Medical Imaging

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.

Deep learning models for medical image classification usually achieve promising results but typically rely on large, annotated datasets or standard transfer learning from ImageNet. Self-Supervised Learning (SSL) has emerged as a powerful alternative, yet common methods like masked autoencoders (MAEs) may inadvertently destroy fine-grained diagnostic features by using random masking. In this paper, we propose a novel SSL pre-training strategy, the Chaotic Denoising Autoencoder (CDAE). Instead of masking, we apply a chaotic transformation to the input image, tasking an autoencoder to reconstruct the original. We hypothesize this forces the encoder to learn robust, domain-specific features by "inverting the chaos". Furthermore, we propose an attentive fusion mechanism that combines features from our CDAE-trained encoder with a standard encoder, leveraging the strengths of both general and domain-specific representations. Our method is evaluated on two public medical datasets: ISIC 2018 (skin lesions) and APTOS 2019 (diabetic retinopathy). The proposed model achieves high performance, with an accuracy of 0.9221 and an F1-macro of 0.8530 on ISIC 2018, and an accuracy of 0.8644 and F1-macro of 0.7433 on APTOS 2019, demonstrating the efficacy of our approach.

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.

Labeling medical images is a major bottleneck in the field of medical imaging, as it requires domain-specific expertise, and it gets further complicated due to variability across different medical centers and different imaging devices. Such heterogeneity introduces domain shifts and modality discrepancies, which limits the generalization of trained models. To address this important challenge, we propose an unsupervised domain adaptation framework that combines transfer learning with a Reproducing Kernel Hilbert Space based Maximum Mean Discrepancy loss for the alignment of source and target domains. By jointly optimizing classification and RKHS-MMD losses, the methodology enhances generalization to unannotated medical datasets while diminishing reliance on manual annotation. Experimental evaluations presented on two chest X-ray datasets, which are obtained from different medical centers, show outstanding improvements over models trained without adaptation. Furthermore, we perform a comparative study to see that RKHS-MMD performs better than the standard Maximum Mean Discrepancy in reducing modality gap, emphasizing its effectiveness for medical image classification and also its strong capability in advanced AI-driven medical diagnostics.

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.

Long-tailed class distributions are pervasive in multi-class medical datasets and pose significant challenges for deep learning models which typically underperform on tail classes with limited samples. This limitation is particularly problematic in medical applications, where rare classes often correspond to severe or high-risk diseases and therefore require high diagnostic accuracy. Existing solutions-including specialized architectures, rebalanced loss functions, and handcrafted data augmentation-offer only marginal improvements and struggle to scale due to their limited and largely deterministic variability. To address these challenges, we introduce a diffusion-model-driven synthetic data augmentation pipeline tailored for medical long-tailed classification. Our approach features a novel inpainting diffusion model combined with an Out-of-Distribution (OOD) post-selection mechanism to ensure diverse, realistic, and clinically meaningful synthetic samples. Evaluated on the ISIC2019 skin lesion classification dataset, one of the largest and most imbalanced medical imaging benchmarks, our method yields substantial improvements in overall performance, with particularly pronounced gains on tail classes with more than $28\%$ improvement on the class with the fewest samples. These results demonstrate the effectiveness of diffusion-based augmentation in mitigating long-tail imbalance and enhancing medical classification robustness.

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.

Learning to Defer (L2D) enables a model to predict autonomously or defer to an expert, but prior work largely assumes flat label spaces. We study the first L2D setting with hierarchical multi-label decisions, motivated by medical-imaging workflows in which findings are organised by clinical taxonomies. In this setting, deferral is a delegation action rather than a label assignment, so treating it as an independent per-label decision can produce deferral incoherence, including taxonomic contradictions, delegation violations, and deferrals of labels already implied by the model's own assertions. We formalise coherent hierarchical deferral under a Selective-Exclusion handoff contract, characterise the Bayes-optimal coherent deferral rule, and show that even nodewise Bayes L2D can be action-incoherent. We then propose two remedies: exact coherent projection, a dynamic-programming decoder over the coherent action set, and Taxonomic Belief Propagation (TBP) with Recursive Policy Optimisation (RPO), a contract-aware joint action model trained through the same recursion used at inference. Across real-reader and controlled-expert medical-imaging benchmarks, naive binary-relevance L2D exhibits non-trivial incoherence. Projection removes it exactly, and fast TBP+RPO drives incoherence near zero while retaining strong utility.

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

Chest X-ray classification suffers from severe class imbalance where gradient updates bias toward majority classes, causing feature drift and poor performance on rare but critical pathologies. We propose a Momentum-Anchored Multi-Scale Fusion Network that uses exponential moving averages (EMA) as a temporal anchoring mechanism to stabilize feature representations under long-tailed distributions. Our approach applies selective momentum updates to the final expansion block of an EfficientNet backbone, creating a slowly-evolving reference branch that resists gradient-induced drift while preserving discriminative patterns for minority classes. Combined with multi-scale spatial fusion ($1\times 1$, $3 \times 3$, $5 \times 5$ convolutions), this anchoring strategy maintains representational stability throughout training. On ChestX-ray14, our method achieves 0.8682 average AUC, outperforming state-of-the-art approaches and showing particular improvements on rare pathologies like Hernia (0.9470) and Pneumonia (0.8165). The results demonstrate that momentum anchoring effectively counters feature instability in long-tailed medical image classification.

Classifying brain tumors using magnetic resonance imaging (MRI) is crucial for early diagnosis and treatment; however, tumor heterogeneity and a dearth of annotated datasets restrict the use of supervised deep learning approaches. In this work, we use self-supervised learning (SSL) to study multi-class brain tumor classification. Using a ResNet-50 backbone, we evaluate four SSL frameworks including SimCLR, BYOL, DINO, and Moco v3 on a publicly available dataset of 4,448 MRIs with 17 distinct tumor types. On the dataset, SimCLR achieved 99.64% accuracy, 99.64% precision, 99.64% recall, and 99.64% F1-score. The workflow includes preprocessing, fine-tuning, linear evaluation, and SSL pretraining with data augmentations. Results show that, when labels are limited, SSL-pretrained models outperform supervised baselines in terms of F1-score, recall, accuracy, and precision. Additionally, by providing visual insights into model decisions, Explainable AI techniques (Grad-CAM, Grad-CAM++, EigenCAM) enhance interpretability. These results demonstrate SSL's scalability and dependability in diagnosing brain tumors from unlabeled medical data.

Orderless encoding methods have shown to improve Convolutional Neural Networks (CNNs) for image classification in the context of limited availability of data. Additionally, hybrid CNN + Vision Transformers (ViT) models have been recently proposed to address CNN locality bias issues. These models outperformed CNN-only approaches. Despite that, the integration of such hybrid models with more elaborated feature representation can be highly beneficial and remains large unexplored in the literature. In this context, we propose the introduction of an orderless encoding method, Fisher Vectors, to hybrid CNN + ViT architectures, aiming at achieving a model suitable for both small and large datasets. Such enconding method relies on estimating a Gaussian Mixture Model (GMM) on image features. In large datasets, computational costs of the GMM estimation is a limiting factor for the application of Fisher Vectors. Thus, we propose a method to limit the growth of GMM estimation costs as we increase the size of the dataset. We explore the feasibility of our method in the context of medical image classification by appling it to MedMNIST (v2), Clean-CC-CCII and ISIC2018. This collection of datasets contains a wide variety of data scales and modalities. We outperform benchmark results in all MedMNIST (v2) datasets and obtain literature-competitive results in Clean-CC-CCII and ISIC2018.

We propose a unified cross-domain transfer learning framework that leverages knowledge from multiple heterogeneous medical imaging datasets to improve performance across segmentation, classification, and object detection tasks. Our approach employs a teacher-student paradigm in which a joint teacher model aggregates domain-invariant representations learned from diverse source datasets, while a task-specific student model is trained via multi-level knowledge distillation. Originally developed for medical image segmentation, the framework is extended to support image-level classification and object-level detection, enabling a general multi-task formulation for medical image analysis. We evaluate our method on a broad suite of datasets, including six segmentation benchmarks, BrainMetShare, ISLES, BraTS (MRI) and Lung MSD, LiTS, KiTS (CT), as well as multiple classification datasets for pulmonary disease and dementia, and detection datasets with native bounding-box annotations. Across all tasks and modalities, the proposed approach yields consistent improvements over strong dataset-specific and multi-head baselines, demonstrating enhanced robustness to distributional shifts and superior generalization. These findings highlight the potential of multi-dataset knowledge distillation as a scalable and task-agnostic approach for enhancing segmentation, classification, and object detection performance across heterogeneous medical imaging domains.

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.

Medical imaging datasets are often characterized by extreme class imbalances, where rare pathologies are significantly underrepresented compared to common conditions. This imbalance poses a dual challenge for Open-Set Recognition (OSR): models must maintain high classification accuracy on known classes while reliably rejecting unknown samples unseen during training in the clinical settings. While recently proposed Deep Simplex Classifier (DSC)\cite{cevikalp2024reaching} and UnCertainty-aware Deep Simplex Classifier (UCDSC)\cite{Aditya_2026_WACV} successfully leverage Neural Collapse to ensure maximal inter-class separation, they rely on a uniform margin that does not account for the varying densities of medical classes. In this paper, we propose DMDSC an enhanced framework featuring a dynamic margin approach. Our approach automatically adapts class-specific margins based on label frequency, enforcing a higher penalty and tighter feature clustering for rare pathologies to counteract the effects of data imbalance. Extensive experiments conducted on diverse medical benchmarks on BloodMNIST\cite{medmnistv2}, OCTMNIST\cite{medmnistv2}, DermaMNIST\cite{medmnistv2}, and BreaKHis~\cite{spanhol2015dataset} datasets, demonstrate that our framework outperforms state-of-the-art methods.

The deployment of artificial intelligence in medical imaging is hindered by high computational complexity and resource-intensive processing of volumetric data. Although chest computed tomography (CT) volumes offer richer diagnostic information than projection radiography, their use in AI-based diagnosis remains limited due to the computational burden of processing uncompressed volumetric images (typically stored in NIfTI or DICOM format). Addressing the growing need for low-resource deployment and efficient electronic data transfer, we investigate the utilization of JPEG-compressed chest CT volumes for thoracic abnormality detection. We propose Feature Attention Style Transfer (FAST), a novel distillation framework that transfers both activation patterns and structural relationships from high-fidelity CT representations to a spatiotemporal visual encoder operating on compressed inputs. By combining Gram-matrix-based attention style preservation with dual-attention feature alignment, FAST enables robust feature extraction from degraded volumes. Furthermore, we introduce Structured Factorized Projection (SFP), leveraging Block Tensor Train decomposition as a parameter-efficient alternative to dense projection layers, reducing projection-head parameters by almost half. Our contrastive learning pipeline, CT-Lite, integrates these components with a SigLIP-based multimodal alignment objective. Experiments on CT-RATE, NIDCH, and Rad-ChestCT demonstrate that CT-Lite achieves AUROC within 5-7% of the uncompressed-input baseline across all three datasets, despite operating on compressed inputs with significantly fewer parameters, paving the way for AI-based clinical evaluation under resource constraints.

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 provide evidence of quantum kernel advantage under noiseless simulation in binary insurance classification on MIMIC-CXR chest radiographs using quantum support vector machines (QSVM) with frozen embeddings from three medical foundation models (MedSigLIP-448, RAD-DINO, ViT-patch32). We propose a two-tier fair comparison framework in which both classifiers receive identical PCA-q features. At Tier 1 (untuned QSVM vs. untuned linear SVM, C = 1 both sides), QSVM wins minority-class F1 in all 18 tested configurations (17 at p < 0.001, 1 at p < 0.01). The classical linear kernel collapses to majority-class prediction on 90-100% of seeds at every qubit count, while QSVM maintains non-trivial recall. At q = 11 (MedSigLIP-448 plateau center), QSVM achieves mean F1 = 0.343 vs. classical F1 = 0.050 (F1 gain = +0.293, p < 0.001) without hyperparameter tuning. Under Tier 2 (untuned QSVM vs. C-tuned RBF SVM), QSVM wins all seven tested configurations (mean gain +0.068, max +0.112). Eigenspectrum analysis reveals quantum kernel effective rank reaches 69.80 at q = 11, far exceeding linear kernel rank, while classical collapse remains C-invariant. A full qubit sweep reveals architecture-dependent concentration onset across models. Code: https://github.com/sebasmos/qml-medimage

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.

Noisy labels are a pervasive challenge in medical image classification, where annotation errors arise from inter-observer variability and diagnostic ambiguity. Although several noise-robust learning methods have been proposed, their evaluation predominantly relies on accuracy-oriented metrics, overlooking the clinical implications of asymmetric error costs. In medical diagnosis, a false negative (missed disease) carries substantially higher consequences than a false positive (false alarm), as delayed treatment can directly impact patient outcomes. In this work, we investigate whether noise-robust training methods preserve clinical safety under label noise. We conduct a systematic risk-aware evaluation of the state-of-the-art noise-robust methods Coteaching, DivideMix, UNICON, and a GMM-based filtering approach on binarized DermaMNIST and PathMNIST datasets under clean and label noise rates of 20%, and 40%. Beyond balanced accuracy, we adopt a cost-sensitive Global Risk formulation that explicitly penalizes false negatives. Our analysis reveals that the robustness of state-of-the-art methods does not guarantee clinical safety. Furthermore, we demonstrate that integrating cost-sensitive optimization into noise-robust training significantly reduces clinical risk, while mantaining model utility. These findings demonstrate that noise-robust learning must be evaluated through a clinical risk lens, and that combining robust training with cost-sensitive optimization can meaningfully reduce risk in noisy-label medical imaging scenarios.

The application of Deep Learning in medical diagnosis must balance patient safety with compliance with data protection regulations. Machine Unlearning enables the selective removal of training data from deployed models. However, most methods are validated primarily through efficiency and privacy-oriented metrics, with limited attention to clinically asymmetric error costs. In this work, we investigate how unlearning affects clinical risk in binary medical image classification. We show that standard unlearning strategies (Fine-Tuning, Random Labeling, and SalUn) may reduce test utility while increasing false-negative rates, thereby amplifying clinical risk. To mitigate this, we propose SalUn-CRA (Clinical Risk-Aware), a variant of SalUn that replaces random relabeling with entropy-based forgetting for malignant samples in the forget set, preventing the model from learning harmful benign associations. We evaluate on DermaMNIST and PathMNIST medical image datasets under 20% and 50% data removal. Using Global Risk metrics with asymmetric costs, SalUn-CRA achieves lower or comparable clinical risk to full retraining while preserving unlearning effectiveness. These results suggest that clinical risk should be an integral component of unlearning validation in medical systems.

Federated learning (FL) is a distributed machine learning method where multiple devices collaboratively train a model under the management of a central server without sharing underlying data. One of the key challenges of FL is the communication bottleneck caused by variations in connection speed and bandwidth across devices. Therefore, it is essential to reduce the size of transmitted data during training. Additionally, there is a potential risk of exposing sensitive information through the model or gradient analysis during training. To address both privacy and communication efficiency, we combine differential privacy (DP) and adaptive quantization methods. We use Laplacian-based DP to preserve privacy, which is relatively underexplored in FL and offers tighter privacy guarantees than Gaussian-based DP. We propose a simple and efficient global bit-length scheduler using round-based cosine annealing, along with a client-based scheduler that dynamically adapts based on client contribution estimated through dataset entropy analysis. We evaluate our approach through extensive experiments on CIFAR10, MNIST, and medical imaging datasets, using non-IID data distributions across varying client counts, bit-length schedulers, and privacy budgets. The results show that our adaptive quantization methods reduce total communicated data by up to 52.64% for MNIST, 45.06% for CIFAR10, and 31% to 37% for medical imaging datasets compared to 32-bit float training while maintaining competitive model accuracy and ensuring robust privacy through differential privacy.

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.

Early detection and classifying brain tumors using Magnetic Resonance Imaging (MRI) images is highly important but difficult to extract in medical images. Convolutional Neural Networks (CNNs) are good at capturing both local texture and spatial information whereas Vision Transformers (ViTs) are good at capturing long-range global dependencies. We propose a new hybrid architecture that combines a SqueezeNet-style CNN branch with a MobileViT-style global transformer branch, through an Adaptive Attention Gate mechanism, in this paper. The gate learns dynamically per-sample, per-feature weights to weight the contribution of each branch, allowing context-sensitive merging of local and global representations. The proposed model has a test accuracy of 97.60, a precision of 97.30, a recall of 97.50, an F1-score of 97.40, and a macro-average area under the curve (AUC) of 0.9946 with a trained and evaluated on the Brain Tumor MRI Dataset (Kaggle). These scores are higher than single CNN and ViT baselines, and current competitive fusion methods, showing that dynamic feature weighting is an effective way to classify medical images.

Recent medical multimodal foundation models are built as multimodal LLMs (MLLMs) by connecting a CLIP-pretrained vision encoder to an LLM using LLaVA-style finetuning. This two-stage, decoupled approach introduces a projection layer that can distort visual features. This is especially concerning in medical imaging where subtle cues are essential for accurate diagnoses. In contrast, early-fusion generative approaches such as Chameleon eliminate the projection bottleneck by processing image and text tokens within a single unified sequence, enabling joint representation learning that leverages the inductive priors of language models. We present CheXmix, a unified early-fusion generative model trained on a large corpus of chest X-rays paired with radiology reports. We expand on Chameleon's autoregressive framework by introducing a two-stage multimodal generative pretraining strategy that combines the representational strengths of masked autoencoders with MLLMs. The resulting models are highly flexible, supporting both discriminative and generative tasks at both coarse and fine-grained scales. Our approach outperforms well-established generative models across all masking ratios by 6.0% and surpasses CheXagent by 8.6% on AUROC at high image masking ratios on the CheXpert classification task. We further inpaint images over 51.0% better than text-only generative models and outperform CheXagent by 45% on the GREEN metric for radiology report generation. These results demonstrate that CheXmix captures fine-grained information across a broad spectrum of chest X-ray tasks. Our code is at: https://github.com/StanfordMIMI/CheXmix.

We study whether deep networks for medical imaging learn useful nonrobust features - predictive input patterns that are not human interpretable and highly susceptible to small adversarial perturbations - and how these features impact test performance. We show that models trained only on nonrobust features achieve well above chance accuracy across five MedMNIST classification tasks, confirming their predictive value in-distribution. Conversely, adversarially trained models that primarily rely on robust features sacrifice in-distribution accuracy but yield markedly better performance under controlled distribution shifts (MedMNIST-C). Overall, nonrobust features boost standard accuracy yet degrade out-of-distribution performance, revealing a practical robustness-accuracy trade-off in medical imaging classification tasks that should be tailored to the requirements of the deployment setting.

This paper introduces EgoMAGIC (Medical Assistance, Guidance, Instruction, and Correction), an egocentric medical activity dataset collected as part of DARPA's Perceptually-enabled Task Guidance (PTG) program. This dataset comprises 3,355 videos of 50 medical tasks, with at least 50 labeled videos per task. The primary objective of the PTG program was to develop virtual assistants integrated into augmented reality headsets to assist users in performing complex tasks. To encourage exploration and research using this dataset, the medical training data has been released along with an action detection challenge focused on eight medical tasks. The majority of the videos were recorded using a head-mounted stereo camera with integrated audio. From this dataset, 40 YOLO models were trained using 1.95 million labels to detect 124 medical objects, providing a robust starting point for developers working on medical AI applications. In addition to introducing the dataset, this paper presents baseline results on action detection for the eight selected medical tasks across three models, with the best-performing method achieving average mAP 0.526. Although this paper primarily addresses action detection as the benchmark, the EgoMAGIC dataset is equally suitable for action recognition, object identification and detection, error detection, and other challenging computer vision tasks. The dataset is accessible via zenodo.org (DOI: 10.5281/zenodo.19239154).

Biomedical imaging data presents enormous potential for deep learning models to predict invaluable properties, such as diseases and drug effects. However, unavoidable alterations of the technical conditions cause batch effects: variations between groups of samples that are not due to any biological signal of interest. Batch effects greatly hinder the generalization abilities of deep learning models, preventing their practical use in the real world. Unsupervised Domain Adaptation (UDA) methods have been proposed to mitigate batch effects, but they usually assume that the data is comprised of only one source domain and one target domain, whereas biological datasets are comprised of multiple domains, both at training and at inference time. While Batch Normalization-based test-time and meta-learning adaptation methods offer a promising mechanism for domain alignment, we show that existing approaches exhibit degraded performance under the usual inference scenarios of small target batch sizes and label shift. We address these limitations by leveraging negative control samples, which are consistently present in every experimental batch in biological datasets, as stable context for adaptation. We propose CS-ARM-BN, a meta-learning BN adaptation method that uses controls both during training and inference to stabilize domain statistics. We perform a suite of experiments of Mechanism-Of-Action (MoA) classification, a crucial task for drug discovery, on the large JUMP-CP imaging dataset. Our experiments show that CS-ARM-BN substantially improves robustness to batch size and class distribution shifts, enabling practical use of deep learning models for biomedical images.

Vision Transformers $(\texttt{ViT})$ have become the architecture of choice for many computer vision tasks, yet their performance in computer-aided diagnostics remains limited. Focusing on breast cancer detection from mammograms, we identify two main causes for this shortfall. First, medical images are high-resolution with small abnormalities, leading to an excessive number of tokens and making it difficult for the softmax-based attention to localize and attend to relevant regions. Second, medical image classification is inherently fine-grained, with low inter-class and high intra-class variability, where standard cross-entropy training is insufficient. To overcome these challenges, we propose a framework with three key components: (1) Region of interest $(\texttt{RoI})$ based token reduction using an object detection model to guide attention; (2) contrastive learning between selected $\texttt{RoI}$ to enhance fine-grained discrimination through hard-negative based training; and (3) a $\texttt{DINOv2}$ pretrained $\texttt{ViT}$ that captures localization-aware, fine-grained features instead of global $\texttt{CLIP}$ representations. Experiments on public mammography datasets demonstrate that our method achieves superior performance over existing baselines, establishing its effectiveness and potential clinical utility for large-scale breast cancer screening. Our code is available for reproducibility here: https://aih-iitd.github.io/publications/attend-what-matters

Accurate disease classification from radiology reports is essential for many applications. While supervised fine-tuning (SFT) of lightweight LLMs improves accuracy, it can degrade reasoning. We propose a two-stage approach: SFT on disease labels followed by Group Relative Policy Optimization (GRPO) to refine predictions by optimizing accuracy and format without reasoning supervision. Across three radiologist-annotated datasets, SFT outperformed baselines and GRPO further improved classification and enhanced reasoning recall and comprehensiveness.

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.

Medical imaging AI development is fundamentally dependent on annotated datasets, yet no existing standard provides machine-enforceable validation across dataset structure, annotation provenance, quality documentation, and ML readiness within a single framework. DICOM standardizes image acquisition, storage, and communication at the individual study level. BIDS organizes neuroimaging research datasets with consistent naming conventions. Neither addresses the curation layer, viz., who annotated what, when, with what tool, and to what quality standard. This paper presents VIDS (Verified Imaging Dataset Standard), an open specification that defines folder layout, file naming, annotation provenance schemas, quality documentation, and 21 machine-enforceable validation rules across two compliance profiles. VIDS uses NIfTI as a canonical working format while preserving full DICOM metadata in sidecars for traceability, and supports export to any downstream ML framework (nnU-Net, MONAI, COCO, flat NIfTI) without loss of provenance. Twenty-two compliance dimensions are defined and four major public datasets -- LIDC-IDRI, BraTS, CheXpert, and the Medical Segmentation Decathlon -- are benchmarked against these dimensions. Even widely used datasets satisfy only 20--39% of these dimensions, with provenance and quality documentation as the largest systematic gaps. LIDC-Hybrid-100 is released as a 100-subject VIDS-compliant reference CT dataset with consensus segmentation masks from four radiologist annotations (mean pairwise Dice 0.7765), validating 21/21 on the Full compliance profile. VIDS is fully open source: the specification is CC BY 4.0, all tools are Apache 2.0, the reference validator is available on PyPI (pip install vids-validator), and LIDC-Hybrid-100 is published on Zenodo (https://doi.org/10.5281/zenodo.19582717).

Fine-grained medical image classification is challenged by subtle inter-class variations and visually ambiguous cases, where confidence estimates often exhibit uncertainty rather than being overconfident. In such scenarios, purely discriminative classifiers may achieve high overall accuracy yet still fail to distinguish between highly similar categories, leading to miscalibrated predictions. We propose T-DuMpRa, a teacher-guided dual-path multi-prototype retrieval-augmented framework, where discriminative classification and multi-prototype retrieval jointly drive both training and prediction. During training, we jointly optimize cross-entropy and supervised contrastive objectives to learn a cosine-compatible embedding geometry for reliable prototype matching. We further employ an exponential moving average (EMA) teacher to obtain smoother representations and build a multi-prototype memory bank by clustering teacher embeddings in the teacher embedding space. Our framework is plug-and-play: it can be easily integrated into existing classification models by constructing a compact prototype bank, thereby improving performance on visually ambiguous cases. At inference, we combine the classifier's predicted distribution with a similarity-based distribution computed via cosine matching to prototypes, and apply a conservative confidence-gated fusion that activates retrieval only when the classifier's prediction is uncertain and the retrieval evidence is decisive and conflicting, otherwise keeping confident predictions unchanged. On HAM10000 and ISIC2019, our method yields 0.68%-0.21% and 0.44%-2.69% improvements on 5 different backbones. And visualization analysis proves our model can enhance the model's ability to handle visually ambiguous cases.

The scarcity of labeled clinical data in oncology makes Few-Shot Learning (FSL) a critical framework for Computer Aided Diagnostics, but we observed that standard Prototypical Networks often struggle with the "prototype instability" caused by morphological noise and high intra-class variance in brain tumor scans. Our work attempts to minimize this by integrating a non-linear Logistic Chaos Module into a fine-tuned ResNet-18 backbone creating the Chaos-Enhanced ProtoNet(CE-ProtoNet). Using the deterministic ergodicity of the logistic chaos map we inject controlled perturbations into support features during episodic training-essentially for "stress testing" the embedding space. This process makes the model to converge on noise-invariant representations without increasing computational overhead. Testing this on a 4-way 5-shot brain tumor classification task, we found that a 15% chaotic injection level worked efficiently to stabilize high-dimensional clusters and reduce class dispersion. Our method achieved a peak test accuracy of 84.52%, outperforming standard ProtoNet. Our results suggest the idea of using chaotic perturbation as an efficient, low-overhead regularization tool, for the data-scarce regimes.

The integration of medical imaging and clinical text has enabled the emergence of generalist artificial intelligence (AI) systems for healthcare. However, pervasive biases, such as imbalanced disease prevalence, skewed anatomical region distributions, heterogeneous imaging protocols, and demographic disparities, pose significant challenges to the fairness and reliability of vision-language systems in real-world clinical settings. Here we present BiasCareVL, a bias-aware multimodal learning framework that introduces bias control directly into model design, rather than treating it as a post hoc correction. BiasCareVL incorporates adaptive uncertainty modeling with optional human-in-the-loop refinement to regulate the influence of dominant data patterns and to promote equitable reasoning under distributional imbalance. Trained on 3.44 million samples spanning over 15 imaging modalities, the framework supports diverse clinical tasks, including visual question answering, disease classification, segmentation, and report generation within a unified representation space. Across eight public benchmarks covering dermatology, oncology, radiology, and pathology, BiasCareVL consistently outperforms 20 state-of-the-art methods, with pronounced gains in clinically challenging scenarios, including over 10% accuracy improvement in multi-class skin lesion diagnosis and more than 20% Dice improvement in small tumor segmentation. Furthermore, BiasCareVL achieves diagnostic performance exceeding human accuracy with substantially reduced time requirements when evaluated with board-certified radiologists. By open-sourcing BiasCareVL, we aim to promote a transparent, reproducible, and equitable future for AI in healthcare, paving the way for general-purpose, trustworthy, and clinically reliable AI systems.

While deep learning systems are becoming increasingly prevalent in medical image analysis, their vulnerabilities to adversarial perturbations raise serious concerns for clinical deployment. These vulnerability evaluations largely rely on Attack Success Rate (ASR), a binary metric that indicates solely whether an attack is successful. However, the ASR metric does not account for other factors, such as perturbation strength, perceptual image quality, and cross-architecture attack transferability, and therefore, the interpretation is incomplete. This gap requires consideration, as complex, large-scale deep learning systems, including Vision Transformers (ViTs), are increasingly challenging the dominance of Convolutional Neural Networks (CNNs). These architectures learn differently, and it is unclear whether a single metric, e.g., ASR, can effectively capture adversarial behavior. To address this, we perform a systematic empirical study on four medical image datasets: PathMNIST, DermaMNIST, RetinaMNIST, and CheXpert. We evaluate seven models (VGG-16, ResNet-50, DenseNet-121, Inception-v3, DeiT, Swin Transformer, and ViT-B/16) against seven attack methods at five perturbation budgets, measuring ASR, Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), and $L_2$ perturbation magnitude. Our findings show a consistent pattern: perceptual and distortion metrics are strongly associated with one another and exhibit minimal correlation with ASR. This applies to both CNNs and ViTs. The results demonstrate that ASR alone is an inadequate indicator of adversarial robustness and transferability. Consequently, we argue that a thorough assessment of adversarial risk in medical AI necessitates multi-metric frameworks that encompass not only the attack efficacy but also its methodology and associated overheads.

Masked image modeling (MIM) is a highly effective self-supervised learning (SSL) approach to extract useful feature representations from unannotated data. Predominantly used random masking methods make SSL less effective for medical images due to the contextual similarity of neighboring patches, leading to information leakage and SSL simplification. Hierarchical shifted window (Swin) transformer, a highly effective approach for medical images cannot use advanced masking methods as it lacks a global [CLS] token. Hence, we introduced an attention guided masking mechanism for Swin within a co-distillation learning framework to selectively mask semantically co-occurring and discriminative patches, to reduce information leakage and increase the difficulty of SSL pretraining. However, attention guided masking inevitably reduces the diversity of attention heads, which negatively impacts downstream task performance. To address this, we for the first time, integrate a noisy teacher into the co-distillation framework (termed DAGMaN) that performs attentive masking while preserving high attention head diversity. We demonstrate the capability of DAGMaN on multiple tasks including full- and few-shot lung nodule classification, immunotherapy outcome prediction, tumor segmentation, and unsupervised organs clustering.

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Medical image segmentation (MIS) is a fundamental component of computer-assisted diagnosis and clinical decision support. Over the past decade, numerous architectures specifically tailored to medical imaging have emerged to address domain-specific challenges such as low contrast, small anatomical structures, and limited annotated data. In parallel, rapid progress in computer vision has produced highly capable general-purpose vision models (GP-VMs) originally designed for natural images. Despite their strong performance on standard vision benchmarks, their effectiveness for MIS remains insufficiently understood. In this controlled empirical study, we examine whether specialized medical segmentation architectures (SMAs) provide systematic advantages over modern GP-VMs for 2D MIS. We compare eleven SMAs and GP-VMs using a unified training and evaluation protocol across three heterogeneous datasets, each covering different 2D imaging modalities, class structures, and data characteristics. Beyond segmentation performance, we employ linear mixed-effects models (LMMs) for statistical assessment and qualitative Grad-CAM visualizations to investigate explainability (XAI)-related model behavior. Our results imply that, for the analyzed settings, GP-VMs achieve performance comparable to that of specialized MIS models. Moreover, XAI analyses indicate that GP-VMs are capable of identifying clinically relevant structures despite the absence of explicit domain-specific architectural priors. These findings suggest that GP-VMs can represent a viable alternative to domain-specific methods for 2D MIS, highlighting the importance of informed model selection. All code and resources are available at GitHub.

DINO models provide rich patch-level representations that have recently enabled strong performance in unsupervised anomaly detection (UAD). Most existing methods extract patch embeddings from normal images and model them independently, ignoring spatial and neighborhood relationships between patches. This implicitly assumes that self-attention and positional encodings sufficiently encode contextual information within each patch embedding. In addition, the normative distribution is often modeled as memory banks or prototype-based representations, which require storing large numbers of features and performing costly comparisons at inference time, leading to substantial memory and computational overhead. In this work, we explicitly model spatial and contextual dependencies between patch embeddings using a 2D autoregressive (AR) model, allowing us to use a simple and efficient model for normative modeling. Instead of storing embeddings or clustering prototypes, our approach learns a compact parametric model of the normative distribution via an AR convolutional neural network (CNN). At test time, anomaly detection reduces to a single forward pass through the network and enables fast and memory-efficient inference. We evaluate our method on the BMAD benchmark, comprising three medical imaging datasets, and the VisA dataset, comprising 12 industrial object categories, and compare it against existing methods, including recent DINO-based approaches. Experimental results demonstrate that explicitly modeling spatial dependencies achieves competitive anomaly detection performance while substantially reducing inference time and memory requirements. Code is available at the project page: https://eerdil.github.io/spatial-ar-dinov3-uad/

Differential privacy (DP)'s effect in medical imaging is typically evaluated only through end-to-end performance, leaving the mechanism of privacy-induced utility loss unclear. We introduce Differential Privacy Representation Geometry for Medical Imaging (DP-RGMI), a framework that interprets DP as a structured transformation of representation space and decomposes performance degradation into encoder geometry and task-head utilization. Geometry is quantified by representation displacement from initialization and spectral effective dimension, while utilization is measured as the gap between linear-probe and end-to-end utility. Across over 594,000 images from four chest X-ray datasets and multiple pretrained initializations, we show that DP is consistently associated with a utilization gap even when linear separability is largely preserved. At the same time, displacement and spectral dimension exhibit non-monotonic, initialization- and dataset-dependent reshaping, indicating that DP alters representation anisotropy rather than uniformly collapsing features. Correlation analysis reveals that the association between end-to-end performance and utilization is robust across datasets but can vary by initialization, while geometric quantities capture additional prior- and dataset-conditioned variation. These findings position DP-RGMI as a reproducible framework for diagnosing privacy-induced failure modes and informing privacy model selection.

In critical decision support systems based on medical imaging, the reliability of AI-assisted decision-making is as relevant as predictive accuracy. Although deep learning models have demonstrated significant accuracy, they frequently suffer from miscalibration, manifested as overconfidence in erroneous predictions. To facilitate clinical acceptance, it is imperative that models quantify uncertainty in a manner that correlates with prediction correctness, allowing clinicians to identify unreliable outputs for further review. To address this necessity, this paper proposes a probabilistic optimization framework grounded in Bayesian deep learning. Specifically, the Confidence-Uncertainty Boundary Curve (CUBC) is first explored as an intermediate operational target. Grounded in this target, a novel Confidence-Uncertainty Boundary Loss (CUB-Loss) is proposed to regularize the alignment between prediction confidence and uncertainty estimates during training, imposing penalties on high-certainty errors and low-certainty correct predictions. Upon completion of training optimization, a Boundary Curve Calibration Error (BCCE) metric is further introduced to measure the degree of boundary alignment in the calibrated model. Building on this measurement, a Dual Temperature Scaling (DTS) strategy is devised to perform post-hoc refinement, further adjusting the posterior predictive distribution across different confidence-uncertainty regions. The proposed framework is validated on three distinct medical imaging tasks: automatic screening of pneumonia, diabetic retinopathy detection, and identification of skin lesions. Empirical results demonstrate that the proposed approach improves uncertainty calibration across diverse modalities, maintains robust performance in data-scarce scenarios, and remains effective on severely imbalanced datasets, underscoring its potential for real clinical deployment.

The classification performance of deep neural networks relies strongly on access to large, accurately annotated datasets. In medical imaging, however, obtaining such datasets is particularly challenging since annotations must be provided by specialized physicians, which severely limits the pool of annotators. Furthermore, class boundaries can often be ambiguous or difficult to define which further complicates machine learning-based classification. In this paper, we want to address this problem and introduce a framework for mislabel detection in medical datasets. This is validated on the two largest, publicly available datasets for Video Capsule Endoscopy, an important imaging procedure for examining the gastrointestinal tract based on a video stream of lowresolution images. In addition, potentially mislabeled samples identified by our pipeline were reviewed and re-annotated by three experienced gastroenterologists. Our results show that the proposed framework successfully detects incorrectly labeled data and results in an improved anomaly detection performance after cleaning the datasets compared to current baselines.

Deep learning has substantially advanced medical image segmentation, yet achieving robust generalization across diverse imaging modalities and anatomical structures remains a major challenge. A key contributor to this limitation lies in how existing architectures, ranging from CNNs to Transformers and their hybrids, primarily encode spatial information while overlooking frequency-domain representations that capture rich structural and textural cues. Although recent studies have begun exploring spectral information at the feature level, supervision-level integration of frequency cues-crucial for fine-grained object localization-remains largely untapped. To this end, we propose Phi-SegNet, a CNN-based architecture that incorporates phase-aware information at both architectural and optimization levels. The network integrates Bi-Feature Mask Former (BFMF) modules that blend neighboring encoder features to reduce semantic gaps, and Reverse Fourier Attention (RFA) blocks that refine decoder outputs using phase-regularized features. A dedicated phase-aware loss aligns these features with structural priors, forming a closed feedback loop that emphasizes boundary precision. Evaluated on five public datasets spanning X-ray, US, histopathology, MRI, and colonoscopy, Phi-SegNet consistently achieved state-of-the-art performance, with an average relative improvement of 1.54+/-1.26% in IoU and 0.98+/-0.71% in F1-score over the next best-performing model. In cross-dataset generalization scenarios involving unseen datasets from the known domain, it also exhibits robust and superior performance, highlighting its adaptability and modality-agnostic design. These findings demonstrate the potential of leveraging spectral priors in both feature representation and supervision, paving the way for generalized segmentation frameworks that excel in fine-grained object localization. Our code is available on GitHub.

Chain-of-Thought (CoT) reasoning has proven effective in enhancing large language models by encouraging step-by-step intermediate reasoning, and recent advances have extended this paradigm to Multimodal Large Language Models (MLLMs). In the medical domain, where diagnostic decisions depend on nuanced visual cues and sequential reasoning, CoT aligns naturally with clinical thinking processes. However, current benchmarks for medical image understanding generally focus on the final answer while ignoring the reasoning path. Such opaque reasoning processes lack reliable bases for judgment, making it difficult to assist doctors in diagnosis. To address this gap, we introduce a new M3CoTBench benchmark specifically designed to evaluate the correctness, efficiency, impact, and consistency of CoT reasoning in medical image understanding. M3CoTBench features 1) a diverse, multi-level difficulty dataset covering 24 examination types, 2) 13 varying-difficulty tasks, 3) a suite of CoT-specific evaluation metrics (correctness, efficiency, impact, and consistency) tailored to clinical reasoning, and 4) a performance analysis of multiple MLLMs. M3CoTBench systematically evaluates CoT reasoning across diverse medical imaging tasks, revealing current limitations of MLLMs in generating reliable and clinically interpretable reasoning, and aims to foster the development of transparent, trustworthy, and diagnostically accurate AI systems for healthcare. Project page at https://juntaojianggavin.github.io/projects/M3CoTBench/.

Recent tool-use frameworks powered by vision-language models (VLMs) improve image understanding by grounding model predictions with specialized tools. Broadly, these frameworks leverage VLMs and a pre-specified toolbox to decompose the prediction task into multiple tool calls (often deep learning models) which are composed to make a prediction. The dominant approach to composing tools is using text, via function calls embedded in VLM-generated code or natural language. However, these methods often perform poorly on medical image understanding, where salient information is encoded as spatially-localized features that are difficult to compose or fuse via text alone. To address this, we propose a tool-use framework for medical image understanding called the Tool Bottleneck Framework (TBF), which composes VLM-selected tools using a learned Tool Bottleneck Model (TBM). For a given image and task, TBF leverages an off-the-shelf medical VLM to select tools from a toolbox that each extract clinically-relevant features. Instead of text-based composition, these tools are composed by the TBM, which computes and fuses the tool outputs using a neural network before outputting the final prediction. We propose a simple and effective strategy for TBMs to make predictions with any arbitrary VLM tool selection. Overall, our framework not only improves tool-use in medical imaging contexts, but also yields more interpretable, clinically-grounded predictors. We evaluate TBF on tasks in histopathology and dermatology and find that these advantages enable our framework to perform on par with or better than deep learning-based classifiers, VLMs, and state-of-the-art tool-use frameworks, with particular gains in data-limited regimes. The project details and the code are available at https://christinaliu2020.github.io/tbm/.

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.