U-Net

Forecasting anatomical changes such as tumor growth and neurodegeneration is a challenging generative vision task. Morphological evolution is subtle relative to static anatomy, highly patient-specific, and inherently stochastic. Existing methods struggle with several issues: deterministic networks ignore biological stochasticity, while standard diffusion models require computationally prohibitive multi-pass sampling to quantify uncertainty. We propose MUMINS (Metadata-conditioned Uncertainty-aware Medical Image Next-state Synthesis), an efficient diffusion framework that jointly diffuses a baseline scan and its follow-up residual, summed to synthesize the follow-up scan, while concurrently predicting a spatial uncertainty map, in a single reverse diffusion process. Conditioned on the time interval and relevant metadata, it preserves fine-grained anatomy by dynamically re-injecting the baseline as a soft anchor at every denoising step, and a negative-log-likelihood head learns the uncertainty map to explicitly flag error-prone regions. Designed without organ-specific heuristics, the same architecture is reused across anatomies via separate, dataset-specific retraining. Extensive evaluations demonstrate that dataset-specific retraining of MUMINS matches or outperforms dedicated, domain-specific state-of-the-art methods on lung CT (PNG) and brain MRI (OASIS-3). Project page: https://github.com/aolivtous/MUMINS.

Image segmentation remains challenging due to occlusions, poor lighting, and irregular structures. Although transformer-based methods achieve high accuracy, they rely heavily on long-range spatial features, leading to high computational costs and neglecting prior knowledge or noise patterns, resulting in missing details and unclear boundaries. To address these issues, we propose Frequency Spatial Aware Network (FSANet), which integrates prior knowledge with a dual-domain solver to sequentially adapt to diverse segmentation tasks. Specifically, we design three key modules: (1) Structure Prior Module, which recovers overlooked details; (2) Dual-Domain Awareness Module, which captures salient features while disentangling noise; and (3) Edge Estimation Module, which enhances edge awareness for more precise segmentation. In addition, the limited availability of comprehensive segmentation datasets covering various real-world scenarios hinders the performance of existing methods. To address this, we introduce SceneX, a novel open-source dataset featuring 10 challenging non-ideal scenarios, establishing a new benchmark for evaluating and improving the robustness and real-world applicability of the segmentation models. Extensive experiments demonstrate the efficiency and effectiveness of FSANet.

Brain tumor segmentation remains difficult because enhancing tumor (ET) has low contrast and overlaps surrounding tissue, while scanner and site variation causes domain shift. We propose DE-GAN, a contrast-enhancing conditional GAN that combines input-adaptive dynamic convolutions, style-aware feature mixing, and coordinate encoding to synthesize slice-adaptive FLAIR images. A label-guided, class-conditional target separates tumor-core (TC) and ET intensities while preserving anatomy. The generated FLAIR is concatenated with the original MR modalities and used to train a 3D U-Net. Across BraTS 2015, 2018, and 2019, DE-GAN improves segmentation over the baseline and static EnhGAN replacement on most reported TC/ET metrics, with the largest gains from retaining both original and enhanced FLAIR. Code and pretrained models are available at https://github.com/zkhansuri-ui/DE-GAN.

Reducing radiation exposure in Positron Emission Tomography (PET) is important for patient safety; however, ultra-low-dose imaging suffers from severe noise, which may affect diagnostic interpretation without appropriate image enhancement. While current 3D deep generative models, particularly diffusion models, have shown strong reconstruction fidelity, their practical use can be limited by long inference times. In contrast, faster 2D-based alternatives may have difficulty maintaining volumetric consistency, an important consideration for whole-body PET imaging analysis. To bridge this gap, we propose a one-pass conditional 3D rectified flow (3D Flow) framework for whole-body PET image denoising that incorporates a novel optimized non-uniform sampling strategy. The model is trained with a one-pass linear-interpolant velocity-matching objective. This approach reconstructs a full 3D volume in approximately 30 seconds in our implementation, compared with multi-hour inference for the evaluated 3D DDPM baseline. Evaluations including zero-shot transfer to an independent clinical dataset show that our model achieves favorable global image quality and lesion conspicuity compared with the evaluated 3D DDPM and DDIM baselines, including on challenging short-acquisition data. Furthermore, the proposed method shows promising zero-shot transfer performance across the evaluated datasets and unseen dose levels (down to 1/100 of the standard dose), with artifact-focused visual comparisons supporting the need for further lesion-level validation. By balancing reconstruction fidelity and computational efficiency, this work presents a candidate approach for ultra-low-dose whole-body PET image denoising.

Electrocardiogram (ECG) delineation identifies the boundaries of P waves, QRS complexes, and T waves, providing structural annotations that can guide AI models in learning to interpret ECGs. However, training accurate delineation models requires manual annotations that are scarce and time-consuming to obtain. Recent work addresses this limitation through semi-supervised learning (SSL), but the design of the architecture, particularly the decoder, has received less attention. To this end, we propose R-U-Net, an ECG delineation model that pairs a ResNet-18 encoder with a U-Net decoder. On SemiSegECG, R-U-Net outperforms the strongest evaluated ResNet-18 + fully convolutional network (FCN) head baseline in each of the 16 in-domain settings by 3.3-13.0 mIoU and achieves 82.6 mIoU in the cross-domain setting, an improvement of 8.1 mIoU. Controlled ablations show that decoder design contributes more to performance gains than the evaluated SSL methods, motivating further exploration of architectures for ECG delineation. All code is open-source at github.com/ELM-Research/ECG-Delineation.

BraTS-GoAT evaluates tumor segmentation across heterogeneous populations. We trained a conventional 3D nnU-Net on 1,351 labeled cases using five-fold cross-validation and 1,000 epochs per fold. The final predictor averaged all folds and applied test-time mirroring. On pooled official validation, global DSC values were 0.7805, 0.8288, and 0.8854 for enhancing tumor (ET), tumor core (TC), and whole tumor (WT). Under matched fold-0 inference, mean regional Dice decreased from 0.9058 on source out-of-fold (OOF) cases to 0.8310 on pooled validation (difference--0.0747). Mirroring gave small single-fold gains but no clear ensemble benefit; a residual-encoder alternative reached 0.8282 mean Dice. In labeled OOF predictions, failure cases had substantially smaller reference ET volumes; after adjustment for ET and WT volume, lower Dice remained associated with more disconnected ET components and a smaller fraction of ET contained in the largest component.

Objective: To develop an intelligent framework, termed CUA-Net, for the automated classification of congenital uterine anomalies (CUA) without requiring coronal plane reconstruction, and to evaluate its clinical applicability. Methods: CUA-Net was built on 3D ResNet-18, equipped with a dynamic data resampling strategy to mitigate the data imbalance issue and a hard sample mining technique to fully learn from the difficult cases by loss adjustment. We further proposed the self-supervised reconstruction to comprehensively explore the volumes and the online data augmentation to refine the wrong predictions and enhance the model's generalization. We compared the CUA-Net with different deep-learning methods and junior/senior sonographers in the testing set. The evaluation metrics included accuracy, precision, recall, F1-score, micro-AUC, and macro-AUC. Results: The proposed CUA-Net exhibited satisfactory performance in both internal and external test sets. In the internal cohort, the model achieved accuracy of 93.88%, precision of 87.01%, recall of 95.92%, F1-score of 88.09%, and micro-AUC of 0.9982 and macro-AUC of 0.9997. In the external set, it maintained good performance with accuracy of 91.52%, precision of 83.27%, recall of 88.63%, F1-score of 81.49%, micro-AUC of 0.9945 and macro-AUC of 0.9990. Our CUA-Net outperformed the junior sonographers across all performance indicators and achieved performance comparable to that of the senior sonographers across most metrics. Conclusion: The CUA-Net demonstrates favorable accuracy and generalizability in classifying common CUA categories, while showing preliminary potential for recognizing less prevalent anomalies. These capabilities may help optimize clinical workflows and support more standardized diagnosis.

Accurate biomedical image segmentation requires not only high global overlap but also reliable delineation of clinically meaningful boundaries. In blood-smear microscopy, cytoplasm and nucleus contours provide the structural basis for downstream morphology analysis; however, deep segmentation models may remain uncertain or overconfident near ambiguous boundary regions even when achieving strong Dice scores. This work proposes a Reliability-Aware Boundary Refinement Network (RABR-Net), a two-stage framework for trustworthy image segmentation. A strong UNet++ EfficientNet-B4 base segmenter first produces initial class probabilities and logits. Predictive entropy, test-time augmentation variance, margin uncertainty, probability gradients, and soft boundary cues are then combined into a boundary-aware reliability representation. This representation guides a gated residual refiner that selectively corrects uncertain boundary pixels while preserving confident regions of the base prediction. The framework is evaluated using overlap accuracy, class-wise Dice, Boundary Dice, HD95/ASSD, calibration, risk--coverage analysis, robustness under image perturbations, qualitative correction maps, and paired statistical testing. On the held-out test set, the proposed method improves Dice from 0.9602 to 0.9614, Boundary Dice from 0.3448 to 0.3611, and HD95 from 3.0354 to 2.8274 compared with the cached base prediction. Statistical analysis confirms significant improvements in Dice, Boundary Dice, and HD95. Qualitative results show that the learned gate concentrates around uncertain cytoplasm and nucleus boundaries, and correction maps confirm localized boundary refinement. Although calibration does not automatically improve after refinement, the proposed framework provides an interpretable and reliability-focused strategy for boundary-sensitive biomedical image segmentation.

Robust medical image segmentation across imaging modalities is challenging because of large differences in appearance and intensity distributions. Models trained on a single modality often show substantial performance drops when applied to unseen domains. In this work, we develop a unified 3D pancreas segmentation framework that applies domain-adversarial learning to 4,604 heterogeneous CT and MRI scans to learn anatomical representations. A shared nnU-Net encoder-decoder is trained for whole-pancreas segmentation, with a latent domain discriminator encouraging CT-MRI feature alignment. The learned encoder is subsequently transferred to pancreatic head-body-tail segmentation using limited MRI-only subregion annotations. An average Dice score of 87.31% on the in-distribution test set and Dice scores ranging from 84.20% to 88.09% across external OOD datasets were achieved in whole pancreas segmentation. Dice scores of 80.53% on MRI and 83.05% on CT were achieved for downstream subregion segmentation, without using CT subregion annotations. These results demonstrate that a unified anatomical representation can support both cross-modality pancreas segmentation and label-efficient downstream transfer.

Brain metastases exhibit high inter-lesion variability in size, enhancement pattern, and post-treatment appearance, making volumetric segmentation of both pre- and post-treatment cases the central challenge of the BraTS 2026 Task 1 (Brain Metastases). We build a pragmatic pipeline on a 5-fold nnU-Net ResEnc-L ensemble, in which each fold is trained independently for 1,000 epochs with the standard Dice + cross-entropy loss on 1,296 four-modality training cases. This ensemble is followed by a rule-based post-processing cascade tuned for the lesion-wise Dice similarity coefficient (LW-DSC), a detection-oriented metric that behaves very differently from the traditional global Dice. The final pipeline reaches an LW-DSC of 0.733 / 0.751 / 0.713 / 0.549 on the enhancing tumour (ET), tumour core (TC), whole tumour (WT), and resection cavity (RC) sub-regions on the official validation leaderboard. Rather than trusting these leaderboard gains, we audit every post-processing stage with a five-fold out-of-fold (OOF) analysis with no model-training leakage over all 1,296 training cases, scored with the official BraTS evaluation code (BraTS_evaluation): it confirms two stages as robust, per-fold-consistent improvements while the third improves only the leaderboard and does not reproduce out-of-fold. We further provide a mechanistic analysis of the LW-DSC metric that explains why recall-recovering post-processing carries low risk whereas component deletion does not, and we report thirteen negative results spanning loss engineering, alternative backbones, and inference-time settings, several of which run counter to widely held intuitions. Source code is released under Apache-2.0 at https://github.com/hornbeamliu/brats2026-met.

All-in-One medical image restoration (MedIR) aims to address diverse tasks across modalities and degradation types using a single universal model. Existing methods typically prioritize modeling inter-task heterogeneity (e.g., distinct data distributions and degradation types). However, they largely neglect the inherent homogeneity present in medical images, such as widely shared anatomical structures within and across modalities, which can be leveraged to ease model training and improve generalization. To this end, we propose UniH3, a novel framework that Unifies Hierarchical Homogeneity and Heterogeneity for all-in-one medical image restoration. Specifically, to comprehensively exploit homogeneity, we introduce a Hierarchical Homogeneity Memory (H2M) module that progressively distills intra- and inter-task homogeneity priors from high-quality images during training, and adaptively retrieves the most relevant priors tailored to the input for guided restoration. These retrieved priors are then injected into the restoration pipeline via an efficient Homogeneity-Guided Attention (HGA) mechanism. Furthermore, to comprehensively address heterogeneity, we design a Hierarchical Heterogeneity Balancer (H2B) that mitigates both inter- and intra-task conflicts during optimization, facilitating balanced and effective multi-task learning. Extensive experiments on two large-scale benchmarks, MedIR-2D-500K and MedIR-3D-3K, demonstrate that UniH3 achieves state-of-the-art performance on both all-in-one and single-task medical image restoration. We hope this work establishes a strong benchmark and advances the development of general-purpose medical image restoration models. Code is available at https://github.com/Yaziwel/UniH3.

Detecting brain metastases in magnetic resonance imaging (MRI) remains challenging because lesions vary widely in size and appearance, with very small metastases occupying only a minute fraction of a three-dimensional input. We investigate whether combining different spatial fields of view (FOVs) improves lesion detection in multimodal MRI and present a scale-aware 3D deep-learning framework. The method uses independently trained $96^3$ and $64^3$ 3D U-Nets whose whole-volume probability maps are combined by weighted late fusion. This design allows us to study the effect of spatial context separately from image resolution and modality choice. On a 97-patient development cohort, cross-FOV fusion improved lesion-level precision and F1 while substantially reducing false positives relative to the individual models. A same-FOV ensemble control showed that these gains were not explained solely by averaging independently trained networks, supporting a contribution from complementary spatial context. An exploratory cross-FOV agreement filter reduced false positives but did not improve overall F1. These results support cross-FOV probability fusion as a simple and computationally practical strategy for improving the precision-false-positive trade-off in 3D brain-metastasis detection.

Large networks and ensembles often lead medical image segmentation challenges, but their storage and inference demands complicate deployment. We present LightMedSeg-ISLES, a 1.26-million-parameter pipeline for T1-weighted stroke lesion segmentation in ISLES'26. On a 146-case held-out cohort, flip test-time augmentation produces 0.618 mean Dice and 0.599 lesion-wise F1. A 102.35-million-parameter nnU-Net ResEnc-L produces 0.634 Dice and 0.544 lesion-wise F1 after size filtering. LightMedSeg therefore retains 97.5% of nnU-Net's Dice with 81.4$\times$ fewer parameters while improving lesion-wise F1 by 0.055. Its four-pass TTA operating point requires 4.7$\times$ fewer FLOPs per standardized patch than nnU-Net. It also slightly exceeds filtered UNETR++ and nnFormer. Longer training and stronger augmentation add 0.0358 Dice without increasing capacity, establishing a strong single-checkpoint alternative to much larger models.

Pixel-level annotation of fixed traffic-camera imagery is expensive, while crosswalk models trained from street-level imagery face a substantial viewpoint and appearance shift when applied to elevated CCTV. We investigate a data-efficient target-domain pipeline using 241 manually annotated CCTV images and 5,926 unlabeled CCTV frames. A source-domain experiment trains a 31.0M-parameter custom U-Net on 3,300 first-person-view (FPV) images and obtains 93.05% IoU on its 330-image FPV test split. This result is a source baseline, not transferred performance: the released CCTV notebook instantiates a 42.0M-parameter DeepLabV3-ResNet50 from torchvision weights, and no compatible mapping from the U-Net checkpoint is implemented. Training on 201 manual CCTV images and selecting on 40 held-out manual masks yields 88.91% IoU. The model then predicts all unlabeled frames; image-level certainty and a largest-component area prior rank the candidates, and the top 1,000 attain mean certainty 0.976 and mean combined score 0.988. A repository audit shows that the reported second-stage 98.52% IoU was measured on a 150-image split containing only teacher-generated pseudo-masks. Because of a directory-layout mismatch, the executed combined-data loader found zero manual samples and split 1,000 pseudo-labeled samples into 850 training and 150 evaluation samples. We therefore report 98.52% as internal pseudo-label agreement rather than human-ground-truth accuracy. The defensible target-domain result is 88.91% IoU on the 40 manual validation images. Batch-one FP32 inference at 512 x 512 requires 12.98 ms, corresponding to 77.03 FPS, on an NVIDIA RTX A6000 48 GB GPU. These findings support the practicality of confidence-and-geometry filtering while also showing why pseudo-label evaluation must remain isolated from the labels used for self-training.

Pancreatic tumor segmentation in 3D CT volumes is challenged by extreme scale variability across both the pancreas and tumor, and highly irregular tumor morphology. While recent advances have pushed segmentation performance, existing methods do not explicitly address these challenges and come at the cost of excessive computational complexity, limiting their practicality in resource-constrained clinical environments. We propose TRIUNE-Net, a lightweight unified architecture that harmonizes scale, shape, and efficiency through three synergistic innovations. A multi-scale context aggregation module with stage-adaptive dilated convolutions enables the model to reason across the broad range of anatomical scales present in both organs. A serial linear-deformable attention mechanism combines large effective receptive fields with shapeadaptive deformable convolutions to capture irregular, non-convex tumor morphologies. Finally, an information-preserving downsampling module replaces conventional max pooling entirely, retaining all spatial information while adding negligible parameters, preventing small tumors from being discarded before they can be recognized. On both the MSD Pancreas and NVD Pancreas datasets, TRIUNE-Net achieves state-of-theart results with only 5.86 M parameters and no external pre-training, outperforming all baselines across all key tumor metrics. Specifically, it surpasses the next-best model by 0.45% in tumor Dice, 6.0 points in F1 score, 6.6 points in sensitivity, and 3.4 points in precision, simultaneously reflecting its ability to suppress both missed tumors and false alarms in clinically realistic conditions. Our code is available at: https://github.com/abdora-ai/TRIUNE-Net

Bone-selective digitally reconstructed radiograph (DRR) synthesis depends on high-resolution encoder detail, yet static skips cannot condition reuse on the evolving decoder representation. We ask whether decoder state adds useful information beyond encoder-only self-recalibration for high-resolution skip reuse. RFS-UNet uses pooled encoder and aligned decoder statistics for bounded residual channel recalibration at the 512^2 and 256^2 skips, leaving the backbone unchanged. In the matched seed-2026 comparison isolating decoder conditioning, RFS raises validation PSNR by 0.254 dB over Self-RFS. Across three seeds, locked-test PSNR rises from 33.225+/-0.048 to 33.537+/-0.128 dB; RFS lowers MAE in 179/200 held-out CT cases and reduces mean MAE by 3.91%. It adds 0.117% parameters and 1.169% counted Conv2d operations. These results support decoder state as a useful conditioning signal for high-resolution feature reuse in controlled paired projection synthesis.

Deep learning has achieved state-of-the-art performance in echocardiographic video segmentation, with an increasing number of models incorporating temporal information. However, quantitative evaluation of temporal explainability remains largely unexplored. We propose a quantitative framework for evaluating Grad-CAM explanations using four complementary metrics measuring temporal consistency, saliency motion, anatomical overlap, and temporal overlap. Using EchoNet-Dynamic, we compare a baseline 2D U-Net with ConvLSTM U-Net models trained across multiple temporal strides. While segmentation performance remained comparable across all models, intermediate ConvLSTM explanations exhibited substantially lower saliency consistency and greater centroid motion than final prediction explanations. Temporal Bottleneck explanations were significantly more stable than Encoder Bottleneck explanations across all strides, while final ConvLSTM Decoder3 explanations were broadly comparable to those of the 2D U-Net. Importantly, conventional frame-wise explanation metrics cannot determine whether variation in intermediate explanations reflects meaningful temporal feature evolution or explanation instability. These findings establish a preliminary quantitative framework for temporal explainability and motivate temporal-aware XAI methods that explicitly account for evolving representations in medical video models.

Multi-contrast MR scans contain redundant structural information that can be leveraged during reconstruction and potentially accelerate acquisition times. This idea has inspired end-to-end guided reconstruction models, leveraging one or more contrasts to guide the reconstruction of a different contrast. However, these models require large paired multi-contrast raw datasets for training, limiting their application in low-data regimes. In this work, we propose a modular framework, namely CoSMo-RecNet, for learning guided reconstruction models in the low-data regime. At its core is a reusable multi-contrast representation based on a content/style model, which can be learned from large-scale, publicly accessible, unpaired multi-contrast image datasets, without available k-space data. Using this frozen model as a multi-contrast prior and using a set of reference contrasts, the reconstruction problem reduces to a much simpler refinement problem that can be solved by a lightweight unrolled network and thus learned from small, task-specific reconstruction datasets. We demonstrate the efficacy of CoSMo-RecNet by evaluating it on the low-field 0.3 T M4Raw dataset, showing stable reconstruction quality on decreasing the raw training data budget. CoSMo-RecNet achieved higher reconstruction quality with 5 training subjects or lower compared to a parameter-count-matched MoDL trained on 100 subjects. On a data-limited and severely out-of-distribution ultra-low-field 47 mT Halbach scanner dataset, CoSMo-RecNet was superior to other viable strategies, including classical reconstruction, transfer learning, and zero-shot reconstruction.

Accurate segmentation of vascular structures in digital subtraction angiography (DSA) images remains challenging due to the thin, elongated, and branching nature of blood vessels. Pixel-wise deep learning approaches such as U-Net achieve strong general-purpose segmentation performance but often produce fragmented or discontinuous predictions in fine vascular regions, since they do not explicitly enforce structural connectivity. Region growing algorithms preserve spatial context and topological continuity, but are highly sensitive to seed point initialization and can be computationally expensive. We propose UI-VISA (U-Net Initialized Vascular Image Segmentation Architecture), a hybrid pipeline that combines the complementary strengths of both approaches. UI-VISA uses U-Net's foreground predictions as informed seed points for a CNN-guided region growing algorithm, which then iteratively refines the segmentation by enforcing local connectivity and recovering fine vessel details that U-Net alone tends to miss or over-predict. We evaluate UI-VISA against standalone U-Net and a prior region-growing-based method (VISA) using 5-fold cross-validation on 26 DSA images. UI-VISA achieves the highest mean Dice and clDice scores across folds, and a paired Wilcoxon signed-rank test shows the improvement in clDice is statistically significant ($p=0.023$), consistent with the method's design goal of preserving vascular connectivity, while the improvement in Dice does not reach significance ($p=0.104$).

Automated lesion segmentation in whole-body PET/CT is complicated by the variety of physiological tracer uptake patterns and by the differing appearance of lesions across tracers. The autoPET/CT V challenge addresses this by making segmentation interactive: user scribbles marking foreground and background are supplied alongside the image, and the algorithm is expected to exploit them. We present our submission, a scribble-conditioned residual encoder U-Net operating on four input channels: CT, PET, and a sparse scribble map for each of foreground and background. The network is initialised from the autoPET-III winning weights and extended from two to four input channels, with the two scribble channels zero-initialised so that the pretrained representation is preserved exactly at initialisation. Every model is fine-tuned per fold from the corresponding autoPET-III fold checkpoint, so that no validation case is seen during pretraining. PET intensities are normalised against a per-scan aorta blood-pool reference derived from a CT segmentation, which removes tracer- and centre-specific scaling without requiring lesion labels. At inference the five fold models are ensembled by averaging their softmax outputs per sliding-window patch, before Gaussian-weighted stitching. On the challenge's five-fold split, with each fold evaluated on its own validation cases, mean Dice is 0.554 and mean lesion-level F1 is 0.528 without scribbles, rising to 0.751 and 0.733 after five correction rounds. About 85% of that gain follows the first scribble, and the spread between fold models narrows five-fold over the same rounds, so interaction largely compensates for how well or badly a given model segments unaided.

Architecture category. Hybrid method: a physics-based analytical pencil-beam (PB) dose engine followed by a 3-D convolutional residual-correction network (RepVGG-U-Net). We addressed the DoseRAD2026 proton dose-prediction task with PyDoseRT Proton, a GPU-accelerated engine implemented in PyTorch and augmented by a learned residual toward Monte Carlo (MC) accuracy. A double-Gaussian PB kernel was calibrated to GATE/Geant4 integrated depth doses in water in two stages: a classical per-energy curve fit, then a gradient-based fit of the full 3-D dose through the PyTorch physics engine as it retains a differentiable execution path for gradient-based optimization of dose-dependent objectives. The engine computes each beamlet on a beam's-eye-view (BEV) lattice with variance-preserving Gaussian splitting, an analytic nuclear halo, and a Fermi-Eyges heterogeneity term, then rotates the result into the patient frame. Additionally, a compact residual U-Net predicts an additive correction in BEV space. It is conditioned on voxelwise material-label embeddings, a discrete energy embedding and spot size. The same model was used for all anatomical sites (thoracic and abdominal). It was trained with a patient-space L1 objective emphasizing the scored high-dose region and multi-scale BEV deep supervision. The submitted CT configuration obtained preliminary-test beamlet MAE 0.0066, image-z IDD distance 0.0025, plan MAE 0.0049, 98.30% gamma pass rate (1%/1 mm), and DVH error 0.460.

Manual annotation remains a major bottleneck in ultrasound (US) bone segmentation, where experts typically iteratively refine rough brush masks rather than delineating precise contours in a single pass. We present ExiL, a mask-conditioned progressive learning framework that models annotation as a structured refinement trajectory. ExiL combines a synthetic expert-like brush simulator based on signed distance fields with a lightweight 7.8M-parameter U-Net that learns to complete and refine imperfect masks from US images. During deployment, an expert mode updates the model directly from accepted refinements, enabling continual adaptation to expert behavior. Evaluated using UltraBones100k cadaver data for quantitative segmentation and a prospective volunteer dataset for annotation-efficiency analysis, ExiL reduced single-expert average annotation time from 60 to 20 seconds per frame (66.7%) and improved mean Dice by approximately 0.045 over non-progressive training, while achieving 0.87 Dice and 2.7 px boundary error in the best trajectory-aware setting. With 10--50 ms inference, ExiL enables real-time, self-improving annotation for US-guided orthopedic workflows in practical clinical labeling.

Convolutional neural networks (CNNs), used widely and successfully in audio enhancement, capture long-range time-frequency dependencies only indirectly, through successive convolution and pooling. Here, we present U-PAST, a hybrid transformer-U-Net architecture that addresses this limitation through self-attention dependency-modeling in the complex spectrogram domain. U-PAST tokenizes a complex STFT representation, similarly to the magnitude spectrogram tokenization of the Audio Spectrogram Transformer (AST), applies a multi-layer transformer encoder, and reconstructs the enhanced complex spectrogram with a U-Net-style decoder. We evaluate four architectural variants with between 1.17M and 2.40M parameters on the DNS Challenge, VoiceBank-DEMAND, and LibriMix corpora under matched, acoustic mismatch, and two-dataset mismatch conditions. U-PAST attains the best SI-SDR of any evaluated model under acoustic mismatch and closely trails substantially larger convolutional and time-domain baselines by 0.26 dB to 0.63 dB SI-SDR under the remaining three conditions while achieving the strongest perceptual (DNSMOS) quality under dataset mismatch. The largest evaluated configuration, U-PAST-H (2.40M parameters), is consistently the strongest variant of the family, offering an attractive performance-to-cost trade-off at a small parameter footprint.

General image fusion aims to integrate complementary information from multiple source images, but existing methods often rely on task-specific models and struggle to maintain robust performance under diverse degradation conditions. In this paper, we propose UniDiffFusion, a unified diffusion framework for multi-task and degradation-robust image fusion. UniDiffFusion leverages the strong generative prior of a pretrained diffusion model to establish a shared fusion backbone across heterogeneous fusion tasks, while introducing task- and degradation-aware conditional adaptation to accommodate their distinct information-selection requirements. Specifically, we employ task prompt modulation to progressively adapt the shared diffusion representations to different fusion objectives, and develop a degradation prompt router to dynamically retrieve degradation-aware priors and restore corrupted source features before fusion. Furthermore, an application prompt bank is introduced to incorporate task-oriented semantic guidance for downstream applications, such as object detection and semantic segmentation, without altering the shared fusion and restoration pathways. The proposed framework is trained in a progressive manner to decouple fusion learning, degradation-aware restoration, and application-specific adaptation, thereby reducing interference among heterogeneous objectives. Extensive experiments on visible-infrared, multi-exposure, and multi-focus image fusion demonstrate that UniDiffFusion achieves superior fusion quality and robustness under both clean and degraded conditions. Moreover, UniDiffFusion consistently improves downstream detection and semantic segmentation performance, demonstrating its effectiveness as a unified diffusion framework for both perceptual fusion and task-oriented vision.

Deep networks segment brain tumours accurately in-distribution, but can fail silently when the input differs from their training data. That risk is central to clinical deployment and is the premise of the BraTS-GoAT generalizability task. We ask not only how well a model segments, but whether its uncertainty knows when it is wrong. On BraTS-GoAT (Task 3) we train a 5-fold cross-validated nnU-Net baseline (one held-out prediction per case) and a 3-seed deep ensemble. Both are evaluated for calibration and error detection on a per-region relevant mask, aggregated per case. In-distribution the 3-seed ensemble improves modestly over the already strong single model on the same held-out split, with the clearest gain in calibration. The separation appears under shift. In a controlled robustness study using graded synthetic corruptions as a proxy for acquisition shift, the single model's confidence stays flat while its accuracy and calibration degrade. Inter-member disagreement instead rises steeply, about a quarter to a third above the clean condition, several times the single model's response. On the official validation leaderboard the 5-fold ensemble of those folds attains whole-tumour Dice 0.87. The generalization gap is concentrated on the harder regions, with a characteristic failure of missing small, satellite lesions on unseen cohorts. In the synthetic study, disagreement among the 3-seed members is a more sensitive case-level indicator of acquisition shift than single-model confidence. Its per-voxel error localisation weakens as severity grows. The contribution is a rigorous, honest reliability comparison rather than a claim that any one uncertainty method dominates.

Background: Accurate segmentation of the Left Anterior Descending (LAD) artery in 3D free-breathing, non-contrast CT is critical for cardiac dose sparing in thoracic radiotherapy. The LAD is extremely small, has poor soft-tissue contrast, and varies substantially across patients; even manual contours show limited inter-observer agreement, underscoring the ambiguity of the vessel boundaries. Purpose: To develop a transformer-based framework that improves LAD delineation in low-contrast, imbalanced CT through local-global context modeling and uncertainty-guided optimization. Methods: We propose NA-UNETR, a 3D transformer-based segmentation model whose Neighborhood Attention (NA) and Dilated NA (DiNA) blocks jointly capture fine structural detail and long-range context. Given the scarcity of annotated LAD data, the model is pretrained on 1,000 CTA volumes of general coronary anatomy and fine-tuned with LoRA-based parameter-efficient adaptation on 20 free-breathing institutional CT scans. A composite Dice-Focal and Hausdorff loss, dynamically balanced via homoscedastic uncertainty, improves overlap and boundary accuracy. Results: NA-UNETR reached 45.64% Dice, 38.16 mm HD95, and 10.01 mm ASD, improving Dice by 3.10 percentage points over nnU-Net and reducing HD95 by 2.96 mm relative to Swin UNETR, with the strongest boundary accuracy among all models and improved centerline stability. On ImageCAS it achieved 79.49% Dice, 8.89 mm HD95, and 1.02 mm ASD. Ablations confirmed that residual blocks, variable kernels, and uncertainty-weighted loss each contributed. Conclusions: NA-UNETR balances local precision and global context for thin, low-contrast LAD structures, offering a computationally efficient framework for substructure-level cardiac segmentation in radiotherapy planning.

Purpose: Deep learning-based medical image segmentation has achieved remarkable success, yet purely data-driven approaches often fail to exploit the rich mathematical structure inherent in medical images. We investigate whether explicit mathematical inductive biases, specifically matrix spectral analysis and vector calculus operators, can enhance segmentation beyond data-driven learning alone. Methods: We propose M-Net (Math-Augmented Network), which integrates three complementary mathematical priors into U-Net: (1) continuous spectral features derived from the condition number of centered local pixel matrices, providing a differentiable measure of texture ill-conditioning; (2) physical field operators (divergence and a discrete curl-like boundary irregularity operator) computed from image gradient fields, capturing focal intensity extrema and edge non-smoothness; and (3) a Math-Attention Gate (MAG) that adaptively fuses mathematical features with CNN-extracted deep features at skip connections. Results: Experiments on three benchmarks (LiTS, KiTS, and BraTS) show that M-Net achieves Dice scores of 78.42%, 76.15%, and 83.67%, outperforming baseline U-Net by 12.37%, 3.52%, and 5.55% on liver, kidney, and brain tumor segmentation, respectively. Ablations reveal that the condition-number feature contributes a 2.14% gain over binary invertibility features, while MAG adds 1.45% over simple concatenation. Conclusion: M-Net establishes that mathematical inductive biases provide effective complementary information for medical image segmentation. The continuous condition-number feature offers superior gradient information over discrete alternatives, and MAG preserves these priors throughout the network. This work opens avenues for integrating linear algebra and vector calculus into deep architectures for medical imaging.

Ambiguous medical image segmentation aims to provide a series of diverse but plausible segmentation hypotheses. However, existing methods introduce stochasticity in a fixed and pre-defined manner, failing to form a progressive semantic modeling process. To address these challenges, we propose KANResDiff to learn local residual diffusion with Kolmogorov-Arnold Network, thereby assigning distinct roles across stages for ambiguity modeling. Specifically, we propose Independent Time Encoding that offers spline-based time embeddings instead of linear ones from MLPs, which enhances the independence across inference stages and assigns progressive semantic roles to different stages. We propose Residual Schrodinger Bridge that injects deterministic residual prior with learnable weights by constructing local Schrodinger Bridge instead of following manually settings, achieving a flexible deterministic-stochastic interaction and stage-aware ambiguity modeling thanks to local optimal diffusion path. Extensive experimental results on two public datasets demonstrate that KANResDiff achieves SOTA performance on GED and HM-IoU, with maximum improvements of 16.8% and 7.7%, respectively, while maintaining competitive performance on the MDM metric. Source code is available at https://github.com/PerceptionComputingLab/KANResDiff.

Accurate medical image interpolation and anatomical structure segmentation are fundamental for computer-aided diagnosis and treatment planning. Anisotropic medical volumes with sparse through-plane sampling often suffer from structural discontinuity and boundary blur, hindering reliable clinical image analysis. Most existing methods implement interpolation and segmentation independently, which introduces redundant computation and fails to fully exploit complementary cross-slice structural information between sequential slices. To address these issues, we propose a continuous position-aware interaction network, termed CoInS-Net, for joint frame interpolation and lesion segmentation. Unlike conventional cascaded interpolation-then-segmentation paradigms, the framework enables bidirectional interaction under a shared Swin encoder with continuous spatial coordinate queries. A spatially continuous position interpolation module generates target-position features at every scale from the relative coordinate and physical spacing, and a prototype-based task mutual interaction module lets the segmentation and interpolation branches exchange global structure through a small set of shared prototypes rather than dense feature mixing. A multi-scale task-cooperative decoder further separates each scale into shared and task-specific components, so the two tasks reinforce common anatomy while preserving their distinct requirements down to the boundary level, without extra annotations. Experiments on four public medical imaging datasets with diverse modalities and anatomical regions demonstrate that the proposed method outperforms conventional single-task schemes. The joint optimization framework effectively realizes mutual promotion between interpolation and segmentation tasks, providing a reliable and universal technical scheme for intelligent clinical medical image analysis.

Accurate 3D medical image segmentation requires the integration of long-range anatomical context with fine boundary detail. Existing methods often model global and local features in separate modules or feature levels and perform channel recalibration independently. This may cause semantic mismatch between global context and local boundaries, insufficient channel relationship modeling, weak spatial-channel interaction, and redundant representations. We propose CDGC-Net, a 3D medical image segmentation network that combines cooperative dual-scale spatial attention with grouped hierarchical channel modeling. With-in each CDGC block, Cooperative Dual-Scale Self-Attention (CDSA) assigns attention heads to parallel local-window and global-sparse branches. The two branches capture fine spatial details and long-range anatomical context at the same feature level. Their outputs are concatenated into an $N\times C$ spatial representation and directly passed to Grouped Hierarchical Channel Attention (GHCA). GHCA organizes the channels into $r$ groups and models both within-group and cross-group dependencies. CDSA and GHCA reuse a shared key projection to maintain a consistent feature reference. Residual feature alignment subsequently integrates the refined features with the original representation. On the Synapse, ACDC, BraTS, and LA datasets, CDGC-Net achieved mean DSC values of 86.96%, 92.91%, 82.56%, and 93.52%, respectively, exceeding the next-highest reported values by 0.39, 0.47, 0.17, and 0.32 percentage points. CDGC-Net contains 25.83M parameters and 28.62G FLOPs for an input size of $64\times128\times128$, reducing these quantities by 39.87% and 40.30%, respectively, relative to UNETR++. These results indicate a favorable trade-off between segmentation accuracy and computational complexity.

Multi-organ ultrasound segmentation remains challenging when anatomically adjacent structures must be delineated jointly, as localized boundary errors can persist even when Dice scores are high. To address these challenges, we propose Boundary-Adaptive Prompting for Multi-Organ Segmentation (BAP-MOS), a closed-loop adaptive prompting framework. BAP-MOS formulates prompt selection as an organ-specific multi-armed bandit problem over box, point, and combined prompts. An outer Tree-structured Parzen Estimator (TPE) loop selects the prompt-selection parameter vector, while an inner UCB-Tuned loop adapts per-organ prompt preferences during fine-tuning using a bounded Dice--MSD--HD95 validation-probe reward. The framework further introduces an organ-scaled negative prompt ring to adapt sparse prompt geometry across anatomical scales, while keeping the image and prompt encoders frozen and updating only the mask decoder. We evaluate BAP-MOS on pooled prostate-region TRUS cohorts against U-Net, nnU-Net, MedSAM, fixed-prompt SAM/MedSAM, and adaptive policy variants. On this benchmark, BAP-MOS achieves Dice 0.982, HD95 0.482, and MSD 0.204, reducing HD95 by approximately 48% and MSD by 45% relative to the strongest conventional baseline. To verify the generalization ability of the framework, we tested it on the external PFUS1 pelvic-floor ultrasound corpus using MedSAM and its adaptive strategy variants, and the results were good. These results support adaptive prompt allocation as an effective mechanism for improving boundary-sensitive multi-organ ultrasound segmentation without modifying the foundation-model backbone. Source Code is available at: https://github.com/SatvikPraveen/BAP-MOS

Accurate aneurysm segmentation in 3D rotational angiography (3DRA) is hindered by extreme class imbalance, morphological similarity to vessels, and absent large-scale 3D pretraining. 2D vision foundation models encode dense structural priors from 1.7 billion images, yet naïve slice-wise transfer fragments anatomical continuity and destabilises optimisation. We propose DINO-3DRA, a dual-path framework achieving effective cross-dimensional semantic transfer by injecting frozen DINOv3 features into a 3D U-Net backbone via Room-Lite spatial mixing and calibrated residual fusion. On multi-centre 3DRA data, DINO-3DRA achieves state-of-the-art aneurysm segmentation (Dice: 0.758; HD95: 2.75 mm; +13% over nnU-Net) with only 5.72M trainable parameters. Ablation studies confirm that gains arise from structured cross-dimensional transfer rather than loss design alone, with bridged foundation features improving anatomical continuity between aneurysms and parent vessels. Without fine-tuning on CADA and SHINY-ICARUS, DINO-3DRA eliminates all catastrophic failure cases observed in baseline architectures, demonstrating robust generalisation across heterogeneous imaging protocols.

Registration-based Few-shot medical image segmentation (RFMIS) aims to generate pseudo-labels for unlabeled images by warping a labeled image through registration. However, existing methods primarily perform pixel-level optimization and inference in Euclidean space, treating anatomical structures as flat and disjoint. This neglect of inherent hierarchies degrades pseudo-label quality and weakens the discrimination of ambiguous regions, limiting the segmentation performance. To overcome this challenge, we propose a Hyperbolic Hierarchy-aware Aggregative Learning framework for RFMIS, termed H2AL, that enhances both deformation plausibility and anatomical discrimination for dual-task learning. Specifically, we introduce a Hyperbolic Hierarchy-aware Infusion (H2I) module, which leverages the hierarchical modeling capability of hyperbolic space to learn precise hierarchy-aware representations via transformation-guided supervised hyperbolic contrastive learning, and injects such hierarchical priors into Euclidean space through a gated infusion block while preserving semantic richness. Furthermore, we propose an end-to-end joint optimization algorithm by gradient aggregation, where the gradients from the registration and segmentation decoders, embedding semantic and hierarchical cues, are aggregated to update the shared encoder to promote collaborative learning across tasks. Extensive experiments on two anatomical regions, with five experimental settings, demonstrate the effectiveness and efficiency of our method in both registration and segmentation. The code is publicly available at https://github.com/JiamingCai469/H2AL.

Dehazing networks are commonly trained on synthetic hazy-clear pairs, but their performance often drops on real photographs. Synthetic haze generated using the atmospheric scattering model does not fully capture the variability of real haze, and paired real hazy-clear images are scarce. In this work, we propose HazeSpikeMamba, a compact dehazing framework that combines a spiking-inspired local path and an attentive state-space global path in a multi-scale U-Net. The local path uses TPCNNSpike, a new spike-emission scheme inspired by the neighborhood coupling of Pulse-Coupled Neural Network (PCNN). Unlike grouped directional scanning, TPCNNSpike updates all neurons in parallel using the previous firing states of their Gaussian-weighted neighborhoods. The global path adapts the Attentive State-Space Module of MambaIRv2, retaining semantic prompting and sequence reordering while removing the window self-attention branch. Its state-space processing models long-range dependencies with complexity linear in sequence length. For target-domain adaptation, a frozen degradation network, pretrained on paired NH-HAZE data, re-synthesizes haze from the dehazed prediction. The reconstruction error updates only the final restoration layers of HazeSpikeMamba without haze-free labels during adaptation. A shared checkpoint is adapted once on each complete unlabeled target set, making the evaluation dataset-level and transductive rather than zero-shot or per-image optimization. The forward network contains 2.02M active parameters and requires 13.27G nominal MACs (measured with thop at 256x256 input). This adaptation consistently improves BRISQUE and NIMA on RTTS, URHI, and HSTS. On RTTS, BRISQUE decreases from 30.13 to 27.72 and NIMA increases from 4.13 to 4.87. Under this transductive protocol, the adapted model also achieves the best BRISQUE and NIMA on URHI and HSTS among the compared methods.

Bidirectional unpaired image translation must preserve source-specific structure while learning coherent transformations in both directions without paired supervision. Existing methods typically employ two direction-specific generators or train separate one-way models. Even when linked by cycle consistency, such models constrain only the round-trip endpoint reconstruction, without requiring the two directions to obey a common local transformation rule. We propose UniCycleFlow, a rectified-flow framework that represents bidirectional translation as forward and reverse integration of a single time-conditioned velocity field. This formulation organizes both directions within the same continuous dynamics, rather than coupling otherwise separate endpoint mappings. A key challenge is that unpaired data provide no meaningful source--target coupling from which rectified-flow trajectories can be constructed. UniCycleFlow addresses this challenge by learning deterministic source-conditioned endpoints whose marginal distributions are adversarially matched to the opposite domains. The resulting paths are regularized by stop-gradient self-flow matching for intermediate velocity supervision, discrete cycle closure for forward--reverse consistency, and representation path-velocity regularization for controlling localized feature changes along the trajectory. Across ten translation directions, UniCycleFlow achieves the lowest FID on 7 of 10 tasks using a single Euler evaluation and obtains the best average FID of 55.1.

Deep neural networks have shown great empirical success in the solution of a wide variety of ill-posed inverse problems in imaging. Yet, very few works have studied their behavior in the limit that turns the discretized ill-conditioned problems into truly ill-posed ones, i.e., for an increasing resolution of the discretization. In this work, we review common approaches to neural operator learning in architectures that resemble a U-Net, one of the most common classical architectures for inverse imaging problems. We discuss advantages and drawbacks of the respective approaches, consider a 1D toy example for improved interpretability, and present extensive numerical experiments on how different types of neural operator U-Nets can improve a first (crude) limited angle CT-reconstruction. In particular, we study how well networks trained for a certain resolution of the discretization generalize to other resolutions. Our finding is that while U-shaped neural operator architectures are by design resolution-invariant, the classical U-Net architecture seems to be more robust with respect to resolution changes than expected.

Previous RGB-D semantic segmentation methods commonly employ dual encoders to separately process RGB and depth inputs, followed by dedicated modules for cross-modal feature fusion. However, such designs often inadequately capture depth representations and consequently limit effective cross-modal interaction, while the additional encoder branch introduces redundant computation that hinders lightweight execution. To tackle these challenges, we propose URNet, a Unified Reparameterized RGB-D Network that performs simultaneous multi-modal feature extraction and cross-modal fusion within a single encoder. Specifically, we adopt a reparameterization strategy to compact the network architecture and facilitate fast inference. Within each Reparameterized Block (RepBlock), a Linear Gated Attention (LGA) module is introduced to fully exploit complementary RGB and depth cues across different feature scales. Furthermore, considering that decoder design has been relatively underexplored in existing RGB-D segmentation models, we develop a concise yet effective universal decoder, termed the Pyramid Merging Decoder (PMD). Extensive experiments on multiple RGB-D segmentation benchmarks demonstrate that URNet achieves state-of-the-art performance while maintaining high efficiency. Code will be available at https://github.com/Wild-Stephen/URNet.

Mapping paddy rice from very-high-resolution imagery in mountainous and hilly regions is difficult because terrain alters optical appearance and increases confusion with visually similar vegetation. We present TRNet for 0.5-m GaoJing-1 red--green--blue (RGB) imagery, a 5-m TanDEM-X digital elevation model (DEM), and derived slope. Separate visual and terrain encoders preserve modality-specific features. At an early encoder stage, Topographic Energy-Spectral Rectification applies terrain-conditioned low-frequency modulation and asymmetric high-frequency regulation to suppress steep-slope clutter and conditionally enhance compatible low-slope rice cues. The Topography-guided Paddy Structure Decoder combines semantic, rice--background boundary, and interior cues, using coarse terrain as context. Experiments used an Area A internal test set and held-out Area B, which had steeper terrain and lower rice prevalence. TRNet achieved rice intersection-over-union (IoU) values of 85.10% and 80.68%, exceeding the original Dual-Encoder U-Net by 9.15 and 18.83 percentage points, respectively. Ablation and slope-stratified results linked these gains to frequency rectification, structure learning, and fewer steep-terrain false positives. The results support coarse topography as a contextual prior for very-high-resolution paddy rice mapping.

Uterine peristalsis is a key physiological phenomenon responsible for various functions across the menstrual cycle, intimately linked to uterine wall microstructure. Alterations in uterine motion and tissue properties are implicated in the etiology of gynecological diseases, yet these processes have been studied in isolation. We introduce a dynamic multi-echo gradient echo EPI framework for simultaneous characterization and correlation of uterine peristaltic activity and time-resolved T2* changes at 0.55T. Inherent susceptibility artifacts, reduced resolution, and burden of manual uterine layer annotation are addressed by an unsupervised adversarial domain adaptation framework, transferring segmentation knowledge from labeled cine MRI to unlabeled dynamic EPI. We implemented Unet-LSTM with multi-scale domain discriminators that exploits temporal layer dynamics. A Dice score of 0.88 and Jaccard index of 0.80 was achieved. Mean T2* values were 108ms, 76ms, and 124ms for the myometrium, junctional zone, and endometrium. A negative correlation between junctional zone area and T2* was observed in 14/39 cases, providing first insights into oxygenation patterns associated with junctional zone contraction and motion, demonstrating feasibility of assessing the interplay between contractility and dynamic T2* changes.

Four-dimensional cone beam CT (4D CBCT) is important for image-guided radiation therapy of thoracic cancers, but its use is limited by long scan times, causing high patient dose and motion/sparse-sampling artifacts. We propose a deep learning method for motion-resolved 4D CBCT reconstruction from conventional free-breathing scans, without a respiratory signal or explicit projection binning. Our CNN takes free-breathing 3D CBCT projections as input and predicts a static volume at maximum inhalation plus ten displacement vector fields (DVFs) spanning a breathing cycle. The network extends U-Net: the encoder acts on filtered projection stacks, the decoder acts in the volume domain, and skip connections are replaced with non-trainable back-projection functions at multiple resolutions to transfer features between domains. The model is trained on simulated CBCT scans and evaluated on 11 unseen simulated patients and 13 clinical free-breathing scans. Two additional models (60 s and 6 s scans) were evaluated by clinical experts on three and two scans, comparing single phases of our 4D reconstruction to reference 3D SART-TV images for tumor and esophagus visibility. Experts preferred our method for tumor visibility (59% vs. 36% no preference, 5% reference) and esophagus visibility (47% vs. 42%, 11%). On simulated data, image quality matched SART-TV (mean RMSE: -1.19 HU, PSNR: +0.09 dB, SSIM: -0.009) while enabling 4D reconstruction. On clinical scans, our method showed sharper dynamic structures (e.g., diaphragm) and fewer motion streak artifacts than traditional reconstruction. This non-patient-specific CNN predicts static volumes and full 4D respiratory motion models from a single free-breathing scan, without a respiratory surrogate or projection binning, reducing motion artifacts while adding motion-modeling capability.

Focal cortical dysplasia (FCD) type II is an important structural cause of drug-resistant focal epilepsy, but its small size, heterogeneous appearance, and subtle MRI characteristics make automated segmentation challenging. Conventional multimodal networks commonly concatenate T1-weighted (T1w) and fluid-attenuated inversion recovery (FLAIR) images, requiring subsequent layers to learn useful cross-modal relationships implicitly. We propose CRIL-U-Net, a 3D U-Net incorporating a Compact Ratio-Interaction Learning module that combines local spatial features, voxel-wise cross-modal mixing, and bidirectional ratio-inspired interactions. CRIL-U-Net was compared with a conventional 3D U-Net and an input self-attention U-Net using five-fold cross-validation on 85 FCD subjects and 25 healthy controls. Each architecture was trained independently using Dice-binary cross-entropy (Dice-BCE) and Focal Tversky-Focal (FTF) losses. With FTF, CRIL-U-Net achieved the highest mean Dice score (0.196 +/- 0.262), compared with 0.136 +/- 0.224 for the U-Net and 0.135 +/- 0.214 for the attention comparator. It produced nonzero lesion overlap in 44 of 85 cases, compared with 36 for the U-Net. Under FTF, CRIL-U-Net significantly outperformed both comparison architectures after false-discovery-rate correction. These findings suggest that compact cross-modal representation learning can improve FCD segmentation within a controlled U-Net setting when combined with an imbalance-aware objective, although the remaining zero-overlap rate of 48.2% highlights the need for further validation and methodological development.

Continual learning in clinical imaging faces a dual challenge: a model must assimilate knowledge from new anatomical domains while retaining representations learned from prior tasks, a problem known as catastrophic forgetting. Existing mitigation strategies, including regularization and knowledge distillation, treat all spatial regions equally, ignoring the fact that prediction uncertainty is strongly correlated with the propensity for forgetting. We introduce UCBound-Net, a continual segmentation framework that exploits Monte Carlo (MC) Dropout uncertainty as a spatial proxy for forgetting risk. Our method contributes three synergistic components: (i) uncertainty-weighted boundary distillation, which amplifies the knowledge transfer signal at high-entropy regions of the frozen teacher; (ii) uncertainty-calibration regularization, which explicitly penalizes overconfident erroneous predictions; and (iii) uncertainty-guided exemplar selection, a memory buffer that preferentially stores samples whose boundary regions exhibit the highest predictive entropy. Evaluated on a sequential domain-incremental benchmark comprising breast ultrasound (BUSI, Task 1) followed by thyroid ultrasound (TN3K, Task 2), UCBound-Net reduces forgetting relative to naive fine-tuning, achieving a backward transfer (BWT) of -0.098 compared with -0.173, while obtaining an average Dice Similarity Coefficient (DSC) of 0.755 across both tasks. The proposed framework outperforms baseline methods without requiring task-boundary supervision. An ablation study further demonstrates that each component contributes independently to forgetting mitigation, providing a practical pathway toward uncertainty-aware continual learning for clinical image segmentation.

Diffusion Transformers (DiTs) have emerged as a core architecture in generative modeling due to their scalability and adaptability to multimodal tasks. DiTs comprise isotropic transformer blocks, and learn representations progressively across depth, where the denoising objective drives later layers to focus on fine-detail reconstruction. This results in degraded representation quality and an imbalanced encoder-decoder behavior. Prior approaches such as representation alignment (REPA) mitigate this by encouraging stronger early representations via training regularization. Alternatively, U-Net-style DiT architectures introduce explicit multi-scale encoder-decoder structures for improved convergence. But they build on standard U-Net wisdom via learnable operators for spatial downsampling, which are not well-suited to transformer architectures, introducing inefficiencies and compatibility issues with components such as cross-attention and representation regularization. In this work, we propose UDT, a U-Net diffusion transformer that combines the representation power of DiTs with the encoding-decoding benefits of U-Nets, through data-adaptive token merging for downsampling and upsampling, while preserving the DiT token dimension. Our baseline UDT architecture outperforms existing U-Net DiTs and achieves performance comparable to REPA across all model sizes. Furthermore, using architectural optimization and REPA, UDT outperforms SiT's 7.9 FID at 1400 epochs (w/o CFG) within 40 epochs (~ 40x faster convergence) for XL model size on 256x256 ImageNet. Finally, it achieves strong image generation performance with CFG, reaching FID of 1.38 (320 epochs) with SD-VAE and 1.35 (500 epochs) with VA-VAE, providing a new backbone for DiTs with strong empirical benefits.

Object detection and segmentation in three-dimensional medical images is a very active area of research. However, most proposed deep learning models carry a high computational cost, and only few aim to be broadly applicable, achieve high detection performance, and remain fast to execute on resource-constrained hardware. To address this gap, we present RadYOLO, a 3D extension of YOLO11 tailored to medical images. We compare it with nnU-Net and nnDetection on five datasets comprising CT and MRI data with varying object sizes and prevalence. RadYOLO's detection performance surpasses that of nnDetection on four of five datasets and is comparable on one. Compared to nnU-Net, RadYOLO performs better on lesion detection tasks, while nnU-Net excels at detecting large organs when precise localization is required. When rough object localization is sufficient, RadYOLO matches or outperforms nnU-Net on all five datasets. Regarding inference time, RadYOLO is 8-46x faster than nnU-Net on a GPU. Compared to nnDetection the speedup is even higher. When executed on a CPU, RadYOLO's inference runs within seconds (still faster than nnU-Net on a GPU) offering a significant advantage for clinical and edge-device deployment. RadYOLO repository: https://github.com/FraunhoferMEVIS/RadYOLO

Underwater image enhancement (UIE) aims to recover clear images from observations affected by wavelength-dependent absorption, scattering, and spatially nonuniform degradation. Although existing generative methods can handle complex degradations, severe information loss may lead to semantic drift in the restored results. To address this issue, we propose RPL-UIE, a two-stage teacher--student framework for reliable prior learning. In the teacher stage, the network learns reliable and complementary spatial priors characterizing appearance and photometric properties from paired degraded and reference images. In the student stage, the network takes only degraded images as input and learns to emulate the teacher's prior extraction capability, thereby providing more reliable restoration guidance for the enhancement process without requiring reference images at inference. To reduce the prior-learning discrepancy between the teacher and student models, we further develop Residual Prior Refinement Diffusion (RPRD) and Frequency-Aware Prior Residual Calibration (FPRC). RPRD uses the coarse priors as anchors and progressively predicts the necessary corrections in the residual space. FPRC retains stable low-frequency residual components and selectively modulates high-frequency detail residuals, producing calibrated priors to support high-quality reconstruction. Experiments on multiple UIE benchmarks demonstrate competitive restoration performance. Downstream underwater object detection and instance segmentation experiments further demonstrate the improved utility of enhanced images for visual perception, while tests on real-world data captured by a remotely operated vehicle (ROV) support the practical applicability of RPL-UIE.

Background and Objective: Generating realistic medical images with anatomically accurate segmentation masks helps address the shortage of annotated data in medical imaging, particularly in optical coherence tomography (OCT) of mouse eyes, where manual retinal layer delineation is labour-intensive due to tiny structures and required expertise, resulting in scarce datasets. While diffusion models perform well in medical image synthesis, joint image-mask generation has relied mainly on U-Net-based denoisers, leaving diffusion transformers largely unexplored. Methods: We propose a conditional dual-output Diffusion Transformer (DualDiT) for joint synthesis of OCT B-scans and segmentation masks of the upper retinal cell layers in ex vivo mouse retina. DualDiT encodes both modalities into a shared latent space via a pretrained VAE, concatenates their latent representations, and performs conditional diffusion over the joint tensor. We compared DualDiT against two adapted diffusion baselines: DDPM and LDM. Generative quality was assessed via Fréchet Inception Distance (FID) and spatial FID (sFID); practical utility via synthetic data augmentation for downstream U-Net segmentation; and perceptual realism via evaluation by three domain experts. Results: DualDiT achieved the best generative quality (FID 56.14, sFID 114.35), outperforming DDPM and LDM. Expert panels misclassified 46% of synthetic samples as real and 42% of real samples as synthetic. Adding DualDiT-generated images and masks improved Dice and IoU scores on a held-out segmentation test set. Conclusions: DualDiT shows that transformer-based diffusion models can effectively learn the joint distribution of OCT images and segmentation masks, surpassing DDPM- and LDM-based baselines in generative fidelity, downstream utility, and perceptual realism, highlighting its potential for data augmentation in annotation-scarce medical imaging.

Ultrasound imaging has become increasingly widespread in clinical practice due to its portability, low cost and real-time capability, making ultrasound image segmentation important. However, ultrasound images differ substantially from CT, MRI, and other medical imaging modalities, as they are often affected by speckle noise, low contrast, acoustic shadows and ambiguous boundaries. Existing ultrasound segmentation methods are still mainly limited to task-specific models or visual-prompt-based foundation models, which are either tailored to particular tasks or require expert-provided visual prompts, making them inconvenient for flexible clinical use. To address these challenges, we propose UltraSAM3, a concept-driven foundation model for universal ultrasound image segmentation. Unlike conventional models, UltraSAM3 enables text-based target specification by adapting SAM3 to ultrasound-specific image--mask--concept triplets. The model is trained on a large-scale ultrasound segmentation corpus covering 37 public datasets and 13 anatomical categories, allowing it to align ultrasound visual patterns with clinically meaningful concepts across diverse organs and lesions. To further improve usability under realistic clinical interaction, we propose an instruction-guided agent that parses complex natural language queries into concise ultrasound concept prompts for UltraSAM3. Extensive experiments demonstrate that UltraSAM3 consistently outperforms representative concept- and text-driven biomedical segmentation models on multi-organ ultrasound benchmarks, external datasets, and visual-prompt-enhanced settings. Moreover, the agent improves segmentation robustness for complex user instructions. These results indicate that ultrasound-specific concept adaptation is effective for building generalizable and interactive ultrasound segmentation foundation models.

The ASNR-MICCAI BraTS Local Synthesis (Inpainting) task asks for the anatomically plausible completion of healthy brain tissue within a masked region of a T1-weighted MRI, providing a tumor-free anatomical reference for downstream analysis. As the task is scored by distortion metrics (SSIM, PSNR, MSE), we build a deterministic regression model and focus on giving it inductive biases tailored to inpainting. Our network follows the U-DiT principle of performing self-attention on a downsampled token grid: a volumetric encoder-decoder imports long-range context through a downsampled global self-attention block with three-dimensional rotary position embeddings, while convolutions and skip connections preserve high-frequency detail. Two ideas drive our results. First, we constrain the attention so that occluded ("void") tokens attend only to known-healthy tokens of the same volume, with a learned bias toward each query's contralateral homologue, forcing the completion to be inferred from observed anatomy rather than from other unknown regions. Second, we add a contralateral-symmetry input that supplies the mirrored healthy hemisphere as a patient-specific prior; since the brain is approximately bilaterally symmetric and lesions are typically unilateral, this prior improves the distortion metrics at matched structural similarity. On the official BraTS-2026 validation leaderboard our submission reaches a mean healthy-region SSIM of $0.864$, PSNR of $24.7$,dB and MSE of $4.6{\times}10^{-3}$ over $219$ cases. We further analyse the residual smoothness inherent to distortion-optimal regression and discuss its implications for anatomical realism.

Medical image segmentation heavily depends on labor-intensive and time-consuming pixel-level annotations. Eye tracking offers a cost-effective solution that can be naturally integrated into clinical workflows. Recorded by eye trackers, gaze conveys the spatial regions of clinicians' attention through fixations and the temporal context of clinicians' progressive visual perception from trajectories. Nevertheless, effective modeling of temporal trajectories remains challenging, and noise in gaze caused by exploratory fixations greatly limits segmentation performance. To overcome these limitations, we propose the Trajectory-guided Uncertainty-aware Network (TrailNet), which exploits gaze-supervised medical image segmentation from spatial semantics modeling to temporal context by jointly leveraging fixations and trajectories. Specifically, the proposed trajectory-guided spatio-temporal encoder models temporal context and establishes complementary interactions with image spatial semantics to strengthen target perception. Furthermore, the multi-scale uncertainty decoder leverages category mutual-exclusivity constraints to produce deterministic predictions and mitigate supervision uncertainty induced by noise. To enable gaze-free inference, we further introduce a cycle distillation strategy that transfers feature-level knowledge via teacher-student networks. Experimental results on two public datasets demonstrate that TrailNet outperforms state-of-the-art methods, achieving Dice scores of 81.25% and 81.85%, respectively.

In practical settings, medical image segmentation models are often developed with limited annotated data rather than fully labeled datasets. Training frequently begins in ultra-low labeled regimes where only a small number of volumes are annotated. In such scenarios, practitioners must simultaneously decide which cases to annotate and how to best use the remaining unlabeled data. Although active learning (AL) and semi-supervised learning (SSL) both target annotation scarcity, they are typically designed and optimized independently, resulting in objective mismatch and unstable training during early-stage "cold start" conditions. We propose RegAL, a unified active semi-supervised framework governed by a shared topology-aware Pareto optimization that couples sample acquisition with unlabeled data utilization. RegAL evaluates images along three complementary axes, voxel-wise uncertainty, feature diversity, and a novel topological consistency metric, to select anatomically informative edge cases for annotation. On the other hand, the same criteria are used to identify geometrically stable atlas candidates for diffeomorphic registration-guided augmentation to train a self-supervised Mean Teacher segmentation network. Across BraTS 2021, dHCP, and ProstateX, RegAL remains stable with few labeled volumes and consistently outperforms state-of-the-art AL, SSL, and active semi-supervised baselines across Dice and boundary-distance (ASD, HD95) metrics under extreme annotation scarcity.

Semantic segmentation in agricultural imagery is often evaluated under in-domain protocols, yet practical deployment requires robustness to appearance perturbations, limited annotations, and cross domain shift. This paper presents a diffusion-guided hybrid segmentation framework in which U-Net, DeepLabV3+, and SegFormer backbones generate coarse masks that are refined by Denoising Diffusion Probabilistic Models (DDPM), latent diffusion, or semantic-guided diffusion. The framework is evaluated through a 3x3 architectural screening study on PlantSegV3, followed by boundary-constrained optimization, perturbation-guided retraining, low-data evaluation, constrained hyperparameter screening, and controlled cross-domain adaptation. On PlantSegV3, the best selected hybrid model achieves 71.83% refined mean Intersection-over-Union (mIoU) and 26.10% refined Boundary-F1, and the selected models remain stable under substantially reduced supervision, demonstrating strong annotation efficiency. Perturbation analysis identifies grayscale conversion, fog, coarse dropout, and shadow as the most disruptive appearance shifts, and the resulting augmentation policy substantially improves robustness during retraining. The adapted models further show effective transfer to external agricultural datasets under limited target supervision, indicating that diffusion refinement and boundary-aware optimization provide transferable structural priors. Overall, the results show that carefully matched backbone-refiner pairings, combined with perturbation-aware retraining, can improve structural delineation and robustness under realistic resource and distribution constraints.

We describe and evaluate BF-ConvUNeXt, a compact bias-free ConvNeXt U-Net for blind additive-white-Gaussian-noise color image denoising, combining four existing ingredients so a single property survives end to end: a frozen depthwise Gabor stem (oriented band-pass, zero trainable parameters), a Laplacian-pyramid encoder routing the high-frequency residual into each skip connection, a ConvNeXt-V1 U-Net body, and bias-free construction throughout (no additive bias, linear head, LeakyReLU, variance-only batch norm). Together these make the 0.82M-parameter network exactly degree-1 homogeneous at inference, D(alpha y) = alpha D(y), licensing a Miyasawa/Tweedie score reading of the residual and blind generalization across noise levels from one model. We train a single blind model on a noise-sigma curriculum (sigma approximately 6.4 to 64, 0-255 scale); it extrapolates past that ceiling without a cliff, degrading smoothly to 22.8 dB at sigma=150 and 20.0 dB at sigma=200. Evaluated unchanged on four standard color sets (CBSD68, Kodak24, McMaster, Urban100) at sigma in {15,25,50}, it matches or beats DnCNN and FFDNet on every set and level, averaging about +0.7 dB over DnCNN. Against heavyweight CNN/transformer state of the art it trails by a small margin (roughly 0.3-1.7 dB depending on set) at 1/15 to 1/39 of their parameters. The homogeneity is inference-only and checkpoint-specific, and the learned residual is a local, not global, score (non-conservative Jacobian), so plug-and-play/RED guarantees do not transfer; it still drives stochastic sampling and linear inverse problems (inpainting, super-resolution, deblurring, compressive sensing).

Agricultural field maps are often proprietary, incomplete, or outdated, yet they provide the spatial framework for crop monitoring, production accounting, and land-conversion analysis. This study presents a reproducible workflow for mapping farmland extent and visible boundaries from 1 m NAIP RGB imagery. Thirty-seven scenes spanning open cropland, peri-urban interfaces, semi-arid irrigation geometries, and fragmented mosaics were annotated in CVAT and converted to binary masks. Non-overlapping 256 x 256 patches yielded 5,698 samples, split by source scene into 3,850 training, 770 validation, and 1,078 test patches. A residual U-Net (ResUNet) trained with a Dice-dominant loss, L = 2.5(1 - Dice) + BCE, achieved test accuracy 0.8808, IoU 0.8605, Dice 0.9234, precision 0.8766, and recall 0.9794. A frozen SAM 3 branch prompted with "agricultural farmland field" was fused with ResUNet by logical OR. On selected difficult patches, Dice improved from 0.858 to 0.955 (orchard rows) and from 0.804 to 0.903 (fragmented parcels). Sliding-window stitching produced coherent regional masks (example tile Dice 0.898 and 0.919). The product is a semantic farmland-extent layer, not a cadastral parcel map, and supports agricultural monitoring where current field layers are unavailable.

Learning high-fidelity point-cloud features in the 3D space poses significant challenges, including permutation invariance, lack of local context, difficulty in fine-grained surface reconstruction, and high computational cost. In this article, we propose Trans-Unet, a novel framework that addresses these issues by first tansforming 3D point-cloud data into a 2D grid domain and then employing a U-shaped hybrid model that integrates Convolutional Neural Networks, and self-attention mechanisms. The proposed Trans-Unet effectively learns and reconstructs precise features from high-resolution 3D point-cloud data (with 40,401 points in surface and 2,382 points in fiber) derived from a predefined finite element brain patch growth model, enabling accurate prediction of brain folding patterns. By combining multiple techniques, Trans-Unet leverages the complementary strengths: the 3D-to-2D transformation preserves fine-grained structural information while significantly reducing computational cost and the curse of dimensionality; convolutional blocks capture hierarchical, low-level local representations; and the self-attention mechanism models global, high-level semantics and long-range dependencies. The dataset consists of 3D point-clouds containing both brain surface patches and fiber information generated by a large-scale finite element model. Trans-Unet is applied to predict brain surface folding from the initial state (state 0 or states 0-2) to the final state (state 3). Experimental results demonstrate that Trans-Unet achieves high-resolution predictions of brain patch growth, surpassing existing methods in both fidelity and accuracy.

Medical ultrasound (US) image segmentation faces significant challenges due to speckle noise, low-contrast boundaries, acoustic shadowing, and acquisition variation across operators and clinical centers. Although encoder-decoder and transformer-based networks have achieved strong performance, many methods recover boundary details through dense decoders or larger backbones, which may still produce over-smoothed contours or unstable predictions under external distribution shifts. In this article, we propose Risk-routed Implicit Boundary Refinement (RIBR), a compact segmentation framework that uses implicit neural representation as a risk-routed residual correction rather than an unconstrained full-mask predictor. RIBR combines boundary-refinement implicit residuals, risk-routed residual control, and geometry- and speckle-aware boundary regularization to refine uncertain contours while suppressing non-boundary oscillations. Evaluation on nine US datasets covering lymph nodes, breast lesions, thyroid nodules, and prostate shows that RIBR achieves the best overall macro-average and consistently reduces boundary error across grouped and organ-specific comparisons under a compact parameter budget. These findings suggest that controlled implicit residual learning is a practical strategy for resource-constrained and boundary-sensitive US segmentation. Source code is available at https://github.com/jinggqu/ribr.

Quantitative drug-induced sleep endoscopy (DISE) requires reliable airway boundaries at specific anatomical levels. Pixel-level DISE annotations are scarce, and manual contouring limits the scalability of quantitative assessment. To address this limitation, we developed ASTRA-Net for known-plane DISE segmentation with limited real annotations. Stage 1 aligned intermediate ConvNeXt-Base representations from 14,250 unlabeled virtual endoscopy frames derived from computed tomography and real DISE frames. Virtual images were used only for feature alignment. Stage 2 fine-tuned four independent UNet++ decoders on 401 real annotated frames. Structured zero-mask supervision constrained incompatible plane outputs and invalid frames. Six alignment configurations used maximum mean discrepancy, domain adversarial learning, or both objectives. On a hold-out evaluation set of 100 frames, the five-model MMD-only segmentation ensemble achieved a mean Dice of 0.8927, with a 95% image-level bootstrap interval of 0.8631 to 0.9160. The mean intersection over union was 0.8239. A classification- enabled variant of the same alignment configuration reached a restricted four-plane top-1 accuracy of 0.92 on the same hold-out frames. These results indicate that ASTRA-Net can support frame-level, plane-specific DISE boundary delineation when real annotations are limited.

Tracking residual tumor after surgery is essential for catching recurrence early, but automating post-operative glioma segmentation remains a difficult task. Although transformer-based architectures, such as SwinUNETR, achieved impressive results, few studies test how well they generalize across clinical protocols. In this paper, we conduct an ablation study on the MU-GLIOMA-POST and UCSF-ALPTDG datasets and show that the standard Generalized Dice Loss (GDL) is unstable under domain shift: the Whole Lesion (WL) Dice drops from 0.88 on the internal validation set to 0.73 on the external UCSF test set. To address this, we pair brain-masked percentile normalization with voxel-level contrastive learning. We also propose a Subspace-Aware Class Attention (SACA) module that re-calibrates the bottleneck features and raises Enhancing Tumor (ET) sensitivity by 8% (9.1% relative improvement) on internal validation. Ensembling these refinements with nnU-Net brings every stable configuration to a WL Dice of 0.94, and the SACA variant ensemble achieves the best boundary error (HD95) of 2.92 mm on MU-GLIOMA-POST.

Accurate segmentation of brain stroke lesions in non-contrast computed tomography (NCCT) scans is critical for rapid clinical decision-making, yet remains difficult due to the low contrast between lesion and normal brain tissue, heterogeneous lesion morphology across ischemic and hemorrhagic subtypes, and ambiguous boundaries caused by partial volume effects. Current deep learning approaches primarily optimize region-level overlap but lack explicit boundary modeling, leading to imprecise delineation that can affect volumetric assessment and treatment planning. We propose FSB-Net, a frequency-spatial boundary network that leverages frequency-domain analysis for boundary-aware stroke lesion segmentation. FSB-Net introduces three components: (i) a Wavelet Boundary Detection Head (WBDH) that applies the discrete wavelet transform to multi-scale encoder features, extracting high-frequency sub-bands as boundary representations; (ii) a Frequency-Spatial Cross-Attention Module (FSCAM) that performs bidirectional attention between wavelet boundary features and spatial decoder features for selective boundary enhancement; and (iii) a Spectral Boundary Loss that penalizes high-frequency discrepancies in the Fourier domain to optimize boundary sharpness. Built on a PVTv2-B2 encoder, FSB-Net is evaluated on a public Brain Stroke CT dataset containing both ischemic and hemorrhagic cases. Experimental results show that FSB-Net outperforms U-Net, UNet++, MANet, and DeepLabV3+ across all metrics, achieving state-of-the-art performance in mean Dice, mean IoU, and HD95.

Robust out-of-the-box performance is essential for the clinical deployment of deep learning models in medical imaging. An important but underexplored factor affecting model generalisability is intensity normalisation, particularly for magnetic resonance imaging (MRI), where image intensities vary across scanners and protocols. In this study, we systematically compared seven normalisation methods and their impact on the performance of a 3D U-Net model for meniscus segmentation from knee MRI. The methods included standard scaling approaches, histogram-based techniques, and a Gaussian Mixture Model (GMM)-based method. Models were trained on the IWOAI 2019 dataset and evaluated on both internal and external test sets (SKM-TEA) to assess generalisability. Performance was similar internally but differences were significant on external data, with Z-score, Nyúl histogram matching, and CLAHE showing greater robustness than other methods. However, these differences were small compared to the significant performance drop observed between datasets. Overall, while intensity normalisation had a measurable effect on model generalisability, its impact was limited relative to the effects of domain shift, highlighting the need for complementary strategies for robust deployment.

Deep learning frameworks like nnU-Net achieve state-of-theart brain lesion segmentation performance but remain difficult to deploy in clinical research environments due to, among other reasons, software dependencies and computational requirements. We introduce StrokeSeg2, a lightweight, modular, cross-platform C++/Qt framework designed to adapt resource-intensive 3D stroke segmentation pipelines into portable and reproducible applications. To improve compatibility with standard clinical workstations, we investigate the combined effect of architectural compression through knowledge distillation and inference optimisation using ONNX Runtime with Float16 quantisation. Across heterogeneous hardware configurations (CPU, integrated GPU, and dedicated GPU) architectural distillation emerged as the primary contributor to efficiency gains, contributing to over 90% reduction in energy consumption and an average 84% reduction in inference time. Specifically, we identify a 0.84M-parameter student model as the most favourable trade-off, reducing the original 102.3M-parameter teacher architecture to a 2.1 MB disk footprint while preserving robust lesion localisation and competitive segmentation performance. This small footprint supports the development of a self-contained installer for clinical workstation targets. Finally, StrokeSeg2 packages these optimisations into standalone installers for Windows, macOS, and Linux. By providing both graphical and commandline interfaces without Docker or external environment dependencies, StrokeSeg2 facilitates deployment of high-performance segmentation workflows for routine clinical research pipelines.