medical imaging software teams

Abstract: Concept-based explanations of melanoma classifiers are rarely tested against controls with known targets. We built a counterfactual audit from a diffusion model conditioned on seven 7-point checklist concepts and tested it with such controls. Colour-calibrated start noise reduced colour outliers from 78.5-84.8\% to 6.6-13.3\%. Four of seven knobs were target-dominant but also changed other concepts. Quartile-based positive controls were confounded, and the audit failed its pre-specified rule. It recovered the targets of all 16 controls matched on the generator's pseudo-labels and of 12 of 12 controls labelled by a second evaluator, for three concepts; concept activation vectors recovered fewer (11 of 16). In 18 permuted-label classifiers, significant sweep responses and target rankings also arose, whereas standardised effect margins separated the controls from these null classifiers. The pigmentation sweep raised the melanoma logit in 15 of 15 ISIC 2020 classifiers (+3.12 on average) and 6 of 6 HAM10000 classifiers (+4.01), about four times the null response in scale-free units; the regression effect did not transfer. An exploratory decomposition, evaluated against the controls, suggested that knob cross-talk partly hides vascular responses. Matched controls and null classifiers are practical checks of concept audits.

Abstract: Deep learning models for coronary vessel segmentation in X-ray angiography often perform poorly on data from centres that were not represented in training. Apart from differences in equipment, the labels of the largest public dataset (ARCADE) are incomplete, as only the segments defined in the SYNTAX score are annotated. In this study, we evaluated whether self-training with pseudo-labels can improve performance on external data without additional manual annotation. Pseudo-labels were generated from two sources, namely the predictions of an nnU-Net model trained on ARCADE and a contrast map obtained by subtracting a pre-contrast frame from the same sequence. The nnU-Net predictions were extended along the contrast map, and pixels detected only in the subtraction image were assigned an ignore label and excluded from the loss. Six models were trained and tested on ARCADE and on two external datasets (XCAD and XACV). All first-round models initialised with the baseline predictions performed better than both the baseline and a control model fine-tuned for the same number of epochs. The model trained on the XCAD pool improved the macro-averaged Dice score by 2.7 points (95% CI 2.3-3.2), while the control decreased it by 0.6 points. A second round of self-training did not lead to further improvement. When an external model trained on 50 fully annotated images was used to generate the initial labels, the XCAD Dice score increased from 0.623 to 0.745 without any XCAD labels, although performance on XACV did not improve because large main vessels were missed. These results suggest that the benefit of self-training depends largely on the sensitivity of the model used to generate the initial pseudo-labels.

Abstract: Reliable vocal-cord localization in emergency video laryngoscopy remains visually challenging due to rapid tissue deformation, specular highlights, and instrument occlusions. We propose Local Point Tracking (LPT), a robust framework that combines a single-frame detector, local point propagation, and stateless mask refinement. LPT follows a localize first, snap second pipeline. First, a single-frame semantic detector generates sparse anchors, within which LPT initializes local query points (SAM-supported by default, with a regular grid as fallback). A point-propagation module tracks these points through detector-missed frames and recovers temporal bounding boxes from their geometry. Second, because point-derived boxes can be loose around the visible boundary, a box-snap step refines the selected box to the target boundary. This decomposition keeps temporal state in local point coordinates rather than a stateful mask or whole-region representation, while the spatial refinement module handles single-frame boundary precision without feeding mask errors back into temporal memory. Extensive evaluations on two distinct datasets demonstrate that our proposed LPT method achieves strong overall performance against existing baselines, with the best mAP_50, success AUC, and missing rate on both datasets. Furthermore, ablation studies confirm that point tracking primarily enhances temporal tracking robustness, while box-snap refinement effectively improves boundary tightness.

Abstract: Visual foundation models learn rich pathological morphology but lack explicit concept-level supervision. Vision--language pretraining can provide this supervision but requires costly image--text pairs. Here, we introduce GloSAGE, a semantic self-distillation framework that uses lesion profiles predicted by a pretrained visual teacher to construct structured pathology descriptions. Reliability-guided selection identifies image--text anchors, while Knowledge-Structured Pathology Text Synthesis and Evidence-Guided Negative-pair Construction account for partially observed lesions. Image--text alignment trains projection layers while retaining the frozen visual encoder; an intermediate Semantic Transfer Layer supplies features for downstream tasks. Developed on GloMillion and evaluated across seven glomerulus- and case-level cohorts, GloSAGE supported zero-shot lesion recognition, image--text retrieval, hard-negative discrimination and concept-intervention analyses. It outperformed its source visual model in most lesion-recognition tasks and improved lesion grading, while supporting competitive case-level disease classification, injury grading and baseline renal function estimation. Ablations supported the combined contributions of knowledge-structured text and evidence-guided negatives, and the intermediate transfer layer improved mean lesion-recognition ROC-AUC relative to the complete projection output. A frozen language model conditioned on GloSAGE features generated glomerular descriptions. These findings suggest that teacher-derived lesion profiles can provide annotation-efficient semantic supervision for extending a glomerular visual foundation model.

Abstract: Automated classification of gastrointestinal (GI) findings in endoscopic images could support early diagnosis, but architectures are often chosen on accuracy alone. We present a controlled, reproducible benchmark of ResNet50 and ViT-B/16 for eight-class GI classification on the public Kvasir dataset (4,000 images), using a stratified split (400 test images) and stratified group 5-fold cross-validation over all images. In cross-validation, ResNet50 and ViT-B/16 reached 92.12% and 91.70% accuracy, and a two one-sided tests (TOST) procedure showed equivalence within a +/-3 percentage-point margin (difference +0.43 points, 90% CI -0.33 to +1.18; p < 0.001). The architectures differed mainly in cost: ResNet50 had 3.6 times fewer parameters and 4.3 times fewer operations, 2.5-fold lower single-image CPU latency (69 vs. 177 ms) and 3.8-fold higher GPU throughput. Cross-validated calibration was similar (expected calibration error 0.021 vs. 0.023). An edge-oriented transformer, MobileViT-S, was most accurate on the test split (95.5%) but lost 9.4 points when an acquisition artefact present in some classes (the ScopeGuide inset) was occluded, whereas ResNet50 was not significantly affected. On 500 unseen polyp images with expert masks, both models' Grad-CAM maps focused on the lesion (3.6 times chance). On a de-duplicated external subset of GastroVision (1,998 images), accuracy fell to 78-80% for all three models and differences between them remained small. Accuracy differences between architectures were thus small relative to the effects of shortcut learning and domain shift, whereas efficiency differences were large. An efficient CNN is a defensible default for resource-constrained screening, but no model is deployment-ready without local validation.

Abstract: Purpose: Human epidermal growth factor receptor 2 (HER2) status is a key biomarker relevant for prognostication and treatment decision making in metastatic breast cancer. Thus, the aim of this work was to explore whether HER2 status can be predicted directly from whole-brain post-contrast T1-weighted (T1w) MRI scans in breast cancer brain metastases (BCBM) using deep learning, and whether providing explicit tumour segmentation information improves prediction. Methods: Using the publicly available BCBM-Radiogenomics dataset, we analysed 135 patients, including 70 HER2+ and 65 HER2- patients. Three approaches were implemented and evaluated: a conventional radiomics model, a simple fully convolutional network (SFCN) using T1w MRI scans alone, and an SFCN using T1w MRI scans with an expert-derived tumour mask as an additional input channel. Results: The radiomics model achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.602 (95% confidence interval [CI]: 0.528--0.677) while the SFCN achieved a ROC-AUC of 0.667 (95% CI, 0.63--0.71) using T1w MRI scans alone, which increased to 0.692 (95% CI, 0.58--0.81) when an explicit tumour mask was additionally provided. Conclusion: However, the modest performance across all approaches demonstrates the difficulty of predicting HER2 status from structural MRI scans alone. The difference between the segmentation-free and mask-guided SFCN models suggests that much of the predictive signal captured by the deep-learning model may be learned directly from whole-brain T1w MRI without requiring explicit tumour delineation. These findings support further investigation of segmentation-free deep-learning approaches as a potential non-invasive strategy to support HER2 status determination in BCBM.

Abstract: Multimodal large language models (MLLMs) can answer clinical questions about medical images, but trustworthy use requires visual grounding: models should localize the pathology they report rather than rely on spurious shortcuts. Whether MLLMs can visually ground clinical findings in retinal optical coherence tomography (OCT), the most widely used imaging modality in ophthalmology, remains largely unexplored. To address this gap, we introduce RetinaGroundBench, the first benchmark for biomarker visual grounding in retinal OCT. It comprises 815 B-scans exhaustively annotated by ophthalmologists with 4,537 bounding boxes covering 13 biomarkers across 8 diseases. Because MLLMs often fragment a single lesion into multiple partial predictions, we propose AggIoU, a metric that evaluates whether the union of overlapping predicted boxes covers the annotated region. Across 27 open-source MLLMs (0.8-38B parameters), we find that visual grounding remains largely unsolved: the best general-purpose model achieves a macro F1 of just 23.7%, with consistently low recall, despite reaching up to 73% balanced accuracy on biomarker presence questions. To narrow this gap, we developed RetGrounder, an MLLM fine-tuned using an OCT-specific strategy integrating grounding and textual information. Despite its relatively small size (8B), RetGrounder improves grounding F1 to 33.9%, a 43% relative improvement. Our benchmark provides a reference point for measuring progress in the field of OCT diagnosis with MLLMs.

Abstract: Combined hepatocellular-cholangiocarcinomas (cHCC-CCA) are a type of cancer that share components of two other primary liver cancers: hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Accurate diagnosis of cHCC-CCA, of which the behavior may resemble that of either HCC or CCA, remains a challenge due to strong intratumoral heterogeneity. Since the prognoses differ between liver cancer types, it is necessary to improve their morphological characterization and recognition in order to accurately identify cHCC-CCA. In this work, we use whole slide images (WSIs) of the two main types of liver cancer (HCC and CCA) and cHCC-CCA, stained with Hematoxylin-Eosin-Safran (HES), to train a classification model that can distinguish between these subtypes and provides a potential solution for localizing different types of tumors in the combined liver cancer images.

Abstract: The diagnostic capability of WSI agents relies on effective slide navigation to identify diagnostically relevant regions and efficiently integrate evidence across the slide. While in clinical practice, pathologists dynamically examine slides across multiple scales, integrating global and cellular evidence in a sequential manner, existing AI navigation approaches mostly operate at a single fixed magnification or rely on predefined magnification traversal. This mismatch prevents existing methods from modeling cross-magnification interactions and adaptive magnification selection inherent to real diagnostic workflows. We propose PathPilot, a clinically consistent multi-magnification WSI navigation agent that explicitly models cross-magnification localization and evidence-adaptive exploration. Specifically, we introduce a CrossMagLoc that learns magnification-specific diagnostic localization from pathologist viewing behavior and integrates information from adjacent magnifications to identify the diagnostically most relevant region within the current ROI, thereby providing a diagnostically informed starting point for subsequent question-conditioned exploration. We further introduce an EviRegionSearch that starts question-conditioned exploration from this region, progressively accumulating question-relevant evidence and adaptively determining the next navigation action according to the remaining evidence requirement. Their iterative interaction enables PathPilot to sequentially explore across ROIs and magnifications until sufficient evidence is acquired. Extensive QA evaluations across five cohorts demonstrate consistent superiority over competing SOTA methods on inter/external cohorts, respectively, validating question-conditioned evidence acquisition across regions and magnifications that mirrors the sequential, knowledge-driven navigation of pathologists.

Abstract: Bronchoscopy inserts a camera through the airways to diagnose endoluminal disease. Locating the camera along the airway usually requires additional equipment, such as an electromagnetic tracker and a preoperative CT scan. In this paper, we investigate the use of the monocular camera stream to localise the bronchoscope without requiring additional sensing. We introduce a monocular SLAM system that localises the tip of a bronchoscope and reconstructs the airway surface around it from RGB video alone. A Depth Anything 3 backbone, fine-tuned on over a million photorealistic airway renderings, returns metric per-pixel depth and is the system's only source of scale. DINOv3 features routed through a custom cross-attention matcher supply sub-pixel correspondences on mucosa where classical descriptors fail. Both enter a factor graph alongside a dense constraint from projective iterative closest point (ICP) registration against the system's own running reconstruction, so surface evidence stabilises the directions the visual factors leave weakly observable. On six airways rendered from patient CT scans, the system reaches 26.1 mm mean absolute trajectory error and 77.5% mean surface F-score. Its mean surface accuracy exceeds that of five recent monocular SLAM and feed-forward baselines. MASt3R-SLAM, which fits a free scale to the ground truth, has a lower mean trajectory error (22.0 mm). ORB-SLAM3 completes only two of the six airways, whereas our system completes all six and also reconstructs two ex vivo specimens.

Abstract: Accurate brain tumor segmentation from magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning; however, manual delineation is labor-intensive and time-consuming. Existing approaches are either task-specific with limited generalization or rely on user-provided prompts during inference. We present BaT-SAM, a parameter-efficient adaptation framework that enables fully automatic brain tumor segmentation with the Segment Anything Model (SAM). BaT-SAM injects local inductive bias into SAM's frozen Vision Transformer (ViT) encoder via Conv-LoRA, where image features are processed by a sparsely gated mixture of multi-scale convolutional experts. This design compensates for the limited translation-equivariant inductive bias of vanilla ViTs while fine-tuning fewer than 5M parameters (less than 1% of the full model). To remove the need for user prompts, we further introduce a lightweight self-prompting box regressor that is jointly optimized with the adapter using scheduled sampling and predicts tumor locations directly from image embeddings. On the BRISC2025 benchmark, BaT-SAM achieves a weighted mean IoU of 0.832 while outperforming state-of-the-art benchmarks. It further demonstrates strong cross-dataset generalization, achieving Dice scores of 0.702 on Figshare and 0.784 on the LGG MRI Segmentation dataset.

Abstract: Whole-slide images (WSIs) are gigapixel-scale digital scans of histopathology tissue and serve as the primary basis for cancer diagnosis. Existing histopathology generative models operate at the patch scale, producing fixed-size tiles of at most 1024$\times$1024 pixels which encompass only a small fraction of the WSI. In contrast, text reports for clinical diagnoses and slide-level diagnostic labels -- the supervision that exists at scale -- operate at the whole-slide level. We present BigCell, the first approach to generate coherent whole-slide histopathology images at native gigapixel resolution. BigCell trains a flow-matching transformer at 2048$\times$2048 pixels on over 120,000 publicly available WSIs spanning multiple organ types. Conditioning on embeddings from pathology foundation models and using an inference-time sliding-window pipeline, BigCell generates coherent images of up to 32,768$\times$32,768 pixels, outperforming prior tile generators on both tile-level and slide-level fidelity metrics. To make gigapixel synthesis practical, we introduce an adaptive scheduling strategy that prioritizes important slide regions, speeding up image generation by over 3\ttimes with minimal quality degradation. Furthermore, we propose the first text-to-image synthesis at 8k resolution by training a separate model that produces dense conditioning grids directly from pathology text reports. We demonstrate that augmenting with synthetic samples improves slide-level few-shot classification performance by up to $18 \%$ over baselines trained on real data.

Abstract: Natural-image-pretrained foundation models are increasingly adapted to medical imaging, yet transfer remains unreliable under domain shift, modality heterogeneity, and label scarcity. We trace part of this fragility to an overlooked design choice. Standard vision transformers place all global modeling on self-attention over spatial tokens, an object-layout prior well suited to natural scenes but not to medical images, where the discriminative signal lies in feature correlations and texture that recur across scanners while layout does not. We ask whether the axis of global attention, spatial versus feature, is itself a lever for transferable medical representations. Existing channel-aware hybrids confound this question, adding channel attention to a spatially-mixed backbone and leaving the axes coupled and the feature axis unmeasurable in isolation. We design FAD-ViT, a backbone that strictly decouples the two axes, making feature-axis attention the primary global operator and the attention axis a controlled variable. Evaluating comprehensively across 23 classification, segmentation, and low-data tasks under matched tokenization, capacity, and protocol, we find that shifting global attention from the spatial to the feature axis leaves from-scratch performance essentially unchanged, yet markedly strengthens transfer. Identical ImageNet pretraining yields up to roughly three times the transfer gain, with consistent improvements on every held-out segmentation task at up to a quarter the parameter count and far lower compute than standard and channel-attention baselines. The advantage is largest where texture rather than geometry is discriminative, tracking greater reuse of pretrained features. The axis of global attention is thus a design lever for medical transfer, and making it channel-primary is a simple, cheap, and principled choice.

Abstract: Clinical vision models are often deployed as frozen black boxes with no access to internals, retraining, or ground truth at inference time. We introduce \textbf{SpatialUQ}, a post-hoc uncertainty method using only output probabilities. It measures the Jensen-Shannon divergence between the global prediction and the mean of five fixed spatial crops in six deterministic forward passes. The premise is simple, trustworthy predictions are spatially consistent. On NIH ChestX-ray14 (DenseNet-121, $N{=}25{,}596$), our Multicrop Uncertainty Score (MUS) reaches $0.784$ failure-detection AUC versus $0.664$ for MC-Dropout ($p{<}10^{-6}$) at one-fifth the compute, with native calibration ($\text{SCE}{=}0.049$ vs.\ $0.127$ for $\ell_1$), the best-calibrated among methods above 0.78 AUC. A supervised fusion of MUS with entropy, confidence, and $\ell_1$ reaches $0.832$, outperforming a five-member ensemble ($0.813$). MUS scales with model quality, reaching $0.899$ with BiomedCLIP ($ρ= 0.846$), while this relationship remains meaningful in-distribution ($ρ= 0.523$) but breaks down under severe distribution shift (VinBigData, $ρ= 0.027$). MUS is well-suited to diffuse findings but is less dependable for small focal lesions such as nodules. Code and experimental materials are publicly available at https://huggingface.co/datasets/kawsher11/SpatialUQ.

Abstract: Reliable volumetric segmentation is critical for clinical diagnostics, yet foundation models such as MedSAM remain deterministic and lack calibrated uncertainty under distribution shift. Existing conformal prediction methods offer statistical guarantees but are frequently applied in 2D and assume symmetric error distributions, so they do not capture the class-specific biases that arise in 3D multi-class segmentation. We propose Class-Aware Asymmetric Weighted Conformal Prediction (CA-WCP), which combines latent-space density-ratio weighting for covariate shift with directional quantiles for the lower and upper volume bounds, and scales each bound by a class-specific asymmetry factor derived from validation-set false-positive and false-negative rates. We prove that CA-WCP retains the weighted-exchangeability marginal coverage guarantee for every class, and we evaluate it on 3D brain tumor segmentation (BraTS 2020) and on a synthetic multi-organ CT benchmark constructed under covariate shift. On both benchmarks the 95\% Clopper--Pearson interval for the observed coverage of CA-WCP contains the nominal 90\% level for every semantic class, while interval width is reduced by 8--14\% relative to symmetric weighted conformal prediction. We further encode the calibrated intervals into structured prompts for a multimodal large language model to produce uncertainty-conditioned radiology reports, linking distribution-shift-aware uncertainty quantification to interpretable clinical communication.

Abstract: Content-based image retrieval (CBIR) in neuroimaging enables the identification of structurally similar brain scans, supporting diagnosis, prognosis, and treatment planning; however, existing methods are often limited to small datasets, single brain regions, or coarse class labels, thereby restricting their clinical utility and generalizability. Here, we present NeuroCBIR, a framework for fast and flexible retrieval of both whole-brain and region-specific 3D T1w MRI scans. A total of 103 cortical and subcortical regions are extracted to enable both whole-brain and region-level queries. NeuroCBIR leverages latent representations learned by a variational autoencoder (VAE) combined with contrastive learning, producing scan-specific embeddings that capture anatomical patterns. These embeddings were evaluated for subject re-identification, zero-shot age prediction, and zero-shot multi-class pathology stratification. Re-identification performance was high across both whole-brain and brain-region levels (mean average precision across the top-5 retrieved images (mAP@5) >= 98.4%), with robust generalization across datasets and acquisition conditions. While NeuroCBIR is not trained for age prediction or pathology stratification, zero-shot evaluations for these two tasks demonstrate that the embeddings encode meaningful information for downstream tasks. Embedding extraction on a 4-core CPU required approximately 18.7 s per scan, whereas similarity search was effectively instantaneous (less than 0.01 s). NeuroCBIR is publicly available for brain MRI with more than 26,000 precomputed T1w MRI embeddings. It supports reproducible research, region-specific flexibility, and clinically meaningful personalized diagnostic support. The software is available at https://github.com/minnelab/NeuroCBIR.

Abstract: High-resolution 3D generation increasingly relies on voxel latents and multi-stage pipelines that first predict active structure and then synthesize local geometry. While effective, this design fragments continuous surfaces into many local tokens, inflates generation cost, and often weakens topological consistency for thin or highly connected shapes. We introduce SILSA, a topology-aware 3D generation framework that represents shapes with compact sliding-window slice latents. Instead of generating expensive voxel tokens, SILSA uses a fixed set of overlapping slices along the three canonical axes, where each token summarizes a local depth window to preserve cross-sectional continuity and support single-stage rectified-flow generation. A Slice VAE encodes oriented surface samples into multi-axis slice latents and reconstructs them with a sparse volumetric decoder, while a Volumetric Anchor Lattice coordinates directional slice streams through a shared 3D workspace. To preserve structural correctness, we introduce slice-level topology supervision that matches persistence diagrams and aligns Betti transitions across neighboring slices. Experiments show that SILSA improves structural fidelity while substantially reducing generation cost. SILSA improves PSNR by $8.7\%$, coverage by $5.96$ absolute points, and Betti error by $9.2\%$ over the strongest baseline, while using $70.0\%$ fewer tokens than the next-most compact baseline and over $98\%$ fewer tokens than sparse or hierarchical tokenizers, effectively reducing training memory by $40.4\%$ and inference time by $58.5\%$. Qualitative results further show improved preservation of thin structures, repeated components, and long-range connectivity.

Abstract: Medical multimodal large language models (MLLMs) are increasingly expected not only to answer clinical questions, but also to localize the visual evidence behind their predictions. A common strategy connects a vision--language model (VLM) with SAM-style segmentation through a special <SEG> token, yet full-parameter training of this unified architecture is difficult because image-level reasoning and pixel-level segmentation impose different requirements on the shared representation space. To address this issue, we propose a parameter-decoupled training framework for unified medical reasoning and segmentation. The framework treats the <SEG> hidden state as a semantic-to-spatial prompt for the mask decoder and encourages it to become separable from generic language states, reducing ambiguous segmentation prompts and potential disruption to reasoning representations. It first performs medical shallow alignment to adapt visual features to clinical language without disturbing the LLM; then controlled instruction tuning shapes separable <SEG> prompt states, monitored by the Davies--Bouldin Index (DBI), while scaling segmentation gradients entering the language backbone; finally, the SAM branch is specialized with the VLM frozen to improve mask precision without altering reasoning parameters. Experiments on medical referring segmentation, grounding, visual QA, and textual QA benchmarks show that our framework achieves strong language-conditioned segmentation while preserving competitive reasoning ability. Ablations show that two-phase instruction tuning, gradient scaling, and segmentation specialization all contribute to the model.

Abstract: High-resolution dynamic functional connectivity (DFC) can reveal rapidly evolving brain-network interactions, but short temporal windows yield noisy, often low-rank covariance estimates. Graph-Variate Dynamic (GVD) connectivity addresses this by modulating fast instantaneous interactions with stable trial-level support. This suppresses spurious fluctuations and emphasizes persistent, informative connections. We show that the Hadamard construction lifts low-rank instantaneous connectivity from the positive-semidefinite to the positive-definite cone, keeping high-resolution trajectories on the SPD manifold without ridge regularisation or post-hoc projection. We introduce GVD-CFM, a class-conditional generative model for high-resolution dynamic connectivity. Each trial is represented as SPD GVD matrices on a product Riemannian manifold, then mapped through a global log-Euclidean diffeomorphism and an invertible temporal DCT basis. A Transformer-based conditional flow models all spectral modes jointly and generates the full trajectory non-autoregressively in Euclidean coordinates while preserving exact correspondence with valid SPD sequences. Retaining the full DCT basis also enables decoding on denser temporal grids without retraining. Across multiple EEG motor-imagery datasets, GVD-CFM delivers the strongest overall results for held-out distributional fidelity, temporal-dynamics preservation, and synthetic-to-real classification. It also remains computationally efficient relative to strong raw-signal and direct GVD-space generative baselines. GVD-CFM therefore provides a practical framework for realistic, temporally coherent, high-resolution brain-network generation with preserved manifold structure and resolution-flexible decoding from a single trained model.

Abstract: Pathological assessment relies on recognizing fine-grained visual details in histological images. Vision-language models (VLMs) increasingly support pathology interpretation, yet their ability to perceive these details remains inadequate. This weakness leads to inaccurate cellular observations that can persist even when final answers are correct. In this paper, we propose ASPECT to improve visually grounded reasoning through explicit supervision of cellular appearance and abundance. ASPECT trains intermediate visual tokens through pathology feature reconstruction, cell feature alignment, and count supervision. Three-stage supervised fine-tuning teaches the model to perceive, generate visual tokens, and reason, followed by reinforcement learning that rewards answer correctness and consistency with reported measurements. We also introduce PathoVernier, a benchmark of 759 expert-reviewed questions from five pathology datasets covering four cellular composition tasks. It evaluates both final answers and intermediate measurements to expose errors hidden by answer accuracy. On PathoVernier, ASPECT achieves relative accuracy gains of approximately 19.2% over the strongest baseline, Gemini-3.1-Pro, and 99.3% over its Qwen3-VL-8B backbone, while reducing RAWR, which measures counting errors within correct responses, by 28.1% and 42.7%, respectively. ASPECT also improves over its backbone on three external pathology benchmarks covering classification and question answering beyond cellular composition tasks.

Abstract: Accurate delineation of whole tumor (WT), tumor core (TC), and enhancing tumor (ET) from multimodal magnetic resonance imaging remains challenging under limited annotation, cross-cohort variation, and severe target sparsity. We propose FSS-UBrain, a region-wise one-shot segmentation framework that uses a labeled positive support slice to condition binary query segmentation separately for WT, TC, and ET. Support-derived foreground and background descriptors guide query-feature adaptation, bottleneck interaction, decoder-side reconstruction, and boundary refinement. Episodic training additionally incorporates hard-negative and fully negative queries with empty-query regularization to suppress spurious foreground activation when the selected region is absent. Although inference operates on two-dimensional support--query slice pairs, checkpoint selection, threshold calibration, and final evaluation are performed after volumetric reconstruction. FSS-UBrain is evaluated on a held-out BraTS 2020 split and under target-supported cross-cohort protocols on BraTS 2023 and BraTS-Africa. Cases used as target support are excluded from the query cohorts, and no target-domain fine-tuning or test-time parameter updates are performed. On BraTS 2020, FSS-UBrain achieves volumetric Dice scores of 89.82%, 82.14%, and 77.42% for WT, TC, and ET, respectively, with corresponding 95th-percentile Hausdorff distance (HD95) values of 11.12, 9.01, and 4.46 mm. It also achieves the highest mean Dice and lowest finite-pair mean HD95 point estimates on BraTS 2023 and BraTS-Africa among the compared few-shot methods. These findings support target-conditioned few-shot segmentation while highlighting sensitivity to support selection and cohort-specific variation.

Abstract: Surgical scene understanding is critical for computer-assisted intervention, yet laparoscopic cholecystectomy remains challenged by the complex anatomy of the hepatocystic triangle and the risk of bile duct injury. Existing methods for Critical View of Safety (CVS) assessment typically treat it as a holistic prediction task, mapping visual features directly to criterion-level labels. This black-box paradigm lacks explicit reasoning about anatomical relationships, limiting both interpretability and compositional generalization. To address this, we propose ReasonCVS, a structured reasoning agentic framework empowered by Vision-Language Models (VLMs) that decomposes CVS assessment into explicit, fine-grained anatomical verification. Specifically, we devise an Anatomical Scene Graph Abstraction (ASGA) that organizes anatomical entities and their spatial relationships into a structured representation. To operationalize this, we introduce a Rationale-Aware Reasoning Agent, powered by a Large Language Model (LLM) fine-tuned via rationale distillation. Functioning as a strict central decision-maker, it invokes VLM-driven Sub-criterion Verifier as a specialized perceptual tool to parse the graph and independently evaluate individual sub-criteria. Through calibrated soft reasoning, this agent synthesizes the tool-gathered distributed observations, yielding a final verdict alongside a traceable clinical rationale. Extensive experiments on the Endoscapes-CVS201 benchmark demonstrate that ReasonCVS achieves superior performance (68.1\% mAP) over state-of-the-art while providing interpretable, criterion-level explanations for reliable surgical assessment.

Abstract: Ultrasound image analysis plays a crucial role in cancer screening and prenatal diagnosis, yet comprehensive assessment requires jointly addressing tasks such as lesion segmentation and benign-malignant classification. While recent vision foundation models have shown remarkable universal representations, unlocking their potential for ultrasound is bottlenecked by the considerable domain gap from natural images. Existing methods typically fine-tune heavy vision encoders for isolated tasks, incurring substantial computational overhead while overlooking the underlying commonalities across heterogeneous tasks. In this work, we propose FreqDINO++, a frequency-guided multi-task routing vision foundation model for universal ultrasound analysis. We first introduce a Multi-task Routing Adapter (MR-Adapter) to support parameter-efficient integration of task-common and task-specific knowledge, a Frequency-aware Feature Enhancer (F$^2$-Enhancer) is then designed to capture the rich multi-scale frequency characteristics of ultrasound images, and a Task-aligned Collaborative Decoder (TC-Decoder) is devised to promote collaboration between dense and global prediction tasks through global-local token interaction. Extensive experiments on large-scale multi-task and external single-task ultrasound benchmarks demonstrate that FreqDINO++ consistently outperforms strong baselines and recent foundation models across 27 diverse clinical task scenarios, while also showing promising generalization to unseen data. The code is at https://github.com/MingLang-FD/FreqDINO-Plus.

Abstract: Multimodal clinical decision-making requires reliable reasoning over heterogeneous evidence from electronic health records, medical images, and physiological signals. Existing models typically map these inputs directly to diagnoses without explicitly assessing evidence sufficiency, tool-use requirements, or diagnostic uncertainty. This paper presents MedTRACE, a tool-augmented multimodal clinical reasoning agent for evidence-grounded decision-making. MedTRACE uses modality-specific encoders to construct a unified patient-state representation and performs an iterative loop of hypothesis formation, toolaware deliberation, and evidence verification. It dynamically invokes visual grounding, evidence retrieval, and structured parsing tools to locate diagnosis-relevant regions, retrieve clinical knowledge and similar cases, and extract structured findings. The acquired evidence enters an evidence memory, where a consistency verifier confirms or revises the current hypothesis. MedTRACE outputs a diagnosis together with supporting evidence, an auditable reasoning trace, and calibrated confidence. Experiments on multiple multimodal clinical diagnosis benchmarks show that MedTRACE improves diagnostic accuracy by 5.4% and AUROC by 4.7 percentage points over the strongest baseline. It also improves evidenceselection F1 by 8.2 percentage points and visual-grounding IoU by 6.5 percentage points, reduces expected calibration error by 31.6%, and decreases unsupported diagnostic errors by 27.8%. These results demonstrate that active evidence acquisition and verification improve the accuracy, interpretability, and reliability of multimodal clinical decisionmaking.

Abstract: Medical vision-language models (VLMs) allow a single model to perform clinical image analysis tasks ranging from diagnosis classification to report generation. However, joint adaptation is challenged by heterogeneous output formats, conflicting task gradients, and imbalanced training data. Hence, we present \textbf{Two-Stage Mixture-of-LoRA}, a framework built on MedGemma-1.5-4B. The framework uses a shared-specific Mixture-of-LoRA architecture comprising one shared LoRA and six task-specific expert LoRAs, together with a two-stage training procedure. In Stage 1, we jointly train the shared LoRA and all task-specific expert LoRAs on all tasks. In Stage 2, we first freeze the backbone, the shared LoRA, and all non-target experts, and refine one task expert at a time. Classification and regression then receive an additional modality-balanced continuation, in which smaller modality groups are repeated to match the largest group. In the FLARE 2026 Task 3 test sets, the proposed method achieves 0.85 balanced accuracy for classification, 0.48 micro-F1 for multi-label classification, 0.79 detection F1, and 17.39 regression MAE. Code is available at https://github.com/YuanYL03/MICCAI-FLARE-2026-Challenge-Task3-2D.

Abstract: Large language models (LLMs) have demonstrated strong capabilities across diverse domains, showing considerable potential in medicine. However, their application in medical settings remains limited by the scarcity of visual question answering (VQA) datasets that capture clinical reasoning and explicit image-text alignment. Here, we leverage de-identified medical images and expert commentaries shared on clinician-oriented social media. By combining an advanced LLM with clinician-in-the-loop verification, we established a rigorous pipeline to construct ThoughtMed-1M, a long-form medical VQA dataset containing over one million VQA pairs and designed to capture structured clinical logic and medical image-text alignment. To demonstrate its utility, we developed a FOundational LLM Trained on ThoughtMed-1M (FOLTMed). FOLTMed achieved state-of-the-art performance across 42 medical VQA benchmark datasets, with a macro accuracy of 85.4%, and generated more clinically coherent responses on the ThoughtMed-1M test set. It outperformed state-of-the-art models by 3--5% across factuality and similarity metrics, highlighting a scalable paradigm for advancing research on clinically grounded multimodal LLMs.