Multicenter Evaluation

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4 papers in the last four weeks, with none the four weeks before. 0.0% of all new papers.

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Oct 1, 2026cs.LG

Fixing a Model That Learned Worse Cancer Means Lower Risk: Monotonic Constraints in Bladder Cancer Recurrence Prediction

Background and Objective: Clinicians expect recurrence risk to climb with cancer severity. In a UK multicentre trial, an unconstrained XGBoost model learnt that higher tumour stage and carcinoma in situ predicted lower recurrence risk, and discrimination, calibration, and SHAP were all blind to it. We developed a counterfactual testing framework to detect this inversion and a monotonic-constraint framework to remove it without hurting performance. Methods: BOXIT enrolled 472 patients with protocol-mandated cystoscopy across 51 UK sites (2007-2012); 435 had at least two years' follow-up (153 recurrences, 35.2%). We developed a counterfactual direction test and a monotonic-constraint correction, with constraint directions drawn from the EORTC and EAU risk systems, and evaluated both against unconstrained XGBoost and logistic regression on 18 predictors (seven directed) over 50 cross-validation folds. The test worsened each patient on one directed feature at a time to check whether risk fell; SHAP direction and calibration were also assessed. Key Findings and Limitations: Tumour stage and carcinoma in situ were associated with lower recurrence, opposite to medical intuition; the unconstrained model reversed carcinoma in situ counterfactuals in 90.2% of cases and stage in 74.3%. Discrimination (

Δ

AUC 0.005, p=0.47), calibration, and SHAP magnitude were all blind to the inversion. Monotonic constraints eliminated every violation at no cost to discrimination (0.723 vs 0.718) and outperformed EORTC (p=8.9e-16). Limitations: single trial, internal-external validation only. Conclusions and Clinical Implications: A model that had learned this inversion passed every conventional check. A counterfactual direction test, run as a single refit with pre-specified monotonic constraints, catches this failure at no cost to performance and should be routine before clinical deployment.

Saram Abbas, David Thomas, Naeem Soomro +3

School of Engineering, Newcastle University, Newcastle upon Tyne, UK · Electronics and Computer Science, University of Southampton, Southampton, UK · Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK +1

Multidisciplinary Tumor Boards Multicenter Evaluation Xgboost Model Counterfactual Generation Monotonicity

Sep 28, 2026q-bio.QM

An integrated geometric quantification and shape analysis framework for axillary lymph node metastasis in breast cancer patients

Quantitative characterization of lymph node morphology is important for assessing axillary lymph node metastasis in breast cancer. However, surfaces reconstructed from computed tomography (CT) segmentation may contain geometric and topological defects that compromise subsequent analysis, while conventional shape descriptors predominantly characterize global morphology. To address these issues, we developed an integrated framework combining topology-aware surface processing with multi-resolution spherical harmonic (SH) analysis of CT-derived axillary lymph nodes. The processing pipeline produced topology-valid genus-0 surfaces with improved mesh quality, which were then represented at multiple SH degrees and characterized using 20 predefined geometric feature families. Geometric fidelity increased with SH degree, whereas predictive performance peaked at intermediate resolutions. Preferred SH degree also differed across feature families. A family-specific mixed-resolution model achieved an AUC of 0.918, compared with 0.884 for the conventional PyRadiomics Shape14 baseline, corresponding to an improvement of 0.0344. Controlled perturbation experiments showed that higher SH degrees transmitted more fine-scale geometric variation and yielded lower stability of curvature-based predictions. Representative geometric descriptors provided interpretable characterization of metastasis-associated surface morphology. Independent validation further supported the framework's transportability: label-free replication in a multicenter lymph node cohort reproduced the family-specific resolution effects, while a labeled LIDC-IDRI lung-nodule experiment reproduced the resolution-dependent relationship between SH degree and predictive performance. Altogether, the framework provides a topology-valid basis for quantitative characterization of lymph node morphology and metastasis-associated imaging phenotypes.

Zixi Yi, Limeng Qu, Gary P. T. Choi

School of Mathematics and Statistics, Central South University, Changsha, Hunan, China · Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China · Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China +1

Tumor Morphometric Analysis Multicenter Evaluation Spherical Harmonics

Sep 24, 2026cs.CV

Detecting Glaucoma Across Multi-ethnic Myopic and Non-Myopic Populations Using an Uncertainty-Aware Vision Transformer: A Multicentre Model Development and Validation Study

Background: Artificial intelligence (AI)-based glaucoma detection from colour fundus photographs (CFP) offers scalable screening, but performance may decline on external datasets because of differences in ground-truth definitions, populations, and coexisting conditions such as high myopia (HM). We developed and validated a Vision Transformer-based deep learning (DL) model for glaucoma detection across multi-ethnic cohorts with and without HM. Methods: A ViT-B/16 model with predictive uncertainty estimation was developed using 56,483 CFPs (57.1% with myopia; 14.4% with HM). Glaucoma labels were standardised using clinical, imaging, and perimetry data. The model was validated on 16 independent datasets across three continents, including four datasets with explicit HM labels. Findings: Internal AUROC was 98.7% (95% CI 98.2-99.1%), with sensitivity 94.5% and specificity 97.3%. Across 16 external datasets from eight countries, AUROCs ranged from 86.4% to 99.6%. In HM eyes, internal AUROC was 97.8% (95% CI 96.1-99.2%), with sensitivity 94.8% and specificity 93.7%. External HM AUROCs were 86.5% in the Beijing Eye Study and 93.3%, 91.8%, and 85.5% in hospital-based datasets from Taiwan, Thailand, and South Korea. In an exploratory HM clinical evaluation, the model had higher CFP-only diagnostic accuracy than ophthalmologists and trained graders (92.0% vs 70.0%; p=0.008) and performed comparably to glaucoma specialists using full clinical information. Interpretation: The model showed robust glaucoma detection across myopic and non-myopic multi-ethnic populations and may support AI-assisted screening in settings with high HM prevalence.

Raghavan Lavanya, Yangqin Feng, Ten Cheer Quek +36

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore · Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore · Institute of Advanced Intelligence and Computing, Agency for Science, Technology and Research, Singapore +14

Glaucoma Detection Fundus Images Self-Supervised Vision Transformers Multicenter Evaluation

Sep 21, 2026cs.CV

Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma by Integrating Multimodal Ultrasound and Clinical Data: A Multicenter Study

Background: Microvascular invasion (MVI) predicts recurrence and survival in hepatocellular carcinoma (HCC) but requires postoperative histopathology for diagnosis. We developed and validated a model integrating multimodal ultrasound and clinical data for preoperative MVI prediction. Methods: This multicenter study included 489 patients with HCC from eight centers. All patients had B-mode ultrasound (BUS), color Doppler flow imaging (CDFI), dynamic contrast-enhanced ultrasound (DCE-US), and clinical information. Data from seven centers (n = 421) were used for model development with five-fold cross-validation; data from the remaining center (n = 68) formed an independent external validation cohort. The proposed multimodal information fusion network used modality-specific encoders, a hemodynamic temporal change module for bidirectional DCE-US perfusion changes, and a representation consistency learning module to align heterogeneous ultrasound representations before Transformer-based fusion. Results: In external validation, DCE-US achieved the highest single-modality area under the receiver operating characteristic curve (AUC; 0.8545+/-0.0198), versus clinical information (0.6715+/-0.0156), CDFI (0.6435+/-0.0344), and BUS (0.6087+/-0.0417). Pixel-difference sampling and the proposed temporal module outperformed alternative sampling and video representation methods. The full model achieved the best performance, with an AUC of 0.8953+/-0.0180, accuracy of 81.18%+/-2.83%, sensitivity of 86.40%+/-6.69%, and specificity of 78.14%+/-6.28. Conclusions: Integrating multimodal ultrasound and clinical information enabled promising preoperative MVI prediction in HCC. DCE-US was the main source of predictive information, while BUS, CDFI, and clinical information provided complementary value. The proposed framework may support preoperative risk stratification and individualized clinical decision-making.

Jun Cheng, Yuanyuan Kong, Qing Huang +9

National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China · Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China · Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China +1

Cholangiocarcinoma Cancer Detection Prognostics Multicenter Evaluation

Sep 17, 2026cs.LG

Multi-center Medical Data Mining with FL-Net - A One-stop Shop for Federated Learning

Federated learning enables collaborative training without sharing patient-level data, but most studies remain simulations. Based on five requirements derived from the literature, we analyzed 14 FL frameworks and found that none fully satisfied these requirements. We present FL-Net, a novel federated clinical research framework to fulfill all requirements. It integrates modular data harmonization, data discovery, disclosure control, securely built versioned FL-Net-Tools and containerized federated workflow execution into a persistent network. It enables the re-use of harmonized data and workflows across studies. FL-Net's end-to-end capabilities were evaluated through harmonization, cross-study patient discovery across MIMIC and US-130, and reproducible, audited federated workflows with up to 50 concurrent clients. FL-Net is being developed within the dAIbetes and Microb-AI-ome EU projects and will cover over 800,000 patients across 10 hospitals in 9 countries covering longitudinal and single point in time data, FL-Net provides a practical foundation for interoperable, reproducible, and privacy-preserving multicenter clinical research.

Simon Süwer, Julian Klemm, Elisa Acitelli +38

Federated Learning Multicenter Evaluation Clinical Trials Harmonization

Sep 1, 2026cs.CL

Towards AI-Assisted Clinical Trial Matching: Practical Considerations, Multicenter Evaluation, and Real-World Deployment

Clinical trials are essential for advancing cancer care and drug development, but many fail because of insufficient patient enrollment. While there is growing interest in using AI to support patient recruitment, existing systems largely perform eligibility assessment alone and have rarely been evaluated in real-world oncology workflows. Here we present TrialGPT 2.0, an AI-assisted clinical trial recommendation system designed for real-world deployment. Rather than asking only whether a patient may qualify, the system also assesses which trials warrant further consideration given the patient's current clinical needs and local workflow priorities, and provides structured, inspectable explanations for expert review. Importantly, we evaluated TrialGPT 2.0 retrospectively and prospectively across multiple oncology-focused settings, spanning government, academic cancer-center, patient-advocacy, and NIH referral workflows. In retrospective multicenter cohorts comprising 288 cases, TrialGPT 2.0 retrieved at least one clinician-recommended trial in its top 10 recommendations for approximately 91% of cases while reducing clinician screening time by 55.0%. In a six-month prospective evaluation embedded in an active precision oncology tumor board, TrialGPT 2.0 contributed additional trial opportunities missed by the routine workflow, expanding patient access to clinical trial participation by 90.9%. To support scientific reproducibility, we also introduce NIH-TrialBench, a clinician-authored dataset comprising 126 diverse synthetic patient vignettes and matching scenarios from 11 NIH Institutes and Centers. Together, these results support the value of AI to assist clinical trial matching by improving clinician efficiency and identifying frequently overlooked trial opportunities, ultimately helping to expand and accelerate accrual to cancer trials.

Yin Fang, Qiao Jin, Shubo Tian +24

Division of Intramural Research, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA. · UI Health, University of Illinois Chicago. Chicago, IL, USA. · University of Illinois Urbana-Champaign, Urbana, IL, USA. +6

Clinical Trials Multicenter Evaluation Multidisciplinary Tumor Boards Medication Leaflet

Jul 23, 2026cs.AI

Agentic coding without the cloud: evaluating open-weight large language models on longitudinal data preparation tasks

Large language models (LLMs) and agents are now widely used tools in code development, with data typically sent to third-party cloud-based models. Their adoption in research using personal data is constrained by governance requirements that typically prohibit data transmission to external services. Locally deployable open-weight models offer an alternative since sensitive data never leave the local environment. We introduce an open-source framework for evaluating the efficacy of AI agents powered by open-weight LLMs on one of the most persistent bottlenecks in research on longitudinal population studies: data preparation. The framework comprises: a curated ground-truth dataset (cleaning scripts preparing six sweeps of data from a British cohort study), task definitions encompassing tasks such as category harmonization and multi-wave merging, and automated routines for evaluating the LLM-produced R code and outputted data. We benchmark LLMs across the (consumer grade) deployment spectrum to assess their efficacy in 20 data preparation tasks (creation of 102 variables). Current state-of-the-art, 31-35B parameter models almost saturated our benchmark ('average task completion' up to 87.9%). The performance of open-weight LLMs running on consumer-grade hardware shows promise of a viable path toward AI-assisted data preparation in governance-restricted research settings. Our framework is publicly available at: https://github.com/UCL-ARC/RRBench.

Mack Nixon, Liam Wright, Yevgeniya Kovalchuk +4

Centre for Advanced Research Computing, University College London, London, UK · Centre for Longitudinal Studies, University College London, London, UK · UK Longitudinal Linkage Collaboration, University of Bristol, Bristol, UK

Coding Agents Preprocessing Artificial Intelligence Agents Multicenter Evaluation

Jul 21, 2026cs.CV

Cross-Dataset Generalization in Breast MRI Tumor Classification via Class-Wise Dataset Mixing

Breast MRI is highly sensitive for detecting breast tumors, but exams contain many slices and require substantial reading time. Deep learning models often perform well on internal splits but can fail across institutions because of domain shift and dataset-origin bias. We study this failure mode for binary breast MRI tumor classification. EfficientNet-B3 and WaveViT-Small are trained using Duke Breast Cancer MRI and fastMRI, and evaluated only on the independent multi-center MAMA-MIA cohort. In a deliberately confounded setup, where label is perfectly correlated with dataset origin, external accuracy is near chance (0.5048--0.5265), despite very high recall. We then construct a mixed training set in which each class contains samples from both Duke and fastMRI, while preserving patient-level splitting, augmentation, and leakage controls. On MAMA-MIA, dataset mixing improves accuracy/F1 to 0.8463/0.8625 for WaveViT-Small and 0.8884/0.8994 for EfficientNet-B3. These results show that controlling dataset-origin bias is important for reliable breast MRI classification.

Mohammad Ali Dadrast, Hamid Usefi

Data Science Program Memorial University of Newfoundland St. John’s, Canada · Department of Mathematics and Statistics Memorial University of Newfoundland St. John’s, Canada

Brain Tumor Classification Cross-Dataset Benchmark Imbalanced Classification Multicenter Evaluation Efficientnet Encoder Biases

Jul 13, 2026cs.CV

A Unified Framework for Comprehensive Cardiac CT Segmentation and Phenotyping: Human-in-the-Loop Data Annotation, Vision Foundation Model Development, Multicenter Evaluation and Clinical Validation

Comprehensive quantification of cardiac structures from computed tomography (CT) remains limited not by data availability but by the scalability of measurements, which makes routine use impractical. Here we present a unified framework for comprehensive cardiac CT segmentation and phenotyping that combines a human-in-the-loop annotation pipeline, a cardiac CT augmentation technique, and a self-supervised foundation model pre-trained on 60,000 unlabeled cardiac CT scans. Using this approach, we assembled the largest and most comprehensive expert-annotated cardiac CT segmentation dataset to date, comprising 1598 cases and 14 distinct cardiac structures (1000 for training, 598 for the external test set). Across five external datasets, the framework segmented all structures more accurately and comprehensively than existing open-source tools. Self-supervised pre-training improved labeling efficiency, with the most significant gains observed during external evaluation in the low-data regime. Benchmarking across convolutional, transformer, and state-space architectures showed comparable performance, indicating that data quality and pre-training, rather than architecture, drove accuracy. The framework was scaled to population-level phenotyping, with segmented anatomy that carries functionally relevant information about ventricular function and disease severity beyond demographic variables. By openly releasing the largest dataset with human labels, code, model weights, a CT augmentation library, and software, this work provides a reproducible foundation for opportunistic cardiac phenotyping from routinely acquired CT scans.

Pooya Mohammadi Kazaj, Leo Fridolin Weber, Wen Xie +17

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland · Department of Digital Medicine, University of Bern, Bern, Switzerland · Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland +4

Echocardiography Multi Organ Computed Tomography Segmentation Cone-Beam Computed Tomography Phenotypes Multicenter Evaluation

Jul 1, 2026cs.CV

EchoRisk: A Multicentre Echocardiography Dataset and Benchmark for Cardio-Oncology

Therapy-induced cardiotoxicity is the leading non-oncological cause of treatment interruption in breast cancer patients, yet early, automated risk stratification from routine cardiac imaging remains an unsolved problem. We present EchoRisk, the first curated, multicentre, longitudinal echocardiography dataset with explicit cardiotoxicity labels, released as the primary technical reference for the EchoRisk-MICCAI 2026 challenge. The dataset comprises 422 patients enrolled in the EU-funded CARDIOCARE prospective study across five European sites, yielding 2,159 echocardiography videos across 1,123 clinical exams acquired at up to five longitudinal timepoints, alongside a dedicated cohort of 280 patients with baseline imaging for early cardiotoxicity prediction. Three clinically grounded tasks are defined: automated estimation of left ventricular ejection fraction from cine video (Task 1), classification of LV dysfunction from longitudinal imaging (Task 2), and early prediction of therapy-induced cardiotoxicity from pre-therapy baseline echocardiography alone (Task 3). For each task we specify the evaluation protocol, primary and secondary metrics, and ranking procedure. We establish baseline performance using an R(2+1)D video backbone with LSTM aggregation trained from Kinetics-400 pretrained weights, demonstrating strong discriminative performance for cardiac functional assessment and LV dysfunction classification, while early cardiotoxicity prediction from a single pre-therapy video remains a significant open problem for the community. The dataset, evaluation code, and baseline implementations are publicly available to serve as a benchmark for further collaboration, comparison, and the creation of task-specific architectures in cardio-oncology.

Grigorios Kalliatakis, Georgia Karanasiou, Georgios Manikis +10

Foundation for Research and Technology Hellas, Greece · University of Ioannina, Greece · Hellenic Mediterranean University, Greece +3

Echocardiography Multicenter Evaluation

Jun 24, 2026eess.IV

Cross-Attention Multimodal Learning for Predicting Response to Neoadjuvant Imatinib in Gastrointestinal Stromal Tumors: A Multicenter Retrospective Study

Background: Response to neoadjuvant imatinib in gastrointestinal stromal tumors (GISTs) is highly variable and cannot be reliably predicted using current clinical or molecular markers. This study developed and evaluated an explainable multimodal deep learning framework integrating computed tomography (CT) imaging and clinical variables to predict treatment response. Methods: Patients from four tertiary centers were retrospectively included between 2000-2023 in independent pretraining (n=935) and prediction (n=213) cohorts. A cross-attention framework integrating clinical variables and tumor-centered CT imaging was developed to predict response to neoadjuvant imatinib. Two training strategies were evaluated: (1) self-supervised pretraining with low-rank adaptation and (2) training from scratch. Hyperparameters were optimized using SMAC3. Performance was assessed through internal cross-validation and external testing. Ablation analyses and attention-based explanations were used to quantify modality contributions. Results: Among 213 patients (54.5% responders), responders had larger tumors (112 vs. 89 mm, P=0.026), higher mitotic index (3 vs. 0, P<0.001), and more frequent KIT mutations (69.0% vs. 56.7%, P=0.019). Cross-attention models achieved the highest internal performance (AUC up to 0.99) but lower external performance (AUC 0.60-0.63). Clinical-only performance was moderate (AUC 0.66), whereas imaging-only models showed limited generalizability (AUC 0.56-0.66). Explainability analyses identified significant differences in feature importance between responders and non-responders, including CD117, BRAF, PDGFRA, age, sex, disease status, and comorbidities (FDR-adjusted P<=0.036). Conclusion: The cross-attention framework shows potential for improving imatinib response prediction in GIST while providing interpretable insights into multimodal determinants of treatment response.

Fariba Tohidinezhad, Douwe J. Spaanderman, Natalia Oviedo Acosta +14

Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands. · Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands. · Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands. +6

Multicenter Evaluation Colorectal Cancer Biomarker Cross-Modal Attention

Jun 15, 2026cs.CV

An Open-Source Monitoring Framework for Data Exploration and Progress Tracking in Multi-Center Radiology Studies

Multi-center studies are crucial for advancing medical and radiological research. Data exploration, collaboration discovery, and study progress monitoring are essential for maximizing their potential. However, in practice these processes often rely on manual communication and shared tables, which quickly become outdated and hinder efficient coordination in large distributed studies. This highlights the need for dedicated monitoring solutions that provide transparent and up-to-date insights into study progress. We propose a lightweight, open-source monitoring architecture for multi-center studies based on the widely used Grafana-Prometheus stack. The framework collects aggregated monitoring metrics from distributed study sites and visualizes them through configurable dashboards. As a real-world deployment example, the framework is integrated into the medical imaging platform Kaapana and evaluated within a large multi-center research network. By deploying our solution within the Germany-wide RACOON consortium, we demonstrate its ability to enable privacy-preserving data exploration and study progress monitoring across all 38 German university clinics. The monitoring framework supports transparent coordination of distributed research activities and can facilitate more efficient management of large-scale multi-center studies. The source code and Kaapana integration are publicly available at https://github.com/MIC-DKFZ/study-monitoring-kaapana.

Markus Bujotzek, Jonas Scherer, Stefan Denner +7

Division of Medical Image Computing, Germany Cancer Research Center, Heidelberg, 69120, Germany. · Medical Faculty, University of Heidelberg, Heidelberg, 69120, Germany. · Faculty for Computer Science, University of Heidelberg, Heidelberg, 69120, Germany. +3

Multicenter Evaluation Medical Images Global Coordination

Jun 10, 2026stat.AP

Estimating Individualized Treatment Effects in Acute Ischemic Stroke with Causal Transformation Models (TRAM-DAG): A Multi-Centre Observational Study with External RCT Validation

Personalized medicine in acute ischemic stroke requires moving beyond average treatment effects (ATE) to individualized treatment effect (ITE) estimates to support treatment decisions. In acute ischemic stroke, mechanical thrombectomy has been shown to be more effective on average than lysis in randomized controlled trials (RCTs), such as the MR CLEAN study. We aim to identify which individual patients benefit most from mechanical thrombectomy compared to lysis. The outcome of interest is the modified Rankin Scale (mRS) at three months, an ordinal measure of functional disability (0: no symptoms, 6: death). We demonstrate that causal transformation models on directed acyclic graphs (TRAM-DAG) can be used for ITE estimation after being fitted on observational MAGIC multi-center stroke patient data. To ensure comparability with the MR CLEAN population, which we use for validation, we train the TRAM-DAG on a MAGIC sub-population with NIHSS at admission >= 6, corresponding to one inclusion criterion of MR CLEAN. The fitted model is then used to estimate ITEs for stroke patients in the MR CLEAN population. While these ITE estimates cannot be confirmed experimentally, we show that their average is consistent with the trial's reported ATE. Furthermore, the ITE estimates correctly rank trial patients by their observed frequency of a good outcome (mRS at three months <= 2). These findings support the use of causal models like TRAM-DAG for personalized decision-making in stroke care and highlight their ability to bridge the gap between observational evidence and clinical trials.

Lisa Herzog, Oliver Dürr, Pascal Bühler +4

Department of Neurology, University Hospital Zurich (USZ), Switzerland · Thurgau Institute for Digital Transformation (TIDIT), Kreuzlingen, Switzerland · HTWG Konstanz – University of Applied Sciences Konstanz, Germany +1

Stroke Heterogeneous Treatment Effects Multicenter Evaluation Controlled Study Clear Ranking

May 21, 2026cs.RO

Remote Teleoperation of Endovascular Intervention Robots: A Systematic Review

Remote robotic-assisted endovascular intervention offers a promising approach to reduce clinician radiation exposure and physical strain, while extending specialized vascular care to geographically distant regions. Despite advancements, teleoperated endovascular intervention remains underexplored, especially for time-sensitive interventions like mechanical thrombectomy for acute stroke. The aim of the current review was to determine the evidence regarding teleoperated endovascular robotic systems, covering technical feasibility, communication infrastructure, and clinical outcomes. The review further identified research gaps and future directions. Following PRISMA guidelines, 16 studies were included that met the inclusion criteria out of 2501 initial search results. We found that teleoperated catheters and guidewires, driven by mechanical or electromagnetic systems, can be navigated across distances up to 7000 km. With robust communication infrastructure, network latency remained within clinically acceptable limits (30-163 ms). Although initial outcomes highlighted 100% procedural success in small-scale human trials, most evidence stemmed from animal or phantom models. Overall, the findings suggest that teleoperated endovascular intervention can reduce occupational hazards, expand patient access to urgent procedures, and optimize resource allocation. Future research should be conducted in low and middle income countries to demonstrate broader geographical access. Ultimately, multi-center clinical trials are required to validate the safety, efficacy, and generalization in diverse clinical settings.

Xingyu Chen, Yinchao Yang, Nikola Fischer +5

School of Biomedical Engineering & Imaging Sciences, King’s College London, WC2R 2LS London, U.K. · Department of Engineering, King’s College London, WC2R 2LS London, U.K. · Department of Neuroradiology, King’s College Hospital, SE5 9RS London, U.K.

Catheters Teleoperation Remote Multicenter Evaluation Systematic Review

May 14, 2026cs.AI

How Sensitive Are Radiomic AI Models to Acquisition Parameters?

A main barrier for the deployment of AI radiomic systems in clinical routine is their drop in performance under heterogeneous multicentre acquisition protocols. This work presents a performance-oriented framework for quantifying scan parameter sensitivity of radiomic AI models, while identifying clinically significant parameter regions associated with improved cross-dataset robustness. We formulate a mixed-effects framework for quantifying the influence that clinically relevant acquisition parameters have on models performance, while accounting for subject-level random effects. We have applied our framework to lung cancer diagnosis in CT scans using two independent multicentre datasets (a public database and own-collected data) and several SoA architectures. To evaluate across-database reproducibility, CT parameters have been adjusted using the data collected and tested on the public set. The optimal configuration selected is the current of the X-ray tube >= 200 mA, spiral pitch <= 1.5, slice thickness <= 1.25 mm, which balances diagnostic quality with low radiation dose. These configuration push metrics from 0.79+-0.04 sensitivity, 0.47+-0.10 specificity in low quality scans to 0.90+-0.10 sensitivity, 0.79 +- 0.13 specificity in high quality ones.

D. Gil, I. Sanchez, C. Sanchez

Universitat Autònoma de Barcelona and Computer Vision Center, Edifici O, Campus UAB, Bellaterra (Cerdanyola), 08193, Barcleona, Spain

Radiomics Cone-Beam Computed Tomography Multicenter Evaluation Acquisition Generalized Linear Model

May 7, 2026physics.med-ph

Overcoming data scarcity through multi-center federated learning for organs-at-risk segmentation in pediatric upper abdominal radiotherapy

Deep learning-based organs/structures-at-risk(OARs) auto-contouring models can improve radiotherapy workflows, but models trained on adult data often underperform in pediatric patients. Developing robust pediatric-specific models is hindered by data scarcity and fragmentation across centers. Federated learning (FL) enables privacy-preserving collaborative training without the need for data sharing. We evaluated the feasibility and performance of FL for developing pediatric-specific OAR segmentation models across two European medical centers. Computed tomography (CT) images from pediatric patients from Utrecht and Heidelberg with a renal tumor or abdominal neuroblastoma were retrospectively collected and locally processed. An nnU-Net-based framework segmented 19 OARs using local and FL schemes. FL was implemented with secure weight exchange on a cloud storage across institutional firewalls. Performance was assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance, and mean surface distance. Robustness to patient orientation, false-positive segmentation of surgically removed kidneys, and failure cases were identified. A total of 310 postoperative CTs from 272 patients (105 renal tumors, 167 neuroblastomas) were included. Local models performed well on their respective center data but showed significantly reduced cross-center performance for four to seven of the nine evaluated OARs (DSC). In contrast, the FL model matched local performance for at least seven of nine OARs and achieved the best cross-center results across three metrics, with DSC gains of 0.003-0.007 over local models. FL also maintained stable performance across patient orientations and reduced false-positive kidney segmentations. Real-world FL improves cross-center robustness of CT-based OAR segmentation models in pediatric upper abdominal tumors.

Mianyong Ding, Maximilian Knoll, Semi Harrabi +7

Department of Radiation Oncology, Imaging and Cancer Division, University Medical Centre Utrecht, Utrecht, The Netherlands · University Hospital Heidelberg, Heidelberg Ion Beam Therapy Centre (HIT), Department of Radiation Oncology, Heidelberg, Germany · Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands +3

Tumor Segmentation Federated Learning Multicenter Evaluation Radiotherapy Semi-Supervised Medical Image Segmentation

Dec 16, 2025cs.LG

AnySleep: a channel-agnostic deep learning system for high-resolution sleep staging in multi-center cohorts

Sleep is essential for health, yet studying its dynamics requires manual sleep staging, a labor-intensive step in research and clinical care. Across centers, polysomnography (PSG) recordings are traditionally scored in 30-s epochs for pragmatic, not physiological, reasons and vary in electrode count, montage, and subject characteristics. These constraints challenge harmonized multi-center studies and the discovery of robust biomarkers on shorter timescales. We present AnySleep, a deep neural network that scores sleep from any electroencephalography (EEG) or electrooculography (EOG) data at adjustable temporal resolutions. We trained and validated the model on over 20,000 overnight recordings (> 200,000 hours of EEG and EOG) from 28 datasets across multiple clinics to promote robust generalization across sites. The model attains state-of-the-art performance and surpasses or equals established baselines at 30-s epochs. Performance improves with more channels, yet remains strong when EOG is absent or only EOG or single EEG derivations (frontal, central, or occipital) are available. On sub-30-s timescales, the model captures short wake intrusions consistent with arousals and improves prediction of pathophysiological conditions (obstructive sleep apnea, narcolepsy type 1, insomnia) over 30-s scoring. We make the model publicly available to facilitate large-scale studies with heterogeneous electrode setups and accelerate biomarker discovery in sleep.

Niklas Grieger, Jannik Raskob, Siamak Mehrkanoon +1

Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, 52428 Jülich, Germany · Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands · Institute for Data-Driven Technologies, FH Aachen University of Applied Sciences, 52428 Jülich, Germany

Sleep Electroencephalography Deep Learning Framework Biomarker Multicenter Evaluation

Oct 27, 2025cs.CV

Accurate and Scalable Multimodal Pathology Retrieval via Attentive Vision-Language Alignment

The rapid digitization of histopathology slides has opened new opportunities for computational tools in clinical and research workflows. Content-based slide retrieval can help pathologists identify morphologically and semantically related precedent cases, supporting expert diagnosis and example-based education. Effective retrieval of whole-slide images (WSIs), however, remains challenging because gigapixel slides contain abundant irrelevant content, focal diagnostic patterns and slide-level semantic information that must be represented at a practicable search cost. Here we present PathSearch, a retrieval framework that combines fine-grained attentive mosaics with slide-level embeddings aligned through vision-language contrastive learning. Trained on 6,926 slide-report pairs, PathSearch captures both fine-grained morphological cues and high-level semantic patterns to enable accurate and flexible retrieval. The framework supports two key functionalities: (1) mosaic-based image-to-image (I2I) retrieval, ensuring accurate and efficient slide search; and (2) multimodal retrieval, where text queries can directly retrieve relevant slides. PathSearch was evaluated on eight tasks comprising 5,021 evaluation slides, spanning malignancy assessment on frozen and hematoxylin and eosin (H&E)-stained slides, lymph-node metastasis detection, tumor subtyping, mixed-gallery rare-cancer retrieval, and hepatocellular carcinoma (HCC) risk stratification. Internal and external experimental results demonstrate that PathSearch consistently outperforms the strongest existing methods without compromising multimodal accuracy. A multi-center reader study further demonstrated increases in task-level mean diagnostic accuracy, confidence, and inter-observer agreement with PathSearch's support. Together, these results support the effectiveness of PathSearch across diverse retrieval tasks and evaluation settings.

Hongyi Wang, Zhengjie Zhu, Junlin Hou +13

Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China · College of Computer Science and Technology, Zhejiang University, Hangzhou, China. · School of Medicine, Wake Forest University, Winston-Salem, NC, USA. +11

Whole-Slide Images Digital Pathology Computational Pathology Multimodal Clinical Data Multiple Instance Learning Vision-Language Alignment+2

Jun 18, 2025cs.LG

Federated Learning for MRI-based BrainAGE: a multicenter study on post-stroke functional outcome prediction

\textbf{Objective:}

Brain-predicted age difference (BrainAGE) is a neuroimaging biomarker reflecting brain health. However, training robust BrainAGE models requires large datasets, often restricted by privacy concerns. This study evaluates the performance of federated learning (FL) for BrainAGE estimation in ischemic stroke patients treated with mechanical thrombectomy, and investigates its association with clinical phenotypes and functional outcomes.

\textbf{Methods:}

We used FLAIR brain images from 1674 stroke patients across 16 hospital centers. We implemented standard machine learning and deep learning models for BrainAGE estimates under three data management strategies: centralized learning (pooled data), FL (local training at each site), and single-site learning. We reported prediction errors and examined associations between BrainAGE and vascular risk factors (e.g., diabetes mellitus, hypertension, smoking), as well as functional outcomes at three months post-stroke. Logistic regression evaluated BrainAGE's predictive value for these outcomes, adjusting for age, sex, vascular risk factors, stroke severity, time between MRI and arterial puncture, prior intravenous thrombolysis, and recanalisation outcome.

\textbf{Results:}

While centralized learning yielded the most accurate predictions, FL consistently outperformed single-site models. BrainAGE was significantly higher in patients with diabetes mellitus across all models. Comparisons between patients with good and poor functional outcomes, and multivariate predictions of these outcomes showed the significance of the association between BrainAGE and post-stroke recovery.

\textbf{Conclusion:}

FL enables accurate age predictions without data centralization. The strong association between BrainAGE, vascular risk factors, and post-stroke recovery highlights its potential for prognostic modeling in stroke care.

Vincent Roca, Marc Tommasi, Paul Andrey +8

Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UAR 2014 - PLBS, F-59000 Lille, France · Univ. Lille, Inria, F-59000 Lille, France · Univ. Montpellier, Inria, F-34090 Montpellier, France +3

Brain Age Stroke Federated Learning Multicenter Evaluation