unlike prior single-modality methods, CRC-SAM provides consistent, modality-agnostic segmentation throughout the clinical workflow. Built on MedSAM, it incorporates low-rank adaptation (LoRA) layers into a frozen encoder, enabling efficient domain transfer to underrepresented modalities with minimal trainable parameters. Experiments on MSD-Colon, CVC-ClinicDB, and EBHI-Seg demonstrate superior performance across modalities, outperforming state-of-the-art baselines and highlighting the effectiveness of lightweight LoRA adaptation for foundation-model-based colorectal cancer analysis.

Daniel Lao

Independent researcher

Cross-Modality Medical Image SegmentationImage SegmentationMedical Imaging Foundation ModelsHistopathology Image SegmentationMedical Image SegmentationOncology
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Apr 25, 2026cs.CV

Learning from Noisy Prompts: Saliency-Guided Prompt Distillation for Robust Segmentation with SAM

Segmentation is central to clinical diagnosis and monitoring, yet the reliability of modern foundation models in medical imaging still depends on the availability of precise prompts. The Segment Anything Model (SAM) offers powerful zero-shot capabilities, although it collapses under the weak, generic, and noisy prompts that dominate real clinical workflows. In practice, annotations such as centerline points are coarse and ambiguous, often drifting across neighboring anatomy and misguiding SAM toward inconsistent or incomplete masks. We introduce SPD, a Saliency-Guided Prompt Distillation framework that converts these unreliable cues into robust guidance. SPD first learns data-driven anatomical priors through a lightweight saliency head to obtain confident localization maps. These priors then drive Contextual Prompt Distillation, which validates and enriches noisy prompts using cues from anatomically adjacent slices, producing a consensus prompt set that matches the behavior of expert reasoning. A Pairwise Slice Consistency objective further enforces local anatomical coherence during segmentation. Experiments on four challenging MRI and CT benchmarks demonstrate that SPD consistently outperforms existing SAM adaptations and supervised baselines, delivering large gains in both region-based and boundary-based metrics. SPD provides a practical and principled path toward reliable foundation model deployment in clinical environments where only imperfect prompts are available.

Jingxuan Kang, Ziqi Zhang, Shaoming Zheng +9

Imperial College London · Beihang University · National Health Service +1

Medical Imaging Foundation ModelsPromptable Image SegmentationMedical Image Segmentation3D Medical Image Segmentation
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Apr 23, 2026q-bio.NC

Foundation models for discovering robust biomarkers of neurological disorders from dynamic functional connectivity

Several brain foundation models (FM) have recently been proposed to predict brain disorders by modelling dynamic functional connectivity (FC). While they demonstrate remarkable model performance and zero- or few-shot generalization, the salient features identified as potential biomarkers are yet to be thoroughly evaluated. We propose RE-CONFIRM, a framework for evaluating the robustness of potential biomarker candidates elucidated by deep learning (DL) models including FMs. From experiments on five large datasets of Autism Spectrum Disorder (ASD), Attention-deficit Hyperactivity Disorder (ADHD), and Alzheimer's Disease (AD), we found that although commonly used performance metrics provide an intuitive assessment of model predictions, they are insufficient for evaluating the robustness of biomarkers identified by these models. RE-CONFIRM metrics revealed that simply finetuning FMs leads to models that fail to capture regional hubs effectively, even in disorders where hubs are known to be implicated, such as ASD and ADHD. In view of this, we propose Hub-LoRA (Low-Rank Adaptation) as a fine-tuning technique that enables FMs to not only outperform customised DL models but also produce neurobiologically faithful biomarkers supported by meta-analyses. RE-CONFIRM is generalizable and can be easily applied to ascertain the robustness of DL models trained on functional MRI datasets. Code is available at: https://github.com/SCSE-Biomedical-Computing-Group/RE-CONFIRM.

Deepank Girish, Yi Hao Chan, Sukrit Gupta +2

College of Computing and Data Science, Nanyang Technological University, Singapore

Medical Imaging Foundation ModelsFunctional ConnectivityfMRI Foundation ModelsScientific DiscoveryLow-Rank AdaptationNeural Network Interpretability+2
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Apr 19, 2026cs.CV

SegTTA: Training-Free Test-Time Augmentation for Zero-Shot Medical Imaging Segmentation

Increasingly advanced data augmentation techniques have greatly aided clinical medical research, increasing data diversity and improving model generalization capabilities. Although most current basic models exhibit strong generalization abilities, image quality varies due to differences in equipment and operators. To address these challenges, we present SegTTA, a framework that improves medical image segmentation without model retraining by combining four augmentations (Gamma correction, Contrast enhancement, Gaussian blur, Gaussian noise) with weighted voting across multiple MedSAM2 checkpoints. Experiments demonstrate consistent improvements across three diverse datasets: healthy uterus segmentation, uterine myoma detection, and multi class hepatic structure segmentation. Ablation studies reveal that large organs benefit from intensity augmentations while small lesions require noise augmentations. The voting threshold controls the coverage precision trade off, enabling task specific optimization for different clinical requirements. Ultimately, on a multiclass hepatic vessel dataset, compared to MedSAM2 baselines, our method achieves an increase of 1.6 in mIoU and 1.9 in aIoU, along with a reduction of approximately 2.0 in HD95. Code will be available at https://github.com/AIGeeksGroup/SegTTA.

Yihong Yao, Chunlei Li, Canxuan Gang +4

AI Geeks · Qingdao Municipal Hospital · University of Chinese Academy of Sciences

Image SegmentationMedical Imaging Foundation ModelsMedical Image SegmentationTest-Time AugmentationZero-Shot Medical Image Segmentation
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Apr 19, 2026cs.CV

SGP-SAM: Self-Gated Prompting for Transferring 3D Segment Anything Models to Lesion Segmentation

Large segmentation foundation models such as the Segment Anything Model (SAM) have reshaped promptable segmentation in natural images, and recent efforts have extended these models to medical images and volumetric settings. However, directly transferring a 3D SAM-style model to lesion segmentation remains challenging due to (i) weak spatial representational capacity for small, irregular targets in intermediate features, and (ii) extreme foreground-background imbalance in 3D volumes.We propose SGP-SAM, a self-gated prompting framework for efficient and effective transfer to 3D lesion segmentation. Our key component, the Self-Gated Prompting Module (SGPM), performs conditional multi-scale spatial enhancement: a lightweight multi-channel gating unit predicts whether the current features require additional multi-scale fusion, and only then activates a Multi-Scale Feature Fusion Block to enrich spatial context. To further address small-lesion learning, we design a Zoom Loss that up-weights lesion-focused supervision by combining Dice and a voxel-balanced focal term.Experiments on MSD Liver Tumor and MSD Brain Tumor (enhancing tumor) show consistent gains over strong transfer baselines based on SAM-Med3D. On MSD Liver Tumor, SGP-SAM improves mDice by 7.3% over fine-tuning.

Zequan Yao, Zixuan Tang, Jielin Ma +1

School of Intelligent Systems Engineering, Sun Yat-sen University, Shenzhen China.

Image SegmentationMedical Imaging Foundation ModelsPromptable Image SegmentationMedical Image Segmentation3D Medical Image Segmentation
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Apr 18, 2026cs.CV

Unified Ultrasound Intelligence Toward an End-to-End Agentic System

Clinical ultrasound analysis demands models that generalize across heterogeneous organs, views, and devices, while supporting interpretable workflow-level analysis. Existing methods often rely on task-wise adaptation, and joint learning may be unstable due to cross-task interference, making it hard to deliver workflow-level outputs in practice. To address these challenges, we present USTri, a tri-stage ultrasound intelligence pipeline for unified multi-organ, multi-task analysis. Stage I trains a universal generalist USGen on different domains to learn broad, transferable priors that are robust to device and protocol variability. To better handle domain shifts and reach task-aligned performance while preserving ultrasound shared knowledge, Stage II builds USpec by keeping USGen frozen and finetuning dataset-specific heads. Stage III introduces USAgent, which mimics clinician workflows by orchestrating USpec specialists for multi-step inference and deterministic structured reports. On the FMC_UIA validation set, our model achieves the best overall performance across 4 task types and 27 datasets, outperforming state-of-the-art methods. Moreover, qualitative results show that USAgent produces clinically structured reports with high accuracy and interpretability. Our study suggests a scalable path to ultrasound intelligence that generalizes across heterogeneous ultrasound tasks and supports consistent end-to-end clinical workflows. The code is publicly available at: https://github.com/MacDunno/USTri.

Chen Ma, Yunshu Li, Junhu Fu +3

College of Biomedical Engineering, Fudan University, Shanghai, China

Medical Imaging Foundation ModelsMulti-Task LearningCross-Domain Transfer LearningUltrasound Imaging
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Apr 16, 2026cs.CV

Beyond Independent Frames: Latent Attention Masked Autoencoders for Multi-View Echocardiography

Echocardiography is a widely used modality for cardiac assessment due to its non-invasive and cost-effective nature, but the sparse and heterogeneous spatiotemporal views of the heart pose distinct challenges. Existing masked autoencoder (MAE) approaches typically process images or short clips independently, failing to capture the inherent multi-view structure required for coherent cardiac representation. We introduce Latent Attention Masked Autoencoder (LAMAE), a foundation model architecture tailored to the multi-view nature of medical imaging. LAMAE augments the standard MAE with a latent attention module that enables information exchange across frames and views directly in latent space. This allows the model to aggregate variable-length sequences and distinct views, reconstructing a holistic representation of cardiac function from partial observations. We pretrain LAMAE on MIMIC-IV-ECHO, a large-scale, uncurated dataset reflecting real-world clinical variability. To the best of our knowledge, we present the first results for predicting ICD-10 codes from MIMIC-IV-ECHO videos. Furthermore, we empirically demonstrate that representations learned from adult data transfer effectively to pediatric cohorts despite substantial anatomical differences. These results provide evidence that incorporating structural priors, such as multi-view attention, yields significantly more robust and transferable representations.

Simon Böhi, Irene Cannistraci, Sergio Muñoz Gonzalez +8

Department of Biomedical Engineering, University of Basel, Switzerland · Department of Computer Science, ETH Zurich, Switzerland

Medical Imaging Foundation ModelsMasked AutoencodersMulti-View LearningEchocardiographyUltrasound ImagingMedical Image Representation Learning
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Apr 14, 2026cs.CV

Brain-DiT: A Universal Multi-state fMRI Foundation Model with Metadata-Conditioned Pretraining

Current fMRI foundation models primarily rely on a limited range of brain states and mismatched pretraining tasks, restricting their ability to learn generalized representations across diverse brain states. We present Brain-DiT, a universal multi-state fMRI foundation model pretrained on 349,898 sessions from 24 datasets spanning resting, task, naturalistic, disease, and sleep states. Unlike prior fMRI foundation models that rely on masked reconstruction in the raw-signal space or a latent space, Brain-DiT adopts metadata-conditioned diffusion pretraining with a Diffusion Transformer (DiT), enabling the model to learn multi-scale representations that capture both fine-grained functional structure and global semantics. Across extensive evaluations and ablations on 7 downstream tasks, we find consistent evidence that diffusion-based generative pretraining is a stronger proxy than reconstruction or alignment, with metadata-conditioned pretraining further improving downstream performance by disentangling intrinsic neural dynamics from population-level variability. We also observe that downstream tasks exhibit distinct preferences for representational scale: ADNI classification benefits more from global semantic representations, whereas age/sex prediction comparatively relies more on fine-grained local structure.

Junfeng Xia, Wenhao Ye, Xuanye Pan +3

Department of Biomedical Engineering, Southern University of Science and Technology, China · School of Biomedical Engineering, Shenzhen University, China

Medical Imaging Foundation ModelsDiffusion TransformerSelf-Supervised Pre-TrainingfMRI Foundation ModelsNeuroimagingConditional Diffusion Models+1
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Mar 19, 2026cs.CV

Towards Interpretable Foundation Models for Retinal Fundus Images

Foundation models are used to extract transferable representations from large amounts of unlabeled data, typically via self-supervised learning (SSL). However, many of these models rely on architectures that offer limited interpretability, a critical issue in high-stakes domains such as medical imaging. We propose \model, a foundation model that is interpretable-by-design via a BagNet backbone whose small receptive fields generate class evidence maps that are faithful to the model's decision-making process. Additionally, \model{} incorporates a 2D2D projection layer during pretraining that enables direct visualization of the representation space, providing a dataset-level view of the learned structure including meaningful clinical clusters as well as potential spurious correlations. We trained \model{} on over 800,000 color fundus photographs from various sources to learn generalizable representations for different downstream tasks. Our model achieves performance comparable to RETFound, which has 16×16\times more parameters, while providing interpretable predictions on out-of-distribution data. These results suggest that large-scale SSL pretraining paired with inherent interpretability can lead to robust representations for retinal imaging. Code and pretrained models are available at www.anonymous.4open.science/dual-IFM.

Samuel Ofosu Mensah, Camila Roa, Kerol Djoumessi +1

Hertie Institute for AI in Brain Health, University of Tübingen, Germany · Tübingen AI Center, University of Tübingen, Germany

Medical ImagingMedical Imaging Foundation ModelsFundus ImagingExplainable Medical Image AnalysisMedical Image Representation LearningSelf-Supervised Visual Representation Learning
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Mar 18, 2026cs.CV

LoGSAM: Parameter-Efficient Cross-Modal Grounding for MRI Segmentation

Precise localization and delineation of brain tumors using magnetic resonance imaging (MRI) are essential for planning therapy and guiding surgical decisions. To address this, we propose LoGSAM, a parameter-efficient, detection-driven framework that transforms radiologist dictation into text prompts for foundation-model-based localization and segmentation. Radiologist speech is first transcribed and translated using a pretrained Whisper ASR model, followed by negation-aware clinical NLP to extract tumor-specific textual prompts. These prompts guide text-conditioned tumor localization via a LoRA-adapted vision-language detection model, Grounding DINO (GDINO). The predicted bounding boxes are used as prompts for MedSAM to generate pixel-level tumor masks without any additional fine-tuning. On BRISC 2025, LoGSAM attains a Dice score of 80.32%, reaching 98.6% of a fully fine-tuned GDINO + MedSAM baseline while training fewer than 5% of its parameters, indicating a favorable accuracy/parameter trade-off. In addition, we evaluate the full pipeline using German dictations from a board-certified radiologist on unseen MRI scans, achieving 91.7% case-level class-extraction accuracy. These results highlight the feasibility of constructing a modular speech-to-segmentation pipeline from pretrained foundation models with minimal parameter updates.

Mohammad Robaitul Islam Bhuiyan, Sheethal Bhat, Melika Qahqaie

Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen, Germany · Siemens Healthineers, Erlangen, Germany

Image SegmentationMedical Imaging Foundation ModelsText-Guided Image SegmentationMedical Image SegmentationMedical Image GroundingBrain Tumor Segmentation
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Mar 6, 2026cs.CV

GreenRFM: Learning a resource-efficient radiology vision-language foundation model via supervision-centric pre-training

Radiology foundation models (RFMs) have largely inherited the scale-first recipe of natural-image vision--language pre-training. This recipe is difficult to deploy in 3D radiology, where training corpora are smaller, reports vary across institutions, and receiving hospitals often need local adaptation under privacy and compute constraints. We ask whether routine radiology reports can instead be converted into auditable diagnostic supervision that shapes the image encoder, text encoder, aligned space, and local-adaptation procedure. We develop GreenRFM, a supervision-centric pre-training framework organized around four empirical principles: More distilled, Ubiquitous, Semantic-enforcing, and Task-aligning (MUST) supervision. These principles convert noisy reports into structured diagnostic signals and use them to learn discriminative unimodal encoders plus an aligned image--text space for diagnosis-centered multimodal use. GreenRFM requires 24 GPU-hours on a single 24GB GPU (lightweight variant: 6GB VRAM, 4~hours) and reaches a zero-shot CT-RATE AUC of 84.8. Evaluations using more than 200,000 volumes from six institutions and two modalities show transfer to private clinical cohorts and to musculoskeletal MRI. On a local institutional cohort, computationally feasible retraining raises macro-AUC from 70.5 to 82.1. The aligned space also improves hepatocellular-carcinoma microvascular-invasion prediction and trans-arterial chemoembolization response analysis over established clinical scores. These results support supervision-centric pre-training as a practical route to resource-efficient, locally adaptable, diagnosis-centered radiology vision--language representations.

Yingtai Li, Shuai Ming, Qiuli Wang +13

School of Biomedical Engineering, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, 230026, China · Center for Medical Imaging, Robotics, Analytic Computing & Learning (MIRACLE), Suzhou Institute for Advanced Research, USTC, Suzhou, Jiangsu, 215123, China · Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, USTC, Hefei, Anhui, 230001, China +7

Medical Imaging Foundation ModelsRadiology VLMsVision-Language ModelsVLM AdaptationMultimodal Pretraining
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Mar 3, 2026cs.CV

Designing UNICORN: a Unified Benchmark for Imaging in Computational Pathology, Radiology, and Natural Language

Foundation models are changing the way we develop medical artificial intelligence. By learning broadly generalizable features across diverse data modalities, a single model can be rapidly adapted to address multiple modalities and tasks with minimal supervision. This potential comes with the urgent need to reliably benchmark, understand and compare the performance and clinical impact of foundation models across data modalities and clinical tasks. We introduce UNICORN, a fundamentally new benchmarking concept for medical foundation models. UNICORN brings four main contributions to medical artificial intelligence. First, a framework that enables a one-to-many benchmarking approach, where a single foundation model is tested across multiple tasks and data modalities. Here, we populate it with 20 tasks across radiology, pathology, and clinical text, covering classification, detection, segmentation, regression, and vision-language generation. Second, a publicly available evaluation platform that implements, for the first time, a two-step approach to run foundation models for data encoding followed by custom task-specific adaptation via few-shot learning and linear probing mechanisms. Third, we create a meta-model that combines state-of-the-art foundation models in pathology, radiology and language with novel task-specific adapters that address all UNICORN tasks, which we refer to as Unicorn Model-0 (UM-0). Finally, we design a novel UNICORN score to benchmark and compare model performance across all tasks. We present the results of UM-0 using sequestered test data from over 2,400 patients, 3,700 vision cases, and 2,400 clinical reports from 17 institutions across eight countries, spanning eight anatomical regions and four imaging modalities. Data, baselines, and evaluation platform are publicly accessible at unicorn.grand-challenge.org.

Michelle Stegeman, Lena Philipp, Fennie van der Graaf +20

and on behalf of the UNICORN consortium · Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands · Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands +2

Computational PathologyMedical Imaging Foundation ModelsHealthcareMultimodal Foundation ModelsMultimodal Model EvaluationMedical Image Benchmarks
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Feb 16, 2026cs.CV

Scalable next-scale autoregression for medical image generation across anatomical regions

Autoregressive pretraining has been key to the scalability of large language models, yet medical generative foundation models remain predominantly based on diffusion. Here we introduce MedVAR, the first foundation model for all-round medical image generation through autoregressive training, and find it offers improved generation quality and efficiency, stronger scalability, and broader adaptability to downstream clinical tasks than diffusion-based models. A tokenizer trained on medical images and separate semantic and structural controls enable generation across six anatomical regions in computed tomography and magnetic resonance imaging. Trained on 438,905 slices from 40 datasets, including seven internal clinical centres, MedVAR generates images 12-19 times faster than 100-step diffusion baselines. Generation quality improves with model size. Pretraining on generated images improves seven-centre hepatocellular carcinoma segmentation Dice from 0.615 to 0.632, while reconstruction using MedVAR images approaches the volumetric segmentation performance of fully sampled volumes. Membership inference reaches 3.54% sensitivity at a 1% false-positive rate, while copy detection performs near chance. These findings establish next-scale autoregression as a scalable and versatile approach to medical image generation and downstream analysis.

Zhicheng He, Yunpeng Zhao, Junde Wu +7

National University of Singapore · University of Oxford · Zhejiang University +1

Medical Imaging Foundation ModelsHealthcareVisual Autoregressive ModelsAutoregressive Image GenerationMedical Image Synthesis
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Jan 1, 2026cs.CV

TotalFM: An Organ-Separated 3D-CT Foundation Model Leveraging Large-Scale Routine Clinical Radiology Data

While foundation models in radiology are expected to be applied to various clinical tasks, computational cost constraints remain a major challenge when training on 3D-CT volumetric data. In this study, we propose TotalFM, a radiological foundation model that efficiently learns the correspondence between 3D-CT images and linguistic expressions based on the concept of organ separation, utilizing a large-scale dataset of 140,000 series. By automating the creation of organ volume and finding-sentence pairs through segmentation techniques and Large Language Model (LLM)-based radiology report processing, and by combining self-supervised pre-training via VideoMAE with contrastive learning using volume-text pairs, we aimed to balance computational efficiency and representation capability. In zero-shot organ-wise lesion classification tasks, the proposed model achieved higher F1 scores in 83% (5/6) of organs compared to CT-CLIP and 64% (9/14) of organs compared to Merlin. These results suggest that the proposed model exhibits high generalization performance in a clinical evaluation setting using actual radiology report sentences. Furthermore, in zero-shot finding-wise lesion classification tasks, our model achieved a higher AUROC in 83% (25/30) of finding categories compared to Merlin. We also confirmed performance comparable to existing Vision-Language Models (VLMs) in radiology report generation tasks. Our results demonstrate that the organ-separated learning framework can serve as a realistic and effective design guideline for the practical implementation of 3D-CT foundation models. The source code and pretrained models are publicly available at https://github.com/jichi-labo/TotalFM.

Kohei Yamamoto, Tomohiro Kikuchi

Department of Radiology, Jichi Medical University · Data Science Center, Jichi Medical University

3D Foundation ModelsMedical Imaging Foundation ModelsRadiology VLMsMedical Image Classification3D VLMs
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Dec 20, 2025cs.CV

Atlas is Your Perfect Context: One-Shot Customization for Generalizable Foundational Medical Image Segmentation

Accurate segmentation of anatomical structures in medical images is essential for diagnosis and treatment planning. While recent interactive segmentation foundation models enhance generalization through large-scale multimodal pretraining, they still depend on precise prompts and can fail in underrepresented clinical contexts (e.g., small organs-at-risk). We present AtlasSegFM, an atlas-guided framework that customizes off-the-shelf foundation models to new clinical contexts with a single annotated example. AtlasSegFM 1) performs atlas-query registration to generate context-aware prompts, 2) refines the segmentation with a frozen foundation model, and 3) applies a lightweight adaptive fusion module to combine atlas priors with foundation-model inputs and predictions. Extensive experiments on six public and in-house datasets across radiotherapy and vascular scenarios show consistent gains, with the largest improvements on small and delicate structures. AtlasSegFM provides a lightweight, deployable solution for one-shot customization of segmentation foundation models in real-world clinical workflows.

Ziyu Zhang, Yi Yu, Simeng Zhu +4

Nanjing University · The Ohio State University · Stanford University

Image SegmentationMedical Imaging Foundation ModelsPromptable Image SegmentationMedical Image Segmentation
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Nov 24, 2025cs.CV

MedSAM3: Delving into Segment Anything with Medical Concepts

Medical image segmentation is fundamental for biomedical discovery. Existing methods lack generalizability and demand extensive, time-consuming manual annotation for new clinical application. Here, we propose MedSAM-3, a text promptable medical segmentation model for medical image and video segmentation. By fine-tuning the Segment Anything Model (SAM) 3 architecture on medical images paired with semantic conceptual labels, our MedSAM-3 enables medical Promptable Concept Segmentation (PCS), allowing precise targeting of anatomical structures via open-vocabulary text descriptions rather than solely geometric prompts. We further introduce the MedSAM-3 Agent, a framework that integrates Multimodal Large Language Models (MLLMs) to perform complex reasoning and iterative refinement in an agent-in-the-loop workflow. Comprehensive experiments across diverse medical imaging modalities, including X-ray, MRI, Ultrasound, CT, and video, demonstrate that our approach significantly outperforms existing specialist and foundation models. We will release our code and model at https://github.com/Joey-S-Liu/MedSAM3.

Anglin Liu, Xu R. Cao, Yifan Shen +4

The Hong Kong University of Science and Technology (Guangzhou) · University of Illinois Urbana-Champaign · Southeast University +1

Image SegmentationMedical Imaging Foundation ModelsText-Guided Image SegmentationMedical Image Segmentation
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Oct 15, 2025cs.CV

Scaling Vision Transformers for Functional MRI with Flat Maps

We study the problem of training self-supervised foundation models for functional MRI. Our main contributions are: (1) we introduce a new model family (CortexMAE) trained using the masked autoencoder framework on 2.1K hours of open fMRI data, and (2) we release the first open evaluation suite (Brainmarks) for fMRI foundation models. Our core innovation is simple: we adapt the Vision Transformer to fMRI by first converting each 3D fMRI volume to a 2D map using a cortical flat map projection. We directly compare flat maps to both parcellation and volume-based representations. While each has its advantages, flat maps generally perform best. We perform the first systematic scaling analysis for fMRI and observe strict power law scaling, albeit with limits. Finally, we use Brainmarks to do controlled benchmark comparisons. On subject-level trait prediction, we report a challenging null result: no single model achieves clear state-of-the-art performance. Moreover, all models struggle to outperform a simple functional connectivity baseline. On cognitive state decoding, we observe more robust performance, and in this setting our CortexMAE family outperforms prior models by a large margin. Code, models, and datasets are available at https://github.com/MedARC-AI/CortexMAE and https://github.com/MedARC-AI/Brainmarks.

Connor Lane, Mihir Tripathy, Leema Krishna Murali +15

MedARC · Sophont · Baylor College of Medicine +3

Medical Imaging Foundation ModelsMasked AutoencodersfMRI Foundation ModelsNeuroimagingMedical Image Benchmarks
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Oct 8, 2025cs.CV

Evaluating Fundus-Specific Foundation Models for Diabetic Macular Edema Detection

Diabetic Macular Edema (DME) is a leading cause of vision loss among patients with Diabetic Retinopathy (DR). While deep learning has shown promising results for automatically detecting this condition from fundus images, its application remains challenging due the limited availability of annotated data. Foundation Models (FM) have emerged as an alternative solution. However, it is unclear if they can cope with DME detection in particular. In this paper, we systematically compare different FM and standard transfer learning approaches for this task. Specifically, we compare the two most popular FM for retinal images-RETFound and FLAIR-and an EfficientNetB0 backbone, across different training regimes and evaluation settings in IDRiD, MESSIDOR-2 and OCT-and-Eye-FundusImages (OEFI). Results show that despite their scale, FM do not consistently outperform fine-tuned CNNs in this task. In particular, EfficientNet-B0 consistently achieves competitive or superior performance across evaluation settings, with FLAIR being the most competitive foundation model, consistently outperforming RETFound. These findings suggest that FMs do not necessarily provide an advantage for fine-grained ophthalmic tasks such as DME detection, even after fine-tuning, highlighting lightweight CNNs as strong baselines in data-scarce environments.

Franco Javier Arellano, José Ignacio Orlando

Yatiris Group, PLADEMA Institute, UNICEN, Tandil, Argentina · CONICET, Tandil, Argentina

Medical Imaging Foundation ModelsVision Foundation Model AdaptationFundus Imaging
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Aug 24, 2025cs.CV

FoundDiff: Foundational Diffusion Model for Generalizable Low-Dose CT Denoising

Low-dose computed tomography (CT) denoising is crucial for reduced radiation exposure while ensuring diagnostically acceptable image quality. Despite significant advancements driven by deep learning (DL) in recent years, existing DL-based methods, typically trained on a specific dose level and anatomical region, struggle to handle diverse noise characteristics and anatomical heterogeneity during varied scanning conditions, limiting their generalizability and robustness in clinical scenarios. In this paper, we propose FoundDiff, a foundational diffusion model for unified and generalizable LDCT denoising across various dose levels and anatomical regions. FoundDiff employs a two-stage strategy: (i) dose-anatomy perception and (ii) adaptive denoising. First, we develop a dose- and anatomy-aware contrastive language-image pre-training model (DA-CLIP) to achieve robust dose and anatomy perception by leveraging specialized contrastive learning strategies to learn continuous representations that quantify ordinal dose variations and identify salient anatomical regions. Second, we design a dose- and anatomy-aware diffusion model (DA-Diff) to perform adaptive and generalizable denoising by synergistically integrating the learned dose and anatomy embeddings from DA-CLIP into diffusion process via a novel dose and anatomy conditional block (DACB) based on Mamba. Extensive experiments on a large simulated multi-dose CT dataset spanning three anatomical regions, together with cross-dataset evaluations on Mayo-2016, CQ500, and piglet datasets, demonstrate superior denoising performance and strong generalization to unseen dose levels and anatomical regions. The codes and models are available at https: //github.com/hao1635/FoundDiff.

Zhihao Chen, Qi Gao, Zilong Li +4

Institute of Science and Technology for Brain-inspired Intelligence and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200433, China · Shanghai Key Lab of Intelligent Information Processing, School of Computer Science, Fudan University, Shanghai 200433, China · School of Cyber Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China +1

Diffusion Models for Image RestorationMedical Imaging Foundation ModelsComputed TomographyLDCT Denoising
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May 27, 2025cs.CV

Good Enough? An Investigation on the Impact of Label Quality in Large-Scale Medical Datasets

Manually refining radiological segmentation masks is highly resource-intensive. To determine when this expert commitment is truly justified for the training of segmentation models, we investigate the relationship between label quality and model performance. Expanding beyond models trained directly for inference, we conduct the first study isolating the impact of label quality in pre-training datasets. While high-quality labels remain essential for models proceeding directly to deployment, we find no evidence that strict label quality is crucial for pre-training efficacy. These results question the necessity of exhaustive human-in-the-loop refinement for massive corpora intended for pretraining and suggest that expert effort is more effectively invested in well-curated downstream target datasets.

Alexander Jaus, Zdravko Marinov, Constantin Seibold +4

Image SegmentationMedical Imaging Foundation ModelsHealthcareMedical Image SegmentationLearning with Noisy LabelsMedical Image Representation Learning
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May 6, 2025cs.CV

Synergistic Vision-Language Reinforcement Enables Scalable On-Demand Analysis across Diverse Clinical Tasks

Accurate delineation of tumors and surrounding organs-at-risk is essential for radiotherapy, surgery and treatment response assessment, yet remains time-consuming and expertise-intensive. Existing artificial intelligence systems often require manual spatial prompts or task-specific retraining, while generic class labels provide limited semantic grounding for heterogeneous disease targets. Here we present SyRe, a promptable segmentation foundation model based on Synergistic vision-language Reinforcement. SyRe strengthens bidirectional interaction between visual and linguistic representations to improve semantically grounded spatial understanding. To support large-scale training, we introduce the Color Region Description strategy and construct SyReData, comprising 20 million image-mask-description triplets across 9 modalities and 229 segmentation tasks. Training with diversified prompt forms further enables open-ended prompting, invalid-prompt rejection and flexible switching between single- and multi-target analysis. SyRe achieves accurate text-prompted segmentation across diverse clinical scenarios, with particularly strong performance on disease-related targets. Across 28 unseen external datasets, including 20 cancer types and multinational in-house cohorts, SyRe generalizes robustly under real-world distribution shifts. SyRe-generated masks also preserve clinically relevant quantitative information in pathology and yield radiomics features that stratify survival and improve prognostic modeling across five retrospective CT and MRI tumor cohorts. Finally, clinician-in-the-loop refinement enables efficient case-level correction when greater precision is required. These results establish SyRe as a generalizable foundation for scalable quantitative oncology and clinician-guided segmentation refinement.

Haonan Wang, Jiaji Mao, Lehan Wang +11

Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR · Department of Radiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China · Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR

Image SegmentationMedical Imaging Foundation ModelsText-Guided Image SegmentationMedical VLMsMedical Image SegmentationOncology+1
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Apr 22, 2025cs.CV

Clinician-Friendly Foundation Models for Ophthalmic Image Diagnostics without Fine-Tuning or Technical Barriers

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We developed GlobeReady, a deployment-oriented platform powered by the RetiGlobe foun- dation model and local feature augmentation. RetiGlobe was pretrained in two stages: 1) self-supervised learning using DINOv2 on 38 million synthetic ophthalmic images, and 2) contrastive learning using CLIP on 475,845 real image-text pairs spanning diverse ethnicities, imaging devices, and geographic regions worldwide. We evaluate GlobeReady on 488,448 ophthalmic images, including color fundus photographs (CFPs) and optical coherence tomography scans, from multi-centres in China, Singapore, Vietnam and the UK. Prospective testing included usability assessment with 31 ophthalmologists. Exploratory analyses evaluated domain generalisability, Bayesian uncertainty quantification, out-of-distribution (OOD) detection, and feature-based case retrieval.

Meng Wang, Tian Lin, Qingshan Hou +69

Medical Imaging Foundation ModelsMedical Image AnalysisMedical VLMsFundus Imaging
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