Medical Imaging

Visual simultaneous localization and mapping (V-SLAM) is a fundamental capability for autonomous perception and navigation. However, endoscopic scenes violate the rigidity assumption due to persistent soft-tissue deformations, creating a strong coupling ambiguity between camera ego-motion and intrinsic deformation. Although recent monocular non-rigid SLAM methods have made notable progress, they often lack effective decoupling mechanisms and rely on sparse or low-fidelity scene representations, which leads to tracking drift and limited reconstruction quality. To address these limitations, we propose NRGS-SLAM, a monocular non-rigid SLAM system for endoscopy based on 3D Gaussian Splatting. To resolve the coupling ambiguity, we introduce a deformation-aware 3D Gaussian map that augments each Gaussian primitive with a learnable deformation probability, optimized via a Bayesian self-supervision strategy without requiring external non-rigidity labels. Building on this representation, we design a deformable tracking module that performs robust coarse-to-fine pose estimation by prioritizing low-deformation regions, followed by efficient per-frame deformation updates. A carefully designed deformable mapping module progressively expands and refines the map, balancing representational capacity and computational efficiency. In addition, a unified robust geometric loss incorporates external geometric priors to mitigate the inherent ill-posedness of monocular non-rigid SLAM. Extensive experiments on multiple public endoscopic datasets demonstrate that NRGS-SLAM achieves more accurate camera pose estimation (up to 50% reduction in RMSE) and higher-quality photo-realistic reconstructions than state-of-the-art methods. Comprehensive ablation studies further validate the effectiveness of our key design choices. Source code will be publicly available upon paper acceptance.

Accurate estimation of the relative concentrations of chromophores in a spectroscopic photoacoustic (sPA) image can reveal immense structural, functional, and molecular information about physiological processes. However, due to nonlinearities and ill-posedness inherent to sPA imaging, concentration estimation is intractable. The Spectroscopic Photoacoustic Optical Inversion Autoencoder (SPOI-AE) aims to address the sPA optical inversion and spectral unmixing problems without assuming linearity. Herein, SPOI-AE was trained and tested on in vivo mouse lymph node sPA images with unknown ground truth chromophore concentrations. SPOI-AE better reconstructs input sPA pixels than conventional algorithms while providing biologically coherent estimates for optical parameters, chromophore concentrations, and the percent oxygen saturation of tissue. SPOI-AE's unmixing accuracy was validated using a simulated mouse lymph node phantom ground truth.

Foundation models (FMs) are rapidly reshaping medical imaging, shifting the field from narrowly trained, task-specific networks toward large, general-purpose models that can be adapted across modalities, anatomies, and clinical tasks. In this review, we synthesize the emerging landscape of medical imaging FMs along three major axes: principles of FM design, applications of FMs, and forward-looking challenges and opportunities. Taken together, this review provides a technically grounded, clinically aware, and future-facing roadmap for developing FMs that are not only powerful and versatile but also trustworthy and ready for responsible translation into clinical practice.

Objective: X-ray angiography is the gold standard imaging modality for cardiovascular diseases. However, current deep learning approaches for X-ray angiogram analysis are severely constrained by the scarcity of annotated data. While large-scale self-supervised learning (SSL) has emerged as a promising solution, its potential in this domain remains largely unexplored, primarily due to the lack of effective SSL frameworks and large-scale datasets. Methods: To bridge this gap, we introduce a vascular anatomy-aware masked image modeling (VasoMIM) framework that explicitly integrates domain-specific anatomical knowledge. Specifically, VasoMIM comprises two key designs: an anatomy-guided masking strategy and an anatomical consistency loss. The former strategically masks vessel-containing patches to compel the model to learn robust vascular semantics, while the latter preserves structural consistency of vessels between the original and reconstructed images, enhancing the discriminability of the learned representations. In conjunction with VasoMIM, we curate XA-170K, the largest X-ray angiogram pre-training dataset to date. Results: We validate VasoMIM on four downstream tasks across six datasets, where it demonstrates superior transferability and achieves state-of-the-art performance compared to existing methods. Conclusion: Incorporating vascular anatomical knowledge into self-supervised pre-training enables more discriminative and transferable representations for X-ray angiogram analysis. Significance: These findings highlight the significant potential of VasoMIM as a foundation model for advancing a wide range of X-ray angiogram analysis tasks. VasoMIM and XA-170K are available on GitHub and Hugging Face, respectively.

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.

Score-based diffusion models are a recently developed framework for posterior sampling in Bayesian inverse problems, enabling high-quality reconstructions in inverse problems by leveraging expressive prior distributions learned from empirical data. Despite their strong empirical performance and growing interest within the machine learning community, their behaviour in realistic, severely ill-posed inverse problems with experimental measurement data remains under-explored. Diffuse optical tomography (DOT) is an inverse boundary value problem that uses boundary measurements of near-infrared light to recover spatially varying absorption and scattering parameters in biological tissue. The problem is highly ill-posed and particularly sensitive to both measurement noise and modelling errors. We introduce a regularization strategy by constructing a mixed score consisting of a learned component and a model-based component. We show that the resulting mixed score approximates the score of a corresponding mixture distribution locally and in the small diffusion-time regime, providing a theoretical justification for the approach. We compare four approaches for difference imaging in DOT: a classical model-based method, an approximate score-based diffusion method (DPS), an exact posterior sampling method (UCoS) and a novel, regularized version of UCoS. We show that both the model-based approach and approximate diffusion-based sampling degrade significantly in the presence of limited-view geometry and real experimental data, whereas UCoS yields more accurate reconstructions.

Vision-language pretraining has driven progress in medical image representation learning, but it depends on paired image-text data and can inherit reporting bias from clinical narratives. We study whether language-free predictive pretraining can produce an image encoder that transfers effectively to radiology report generation. RadJEPA is a chest-X-ray adaptation of I-JEPA, pretrained on approximately 840K unlabeled radiographs using latent context-to-target prediction. Our primary contribution is an extensive empirical evaluation of this language-free encoder for report generation: the frozen image encoder is coupled to a trainable two-layer projector and language decoder, and is also substituted into four established vision-language backbones. Across MIMIC-CXR and IU-Xray, RadJEPA matches or exceeds the evaluated image-only and image-text baselines on lexical, entity-relation, and clinical-label metrics. Controlled MIMIC-only comparisons provide evidence that the predictive objective contributes beyond domain-specific pretraining, while broader comparisons also reflect differences in pretraining data, model capacity, and input resolution. Complementary classification and segmentation experiments assess transfer beyond report generation.

The human spine commonly consists of seven cervical, twelve thoracic, and five lumbar vertebrae. However, enumeration anomalies may result in individuals having eleven or thirteen thoracic vertebrae and four or six lumbar vertebrae. Although the identification of enumeration anomalies has potential clinical implications for chronic back pain and operation planning, the thoracolumbar junction is often poorly assessed and rarely described in clinical reports. Additionally, even though multiple deep-learning-based vertebra labeling algorithms exist, there is a lack of methods to automatically label enumeration anomalies. Our work closes that gap by introducing "Vertebra Identification with Anomaly Handling" (VERIDAH), a novel vertebra labeling algorithm based on multiple classification heads combined with a weighted vertebra sequence prediction algorithm. We show that our approach surpasses existing models on T2w TSE sagittal (98.30% vs. 94.24% of subjects with all vertebrae correctly labeled, p < 0.001) and CT imaging (99.18% vs. 77.26% of subjects with all vertebrae correctly labeled, p < 0.001) and works in arbitrary field-of-view images. VERIDAH correctly labeled the presence 2 Möller et al. of thoracic enumeration anomalies in 87.80% and 96.30% of T2w and CT images, respectively, and lumbar enumeration anomalies in 94.48% and 97.22% for T2w and CT, respectively. Our code and models are available at: https://github.com/Hendrik-code/spineps.

Depth estimation is a foundational component for 3D reconstruction in minimally invasive endoscopic surgeries. However, existing monocular depth estimation techniques often exhibit limited performance to the varying illumination and complex textures of the surgical environment. While applying foundation models offers a promising approach to enhance the depth estimation performance, the domain gap between the natural images used for pre-training and the target endoscopic images leads to significant semantic perception deficiencies. In this study, EndoUFM is introduced as an unsupervised monocular depth estimation framework that innovatively Utilizes dual Foundation Models for Endoscopic images, thereby enhancing the depth estimation performance by leveraging the powerful pre-learned priors. The framework features a novel adaptive fine-tuning strategy that incorporates Random Vector Low-Rank Adaptation (RVLoRA) to enhance model adaptability, and a Residual block based on Depthwise Separable Convolution (Res-DSC) to improve the capture of fine-grained local features. A mask-guided smoothness loss is also introduced to enforce depth consistency within anatomical structures. Extensive experiments on the SCARED, Hamlyn, SERV-CT, and EndoNeRF datasets confirm that our method achieves state-of-the-art performance while maintaining an efficient model size. This work contributes to augmenting surgeons' spatial perception during minimally invasive procedures, thereby enhancing surgical precision and safety, with crucial implications for augmented reality and navigation systems. Our code is available at https://github.com/RealMindyY/EndoUFM.

Endoscopic diagnosis is an iterative process in which clinicians acquire, compare, and verify local visual evidence before reaching a conclusion. Current AI systems do not adequately support this process because fine-grained evidence acquisition and multi-step reasoning remain weakly coupled, complicating reconciliation of image-derived findings with their textual interpretations. This gives rise to two failure modes, hallucinated evidence and uncorrected error accumulation, that undermine diagnostic reliability. We propose EndoCogniAgent, a closed-loop agentic framework that formulates endoscopic diagnosis as a controlled state update process for integrating complementary visual and textual evidence. At each reasoning round, a central planner selects an evidence acquisition action, specialized expert tools extract spatial and semantic observations as structured textual evidence, and a self-consistency validation mechanism examines this evidence along two dimensions, knowledge consistency against the input image and temporal consistency with prior validated findings, before updating the diagnostic state. Validated observations are admitted into the evolving state to condition subsequent planning, while insufficiently supported or conflicting findings are retained with corrective feedback that redirects the planner toward additional verification. We further introduce EndoAgentBench, a workflow-oriented benchmark comprising 6,132 question-answer pairs from 11 endoscopic datasets, to evaluate diagnostic agents across a comprehensive diagnostic chain, from fine-grained visual perception to high-level diagnostic reasoning. EndoCogniAgent achieves 85.23% overall accuracy on perception tasks and 71.13% clinical acceptance rate on reasoning tasks. Blinded clinician evaluation further shows consistent improvements in diagnostic response quality over the evaluated baselines.

Interest in generating realistic synthetic medical images has grown in recent years. Such datasets can mitigate the scarcity of public data for artificial intelligence research and support education. Work on synthesizing dental panoramic radiographs (PRs) has so far relied almost exclusively on generative adversarial networks (GANs), and three limitations recur: the synthesized field of view is often restricted to a cropped dentoalveolar region rather than a complete PR; observer studies of GAN-generated PRs report that clinicians still identify synthetic images with accuracies of roughly 78-82%, implying persistent visible giveaways; and adversarial training remains sensitive to instability and mode collapse. Generating a full-size PR directly at diagnostic resolution with a diffusion model is an alternative, but sampling at that resolution is costly. We therefore present PanoDiff-SR, an end-to-end two-stage pipeline developed and evaluated specifically for panoramic radiography: a denoising diffusion implicit model (PanoDiff) generates a low-resolution (LR) seed PR ($256\times128$), which a fine-tuned hybrid attention transformer (HAT) super-resolution (SR) stage upscales to a high-resolution (HR) PR of $1024\times512$. Decoupling the expensive generative step from the resolution step yields complete, full-arch PRs at diagnostic resolution on a single 47 GB GPU. The Fréchet inception distance between 7243 real and synthetic HR images is 40.5. Inception scores were 2.68, 2.38, 2.90 and 2.98 for real HR, synthetic HR, real LR and synthetic LR images, respectively. Six clinical experts, each evaluating 100 synthetic and 100 real PRs under a time limit, distinguished real from synthetic images with an average accuracy of 68.5% (50% corresponds to random guessing), substantially closer to chance than reported for GAN-based studies. Project page: https://s4nyam.github.io/panodiff/

Accurate segmentation of coronary Digital Subtraction Angiography (DSA) images is essential for diagnosing and treating coronary artery disease (CAD). Despite advances in deep learning, challenges such as high intra-class variance and class imbalance limit precise vessel delineation. Existing approaches for coronary DSA segmentation cannot effectively address these issues. Furthermore, existing segmentation network encoders do not directly generate semantic embeddings, which could enable the decoder to reconstruct segmentation masks more effectively. We propose a Supervised Prototypical Contrastive Loss (SPCL) that combines supervised and prototypical contrastive learning to enhance coronary DSA image segmentation. The supervised contrastive loss enforces semantic embeddings in the encoder, improving feature differentiation. The prototypical contrastive loss enables the model to focus on the foreground class while alleviating high intra-class variance and class imbalance by concentrating only on hard-to-classify background samples. We implement the proposed SPCL within MSA-UNet3+, a Multi-Scale Attention-Enhanced UNet3+ architecture. The architecture integrates a Multi-Scale Attention Encoder (M-encoder), a Multi-Scale Dilated Bottleneck (MSD-Bottleneck) for multi-scale feature extraction, and a Contextual Attention Fusion Module (CAFM) to preserve fine-grained details while improving contextual understanding. Experiments on a private coronary DSA dataset demonstrate that MSA-UNet3+ outperforms state-of-the-art methods, achieving the highest Dice coefficient and F1-score while significantly reducing ASD and ACD. The framework provides precise vessel segmentation for accurate identification of coronary stenosis and supports informed diagnostic and therapeutic decisions. The code will be released at https://github.com/rayanmerghani/MSA-UNet3plus.

Interpretability is crucial for utilizing machine learning models as clinical decision support tools for medical diagnostics. However, most state-of-the-art image classifiers based on neural networks are not interpretable. As a result, clinicians often resort to known biomarkers to guide diagnosis, although biomarker-based classification often suffers from drastic information loss compared to raw medical images. This work proposes a method that preserves the rich imaging information while simultaneously enhancing the interpretability of predictions for diabetic retinopathy staging from optical coherence tomography angiography (OCTA) images. The core contribution of our method is a novel biology-informed heterogeneous graph representation that models retinal vessel segments, intercapillary areas, and the foveal avascular zone (FAZ) in a human-interpretable way. This graph representation allows us to frame diabetic retinopathy staging as a graph-level classification task, which we solve using an established, efficient graph neural network architecture. We compare our method against established methods, including classical biomarker-based classifiers, convolutional neural networks (CNNs), and vision transformers in predicting the clinically assigned DR stage based on color fundus photography images. We find stage agreement rates of our method and alternative vision model based classifiers saturating at AUC-ROC values of 84%. Crucially, we use our biology-informed graph to provide explanations of great detail. Our approach surpasses existing methods in precisely localizing and identifying abnormal vessels and non-perfusion areas. Our approach sets the stage for the interpretable identification of patients who require special attention due to their traceable microvascular changes, only observable using the details of OCTA images.

Digital Subtraction Angiography (DSA) is one of the gold standards for vascular disease diagnosis. With the help of a contrast agent, time-resolved 2D DSA images deliver comprehensive blood flow information and can be utilized to reconstruct 3D vessel structures for medical assessment. Current commercial DSA systems typically require hundreds of scanning views to perform reconstruction, resulting in substantial radiation exposure. In this study, we propose a neural rendering-based optimization framework tailored for high-quality sparse-view DSA reconstruction to reduce radiation dosage. Our approach, termed vessel probability guided attenuation learning, represents DSA imaging as a complementary weighted combination of static and dynamic attenuation fields, with the weights derived from the time-independent vessel probability field. Functioning as a foreground mask, vessel probability provides proper gradients for both static and dynamic fields adaptive to different scene types. This mechanism enables self-supervised decomposition between static backgrounds and dynamic contrast agent flow, and significantly improves reconstruction quality. Our model is trained by minimizing the discrepancy between synthesized projections and real captured DSA images. We further employ two training strategies to improve reconstruction quality: (1) coarse-to-fine progressive training for better geometry and (2) temporal perturbed rendering loss for temporal consistency. Experimental results have demonstrated high-quality 3D vessel reconstruction and 2D DSA image synthesis.

This paper presents a method to efficiently classify the gastroenterologic section of images derived from Video Capsule Endoscopy (VCE) studies by exploring the combination of a Convolutional Neural Network (CNN) for classification with the time-series analysis properties of a Hidden Markov Model (HMM). It is demonstrated that successive time-series analysis identifies and corrects errors in the CNN output. Our approach achieves an accuracy of $98.04\%$ on the Rhode Island (RI) Gastroenterology dataset. This allows for precise localization within the gastrointestinal (GI) tract while requiring only approximately 1M parameters and thus, provides a method suitable for low power devices